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The Scramble Is On To Build Temporary Healthcare Space

In the face of a pandemic that threatens to overwhelm the U.S.' capacity to provide healthcare, states and localities are racing to improvise new space.

As the number of acute COVID-19 cases grows exponentially, so does the need for beds. The hundreds of thousands of expected COVID-19 patients will need them, and others will too, in ways that don't expose them to the virus.

Across the country, governments and the private sector are working to expand existing healthcare facilities and convert or construct a wide variety of other spaces into makeshift hospitals as the healthcare industry prepares to be overwhelmed.

A hospital bed at the Javits Center in New York

The need for beds will be most urgent in the coming month, perhaps peaking in mid-April, the Seattle-based Institute for Health Metrics and Evaluation said on Monday.

More than 224,300 hospital beds will be needed nationwide by April 15 because of the outbreak, the institute estimates. That leaves the U.S. healthcare system with a bed shortage of more than 61,500. The virus could drive the need for more than 33,400 ICU beds — for patients who need to be treated with a ventilator — by April 15, representing a shortage of more than 15,000.

The first line of attack for many municipalities has been to try expanding the capacity of existing facilities.

"During this crisis, we've seen different types of properties being used by hospital systems to meet rising patient demand," Transwestern Executive Managing Director of National Healthcare Advisory Services Eric Johnson said. "One of the fastest conversions has been taking vacant post-acute and behavioral health beds and using them for makeshift triage facilities for COVID-19 patients."

In Chicago, Rush University Medical Center expanded its capacity by transforming its lobby into an emergency room for mildly sick or injured patients and is performing triage in tents raised in its emergency department’s ambulance bay, which has become an area for testing potential COVID-19 patients in isolation.

The triage area includes seats placed 6 feet apart, to lessen the risk of cross-contamination. The area also includes controlled entry into the hospital and negative airflow, to guard against the rest of the patient population coming into to contact with COVID-19 patients.

Army Lt. Gen. Todd Semonite, commander of the Army Corps of Engineers, briefing reporters at the Pentagon about Corps support of the Defense Department’s coronavirus response.

Expanding existing healthcare on short notice isn't easy, JLL Healthcare Director of Compliance Strategies Katherine Tolomeo said, and that strategy isn't enough to meet the needs of the pandemic.

"Most facilities don't have the appropriate infrastructure, such as ventilation, piped medical gases and vacuums, or emergency power, or the design elements to accommodate the needs of various patients populations," Tolomeo said. 

Spearheading the drive to build temporary space to relieve the pressure on hospitals is the U.S. Army Corps of Engineers, in collaboration with state and local agencies. The Corps is currently building or planning 114 facilities in 50 states and five territories, Army Lt. Gen. Todd Semonite, commander of the Army Corps of Engineers, told reporters at the Pentagon Friday.

One highly publicized conversion overseen by the Corps is the 1.8M SF Jacob Javits Center in Manhattan, which opened on Monday to provide 1,000 new beds for the stricken city. The center is organized into four hospitals of 250 beds each, with each bed enclosed by three temporary walls and a curtain entrance. They will service non-COVID patients. 

"What is nice about using a permanent facility is that you have all the infrastructures there," Semonite said during the press conference. "We're going into these facilities that already have electricity. They already have water. They have all the fire protection. They have all of the driveways open. They have all the capability they need."

The Corps collaborated with the National Guard and the Federal Emergency Management Agency to complete the Javits Center. Elsewhere in the city, Aqueduct Racetrack in Queens, CUNY Staten Island, the Brooklyn Cruise Terminal, and the New York Expo Center in the Bronx are slated to be similar field hospitals. On Monday, the city announced that a 350-bed facility will rise at the Billie Jean King National Tennis Center in Flushing Meadows-Corona Park, where the U.S. Open tournament is played each year.

Other organizations are also facilitating new field hospitals in New York. On Sunday, Samaritan's Purse, a humanitarian aid organization, completed a 68-bed respiratory care unit under a tent in Central Park's East Meadow on the Upper East Side, near Mount Sinai Hospital.

Chicago-based Rush University Medical Center's Emergency Department ambulance bay, where triage tents have been set up for coronavirus testing, isolated from other patients.

Other parts of the country are similarly preparing for increased hospitalizations. In California, FEMA is building eight temporary hospitals statewide totaling 2,000 beds, including a facility in the Santa Clara Convention Center. It will be used to treat non-COVID-19 patients, the Mercury News reports.

"We're working with state and local officials to prepare for a surge in patients," a spokesperson for California regional healthcare system Sutter Health told Bisnow. "They're working to identify locations for additional hospital beds throughout the state, and one of those is the California Pacific Medical Center Buchanan Street campus, which is currently inactive.” 

Sutter Health closed the Buchanan Street campus in San Francisco last year. If reopened, that would add 150 beds in the Bay Area.

In Louisiana, three state parks are being used as isolation areas to house people awaiting coronavirus test results and who cannot be sent home, such as nursing home residents. In Florida, the state is building field hospitals in Orlando, Broward County and Ocala.

In Seattle, the Army Corps of Engineers is working on a field hospital at CenturyLink Field Event Center, where the Seahawks play. In Detroit, the Corps is assessing Michigan locations nominated by the state government, including the city's TCF Center convention center and the Detroit Pistons Performance Center. Other evaluations are being made by the Corps nationwide. 

Semonite, who has been chief of engineers and commanding general of the USACE since 2016, told 60 Minutes Sunday that the complexity of the situation calls for a "good enough design," not a complicated one.

"If we try to do any more than the good enough, we're going to miss the window," Semonite said. "I'm telling my guys, you don't have the time to do it exactly the way everybody wants it. You've got to get it done by when that mayor or that governor says, 'This is my absolute critical peak.'"