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Army Corps of Engineers and FEMA construct an alternate COVID-19 care facility at Javits Convention Center in New York City. Photo: K.C. Wilsey, FEMA

The Challenges of Converting Buildings Into COVID-19 Treatment Centers

In March, when New York City hospitals were anticipating a shortage of beds for COVID-19 patients, FEMA and the Army Corps of Engineers stepped in to convert the Javits Conference Center into a temporary COVID-19 hospital. To outside observers, the process seemed quick and straightforward. Those of us in the design industry know that the reality was far more complex.  

Any adaptive-reuse project is difficult at the best of times, even for temporary facilities. But factor into the equation a virus that spreads rapidly and easily, and the challenge increases exponentially, especially from an engineering standpoint.  

When admitted to the hospital, patients with infectious diseases (like measles or tuberculosis) are housed in airborne infection isolation rooms (AIIs). Within these units, air is exhausted rather than recirculated, with more air being exhausted than supplied. Engineers call this process “negative pressure,” and it is essential for protecting COVID-19 caregivers from airborne contaminants.    

The healthcare team at Syska Hennessy has undertaken many COVID-19-related projects over the past few months.  Most of our work on these projects centers on mechanical, electrical, and plumbing engineering, all of which play an important role in the treatment of patients and preventing the spread of the virus within facilities.  

For example, we recently converted residential space for nurses into COVID-19 ICUs at North Central Bronx Hospital in New York City.  The existing HVAC equipment comprised fan coil units, which would have recirculated the air. We had to replace these with air-handling units with two different modes of operation: neutral pressure space for normal operation and negative pressure to help protect the caregivers and the adjacent departments. These addressed the unique demands of a pandemic but can also be used for conventional ICUs in the future.   

Ventilators posed another challenge. Since so many patients in COVID-19 ICUs require them, the load on the existing oxygen distribution system was enormous. Accordingly, at North Central Bronx Hospital, we had to work closely with a vendor to expand the capacity of this system and route a new riser to accommodate this extra load. We also had to design a dedicated electrical circuit to avoid overload. The sharing of circuits could cause a circuit breaker to trip, which, in turn, could shut off the ventilator. And then there is dialysis, an increasingly common treatment because COVID-19 patients sometimes experience kidney failure. The operation of dialysis machines requires not only extensive electrical power, but also intricate plumbing systems for purging purposes. Our designs had to fulfill both requirements.   

All of these challenges had to be overcome on a rapid-response basis. A few months ago, we had no clue that the coronavirus would ravage the U.S. so quickly. We and our clients had limited time to react. Amazingly, the project team completed the hospital conversion within thirty days. Contrast that timeframe with the typical one for a project of this size and scope—six months. To compress the timeline this much, our office, the architect, the contractors, and the client were all basically working around the clock.  

There was also another important complication, virtual coordination. Because of how contagious the virus is, we had to limit in-person meetings and site visits. As it turned out, the lead architect for the project came down with the coronavirus after the initial on-site meeting. I had attended that nine  hour meeting and subsequently had to self-quarantine for fourteen days. After that, we relied primarily on Skype, Microsoft Teams, email, and calls to coordinate work with project partners. One engineer even performed an on-site survey while sharing the feed with other team members, which allowed us to collaborate in real-time.  

Our project is a clear example that the repurposing of space for COVID-19 treatment is hardly straightforward or simple. But as the coronavirus spreads from the epicenter in New York City to other areas of the country, placing extreme demands on medical facilities in the process, more of these conversions may be necessary.  

Some commercial buildings, however, are better suited to conversions than others. In New York City, local governments considered dormitories, hotels, office buildings, and other spaces. Meanwhile, my colleagues and I partnered with the Greater New York Hospital Association to assess the viability of local spaces for COVID-19 conversions. In many cases, we determined that the best solution would be adapting these spaces to administrative usage to free up space in hospitals for COVID-19 treatment. The reasoning for this is that medical-grade systems in the hospitals are already in place, which saves a giant step.  

Tents are another option for non-acute care. My team recently designed mechanical, electrical, and plumbing systems for a temporary hospital in the parking lot of New Bridge Medical Center in Paramus, New Jersey. But tents present challenges of their own. You must bring in electrical service from a local utility to the site, and you have to equip the space with sufficient HVAC units to meet code compliance.

Fortunately, in the tri-state area (New York, New Jersey, and Connecticut), local hospitals were able to cope with the increased demand, which led to the closing of the Javits Center temporary facility and the departure of the hospital ship USNS Comfort. But we learned many lessons from this experience, and we hope to apply these lessons to other areas of the country. To this end, the senior leadership team across our U.S. offices holds daily calls to discuss best practices.  It is a young virus—we don’t know much about it yet. But we are preparing for the next phase, whether that entails wider geographic penetration, a second wave, or both.    

Because of state lockdowns, many commercial facilities have low occupancy these days. Some may be good candidates for COVID-19 treatment centers. Others may be better suited to temporary offices for hospital administration. In my experience to date, the commercial real estate industry has responded to the prospect of conversions with enthusiasm and generosity. Our design community appreciates the support. At the same time, we want to caution owners and operators that the conversion process will not be easy, even though it might be quick because of the urgency of the situation. It is hard to predict the next stage of the crisis, but one thing is certain: By planning ahead to repurpose space, we can improve the outcome.   

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