The new guidelines will determine which patients doctors should prioritize if there aren’t enough beds and life-saving equipment to treat everyone. The standards, which would determine who lives and who dies, raises a number of ethical questions and criticism that the plan could lead to discrimination against older people and people of color.

Colorado Gov. Jared Polis’ Expert Emergency Epidemic Response Committee, created in 2000 to give advice related to dealing with epidemics, is working on the new standards. The committee, made up of 19 physicians and healthcare specialists, and three other non-voting advisors, is rewriting earlier standards created in spring of 2020, at the onset of the pandemic.

Their rethinking of those standards comes during a huge upswing in COVID hospitalizations in Colorado. On Thursday, there were only 488 general beds and 82 intensive-care beds open in the entire state, according to The Denver Press.

This is “the lowest number of beds available in the state of Colorado than we have seen at any previous point in the pandemic,” said Scott Bookman, director of Colorado’s Division of Disease Control and Public Health Response and the COVID-19 Incident Command.

As of Wednesday, Colorado had 1,526 people hospitalized, lower than the state’s peak in December 2020, when 1,847 were hospitalized. Bookman said last week that if nothing changes, the state could reach a number of hospitalizations that exceeds the number of beds available, putting Colorado in a “precarious position.”

In October, Dr. Eric France, chief medical officer at the Colorado Department of Public Health and Environment and a member of the epidemic response committee, warned that Colorado hospitals may have to start using “rationing standards” if the number of hospitalized patients continued to rise. The standards are meant to only be used in an “extreme situation” and avoided if possible. They include a formula that healthcare workers can use to determine how likely it is a patient will survive the next month, and whether the hospitals’ limited resources are best used on them or someone else.

People with the lowest scores have better chances of surviving and, according to the written standard, would “be given higher priority to receive scarce resources.” Those with the highest scores, or with the least potential to survive the virus, would be given lower priority when it comes to intensive care, but would be given pain treatment. Patients above 50 years of age and older would get anywhere from one to four points added to their score. Underlying conditions like chronic heart failure and AIDS would garner two and four points, respectively.

The standard system is built with the goals of “maximizing benefit to the greatest numbers of patients, maximizing survivability in the near-term,” and protecting all healthcare workers. Yet, some people, like Janine Vanderburg, director of Changing the Narrative, a campaign against ageism, worry that the point-system could be too simplistic to understand the full scope of a patient’s condition and end up being discriminatory against “older people and especially people of color,” The Denver Post reports. She urges that the committee put more focus on a patient’s organ function than on other conditions.

A member of the committee, Claire Uebbing, who is the vice president of Healthy Communities and Wholeness at Centura Health, recommended that the committee add a line in the standards protocol that prohibits doctors from making decisions on resource allocation based on people’s vaccination status. The standards already state that no decisions should be made simply because of “race, disability, or age.”

Just under 63% of Colorado’s population has been fully vaccinated. Of those hospitalized, Bookman said that 80% are unvaccinated.