Supplies

The new administration under President Biden has issued a large number of executive orders in its first days, including several related to pandemic response. Among other actions are orders:

• Invoking various emergency authorities, including the Defense Production Act, to increase supplies and availability for government authorities, health systems, HCWs, and patients, among others. Initially, most of the order requires reviews and assessments at various levels, but it sets the stage for further actions to acquire supplies and expand production capacity, particularly with respect to PPE. The order also includes assessment of the status and inventory of the Strategic National Stockpile, as well as steps to facilitate access by various Tribal- and Indian Health Service-affiliated entities. The order further details requirements for review of pricing related to pandemic response supplies, including possible forthcoming actions to control pricing and avoid hoarding or price gouging.
• Commanding HHS and NIH to develop a plan for accelerating development of novel COVID-19 therapies, including research support for rural hospitals and other rural locations and consideration of steps to ensure clinical trials include historically underrepresented populations.
• Mandating OSHA issue revised guidance on workplace safety during the pandemic with respect to exposure, including mask-wearing and enforcement of other health and safety requirements.

Additional executive orders and new administrative rules and guidance in these areas are highly likely in the coming weeks and months as the new administration acts to establish and further its priorities in addressing the pandemic.

Facilities

This JAMA Network Open article by Bravata et al. reports findings of a study of over 8500 patients with COIVD-19 admitted to 88 US Veterans Affairs hospitals, finding that patients treated in hospital ICUs during peak demand related to COVID-19 had a much higher risk of mortality compared to those treated during period of lower demand. Although hospitals worked to increase their ICU capacity in response to heightened demand, these findings support the conclusion that strained hospital ICU capacity was nevertheless associated with mortality, highlighting the importance of policy interventions to reduce infection (e.g., social distancing) and to reduce capacity strain (e.g., coordination of admissions among facilities).

Resource Allocation

This viewpoint article by Supady et al. in the Lancet Respiratory Medicine explores practical challenges to the use of institutional triage committees for allocation of scarce resources under crisis standards of care during the pandemic. The authors assert that rapidly changing circumstances, diversity of facility locations, and absence of essential information make reliance on triage committees potentially impractical for decision-making related to individual patients. They also contend that the utilitarian principles underlying a committee-based approach were undercut during the current the current pandemic by uncertainty regarding the effectiveness of various therapeutic options. In response, the authors propose that triage committees provide policies and guidance, but that decision-making tasks remain with bedside clinicians in some contexts, guided by committee policies informed by principles combining utilitarian and egalitarian principles. The authors liken this model more closely to the role of clinical ethics committees.