Coronavirus forces hospitals to prepare for life-or-death decisions

Amid growing fears that the United States could face a shortage of ventilators for coronavirus patients, state officials and hospitals are quietly preparing to make excruciating decisions about how they would ration lifesaving care.

The plans may not be necessary, as officials are scrambling to secure more ventilators, which can make the difference between life and death for coronavirus patients in critical condition who are struggling to breathe. Social distancing and other mitigation efforts to slow the virus' spread could prevent hospitals from being overwhelmed. But hospitals are already huddling with state health officials to hammer out their policies to determine which coronavirus patients would get ventilators if they run short — essentially deciding whose lives to save first.

In Maryland, state officials are in discussions with the biggest hospital systems in the region about how to factor in age, pre-existing health conditions, overall life expectancy and other criteria to determine which patients would have priority if there are not enough ventilators, said Dr. David Marcozzi, who is directing the coronavirus response for the University of Maryland Medical System, which has 14 hospitals.

"These are conversations that no one wants to have. But we need to have these conversations just in case," said Marcozzi, who has been appointed to the state's coronavirus response team. "We need to put steps in place to ensure the public's confidence that those difficult decisions will be made with the greatest care."

States are revisiting recommendations that many began developing in the aftermath of Hurricane Katrina 15 years ago, when medical providers hastened the deaths of some patients after their hospital lost power. The goal is to provide hospitals with consistent, transparent guidance for patient care when lifesaving resources are scarce — part of a framework known as "crisis standards of care," which prioritize the survival of the group over the survival of the individual patient during disasters.

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Coronavirus in the United States
Reading, PA - March 26: A Stay Strong sign has been erected in the cloverleaf at the Penn Street exit of Route 422, in Reading, PA Thursday, March 26, 2020, to offer encouragement in the coronavirus epidemic.(Photo by Bill Uhrich/MediaNews Group/Reading Eagle via Getty Images)
UNITED STATES - MARCH 27: Rep. Tom Malinowski, D-N.J., walks down the House steps as the House votes on the Coronavirus Aid, Relief, and Economic Security Act in Washington on Friday, March 27, 2020. (Photo by Caroline Brehman/CQ-Roll Call, Inc via Getty Images)
NEW YORK, USA - MARCH 25: A patient with a face mask is seen at the Maimonides Medical Center in Brooklyn, New York, United States on March 25, 2020. The coronavirus-related deaths in the U.S. topped 800 on Wednesday, while the number of cases reached over 55,200, according to latest figures by Johns Hopkins University. (Photo by Tayfun Coskun/Anadolu Agency via Getty Images)
NEW YORK, NY - MARCH 27: A New York Police officer wears a face mask as he directs traffic on a local street on March 27, 2020 in New York City. At least 350 members of the New York City Police Department including deputy commissioner John Miller were confirmed to have the virus. (Photo by Eduardo Munoz Alvarez/Getty Images)
NEW YORK, NY - MARCH 27: A New York Police officer wears a face mask as he directs traffic on a local street on March 27, 2020 in New York City. At least 350 members of the New York City Police Department including deputy commissioner John Miller were confirmed to have the virus. (Photo by Eduardo Munoz Alvarez/Getty Images)
WASHINGTON, DC - MARCH 27: U.S. Speaker of the House Nancy Pelosi (D-CA) talks with reporters as she arrives at the U.S. Capitol on March 27, 2020 in Washington, DC. The House of Representatives is scheduled to vote today on the stimulus bill intended to combat the economic effects caused by the coronavirus pandemic. (Photo by Win McNamee/Getty Images)
NEW YORK, NY - MARCH 27: People cross Park Av. after it was announced that some streets will be shut as lockdown continues in response to the coronavirus (COVID-19) outbreakon March 27, 2020 in New York City. Mayor Bill de Blasio chose four streets across four boroughs to test whether shutting down streets to vehicular traffic would increase social distancing among pedestrians during the COVID-19 pandemic shutdown. (Photo by Eduardo Munoz Alvarez/Getty Images)
FLORIDA, USA - MARCH 20: Paramedics dressed in hazmat suits assist the evacuation of cruiseships crew members with respiratory symptoms associated with coronavirus (COVID-19) at the Coast Guardâs Miami Beach station, in Miami, Florida, United States on March 26, 2020. (Photo by MARCO BELLO/Anadolu Agency via Getty Images)
FLORIDA, USA - MARCH 20: An ambulance is seen during the evacuation of cruiseships crew members with respiratory symptoms associated with coronavirus (COVID-19) at the Coast Guardâs Miami Beach station, in Miami, Florida, United States on March 26, 2020. (Photo by MARCO BELLO/Anadolu Agency via Getty Images)
Reading, PA - March 26: (L-R) Siblings Azuleirys Francisco, 10, Alexander Francisco, 6, and Jovani Francisco, 8, sanitize their hands as a precaution against coronavirus while picking up meals from the parking lot at 4th and Windsor in Reading, PA Thursday afternoon Thursday March 26, 2020. The site is run by Olivets and the Reading School District.(Photo by Lauren A. Little/MediaNews Group/Reading Eagle via Getty Images)
Amity twp., PA - March 26: The sign for Hope Church in Amity Township that reads "Social Distancing, Join us online..." Thursday afternoon March 26, 2020.(Photo by Ben Hasty/MediaNews Group/Reading Eagle via Getty Images)
A woman poses for a photo with her dog in a mostly empty Times Square, New York, US, on March 25, 2020. (Photo by John Lamparski/NurPhoto via Getty Images)
NEW YORK, USA - MARCH 25: A view of empty road in Brooklyn, New York, United States on March 25, 2020. The coronavirus-related deaths in the U.S. topped 800 on Wednesday, while the number of cases reached over 55,200, according to latest figures by Johns Hopkins University. (Photo by Tayfun Coskun/Anadolu Agency via Getty Images)
A sign is displayed at a coffee shop on March 25, 2020 in New York City. - The number of confirmed cases of the new coronavirus in the United States reached 60,115 on Wednesday while 827 people had died, a tracker run by Johns Hopkins University showed. (Photo by Angela Weiss / AFP) (Photo by ANGELA WEISS/AFP via Getty Images)
NEW YORK, NY - MARCH 25: Basketball courts are seen empty due to coronavirus spread on March 25, 2020 in New York City, New York. Across the country schools, businesses and places of work have either been shut down or are restricting hours of operation as health officials try to slow the spread of COVID-19. (Photo by Eduardo Munoz Alvarez/Getty Images)
SAN FRANCISCO, CA, USA - MARCH 18: Shoppers at Walgreens in San Franciscoâs Castro District make last minute purchases minutes before the shelter in place directive was to take effect on March 18, 2020. (Photo by Neal Waters/Anadolu Agency via Getty Images)
SAN JOSE, CA, USA - MARCH 18: A Safeway store in San Jose posts new shorter store hours to provide a safer work environment ahead of Tuesdayâs directive to shelter in place for residents of the six counties that make up the Bay Area, on March 18, 2020. (Photo by Neal Waters/Anadolu Agency via Getty Images)
SAN FRANCISCO, CA, USA - MARCH 18: Mounted officers patrol the area outside Pier 39 in San Francisco on day one of the shelter in place order on March 18, 2020. (Photo by Neal Waters/Anadolu Agency via Getty Images)
MANASSAS, USA - MARCH 17: Weapons on display at a gun shop in Manassas, Virginia, United States as gun and ammunition sales in the U.S. have skyrocketed as the coronavirus (COVID-19) pandemic spread across the country. (Photo by Yasin Ozturk/Anadolu Agency via Getty Images)
A security officer stands guard at a tent set up outside the emergency room at an AdventHealth hospital on March 17, 2020 in Orlando, Florida. The tent is part of AdventHealth's surge planning in case extra space is needed to care for potential coronavirus cases in the community. (Photo by Paul Hennessy/NurPhoto via Getty Images)
A tent is seen set up outside the emergency room at an AdventHealth hospital on March 17, 2020 in Orlando, Florida. The tent is part of AdventHealth's surge planning in case extra space is needed to care for potential coronavirus cases in the community. (Photo by Paul Hennessy/NurPhoto via Getty Images)
External and outside of emergency room views of the pandemic, novel Coronavirus, or COVID-19 are seen at Advocate Lutheran General Hospital on March 17, 2020 in Park Ridge, Illinois, United States. The collection includes additional tents, a warning construction sign, an empty road, a congested road, a law enforcement vehicle, and a drive through testing area. (Photo by Patrick Gorski/NurPhoto via Getty Images)
NEWTON, MA - MARCH 17: Medical professionals work in coronavirus testing tents at Newton Wellesley Hospital in Newton, MA on March 17, 2020. (Photo by Suzanne Kreiter/The Boston Globe via Getty Images)
BOSTON, MA - MARCH 17: An emergency tent is set up at the Carney Hospital in Boston's Dorchester for coronavirus pandemic use on March 17, 2020. (Photo by David L. Ryan/The Boston Globe via Getty Images)
LEONARDTOWN, MARYLAND - MARCH 17: Nurses screen patients for COVID-19 virus testing at a drive-up location outside Medstar St. Mary's Hospital on March 17, 2020 in Leonardtown, Maryland. The facility is one of the first in the Washington, DC area to offer coronavirus testing as more than 5,200 cases have been confirmed in the United States, and more than 90 deaths have been attributed to the virus. (Photo by Win McNamee/Getty Images)
A sign on a table provides instructions for social distancing, while a group of people are seen in the background, selective focus, sitting around a small table, at a hospital in San Francisco during an outbreak of the COVID-19 coronavirus, California, March 16, 2020. (Photo by Smith Collection/Gado/Getty Images)
NEWTON, MA - MARCH, 16: Nurse practitioner Amy Israelian puts on protective gear in a tent in the parking lot of the Newton-Wellesley Hospital before testing a possible coronavirus patient in Newton, MA on March 16, 2020. (Photo by Adam Glanzman/For The Washington Post via Getty Images)
Two staff members wheel Amwell telemedicine carts into the entrance of the University of California San Francisco (UCSF) Benioff Children's Hospital in Mission Bay, San Francisco, California during an outbreak of the COVID-19 coronavirus, March 16, 2020. As a result of the outbreak, patients are increasingly being asked to conduct telemedicine appointments to avoid infecting healthcare workers. (Photo by Smith Collection/Gado/Getty Images)
People line up to enter a triage tent outside of the emergency room at Memorial West Hospital in Pembroke Pines, Fla., on Monday, March 16, 2020. (Matias J. Ocner/Miami Herald/Tribune News Service via Getty Images)
WESTMINSTER, MARYLAND - MARCH 16: Dawn Canova, clinical manager for outpatient wound care at Carroll Hospital, takes off her protective gloves after taking a sample to test a person for the coronavirus at a drive-thru station in the hospital's parking garage March 16, 2020 in Westminster, Maryland. Not open to the general public for testing, the station was set up to take samples from people who had spoken with their doctors and received explicit direction to get a test for the novel coronavirus called COVID-19. (Photo by Chip Somodevilla/Getty Images)
WESTMINSTER, MARYLAND - MARCH 16: Carroll Hospital Critical Care Unit Clinical Manager Stephanie Bakert talks to a person through his car window using a mobile phone before testing him for the coronavirus at a drive-thru station in the hospital's parking garage March 16, 2020 in Westminster, Maryland. Not open to the general public for testing, the station was set up to take samples from people who had spoken with their doctors and received explicit direction to get a test for the novel coronavirus called COVID-19. (Photo by Chip Somodevilla/Getty Images)
NEW YORK, NY - MARCH 15: An exterior view of Lenox Hill Hospital as the coronavirus continues to spread across the United States on March 15, 2020 in New York City. The World Health Organization declared coronavirus (COVID-19) a global pandemic on March 11th. (Photo by Cindy Ord/Getty Images)
NEW YORK, NY - MARCH 15: Passengers disembark from the Norwegian Bliss cruise ship on March 15, 2020 in New York City. Mayor Bill de Blasio said on Tuesday that any cruise ship passenger disembarking in New York City with a temperature over 100.4 will be given the choice of self-isolating at home or be taken to a hospital to protect against the spread of COVID-19. (Photo by Stephanie Keith/Getty Images)
DAYTON, WA - MARCH 14: Dr. Lewis Neace, head of the ER at Dayton General Hospital poses for a photograph. Dayton, a small town in rural southeast Washington has an aging population, had its first positive test for Coronavirus and is waiting on results of more tests. (Photo by Nick Otto for the Washington Post)
NEW YORK, NEW YORK - MARCH 14: An exterior view of Harlem Hospital Center, aka NYC Health + Hospitals/Harlem, as the coronavirus continues to spread across the United States on March 14, 2020 in New York City. The World Health Organization declared coronavirus (COVID-19) a global pandemic on March 11th. (Photo by Dia Dipasupil/Getty Images)
JACKSONVILLE, FL - MARCH 14: A general view of the Ascension St. Vincent's Riverside Hospital on March 14, 2020 in Jacksonville, Florida. The World Health Organization (WHO) declared Coronavirus (COVID-19) a pandemic. (Photo by Cliff Hawkins/Getty Images)
Un puñado de personas transitan la terminal de Grand Central en Nueva York el 23 de marzo del 2020. Normalmente hay multitudes en la estación, pero muy poca gente está viajando como consecuencia del coronavirus. (AP Photo/Mark Lennihan)
A sign displaying messages on how to reduce the spread of COVID-19, the disease caused by the new coronavirus, is displayed at the mouth of the Manhattan Bridge, Monday, March 23, 2020, in the Brooklyn borough of New York. (AP Photo/John Minchillo)
NEW PALTZ, NY - MARCH 22: A highway information display says, "STOP THE SPREAD SAVE LIVES" on a mostly empty Interstate 87 on Sunday afternoon. The highway was mostly empty on the same day that New York State Governor Andrew Cuomo pleads with New York residents to take the stay-at-home orders seriously regarding the Coronavirus pandemic. Photographed in New Paltz, New York on March 22, 2020, USA. (Photo by Ira L. Black/Corbis via Getty Images)
People are seen lining up for testing Covid-19 in Elmhurst Queens to test for Coronavirus, on March 21, 2020. (Photo by John Nacion/NurPhoto via Getty Images)
People are seen lining up for testing Covid-19 in Elmhurst Queens to test for Coronavirus, on March 21, 2020. (Photo by John Nacion/NurPhoto via Getty Images)
STONY BROOK, NEW YORK - MARCH 21: A sign direct people to a COVID-19 test facility at Stony Brook University on March 21, 2020 in Stony Brook, New York. The World Health Organization declared coronavirus (COVID-19) a global pandemic on March 11th. (Photo by Bruce Bennett/Getty Images)
US President Donald Trump and other members of the task force listen as National Institute of Allergy and Infectious Diseases Director, Dr. Anthony Fauci, speaks during the daily briefing on the novel coronavirus, COVID-19, at the White House on March 21, 2020, in Washington, DC. (Photo by JIM WATSON / AFP) (Photo by JIM WATSON/AFP via Getty Images)
Women wear face masks a a scarf to protect their mouths and nose as they walk along 34th St., Friday, March 20, 2020, in New York. New York Gov. Andrew Cuomo is ordering all workers in non-essential businesses to stay home and banning gatherings statewide. "Only essential businesses can have workers commuting to the job or on the job," Cuomo said of an executive order he will sign Friday. Nonessential gatherings of individuals of any size or for any reason are canceled or postponed. (AP Photo/Mary Altaffer)
A subway customer wears protective gloves on an empty car as it stops at a sparsely populated 57th Street station due to COVID-19 concerns, Friday, March 20, 2020, in New York. Gov. Andrew Cuomo is ordering all workers in non-essential businesses to stay home and banning gatherings statewide. "Only essential businesses can have workers commuting to the job or on the job," Cuomo said of an executive order on Friday. Nonessential gatherings of individuals of any size or for any reason are canceled or postponed. (AP Photo/John Minchillo)
A postal worker wears a protective mask and gloves while operating a route in the Queens borough of New York, Friday, March 20, 2020. Gov. Andrew Cuomo is ordering all workers in non-essential businesses to stay home and banning gatherings statewide. "Only essential businesses can have workers commuting to the job or on the job," Cuomo said of an executive order he will sign Friday. Nonessential gatherings of individuals of any size or for any reason are canceled or postponed. (AP Photo/John Minchillo)
A Red Robin reastaurant in Tigard, Ore., has closed some tables in order to maintain 'social distancing' between diners per CDC guidelines Sunday, March 15, 2020. They said they were running the place at 50 percent capacity so they could leave tables empty between customers. (AP Photo/Gillian Flaccus)
A commuter pauses to read a video display on the Gallery Place Metro subway train platform in Washington, Friday, March 13, 2020, with a message from the Centers for Disease Control and Prevention (CDC) on the proper way to wash your hands to combat the coronavirus outbreak. (AP Photo/Carolyn Kaster)
US Vice President Mike Pence, flanked by CDC Director Robert R. Redfield (L) and FEMA Administrator Peter Gaynor, shows documents to reporters during the daily briefing on the novel coronavirus, COVID-19, at the White House on March 22, 2020, in Washington, DC. (Photo by Eric BARADAT / AFP) (Photo by ERIC BARADAT/AFP via Getty Images)
An electronic billboard sponsored by the Centers for Disease Control and Prevention (CDC) provides tips for the public on ways to prevent the spread of coronavirus (COVID-19) on March 20, 2020 along Interstate 4 in Deland, Florida. (Photo by Paul Hennessy/NurPhoto via Getty Images)
Street performer Eddie Webb looks around the nearly deserted French Quarter looking to make money in New Orleans, Sunday, March 22, 2020. With much of the city already hunkered down due to the coronavirus pandemic, Louisiana Gov. John Bel Edwards issues a shelter-in-place order to take effect starting Monday at 5:00 PM. (AP Photo/Gerald Herbert)
A sign to draw customers is seen outside the nearly empty Superior Seafood and Oyster Bar in New Orleans, Thursday, March 19, 2020. Louisiana Governor John Bel Edwards and New Orleans Mayor LaToya Cantrell have ordered all restaurants and bars to close except for takeout, and asked residents to remain home and maintain social distancing from others when outside, due to the COVID-19 virus pandemic. (AP Photo/Gerald Herbert)
Kamari Fletcher waits for her to-go order inside the nearly empty Superior Seafood and Oyster Bar in New Orleans, Thursday, March 19, 2020. Louisiana Gov. John Bel Edwards and New Orleans Mayor Latoya Cantrell have ordered all restaurants and bars to close except for takeout, and asked residents to remain home and maintain social distancing from others when outside, due to the coronavirus pandemic. (AP Photo/Gerald Herbert)
A shuttered business is seen in the French Quarter in New Orleans on March 26, 2020, during the coronavirus outbreak. - New Orleans, the Louisiana city known as the "Big Easy" famed for its jazz and nightlife, has become an epicenter of the coronavirus pandemic gripping the United States. The southern US state now has 2,305 confirmed cases and 83 deaths. New Orleans alone accounts for 997 of the cases and 46 of the deaths. (Photo by Emily Kask / 30203169A / AFP) (Photo by EMILY KASK/30203169A/AFP via Getty Images)
Words from Gloria Gaynor's "I Will Survive" are painted onto plywood covering the window of a closed business during the coronavirus outbreak in New Orleans on March 26, 2020. - New Orleans, the Louisiana city known as the "Big Easy" famed for its jazz and nightlife, has become an epicenter of the coronavirus pandemic gripping the United States. The southern US state now has 2,305 confirmed cases and 83 deaths. New Orleans alone accounts for 997 of the cases and 46 of the deaths. (Photo by Emily Kask / 30203169A / AFP) (Photo by EMILY KASK/30203169A/AFP via Getty Images)
A closure note is posted on the family-owned Bar Redux in the Bywater in New Orleans on March 26, 2020. - New Orleans, the Louisiana city known as the "Big Easy" famed for its jazz and nightlife, has become an epicenter of the coronavirus pandemic gripping the United States. The southern US state now has 2,305 confirmed cases and 83 deaths. New Orleans alone accounts for 997 of the cases and 46 of the deaths. (Photo by Emily Kask / 30203169A / AFP) (Photo by EMILY KASK/30203169A/AFP via Getty Images)
A shuttered business is pictured on Decatur Street in New Orleans, Louisiana, on March 26, 2020. - New Orleans, the Louisiana city known as the "Big Easy" famed for its jazz and nightlife, has become an epicenter of the coronavirus pandemic gripping the United States. The southern US state now has 2,305 confirmed cases and 83 deaths. New Orleans alone accounts for 997 of the cases and 46 of the deaths. (Photo by Emily Kask / 30203169A / AFP) (Photo by EMILY KASK/30203169A/AFP via Getty Images)
A shuttered restaurant is pictured in the French Quarter in New Orleans, Louisiana, on March 26, 2020. - New Orleans, the Louisiana city known as the "Big Easy" famed for its jazz and nightlife, has become an epicenter of the coronavirus pandemic gripping the United States. The southern US state now has 2,305 confirmed cases and 83 deaths. New Orleans alone accounts for 997 of the cases and 46 of the deaths. (Photo by Emily Kask / 30203169A / AFP) (Photo by EMILY KASK/30203169A/AFP via Getty Images)
National Guard members walk down Rampart Street in New Orleans, Louisiana, on March 26, 2020. - New Orleans, the Louisiana city known as the "Big Easy" famed for its jazz and nightlife, has become an epicenter of the coronavirus pandemic gripping the United States. The southern US state now has 2,305 confirmed cases and 83 deaths. New Orleans alone accounts for 997 of the cases and 46 of the deaths. (Photo by Emily Kask / 30203169A / AFP) (Photo by EMILY KASK/30203169A/AFP via Getty Images)
Stony Brook, N.Y.: State workers and members of the National Guard check in people arriving for the drive-thru coronavirus testing at Stony brook University in New York on March 25, 2020. (Photo by John Paraskevas/Newsday RM via Getty Images)
Gov. Brad Little issues a statewide stay-at-home order to further prevent spread of coronavirus COVID-19 at a press conference Wednesday, March 25, 2020 held at Gowen Field, headquarters of the Idaho Army National Guard in Boise, Idaho. (Darin Oswald/Idaho Statesman/Tribune News Service via Getty Images)
A Healthcare worker help to check in with the assistant from the Florida Army National Guard as vehicles line up at the COVID-19 drive-thru testing center at Marlins Park as the coronavirus pandemic continues on Wednesday, March 25, 2020 in Miami. (David Santiago/Miami Herald/Tribune News Service via Getty Images)
A Healthcare worker help to check in with the assistant from the Florida Army National Guard as vehicles line up at the COVID-19 drive-thru testing center at Marlins Park as the coronavirus pandemic continues on Wednesday, March 25, 2020 in Miami. (David Santiago/Miami Herald/Tribune News Service via Getty Images)
WASHINGTON, DC - MARCH 26: (L-R) U.S. President Donald Trump and National Institute of Allergy and Infectious Diseases Director Anthony Fauci arrive for a briefing on the coronavirus pandemic in the press briefing room of the White House on March 26, 2020 in Washington, DC. The U.S. House of Representatives is scheduled to vote Friday on the $2 trillion stimulus package to combat the effects of the COVID-19 pandemic. (Photo by Drew Angerer/Getty Images)
WASHINGTON, DC - MARCH 26: National Institute of Allergy and Infectious Diseases Director Anthony Fauci listens as U.S. President Donald Trump speaks during a briefing on the coronavirus pandemic, in the press briefing room of the White House on March 26, 2020 in Washington, DC. After the U.S. House of Representatives votes on Friday, President Trump is expected to sign the $2 trillion stimulus package to combat the effects of the COVID-19 pandemic. (Photo by Drew Angerer/Getty Images)
WASHINGTON, DC - MARCH 25: Flanked by National Institute of Allergy and Infectious Diseases Director Anthony Fauci (L) and White House coronavirus response coordinator Deborah Birx, Vice President Mike Pence speaks during a briefing on the coronavirus pandemic, in the press briefing room of the White House on March 25, 2020 in Washington, DC. The United States Senate continues to work on a $2 trillion aide package to combat the health and economic effects of the COVID-19 pandemic. (Photo by Drew Angerer/Getty Images)
BLOOMINGTON, UNITED STATES - MARCH 26, 2020: A volunteer puts on gloves before participating in the Monroe County Food Train to give meals, and groceries to youth 18 and under, during the COVID-19/Coronavirus emergency in Bloomington. Hundreds of workers have been laid off in the community, and the governor has issued a stay-at-home order.- PHOTOGRAPH BY Jeremy Hogan / Echoes Wire/ Barcroft Studios / Future Publishing (Photo credit should read Jeremy Hogan / Echoes Wire/Barcroft Media via Getty Images)
BOSTON, MA - MARCH 26: Secretary of Health and Human Services Marylou Sudders and Gov. Charlie Baker hold a press conference in the Gardner Auditorium at The Massachusetts State House in Boston on March 26, 2020. Baker and Sudders addressed attempting to secure more pieces of personal protection equipment and mobile schooling concerns. (Photo by Blake Nissen/The Boston Globe via Getty Images)
The Magic Bag theater is pictured closed, due to Michigan Governor Gretchen Whitmer's measures to stop the spread of COVID 19 in Ferndale, Michigan on March 26, 2020. (Photo by JEFF KOWALSKY / AFP) (Photo by JEFF KOWALSKY/AFP via Getty Images)
A Great Clips hair salon sign is pictured as it's closed, due to Michigan Governor Gretchen Whitmer's measures to stop the spread of COVID 19 in Ferndale, Michigan on March 26, 2020. (Photo by JEFF KOWALSKY / AFP) (Photo by JEFF KOWALSKY/AFP via Getty Images)
A closed sign is seen on the Suburban Buick GMC that is currently closed by Michigan Governor Gretchen Whitmer to stop the spread of coronavirus,COVID-19, in Ferndale, Michigan on March 26, 2020. - President Donald Trump, keen for an early lifting of economically costly social distancing measures against the coronavirus, said he would propose dividing the United States by risk levels. In a letter to state governors released by the White House, Trump said that better testing now allows the mapping of virus threat on a local level. (Photo by JEFF KOWALSKY / AFP) (Photo by JEFF KOWALSKY/AFP via Getty Images)
BOSTON, MA - MARCH 26: The Boston Public Garden on March 26, 2020 in Boston, United States. Massachusetts Governor Charlie Baker required all non-essential businesses to close on Tuesday and requested the population to stay home as much as possible. (Photo by Scott Eisen/Getty Images)
METHUEN, MA - MARCH 25: A sign in front of the Donald P. Timony Grammar School in Methuen, MA reminds students and parents to check their email often for updates on March 25, 2020. Massachusetts Governor Charlie Baker announced that schools in the state will remained closed until at least May 4 in response to the coronavirus emergency. The announcement came as state public health officials reported that the total number of coronavirus-related deaths had risen to 15, up from 11 the day before. Officials reported 679 new confirmed cases of the disease, bringing the tally in Massachusetts to 1,838, up from 1,159. Officials said 19,794 people had been tested as of Wednesday, up from 13,749. (Photo by Jim Davis/The Boston Globe via Getty Images)
A Los Angeles traffic officer wear a mask as he directs traffic on March 24, 2020. - In California, already under orders to stay home because of the coronavirus outbreak, Governor Gavin Newsom tightened the lockdown to shut parking lots at beaches and parks after tens of thousands flouted social distancing rules. (Photo by Frederic J. BROWN / AFP) (Photo by FREDERIC J. BROWN/AFP via Getty Images)
SAN JOSE, CALIFORNIA - MARCH 24: Members of the California National Guard 115th Regional Support Group help pack boxes of food at the Second Harvest Food Bank of Silicon Valley on March 24, 2020 in San Jose, California. California Gov. Gavin Newsom has deployed the California National Guard to help distribute food at food banks across the state that have seen a huge decline in volunteers that usually help sort and pack food for the needy. (Photo by Justin Sullivan/Getty Images)
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"You're looking for the most good for the greatest number — it really is a shift," said Dr. Stephen Cantrill, an emergency physician at Denver Health Medical Center, who helped create foundational recommendations for the standards from the National Academy of Medicine. "Normally, we operate with the individual patient's best interest at heart."

Full coverage of the coronavirus outbreak

In Italy, the flood of coronavirus patients in critical condition has already forced hospitals to make decisions to prioritize care for younger, healthier people who have better chances of survival. U.S. officials and health care providers are now racing to prevent hospitals from having to face such wrenching choices, pleading with the White House to help procure more ventilators and with the public to stay at home and avoid emergency room visits whenever possible to prevent hospitals from running out of intensive care bed space, equipment and other scarce resources.

In the meantime, state officials and major hospitals across the country are making sure they are prepared for the worst. While most of the state plans have been years in the making — often created in consultation with bioethicists, legal experts and religious leaders — they have never been broadly put into effect.

"Without question, this is certainly the closest we've come on a nationwide level," Cantrill said.

Some hospitals are already resorting to outdoor triage tents and other contingency measures to handle the influx of patients. And many are working out their own plans to alter care should they run out of ICU beds, trained staff and ventilators. In New York — which has more cases than any other state and a potential shortfall of 18,000 ventilators — Montefiore Health System is revamping its ventilator allocation policy and determining which staff members will serve on the triage team that would make those decisions, said Dr. Patricia Powell, director of the Montefiore Einstein Center for Bioethics.

If there isn’t enough equipment, "you might not get access to a ventilator if you get a prognosis that no matter what, you probably won't get better," said Powell, who served on a New York state task force that created guidelines for hospitals on which patients to ventilate if there is a shortfall. "That's not a circumstance that people in America are used to thinking about."

In Washington state, where more than 50 people have died so far, state officials are conferring with hospitals, outside experts and the Centers for Disease Control and Prevention on revised guidelines to allocate scarce resources like ventilators, according to Dr. John Hick, a disaster response expert who is helping to review the state's plan.

"Our supply situation is very serious," said Cassie Sauer, CEO of the Washington State Hospital Association, which represents hospitals across the state. "Expect a surge plan and a crisis standards plan to be public shortly."

Thirty-six states have worked on plans for rationing care during emergencies since Hurricane Katrina, but not all of them have been made public, said Hick, a Minnesota-based physician who helped develop national guidance for states and hospitals to follow. The state guidelines go into effect only if state officials decide to enact them during a public health emergency, which has yet to happen with the coronavirus. The recommendations, which are nonbinding, can vary significantly from state to state.

Minnesota's recently updated guidance includes contingency measures to make the most of a dwindling supply of ventilators, such as decreasing elective procedures that require ventilators, reusing certain ventilator parts or employing alternative forms of respiratory support.

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Coronavirus vaccine trial in Seattle
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Coronavirus vaccine trial in Seattle
A pharmacist gives Jennifer Haller, left, the first shot in the first-stage safety study clinical trial of a potential vaccine for COVID-19, the disease caused by the new coronavirus, Monday, March 16, 2020, at the Kaiser Permanente Washington Health Research Institute in Seattle. (AP Photo/Ted S. Warren)
Jennifer Haller poses for a photo in the living room of her home, Monday, March 16, 2020, in Seattle. Earlier in the day, Haller was the first person to receive a shot of a potential vaccine for COVID-19, the disease caused by the new coronavirus, at the start of the first-stage safety study clinical trial of the vaccine at the Kaiser Permanente Washington Health Research Institute in Seattle. (AP Photo/Ted S. Warren)
Pharmacist Michael Witte opens a package taken from a freezer that contains the potential vaccine for COVID-19, the disease caused by the new coronavirus, on the first day of a first-stage safety study clinical trial of the vaccine, Monday, March 16, 2020, at the Kaiser Permanente Washington Health Research Institute in Seattle. (AP Photo/Ted S. Warren)
Pharmacist Michael Witte, left, gives Rebecca Sirull, right, a shot in the first-stage safety study clinical trial of a potential vaccine for COVID-19, the disease caused by the new coronavirus, Monday, March 16, 2020, at the Kaiser Permanente Washington Health Research Institute in Seattle. Sirull is the third patient to receive the shot in the study. (AP Photo/Ted S. Warren)
Jennifer Haller is reflected in a mirror as she waits in an exam room before she was given a shot in the first-stage safety study clinical trial of a potential coronavirus vaccine, Monday, March 16, 2020, at the Kaiser Permanente Washington Health Research Institute in Seattle. Haller was the first person to receive the shot in the study. (AP Photo/Ted S. Warren)
Pharmacist Michael Witte, left, gives Neal Browning, right, a shot in the first-stage safety study clinical trial of a potential vaccine for COVID-19, the disease caused by the new coronavirus Monday, March 16, 2020, at the Kaiser Permanente Washington Health Research Institute in Seattle. Browning is the second patient to receive the shot in the study. (AP Photo/Ted S. Warren)
The first clinical trials to find a coronavirus vaccine have begun at a hospital in Seattle. A total of 45 men and women have volunteered to be injected. Unlike most vaccines, these COVID-19 vaccines have not been tested on mice, and will go directly to humans due to the urgent need for the drug. Lisa Guerrero spoke with Neal Browning, one of the men who is participating in the trial. He explained what he has to go through as part of this brave new experiment.
The first clinical trials to find a coronavirus vaccine have begun at a hospital in Seattle. A total of 45 men and women have volunteered to be injected. Unlike most vaccines, these COVID-19 vaccines have not been tested on mice, and will go directly to humans due to the urgent need for the drug. Lisa Guerrero spoke with Neal Browning, one of the men who is participating in the trial. He explained what he has to go through as part of this brave new experiment.
Pharmacist Michael Witte, left, gives Rebecca Sirull, right, a shot in the first-stage safety study clinical trial of a potential vaccine for the coronavirus, Monday, March 16, 2020, at the Kaiser Permanente Washington Health Research Institute in Seattle. Sirull is the third patient to receive the shot in the study. (AP Photo/Ted S. Warren)
Dr. Lisa Jackson, a senior investigator at the Kaiser Permanente Washington Health Research Institute, poses for a photo, Sunday, March 15, 2020, in Seattle. Jackson is leading the first-stage safety study clinical trial of a potential vaccine for COVID-19, the disease caused by the new coronavirus, which was given to the first volunteer in the study by injection, Monday, March 16 in Seattle. (AP Photo/Ted S. Warren)
Dr. Lisa Jackson, a senior investigator at the Kaiser Permanente Washington Health Research Institute, works in her office with an image of COVID-19 taped to her door, Sunday, March 15, 2020, in Seattle. Jackson is leading the first-stage safety study clinical trial of a potential vaccine for COVID-19, the disease caused by the new coronavirus, which was given to the first volunteer in the study by injection, Monday, March 16. (AP Photo/Ted S. Warren)
Rebecca Sirull, center, poses for a photo with her roommates, Anna Thomas, left, and Madeleine Busch, Monday, March 16, 2020, at the home they share in Seattle. Earlier in the day, Sirull was the third person to receive a shot of a potential vaccine for the COVID-19 coronavirus at the start of the first-stage safety study clinical trial of the vaccine at the Kaiser Permanente Washington Health Research Institute in Seattle. (AP Photo/Ted S. Warren)
Rebecca Sirull works on her laptop, Monday, March 16, 2020, at her home in Seattle. Earlier in the day, Sirull, an editorial coordinator for the Institute for Health Metrics and Evaluation, was the third person to receive a shot of a potential vaccine for the COVID-19 coronavirus at the start of the first-stage safety study clinical trial of the vaccine at the Kaiser Permanente Washington Health Research Institute in Seattle. (AP Photo/Ted S. Warren)
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Minnesota's patient care guidelines also include a detailed breakdown of the factors used to determine whether a ventilator will be withheld or removed from patients, including their response to the treatment, likelihood of death and underlying conditions, such as severe chronic lung disease, congestive heart failure and cirrhosis. The state also details strategies for palliative care to relieve pain, explaining that "it may be the only care that is able to be provided due to the patient's prognosis and available resources."

New York's ventilator guidance does not specify the medical conditions that would exclude patients from being ventilated. Instead, it recommends that hospitals create a list of such conditions based on “immediate or near-immediate mortality even with aggressive therapy”; rate patients based on their likelihood of survival; and use trials to determine how much they are medically benefiting from a ventilator.

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Age should be used only as a tiebreaker, the New York state panel said, and health care workers and first responders should not get priority over others. By contrast, Michigan's guidelines specify that hospitals could choose to prioritize workers performing "essential social functions" — including doctors and nurses treating patients, as well as police, military members and firefighters — to receive scarce resources like ventilators and ICU beds.

Disaster planning experts stress that it is crucial to create such guidance ahead of time — and to separate the decision-making process from the doctors on the front lines of caregiving.

"Without prior planning, you're going to have these life-or-death decisions made by clinical staff not trained in this, who are exhausted and overworked," Powell said.

Disaster response experts stress that there is still time for the public and officials to act to avoid forcing hospitals to make such painful choices.

"It all depends on how effective our social controls are — how much can we flatten the curve?" Hick said, referring to the social distancing measures the public can take to slow the virus. "Some cities are on their way to crisis. We're holding our breath."

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