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The COVID-19 Third Wave: Rating States’ Preparedness Efforts

As hospitals’ COVID-19 censuses starts to tick upward this fall, many are wondering how individual states are preparing for the added caseload. To assess progress, Premier surveyed members across the country to gain a better understanding of the best (and worst) strategies being deployed at the state level.

Preparedness strategies are being deployed – but will they help?

According to survey respondents, the top preparedness measures being deployed include increased testing (cited by 19 percent of respondents), better reporting and tracking processes (18 percent), improved contact tracing (17 percent) and clearer guidelines for opening/closing businesses, schools and other public sites (13 percent).


Increased Testing

Will it Help Verdict: Yellow Light

While frequently administered tests are needed among high-risk individuals such as front-line health workers, teachers/students returning to in-person learning and other essential workers, there are limits to this strategy. Research shows that most tests can’t reliably detect the virus until five days after exposure. Moreover, tests and supplies remain in shortage, while COVID-19 testing labs continue to struggle with throughput. This is why programs at the state level should augment testing with surveillance technologies in the ambulatory setting in order to monitor for upticks in COVID-19 symptoms, often the first and earliest warning of an outbreak cluster. However, no state surveyed is currently taking this step.

Better Tracking and Reporting

Will it Help Verdict: Red Light

If there’s one thing that COVID-19 has exposed, it’s the antiquated and siloed nature of public health data systems and technologies. This is why Dr. Deborah Birx of the coronavirus task force said in a recent article in the Wall Street Journal that it’s easier to get AIDS data from clinics in Africa than it is to get COVID-19 data from U.S. healthcare providers. While simplifying and streamlining processes at the state level could help, it won’t entirely fix the problem, as providers will remain saddled with dysfunctional reporting systems required at the federal level that do little to accurately predict spread – and will still have an inability to move data across state lines.

Improved Contact Tracing

Will it Help Verdict: Green Light

Contact tracing can be done very effectively at the state level, provided it is technology-enabled. Today, states such as Virginia and North Carolina are improving contact tracing through free apps that use mobile phone signals to track close contact with others (six feet or less for 15 minutes). Although adoption of the apps has been sporadic, research from Oxford University suggests that app use among just 14 percent of the population can dramatically speed contact tracing, while adoption of 60 percent can halt an outbreak completely.

Clearer Guidelines

Will it Help Verdict: Yellow Light

Clear and consistent standards and criteria for re-opening businesses and schools are certainly valuable to prevent running before walking, ensuring a safer environment for the public to slowly begin congregating in limited ways. However, the standards are only as good as they are followed. Today, the news is replete with examples of businesses and customers that do not follow or even flout those standards, with predictable – and often tragic - results.


Will it Help Verdict: Yellow Light

Almost universally, respondents to the survey felt that stockpiles were an important preparation strategy. However, as individual facilities, states and the federal government create and maintain stockpiles of critical supplies, respondents expressed concern that these efforts are not being coordinated to work together. For instance, there is no current mechanism to transparently share inventory levels with providers or create standards for how, when and why to access a stockpile. These problems were particularly noted with the Strategic National Stockpile (SNS), where three quarters of respondents said the process was complicated, confusing and overly bureaucratic.


Considering that nearly 90 percent of Premier members are contributing to stockpiles (either their own or those of the individual states), standards are urgently needed to avoid another round of confusion and competition for supplies that leads to shortages. Check out Premier’s full recommendations to enhance the national stockpiling strategy.

Regulatory Waivers

Will it Help Verdict: Green Light

According to respondents, some of the most helpful preparation measures undertaken by the states come in the form of regulatory flexibilities for use of at-home care technologies and workforce waivers.

Here is how respondents answered when asked to rank the top three regulatory flexibilities they wanted to see made permanent in Medicaid:


In particular, telehealth waivers are so valuable to health systems that 33 percent of respondents think they should become permanent requirements. According to Premier’s data, telehealth visits increased 149X between March and May, fueled by the waivers in order to keep healthy patients out of a setting where they could contract the virus. Another 20 percent of respondents favor removing workforce requirements for physician supervision of routine activities, so that all clinical staff can be stretched and leveraged to the top of their licensure.

The Bottom Line

Without question, the country is better prepared for a third wave of COVID-19 than it was for the first one this spring or the second uptick this summer. Care has improved dramatically as providers have learned more about the condition and developed better treatments. However, without continued careful planning and a strategic approach to managing resources, a heavy increase in cases could once again throw the healthcare system into crisis. While states are taking preparation steps, some will be more effective than others.

A more strategic approach to preparedness is necessary based upon foundational principles of cooperation, coordination and communication. Check out all the ways in which Premier is leading supply chain resiliency across our industry.


Premier’s survey was conducted from Sept.-Oct. 9, 2020, and sent to a representative portion of the Premier membership. Responses were collected from systems representing 905 unique hospitals with more than 125,000 staffed beds across 33 states. Not every respondent answered every question. Premier has not independently verified the data submitted in response to the survey.

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