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American College of Surgeons

American Society of Anesthesiologists

Association of periOperative Registered Nurses

November 23, 2020

Mike Pence, Vice President and Chair, Coronavirus Task Force
Alex Azar, Secretary U.S. Department of Health and Human Services

The Honorable Nancy Pelosi, Speaker of the House
The Honorable Mitch McConnell, Senate Majority Leader

Joe Biden, President-elect
Kamala Harris, Vice President-elect

David Kessler, co-chair, Biden COVID-19 Task Force
Marcella Nunez-Smith, co-chair, Biden COVID-19 Task Force
Vivek Murthy, co-chair, Biden COVID-19 Task Force


Dear Honorable Leaders:

We write on behalf of our respective organizations and all health care workers who are on the front lines of the COVID-19 crisis to implore our nation’s leadership to act collectively and quickly in support of hospitals and health care providers as they continue to struggle in response to the ongoing pandemic.

Throughout the pandemic, our hospitals and health care providers faithfully and determinedly have marshalled all resources and human capital to treat the growing number of patients with COVID-19.  Despite some progress in treating COVID-19 patients and a modest increase in supplies and personal protective equipment (PPE), hospitals and providers remain under resourced and over worked, a state many presumed was temporary while the nation responded to the virus’s initial assault. Now, nine months into the pandemic, the alarming and unrelenting surge in infection rates is a stark reminder to all that many months remain in this journey.

During the initial phase of the pandemic when elective surgeries were postponed to allow facilities to dedicate all available resources to treatment of virus patients, the undersigned issued nationwide guidance to ensure safety for all patients and staff once facilities were able to resume surgery. In August, we issued an updated Roadmap for Maintaining Essential Surgery during the COVID-19 Pandemic. We write now to share with you enhancements to this Roadmap and stress the ongoing need for federal leadership to address capacity and resource allocation to enable facilities and providers to continue to provide essential surgeries and meet patient and staff needs.

In addition to the principles and considerations set forth in the joint Roadmap, we implore leadership to focus on the following in full support of our nation’s health care providers and COVID-19 patients and their families:

  1. Health care worker well-being and staffing issues.
    Our nation’s health care workforce is fatigued and stressed beyond capacity right now, placing both COVID and non-COVID patients at grave risk for human error and substandard care. Facilities are experiencing unprecedented staffing shortages as nurses and other providers experience burn-out, contract COVID, or are otherwise forced to choose between personal well-being and trying to serve patients in under resourced conditions. Our facilities and providers need staffing relief and realistic tools and resources to maintain endurance and strength in the coming months. Without an influx of new and targeted support, our providers will be simply incapable – both in numbers and spirit – of providing the level of care required to meet our nation’s growing health care needs.

  2. Federally coordinated deployment of supplies, medications and vital equipment.
    We require national collaboration to procure and distribute vital equipment and supplies. Federal leadership is needed to address ongoing drug shortages, build stockpiles of critical equipment, PPE, testing supplies and medications, and maintain distribution of appropriate PPE to providers. Federal leadership is also instrumental to local, state and regional cooperation among public health authorities, state hospital associations and local hospitals to monitor ICU overloads and manage resources for optimal care of all patients in a region so facilities will no longer have to resort to crisis standards of care.

  3. Increased Communication and Vaccine Distribution Plan Transparency

Our organizations, health care facilities, and health care providers need prompt, transparent and comprehensive communication from the federal agencies leading the COVID-19 response efforts, including the FDA related to drug and equipment needs, the CDC related to testing, infection control, and NIH related to treatment developments including vaccine approvals and deployment. This need for communication is particularly acute as the administration transitions over the next few months.

We implore you to act concertedly and swiftly in support of our nation’s health care providers to ensure safe and optimal care remains available to all Americans during this crisis.  If our organizations can be of any assistance to you or your staff, please do not hesitate to contact us via Cori Ashford at [email protected] or (312) 202-1199.


David Hoyt
David Hoyt, MD FACS
Executive Director
American College of Surgeons

Beverly Philip, MD
Beverly K. Philip, MD FACA FASA
American Society of Anesthesiologists

Linda Signature
CEO/Executive Director
Association of periOperative Registered Nurses

Encl:    Joint Statement: Roadmap for Maintaining Essential Surgery during COVID-19 Pandemic, Updated November 23, 2020