Crisis Standards of Care and COVID-19: What Did We Learn? How Do We Ensure Equity? What Should We Do?

Impact of hospital strain on excess deaths during the COVID-19 pandemic—United States, july 2020–july 2021

“…Surges in COVID‐19 cases have stressed hospital systems, negatively affected health care and public health infrastructures, and degraded national critical functions 1,2 . Resource limitations, such as available hospital space, staffing, and supplies, led some facilities to adopt crisis standards of care, the most extreme operating condition for hospitals, in which the focus of medical decision‐making shifted from achieving the best outcomes for individual patients to addressing the immediate care needs of larger groups of patients 3 . When hospitals deviated from conventional standards of care, many preventive and elective procedures were suspended, leading to the progression of serious conditions among some persons who would have benefitted from earlier diagnosis and intervention 4 .…”

Rebuttal From Dr White et al

“…Therefore, unless society believes that it is acceptable for ICU triage to widen disparities, equity considerations must be built into triage frameworks. Hick et al 1 have elsewhere declared that crisis care protocols “should not exacerbate underlying disparities”. 1 …”

“…Hick et al 1 have elsewhere declared that crisis care protocols “should not exacerbate underlying disparities”. 1 …”

Ambulances Required to Relieve Overcapacity Hospitals: A Novel Measure of Hospital Strain During the COVID-19 Pandemic in the United States

“… 4 , 5 , 6 , 7 However, adequate load balancing schemes among hospitals to prevent excess deaths at overloaded hospitals have remained rare throughout the pandemic in the United States. 8 , 9 , 10 , 11 Despite some public calls that transfers may have been able to save lives, 12 , 13 rationing of care away from patients with a poor prognosis has received far more attention, even though crisis standards of care in most jurisdictions call for transfers to first be exhausted before any rationing. Could the roughly 58,000 operating American ambulances have been underutilized during the COVID-19 pandemic?…”