COVID-19 has challenged the U.S. health care industry like no other pandemic, disaster, regulatory or payment change in modern history.

Hospitals have streamlined over the past 40 years to efficiently deliver care at the highest possible quality, but also to maximize profits or stretch limited resources. They have drilled on emergency preparedness plans.

But the COVID-19 pandemic upended cost-saving approaches and exposed weaknesses in hospital staffing strategies designed to limit nurses and other health care workers to daily inpatient volumes.

The failure of hospitals to be prepared for COVID-19 in March and April is a systemic problem that has been criticized for years by nurses and health care unions. The “short staffing” of critical departments often leads to employee dissatisfaction, burnout and resignations.

COVID-19 exposed many hospitals’ lack of personnel and supplies to adequately treat the hundreds and thousands of patients requiring critical and intensive care. Of the nation’s nearly 1 million hospital beds, only 10 percent are reserved for intensive care.

The federal government also was woefully unprepared, with insufficient reserves of ventilators, respirators and other personal protective equipment. A national emergency coordination plan for COVID-19 testing, use of face masks and stay-at-home orders in regions of high viral spread also failed to materialize.

Governments have underfunded public health systems for decades. As county hospitals have closed, public health clinics have been used to provide free or low-cost services for the under-insured or uninsured.

Nursing homes, rehabilitation centers and behavioral health providers also were caught flat-footed. The pandemic sliced through many long-term care facilities predominated by seniors in their 70s, 80s and 90s, many with multiple chronic diseases and weakened immune systems.

Nearly 25 percent of the deaths to COVID-19 in Michigan were at nursing homes.

Long-term underfunding of post-acute care facilities and of behavioral health care also has played a role in unpreparedness in Michigan for the influx in COVID-19 patients and community impact.

So far in Michigan, more than 84,000 people have tested positive for COVID-19 with more than 6,200 deaths. Probable cases and deaths are about 5 percent higher than those totals. The infection rates and deaths also are much higher in the minority population with 26 percent of Blacks and 8 percent Hispanic groups affected, indicating to federal officials social and health inequities.

What we’ve learned: Within one week of the first COVID-19 positive case on March 10, Gov. Gretchen Whitmer ordered the shutdown of a number of businesses, including theaters, bars, casinos and indoor restaurant dining, to limit community spread. She has issued more than 170 executive orders and directives related to COVID-19.

Still, some question whether the state response was quick or strong enough, given that Michigan ranked in top three states for positive cases and deaths into June. As of Aug. 3, the state ranks No. 8 in death rates by population at 65 per 100,000.

Hospitals have been shoring up supply chains by investing in American companies for personal protective equipment and rethinking “just-in-time” supply and staffing strategies.

They also have reorganized medical departments to quickly pivot to critical and intensive care uses if COVID-19 volume increases.

Physicians, dentists and other outpatient health care providers are preparing for a new normal that includes social distancing patients and using telemedicine and other technologies.

Doctors of COVID-19 patients now closely watch for blood clots, place ventilated patients on stomachs and monitor organs such as lungs, heart, liver, kidneys and brain.

Unanswered questions: Big ones are when will vaccines be available; how effective will they be and how long will they last. In 2019, the influenza vaccine was 45 percent effective but only about 65 percent get inoculated. More will be needed to stifle COVID-19.

What’s next: Experts say the world must be prepared to more quickly contain and then coordinate a response to the next pandemic. Doctors and hospitals are preparing for a possible second wave this fall. They say they are more prepared now than in March and April. They have stocked up on personal protective equipment, ventilators and oxygen support machines and medicines known to minimize the virus’ inflammatory effects. They also can quickly reopen intensive care units designed for COVID-19 patients and more appropriately triage and isolate patients.

Rapid and widespread viral testing and vaccine development must be perfected as a first line of defense.

But the bottom line, say experts, is that after public alerts are given and containment and protections are put in place, it is up to individuals to accept shared safety rules to reduce community spread and deaths.