How a major earthquake in the Bay Area could jeopardize access to health care

The study shows that damage to hospitals and transportation networks could exacerbate failures across the region

November 6, 2025 By Marnie Ellery

No one knows when the next big earthquake will happen. In the meantime, researchers are working to understand how these events could disrupt access to health care in densely populated areas, and how best to prepare for them.

As reported in Nature Communications, researchers from UC Berkeley, New York University, the World Bank Group, and Stanford University simulated a large earthquake in the San Francisco Bay Area, then studied its impact on access to acute care hospitals. Their findings revealed life-threatening disorders that could be mitigated through a combination of more resilient healthcare and transportation infrastructure.

The idea that earthquakes, even moderate ones, can affect access to health care is not new. Previous studies have examined how structural and nonstructural damage—such as generator failure or water system failure—affect hospital operations, often focusing on individual facilities and the communities they serve. However, in this study, researchers analyzed health care infrastructure at a regional level to understand how failures can interact to disrupt access to emergency health care in densely populated urban areas.

“Using detailed real-world datasets on hospital and bridge infrastructure, we were able to model these compound failure impacts across the San Francisco Bay Area,” said Luis Severino, lead author of the study and an assistant professor of civil and environmental engineering at UC Berkeley. “Our hope is that this new approach will shed light on how failures spread across urban systems, so that we can more effectively prioritize mitigation efforts and guide policy changes.”

According to Severino, much of the Bay Area's healthcare infrastructure is located near major, active faults. This includes the Hayward Fault, which runs through several densely populated cities and has been accumulating energy since its last major earthquake in 1868.

In the study, researchers modeled a M7.25 earthquake on the Hayward fault, then analyzed 76 hospitals — 426 buildings with 16,639 beds — and 5,163 bridges to measure simultaneous failures and cascading disruptions across health care and transportation systems.

The results revealed that hospital bed capacity across the region could drop to 51%, with Alameda County retaining just 20% — or just 651 out of 3,221 functional beds. In addition, they found that widespread transportation failures restricted access, causing regional travel times to increase by 177% — from 6.1 minutes before the quake to 16.9 minutes after the quake — and exceeding 1,000% in parts of the East Bay.

Failures at one facility can cascade across a regional network, overwhelming nearby hospitals, increasing patient travel distances and deteriorating health outcomes, Severino explained. At the same time, bridge collapses and other road hazards exacerbate this problem and can have other serious impacts, such as isolating an entire hospital and an entire urban community.

“For effective resilience planning across large metropolitan areas, we need area-level models grounded in real exposure data that can capture these operational interconnections between health care and transportation infrastructure,” Severino said. “This study provides one of the most comprehensive simulations to date of interconnected failures that affect access to health care after an earthquake.”

Based on their findings, Alameda County, with a population of 1.6 million, will likely face the most severe health care disruptions in the region, due to its proximity to the Hayward Fault and concentration of weak hospitals. In addition to significantly reduced bed capacity, the county also faces more significant transportation impacts, maintaining only 282 effective bridges out of 642, or 44%.

Their model also shows how the double whammy of simultaneous failure of transportation and hospital infrastructure can significantly hinder access to health care. This was observed in Novato, a city in Marin County, where travel times increased from 7.3 to 185.5 minutes under the combined disruptions caused by transportation and hospital infrastructure issues, compared to an increase of only 14.1 minutes when only hospital infrastructure issues were taken into account.

“Although our study is located in the San Francisco Bay Area, it highlights systemic barriers to accessing health care after earthquakes under conditions common in many dense urban areas,” Severino said. “More importantly, our findings underscore the need for a system-wide approach to infrastructure resilience planning – one that prioritizes interconnectedness and regional importance rather than treating assets, such as bridges, in isolation.”

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Getting ready for the next “big one.”

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