State revises regs on crisis care

The Baker administration revised its voluntary guidelines for who should receive scarce treatments like ventilators during the COVID-19 crisis by prioritizing those likely to survive for the next five years and ignoring longer-term health outcomes.

The change downplays underlying conditions that might not hinder a person’s ability to recover in the short-term but could in the long-term. Many of those underlying conditions, such as asthma or diabetes, are believed to reflect socioeconomic factors that tend to impact people of color more.

“The recommendations were created to prevent unconscious bias against people of color, people with disabilities, and other community members who are marginalized,” a Department of Public Health spokeswoman said of the updated guidelines.

The guidelines, which may become little more than a theoretical exercise if new cases continue to decline and so-called crisis standards of care never have to be implemented, have become a flashpoint in the debate over inequality.

Jeff Markuns, a physician at Boston Medical Center, wrote on Friday in CommonWealth that “The very foundation of these standards – and the direct correlation between societal disadvantages and health outcomes – ensures that many of these same characteristics will, in fact, play a substantial role in who lives and who dies.”

The revisions announced on Monday are perhaps best exemplified by changes to the wording of a section on priority scoring for adult patients.

Here is the original wording: “This allocation framework is based on two considerations: 1) saving the most lives; and 2) saving the most life-years. Patients who are more likely to survive with intensive care are prioritized over patients who are less likely to survive with intensive care. Patients who do not have serious comorbid illness are given priority over those who have illnesses that limit their life expectancy.”

Here is the same section in the revised guidelines: “The allocation framework has two primary scoring components: one, prognosis for hospital survival and two, prognosis for near-term survival beyond the acute incident. …The presence of underlying conditions in such an advanced state that they would limit duration of benefit to no more than five years from the episode of acute illness is used to characterize patients’ prognosis for near-term survival.”

Collin Killick, a disability rights advocate, told WBUR that five years out is still too far out to look. He said New York uses a patient’s one-year prognosis as its yardstick, which he believes is fairer.

Dr. Lachlan Forrow, director of ethics and palliative care at Beth Israel Deaconess Medical Center and a member of the committee that has been working on the guidelines, told the Boston Globe the five-year window is an attempt to avoid situations where someone with a terminal illness but unlikely to die within a year is chosen over someone with a 30-year life expectancy.

“That just seemed wrong,” Farrow said.



Big decisions are coming up for Gov. Charlie Baker on reopening the state. Where do we stand? Stats make a May 4 reopening unlikely while a new state dashboard on the crisis inexplicably covers up surging nursing home deaths again. (CommonWealth) The state’s new dashboard includes ranges for COVID-19 cases at nursing homes, but the ranges don’t tell the full story. (MassLive).

Baker signs into law legislation barring evictions, drawing anger from the real estate industry and praise from tenant rights advocates. (CommonWealth)

Beacon Hill leaders have been slow to figure out how to get the Legislature fully in gear in the coronavirus era. (Boston Globe)


Stow police chief Ralph Marino is relieved from his duties and put on leave with no indication why. (Telegram & Gazette)

Leaders in Brockton, a coronavirus hot spot, offer clues to why race matters during pandemics (The Enterprise)

A Quincy program has paid nearly $300,000 to local landlords in the form of rental assistance. (Patriot Ledger)


Health care modeling suggests the coronavirus curve in Massachusetts is flattening, even as federal authorities voice concern about the state’s disease burden from the pandemic. (Boston Globe)

Local hospitals in the Berkshire are harvesting the blood of survivors of COVID-19 for the resistant antibodies that could be used to treat current patients. (Berkshire Eagle)

Seventeen residents and seven staff test positive for coronavirus at St. Patrick’s Manor in Framingham. (Metrowest Daily News)

MassLive publishes the state list of all the nursing homes in Massachusetts that have confirmed COVID-19 cases, and also looks at the new data on numbers of cases by hospital.

Tenet Healthcare implemented voluntary nurse furloughs at St. Vincent’s Hospital in Worcester  citing financial instability (WGBH)

Nearly two-thirds of the residents at Pleasant Bay Nursing & Rehabilitation Center in Brewster have tested positive for COVID-19. (Cape Cod Times)


From Hopkinton to Boston, runners and residents feel the loss of the Boston Marathon this year. (Associated Press)


President Trump tweeted that he will temporarily suspend immigration in the US to protect jobs and protect against the coronavirus. (Washington Post)

Just like a pollster, New York Gov. Andrew Cuomo is ordering antibody testing of a random sample of 3,000 people to gauge how far COVID-19 has spread in the state. (NPR)


A federal judge in California ordered Immigration and Customs Enforcement to identify all detainees at elevated risk from COVID-19 and consider releasing them. (NPR) Massachusetts was the first state to do this on April 3 when US District Court Judge William Young began releasing ICE detainees held by Bristol County Sheriff’s Office to house arrest.


Bill Galvin, the state’s top election official, backs mail-in voting. (CommonWealth)

Joe Biden begins his campaign nearly $187 million behind President Trump. (New York Times)


Virus notes: Gig economy workers are finally allowed to apply for unemployment insurance. And more. (Commonwealth) ICYMI: Sharon Block and Mike Firestone say gig economy employers are gaming the system. (CommonWealth)

The big congressional aid plan for businesses that was part of the CARES Act is leaving minority enterprises behind, writes Shirely Leung. (Boston Globe) Jon Chesto looks at five local small businesses eagerly awaiting a second round of federal aid, which congressional leaders are nearing a deal on. (Boston Globe)

The marijuana holiday 4/20 is a bust this year, with recreational marijuana shops closed and gatherings banned due to the coronavirus pandemic. (Telegram & Gazette)

What it’s like to have a grand opening during coronavirus — Sugar Plum Sweets, a new gelato and candy shop in New Bedford, is dealing with that issue. (Standard-Times)


Boston Mayor Marty Walsh said there’s no way Boston schools will be reopening on May 4. (Boston Herald)


The futures price for oil goes negative, as decreased demand for fuel and full reserve tanks make it difficult to store new product anywhere. (Associated Press)


Notorious North Shore robber Raymond Wallace, who was injured in a shootout with correctional officers during an escape attempt, is among those asking for release due to COVID-19. (The Salem News)