Bracing healthcare facilities for impact of pandemics

Nebil Achour, Director for the MSc Healthcare Management programme at Anglia Ruskin University, argues that while frontline NHS clinical staff and their estates and facilities colleagues have undertaken tremendous work as the pressure on healthcare facilities has ramped up during the UK coronavirus outbreak, a re-think is needed on making hospitals and other healthcare facilities more resilient and able to ‘cope’ in the face of events such as pandemics, where existing guidance and contingency plans may no longer be up to date or relevant enough to today’s healthcare, or to the mass casualties that such events can cause.

The ongoing COVID-19 outbreak has demonstrated its ability to disrupt healthcare services globally, and afforded some sense of scale as to what a severe mass casualty event looks like. The pandemic started in China in December 2019; however, it did not cause any significant concerns for the Chinese authorities until January this year, when the number of infected people started increasing exponentially, forcing such authorities to look to immediate solutions. The WHO declared COVID-19 as a pandemic at a later date, when there was sufficient evidence that it was beginning to rapidly spread across the world. At the time of writing this article, over 8.7 million people have become infected, hundreds of thousands are receiving care , and around 462,000 people globally have lost their lives as a result of contracting the virus.

Risk is often modelled as a combination of hazard, vulnerability, and exposure, which tend to affect the risk as they increase or decrease (Fig. 1). In the case of COVID-19, ‘hazard’ (i.e. the coronavirus), and vulnerability (i.e. lack of health immunity), are perhaps difficult to control at this stage, for a substantial number of reasons, meaning that exposure to the virus (i.e. the number of individuals exposed) is the only one of the three aforementioned factors that nations and societies worldwide can influence; this explains the lockdown policies implemented in recent weeks in many countries, including the UK. Via such a lockdown, the hope is that the numbers of casualties, and in turn the resulting pressures and demand on healthcare systems not designed to cater for such a sudden influx of patients, can be reduced.