Lessons learned are helping hospitals boost pandemic preparedness

Lessons from the COVID-19 response are helping hospitals sharpen their planning for major crises—and improve their responses to this one.

“There are multiple lessons learned around the critical stressors on health care resources and delivery,” said Sunita Sharma, MD, Associate Professor of Pulmonary Sciences & Critical Care Medicine at the University of Colorado Anschutz Medical Campus. “No one imagined the scope of the challenges on the system, including the need to creatively use nonclinical spaces for patient care. We are all looking at and adapting new locations and new strategies for patient care.”

Dr. Sharma will co-chair Pandemic Preparedness: Challenges Faced and Lessons Learned for the Next Health Care Crisis on Monday at 9:15 am CT with Andrew Goodwin, MD, Professor of Medicine and Medical Director of the Medical Intensive Care Unit at the Medical University of South Carolina. They originally envisioned this session as a look back at COVID-19 after near-universal vaccination had effectively ended the pandemic.

“Instead, we’re continuing to address resource allocation in real time as the pandemic continues,” Dr. Sharma said. “In the last 19 months, we have had to not just conceptualize crisis standards of care but to discuss strategies to implement them. I’m not sure how many of us ever envisioned seeing that happen during our lifetime as practicing physicians.”

The last infectious respiratory virus on a pandemic scale was influenza in 1918. Many, perhaps most, of today’s hospitals did not exist a century ago. Institutional memories of 1918–1920 were sparse.

“We are keeping a playbook for posterity’s sake, and I’m sure many institutions are doing the same,” Dr. Goodwin said. “What are the steps to take when you need to shut down nonessential activities? How do you identify clinical spaces that can be converted to isolation wards? We had hours and days with doctors, administrators, and facilities staff poring over ventilation blueprints trying to figure out which units shared air handlers so that we could decide where we could put patients without contaminating one unit with air shared from another unit. Good records will help us respond more quickly the next time.”

COVID-19 also emphasized the need for novel therapeutics in a hurry.

“We had to think about prioritizing research to identify potential new therapeutics without over-burdening a health care system that was already stretched,” Dr. Sharma said. “We have had to look at ways to maintain not just research but the whole academic and medical education mission within the constraints of a severely taxed health care system. Our contemporary academic mission still has a lot to learn from this pandemic that will help us optimize processes for the future.”

One of the biggest surprises was the widespread and escalating levels of stress, Dr. Goodwin added. The broad mindset that settled in March, April, and May of 2020 was uncertainty, which bred anxiety.

“We didn’t know what to expect, we didn’t know how to deal with it, and we knew, especially from Italy, that a lot of team members were being infected,” he said. “It caused a level of anxiety that was almost unparalleled in my career. And when people are anxious, they want to do something, even if there are no data. When you think about lessons learned, the best, most effective, most helpful thing we can do is to stick to our tried-and-true care principles. Rather than lunging at this experimental therapy and that with no data, focus on doing what we know works, and stand up trials to identify new therapies as quickly and as efficiently as we can. When this happens again, we can be better prepared to stay cooler, calmer, and more effective.