The National Academy of Medicine and nine other national organizations call for key actions to be taken in order to do the most good possible for the largest number of people with limited resources.
The crisis is now: governors, health departments, hospitals, and other health care sector partners must take immediate action to save lives and fairly allocate limited resources. Hospitals across most of the United States are experiencing alarmingly high surges in COVID-19 patients, and many intensive care units across the country are already over capacity and many more will be so in the coming weeks. In response, hospitals are canceling admissions and non-emergency procedures, identifying ways to augment staff, transferring patients outside their local jurisdictions, and even establishing and operating alternate care sites. Many of the hardest-hit hospitals are those that serve Black, Brown, Asian, and tribal communities, threatening to exacerbate existing inequities in care quality and outcomes.
We have reached a point in the crisis at which critical decisions must be made in order to do the most good possible for the largest number of people with limited resources. These decisions effectively signal a shift from conventional to crisis standards of care (CSC). This means making unprecedented and agonizing decisions about how resources are used, stretching many resources well beyond conventional limits. Every action possible should be taken now to mitigate the need to operate under crisis conditions. Failure to act will inevitably mean more lives lost, lasting damage to our fragile health care system, and deepened scars of health inequity.
We recommend the following key actions be taken now:
- Work with the health departments and hospitals in their state to prepare appropriate draft emergency declarations that identify resources that are in limited supply, as well as consider appropriate legal and regulatory relief for actions that might have to be taken by health care providers to address the unprecedented demand for health care services.
- Work with health departments and hospitals to ensure equitable resource allocation in CSC conditions, with special attention to outcomes for people of color, people with disabilities, and people with low income. This includes collecting, analyzing, and reporting on data disaggregated by race, ethnicity, disability, neighborhood, and other sociodemographic characteristics.
- Work with health departments to monitor the impact on health care facilities and support distribution of resources and patients to enhance fairness and avoid inequity.
- Frequently communicate with patients, families, and providers with full transparency. Messages should reflect the current situation, with updates and details of recommended actions, when appropriate.