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      Recommendations on COVID‐19 triage: international comparison and ethical analysis

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          Abstract

          On March 11, 2020 the World Health Organization classified COVID‐19, caused by Sars‐CoV‐2, as a pandemic. Although not much was known about the new virus, the first outbreaks in China and Italy showed that potentially a large number of people worldwide could fall critically ill in a short period of time. A shortage of ventilators and intensive care resources was expected in many countries, leading to concerns about restrictions of medical care and preventable deaths. In order to be prepared for this challenging situation, national triage guidance has been developed or adapted from former influenza pandemic guidelines in an increasing number of countries over the past few months. In this article, we provide a comparative analysis of triage recommendations from selected national and international professional societies, including Australia/New Zealand, Belgium, Canada, Germany, Great Britain, Italy, Pakistan, South Africa, Switzerland, the United States, and the International Society of Critical Care Medicine. We describe areas of consensus, including the importance of prognosis, patient will, transparency of the decision‐making process, and psychosocial support for staff, as well as the role of justice and benefit maximization as core principles. We then probe areas of disagreement, such as the role of survival versus outcome, long‐term versus short‐term prognosis, the use of age and comorbidities as triage criteria, priority groups and potential tiebreakers such as ‘lottery’ or ‘first come, first served’. Having explored a number of tensions in current guidance, we conclude with a suggestion for framework conditions that are clear, consistent and implementable. This analysis is intended to advance the ongoing debate regarding the fair allocation of limited resources and may be relevant for future policy‐making.

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          Author and article information

          Contributors
          biller-andorno@ibme.uzh.ch
          Journal
          Bioethics
          Bioethics
          10.1111/(ISSN)1467-8519
          BIOE
          Bioethics
          John Wiley and Sons Inc. (Hoboken )
          0269-9702
          1467-8519
          25 September 2020
          : 10.1111/bioe.12805
          Affiliations
          [ 1 ] Institute of Biomedical Ethics and History of Medicine University of Zurich Switzerland
          Author notes
          [*] [* ] Correspondence

          Nikola Biller‐Andorno, University of Zurich, Institute of Biomedical Ethics and History of Medicine, Winterthurerstrasse 30, Zurich 8006, Switzerland.

          Email: biller-andorno@ 123456ibme.uzh.ch

          Author information
          https://orcid.org/0000-0002-9509-8631
          https://orcid.org/0000-0001-7066-8135
          https://orcid.org/0000-0001-7661-1324
          Article
          BIOE12805
          10.1111/bioe.12805
          7537413
          32975826
          9c4e4373-1f8f-4448-a37e-78937c432313
          © 2020 The Authors. Bioethics published by John Wiley & Sons Ltd

          This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made.

          History
          : 18 June 2020
          : 15 July 2020
          Page count
          Figures: 0, Tables: 1, Pages: 12, Words: 8529
          Funding
          Funded by: Schweizerische Akademie der Medizinischen Wissenschaften , open-funder-registry 10.13039/501100008485;
          Award ID: Käthe‐Zingg‐Schwichtenberg‐Fond
          Categories
          Original Article
          Original Articles
          Custom metadata
          2.0
          corrected-proof
          Converter:WILEY_ML3GV2_TO_JATSPMC version:5.9.2 mode:remove_FC converted:06.10.2020

          Ethics
          comparison,covid‐19,ethics,guidelines,public health,triage
          Ethics
          comparison, covid‐19, ethics, guidelines, public health, triage

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