As a hospitalist on the front lines of COVID-19, I know firsthand how the homeostasis of a hospital is altered when community cases of COVID-19 increase. For example, emergency departments immediately enact novel pathways and protocols for triage, evaluation, and admission (1). Hospitals begin to assess and enhance inpatient capacity, often by opening units not traditionally used for general medical care (for example, postoperative care units) as COVID-19–designated areas (2). Additional tactics, such as decreasing elective surgical cases, merging specialized intensive care units (ICUs), and offering staff moonlighting opportunities to increase critical care capacity, are also pursued. And in short order, hospital command centers spring up to monitor patient flow, streamline communication, and coordinate activities ranging from patient visitation policies to media releases (3).

Preparedness is not a new concept for hospitals and health systems, and it goes far beyond the walls of the hospital itself. Hospitals and health systems prepare for multiple different types of mass casualty incidents, including public health emergencies. 

According to the Center for Disease Control (CDC) approximately 795,000 patients suffer from stroke4 annually in the United States, 87% of which are ischemic5 with 14-30% of those being cardioembolic in nature6. A 2019 article published in the Journal of Neurological Sciences estimated the total cost of stroke including costs associated with underemployment and premature death at 103.5 billion US dollars7.