COVID-19 vaccination status should not be used in triage tie-breaking

Abstract

This article discusses the triage response to the COVID-19 delta variant surge of 2021. One issue that distinguishes the delta wave from earlier surges is that by the time it became the predominant strain in the USA in July 2021, safe and effective vaccines against COVID-19 had been available for all US adults for several months. We consider whether healthcare professionals and triage committees would have been justified in prioritising patients with COVID-19 who are vaccinated above those who are unvaccinated in first-order or second-order triage. Given that lack of evidence for a correlation between short-term survival and vaccination, we argue that using vaccination status during first-order triage would be inconsistent with accepted triage standards. We then turn to notions of procedural fairness, equity and desert to argue that that there is also a lack of justification for using vaccination status in second-order triage. In planning for future surges, we recommend that medical institutions base their triage decisions on principles meant to save the most lives, minimise inequity and protect the public’s trust, which for the time being would not be served by the inclusion of vaccination status.

Public support for unequal treatment of unvaccinated citizens: Evidence from Denmark

“…Our main outcome variable is support for five proposals for additional Corona regulations. These are inspired by political and scientific discussions ( Dyer, 2022 , Library of Congress, 2021 ; Schuman et al, 2022 ), but were not in place in Denmark at the time of the surveys. They are as follows: Paying a small fee for Corona tests (“Fee for Test”) Discontinuing the less reliable quick tests as proof of infection status (“Quick Test as Proof”) Abolishing the possibility to say one is exempt from showing the Corona passport (“Corona Pass Exemptions”) Abolishing wage compensation during mandatory isolation for public employees (“No Isolation Pay”) Giving lower priority to COVID-19 patients compared to other patients if there is a shortage of hospital beds (“Lower Priority in Hospitals”) …”

“…One solution is to impose stricter COVID-19-related regulations on the unvaccinated regarding their behaviors and access to public services, thereby animating them to become vaccinated ( Mills and Tobias, 2022 ). For example, the Canadian province of Quebec considered plans for a special tax only to be paid by the unvaccinated ( Dyer, 2022 ), the German government abolished quarantine wage compensation for this group ( Library of Congress, 2021 ), and there have been discussions to deprioritize the unvaccinated in Triage situations ( Schuman et al, 2022 ).…”

Ethics in Emergency Times: The Case of COVID-19

“…However, it is significant to observe that it was precisely the recurrence of an emergency situation in ICUs after some months of the vaccination campaign that prompted a debate on the possibility of triaging based "on what people 'deserve' (i.e., 'desert-based considerations') based on their past choices". Considering vaccination status, at least at some point, could appear "like a just or equitable response that compensates vaccinated patients for safeguarding their health, the health of others and accepting public health recommendations" [58] (p. 2).…”

“…It is noteworthy that paternalism is introduced as a corrective to an approach building on the radically non-paternalistic assumption of full responsibility for one's own actions. Schuman et al, with reference to the pandemic, underline that "even people who cause harm or endanger others, such as those who drink and drive, are given consideration based on their need and potential to benefit": the standard that applies "in times of convention" must be applied also "in times of crisis" [58] (p. 2).…”

“…In time, he could not avoid feeling the moral unease for a choice that was perhaps, after all, "just a kind of revenge" and had, in any case, nothing to do with his "job" [39] (pp. [56][57][58].…”