Ahead of an expected surge of coronavirus cases in Massachusetts, which is expected to overwhelm the area’s hospitals in the coming weeks, a Harvard Medical School professor said a lottery system is the only just way to ration medical care and equipment.
Dr. Michelle Holmes, an associate professor of medicine at Harvard Medical School and an associate professor of epidemiology at Harvard’s School of Public Health, told Jim Braude on WGBH News’ Greater Boston Monday that a more randomized system is needed because state-issued guidelines and other recommendations that take prior health and life expectancy into account can unintentionally discriminate against people of color.
“I’m troubled by the notion that kind of fancying up the rationing system with points somehow protects and absolves us from our own implicit biases,” said Holmes. “Promoters of this system like to say that it’s fair because it doesn’t have these categorical exclusions. But that’s, I think, naïve, because poor health is a proxy for race, for poverty, for immigration status.
“My colleagues who have designed these systems are really doing best they can in truly tying times,” she added.
Holmes’s proposal, which she first made in a Change.org petition to the U.S. Surgeon General and other members of the White House Coronavirus Task Force, does have exceptions for patients who do not want or could not survive invasive treatments like being put on a ventilator.
“After excluding patients who cannot survive and [those] who don’t want that kind of treatment, I propose the lottery would give us the true objectivity that we seek,” she said. “My hope is that we would never use it.”
The coronavirus outbreak has already hit local communities of color disproportionately hard. In Boston, race and ethnicity data was only recorded for a little more than 60 percent of the city’s 4,086 cases. But of those cases, black residents made up more than 40 percent, while the same group makes up less than a quarter of the city’s population.
Holmes said a long history of inequality is to blame for people of color contracting and dying from coronavirus in greater numbers than their white neighbors.
“It’s caused by a history of systemic racism that has allowed people of color to be exposed to toxic pollution … to be targeted by soda companies and junk food companies, to live in food deserts, to have poor access to healthcare,” she said. “It’s also because a number of essential workers, such as bus drivers, sanitation workers, farm workers, grocery store clerks are majority people of color and they do not have the same access to protection that even healthcare workers get.”
Holmes said she also hopes that the coronavirus crisis will spur greater efforts to address such racial disparities.
“Hopefully this is a moment that allows us to bring that debate to the forefront.”