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The COVID-19 pandemic has placed enormous pressure on healthcare systems. In the first line of the "war" against the virus, hospitals tried to maintain their general operations, while supplementing their services with COVID-19 patient care. To tackle the new difficulties, hospitals had to develop strategic response plans, and were in need of finding the most effective management structure for their institution. The focus of this paper is the aforementioned management structures. After overviewing the international literature, we identified three different approaches and we named them the Horizontal, Vertical, and Intermedier Approach. The separation is based on the following features: decision making, information distribution, command forwarding, intra-hospital communication channels, hierarchy, and control. After summarizing the international experiences, we introduce a Hungarian centrum hospital's approach, as the institution was assigned to fulfil COVID-19 centrum hospital duties in the middle of the first wave. The North-Buda Szent János Central hospital was in need of restructuring their management structure, and the leadership decided to transform it into a hierarchical, vertical structure, operating with centralized decision making and personal control. This control–command system idea came from the hospital's Internist Head Coordinator Physician, who is the first author of our article, and had serious military medicine experiences (in Afghanistan). [ABSTRACT FROM AUTHOR]