Responding to a major pandemic and planning for allocation of scarce resources (ASR) under crisis standards of care requires coordination and cooperation across federal, state and local governments in tandem with the larger societal infrastructure. Maryland remains one of the few states with no state-endorsed ASR plan, despite having a plan published in 2017 that was informed by public forums across the state. In this article, we review strengths and weaknesses of Maryland’s response to COVID-19 and the role of the Maryland Healthcare Ethics Committee Network (MHECN) in bridging gaps in the state’s response to prepare health care facilities for potential implementation of ASR plans. Identified “lessons learned” include: Deliberative Democracy Provided a Strong Foundation for Maryland’s ASR Framework; Community Consensus is Informative, Not Normative; Hearing Community Voices Has Inherent Value; Lack of Transparency & Political Leadership Gaps Generate a Fragmented Response; Pandemic Politics Requires Diplomacy & Persistence; Strong Leadership is Needed to Avoid Implementing ASR … And to Plan for ASR; An Effective Pandemic Response Requires Coordination and Information-Sharing Beyond the Acute Care Hospital; and The Ability to Correct Course is Crucial: Reconsidering No-visitor Policies.

应对重大流行病并根据危机护理标准规划稀缺资源（ASR）的分配需要联邦、州和地方政府与更大的社会基础设施的协调与合作。马里兰州仍然是少数没有国家认可的 ASR 计划的州之一，尽管该计划于 2017 年发布，并由全州公共论坛通报。在本文中，我们回顾了马里兰州应对 COVID-19 的优势和劣势，以及马里兰州医疗保健道德委员会网络 (MHECN) 在弥合该州应对措施中的差距、为医疗保健设施做好可能实施 ASR 计划的准备方面所发挥的作用。确定的“经验教训”包括： 协商民主为马里兰州的 ASR 框架提供了坚实的基础；社区共识是信息性的，而不是规范性的；倾听社区的声音具有内在的价值；缺乏透明度和政治领导差距导致反应支离破碎；流行病政治需要外交和坚持；需要强有力的领导才能避免实施 ASR……并为 ASR 进行规划；有效的流行病应对措施需要急诊医院以外的协调和信息共享；纠正路线的能力至关重要：重新考虑禁止访客政策。