ABSTRACT
The ability of the healthcare infrastructure to overcome overwhelming needs during a crisis or disaster with equitable care stems from the implementation of crisis standards of care (CSC). CSC provides a framework for the discussion and planning of how to adapt care to meet these needs, while focusing on the greatest good for the greatest number. The COVID-19 pandemic has challenged healthcare infrastructure, but no formal CSC declaration or disclosure to the public within the first wave of the COVID-19 pandemic leads to the need for further inquiry surrounding the planning and implementation for CSC. This research evaluates data and inferential indicators related to CSC implementations from public documents in Brazil, India, Italy, and New York State during the first wave of the COVID-19 pandemic. Were there mitigation methods that could be implemented prior to the need for CSC? Are there policy and decision-making implications to CSC? Lastly, how does CSC relate to changes in mortality during a pandemic, especially with the phenomena surrounding excess mortality? While CSC were not openly implemented by any nation or state in the first wave of the COVID-19 pandemic, CSC principle use of expanding capacity to non-clinical areas, need for healthcare workers, critical supply lacking, and excess mortality, along with healthcare collapse for India and Brazil can be gleaned from the data. Acknowledging a strain on healthcare infrastructure and the need for CSC implementation allows for the community to respond as a whole to better ensure that care remains equitable.