The coronavirus disease 2019 (COVID-19) pandemic has affected numerous communities, and reports of overburdened hospitals, specifically critical care units, have become commonplace. High-quality supportive care remains the foundation for ensuring that people with COVID-19 who are critically ill have the best chance of surviving.

Such care in pre-pandemic times relied on sufficient expert staffing, specialized equipment, and appropriate environments of care to reliably implement a myriad of processes that are associated with better outcomes.

Given that these resources may not all be consistently available when severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is rapidly spreading throughout a community, Bravata et al1 sought to evaluate the association of critical care strain from March through November 2020 with COVID-19 mortality in 88 Veterans Administration hospitals with 10 or more intensive care unit (ICU) beds in the US.

The authors used 2 metrics for critical care strain: ICU load (ie, the ratio of the mean number of patients with COVID-19 in the ICU during the patients’ hospitalization and the total number of ICU beds at the facility) and ICU demand (ie, the ratio of the mean number of patients with COVID-19 in the ICU and the peak number of patients with COVID-19 in the ICU at that facility during the study period).

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