The coronavirus disease 2019 (COVID-19) pandemic has affected numerous communities, and reports of overburdened hospitals, specifically critical care units, have become commonplace. Highquality 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 prepandemic times relied on sufficient expert staffing, specialized equipment, and appropriate environments of care to reliably implement a myriad of

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... es 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 al 1 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). Patients with COVID-19 treated in the ICU during periods of high ICU load or demand fared worse than those treated during times of low COVID-19 ICU load or demand. Being elderly and requiring mechanical ventilation had a stronger association with hazard of death, but ICU strain had a clear association with mortality. If these results represent true causality, they provide additional support for public health strategies to "flatten the curve." 2 This important early investigation suggests that mortality for patients with COVID-19 who are critically ill may be associated with the extent of burden of other patients with COVID-19 in the ICU. Additionally, the timing of an individual's hospitalization within the surge of the virus across the community may be associated with ICU survival, again as a result of the concurrent critical care COVID-19 burden during the individual's admission. Given these findings, it is appealing to advocate