State guidelines to help hospitals decide who would get a ventilator if the medical system becomes overwhelmed by COVID-19 patients could disproportionately leave people from already disadvantaged groups to die, according to a letter from hundreds of front-line health care workers.
The letter by the workers, who said they had the support of more than 250 doctors, nurses, and other professionals, urged Governor Charlie Baker and the state’s Department of Public Health to revisit the recommendations for what medical facilities should do if they no longer have enough resources to care for all patients in critical need.
The letter arrives as the state braces for a predicted surge in cases that could strain medical facilities, though hospital officials say they are cautiously optimistic about their ability to handle the crisis.
On Sunday, the state reported 2,615 new cases of COVID-19, bringing the total confirmed in Massachusetts to 25,475. A total of 756 people in the state have now died due to coronavirus infections, including 70 deaths announced Sunday.
The new cases, the highest single-day increase to date, emerged from nearly 8,000 test results, also a daily high. Though the deaths continued to hit heavily among people in their 70s and above, Sunday’s victims also included a Plymouth County man in his 30s.
The growing number of cases could soon lead to hard choices for health care providers, officials have said. In the letter to the state, the group of concerned health care professionals said the state standards “will result in the withdrawal of life-saving care ― including mechanical ventilation ― from a disproportionate number of indigenous people, Black people, Latinx people, other communities of color, elders, immigrants, asylees, refugees, and those who are undocumented, uninsured, incarcerated, homeless, experiencing poverty, or living with disability.”
As the coronavirus pandemic plays out in Massachusetts, the health care system has so far managed to stay ahead of the growing need. But with the number of cases escalating toward a peak that could come within about a week, providers are thinking about how they would make choices that could determine who lives or dies.
The state’s guidance is not mandatory. It advises hospitals to give patients a score that emphasizes healthier patients who have a greater chance of surviving COVID-19, and living longer overall. It gives further advantage to medical personnel, and to women further along in pregnancy. In the event of tie scores, younger patients are given priority.
Department of Public Health officials said in a statement that the guidelines were developed “to ensure fair and equitable critical care decision making processes during this pandemic and only in the event of an extreme scarcity of medical resources."
The department said it hoped the standards would “mitigate against unconscious biases, including but not limited to race, disability, gender, sexual orientation, gender identity, ethnicity, ability to pay, socioeconomic status, perceived social worth, perceived quality of life, immigration status, incarceration status, homelessness, or past or future use of resources.”
“We recognize that people of color, the poor, the sick, the elderly, and those with no or limited access to health care, are most vulnerable [to] this illness,” the department’s statement said.
High-risk conditions for COVID-19 patients include asthma, diabetes, lung disease, heart conditions, and obesity, according to the US Centers for Disease Control and Prevention.
But critics say the use of the criteria would ensure that longstanding systemic bias will play a major role.
“Patients who historically have experienced health disparities because of racial injustice or economic injustice or disability are going be penalized through that scoring system,” said Dr. Lana Habash, a family medicine physician who has been working in Boston for more than two decades and is one of the organizers of the letter.
The letter suggests several factors that the state should take into account as it considers the guidelines ― including measures to make sure that hospitals with less demand are sharing resources with harder-hit sites ― but Habash said they should be revised with the input of the groups that are most affected.
“This is obviously an unprecedented moment in our community, and I think we have to be really, really mindful of making sure we are being responsible and ethical in our crisis response,” Habash said.
The critique follows similar arguments from other groups. Eighteen organizations had previously written Baker urging him to develop statewide guidelines to prevent discrimination if rationing becomes necessary.
And last week, US Representative Joe Kennedy III and state Representative Jon Santiago ― who is an emergency room doctor ― said the focus of the guidelines on “co-morbid" illnesses would disadvantage groups more likely to have such conditions.
“People of color are more likely to have pre-existing conditions given longstanding inequities within every system in the United States,” Kennedy and Santiago said last week. “Prioritizing those without comorbidities inevitably ranks people of color lower than others.”
The lawmakers cited reports that “racial and ethnic minorities are disproportionately affected by COVID-19 in both number of cases and deaths.”
Available data in Massachusetts suggest communities of color are being hit hard by the virus, though most cases reported publicly so far don’t include information about patients’ race and ethnicity.
Of the cases where that information is listed, 16 percent of those affected are Black (only 9 percent of state residents are Black, according to the US Census); 22 percent of the tracked cases involved Latino patients (Latinos represent 12 percent of the overall population).
Meanwhile, numbers released by the city of Boston last week showed stark disparities in infection rates between the city’s Black and white residents.
As the most dangerous period in Massachusetts draws near, the state is trying to put resources in place to avoid such heartbreaking decisions as those laid out in the guidelines.
To prepare for the expected surge in cases, Boston leaders have set up a medical center for COVID-19 patients at the Boston Convention and Exhibition Center. The facility is called Boston Hope Medical Center.
The city of Boston shared a video Saturday of crews setting up the space, which is one of several medical centers being set up across the state.
Boston Hope will have 1,000 beds, six acute care suites, 52 nurse stations, 48 bathroom facilities, and a physical therapy suite, according to the city.
Also Sunday, Massachusetts first lady Lauren Baker said a fund to help support communities affected by the virus had been raising money steadily. She told NBC10 Boston that the Massachusetts COVID-19 Relief Fund had brought in $4 million in its first week, bringing its total to about $17 million. The fund was launched with $13 million in gifts, mostly from philanthropists.
State Senate President Karen E. Spilka said Sunday during a WBZ-TV interview her biggest concern about the virus is that hospitals and community health centers will become overwhelmed.
Though she remains hopeful the state will weather the storm, she criticized the Trump administration’s performance in delivering needed supplies: “Unfortunately, states are on their own.”
“I don’t know what they’re doing. But clearly I believe they’re not doing enough,” Spilka added.
Liz Kowalczyk and Felicia Gans of the Globe staff contributed to this report