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Pulse oximetry (scarcity)

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Over the past eight years, Lifebox has distributed 1108 devices in Ethiopia, typically directly to anaesthesia providers; nearly half of those surveyed had received one, and of 140 devices that were identified during the survey work, 123 were still in use up to 7 years later (nine were reported as missing and eight reported as malfunctioning). These were typically owned by the providers themselves and were thus not available for flexible clinical use.

Despite its durability and usefulness in clinical care, there were very few generally available portable pulse oximeters that could move to areas of a hospital as needed, whether to recovery rooms, intensive care, emergency units, or even point-of-care screening and triage areas.

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Across the globe, including in the USA, the pandemic has raised concerns for exacerbating social and structural inequities in the health care system. Disparities in chronic cardiopulmonary disease prevalence, socioeconomic status, and access to health care have placed vulnerable populations, including racial and ethnic minorities, at higher risk of COVID-19 infection, hospitalization, and death. Black, Hispanic, and Native Americans have been shown to be infected and dying at disproportionately higher rates than their white counterparts in large urban and rural areas across the USA. 

As the number of positive cases rise, so too has the expectation of scarce health care resources including SARS-CoV-2 antigen and antibody testing, antiviral medications, intensive care unit beds, and ventilators, elevating calls by health care leaders and public health officials to develop and implement strategies for rationing of critical resources. These calls are especially alarming for marginalized populations whom history has shown are persistently excluded from resources, both scarce and abundant, in the USA.

As the current pandemic draws into focus the stark variation in access to limited resources, from personal protective equipment to dialysis machines, we caution that equity must be placed at the center of all rationing strategies, citing examples from organ transplantation and end-of-life care to amplify a call for action to protect vulnerable communities in this health crisis.