Issue: April 2020
Disclosures: Keskinocak and Lesse report no relevant financial disclosures.
April 22, 2020
2 min read

What is the US’ single greatest weakness in regard to pandemic preparedness?

Issue: April 2020
Disclosures: Keskinocak and Lesse report no relevant financial disclosures.
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Click here to read the Cover Story, "‘We should have been prepared’: COVID-19 devastates vulnerable US."


Our lack of capacity to meet increasing health care demands is our greatest weakness.

Pinar Keskinocak, PhD, MS
Pinar Keskinocak

The imbalance between the demand for health care services and the capacity that is available may be the United States’ greatest weakness during this pandemic. Think about how much time is already spent in the ED, how long it takes to make an appointment with a health care provider and how long you spend in the waiting room once you actually go in for your appointment. The demand for medical services will only surge because of the pandemic.

With COVID-19, there may be many people who are infected but are not showing any symptoms and are unknowingly spreading the infection. In the absence of widespread testing, this is analogous to trying to keep a fire under control without seeing exactly where the fire is. It is a serious weakness.

Health systems, insurance companies and the government need to take action now to handle this increased demand from patients, including those who are not insured. How do you expand capacity and flexibility to handle the increased demand for services and claims? How do you prioritize who will receive a COVID-19 test, treatment or vaccine when they become available on a greater scale but are not yet in ample supply?

Pinar Keskinocak, MS, PhD, is the director of the Center for Health and Humanitarian Systems and a professor in the H. Milton Stewart School of Industrial and Systems Engineering at Georgia Institute of Technology.  

Disclosure: Keskinocak reports no relevant financial disclosures.


Lack of testing is the US’s greatest weakness.

Alan Lesse, MD
Alan Lesse

The lack of testing and inability to prepare for the large number of tests that we’re going to need to track and identify COVID-19 cases and prevent its spread is perhaps the United States’ greatest weakness when it comes to pandemic preparedness.

Although the U.S. had sufficient time from the outbreaks in China and the Far East to plan and prepare for COVID-19 reaching America, and although there were experts available for the U.S. to consult with as it coordinated its response to COVID-19, it doesn’t appear that the U.S. did enough planning.


Our response to the novel coronavirus is much different than the response to the novel H1N1 pandemic in 2009. Back then, the situation was handled much more aggressively. There was rapid development of a vaccine. There was rapid development of diagnostic tests that were specific to the new H1N1 strain. The country appeared to proceed with much greater emphasis on planning and execution than it has during the current pandemic.

The predictions are that the COVID-19 pandemic will result in significant numbers of lives lost — with case fatality rates ranging from 0.6% in South Korea, where they’ve done an enormous amount of testing, to 4.6% in Italy. Approximately 80% of the mortality in the U.S. is occurring among those aged 60 years and older. The pandemic may also trigger enormous economic losses throughout the world that, unfortunately, will be felt disproportionately in different populations. These numbers are not catastrophic, but they are quite alarming.

Alan Lesse, MD, is associate professor of medicine with a specialization in infectious diseases and senior associate dean for medical curriculum at the Jacobs School of Medicine and Biomedical Sciences at the University at Buffalo.

Disclosure: Lesse reports no relevant financial disclosures.