Background: The economic effects of the COVID-19 crisis are not like anything the U.S. health care system has ever experienced. Methods: As we begin to emerge from the peak of the COVID-19 pandemic, we need to plan the sustainable resumption of elective procedures. We must first ensure the safety of our patients and surgical staff. It must be a priority to monitor the availability of supplies for the continued care of patients suffering from COVID-19. As we resume elective orthopedic surgery and total joint arthroplasty, we must begin to reduce expenses by renegotiating vendor contracts, use ambulatory surgery centers and hospital outpatient departments in a safe and effective manner, adhere to strict evidence-based and COVID-19eadjusted practices, and incorporate telemedicine and other technology platforms when feasible for health care systems and orthopedic groups to survive economically. Results: The return to normalcy will be slow and may be different than what we are accustomed to, but we must work together to plan a transition to a more sustainable health care reality which accommodates a COVID-19 world. Conclusion: Our goal should be using these lessons to achieve a healthy and successful 2021 fiscal year.

The coronavirus (COVID-19) pandemic has created health care and economic crises at large metropolitan areas throughout the United States, and it is predicted to drive unemployment to a level not seen since the Great Depression. In the United States, fears of the COVID-19 outbreak began as we watched Italy’s health care system grapple with a massive influx of patients. As a result, the U.S. stock market recorded its largest point drop in history on Monday, March 9, 2020 [1]. The World Health Organization designated the COVID-19 outbreak a pandemic on March 11 [2]. From February 19 to March 19, the Dow Jones Industrial Average lost over 35% of its value [3]. California then ordered the first statewide stay-at-home orders for its residents on March 19, 2020 [4]. Similar stay-athome orders and the closure of all nonessential businesses would follow over the next few weeks in 42 states including New York and Massachusetts [5]. The prompt closure of businesses deemed nonessential has forced >16 million Americans to file for unemployment, fueling speculation that the unemployment rate will reach 20% in the second quarter and may reach as high as 30% by the summer of 2020 [6,7]. For comparison, the Great Recession of 2008 reached a peak unemployment rate of 10% [8]. The COVID-19 crisis has created substantial stock market shifts, raised unemployment to a record high, created travel restrictions, and has overwhelmed health care systems throughout the world. The economic implications from the COVID-19 crisis are not like anything we have ever experienced.