Duty to Plan: Health Care, Crisis Standards of Care, and Novel Coronavirus SARS-CoV-2

The novel coronavirus SARS-CoV-2 and resulting disease state COVID-19 pose a direct threat to an over-burdened U.S. medical care system and supporting supply chains for medications and materials.The principles of crisis standards of care (CSC) initially framed by the Institute of Medicine in 2009 ensure fair processes are in place to make clinically informed decisions about scarce resource allocation during an epidemic.This may include strategies such as preparing, conserving, substituting, adapting, re-using, and re-allocating resources.In this discussion paper for health care planners and clinicians, the authors discuss the application of CSC principles to clinical care, including personal protective equipment, critical care, and outpatient and emergency department capacity challenges posed by a coronavirus or other major epidemic or pandemic event.Health care facilities should be developing tiered, proactive strategies using the best available clinical information and building on their existing surge capacity plans to optimize resource use in the event the current outbreak spreads and creates severe resource demands.Health care systems and providers must be prepared to obtain the most benefi t from limited resources while mitigating harms to individuals, the health care system, and society.