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Clin Infect Dis ; 2021 Dec 18.
Article in English | MEDLINE | ID: covidwho-1596931


The U.S. FDA has issued emergency use authorizations (EUAs) for monoclonal antibodies (mAbs) for non-hospitalized patients with mild or moderate COVID-19 disease and for individuals exposed to COVID-19 as post-exposure prophylaxis. One EUA for an oral antiviral drug, molnupiravir, has also been recommended by FDA's Antimicrobial Drugs Advisory Committee, and others appear likely in the near future. Due to increased demand because of the Delta variant, the federal government resumed control over the supply and asked states to ration doses. As future variants with increased infectivity and/or severity (e.g., potentially the Omicron variant) emerge, further rationing may be required. We identify relevant ethical principles (i.e., benefiting people and preventing harm, equal concern, and mitigating health inequities) and priority groups for access to therapies based on an integrated approach to population health and medical factors (e.g. urgently scarce healthcare workers, persons in disadvantaged communities hard hit by COVID-19). Using priority categories to allocate scarce therapies effectively operationalizes important ethical values. This strategy is preferable to the current approach of categorical rules based on vaccination, immunocompromise status, or older age, or the ad hoc consideration of clinical risk factors.

Health Aff (Millwood) ; 40(11): 1784-1791, 2021 11.
Article in English | MEDLINE | ID: covidwho-1496547


Racial health inequities exemplified during the COVID-19 crisis have awakened a sense of urgency among public health and policy experts to examine contributing factors. One potential factor includes the socioeconomic disadvantage of racially segregated neighborhoods. This study quantified associations of neighborhood socioeconomic disadvantage in Chicago, Illinois, as measured by the Area Deprivation Index (ADI), with racial disparities in COVID-19 positivity. A retrospective cohort included 16,684 patients tested for COVID-19 at an academic medical center and five community-based testing sites during Chicago's "first wave" (March 12, 2020-June 25, 2020). Patients living in Black majority neighborhoods had two times higher odds of COVID-19 positivity relative to those in White majority neighborhoods. The ADI accounted for 20 percent of the racial disparity; however, COVID-19 positivity remained substantially higher at every decile of the ADI in Black relative to White neighborhoods. The remaining disparities (80 percent) suggest a large, cumulative effect of other structural disadvantages in urban communities of color.

COVID-19 , Chicago/epidemiology , Humans , Residence Characteristics , Retrospective Studies , SARS-CoV-2 , Socioeconomic Factors
Health Serv Res ; 56(4): 569-572, 2021 08.
Article in English | MEDLINE | ID: covidwho-1338790
Am J Public Health ; 111(2): 286-292, 2021 02.
Article in English | MEDLINE | ID: covidwho-1060799


As the COVID-19 pandemic has unfolded across the United States, troubling disparities in mortality have emerged between different racial groups, particularly African Americans and Whites. Media reports, a growing body of COVID-19-related literature, and long-standing knowledge of structural racism and its myriad effects on the African American community provide important lenses for understanding and addressing these disparities.However, troubling gaps in knowledge remain, as does a need to act. Using the best available evidence, we present risk- and place-based recommendations for how to effectively address these disparities in the areas of data collection, COVID-19 exposure and testing, health systems collaboration, human capital repurposing, and scarce resource allocation.Our recommendations are supported by an analysis of relevant bioethical principles and public health practices. Additionally, we provide information on the efforts of Chicago, Illinois' mayoral Racial Equity Rapid Response Team to reduce these disparities in a major urban US setting.

African Americans/statistics & numerical data , COVID-19/therapy , Health Status Disparities , Healthcare Disparities/statistics & numerical data , COVID-19/ethnology , Health Services Accessibility/statistics & numerical data , Humans , Quality of Health Care/statistics & numerical data , Racism , Socioeconomic Factors , United States