The U.S. Army Corps of Engineers plans to convert convention centers, arenas and a high school gym into alternate care sites with makeshift hospital beds to handle the overflow of COVID-19 patients.
With the anticipated surge in COVID-19 cases, those are just a few of the building options public health officials are quickly weighing as they seek to create temporary patient care facilities to offload low-acuity patients from health system demand.
Hotels represent an opportunity to leverage unused space for low-acuity COVID-19 patients as travel and tourism dropped during the pandemic, according to Jason Schroer, principal and director of health at the Dallas branch of HKS, an architectural firm that designs hospitals, during a virtual event with the Army Corps of Engineers this week.
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Full-service convention hotels provide the best opportunity to quickly create and support functional patient care spaces that will be needed if the virus spreads to predicted levels, according to a concept study created by the architectural firm.
According to HKS' plan, here's how it could work:
- Hotel lobbies as assessment sites: Many hospitals are looking at alternative locations for assessment and testing of potential COVID-19 patients away from their hospitals and emergency departments. With a full-service convention hotel, the drive-up area and lobby could be used for testing and triage as well as assessment and registration.
- Converting guest rooms into patient rooms: A guest room conversion for low-acuity patients can be rather simple, according to HKS architects. Nonessential furniture would need to be removed to allow for more caregiver space and other small equipment such as IV poles and pulse oximeters. If the hotel bed is used, it's recommended that all mattresses be fully contained within a waterproof protective wrap and hotel sheets replaced with medical-grade linens.
Features already in the guest rooms can be used such as the television, a telephone that connects to a central station, Wi-Fi connectivity and a toilet/ shower room with a sink. For additional patient monitoring, off-the-shelf camera systems can be easily installed in the rooms. Hotel carpets also would need to be covered with "carpet protection tape” that can be easily changed between patients.
"While this is not ideal for infection control it can help to reduce the incidence of contamination and spread due to fluid ejections and spills. And, it is achievable," HKS said in its concept study.
- Air quality considerations: Recent guidance from the Centers for Disease Control and Prevention suggests that negative pressure is not imperative for low-acuity COVID-19 patients who are not undergoing procedures that could cause aerosolization of droplets. If using hotel guest rooms for patient care during this surge emergency, the most efficient implementation scenario may be to leave the air conditioning systems as originally intended and operational. A cleaning regimen can be employed for the accessible components of the system, but cleaning the fan coil between every room change may be impractical, HKS said.
- Ballrooms as patient wards: Hotel ballrooms can be used as patient wards for better observation of those with worsening conditions and needing more real-time specialized care. Air exchanges in ballrooms tend to be at higher rates than guest rooms, with higher percentages of outside air, which will serve a ward configuration well. The use of ballrooms also allows for more efficient staffing by allowing for higher clinician-to-patient staffing ratios.
- Post-COVID-19 use: For hotel operators, a major consideration would be converting the hotel back to guestrooms after the COVID-19 crisis has abated. That could be a major undertaking, especially if there is a stigma attached to serving as a care site for patients with the highly contagious virus.
The hotel would need to be thoroughly cleaned and all carpet should be removed and replaced before the hotel returns to standard operations, HKS architects said. The air exhaust and ventilation systems would need to be cleaned through pressure washing and other methods. In many cases, the hotel interior would need to be completely renovated.
Other considerations
The speed of conversion is key in any of these alternative sites.
The Army Corps of Engineers has assessed about 820 facilities as alternative care sites, with about half of those locations being arenas and the other half hotels and dormitories. They've awarded contracts for 17 alternate care sites in New York, Michigan, Florida, California, Colorado, New Mexico, Illinois and Tennessee. Those sites will have a total bed count of 15,500 beds.
State officials have shown a preference for converting arenas and convention centers as these facilities are typically owned by state and local governments, said George Lea, chief of military engineering at the Army Corp of Engineers.
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With the right resources and team, a full-service convention hotel could be converted for patient care in 10 to 14 days, according to the concept study.
But according to the Army Corp of Engineers, approved site adaptations must happen in as little as five days and at most two weeks to align with state projected virus peaks. The most high-profile project to date has been the conversion of New York City's 1.8 million-square-foot Jacob K. Javits Convention Center into an alternate care facility for more than 2,000 patients. The corps was able to complete the project in about a week.
"It does save time in the process, as far as negotiations. We don’t have the luxury of time. Our timeline is about five days," he said.
To date, only four contracts have been awarded to convert facilities classified as "hotels/dorms" to alternative care sites. But, so far, those facilities aren't actual hotels but include former hospitals and a center for intellectual and developmental disabilities.
But converted hotels could work well for convalescent care or even hospice care. They are also predominantly located in the population centers where the needs for COVID-19 treatment and sequestration may be higher and likely near major hospitals, according to the report.