GOVERNMENT

What can my local, state, and federal government do?

At the local, state, and national level, government must act NOW.  COVID-19 has already been devastating in communities of people of African descent.  This has the potential to continue or expand as infection spreads, particularly in the rural South.

1.     Collect Disaggregated Data.  Everywhere

·      COVID-19 has been shown to be disproportionately impact Black communities in the US and in some other countries.  Data disaggregated by race and other factors is the best information we can use to determine what is driving the risk and how to reduce it. 

·      At every level of government, data on infection, severity, intubations, therapeutic treatment effectiveness, and anything else related to the pandemic and its response is necessary. If we care about Black and Brown communities, that data must also be disaggregated by race in order to ensure the protocols evolve with specific expertise relating to community needs and realities.

2.     Mitigate Racial Bias in Decision-Making of Physicians and Policy-Makers.  Research proves racial bias in decision-making everywhere we look for it. Stress, scarcity, lack of sleep, overwork exacerbates biased decision-making. Finding ways to understand, confront, and reduce racial bias could save lives.

3.     Review Triage Protocols NOW.  We need to understand how bias may play out in the operation of protocols that may have been developed without representation by the groups they most impact. 

·      Existing state protocols fail to examine or reduce racial bias in physicians’ decision making, proven to exist in many contexts.   

·      Existing state protocols also fail to understand the diversity of people with disabilities, even those in chronic care – this may be particularly dangerous for intersectional populations of People of African descent with disabilities and the like.

·      One overarching problem with these policies is that they focus on EQUALITY, often to the exclusion of EQUITY. For example, the task force’s determination that chronic care patients who develop an urgent need for hospitalization may lose access to their ventilators may be an immediate decision to deprioritize a person who definitely dies without a ventilator in favor of a person who may die without a ventilator. Surely, there should be more nuanced consideration than this.

·      Excerpt from New York State Department of Health’s 2015 Ventilator Allocation Guidelines (New York State Task Force on Life & the Law)

 “While a policy to triage upon arrival may deter chronic care patients from going to an acute care facility for fear of losing access to their ventilator, it is unfair and in violation of the principles upon which this allocation scheme is based to allow them to remain on a ventilator without assessing their eligibility. Distributive justice requires that all patients in need of a certain resource be treated equally; if chronic care patients were permitted to keep their ventilators rather than be triaged, the policy could be viewed as favoring this group over the general public.”

·      Unlike some recent public statements, doctors do not have sole discretion to determine who lives and who dies, i.e., treatment rationing. Yet, we are seeing very haphazard approaches to treatment rationing.

4.     Pay Extra Attention to High-Risk Communities. Certain communities face even greater risk – this includes incarcerated people, homeless people, and people who lack the financial and other resources to self-quarantine for weeks.  Reducing the risk of infection in these communities – by providing housing, food, or reliable resources, could decrease infection for everyone.