Rationing of Scarce COVID-19 Drug Treatments: A Podcast with Drs. DeJong, Chen, and White

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GeriPal - A Geriatrics and Palliative Medicine Podcast 49 min 3 speakers 8 chapters transcribed 11 hours ago

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What is the episode’s main focus on allocating scarce COVID‑19 medications?

Unknown 0:01

The JerryPowl podcast is brought to you by Archstone Foundation, preparing society and meeting the needs of an aging population. And now, here are your hosts.

Eric Widera 0:12

Welcome to the JerryPal Podcast. This is Eric Quadera.

Alex Smith 0:15

This is Alex Smith.

Eric Widera 0:17

And Alex, today we're getting, I think, close to a record of the number of guests on our podcast.

Alex Smith 0:23

We have a record number of guests. First joining us from UCSF is Colette Jong, who is a resident in internal medicine and is finishing tomorrow. She will be chief resident at UCSF. Um welcome to the Jerry Powell podcast, Colette.

Eric Widera 0:39

Thank you. And just give everybody a primer, uh, Colette was first author in a JAMA paper on the ethical framework for allocating scarce inpatient medications for COVID nineteen in the US. And that's gonna be our topic for today, and that's why we have all these other guests with us. Who else is there?

Alex Smith 0:56

Yes, second author on that paper is Alice Chen, who's professor at UCSF and Deputy Secretary for Policy and Planning at the California Health and Human Services Agency. Welcome to the Jerry Powell podcast, Alice.

Alice Hm Chen 1:08

Thanks for having me. Delighted to be here.

Alex Smith 1:11

And returning to our podcast, we have Doug White, who is professor of critical care medicine and and and uh director of p the program in ethics and decision making and critical illness at the University of Pittsburgh. Welcome back to the JerryPel Podcast, Doug. Hello, everyone. Thanks for having me. And we have Lynn Flint, who is a frequent host and guest on our podcast, who's associate professor at UCSF in the Division of Geriatrics. Welcome back, Lynn.

Lynn Flint 1:35

Thank you.

Eric Widera 1:37

No, um we always start off with a song request before we get into the topic at hand. Um I'm not sure who has the song.

Colette DeJong 1:45

I requested the song. Oh what do you got? What do you

Eric Widera 1:47

got?

Why did Colette DeJong become interested in COVID‑19 drug allocation ethics?

Eric Widera 1:47

What do you got, Colette?

Colette DeJong 1:48

I requested the King of Wishful Thinking. I can't remember who it's by, but Alex probably remembers.

Alex Smith 1:54

It's by Go West, although I'm gonna do a cover that I heard on the internet. So but t first tell us why you chose this song, Colette.

Colette DeJong 2:03

Well, first of all, it's just one of my favorites. It's from the Pretty Woman soundtrack, as I think a lot of you will recognize. Um, and I'm afraid Eric and I are on service together right now and he pointed out right before the podcast that the title sounds really cynical and that's not at all why I picked it. I actually thought that The if you listen to the lyrics, it's about someone telling himself to be hopeful and that we'll get through this. And so I thought that was relevant.

Alex Smith 2:26

Great. All right, we'll see you let's tr have a go at the hopeful lyrics here.

Unknown 2:36

I don't need to fall at your feet. Just cause you cut me to the bone. And I won't miss the way that you kiss me. We were never carved in stone. I don't listen to the talk of the town. Maybe I can fool myself. I'll get over you. I know I will I'll pretend my ship's not sinking. I'll tell myself I'm over you, cause I'm the king of wish for thinking. I'm the key of wish for thinking.

Alex Smith 3:25

Nice.

Colette DeJong 3:27

Wow, that was beautiful.

Alex Smith 3:28

It's a blast from the past. That's like the somebody said online that's the most eighties song that was released in the nineties.

Lynn Flint 3:38

I just had Julia Roberts was just in my mind the whole That was great. Um, so I think we're gonna get started with uh just asking you, Colette, kinda how you got interested in this topic uh and what what motivated you to write this paper.

Colette DeJong 3:56

Yeah, absolutely. Um, I really don't have much of a background in ethics. I learned a huge amount uh about it just through this process. But um Alice has just been a hero of mine and a incredibly important mentor to me since like, I don't know, one of my very first months of medical school, uh, which was years and years ago. And so um I had heard about how active and um what a huge role Alice was playing in the response for California. Uh and uh initially I was I thought Alice was probably too busy to even uh send her an email. But um, you know, one day I emailed and I just asked if there was any way I could help out and um she immediately kind of stepped out of her way to um make time for me to to join on with some projects.

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Chapters

8 chapters

1 What is the episode’s main focus on allocating scarce COVID‑19 medications? 0:01–1:47 2 Why did Colette DeJong become interested in COVID‑19 drug allocation ethics? 1:47–4:47 3 How do Alice Chen and the California Health Agency view the evidence for remdesivir? 4:47–8:16 4 What are the challenges of first‑come‑first‑served versus random allocation of remdesivir? 8:16–12:08 5 How does the University of Pittsburgh’s weighted lottery prioritize patients? 12:08–16:12 6 What ethical principles guide the weighted lottery (ADI, essential workers, prognosis)? 16:12–22:27 7 How do state and county level allocation frameworks differ from hospital‑level decisions? 22:27–26:41 8 What are the key take‑aways and next steps for fair COVID‑19 medication distribution? 26:41–49:31

Speakers

3 identified

Eric Widera 5 min Alex Smith 4 min Lynn Flint 1 min

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Topics in this episode

COVID 1 New York City 1 California 2 Michigan 1 Alex 4 Pennsylvania 1 Alex Smith 1 Eric 1 UCSF 3 HHS 1 Doug 1 Archstone Foundation 2

Source

Recorded02 Jun 2020

Publisherrss.libsyn.com ↗

Transcriptspeaker-named · 100+ languages

Handlerec:20524730

Show notes

The question of who should get limited supplies of drugs that treat COVID-19 is not a theoretical question, like what seems to have happened with ventilators in the US. This is happening now. Hospitals right now have limited courses of remdesivir. For example the University of Pittsburgh hospital system has about 50 courses of remdsivir. They expect it to last to mid-June, enough for about 30% of patients who will present in the next 3 weeks. Who do you give it to? The first that present to the hospital (give it all away in the first week)? Random lottery? Or something else that is also accounts for the greater impact of COVID-19 has on disadvantaged communities ? On today's Podcast we talk with Colette DeJong, 3rd year medicine resident at UCSF, and Alice Hm Chen, Deputy Secretary for Policy and Planning at the California Health and Human Services Agency, who were two of the authors of a recently published JAMA article titled "An Ethical Framework for Allocating Scarce Inpatient Medications for COVID-19 in the US". We also bring on our repeat guest, Doug White, who authored the University of Pittsburgh model hospital policy for fair allocation of scarce COVID-19 medications, which can be found here. The University of Pittsburgh allocation strategy doesn't use a first-come, first-served or random allocation, but rather a waited lottery that is aimed at reducing the impact of social inequities on COVID-19 outcomes in disadvantaged communities. In particular, the following groups receive heightened priority in this framework: Individuals from disadvantaged areas, defined as residing at an address with an Area Deprivation Index score of 8 to 10 (range 1-10; with higher numbers meaning worse deprivation) Essential workers, defined by the state's list of essential businesses that are required to continue physical operations during the pandemic, which include lower-paid workers who may be socially and economically vulnerable, such as grocery store clerks, bus drivers, agricultural workers, and custodial workers. Of note, the Area Deprivation Index was developed in large part by Amy Kind, Geriatrician at the University of Wisconsin, and recipient of the 2019 American Geriatrics Society Thomas and Catherine Yoshikawa Award for Excellence in Scientific Achievement. by: Eric Widera NOTE: Links to the papers discussed above can be found on our blog site at GeriPal.org

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