AMA in court: Race and ethnicity help gauge risk of COVID-19 severity

The 2nd United States Circuit Court of Appeals is considering whether plaintiffs in two separate lawsuits can continue to challenge New York State Department of Health (NYSDOH) guidelines that physicians should determine whether a patient COVID-19 is of non-Caucasian race or Hispanic or Latino descent. when assessing the risk of serious disease and deciding whether to prescribe rare oral antiviral treatments.

Earlier this year, lower court judges in different parts of the state dismissed the lawsuits. New York Northern District judge removed from office Jacobson vs. Bassett, holding that there was a lack of jurisdiction ratione materiae. New York Eastern District judge removed from office Roberts vs. Bassett asserting that the plaintiff lacked standing to bring suit against the city and state.

But the plaintiffs in both cases are asking the appeals court to reconsider those decisions and allow the prosecution to continue.

Doctors say the cases are not expected to continue.

The Litigation Center of the American Medical Association and State Medical Societies and the Medical Society of the State of New York (MSSNY) joined about half a dozen other organizations in filing amicus briefs urging the 2nd Circuit uphold each of the lower court decisions that dismissed the lawsuits. The briefs, similar to their briefs filed in lower court proceedings, explain the importance for doctors to consider race and ethnicity when determining a treatment plan for COVID-19 patients.

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Failing to account for the increased risk of becoming seriously ill or dying that patients from historically marginalized racial and ethnic groups — as well as other relevant circumstances — when COVID-19 treatments are in low supply, they say, would likely mean that these patients would continue to become seriously ill and die at disproportionately higher rates than white patients.

“Indeed, their risk would be underestimated,” the brief states.

Learn more about the cases in which the AMA Dispute Center provides assistance and learn more about the criteria for selecting cases from the Dispute Center.

A 2020 New York State study found that people from historically marginalized races and ethnicities died at a disproportionately high rate compared to whites. And the numbers have yet to stabilize in New York and New York.

Citing data from NYSDOH’s COVID-19 Death Tracker as of late June, the brief notes that the age-adjusted COVID-19 death rate for black New Yorkers is more than double that of white residents of New York.

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Among people with conditions such as heart disease and diabetes – two of the most common underlying medical conditions in patients with COVID-19 – research shows that patients from historically marginalized racial and ethnic groups tend to have their conditions less well treated, more deadly and more severe than white individuals, according to the brief from the AMA Litigation Center and MSSNY.

Therefore, risk factors such as age and underlying conditions do not fully reflect the risk that COVID-19 poses to patients from historically marginalized racial and ethnic groups who have traditionally had less access to healthcare. and whose other systemic factors impacted their overall health.

For example, doctors tell the court that New York guidelines suggest that doctors and other medical professionals consider a patient’s heart disease a risk factor.

“But,” says the memoir, “this consideration alone does not account for the likelihood that the black individual’s heart disease will manifest earlier and be more severe than that of a white individual of the same age with same condition. Nor does this consideration alone explain the increased risk of developing heart failure, increased risk of inflammation, or any of the other increased risks associated with their race that do not apply to a COVID-19 patient. white in the same situation.

Therefore, according to the brief, allowing physicians and other medical professionals to consider a patient’s race or ethnicity in decision-making is justified and the court should uphold lower court rulings.

Learn more with the AMA about the impact of COVID-19 on patients from historically marginalized racial and ethnic groups, and check out other great resources on COVID-19 health equity.

Martin E. Berry