Adherence to regular operating procedures, since the demand for resources does not threaten the supply. While there may be conservation of resources in anticipation of future crisis, it does not significantly alter patient care.


Conventional standard of care 

Currently in place for many healthcare systems. Resources are dwindling, so some rationing and adjustment of procedures to conserve, re-use, or substitute scarce resources such as PPE may occur. Non-urgent procedures are postponed. Testing and treatment necessary to avoid disease and death are implemented.


Contingency standard of care

Demand outstrips supplies, both patients with and without COVID-19 are triaged, and resources must be selectively allocated and reallocated (withdrawn from some patients and given to others). For example, to maximize benefit, a triage team should give a ventilator to a COVID-19 patient with acute respiratory failure instead of a patient with end-stage heart failure. A true crisis involves region-wide, and not just hospital-wide, shortages.


Crisis standard of care

The standards of care, or criteria for healthcare system guidelines during the pandemic, are as follows:
- Conventional standard 
- Contingency standards
- Crisis standards

Syracuse University

During the COVID-19 pandemic, scarce medical resources force healthcare systems under crisis standards to make difficult decisions regarding triage, allocation, and reallocation. These decisions must be guided by ethical principles and should not be made by individual bedside clinicians. Additionally, healthcare workers must maintain transparency, clear communication, and a dedication to providing the highest quality of care to patients, including palliative care.

Healthcare Systems During the COVID-19 Pandemic

Kirkpatrick, J. N., Hull, S. C., Fedson, S., Mullen, B., & Goodlin, S. J. (2020). Scarce-Resource Allocation and Patient Triage During the COVID-19 Pandemic. Journal of the American College of Cardiology, 76(1), 85-92. 
doi:10.1016/j.jacc.2020.05.006
https://www.sciencedirect.com/science/article/pii/S0735109720352232?via%3Dihub

Scarce-Resource Allocation and Patient Triage During the COVID-19 Pandemic

- Journal of the American College of Cardiology
- The Lancet Public Health 
- Clinical Chemistry and Laboratory Medicine (CCLM)
- US National Library of Medicine National Institutes of Health
- Journal of the Association for Consumer Research

References for Healthcare Systems During COVID-19 Pandemic by Journal

Scarce resources include, but are not limited to, intensive care unit (ICU) beds, ventilators, dialysis machines, extra-corporeal membrane oxygenation circuits, personal protective equipment (PPE), and healthcare workers.


Scarce Resources for Healthcare Systems During COVID-19

The principles of medical ethics are:
- Autonomy
- Beneficence/non-maleficence
- Justice
- Fair innings
- Instrumental value

Medical Ethics in Healthcare Systems Response to COVID-19

Standards of Care in COVID-19

In hospitals, triage teams reduce moral distress for clinicians and legally protect them by deciding 1) which patients should receive allocation (life-sustaining intervention) and 2) whether resources will be withdrawn from one patient and given to another. They must be transparent about their principles and decision-making factors, but the team member identities may be private. 

Triage Teams for Healthcare Systems and COVID-19

- Bacherini, D., Biagini, I., Lenzetti, C., Virgili, G., Rizzo, S., &amp; Giansanti, F. (2020, April 06). The COVID-19 Pandemic from AN Ophthalmologist's Perspective. Retrieved February 02, 2021, from https://www.sciencedirect.com/science/article/pii/S1471491420300885?casa_token=hsg1JKQlpE8AAAAA%3A5mx8GOqoHkqAYlHzR_0sl_GY-l0XDnn28lrCW9yNm_qkWhrClyco5oEaaAK8jJI_vGbRfmQHwPY
- Nguyen, L.H., Drew, D.A., Graham, M.S., Joshi, A.D., Guo, C-G, Ma, W., et al (2020, July 31). Risk of COVID-19 among front-line health-care workers and the general community: a prospective cohort study. Retrieved February 02, 2021 from https://www.thelancet.com/journals/lanpub/article/PIIS2468-2667(20)30164-X/fulltext

References for Healthcare Providers' Role in Spreading COVID-19

- Healthcare workers have been shown to be at a largely increased risk for becoming infected with COVID-19 while compared to the general public
- Factors that affect this finding include testing, PPE, ethnic factors, and clinical setting


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