This document has been developed to support Missouri hospitals and clinicians during the 2020 COVID-19 pandemic. Current national COVID-19 disease modeling includes variables such as percent of infection attack rate ranging from 20% to 60% and duration of surge extending between 6 and 18 months. A best-case scenario of a low infection attack rate of 20% extending over 18 months likely can be managed within the current health care system. Current models suggest the health care system has 91.4% of hospital beds needed and 74.8% of intensive care beds needed if Missouri experiences a 20% infection attack rate over six months. This model does not account for the increased capacity hospitals have undertaken by canceling elective procedures and converted space and beds for additional patients.
However, modifying national models using more specific Missouri data suggests increasing the infection attack rate to 40% with a surge duration of six months will overwhelm the Missouri health care system providing only a 45.7% supply of hospital beds and 37.4% supply of intensive care beds needed. (Appendix A). It is for this reason planning for the worst-case scenarios is of utmost priority.
Ideally, this document would have been developed through a deliberative process involving many stakeholders and reviews. However, the need for established guidance at this critical time necessitated the expedited development of a framework for Missouri hospitals. This guidance is based on other well-established plans such as the Utah Crisis Standards of Care (2019) to provide an ethical foundation for system-level and regional decisions to determine most appropriate settings for care and allocation of scarce resources.
Existing models describe a continuum during emergency events in which hospitals move from conventional to contingent to crisis operations. During the latter phase, also known as Crisis Standards of Care (CSC), this guidance only should be used when medical care must shift from a solely patient-centric approach to allocating scarce resources to promote achieving the greater societal good of survival, safety and security for the population as a whole. This is not intended to be an exact or mandated decision support algorithm.
Research, emerging practices and other surge management resources have been utilized and are referenced throughout the document. This guidance is based on the Crisis Standards of Care: A Systems Framework for Catastrophic Disaster Response.