Let’s be honest. Most American hospitals are unprepared to treat a sudden surge in very sick and contagious COVID-19 patients.
Most hospital emergency departments are not laid out to instantly isolate possible coronavirus carriers. Most ED beds, general hospital rooms and surgical suites cannot be quickly converted into temporary intensive-care unit beds. The number of existing ICU beds, like hospital beds generally, have been in slow, steady decline.
This is by design. Over the past decade, government officials, healthcare payers and hospital leadership have focused on shrinking hospital bed capacity. More care is moving to home, hospice and outpatient settings. Complex procedures that once required a prolonged stay can now be done in a day. Cost-cutting and cost-effectiveness have been uppermost in the minds of hospital planners, not emergency preparedness.
Now, with the coronavirus pandemic pummeling the U.S. economy, hospitals across America are scrambling to prepare for an influx of very sick patients. A team of Harvard-based researchers estimated that only under a best-case scenario—a 20% infection rate stretched out over a year’s time—will the U.S. have enough beds to meet the demand, and that assumes half of the hospital beds are not used for their usual purposes.
This raises an important question. Why didn’t new or rehab construction projects over the past decade—post SARS (2003), post H1N1 (2009), post Ebola (2014-16) and post MERS (2015)—add surge capacity or include new or rebuilt rooms capable of rapid conversion for emergency use in an infectious-disease outbreak?
“For the most part, budgets don’t accommodate planning for a surge,” says Cyndi McCullough, director of evidence-based design for HDR, the nation’s largest hospital design firm.
There are a few notable exceptions. In 2012, Rush University Medical Center in Chicago rebuilt its flagship 697-bed hospital with pandemic preparedness in mind. Its ED ambulance bays can convert into large-scale decontamination zones with over twice normal capacity. A quarter of its regular beds can convert to negative air-flow rooms to protect both patients and staff.
But such projects are expensive and, as a result, few and far between. That’s why, as political leaders consider a massive stimulus package to ward off this pandemic-induced recession, they should give serious consideration to creating a grant and loan program modeled on the 1946 Hill-Burton Act.
It shouldn’t be used to expand capacity. That would only add to America’s healthcare cost problem. Rather, funds should go to rebuilding and remodeling existing hospital and outpatient facilities to double as surge capacity.
An Israeli hospital, for instance, rebuilt an underground parking lot to serve as an emergency 2,000-bed hospital. They installed hookups in the walls where they also stored beds, oxygen tanks and other critical equipment.
Hospitals across the country are preparing pop-up tents to serve as triage entry points and as emergency beds. But it’s not a good solution.
“One of the guiding principles for surge capacity is to have it be an extension of what the staff does on a day-to-day basis,” says James Lennon, ED design specialist for HKS, a hospital architecture-design firm. That means rooms, not tents.
Hospital architects estimate it would cost around $150,000 to build each new hospital room or refurbish existing ones for multiple purposes. A third of the nation’s hospital capacity could be modernized with a $40 billion program, which would be just a small fraction of a trillion-dollar-plus stimulus package.
As things stand now, hospitals are scrambling to make do with what they’ve got. They’re canceling elective surgeries. They’re clamoring for more respirators and personal protection equipment. They need immediate financial help to meet those needs.
But as Congress and public health officials grapple with those issues, they should also begin preparing for future pandemics. Helping hospitals rebuild as dual-purpose facilities should be put on the stimulus plan agenda.