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An Ethical Framework for Allocating Scarce Inpatient Medications for COVID-19 in the US

Educational Objective
To understand the ethical challenges of allocating scare impatient medications for COVID-19 patients
1 Credit CME

As researchers and drug manufacturers work tirelessly to find effective treatments for coronavirus disease 2019 (COVID-19), the media and the public await any report of a promising therapy. The antiviral drug remdesivir recently received Emergency Use Authorization (EUA) from the US Food and Drug Administration (FDA) for treatment of COVID-19. Many other new or existing therapies are under investigation, and the FDA has committed to expedited approval of proven new therapies. With patients and clinicians desperate for effective treatments, each new therapy will be in high demand. The need is projected to exceed the available supply, even as manufacturers strive to increase production,1 and shortages may be exacerbated by distribution problems and new waves of disease in the pandemic. When there is not enough of a new therapy available, frontline clinicians will need to rapidly identify which patients should receive it.

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Article Information

Corresponding Author: Bernard Lo, MD, The Greenwall Foundation, One Penn Plaza, Ste 4726, New York, NY 10119 (bernardlo@greenwall.org).

Published Online: May 15, 2020. doi:10.1001/jama.2020.8914

Conflict of Interest Disclosures: Dr DeJong reports being deposed as an expert witness in a 2018 legal action pertaining to drug and device industry marketing to physicians. Dr Chen reports employment by the California Health and Human Services Agency (CHHS) as Deputy Secretary of Policy and Planning and Director of Clinical Affairs. Dr Lo reports serving as an unpaid ethics consultant to Gilead Sciences.

Disclaimer: The opinions represented in this article are not representative of CHHS or the state of California.

Additional Contributions: We thank Laurie Dornbrand, MD, for her expert editing of the manuscript.

References
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National Academies of Sciences, Engineering, and Medicine.  Crisis Standards of Care: Ten Years of Successes and Challenges. Proceedings of a workshop. National Academies Press; 2020.
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Owen  WF  Jr , Carmona  R , Pomeroy  C .  Failing another national stress test on health disparities.   JAMA. Published online April 15, 2020. doi:10.1001/jama.2020.6547PubMedGoogle Scholar
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Office for Civil Rights. Emergency preparedness resources for persons from diverse cultural origins. Accessed May 9, 2020. https://www.hhs.gov/civil-rights/for-individuals/special-topics/emergency-preparedness/diverse-cultural-origins/index.html
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