At various times during the COVID-19 pandemic, including surges produced by the Delta and Omicron variants, hospitals around the nation experienced tremendous strain, creating a shortage of beds and other resources such as staffing and medical supplies, and producing a situation where the necessary care could not be provided to all patients. In response, Crisis Standards of Care (CSC) were activated in facilities around the country.
CSC provide a guide for medical providers who are forced to ration life-saving treatment. The American Medical Association notes that when CSC is utilized, the commitment to a patient is counterbalanced with the need to protect the welfare of a population of patients. This balancing is carried out by extending available key resources, while minimizing the impact of clinical care shortages. In CSC, specific protocols developed to predict mortality among critically ill patients – such as the Sequential Organ Failure Assessment (SOFA) – are used to determine how care should be rationed.
The Center for Medicare Advocacy has been monitoring the issue of rationing health care since the beginning of the pandemic and has found that CSC plans must be carefully defined in order to avoid discrimination on the basis of age, disability, racial, ethnic or socioeconomic status.
A study recently published in JAMA Open Network, found that nearly twice the proportion of Black patients were scored in the lowest priority group to receive scarce resources compared with all other patients. Researchers analyzed scoring data that were generated when the Boston area experienced a surge in COVID-19 cases. The hospital network in the Greater Boston area preemptively scored patients in order to prepare for a potential shortage of critical care resources, such as ventilators and staffed ICU beds. While CSC ultimately was not implemented, the scoring data shed light on racial inequities in SOFA scores.
Black patients had higher rates of COVID-19 infection and were admitted to ICUs with higher levels of combined acute and chronic severity of illness, which meant that they received lower prioritization for critical care resources. “Had this scoring system been actually used,” the researchers noted, “it could have led to resources being disproportionately allocated away from Black patients due to a higher proportion of Black patients falling into the lowest priority group based on severity of illness scoring.”
March 23, 2022 – C. St. John
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 Hanfling, D., & Hick, J. Crisis standards of care and COVID-19: What did we learn? How do we ensure equity? What should we do? National Academy of Medicine. (Sept. 10, 2021). Available at: https://nam.edu/crisis-standards-of-care-and-covid-19-what-did-we-learn-how-do-we-ensure-equity-what-should-we-do/
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 Association of American Medical Colleges. COVID-19 Crisis Standards of Care: Frequently Asked Questions for Counsel. AAMC. (Dec. 18, 2020). Available at: https://www.aamc.org/coronavirus/faq-crisis-standards-care
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 Kertesz, K. “Advocacy Update: Medical Rationing” Center for Medicare Advocacy. (July 16, 2020). Available at: https://medicareadvocacy.org/advocacy-update-medical-rationing/
 Center for Medicare Advocacy. Utah Removes Age Discrimination from its “Crisis Standards of Care”. CMA. (Dec. 3, 2020). Available at: https://medicareadvocacy.org/utah-removes-age-discrimination-from-its-crisis-standards-of-care/
 Riviello, E. D., Dechen, T., O’Donoghue, A. L., Cocchi, M. N., Hayes, M. M., Molina, R. L., Moraco, N. H., Mosenthal, A., Rosenblatt, M., Talmor, N., Walsh, D. P., Sontag, D. N., & Stevens, J. P. (2022). Assessment of a Crisis Standards of Care Scoring System for Resource Prioritization and Estimated Excess Mortality by Race, Ethnicity, and Socially Vulnerable Area During a Regional Surge in Covid-19. JAMA Network Open, 5(3). https://doi.org/10.1001/jamanetworkopen.2022.1744