Crisis Standards of Care-More Than Just a Thought Experiment?

Summary: In this retrospective cohort study involving 20,736 adults with COVID-19 in the United States, in-hospital mortality rates decreased after March and April and remained at a lower level from May through November, regardless of changes in patient characteristics.

Summary: Prominent bioethicists have pushed for prolonging life-years as a rationing strategy during the Covid-19 pandemic, but the philosophical justification for this approach is lacking. Evidence of public support for prioritizing life-years is scarce, and organ transplantation protocols often cited in pandemic response plans do not set a precedent for maximizing life-years. Many state emergency-response plans have rejected or compromised the idea of saving the most life-years, and philosophical arguments in favor of rationing by life-years are notably deficient. An alternative approach based on standard principles of beneficence, respect for persons, and justice is proposed as a fair solution.

Summary: A study in a three-hospital academic health system in New York showed a decrease in hospital mortality rates among COVID-19 patients, with adjusted mortality dropping from 25.6% in March to 7.6% in August. The standardized mortality ratio also decreased from 1.26 in March to 0.38 in August, indicating an improving trend in patient outcomes. These findings suggest that mortality from COVID-19 may be decreasing even after adjusting for patient characteristics.