The pre-COVID-19 hospital capability research gives perception into pandemic preparedness

IMAGE: Doctors and scientists from the University of Pittsburgh surveyed surge capacity managers in 53 hospitals across the United States on a variety of topics, including preparing for pandemics. view More

Photo credit: Harris, GH, et al. JAMA Network Open, 2021

PITTSBURGH, March 19, 2021 – A survey of dozens of surge capacity managers in hospitals across the country conducted by the School of Medicine at the University of Pittsburgh tracks the pandemic readiness status of the U.S. healthcare system in the months leading up to the first COVID- 19 cases have been identified in China.

The research, published today in JAMA Network Open magazine, details the stress on U.S. hospitals during the 2017-18 influenza season, which was marked by serious illness and the highest infectious disease-related hospitalization rates in at least a decade. At this point, pandemic planning in hospitals was not considered a priority.

“The timing for our survey couldn’t have been better – ultimately, it serves as a pre-COVID-19 time capsule of our willingness to accommodate fluctuations in patients admitted to hospital for acute illness,” said senior author David Wallace, MD , MPH, Associate Professor in Pitt’s Intensive Care and Emergency Medicine Departments. “It was surprising to hear that there were very detailed reports on the stress hospitals in the 2017/18 flu season, but no pandemic planning emerged from them.”

The 2017-18 flu season was linked to more than 27.7 million doctor visits, nearly 1 million hospitalizations, and nearly 80,000 deaths, according to the U.S. Centers for Disease Control and Prevention. That is more than double the deaths in a typical flu season and the highest rate of hospitalization since seasonal influenza surveillance was introduced in 2005.

Wallace and his team, which included health policy, medical anthropology and infectious disease specialists, began surveying surge capacity managers in a random sample of 53 hospitals in the US starting April 2018 at the end of the flu season. With the help of a structured survey, they recorded detailed interviews on everything from bed capacity in the intensive care unit to staff ratios to the perceived effects of the exposure on the quality of patient care and the well-being of employees.

All respondents said they were hospitalized during the 2017-18 flu season. The exposure was generally described as the result of high patient occupancy, which resulted in demand exceeding the supply of resources – in fact or perception.

The “4S” – people, materials, space and systems – have been cited as the widespread challenges that capacity managers consistently faced during the flu season in continuing healthcare. The staff was of particular concern as the staff was tired, or had the flu, or was caring for a sick family.

“This shows that the perception of staff workload, patient care and capacity that we saw during the COVID-19 pandemic was already there in previous epidemics,” said senior author Gavin Harris, MD, an assistant professor from Emory University School of Medicine, who conducted this research at Pitt. “Less than two years before COVID-19 kicked off in the US, we had a preview of the strain a fast-spreading, severe respiratory infection is putting on our healthcare system.”

In the fall of 2013 – four years before this challenging flu season – the U.S. Department of Health’s Assistant Secretary for Preparedness and Response created the Interim Healthcare Coalition Checklist for the Pandemic Planning Report, which identified eight categories that hospitals should handle when planning for crises, especially rising ones Acute Care Needs. None of the survey participants commented on all eight categories and did not report specifically using the checklist.

“Hospitals tend to grapple with what’s right in front of them, the present,” Wallace said. “In doing so, we also have to learn when certain levers – such as a checklist to prepare for pandemics – have to be used. This is done by thinking after a crisis has subsided and looking for ways to improve before the next crisis occurs. When the past year has everything to us taught that infectious diseases don’t go away and we always get the chance to put what we’ve learned into action. “


Additional authors on this research include Kimberly Rak, Ph.D., MPH, Jeremy Kahn, MD, M.Sc., Derek Angus, MD, MPH, Olivia Mancing, and Julia Driessen, Ph.D., all of Pitt.

This research was supported by grants from the National Institutes of Health R03HL16020, K08HL122478, and K24HL133444.

To read or share this version online, visit [when embargo lifts].

About the University of Pittsburgh School of Medicine

As one of the leading academic centers in the country for biomedical research, the University of Pittsburgh School of Medicine integrates advanced technology with basic research in a wide range of disciplines to harness the power of new knowledge and improve the human condition. Mostly powered by the School of Medicine and its affiliates, Pitt has been a top 10 recipient of funding from the National Institutes of Health since 1998. In the rankings recently published by the National Science Foundation, Pitt was ranked fifth among all American universities across the state for Research and Development Support in Science and Technology.

Likewise, the School of Medicine is committed to advancing the quality and strength of its medical and academic education programs, for which it is recognized as a leader in innovation, as well as training highly skilled, compassionate clinicians and creative scientists who are well-equipped for these world-class research . The School of Medicine is the academic partner of UPMC, which has worked with the university to raise the standard of medical excellence in Pittsburgh and position healthcare as the driving force behind the region’s economy. More information about the School of Medicine can be found at

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