By Kenneth L. Davis and Brendan Carr, Mount Sinai Health System
By all counts, we are finally starting to get COVID-19 under control.
But while deaths and hospitalizations decrease, health systems are still being stretched thin managing this extraordinary health crisis — and the next pandemic threat may soon arrive. The Ebola virus, resurging in Congo and Guinea, has already initiated preparations at hospitals across the country like ours. While we hope for the best, we plan for the worst; hope is not a plan. We must find ways to invest in a future that will be fully equipped to handle these threats to the public’s health. Even as we emerge from COVID-19, our hospital and health care system must be prepared for what comes next.
Individual public health threats are unpredictable — whether it be a pandemic, a natural disaster, terrorism or a mass shooting. But we know to expect them, and we know the formula for managing them. Despite this, disasters drive hospitals to the brink of financial crisis. They crumble under the weight of disaster response and are forced to seek congressional funding as a lifeline. COVID-19 was no different.
The truth is that our health care system is simply not built to withstand a public health threat like COVID-19. Traditional payment structures in health care force hospitals to operate on “just-in-time” margins, requiring them to meet only current demands. This manifests in our daily lives as long waits for access to appointments with specialists, limited same-day sick visit capacity and tightly scheduling planned procedures. Hospital systems like the one we lead here in New York City are penalized for having unused space, resources and capacity. Extra beds that we would call “surge capacity” are considered “waste.”
As a result, the infrastructure for health preparedness is limited. This is a major reason why disadvantaged communities are disproportionately impacted by public health emergencies. When large scale crises hit, hospitals are stretched dangerously thin and forced to do unimaginable things — like build a field hospital in Central Park — in order to save lives.
As new public health threats brew, we need to ensure there is capacity to serve the people of this country, and the people of New York. There is a strong business case for readiness, but it requires a paradigm shift in how we think about the intersection of routine care, unscheduled care, and the health of the populations we serve. Other countries like Israel maintain underground hospitals in conflict zones designed to accommodate an increase in demand following chemical or other warfare, now used for COVID-19 patients. It costs money to keep the lights on, hire the staff and have the resources on hand for an emergency, but it pays to be prepared.
First, we need to form a network of “national security hospitals” in every region by paying hospitals for preparedness. Hospitals are essential to disaster response — just like our police, fire departments, EMS and even our military. Trauma centers, oncology hubs, and referral hospitals with critical care capacity should be incentivized to increase capacity on a dime with extra space, beds, intensive care capacity and trained staff at the ready.
This, of course, requires resources and funding. So next, we need to establish a federal Emergency Healthcare Fund, to incentivize facilities that meet specific criteria for national security — ensuring they continue to have the funds needed to maintain essential resources. Establishing this fund and providing resources to hospitals would not only save lives and help to prevent crises from overwhelming systems, but also ultimately save money that it currently requires to ramp up. This would also ensure that the health care system can continue to deliver care for cancer, cardiac disease and the routine care of Americans.
Preparedness means little without a strong, well-resourced supply chain to keep the system resourced and humming. At the height of COVID-19 pandemic, we saw stories about how the national stockpile wasn’t nearly enough to get us through during this critical time, and we now know that a lack of PPE likely contributed to disease spread.
That’s why we also need to revamp the health care supply chain using tools that can help us better manage and allocate supplies – reducing the tension between states and the federal government we’ve seen at every turn of the pandemic. We should shore up supply chain resilience with “strategic incentives,” including commitments from the federal government to purchase supplies regularly, manufacture and produce medical products in geographically diverse regions across the country, along with providing zero-interest loans for supply-related purchases.
Overwhelmed health systems leave our country vulnerable and investing in preparedness can keep us from reaching that breaking point. Just as defense spending helps to keep us safe by anticipating threats before they become real, funding for pandemic preparedness can help to mitigate crises before they reach the unimaginable apex that we saw with COVID.
The U.S. health care system is a foundational component of our national security and national response capability. The next enemy virus is lying in wait. Let’s honor the hundreds of thousands of American lives lost to COVID by preparing for and investing in our future.
Dr. Kenneth L. Davis is the president and chief executive officer of Mount Sinai Health System and a professor of psychiatry and pharmacology at the Icahn School of Medicine at Mount Sinai.
Dr. Brendan Carr is the professor and system chair of Emergency Medicine at the Icahn School of Medicine at Mount Sinai and the Mount Sinai Health System.