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Record W3012690896 · doi:10.1056/nejmsb2005114

Fair Allocation of Scarce Medical Resources in the Time of Covid-19

2020· article· en· W3012690896 on OpenAlexaff
Ezekiel Emanuel, Govind Persad, Ross Upshur, Beatriz Thomé, Michael Parker, Aaron Glickman, Cathy Zhang, Connor Boyle, Maxwell J. Smith, James P. Phillips

Bibliographic record

VenueNew England Journal of Medicine · 2020
Typearticle
Languageen
FieldHealth Professions
TopicHealthcare cost, quality, practices
Canadian institutionsUniversity of TorontoWestern University
Fundersnot available
KeywordsCoronavirus disease 2019 (COVID-19)PandemicScarcityRationingSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2)2019-20 coronavirus outbreakHealth careMedical careHealth care rationingResource allocationBusinessComputer scienceVirologyMedicineEconomicsInfectious disease (medical specialty)Economic growthNursingOutbreakDiseaseMicroeconomics

Abstract

fetched live from OpenAlex

Covid-19 is officially a pandemic. It is a novel infection with serious clinical manifestations, including death, and it has reached at least 124 countries and territories. Although the ultimate course and impact of Covid-19 are uncertain, it is not merely possible but likely that the disease will produce enough severe illness to overwhelm health care infrastructure. Emerging viral pandemics “can place extraordinary and sustained demands on public health and health systems and on providers of essential community services.” Such demands will create the need to ration medical equipment and interventions. Rationing is already here. In the United States, perhaps the earliest example was the near-immediate recognition that there were not enough high-filtration N-95 masks for health care workers, prompting contingency guidance on how to reuse masks designed for single use. Physicians in Italy have proposed directing crucial resources such as intensive care beds and ventilators to patients who can benefit most from treatment. Daegu, South Korea — home to most of that country’s Covid-19 cases — faced a hospital bed shortage, with some patients dying at home while awaiting admission. In the United Kingdom, protective gear requirements for health workers have been downgraded, causing condemnation among providers. The rapidly growing imbalance between supply and demand for medical resources in many countries presents an inherently normative question: How can medical resources be allocated fairly during a Covid-19 pandemic?

Fetched live from OpenAlex and de-inverted. Abstracts are not stored in this database: the inverted indexes are 8.6 GB of the frame’s 9.3 GB of text, and the host has 13 GB free.

How this classification was reachedexpand

Full frame machine prediction

Teacher imitation

Not calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.

metaresearch head score (Codex)0.027
metaresearch head score (Gemma)0.079
Version: metacan-v3-hybrid-931329e0061cValidation status: machine_predicted_unvalidated
Candidate categoriesnone
Consensus categoriesnone
DomainCandidate signal: none · Consensus signal: none
Study designCandidate signal: Theoretical or conceptual · Consensus signal: Theoretical or conceptual
GenreCandidate signal: Commentary · Consensus signal: Commentary
Teacher disagreement score0.027
Threshold uncertainty score0.145

Distilled classifier scores by category (both heads)

CategoryCodexGemma
Metaresearch0.0270.079
Meta-epidemiology (narrow)0.0000.000
Meta-epidemiology (broad)0.0010.001
Bibliometrics0.0010.001
Science and technology studies0.0050.019
Scholarly communication0.0130.014
Open science0.0020.010
Research integrity0.0080.008
Insufficient payload (model declined to judge)0.0120.001

Machine scores (provisional)

The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.

Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.

Opus teacher head0.481
GPT teacher head0.540
Teacher spread0.060 · how far apart the two teachers sit on this one work
Validation statusscore_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from it

Classification

machine, unvalidated

Machine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.

The models applied no category: nothing in the taxonomy fit this work.
Study designTheoretical or conceptual
Domainnot available
GenreCommentary

How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".

Quick stats

Citations3,244
Published2020
Admission routes1
Has abstractyes

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