Ensuring Adequate Palliative and Hospice Care During COVID-19 Surges.

Relieving physical and emotional distress and supporting patients and families through illness, even when cure is not possible, is foundational to medicine. Yet, while states and health systems have devoted much work to the fair allocation of scarce critical care resources, novel therapeutics, and potential vaccines during the coronavirus disease 2019 (COVID-19) pandemic, many triage protocols assume all patients who need palliative and hospice care will have access to these services.1 But even under usual conditions, shortages in these services are common.2 As the United States surpasses the grim milestone of 200 000 excess deaths due to COVID-19,3 surges in demand for end-of-life care have exposed and exacerbated underlying gaps in access to specialty-trained physicians and teams, palliative care medications, and bereavement support for patients and families.2 These gaps jeopardize the quality of care for seriously ill and atrisk patients, including those whose prognosis is uncertain and those with diseases other than COVID-19. Beyond surging demand in addition to preexisting resource limitations, the pandemic has also brought novel challenges to ensuring quality end-of-life care. Most important and always, good care involves having a clear