While converting existing buildings into fully functioning hospitals is unfeasible, high schools and large hotels can be used as care space for coronavirus patients, says Jason Schroer, who is director of health at HKS's firm in Dallas. Here he explains how.
The Covid-19 pandemic brings a unique challenge to all healthcare architects. It stretches our design paradigm and asks us to play a key support role in the trajectory of health outcomes in our communities.
In just 10 to 14 days, a hotel, high school or public assembly space can be converted into a temporary patient-care facility that will ease the pressure on mainline hospitals by providing more space for patient beds. No alternative space is perfect, but attempting a hard-walled construction project or launching the cumbersome permitting process a new facility would require – even one with pre-fabricated modular components – isn't practical.
It's also too time-consuming and expensive to convert and/or renovate most existing building types into fully operational hospitals that meet all licensing and compliance requirements. In our current Covid-19 environment, speed and efficiency are major design drivers – but patient and staff safety also remain paramount.
There's a lot to quickly consider when we assess buildings for conversion to patient care facilities
It must be acknowledged that a non-healthcare building converted to patient care space is not quite a hospital. It's not practical, and there isn't enough time to make such a conversion. There's a lot to quickly consider when we assess buildings for conversion to patient care facilities, and the baseline criteria is straightforward: is it a building type that can converted quickly; is there enough space to allow flexibility for a critical mass of patients; and is it located in an area or region that requires more bed capacity in the immediate near term?
Drilling down further, it's important to match patients' acuity levels to the facility. The Centers for Disease Control and Prevention offers guidance regarding which Covid-19 patients are appropriate for alternative care sites.
A tier one site is for individuals who test positive for Covid-19 but cannot stay at home. This would require limited monitoring and require primary self-care. A tier two site would be considered a low-acuity site for individuals that require some monitoring and additional care. A tier three site would house high-acuity patients that would require intense monitoring and respiratory treatment with a highly trained care staff.
After studying a wide variety of educational facilities, it became clear that medium to large high schools are optimum
The patients most appropriate for a Covid-19 hotel, school, or public assembly space would include those who are in the tier one and tier two category: suspected of being a Covid-19 carrier; confirmed Covid-19 positive, but are not presenting severe symptoms; confirmed Covid-19 positive, live with high-risk population; confirmed Covid-19 positive, live alone and cannot self-care; recovering from Covid-19 but still require care or sequestration. In the case of pediatrics, it is recommended that children with severe cases be treated within hospitals.
We studied many different hotel types. We found that a full-service convention hotel provides the best opportunity to quickly create and support functional patient-care spaces. Convention hotels are predominantly located in large population centers where the need for Covid-19 treatment and sequestration could potentially be higher. These hotels are also likely situated near major hospitals.
After studying a wide variety of educational facilities, it became clear that medium to large high schools are optimum – here's why. High schools are generally easy to access and are found in almost all communities and publicly owned. These schools are large enough to house between 200 and 500 patients, depending on the facility and the ancillary spaces available (like gymnasiums). They offer wide corridors and mostly non-porous/durable surfaces to maintain cleanliness.