Triage during the COVID-19 pandemic

Area of Science:

• Medical Ethics
• Public Health
• Emergency Medicine

Background:

• The emergence of novel infectious diseases, such as coronavirus disease (COVID-19), presents unprecedented ethical challenges.
• Pandemic-associated ethical dilemmas, particularly concerning resource allocation, have been subjects of extensive study and debate.
• Triage, the prioritization and allocation of limited medical resources, is a critical component of pandemic response.

Purpose of the Study:

• To outline a framework for ethical triage decision-making during pandemics.
• To emphasize the importance of established protocols for allocating scarce medical resources.
• To highlight the crucial role of public trust in the fairness of triage criteria.

Main Methods:

• Review of existing ethical frameworks for triage and resource allocation.
• Analysis of key factors influencing triage decisions, including survival, quality of life, and resource consumption.
• Proposal of a sequential clinical assessment approach for patient prioritization.

Main Results:

• Triage decisions during pandemics should be guided by protocols that consider medical needs and therapeutic benefits.
• Exclusion criteria and risk of mortality are primary considerations in triage.
• Sequential clinical assessments, repeatable at defined intervals, are recommended for ongoing evaluation.

Conclusions:

• The optimal approach involves triaging all patients and prioritizing those most likely to benefit from interventions.
• Effective allocation of insufficient medical resources necessitates transparent and trustworthy triage criteria.
• Public trust is a fundamental prerequisite for the successful implementation of pandemic triage strategies.