Running two emergency responses at once is its own kind of stress. While I was on a municipal COVID-19 response team, there was a stretch when we managed pandemic operations and an emerging Monkeypox outbreak at the same time. Each had its own case definitions, reporting lines, and partners, and one team had to keep both going without dropping either.
That period taught me more about emergency management than either crisis would have alone. It forced a question every public health team runs into eventually: what keeps a response working when the volume is bigger than your normal systems were built for?
Structure beats heroics
In a crisis, the instinct is to work harder. What actually holds an operation together is structure. The Incident Command System exists for a reason: clear roles, defined reporting lines, one point of coordination. The responses that held up under pressure were the ones where people trusted that structure and stayed in their lane, instead of everyone trying to do everything.
At the peak of COVID-19, our team handled several hundred case reports a week, plus contact tracing, cluster investigations, and daily situation reports for department leadership. You can only sustain that if the workflow was designed for it ahead of time. The processes we built before the peak scaled. The ones improvised in week one didn’t.
Data has to keep up with decisions
In a normal program, weekly or monthly reporting is usually fine. In an emergency it isn’t. Department leadership, the mayor’s office, and state and federal partners need current numbers to put resources in the right place, and during an active outbreak “current” can mean daily.
This is where forecasting and live dashboards earn their keep. During a surge, forecasts of case trends and hospital demand tell a department where to send mobile testing, which hospitals are likely to come under strain, and where transmission is speeding up before raw case counts make it obvious.
Most of the job is coordination
From the outside, it’s easy to underestimate how much of crisis response is coordination rather than analysis. Acting as a liaison between a local health department, the state, and CDC means constantly agreeing on case definitions, reporting formats, and resource requests, often on daily calls, with information changing on both ends.
If that coordination breaks down, even excellent local data doesn’t turn into a good regional response. When it works, a small team can shape outcomes for an entire city.
What carries over to normal times
Most of what made our emergency response work wasn’t special to emergencies. It was ordinary good practice done under time pressure: clear escalation paths, data systems that don’t need manual reconciliation, and relationships with state and federal partners built before you urgently need them.
Programs that wait for a crisis to build those things will always be a step behind. The departments that handle the next emergency best are the ones doing that work now, while things are calm enough to do it properly.