COVID-19 Crisis Timeline: The Warning and the Surge

After an initial warning, an infectious health crisis, especially a viral one, can surge rapidly from a small outbreak to an overwhelming epidemic or even a pandemic. A surge usually consists of a rapid escalation phase, a peak phase, and a slow de-escalation phase. A surge may include an increase of all categories of patients, emergency room visits, in-patient admissions, and critically ill patients with multi-organ failure requiring ventilation, hemodialysis, and other intensive care measures. There is an accumulative effect of the rapid successive waves of patients admitted into the hospital, with a severe strain on the human and material resources of the hospital. In many health crises, as with the COVID-19 pandemic, the majority of the patients are hospitalized for a long time. Such a long hospitalization slows down the recovery from the crisis significantly. There is a disruptive effect of a health crisis on regular hospital functions and services, such as elective surgery, ambulatory clinics, and care and follow-up of patients with diseases other than the cause of the infectious crisis. This disruption may result in worsening of chronic diseases, such as diabetes, asthma, mental illnesses, and others. It may also result in delay in diagnosis and treatment of various types of cancers and later presentation of cancers at higher stages. Consequently, the disruption places special requirements for resumption of regular services after the crisis and an additional substantial burden on hospital capabilities. This chapter describes the initial COVID-19 crisis at SBH Health System in the Bronx, New York, USA, and shows its unfolding surge over time alongside an overview of the response. While the COVID-19 crisis has unique characteristics, many lessons learned from this crisis can be applied to other crises, especially infectious pandemics.