Delayed Primary and Specialty Care: The COVID-19 Pandemic Second Wave

COVID-19 Pandemic Second Wave

Table of Contents


Time is of the essence to continue the pandemic disaster(COVID-19 Pandemic Second Wave) cycle with a comprehensive post-COVID-19 health care delivery system RECOVERY analysis, plan, and operation at the local, regional, and state level. The second wave of COVID-19 pandemic(COVID-19 Pandemic Second Wave) response is not the ripples of acute COVID-19 patient clusters that will persist until a vaccine strategy is designed and implemented to affect herd immunity. The COVID-19 second wave is the patients that have had their primary and specialty care delayed. This exponential wave of patients requires prompt health care delivery system planning and response.

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Key Words:

COVID-19, disaster recovery, incident command system, primary care, surge capacity


After a sudden onset mass casualty incident, the destruction and degradation of the health care delivery system create longitudinal problems until the public infrastructure gradually returns: electricity becomes reliable, water is fit to drink, cell towers are resurrected, and the roads are opened. Buildings are inspected, adapted to, and eventually returned to duty, or alternative care sites are identified and fitted to accommodate staff, stuff, and the systems to deliver care. Outside staffing resources are welcomed by the community to augment the familiar faces. Supply lines restore the last link in the chain of health care. Recovery of the health care delivery system, this fourth phase of a sudden onset disaster cycle, has been planned and exercised, even studied after hurricanes, floods, and typhoons. There is no model of health care delivery system recovery after a pandemic.

The impact of the coronavirus disease–2019 (COVID19) pandemic response phase has already exceeded the capacity and capabilities of most city, regional, state, and national health care delivery systems. There are clinical, non-clinical, and support staff who are assigned to attend non-COVID-19 patients in the acute care setting, but the overwhelming majority of the staff have been consumed in acute care hospitals for the COVID-19 response. Some have fallen ill or have had to be quarantined. The breadth of the toll of a prolonged acute COVID-19 pandemic (COVID-19 Pandemic Second Wave)response on the well-being and mental health of staff has yet to be appreciated and addressed. Non-acute care staff or acute care staff who typically do not attend to pneumonia or sepsis patients with skills that can be adapted to the acute COVID-19 care environment have been redeployed from their usual practice settings with just-in-time education.

Throughout the world, government restrictions have canceled, postponed, or limited by priority primary and specialty care visits. Additionally, the fear of acquiring severe acute respiratory syndrome, novel coronavirus 2 (SARS-nCoV-2) has kept people away from their health care providers.1 In the United States, this has reduced health care system revenue, specifically the decrease in elective surgical, endoscopy, and other procedures. Across the United States and in most other countries, there has been a marked decrease in emergency department visits and subsequent admissions that have decreased hospitals’ bed census to open space for COVID-19 patients during this slow-developing pandemic mass casualty incident; this has also decreased revenue.2 Hospitals have been adhering to the mass casualty surge capacity theory to limit or postpone elective surgery and imaging services and to also free in-patient beds (and imaging services) for the acute COVID-19 response; this has also decreased revenue. In the United States, there is a growing number of health care delivery systems that have furloughed clinical, non-clinical, and support staff deemed not essential to the acute COVID-19 response to reduce the impact of projected future revenue loss.3 The staff affected by this health care delivery service disruption remain available to return to their duty stations.

Final words:

The U.S. Federal Emergency Management Agency (FEMA) National Disaster Recovery Framework5 is applicable for most counties post-sudden onset disaster. Adapting these health and social services is a critical strategy for the post-acute COVID-19 environment:

  • Identify acute COVID-19 staff: logistics, clinical, support, and administrative and determine how long they will be required to maintain their acute COVID-19 duty.
  • Identify non-acute COVID-19 staff: idled, furloughed, or redeployed to the acute-COVID-19 care environment. Determine the time frame to develop a training program for this staff unaccustomed to operate in their duty stations using appropriate personal protective equipment (PPE). When developing this program, consider that the staff may be deployed to a non-acute COVID-19 alternative care site and may have to use alternative or adaptive materials.
  • Inventory non-acute COVID-19 stuff that has been consumed, redeployed or redirected to the acute COVID-19 response to determine a timeline for replacement or how to adapt available materials to be viable in a non-acute COVID-19 primary and specialty care environment.
  • Identify the timeline to return non-COVID-19 clinical and other structures or spaces to their prior functional status.
  • Identify non-acute COVID-19 alternative primary and specialty care structures (wards, clinics, offices, outpatient surgical and imaging) and spaces (examination and treatment rooms).
  • Complete an assessment of primary and specialty care within that specific health care delivery system and prioritize these needs based on the input and participation from the primary and specialty care providers, as well as patients and families in the health care delivery system recovery planning process; and develop a comprehensive timeline for the most-to-least COVID-19 Second Wave 2 Disaster Medicine and Public Health Preparedness Downloaded from IP address:, on 11 Jun 2020 at 20:59:41, subject to the Cambridge Core terms of use, available at essential services that include consideration of available staff, stuff, and structures to commence the delivery of this care as soon as possible to reduce the untoward effects of delayed care.
  • Involve the non-acute COVID-19 staff who are waiting to return to their duty station to learn the evolving recommendations as directed by the recovery incident command system in the process to adapt their duty station to this duty station functional parameters.
  • Implement strategies to protect the health and safety of the staff, patients, and their families with education. Involve community partners to facilitate the resumption of this care. Prepare for an increase in mental health visits related to the isolation and attempts to accept the COVID-19 pandemic by the population.
  • Develop non-acute COVID-19 primary and specialty care telehealth, identifying those in patients who may not have the means to participate. Involve community partners to facilitate this essential service.

Time is of the essence to continue the pandemic disaster(COVID-19 Pandemic Second Wave) cycle with a comprehensive post-COVID-19 health care delivery system RECOVERY analysis, plan, and operation at the local, regional, and state level.

About KSRA

The Kavian Scientific Research Association (KSRA) is a non-profit research organization to provide research / educational services in December 2013. The members of the community had formed a virtual group on the Viber social network. The core of the Kavian Scientific Association was formed with these members as founders. These individuals, led by Professor Siavosh Kaviani, decided to launch a scientific / research association with an emphasis on education.

KSRA research association, as a non-profit research firm, is committed to providing research services in the field of knowledge. The main beneficiaries of this association are public or private knowledge-based companies, students, researchers, researchers, professors, universities, and industrial and semi-industrial centers around the world.

Our main services Based on Education for all Spectrum people in the world. We want to make an integration between researches and educations. We believe education is the main right of Human beings. So our services should be concentrated on inclusive education.

The KSRA team partners with local under-served communities around the world to improve the access to and quality of knowledge based on education, amplify and augment learning programs where they exist, and create new opportunities for e-learning where traditional education systems are lacking or non-existent.

FULL Paper PDF file:

COVID-19 Pandemic Second Wave


Disaster Medicine and Public Health Preparedness
Copyright © 2020 Society for Disaster Medicine and Public Health, Inc. This is an Open Access article, distributed under the terms of the Creative
Commons Attribution license (, which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.



About the Authors

Research Center in Emergency and Disaster Medicine (CRIMEDIM), Università
degli Studi del Piemonte Orientale, Novara Italy (Drs Weinstein, Ragazzoni, Della
Corte); Harvard Humanitarian Initiative, Harvard University, and T H Chan
School of Public Health, Boston, Massachusetts (Dr. Burkle); Woodrow Wilson
International Center for Scholars, Washington, DC (Dr. Burkle); Del Valle
Institute for Emergency Preparedness, Office of Public Health Preparedness,
Boston Public Health Commission, Boston, Massachusetts (Ms. Allen) and
Educational Development, TeamHealth Academic Consortium, Moore,
Oklahoma (Dr. Hogan).
Correspondence and reprint requests to Eric S. Weinstein, Via Lanino, 1-28100
Novara (NO), Italy (e-mail:

Conflict of Interest Statement

The authors have no conflicts of interest to declare.

PDF reference and original file: Click here

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Professor Siavosh Kaviani was born in 1961 in Tehran. He had a professorship. He holds a Ph.D. in Software Engineering from the QL University of Software Development Methodology and an honorary Ph.D. from the University of Chelsea.