Since early 2020, the Martha’s Vineyard community has lived and worked through the Covid-19 pandemic. Businesses were closed and workers were unemployed, gatherings were restricted, summer events canceled, masks were required and schools operated remotely. Uncertainty and fear were rampant. Especially in the early days, people were very uncertain about the health risks of the virus, what should be done to protect oneself and one’s family, what could be the likely social and economic impacts, what are the most effective public health measures and what would happen in the future.

In response to the threat, government, public health and healthcare leaders across the Island collectively mounted an aggressive testing program and later a vaccination campaign that achieved high coverage rates. As a result of these and other policies, the economic losses were less than initially feared. Although thousands of Islanders were infected over three years, the Island’s case load and hospitalizations were significantly lower than the rest of the country. There was only one death, when a community of our size would expect around 60. Moreover, the Island did not experience the same degree of conflict over shutdowns and restrictions compared with experiences in many other American communities.

With the goal of learning from this experience and preparing for future health emergencies, we convened 16 stakeholders representing organizations including the Martha’s Vineyard Hospital, Island Health Care, town health agents, school officials, social service organizations and business owners. Over the course of a day, we reviewed the community’s response to the pandemic and identified opportunities for improvement.

The group concluded that the primary reason for the relatively-successful outcome was the “collective whole” response to the Covid-19 pandemic, with buy-in and cooperation from key stakeholders across the Island. To an unprecedented degree, the six towns coordinated their public health policies and businesses cooperated. Social service organizations stepped up to assist families impacted by the restrictions. The Martha’s Vineyard Hospital and Island Health Care worked together with the town health agents and others to develop Islandwide testing and later immunization programs; volunteers were instrumental in these efforts.

All of these organizations also made special efforts to reach out to underserved populations, particularly the Island’s Brazilian community. Social scientists refer to this as “social capital” but locally it is often called the Vineyard’s “Island spirit.” While there was undoubtedly a substantial degree of fear, there was also a strong thread of trust that all parties were acting in the interest of the entire community.

The Vineyard faced unique circumstances because of the seasonal economy and surges of both summer visitors and workers and the year-round population. Furthermore, as an Island community, access to some of the health care and public health services provided directly by the state on the mainland such as mass vaccination sites was more challenging. Guidance regarding public health matters such as business restrictions had to be adapted. For example, because tradesmen often drive together to work sites, construction was restricted longer on the Island than elsewhere in Massachusetts.

In response to these challenges, a number of ad hoc solutions developed organically among the collective leaders on the Island. For example, Island Health Care collaborated with town health agents, and with private sector support established an Islandwide testing program that supported Island-wide contact tracing operations and allowed the hospital to focus on testing symptomatic individuals. In addition to state-level reporting of Covid-19 metrics, the boards of health cooperated to produce weekly and at times daily surveillance reports. These actions were enabled by regular communications among the key stakeholders and trust between Islanders and health institutions.

Although future emergencies will require their own unique approaches, the Covid-19 experience highlighted areas that require work now to enable future success. One is the development of a shared data system. The Vineyard’s regular surveillance reports were critical, but relied on a collection of databases designed for different purposes. For the future, it would be useful to start now to develop a unified, Islandwide data system that supports surveillance, case management and other needs.

There are also opportunities to build on some of the ad hoc adaptations of leadership structures that supported collaboration and communications structures for the Island. During the response, personal relationships, as well as the fact that many individuals “wear many hats” — as one finds in a small community ­— were also critical for sustaining continuous communication. This led to breaking down silos and streamlining of response efforts. The hospital, for example, opened its meetings to the health agents and others as necessary. Similarly, the school administration set up regular meetings involving health agents, school nurses, and medical advisors from the hospital.

In this way, the Vineyard adopted a kind of “swarm leadership” that was also successful in the San Francisco Bay Area’s initial response to the pandemic and also in the Boston response to the Marathon bombing. The Vineyard’s interlocking organizations and personal connections will always be a strength, but now is the time to build on the experience of the pandemic response and to formalize and advance the Island’s approach to coordination and communication before the next public health emergency.

Claire Seguin is the chief nurse and vice president of operations at the Martha’s Vineyard Hospital; Michael Stoto, PhD, is professor emeritus at Georgetown University.