Covid will not be the last pandemic we face. But during this particular one, a key issue has been the risk that the health system would be swamped by sudden surges in demand – and, early on, a consensus quickly emerged that we mitigate that risk through lockdowns. These obviously have highly adverse consequences for society. In a future pandemic we might prefer to mitigate the risk in some other way.

Imagine we wanted to design a health system for the long-term in which, every 6 to 18 months, we were suddenly going to require four times as much emergency capacity as normal. How should we do it?

One of the main ways we currently do that is through the rescheduling of non-emergency care. That would obviously play some role but Covid showed that under some circumstances it may not be enough. It also causes deeply undesirable long-term health problems. Another option would be simply to build four times the emergency capacity and have it there sitting idle for 49 weeks per year. That might be considered crude and highly wasteful, and so we must give consideration to some more creative – and perhaps quirky – ideas. 

Maybe the state could pre-purchase, from the private sector, an option to use resources for emergency purposes at a pinch. So (relevantly-trained) medical staff could do private sector cosmetic surgery for 49 weeks per year whilst being paid a retainer, then come on-board for the three weeks required. And perhaps, if the technical nature of the surge demand were sufficiently predictable, we could supplement this with a kind of citizens’ emergency service training. Perhaps everyone could be taught some set of relevant emergency care protocols at school or work, and in the peak periods people could be asked to care for their loved ones at home.

To increase efficiency a bit further, as well as some of the on-call domestic resources the Government could try to have cyclical capacity availability (for instance, allowing for a surge in temporary staff from abroad and extra floor space in the UK winter). If there were a sufficiently seasonal pattern, maybe one could imagine some kind of agreement with medical resources suppliers with opposite seasonal patterns, in countries such as Australia. 

We could even have some kind of agreement with a sufficiently nearby foreign government (Ireland, France, Norway) that we could send emergency patients there in busy times? An obvious problem with this is that these nearby countries are quite likely to face demand surges at the same time we do.

When we reflect upon the above we see that none of the options is terribly attractive. The brutal reality is that if we again face a scenario in which we face such huge surges in demand for emergency care, any viable solution would be highly imperfect or very expensive. The alternative would be the disruption to non-emergency care and restrictions to our freedoms that we’ve seen throughout this pandemic. 

Even though it may look like fighting the last war, anticipating this sort of scenario should form part of any revised pandemic planning. If the rush to lockdown proved anything, it was that we didn’t prepare enough for the potential of a large increase in hospital admissions.