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In March 2020, John Jenkins, the new chief medical officer of Garfield Health System (GHS) University Hospital, was at the cusp of a crisis. While he had been informed of COVID-19 previously by the hospital epidemiologist, Jenkins had not anticipated the scale or scope of the looming pandemic. Fortunately, under the leadership of the hospital epidemiology department, GHS had acquired a 90-day supply (at normal levels) of N-95 masks in early January. Everything in the community was open, and the university students had just left for spring break. Jenkins was not sure if COVID-19 would resemble swine flu or result in something more severe. As the situation rapidly deterioriated and the World Health Organization declared a global pandemic, Jenkins met by phone with the CEO and cabinet of the health system. He shared several complex and critical decisions: Should the health system limit the number of patients being seen in the hospital? Should elective surgeries be stopped or limited? Should outpatient clinics be shut down and converted to telehealth? What level of personal protective equipment should be worn in the hospital (i.e., did every health care worker need an N-95 or regular surgical mask)? This case set is taught in the Darden elective, "Challenges in Health Care."