A motion blurred photograph of a patient on stretcher or gurney being pushed at speed through a hospital corridor by doctors & nurses to an emergency room

Bioethics Forum Essay

Why Health Care Workers Should Receive Priority Care for Covid-19

The Covid-19 pandemic has imposed tremendous risk on doctors, nurses, and other health care workers not seen in a century. It is time to reconsider prioritization of health care workers’ access to scarce critical resources.

Historically, for multiple reasons, health care workers have not been prioritized for access to medical care during a pandemic.  First, health care workers willingly accept some level of personal risk. Second, in previous pandemics, health care workers who became ill were not expected to return to their jobs quickly enough to maintain the workforce, and thus it was not imperative to prioritize their care. Third, there was concern that prioritizing health care workers over the general population could lead to an erosion of the public’s trust in the health care system because of the possible perception that this policy was self-serving. However, given the unprecedented circumstances surrounding the Covid-19 pandemic, it is justifiable to prioritize health care workers when all else is equal between two patients.

Health care workers are bound by a duty to treat, a professional obligation to tend to the sick despite personal risk. There is, however, a corresponding duty, which is society’s obligation to reasonably mitigate such risk to health care workers. In an active shooter incident, emergency medical services are not expected to enter a scene to provide care until the scene is secured by police. With respect to the coronavirus pandemic, such safety assurances are lacking. The unusually high transmission rate of Covid-19 to health care workers, further exacerbated by the shortage of personal protective equipment, reduces the ability to safely provide care. Nurses, physicians, and other personnel have contracted Covid-19 in significant numbers resulting in critical illnesses and deaths. In certain epicenters of the pandemic, health care workers represent  3% to 11% of the total infections in the United States and more than 1,000 have died worldwide. In this context, the principle of reciprocity presses society to recompense health care workers by giving them priority access to care should they fall ill from the virus. Moreover, this reassurance can be expected to boost morale, allay fear, and prevent attrition in an already overburdened workforce.

Second, prioritizing health care workers for care during this pandemic offers the valuable and practical benefit of returning key staff to their roles. This logic did not always hold true in past pandemics, which were often shorter in and, therefore, did not allow for health care workers to recover from a serious illness in time to rejoin the workforce. Given our current understanding of the expected length of the Covid-19 cycle (and potential seasonal reemergence), infected health care workers will be able to return to hospitals. Further, these workers may be immune to the virus for some period. There is a significant benefit to society in healing and returning health care workers during the prolonged battle against Covid-19. 

Finally, the application of resource allocation systems triggers challenging but necessary changes to our typical standard of care. To maintain public trust, the drivers for change must be made explicit and policies should be made widely available to the public. Allocation procedures must be transparent and consistently applied. Triage places emphasis on saving the most lives. When patients with high likelihood of survival outnumber crucial resources such as beds or ventilators, the choices are limited: first come, first served; younger patients over older (the “cycle of life” preference) or, we propose, health care workers who may return to work in time to save other patients. Given the worldwide public displays of support for health care workers and media attention on the shortages of personal protective equipment, the public should be able to  accept the benefits of prioritizing  health care workers.

The surge of Covid-19 cases will continue to overwhelm portions of the U.S. health care system, inevitably forcing difficult decisions about the allocation of limited resources. Health care workers treating the pandemic will themselves become among the most limited resources as they succumb to the virus. While prioritizing these workers to receive care has not been a standard policy in past pandemic planning, doing so now will save lives by maintaining a functioning and resilient health care workforce. Health care workers bravely on the front lines should have reasonable assurances to critical care access during this pandemic.

David Blitzer, MD, MBE is a cardiothoracic surgery resident at Columbia University Irving Medical Center. Susan Regan, JD, is an assistant clinical professor of medical ethics at Weill Cornell Medical College.  David Fischkoff is an investment professional in New York City. Katherine Fischkoff, MD, MPA, HCEC-C is an assistant professor of surgery and critical care and an ethics consultant at Columbia University Irving Medical Center.


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  1. This is an excellent essay, thank you. By outlining the need to incentivize healthcare workers to show up for work and expose themselves to unmeasured risk, and the need to keep healthcare workers healthy enough to provide patient care on an ongoing basis, you make a compelling argument for prioritizing their treatment ahead of care for the population as a whole.
    Another related argument is the inherent moral hazard that arises if we normalize and condone societies failure to invest in clinician safety through adequate stockpiling, and equitable distribution, of PPE and portable ventilators. There is no economic or political justification for our lack of preparedness for this the latest incarnation of pandemic disease. Our lack of preparation can only be explained by societies immature desire to extract a benefit without giving even fair compensation. If clinicians capitulate to providing patient care under unsafe circumstances political leaders will have a little incentive to make the difficult decisions and financial investments needed to be sure that we are better prepared and adequately resourced for the next, inevitable pandemic event.

  2. This paper summarizes my initial view on this topic and I’m sympathetic to the arguments raised herein. Yet, how can we adequately define who is “essential” to health “care?” As I think of all the people who truly contribute to my health each day the list is very very long. And it goes far beyond those who work in a hospital setting. I think the tweet exchange with our colleague Steve Joffe and reference to an article written by our current Harvard Medical School class president Lash Nolen (below) captures the complexity of defining who would receive this preference. It wouldn’t simply be doctors and nurses and respiratory therapists. It would be as well those who work in environmental services, and food services and those who deliver our food and collect our trash among many many others. We have failed to protect not only our healthcare workers but so many others. We MUST do better. Thank you to the authors for raising this important topic.

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