COVID-19 Resources Society of Critical Care Medicine Standard recommendations for triaging critical resources during the COVID-19 pandemic. Retrieved from www.sccm.org/getattachment/179d65cb‐9076‐4cf2‐a06a‐3ae7c928e634/Triaging‐Critical‐Resources [accessed 2021 Aug 24]. Therefore, in order to judge the public`s views on triage, we must consider which characteristics they think should be considered and which should not. Previous studies on laypeople`s views on the allocation of medical resources have been conducted (e.g. [21]) and there was a shortage of medical resources even before the current pandemic. Nevertheless, people`s exposure to resource scarcity and its cause due to this pandemic has provided a rare opportunity to gauge this public opinion at a time of heightened awareness of this problem. We do not argue that we should draw normative conclusions directly from these public opinions, but public opinions are relevant to policymakers who may want to respond to community values. Reason: A discretionary selection policy can lead to arbitrary and inconsistent allocation decisions. Currently, the prognostic tools needed to create an effective decision support system (triage protocol) are lacking, as are most critical care triage infrastructure, processes, legal protections and training. 13 For a new disease such as COVID-19, it is difficult to assign relative survival probabilities to patients or predict length of stay in bed.14 Data are from China, Italy and Spain, but are limited. Conclusions can be drawn from more established data on acute respiratory distress syndrome (ARDS) and viral pneumonia, but data to date on COVID-19 suggest that it may differ significantly from these other illnesses. While clinical-physiological tools such as SOFA (Sequential Organ Failure Assessment) and APACHE (Acute Physiology and Chronic Health Evaluation) help predict clinical outcomes, they may not be practical under pandemic conditions (e.g., SOFA requires laboratory testing, which may experience bottlenecks or delays). Moreover, studies have shown that even the best tools for predicting clinical outcomes during the H1N1 pandemic are satisfactory, but not good.
The SOFA score is subject to clinician subjectivity, and missing data points create additional uncertainty. Stratification of patients into priority groups is not a clear science; If the criteria are too strict, resources will be wasted, but if they are too loose, the increase in the number of lives saved will be limited. A change in the SOFA score over time may be a useful predictor of clinical outcomes in patients with ARDS and pneumonia, but its predictive value is low when the intervals are too short. A common suggestion in ventilation triage policy is to reassess patients after 48 hours of ventilation, but this may not be sufficient to observe changes that would be a significant predictor of outcomes.15 Our findings appear to have interesting implications for prejudice against people with disabilities who face unique barriers to seeking medical help during the pandemic [15]. In a previous discrete choice experiment, people had shown a small but statistically significant preference over people who were not physically or mentally disabled when deciding whether to allocate ventilators [16]. In contrast, we did not see clear evidence of bias in disabled patients in our studies. For example, 43% of survey respondents 2 believed that disability should not count for or against a patient, followed by those who thought it should matter to them (37%) and finally those who thought they should count against them (20%). In our study, therefore, only a small minority believed that patients with disabilities should be deprioritized. Nevertheless, our result is consistent with the possibility that our participants who responded neutrally in our survey would have chosen against disabled patients if they had had to choose between a disabled patient and a non-disabled patient, so our results did not completely rule out such bias. Clinicians who retain or remove ventilators could be prosecuted for negligence, particularly medical malpractice.3 Unlike criminal lawsuits, which can only be brought by prosecutors, civil lawsuits could be filed by survivors of one of the thousands of people who could die as a result of ventilator triage decisions.