But even a city as prepared as Toronto wouldn't have been able to handle a surge of patients, had the pandemic been more severe.

"If it had been a severe pandemic, it is certainly true that all hospitals would have run out of ICU capacity, ventilation equipment and trained users," says Howard. "I'm not sure society prepared people for the kinds of decisions that might need to be [made]."

Still, even basic measures may prove to make the difference in fighting off future pandemics. Many hospitals are already taking extra steps to minimize the potential. In fact, according to the MMHC study, 84 percent of respondents provided facial tissues, no-touch receptacles for tissue disposal and hand sanitizer in waiting areas and exam rooms.

Back to basics

As hospitals and their emergency preparedness teams look back on the 2009-2010 pandemic of H1N1, they note what improvements need to be made, what they did well and where their plans fell short. But ultimately, keeping the virus in control came down to the fundamentals: hand-washing and basic infection control.

Gregg Pane, ASPR's director of hospital preparedness, points out that the health care facilities that fared a lot better during the 1918-1919 pandemic adhered to all of the basic infection control rules.

"We learned from 1918, that just washing hands, covering coughs, social distancing - those communities did better," he says. "Basics are always the underlying foundation to everything else."

In addition to the basic rules of hygiene and infection prevention, experts reflecting back on the H1N1 pandemic point out that it's important to talk and communicate and recognize that a pandemic is always looming.

The future "is something we need to encourage people to talk about," says Howard. "People don't really want to talk about it...For us, planning was the key. It's difficult to plan when really nothing exciting is happening...It's hard to keep people planning when the threat doesn't seem imminent."

With every infectious disease outbreak, pandemic or not, the public and health care professionals learn what worked and what didn't. But even with careful, meticulous planning, the unexpected inevitably happens.

With regard to the 1918-1919 pandemic, Knebel asks, "Are you ever ready for something that's that overwhelming?"

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