Should the US Start Building More Hospitals to Handle COVID19?
Andrew M. Ibrahim MD, MSc
Surgeon-Scientist building for health, Vice Chair, Board Director, ex- C-suite | Improving health through evidence and design
1/ Was asked today by Architectural Digest, "Do we need to start building new hospitals right now to handle the Corona Virus epidemic?" #COVID19
Short answer: Maybe. But not the kind you're probably thinking.
Explanation below...
2/ The first move to improve hospital capacity for #COVID19 has nothing to do with hospitals. It is reducing demand. All the efforts #FlattenTheCurve including #SocialDistancing are key to making this epidemic manageable. A primer from @AriadneLabs : https://www.ariadnelabs.org/resources/articles/news/social-distancing-this-is-not-a-snow-day/
3 / Thoughtful work from Ashish Jha and Thomas Tsai with Sarah Kliff have modeled our bed capacity across the US. What determines if we have enough? How many people get the virus and how fast it spreads. Another compelling case for #FlattenTheCurve https://nytimes.com/interactive/2020/03/17/upshot/hospital-bed-shortages-coronavirus.html
4 / But we probably *will* need more hospital capacity than we have right now because we're late to #FlattenTheCurve efforts. So now what? Build more hospitals? Not yet...
Next, move clinic appts to telehealth (now easier w/ new @CMSGov payment waivers): https://cms.gov/newsroom/fact-sheets/medicare-telemedicine-health-care-provider-fact-sheet
5 / Clinic visits and virtual health will limit spread, but won't free up inpatient beds.
*NOW* can we build more hospitals? No.
Relocate, postpone or cancel non-emergency medical, dental and surgical procedures. Some guidance from The American College of Surgeons: https://facs.org/about-acs/covid-19/information-for-surgeons/triage
6 / How does stopping surgical procedures free up beds to manage #COVID19 patients?
- 1.) Frees up staff (e.g. surgeons, anesthesia, nursing)
- 2.) ICU beds reserved for surgical patients now free
- 3.) ORs can be converted to ICUs...
Quick overview from Adam Schlif: https://generalsurgerynews.com/Web-Only/Article/03-20/Preparing-for-Overwhelmed-ICUs-by-Leveraging-Existing-ORs-Anesthesia-Machines-and-Perioperative-Personnel/57642…
7 / Now can we build? Patients in respiratory failure require:
- Hospital intensive care bed
- Mechanical Ventilator
- ICU Staff (esp nursing!)
- Personal Protective Equipment (Gowns, eye shields, face masks, etc.)
#4 to run our first, not #1: https://vox.com/the-goods/2020/3/20/21188369/face-masks-short-supply-coronavirus-donations
8/ OK, so if we exhaust our capacity, have enough PPE / vents / staff, should we build more hospitals? Two Options...
Plan A: Use prefabricated ("Pre-Fab") hospital components to make a very lean version of a hospital (think trailers + Legos). https://architecturaldigest.com/story/china-building-hospital-10-days-what-design-must-get-right
9 / Pre-fabricated hospital may work, but probably take longer than the two weeks reported in China. What might be faster?
Plan B: Take advantage of existing - but now empty - buildings like hotels, schools or others still under construction. https://architecturaldigest.com/story/should-us-follow-china-model-makeshift-hospital-stop-coronavirus?utm_source=twitter&utm_medium=social&utm_campaign=onsite-share&utm_brand=architectural-digest&utm_social-type=earned
10 / In fact, efforts already underway to explore how existing empty buildings in NYC could readily be converted into hospitals beds. Particularly lower acuity beds that off-load the larger centers handling of most COVID patients.
11/ Like all things #COVID19 related, the data & what we're learning is constantly changing and informing new plans. For now, we ought to work to hard to decrease hospital demand (#FlattenTheCurve), maximize current infrastructure, THEN... we may need to build.
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Andrew M. Ibrahim MD, MSc is the Chief Medical Officer at HOK and Directs the Design & Health Fellowship at the University of Michigan. All views expressed above are his own and do not reflect HOK of the University of Michigan.
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