The recently formed National Academies Standing Committee on Emerging Infectious Diseases and 21st Century Health Threats, assembled at the request of the White House Office of Science and Technology Policy and the U.S. Department of Health and Human Services’ Office of the Assistant Secretary for Preparedness and Response in response to the COVID-19 outbreak, has been providing rapid expert consultations on several topics, such as social distancing and severe illness in young adults.  The standing committee’s latest rapid expert consultation, requested by the U.S. Department of Health and Human Services’ ADM Brett Giroir, assistant secretary for health, and Robert Kadlec, assistant secretary for preparedness and response, focuses on implementation of crisis standards of care and is available for immediate release.

Crisis standards of care (CSC) are applied when a pervasive or catastrophic disaster make it impossible to meet usual healthcare standards.  Given the resources available at the start of the COVID-19 pandemic and expected during the immediate period, demand for healthcare services, especially in critical care, will soon outstrip healthcare providers’ ability to deliver usual care in many communities, as has already occurred in several metropolitan areas.  Reports on extreme conditions elsewhere may not prepare the public for the shift to CSC in their own hometowns, and healthcare and political leaders have a duty to forewarn the public about what is coming and the implications of CSC, the rapid expert consultation says.

Building on a decade of previous National Academies reports, the aim of this rapid expert consultation is to articulate the guiding principles, key elements, and core messages that undergird CSC decision-making at all levels.  The authors note that choices and preferences that apply to specific situations depend on the demands of the epidemic relative to locally available facilities, equipment, personnel, and other needed resources, and that this document describes the basis upon which to carry out such decision-making whenever it has to happen.  The key elements of CSC planning described in the document include a strong ethical grounding; integrated, continuing community and provider engagement, education, and communication; assurances regarding legal authority and environment; clear indicators, triggers, and lines of responsibility; and evidence-based clinical processes and operations.

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