The question of hospital capacity is a recurring theme when discussing the impacts of COVID-19, and many options have been explored to determine the right locations for accommodating coronavirus patients and healthcare workers on the frontlines.
For any unique interventions, Authorities Having Jurisdiction (AHJ) will need to be brought onside very quickly if permits have to be waived, or if any restrictions and regulations are to be temporarily altered under such extraordinary circumstances. For each situation, there isn’t always a perfect solution, as the options below have their own pros and cons.
Using hotels for inpatient care was initially introduced, but this approach was quickly discarded as questions arose around how easily patients could be supervised from central locations. Corridors are too narrow to turn beds and padded carpets would make moving equipment dangerous for staff.
Converting hotels into healthcare facilities was also brought into question as they would have to be stripped of beds, chairs, desks, and other furniture. Hotels won’t have storage space, as meeting rooms and convention areas would also be used for patient care.
That being said, hotels could be a good solution for healthy and non-coronavirus long-term care patients as a way to create more room within facilities that consist of two and four bed rooms. This could reduce the spread of COVID-19 within a nursing home and would also be a viable option for healthcare workers who don’t want to take the chance of infecting family members, or who live at distance from their work.
Tents are one of the most popular solutions as they provide the fastest implementation, with other advantages including ease of dismantling and storage, paired with lower cost.
The use of movable partitions to separate patients, and workstations on wheels (WOWs) can be implemented to make flexible use of space – however, just like shopping carts or cellphones, these options are problematic in terms of disinfection to prevent spreading the virus. On top of this, the availability of very large tent structures was greatly impacted as many hospitals quickly supported the idea, resulting in reduced stock and increased prices.
Tents come with further drawbacks. As most of these shelters were set up in parking lots, they need protection from elements, such as high winds and flooding. Both are a concern at this time of the year, particularly in the southern U.S. Supplemental facilities, such as washrooms, are also needed.
What other facilities are available that can be used for care of COVID-19 patients? Community centres, arenas, convention centres, armouries, exhibition halls, and university convocation halls come to mind. These facilities share many features: large open spaces, washrooms, comprehensive mechanical systems and multiple entries for separation of patient care streams, separate entryways for staff, suppliers, and waste management. They also have appropriate catering facilities on site, and may not be occupied at the time, meeting immediate demands. Unlike the tent solution, they are weather enclosed, with emergency power usually easily available.
Another option is modular booths for triage and testing of patients. These modular booths are designed to keep staff safe, especially where PPE is in short supply. As temporary structures, they’re easy to install, and can be located in an ambulance garage or under canopy structures.
Unlike tents, modular booths can serve a further purpose once the pandemic subsides. They’d be well suited for harm reduction facilities, used for treating those facing housing insecurity, and testing of the general population prior to a return to work.
More questions arise when looking for innovative solutions. Can unfinished buildings be used before they’re complete? In the U.S., several hospitals under construction have worked with contractors to occupy new facilities months before they were complete. These new and unfinished facilities not completed and ready for patient care were considered as they met the needs for mechanical systems capacity and emergency power capacity.
Unsurprisingly, this option comes with several issues: AHJ have to agree and issue Temporary Occupancy Certificates, relying on virtual inspections as building inspectors cannot go on site. In some instances, life safety systems had to be pushed to be completed in a staged manner, going floor by floor instead of the entire facility. Another downside to using unfinished buildings is that temporary flooring and millwork is required, that will need to be removed in the future.
When unforeseen and difficult problems arise, the most unique solutions come to life, such as converting container ships into floating hospitals. We’ve seen exemplary cooperation and innovation from leaders across industries, demonstrating that there are everyday heroes within every field and sector.