Racial Disparities in Preemies and Pandemics

As COVID-19 related hospitalizations surged in other countries and began to rise sharply in the United States, hospitals, healthcare systems, and states began to grapple with the terrifying question of what to do if ventilators became scarce. Centers began to develop protocols to guide how scarce resources would, if necessary, be allocated among different patients. Extremely preterm infants continue to be born during the pandemic and require critical care resources, including ventilators (not because of COVID-19 but because of their immature organ systems). Haward and colleagues address the question of how these fragile newborns should factor into scarce resource allocation protocols (Haward et al. 2020). The authors address important realities commonly encountered by the neonatology community. Their compelling arguments for supporting the claims of extremely premature infants to continued ventilator provision within these protocols include: existing bias against extremely premature infants, the difficulty in predicting the outcome of a given extremely premature infant, and the absence of acceptable tools to compare long or short-term prognoses for an extremely preterm baby (“Judy”) against those of an adult (“Jim”). The authors rightly caution against the use of QALYs as potentially leading to ableist and ageist discrimination. Haward and colleagues acknowledge that many groups have historically and currently encounter discrimination, however, the conversation of scarce resource allocation is not complete without addressing such inequities. Healthcare disparities are too closely intertwined with prematurity and COVID-19 outcomes to discount in hopes of “leveling the field” when considering whether Judy (the premature infant) or Jim (the septuagenarian) gets the ventilator. We must recognize disparities as they pertain to ventilator allocation protocols and wish to highlight racial disparities that have been exposed by the COVID-19 pandemic, and how these same disparities affect premature newborns.