Healthcare Preparedness After COVID: What Still Hasn’t Been Fixed

Four years after the height of COVID-19, one truth has become painfully obvious: the healthcare system did not fundamentally reform—only recover. What the public saw as temporary strain was, in reality, long-standing structural vulnerabilities exposed at scale.

And despite lessons written in bold, the healthcare industry remains dangerously underprepared for the next major disruption.

Hospitals, clinics, long-term care facilities, public health agencies, and healthcare coalitions are facing a threat landscape more severe than anything that existed in 2020—yet many of the problems that nearly fractured the system remain unresolved.

Preparedness didn’t advance.
Risk did.

This article is not about hindsight.
It’s about the vulnerabilities that still exist—and the urgent need for modernization before the next crisis hits.

1. The Workforce Crisis Has Become a Permanent Hazard

COVID didn’t create staffing shortages—it accelerated them to irreversible levels.

Nursing shortages are chronic, not temporary.

Many regions operate with:

• 20–30% vacancy rates in critical units

• Reliance on expensive travel nurses

• Burnout driving early retirements

Specialist shortages are worse.

Respiratory therapists, critical care physicians, emergency medicine staff, and behavioral health specialists remain in short supply.

Turnover has no seasonality anymore.

Healthcare HR now faces continuous churn.

What this means:

Workforce capacity is now a primary hazard—as impactful as power outages or cyberattacks. Any disruption (heat waves, wildfires, protest surges, cyber incidents) immediately overwhelms already fragile staffing levels.

Preparedness cannot exist without workforce stabilization.
Right now, stabilization does not exist.

2. Hospital Infrastructure Still Lacks Resilience

Despite national attention on infrastructure during COVID, the reality is stark:
Most U.S. hospitals are not built to withstand modern climate patterns or sustained operational stress.

Climate impact on facilities has intensified:

• Heat waves are taxing HVAC and cooling systems

• Wildfire smoke infiltrates aging air handling systems

• Increased flooding threatens surgical suites, ED access points, and mechanical basements

• Backup generators are still located in flood-prone zones

• Power outages and grid instability are increasing in frequency

Capital investments are slow, expensive, and reactive.

Hospitals are spending more on patching vulnerabilities than reinforcing resilience.
The next infrastructure failure will look less like inconvenience and more like catastrophic service interruption.

3. Supply Chain Fragility Never Recovered

Global supply chains stabilized—but did not strengthen.

Critical items remain vulnerable:

• IV fluids

• PPE components

• Pharmaceuticals (over 200 drugs in shortage in 2025)

• Specialized diagnostic supplies

• Semiconductor-dependent medical devices

Single-source dependencies continue to dominate procurement.

Hospitals largely returned to pre-pandemic sourcing models—centralized, lean, fragile—without real redundancy.

Regional competition for supplies still outpaces coordination.

The next major disaster will recreate the same shortages—only faster.

Preparedness requires multi-vendor redundancy, stockpile diversification, and supply chain mapping.
Most organizations have none.

4. Public Health Has Not Recovered from the Operational Collapse

Public health agencies experienced:

• Massive workforce loss

• Political pressure

• Sustained burnout

• Funding gaps

• Attrition of senior leadership

Today, many public health systems operate at reduced capacity, limiting:

• Surveillance

• Community outreach

• Laboratory functions

• Vaccination capability

• Emergency response

In many regions, public health systems remain one high-impact event away from functional collapse.

5. Cyber Threats Are Outpacing Preparedness

Healthcare is the most targeted sector in the U.S., and ransomware is now a patient safety issue.

Current cyber realities:

• Downtime threatens clinical care

• Electronic health records (EHR) outages halt workflow

• Ambulance diversion spikes during cyber incidents

• Imaging and lab systems fail without warning

• OT systems (HVAC, oxygen, power controls) are increasingly targeted

Cyber preparedness remains deeply siloed.

Most hospitals:

• Do not integrate cyber into continuity plans

• Do not have manual fallback systems

• Do not train clinicians for degraded environments

• Rarely integrate cyber into full-scale exercises

This gap will cost lives during the next major cyber incident.

6. Behavioral Health Demand Exceeds System Capacity

COVID opened the floodgates on behavioral health demand. The system never caught up.

Hospitals face:

• Surge in behavioral emergencies

• Longer ED holds

• Lack of inpatient psychiatric beds

• Staff safety concerns

• Coordination challenges with law enforcement and EMS

Youth mental health crises are rising sharply.

Preparedness here requires entire community systems—not just hospitals.
Those systems remain misaligned, understaffed, and underfunded.

7. Healthcare Coalitions Are Uneven, Underresourced, and Overloaded

Some coalitions operate as high-performing regional partners.
Many do not.

Persistent coalition challenges:

• Limited staffing

• Inconsistent participation

• Minimal supply chain integration

• Weak information sharing

• Outdated hazard analyses

• No cyber integration

• Poor public health linkage

Healthcare coalitions should serve as the backbone of regional health resilience.
Instead, many serve as administrative hubs rather than operational force multipliers.

8. Continuity of Operations (COOP) Is Still Underdeveloped

For most healthcare systems:

• Continuity plans are outdated

• Dependencies are poorly mapped

• Manual fallback processes are untested

• Vendors are not incorporated into exercises

• Recovery timelines are unrealistic

• Alternate care sites are theoretical, not operational

COOP remains one of the weakest links in healthcare preparedness.

9. Hospitals Still Underestimate Cascading Failure Scenarios

Most plans focus on single disruptions.
Modern healthcare disruptions are compounded.

Examples include:

• Cyber incident + heat wave + staff shortage

• Wildfire smoke + surge event + power instability

• Severe weather + supply chain disruption + EMS overload

• Public health crisis + political unrest + facility failure

Every year, healthcare grows more interconnected.
Every year, cascading failures grow more likely.
Planning has not kept pace.

What Healthcare Must Do to Modernize Preparedness

1. Invest in Workforce Resilience as a Core Capability

• Retention programs

• Behavioral health support for staff

• Rapid onboarding models

• Cross-training clinical and nonclinical roles

Workforce protection is operational protection.

2. Harden Hospital Facilities Against Climate and Infrastructure Threats

• Redundant cooling

• Elevated electrical systems

• Flood-proofed critical infrastructure

• Smoke-resistant HVAC upgrades

• Backup power modernization

Modern risk requires modern facilities.

3. Integrate Cyber and Emergency Management

• Joint playbooks

• Unified command during cyber incidents

• Downtime procedures for all clinical units

• Cyber-integrated full-scale exercises

• OT risk analysis

Cyber is now a clinical hazard.

4. Strengthen Regional Collaboration and Coalition Capability

• Shared situational awareness

• Regional surge planning

• Medical supply cache management

• Redundant transport pathways

• Information-sharing frameworks

Healthcare is a team sport—even when organizations compete.

5. Modernize COOP for Real Operational Stress

• Manual fallback workflows

• Vendor contingency mapping

• Tiered prioritization of essential services

• Alternate care site readiness

• Leadership succession plans

COOP must reflect real-world constraints—not ideal conditions.

How Celtic Edge Supports Healthcare Resilience

Celtic Edge provides direct support to modernize healthcare preparedness, including:

• Healthcare-specific COOP modernization

• Cyber-physical integrated exercise design

• Infrastructure and facility hazard analysis

• Surge and evacuation planning

• Leadership crisis training

• Behavioral health crisis coordination planning

• Regional coalition enhancement programs

• Supply chain vulnerability assessments

• Healthcare continuity + operational resilience integration

Preparedness is no longer about compliance.
It’s about survival.

Final Thought

COVID was a wake-up call. The years since have been a test.
Healthcare passed the test through extraordinary effort—not structural strength.

The next crisis will not give the system the same margin.
The vulnerabilities that remain will become the failures that matter.

Celtic Edge helps healthcare organizations build resilience that matches the severity of the threats they now face—not the ones they wish they had.