Previous pandemics  did not take into account how closure of schools would impact our healthcare work capacity (referring to healthcare workers who would have to miss work to take care of their children). 
Will the increased need for childcare increase net mortality? 
At what point will the strain on labour supply undo the benefits that school closures have? 
- Approx 15% of healthcare workers (14.8-15.2 CI) are in need of child care during a school closure
-Estimating that school closures bring a 15% reduction in COVID cases 
-Estimating a baseline mortality rate of 2% 

-With these estimates, a 15% decrease in the health-care labour force would need to decrease the survival probability (per health-care worker lost) by 17.6% for school closure to increase cumulative mortality
-If infection mortality rate increased from 2.00% to 2.35% in conjunction with a 15% reduction in healthcare labour, school closures would lead to more deaths than they prevent

Impact of School Closures for COVID-19 on the US Health-care workforce and net mortality

Scarce resources include, but are not limited to, intensive care unit (ICU) beds, ventilators, dialysis machines, extra-corporeal membrane oxygenation circuits, personal protective equipment (PPE), and healthcare workers.


Syracuse University

During the COVID-19 pandemic, healthcare systems faced severe operational challenges due to massive patient influxes and critical shortages of medical resources. To manage these constraints, systems adopted crisis standards of care and established specialized triage teams for resource allocation. These difficult decisions were guided by strict medical ethics rather than individual bedside clinicians to ensure fairness and reduce moral distress, while healthcare workers simultaneously navigated heightened risks of occupational infection.

Healthcare Systems During the COVID-19 Pandemic

Kirkpatrick, J. N., Hull, S. C., Fedson, S., Mullen, B., & Goodlin, S. J. (2020). Scarce-Resource Allocation and Patient Triage During the COVID-19 Pandemic. Journal of the American College of Cardiology, 76(1), 85-92. 
doi:10.1016/j.jacc.2020.05.006
https://www.sciencedirect.com/science/article/pii/S0735109720352232?via%3Dihub

Scarce-Resource Allocation and Patient Triage During the COVID-19 Pandemic

- Journal of the American College of Cardiology
- The Lancet Public Health 
- Clinical Chemistry and Laboratory Medicine (CCLM)
- US National Library of Medicine National Institutes of Health
- Journal of the Association for Consumer Research

References for Healthcare Systems During COVID-19 Pandemic by Journal

The principles of medical ethics are:
- Autonomy
- Beneficence/non-maleficence
- Justice
- Fair innings
- Instrumental value

Medical Ethics in Healthcare Systems Response to COVID-19

The standards of care, or criteria for healthcare system guidelines during the pandemic, are as follows:
- Conventional standard 
- Contingency standards
- Crisis standards

Standards of Care in COVID-19

In hospitals, triage teams reduce moral distress for clinicians and legally protect them by deciding 1) which patients should receive allocation (life-sustaining intervention) and 2) whether resources will be withdrawn from one patient and given to another. They must be transparent about their principles and decision-making factors, but the team member identities may be private. 

Triage Teams for Healthcare Systems and COVID-19

- Healthcare workers have been shown to be at a largely increased risk for becoming infected with COVID-19 while compared to the general public
- Factors that affect this finding include testing, PPE, ethnic factors, and clinical setting


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