"A non-healthcare building converted to a patient care space is not quite a hospital"

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.

The conversion of a high school requires minimal intervention and/or construction

High schools are designed for older/larger students, unlike their elementary school counterparts. These spaces come equipped with Centralised Mechanical Electrical Plumbing (MEP) systems that can provide a higher quality of control for spaces.

High schools provide multiple spaces that are easily convertible for patient care and its support requirements. The conversion of a high school requires minimal intervention and/or construction, and can be done quickly.

Large assembly spaces in buildings like gymnasiums, arenas, stadiums, ballparks and convention centers are being considered for rapid transformation. These building types share several attributes that make them efficient large-scale alternative care facilities in times of pandemic.

These attributes include: publicly owned facilities can be occupied faster; large flat floors offer flexible patient care configurations which can easily expand if needed; efficient loading systems for quick set-up and delivery; readily available facilities staff to assist; ability to accommodate large numbers of people; easy vehicular and transit access located in city centers; a variety of support spaces easily convertible for use as patient care support.

I'm encouraged to see healthcare architects and allied professionals mobilise and respond proactively to this health crisis

As part of the US Army Corps of Engineers' effort to support the nations' surge bed capacity needs, HKS was recently commissioned as part of a team with Gilbane Building Company to retrofit the 250,000-square-foot (23,226-square-metre) Suburban Collection Showplace in Novi, Michigan into a 1,000-bed alternative care facility.

Located in suburban Detroit, this expo centre represents a great combination of what we require as far as location, size and easily convertible space. As part of an industry-wide effort to collaborate and develop creative solutions by using our core competencies around planning and design, I'm encouraged to see healthcare architects and allied professionals mobilise and respond proactively to this health crisis by committing to quickly design structures that will help save lives and prevent further transmission of the Coronavirus.

The American Institute of Architects has assembled a task force to assist public officials, health facility owners and architects as they adapt buildings into temporary healthcare facilities. Two of my HKS colleagues, Erin Peavey and Yiselle Santos Rivera, serve on this task force and are hard at work developing a Covid-19 Rapid Response Safety Space Assessment for Alternative Care Sites (ACS) to safely and effectively provide health care operations in unconventional buildings and locations.

Photograph of the temporary hospital in New York's Jacob K Javits Convention Center is by The National Guard.

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