New York prioritizes 'non-white' people for COVID treatments to fight 'inequity'

In light of the shortage of oral antibody and monoclonal antibody treatments in New York, the New York State Department of Health has issued new guidelines for health professionals to figure out how to ration the medication.

The goal is to give the opportunity for treatment to those most at risk, and those who are of a "Non-White race or Hispanic/Latino ethnicity," the Dept. of Health writes, should have that identity "be considered a risk factor," because of systemic racism.

The eligibility requirements for receipt of these treatments are for those "patients who meet all the following criteria:

• "Age 12 years and older weighing at least 40 kg (88 pounds) for Paxlovid, or 18 years and older for molnupiravir

• "Test positive for SARS-CoV-2 on a nucleic acid amplification test or antigen test; results from an FDA-authorized home-test kit should be validated through video or photo but, if not possible, patient attestation is adequate

• "Have mild to moderate COVID-19 symptoms

o "Patient cannot be hospitalized due to severe or critical COVID-19

• "Able to start treatment within 5 days of symptom onset

• "Have a medical condition or other factors that increase their risk for severe illness.

o "Non-white race or Hispanic/Latino ethnicity should be considered a risk factor, as longstanding systemic health and social inequities have contributed to an increased risk of severe illness and death from COVID-19"

While the note on eligibility from the Dept. of Health says that those who receive the treatment must meet all of the criteria, the note on race is a subsection of the eligibility factor that could be interpreted as being about comorbidities. Essentially, among the factors that can be considered as comorbid, are being not white.

White people, per this directive, could be considered eligible for the treatment if they meet the full criteria, but for those who are non-white, their race or ethnicity alone can be considered a comorbidity even if they are in perfect health otherwise, Covid aside.

"Longstanding systemic health and social inequities" that the Dept. of Health associates with race or ethnicity, and not with a medical health issues, are essentially considered a risk factor, a comorbidity, on their own.

This comes as the US Food and Drug Administration issued guidance for COVID treatments, saying that "Other medical conditions or factors (for example, race or ethnicity) may also place individual patients at high risk for progression to severe COVID-19 and authorization of bamlanivimab and etesevimab under the EUA is not limited to the medical conditions or factors listed above.

"For additional information on medical conditions and factors associated with increased risk for progression to severe COVID-19, see the CDC website: People with Certain Medical Conditions. Health care providers should consider the benefit-risk for an individual patient." This phrasing is in much of the FDA guidance on COVID treatments and care.

There have been concerns about the rationing of the COVID treatments by the Biden administration, with Florida's Surgeon General slamming the federal government for not producing enough of these treatments to those who need them.

The New York City Board of Health declared that racism was a "public health emergency" in October. Governor Kathy Hochul, who came to power after Andrew Cuomo was forced from office over a series of scandals uncovered by Attorney General Letitia James, declared racism to be a public health crisis in late December.

"Legislation S.2987-A/A.5679 declares racism a public health crisis and establishes a working group to promote racial equity throughout the State of New York."

Of that directive, Assemblyman Taylor Darling said that "Declaring Racism a public health crisis is vital because racism continues to result in a lack of resources and opportunities for people in communities of color. The effects of the COVID-19 pandemic on the African American community intimately shows the need for this working group to specifically focus on our needs holistically. This law will establish a working group within the department of health to promote racial equity throughout the State of New York and address some of the enormous issues we are currently facing."

In March, doctors in Boston called for medical resources to be allocated with race playing a major factor in considering how to dole out care. They suggested implementing standards that would show racial preference to patients.

The AP reported in June that "Black people account for 15% of all COVID-19 deaths where race is known, while Hispanics represent 19%, whites 61% and Asian Americans 4%." However, those among minority racial and ethnic groups who died under this assessment skewed younger, while those white Americans who died were primarily among the elderly.

Minnesota has similar eligibility requirements, saying that "Clinicians and health systems should consider heightened risk of progression to severe COVID-19 associated with race and ethnicity when determining eligibility for mAbs."