LitCovid-sentences  

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Id Subject Object Predicate Lexical cue
T868 0-80 Sentence denotes 10 FAIR ALLOCATION OF ICU AND CRITICAL CARE DEVICES: PRIORITIZATION OF PATIENTS
T869 81-242 Sentence denotes Resource allocation guidelines pertaining to in‐hospital COVID‐19 emergencies have the objective of fairly apportioning access to scarce critical care resources.
T870 243-303 Sentence denotes In this specific context, what criteria ought to be applied?
T871 304-356 Sentence denotes How can the interests of the worst off be protected?
T872 357-1072 Sentence denotes A survey undertaken before the current pandemic identified various criteria that have been offered for the allocation of critical care resources, including: “‘sickest first’, ‘waiting list’, ‘prognosis’, ‘behaviour’ (i.e., those who engage in risky behaviour should not be prioritized), ‘instrumental value’ (e.g., health care workers should be favoured during epidemics), ‘combination of criteria’ (i.e., a sequence of the ‘youngest first’, ‘prognosis’, and ‘lottery’ principles), ‘reciprocity’ (i.e., those who provided services to the society in the past should be rewarded), ‘youngest first’, ‘lottery’, and ‘monetary contribution’.”147 Krütli, P., et al. (2016) How to Fairly Allocate Scarce Medical Resources:
T873 1073-1149 Sentence denotes Ethical Argumentation under Scrutiny by Health Professionals and Lay People.
T874 1150-1159 Sentence denotes PLoS ONE.
T875 1160-1176 Sentence denotes 11(7): e0159086.
T876 1177-1253 Sentence denotes Retrieved March 23, 2020, from https://doi.org/10.1371/journal. pone.0159086
T877 1254-1431 Sentence denotes With specific reference to COVD‐19, guidelines coming out of many countries have been offered, including those from the United States,148 Emanuel, E.J., et al. (2020, March 23).
T878 1432-1501 Sentence denotes Fair Allocation of Scarce Medical Resources in the Time of Covid‐ 19.
T879 1502-1538 Sentence denotes The New England Journal of Medicine.
T880 1539-1649 Sentence denotes Retrieved March 23, 2020, from https://www.nejm.org/doi/full/10.1056/NEJMsb2005114?query=featured_coronavirus.
T881 1650-1697 Sentence denotes Italy,149 Vergano, M., et al. (2020, March 16).
T882 1698-1826 Sentence denotes Clinical Ethics Recommendations for the Allocation of Intensive Care Treatments, in Exceptional, Resource‐Limited Circumstances.
T883 1827-1913 Sentence denotes Italian Society of Anesthesia, Analgesia, Resuscitation, and Intensive Care (SIAARTI).
T884 1914-2105 Sentence denotes Retrieved March 23, 2020, from http://www.siaarti.it/SiteAssets/News/COVID19%20‐%20documenti%20SIAARTI/SIAARTI%20‐%20Covid‐19%20‐%20Clinical%20Ethics%20Reccomendations.pdf. opens in new tab).
T885 2106-2144 Sentence denotes France,150 Azoulay, E., et al. (2020).
T886 2145-2235 Sentence denotes Admission Decisions to Intensive Care Units in the Context of the Major COVID‐19 Outbreak:
T887 2236-2287 Sentence denotes Local Guidance from the COVID‐19 Paris‐Region Area.
T888 2288-2302 Sentence denotes Critical Care.
T889 2303-2308 Sentence denotes 24:1.
T890 2309-2391 Sentence denotes and the Philippines.151 Task Force Ethics Guidelines COVID‐19 Philippines. (2020).
T891 2392-2480 Sentence denotes Ethical Guidelines for Leaders in Health Care Institutions during the COVID‐19 Pandemic.
T892 2481-2521 Sentence denotes Philippine Journal of Internal Medicine.
T893 2522-2528 Sentence denotes 58(1).
T894 2529-2653 Sentence denotes Retrieved April 9, 2020, from https://www.pcp.org.ph/index.php/pjim/pjim/1094‐phil‐journal‐of‐internal‐medicine‐vol‐58‐no‐1.
T895 2654-2800 Sentence denotes Considering that issues may arise in variable contexts, it is helpful to be clear about the level of scarcity obtaining in a particular situation.
T896 2801-3304 Sentence denotes The WHO Working Group on Ethics and COVID‐19 distinguishes three levels of scarcity and their corresponding effects on the fair allocation of resources like ventilators: first, with little scarcity, first come, first served may be best for equality; second, with more scarcity, the prioritization of the worst off may be best; and third, “with even greater scarcity, a principle that aims to maximize benefit from the resource may be most justified.”152 WHO Working Group on Ethics and COVID‐19. (2020).
T897 3305-3325 Sentence denotes Ethics and COVID‐19:
T898 3326-3367 Sentence denotes Resource Allocation and Priority Setting.
T899 3368-3482 Sentence denotes Retrieved June 29, 2020, from https://www.who.int/ethics/publications/ethics‐covid‐19‐resource‐allocation.pdf?ua=1
T900 3483-3533 Sentence denotes Of interest in this section is the scarcest level.
T901 3534-3841 Sentence denotes In extreme situations where there are simply not enough resources to accommodate everyone in need, giving protection to the vulnerable could take a backseat as medical vulnerability, in the sense of having comorbidities, could be seen to indicate futility of critical care that includes ventilatory support.
T902 3842-4121 Sentence denotes An early study showed that for COVID‐19, the Case Fatality Rate (CFR) was elevated among those with preexisting comorbid conditions such as cardiovascular disease, diabetes, chronic respiratory disease, hypertension, and cancer.153 Wu, Z., & McGoogan, J.M. (2020, February 24).
T903 4122-4226 Sentence denotes Characteristics of and Important Lessons from the Coronavirus Disease 2019 (COVID‐19) Outbreak in China:
T904 4227-4328 Sentence denotes Summary of a Report of 72,314 Cases from the Chinese Center for Disease Control and Prevention. JAMA.
T905 4329-4400 Sentence denotes Retrieved March 26, 2020, from http://dx.doi.org/10.1001/jama.2020.2648
T906 4401-4667 Sentence denotes Another study of laboratory‐confirmed cases of COVID‐19 showed that “patients with any comorbidity yielded poorer clinical outcomes than those without” and “a greater number of comorbidities also correlated with poorer clinical outcomes.”154 Guan, W., et al. (2020).
T907 4668-4758 Sentence denotes Comorbidity and its Impact on 1590 Patients with Covid‐19 in China: a Nationwide Analysis.
T908 4759-4788 Sentence denotes European Respiratory Journal.
T909 4789-4863 Sentence denotes Retrieved April 20, 2020, from https://doi.org/10.1183/13993003.00547‐2020
T910 4864-5280 Sentence denotes Moreover, “persons with underlying chronic illnesses are more likely to contract the virus and become severely ill, . . . [while those] with history of hypertension, obesity, chronic lung disease, diabetes, and cardiovascular disease have the worst prognosis and most often end up with deteriorating outcomes such as acute respiratory distress syndrome (ARDS) and pneumonia.”155 Sanyaolu, A., et al. (2020, June 25).
T911 5281-5334 Sentence denotes Comorbidity and its Impact on Patients with COVID‐19.
T912 5335-5370 Sentence denotes SN Comprehensive Clinical Medicine.
T913 5371-5378 Sentence denotes 2, 1–8.
T914 5379-5451 Sentence denotes Retrieved June 27, 2020, from https://doi.org/10.1007/s42399‐020‐00363‐4
T915 5452-5669 Sentence denotes A patient rendered vulnerable by comorbidities may be considered ineligible for the application of “intensive care treatments, in exceptional, resource limited circumstances.”156 Vergano, et al., op. cit. note 149, p.
T916 5670-5672 Sentence denotes 1.
T917 5673-5863 Sentence denotes Within Italy, COVID‐19 deaths were mainly observed among older, male patients who were also suffering from multiple comorbidities.157 Onder, G., Rezza, G., & Brusaferro, S. (2020, March 23).
T918 5864-5954 Sentence denotes Case‐Fatality Rate and Characteristics of Patients Dying in Relation to COVID‐19 in Italy.
T919 5955-5960 Sentence denotes JAMA.
T920 5961-6032 Sentence denotes Retrieved April 15, 2020, from http://dx.doi.org/10.1001/jama.2020.4683
T921 6033-6257 Sentence denotes According to another study, “the existence of comorbidities increases the probability of dying from COVID‐19 by 2.4 times compared to those who do not have pre‐existing conditions.”158 Espinosa, O.A., et al. (2020, June 22).
T922 6258-6379 Sentence denotes Prevalence of Comorbidities in Patients and Mortality Cases Affected by SARS‐CoV2: a Systematic Review and Meta‐Analysis.
T923 6380-6524 Sentence denotes Revista do Instituto de Medicina Tropical de Såo Paulo vol.62 São Paulo. Retrieved May 2, 2020, from https://doi.org/10.1590/s1678‐9946202062043
T924 6525-6761 Sentence denotes In the United States, a study showed deaths were 12 times higher among patients with reported underlying conditions compared with those without reported underlying conditions (19.5% versus 1.6%).159 Stokes, E.K., et al. (2020, June 19).
T925 6762-6846 Sentence denotes Coronavirus Disease 2019 Case Surveillance — United States, January 22–May 30, 2020.
T926 6847-6885 Sentence denotes Morbidity and Mortality Weekly Report.
T927 6886-6902 Sentence denotes 69(24), 759–765.
T928 6903-6973 Sentence denotes Retrieved June 30, 2020, from http://dx.doi.org/10.15585/mmwr.mm6924e2
T929 6974-7101 Sentence denotes Research findings such as these resulted in elderly patients being refused ventilatory support in Italy.160 Bosotti, A. (2020).
T930 7102-7121 Sentence denotes Coronavirus Horror:
T931 7122-7192 Sentence denotes Over‐70s Left to Die in Italy as Doctors Told Focus on Young Patients.
T932 7193-7201 Sentence denotes Express.
T933 7202-7357 Sentence denotes Retrieved April 15, 2020, from https://www.express.co.uk/news/world/1257840/Coronavirus‐news‐Italy‐over‐70s‐dead‐covid‐19‐death‐toll‐Bergamo‐funeral‐latest
T934 7358-7810 Sentence denotes The Independent reported that a doctor gave an account of medics being forced to ration care to patients in the wake of the COVID‐19 outbreak such that elderly patients were being denied care based on their age and whether they had other conditions or not: “In Bologna, we are working with 80‐years‐old as our cut off, but between 65 and 80‐years‐old we still consider comorbidities.”161 Lintern, S. (2020, March 13). ‘We are making difficult choices’:
T935 7811-7864 Sentence denotes Italian doctor tells of struggle against coronavirus.
T936 7865-7877 Sentence denotes Independent.
T937 7878-8035 Sentence denotes Retrieved August 16, 2020, from https://www.independent.co.uk/news/health/coronavirus‐italy‐hospitals‐doctor‐lockdown‐quarantine‐intensive‐care‐a9401186.html
T938 8036-8187 Sentence denotes There are similar accounts pertaining to Sweden’s Karolinska Institute.162 Habib, H. (2020, April 13). ‘I’ve never written so many death certificates’:
T939 8188-8233 Sentence denotes Is Sweden having second thoughts on lockdown?
T940 8234-8246 Sentence denotes Independent.
T941 8247-8401 Sentence denotes Retrieved August 25, 2020, from https://www.independent.co.uk/news/world/europe/sweden‐coronavirus‐lockdown‐doctor‐death‐certificates‐latest‐a9462796.html
T942 8402-8452 Sentence denotes , 163 Svensson, O. (2020, April 9) Dokument visar:
T943 8453-8491 Sentence denotes De prioriteras bort från intensivvård.
T944 8492-8504 Sentence denotes Aftonbladet.
T945 8505-8642 Sentence denotes Retrieved August 25, 2020, from https://www.aftonbladet.se/nyheter/samhalle/a/lAyePy/dokument‐visar‐de‐prioriteras‐bort‐fran‐intensivvard
T946 8643-8772 Sentence denotes Yet, the acceptance of advanced age in itself as an indicator of medical futility has to be conclusively established by evidence.
T947 8773-9031 Sentence denotes Statistical findings of high mortality rates among patients belonging to the highest age groups can merely be reiterative of the high mortality rates among patients with comorbidities ‐‐ elderly patients have a higher likelihood of having more comorbidities.
T948 9032-9325 Sentence denotes If we overlook this point, the elderly could be exposed to unfair allocation of resources based simply on their age rather than on their having comorbidities that leave them with poor chances of surviving with the use of critical care devices.164 de Castro‐Hamoy, L., & de Castro, L.D. (2020).
T949 9326-9458 Sentence denotes Age Matters but it Should not Be Used to Discriminate Against the Elderly in Allocating Scarce Resources in the Context of COVID‐19.
T950 9459-9482 Sentence denotes Asian Bioethics Review.
T951 9483-9495 Sentence denotes 12, 331–340.
T952 9496-9570 Sentence denotes Retrieved August 16, 2020, from https://doi.org/10.1007/s41649‐020‐00130‐6
T953 9571-9894 Sentence denotes As George Kuchel asserts, “having multiple chronic diseases and frailty is in many ways as or more important than chronological age” and “an 80‐year‐old who is otherwise healthy and not frail might be more resilient in fighting off infection than a 60‐year‐old with many chronic conditions.”165 Begley, S. (2020, March 30).
T954 9895-9946 Sentence denotes What Explains COVID‐19’s Lethality for the Elderly?
T955 9947-9998 Sentence denotes Scientists Look to ‘Twilight’ of the Immune System.
T956 9999-10009 Sentence denotes STAT News.
T957 10010-10125 Sentence denotes Retrieved April 15, 2020, from https://www.statnews.com/2020/03/30/what‐explains‐coronavirus‐lethality‐for‐elderly/
T958 10126-10294 Sentence denotes In addition, recent studies have generated optimism about the success of measures to delay or minimize age‐related immunological defects.166 Nikolich‐Žugich, J. (2017).
T959 10295-10320 Sentence denotes The Twilight of Immunity:
T960 10321-10369 Sentence denotes Emerging Concepts in Aging of the Immune System.
T961 10370-10388 Sentence denotes Nature Immunology.
T962 10389-10402 Sentence denotes 19(1), 10–19.
T963 10403-10476 Sentence denotes Retrieved August 16, 2020, from https://doi.org/10.1038/s41590‐017‐0006‐x
T964 10477-10591 Sentence denotes Admittedly, age serves as a useful indicator of the presence of comorbidities that the elderly are likely to have.
T965 10592-10777 Sentence denotes However, the studies about chronological age and immunological developments cited above indicate that statistical correlation should not necessarily be taken to mean causal correlation.
T966 10778-10887 Sentence denotes For this reason, age by itself should not be regarded as a valid basis for short‐term triage decision‐making.
T967 10888-11249 Sentence denotes In the absence of validated empirical proof that a particular age level indicates the medical futility of applying scarce critical care resources, the vulnerability of patients that is associated with advanced age should instead signify a need for them to be given protection deserved by those who are worst off – the most vulnerable – among members of society.
T968 11250-11464 Sentence denotes Vulnerability can also give rise to injustice when a patient’s level of health literacy results in a failure accurately to communicate one’s medical history or the nature or intensity of symptoms being experienced.
T969 11465-11592 Sentence denotes This exemplifies a failure in relation to the fair allocation of full and adequate information mentioned in an earlier section.
T970 11593-11811 Sentence denotes For instance, a poor patient from a far‐flung area with no prior knowledge about her condition may not mention relevant details in her history because she feels that these may not be important for a doctor’s diagnosis.
T971 11812-12021 Sentence denotes When caregivers overlook this point and do not try hard enough to clarify to the patient what could be relevant, they could be compounding the effects of inequity in education, or dissemination of information.
T972 12022-12164 Sentence denotes By their neglect, they allow the inequity to be manifested in the allocation of scarce lifesaving resources, especially in a triage situation.
T973 12165-12363 Sentence denotes Where the dangers to a patient’s life may already be difficult to deal with, missing treatment opportunities just because of miscommunication is going to magnify the adverse impact of vulnerability.
T974 12364-12577 Sentence denotes These examples of possible discrimination in a triage setting are most likely to affect those who belong to economically and educationally disadvantaged sectors of society because of their limited health literacy.
T975 12578-12831 Sentence denotes Rather than being blamed on the disadvantaged themselves, a community’s level of health literacy should be presumed to be the result of a failure on the part of health authorities to convey pertinent information and make it understandable to the public.
T976 12832-12944 Sentence denotes Disadvantaged sectors are also more likely to be affected by disparities in the location of hospital facilities.
T977 12945-13203 Sentence denotes In order to address the disproportionate access to critical care services by disadvantaged sectors, it would have been useful to have a monitoring, communication, and transport mechanism to facilitate their conveyance to pertinent facilities in case of need.
T978 13204-13421 Sentence denotes Moreover, temporary measures established during this period have to make way for a more durable network for the just distribution of various levels of hospital care consistent with the concept of universal healthcare.
T979 13422-13619 Sentence denotes In light of the risk of the country’s emergency care infrastructure being overwhelmed by COVID‐19, it may be tempting to invest huge sums of money on acquiring more critical care units and devices.
T980 13620-13727 Sentence denotes However, a more sustainable response would be mindful of the unfair allocation of access to such resources.
T981 13728-14014 Sentence denotes It would be more prudent to invest in a healthcare infrastructure that is anchored on equity and gives priority to the preventive aspects of healthcare that would give timely attention to the needs of disadvantaged sectors and eventually ease the burden on more expensive tertiary care.