Convention centers are empty. Hotels are vacant. Dorms—most dorms—are gathering dust. But public officials across the country are now preparing some of these spaces to become makeshift hospital facilities for patients with COVID-19. Even with effective social distancing measures like business shutdowns, public health experts are anticipating a strain on health systems that will include a shortage of hospitals beds as the coronavirus spreads. New York Gov. Andrew Cuomo has said that the state currently has 53,000 hospital beds and 3,000 intensive care unit beds; it may eventually need as many as 140,000 hospital beds and 40,000 ICU beds. And those beds will have to go somewhere.
Partly in response to the anticipated need for more hospital space, colleges such as New York University and Tufts have offered their dorms for housing patients. The U.S. Army Corps of Engineers has plans to convert 10,000 empty hotel and dorm rooms into hospital rooms and is considering similar initiatives in California and Washington. Officials in King County, Washington, set up a 200-bed hospital in a school soccer field. The Navy has also dispatched two hospital ships to New York and Los Angeles to help increase capacity, and next week the Javits Convention Center in New York City will open as a 1,000-bed hospital.
The Federal Emergency Management Agency is expected to release blueprints with details for converting hotels and dorms into hospital rooms this week. Thus far, the Army Corps has indicated that it will set up nurse stations in the hallways and have crash carts for patients needing critical emergency care. Contractors will use air conditioning units to create negative pressure rooms, which are optimized to suck air outside the room through a vent, thus minimizing the number of airborne contaminants. Plastic sheets help to seal the room and maintain the negative pressure. In some cases, the Corps may have to replace air conditioning units that can’t maintain a negative pressure environment with ones that can.
The task is certainly not without its challenges. Dorm rooms, for instance, aren’t optimal for intensive care because they often lack hallways big enough to roll large equipment through; buildings with large open spaces like warehouses and sports arenas tend to be better suited for this purpose. Also, gathering a large number of sick people in a single building that’s not specifically designed for health care may increase the risk of spreading the virus further. Experts have also floated the idea of having asymptomatic people who need to be quarantined and health care personnel stay in these facilities, while more severe symptomatic cases can go to hospitals.
According to David Levine, a clinician-investigator at Brigham and Women’s Hospital and Harvard Medical School, these retrofitted buildings may also be more suitable for housing and monitoring patients whose symptoms aren’t too severe. For people who need intensive care, Levine suggests, setting up hospital rooms in their homes could be a safer option, if a hospital room isn’t available. “They are ill, they need to be admitted, but instead of being admitted to the hospital, they get admitted to their home with a specialized home hospital team,” said Levine, who specializes in home care and telemedicine. “Most of the things you would expect from a hospital we can make portable and deliver at home.” For instance, machines that deliver oxygen by nasal cannula, the small clear tubes that are inserted into the nostrils of COVID-19 patients who are having trouble breathing, can easily be set up in a home environment. People who need more intensive oxygen therapies and other treatments are best served by going to an actual hospital, he stresses.
Levine notes that the home hospital program at Brigham and Women’s Hospital has mostly been focused thus far on assisting patients with medical issues besides COVID-19, thus freeing up space in the main facility for people who have been infected by the virus. He believes, though, that setting up home care for coronavirus patients is a wise next step, particularly if health care workers can use remote systems and video visits to monitor people from afar. “I’m a proponent of some version of home monitoring,” he said, “where we could essentially watch those folks at home instead of having them all gathered in one large dorm room.”