As the burgeoning COVID-19 pandemic became more omnipresent in American life in mid-March 2020, Twitter and Instagram rumors about coronavirus patients with high body mass indices being denied ventilator treatment began to spread.
RT @biggirlsworkout: High BMI is currently being used to exclude people from ventilator treatment due to the shortage… I predict that in a year, doctors point to higher death rate for fat people from COVID and say, "See? I told you so!" BUT THEY ARE LITERALLY CAUSING IT NOW.
— Lindo Bacon (formerly Linda Bacon) (@LindoBaconX) March 19, 2020
High BMI is currently being used to exclude people from ventilator treatment due to the shortage of machines. I predict that in a year, doctors will point to the higher death rate for fat people from COVID and say, "See? I told you so!" BUT THEY ARE LITERALLY CAUSING IT NOW.
— The Fat Personal Trainer (@biggirlsworkout) March 19, 2020
The multifaceted claim held:
- COVID-19 patients with a non-specifically high body mass index (BMI) were being denied ventilator treatment;
- High BMI COVID-19 patients were thus likelier to die, due to their purportedly lower chances of receiving life-saving treatment like ventilator use;
- Consequently, more patients with high BMIs were dying of COVID-19 due to the purportedly withheld ventilator treatment;
- In time, the medical community would interpret COVID-19 deaths in patients denied ventilators due to high BMI as caused solely by obesity (not the withholding of life-saving treatment afforded other patients, like ventilators).
However, the rumor as presented was entirely without even an anecdotal source for the COVID-19 BMI and ventilators claim. Typically, claims that popular were attributed to:
- Hospital workers (doctors or nurses);
- A friend of the individual denied a ventilator due to their BMI;
- A friend of a friend in general;
- A claim spotted on a social media site.
Without a definitive source for any claim, it is difficult to determine its accuracy level under normal circumstances. When a source is provided, there is at least a starting point to see if any matching claims preceded the rumor.
Consequently, any claims that COVID-19 patients with high BMIs were denied ventilators appearing after March 19 2020 were similarly sourceless — it was possible and even likely the initial rumor spawned its own iterations with a source retroactively added.
On March 20 2020, a screenshot of the second, viral tweet was shared to Facebook:
At least one person in the comments claimed that the tweet was “misleading.” Although that commenter’s “misleading” label would suggest they might go on to claim there was no evidence that high BMI patients were being denied ventilators, they in fact went on to defend the putative practice as the most equitable way of divvying up resources in short supply:
I would say this is an unfair/misleading post. When you have to ration equipment like ventilators (VERY UNBELIEVABLE AND UNFORTUNATE THAT THIS IS HAPPENING AT ALL), those resources are given to those with the best chance of living and highest potential quality of life. If you look at it the same way as applying for an organ donation (like a new lung), wouldn’t you want it to go to the best candidate? I doubt the people being turned away are just “overweight.” They are more likely to be morbidly obese with several other comorbidities. This is very misleading.
Although rumors about COVID-19, BMI, and ventilators began spreading fairly early on in the pandemic, they were followed by stories hammering home the chaotic reality of medical settings in the midst of the outbreak. On March 30 2020, WLNY described clinical settings in hard-hit places like New York as similar to a “war zone“:
Across New York City, health care workers face tremendous challenges to treat patients, and at Brooklyn’s Brookdale Hospital Medical Center they are at their maximum capacity.
Patient beds line the hallways as every inch of this building is now being used because of the coronavirus COVID-19 outbreak, reports CBS2’s Kevin Rincon.
“Well, this is a warzone, a medical warzone,” said Dr. Arabia Mollette. “Every day I come, what I see on a daily basis is pain, despair, suffering and healthcare disparities.”
Mollette works in the emergency room where more than 100 coronavirus patients have walked through with another 70 people under investigation.
“This virus sees no it is no difference,” she said. “It has nothing to do with age, has nothing to do with access to healthcare, has nothing to do with socio-economics, race or ethnicity. This virus is killing a lot of people.”
One day later, CNN reported that the same hospital in Brooklyn was nearly depleted of resources:
As is the case with many other hospitals across the country, Brookdale Hospital is struggling to keep up with the demand for resources as more patients come in.
“We need gowns, we need gloves we need masks we need more vents (ventilators),” Mollette said. “We need more medical space. We need psychological support as well. It’s not easy coming here when you know what you’re getting ready to face.”
That reporting involved a shortage of respirators specifically, along with doctors’ concerns regarding an eventual position in which clinicians would have to “triage treatments based on resource availability”:
But Dr. Amy Plasencia, chief medical resident at Brookdale Hospital, said the hospital has “a critical shortage of ventilators in relation to the numbers that we are seeing.”
Ventilators are used on serious cases of Covid-19 to help patients breathe who are struggling to do so on their own, Plasencia said.
Once patients are hooked up to the machines, they generally need to continue using them for one to two weeks or longer, she said.
“Certainly no physician wants to be put in a position where they have to triage treatments based on resource availability,” she said. “But in this national crisis that is where we may be heading.”
And on April 2 2020, WABC-TV and WNBC covered new purported guidance for EMS workers regarding changed protocols for resuscitation in the event of a cardiac arrest; however, the New York State Department of Health later disputed the validity of that guidance.
On April 3 2020, we located a circulating undated Google Docs sheet titled “#NoBodyIsDisposable Know Your Rights Guide to Surviving COVID-19 Triage Protocols.” It began with an “Overview” section, which indicated it was created for people “facing potential triage discrimination based on disability or weight during the COVID-19 pandemic”:
This is a “Know Your Rights” toolkit for people facing potential triage discrimination based on disability or weight during the COVID-19 pandemic in the United States. This document covers rights and strategies for fat and disabled people of all ages. You can share it using the link: https://tinyURL.com/CovidKnowYourRights
(Note: We hope to amend this document with more information related to age discrimination in the future.)
This toolkit is not legal advice or medical advice. Information has been sourced from the web, and is for general information purposes only. This is a changing situation. Laws differ by state and location. Policies differ by hospital. This document may change as things progress, so check back. This information may not be up to date. It’s up to you to be sure the information is correct and applicable to you.
In total, the document numbered eleven pages; on page ten, an “about” section read:
NoBody Is Disposable Coalition
We are people targeted by triage plans during the COVID-19 pandemic — people with disabilities, fat people, old people, people with HIV/AIDS or other illnesses — and our loved ones who don’t want us to die. We are allies who want to help. We partner with social justice and civil rights organizations, as well as medical professionals to demand policies that avoid triage and avoid discrimination in triage.
This Toolkit was produced with input from a lot of people – fat rights, disability, social justice and civil rights lawyers; leaders in fat liberation, elder services, and disability justice; doctors and nurses; students, artists and writers… Thank you to everyone for finding time in this crisis to share your knowledge.
Overall, “#NoBodyIsDisposable Know Your Rights Guide to Surviving COVID-19 Triage Protocols” included what appeared to be a well-researched and painstakingly put-together document. In its “Background” section, its authors explained why they created it and for whom it was compiled:
People are concerned that higher weight individuals are facing direct weight discrimination via triage protocols, or indirect weight discrimination (based on other diagnoses or stereotypes associated with higher weight). Such discrimination will have a disproportionate impact on many people of color, who already experience systemic inequalities and bias within the healthcare profession. Other groups, including the LGBTQIA community, may also be at risk.
Of note is that the document did not claim that the practices was necessarily taking place, but instead it was presented as a guide for people potentially in high-risk groups to be armed with information for their own security in clinical settings during the pandemic.
In that respect, “#NoBodyIsDisposable Know Your Rights Guide to Surviving COVID-19 Triage Protocols” was clearly a valuable document for many reasons during the coronavirus outbreak, and it did not need to be predicated on proof-positive instances of individuals discriminated against in hospitals. It merely needed to serve as a repository of information for disabled, LGBTQ+, and individuals at higher weights to reference in the event they suspected they were being treated insufficiently in a medical setting due to those factors.
The document included several pages on “what to do before needing to go to the hospital,” covering organization of personal documents and the creation of a “connection kit” during social distancing measures. It also provided six points of “strategies for advocacy,” and continued:
POTENTIAL SURVIVAL STRATEGIES TO CONSIDER IF YOU FACE DISCRIMINATION
Warning: We hope that these strategies won’t be necessary to use. We also know that some of us will be in life or death situations, so it’s worth considering many options. We know that it will be exponentially harder for people of color, trans/non-binary folks, and other marginalized groups. We acknowledge that some of these strategies may cause the user harm and may be futile. For some people, it may be better to resist right away; for others, trying to be nice may be the best approach. Use what works for you, discard what does not.
Those strategies included forming a relationship with nurses and doctors, as well as advising that people become acquainted with regional discrimination laws. The document added:
If health care providers make you feel less deserving of the best chance to live, remember that there are hundreds of thousands of fat, disabled people and allies who know you deserve to live and we are rooting for you! You deserve to live!!!
Again and throughout, the document raised an important distinction with respect to the rumor — regardless of whether it was occurring, the rumor itself made people feel powerless and raised fears that life-saving treatments might be withheld from specific groups.
In late March 2020, rumors began circulating that COVID-19 patients who had a “high BMI” were being denied ventilator treatment. We were unable to verify the rumor was accurate, but we did locate a community resource (“#NoBodyIsDisposable Know Your Rights Guide to Surviving COVID-19 Triage Protocols”) created for anyone fearing that they might face medical discrimination. Finally, the BMI/ventilator rumors appeared less than two weeks before a series of alarming developments in coronavirus epicenters where doctors and regional medical groups both discussed and advised on how to strategically manage the distribution of resources — including later disputed, but existing, EMS orders to cease transporting patients in cardiac arrest to hospitals in New York City and on Long Island.