As communities across the country grappled with the surge in COVID-19 cases in December, the pandemic continued to critically stress staffing and resources at the six hospitals within the Johns Hopkins Health System.

Johns Hopkins Bayview Medical Center saw a 360 percent increase in patients hospitalized with COVID-19 during the month of December — the highest increase the hospital experienced since the start of the pandemic. In response, Johns Hopkins leaders implemented Crisis Standards of Care (CSC) protocols at Johns Hopkins Bayview on December 29.

“This decision was not taken lightly,” said Kevin Sowers, president of the Johns Hopkins Health System and executive vice president of Johns Hopkins Medicine. “Unfortunately, we’ve seen Johns Hopkins Bayview’s census of patients with COVID-19 and non-COVID-19 clinical needs spike dramatically … Working closely with the Johns Hopkins Medicine Unified Command Center staff, we have agreed that moving to CSC is the right decision.” Then, on January 4, leaders implemented CSC protocols for Howard County General Hospital.

The CSC concept was developed by the Institute of Medicine at the request of the Department of Health and Human Services, following Hurricane Katrina, to provide a standard of care framework that would apply during disaster situations. Johns Hopkins Medicine has worked with the University of Maryland Medical System to standardize the process for activating the standards.

Leading up to December 29, Johns Hopkins Health System hospitals had already opened additional treatment spaces for patients with COVID-19, rescheduled elective surgical procedures and redeployed staff to ensure that patients with COVID-19 and those dealing with other medical conditions were receiving safe, high-quality care. Among other measures, changes under Crisis Standards of Care protocols allowed additional flexibility in further modifying elective surgical schedules, simplifying documentation requirements, and improving patient flow through measures such as early discharges when safe and appropriate.

The spike in COVID-19 cases in December prompted university leaders to announce, on December 21, that faculty, staff, postdoctoral fellows, and undergraduate and graduate students would be required to get either the Pfizer or Moderna COVID booster shot by February 1. (Members of clinical departments at the School of Medicine are governed by Johns Hopkins Health System vaccination policies.)

The new requirement came as a team of Johns Hopkins researchers shared the results of a nationwide, multicenter clinical trial that provides solid evidence for the use of plasma from convalescent patients — those who have recovered from the disease and whose blood contains antibodies against SARS-CoV-2 — as an early treatment. The researchers showed that convalescent plasma reduced the need for hospitalization by half for outpatients with COVID-19 who participated in the study.

The findings were posted December 21 on the preprint website medRxiv.