As current and projected demand for added hospital beds to care for COVID-19 patients reaches dire levels in parts of the U.S., contractors are helping health care systems and governments explore a variety of ways to address the shortages.
As large field hospitals pop up in major metro areas, contractors are working with clients to fast-track existing projects, fit out shell spaces, reopen shuttered facilities, deploy modular structures and convert nonmedical facilities into usable health care space. As Gilbane Building Co. tracks 50 potential health care projects, it is in a “rapid response mind-set,” says Karen Medeiros, senior vice president and chief marketing officer. “We’re working in disaster-recovery mode.”
The potential demand for additional bed capacity is daunting. The Institute for Health Metrics and Evaluation at the University of Washington suggested in late March that there is a shortage of more than 54,000 hospital beds nationwide to meet the projected number of COVID patients in the coming weeks and months. Even more dire, health care facilities could be short nearly 14,000 intensive-care unit beds, the institute said.
The U.S. Army Corps of Engineers is leading most of the first wave of response, deploying field hospitals in areas such as New York City, Seattle, New Orleans, Detroit, Chicago, Dallas and Los Angeles (see p. 19). By the end of March, 1,000 beds were made available at the Jacob K. Javits Convention Center in New York to relieve hospitals fighting coronavirus. It is just one of several Corps projects in the area.
On Long Island, Turner Construction started a three-week, 1,000-bed Corps field hospital project at Stony Brook University. In addition to Corps work, Steve Fort, a Turner senior vice president, says the firm has been in touch with 154 current and former clients nationwide to discuss a range of ways Turner can help, including feasibility studies to expand bed capacity or increase the number of isolation rooms or convert shell emergency space into COVID-19 overflow and response space. “We’re taking lots of looks at what can be done,” he says.
Fort sees several clients seeking to bring shuttered health care facilities back on line. Turner was awarded a contract by the Corps’ Chicago District to reopen the Sherman Hospital site in Elgin, Ill., which opened in 1898 and closed in 2009. At press time, the number of beds that will be added was being evaluated.
In Boston, Gilbane is working to temporarily reopen the decommissioned Newton Pavilion at Boston Medical Center. It would have as many as 250 beds for a range of needs, including a focus on supporting the city’s homeless people.
In most cases, field hospitals and other temporary solutions are focused on providing what the Corps calls “alternative care facilities,” which are intended to reduce the burden on established hospitals and medical facilities. Sean Ashcroft, national health care core market leader at DPR Construction, says most systems see a need to move low-acuity and non-COVID-19 infected patients to these facilities to relieve the load on existing hospitals. “Health care systems are taking a hard look at this because they are worried about dividing their already limited staff and equipment,” Ashcroft says.
Hospitals are also looking at cafeterias, conference rooms and boardrooms as spaces for beds. “Maybe those areas are where the low-acuity patients go,” Ashcroft says. Several owners and contractors are considering using hotels, dormitories and other nonmedical facilities to house patients. Plaza Construction and Central Consulting & Contracting joined forces in March to offer fast-track services to health care providers in the Northeast, the mid-Atlantic region and Florida. Brad Meltzer, Plaza Construction’s president, says the team’s initial push has been to help fit out existing health care spaces, but it is also studying converting nontraditional spaces into temporary health facilities.
To help meet demand for more high-acuity spaces, contractors such as L.F. Driscoll and Balfour Beatty are accelerating projects. Together, the two firms are expediting portions of Penn Medicine’s $1.5-billion Pavilion project in Philadelphia to deliver 119 rooms for COVID-19 patients by mid-April—15 months early. In late March, Turner accelerated delivery of an emergency department at Johnson Memorial Health in Franklin, Ind., putting 22 beds online for COVID-19 patients. That is one portion of a $47-million ongoing expansion project.
Contractors are also being asked to expedite fit-outs of existing shell spaces. In Baltimore, Mercy Medical Center is fast-tracking 32 acute-care beds, fitting out a floor of shell space at the Mary Catherine Bunting Center. The project was approved the day after Maryland Gov. Larry Hogan (R) called for an increase in hospital beds in the state. Whiting-Turner, the contractor, is also providing short-term financing for the $12.5-million, 75-day project, allowing work to move forward immediately.
Modular solutions could speed delivery of acute and non-acute-care spaces. Plaza Construction and Central Consulting & Contracting are working with FullStack Modular to create complete modular rooms inside shipping containers. Roger Krulak, CEO of FullStack Modular, says some clients are considering camps of modules in surface parking lots adjacent to hospitals. “Once we mobilize in a couple of weeks, we could get 200 to 300 units out per week,” he says.
For now, the team says the fastest solution is for contractors to provide non-acute beds and other facilities, which require less infrastructure. Krulak says modular ICUs can be produced, but would take longer. “For a second wave of facilities, we could provide an ICU solution, but it’s not something we can provide three weeks from now,” he adds.
DPR’s Ashcroft says another option is splitting up trailers for transport and combining them to make larger spaces. Overall, he says, there is no one-size-fits-all approach, so DPR is presenting a wide range of solutions to owners. He says, “There is a ton of information sharing and a lot of great ideas from some great minds.”