Table 1.
Example Showing That Pure Prognosis-Based Triage Would Exacerbate Population-Level Racial Disparities
| Situation | Race | ICU Need (per 100k)a | Death Rate due to 30% ICU Bed Scarcity (per 100k)b | Death Rate Among Patients Receiving ICU Treatment (per 100k)c | Total Deaths Among Critically Ill Patients (per 100k)d | Excess Death Rate Among Black Patients (per 100k) e |
|---|---|---|---|---|---|---|
| No ICU scarcity | Black | 191 | … | 85.5 | 85.5 | 55.0 |
| White | 61 | … | 30.5 | 30.5 | … | |
| ICU scarcity and prognosis-based triage | Black | 191 | 57.3 | 46.8 | 104.1 | 70.9 |
| White | 61 | 18.3 | 14.9 | 33.2 | … |
ICU admission rate by race is derived from published US data.
Death rate caused by ICU bed scarcity is 0 when no triage is required and 30% of eligible patients in each racial group, assuming a moderately severe shortage of ICU beds and assuming that all patients who are denied an ICU bed die.
Under conditions of no triage, 50% of patients who receive ICU care die, which is comparable to outcomes of intubated COVID patients. Under conditions of prognosis-based triage, 35% of patients who receive ICU care die; the lower death rate among patients who receive ICU treatment under conditions of triage is attributable to the fact that the group who receive ICU care would have fewer patients with a poor prognosis because of triage and therefore would have a lower mortality rate.
Total deaths among critically ill patients is calculated by adding the death rate attributable to ICU bed scarcity and the death rate among patients receiving ICU treatment.
The excess death rate among Black patients per 100,000 is calculated by subtracting the total deaths among White patients from the total deaths among Black patients. Excess death rate is a measure of the disparities in COVID-19 outcomes. In this hypothetical example, when no triage is required, the magnitude of disparities in death rates between Black and White patients is in excess of 55 deaths per 100,000 among Black patients. When prognosis-based triage is used, the excess death rate among Black patients increases to 70.9 deaths per 100,000. The degree to which prognosis-based triage exacerbates racial disparities is the increase in death rate between circumstances in which no triage is required and conditions in which prognosis-based triage is used (ie, 15.9 excess deaths among Black patients per 100,000).