Lessons Learned from the Allocation of Diagnostic Testing as a Scarce Resource in the COVID-19 Pandemic

Abstract

While scarce resource allocation has been discussed due to the demands the COVID-19 pandemic has placed on the healthcare system, diagnostic testing has not been conceptualized as a scarce resource. SARS-CoV-2 diagnostic testing was limited in the early phases of the pandemic, narrowing access to priority groups recommended by the Centers for Disease Control and Prevention (CDC). The early lack of testing led to the utilization of community mitigation strategies as primary prevention. The resulting work and school closures came at a serious economic and educational cost, particularly for underserved populations. Testing guidelines have contributed to inequities in how the pandemic has affected vulnerable populations, including people experiencing homelessness, inmates, and frontline essential workers. Testing should be ethically allocated to maximize population benefits, minimize harms, and mitigate the inequities the pandemic has highlighted. This discussion on the ethical implications of rationing diagnostic testing as a scarce resource will hopefully inform guidelines in future pandemics.