5 insights as architects lead hospital conversion for COVID-19

In the race to treat the staggering number of COVID-19 patients around the globe, architects bring a crucial skill to adapt buildings for hospital conversion: multidimensional thinking.

hospital conversion jacob k javits center nyc

Zach Mortice

April 21, 2020

min read
hospital conversion jacob k javits nyc
Government staff build temporary treatment rooms at the Jacob K. Javits Convention Center in New York, March 26, 2020. Image courtesy of K.C. Wilsey/FEMA.

In February 2020, Molly Scanlon—a licensed architect and environmental health scientist—started noticing curious videos of modular hospitals in Wuhan, China, for patients who had contracted a mysterious new virus.

The hospitals were austere and institutional, bordering on factory-like, with wide, segmented bays. Prefabricated components were trucked on-site and slotted into steel frames. Patient-care rooms had negative-pressure ventilation systems to minimize contagion spread. And hospital staff were covered head to toe in personal protective equipment (PPE). But the speed of the endeavor was perhaps most impressive: From clear-cutting the site to staffing up, the first such hospital was built in 10 days, opening its doors on February 5, 2020.

“When I first saw these images on social media, my architectural colleagues said, ‘Isn’t this interesting how rapidly the hospitals are being built?,’” Scanlon says. “I looked at it and said, ‘This is a pandemic response. This is a quarantine facility.’ That was a clue this was going to turn into a wide epidemic, if not a pandemic. These were signals that something is coming.”

Now that COVID-19 is here, architects and builders in the United States are responding with what they have at hand, which largely means the ad-hoc adaptive reuse of existing buildings for hospital conversion—from constructing a makeshift field hospital inside New York’s Jacob Javits Convention Center to reopening Los Angeles’ shuttered St. Vincent Medical Center. To aid this effort, the American Institute of Architects (AIA) assembled a task force that Scanlon chairs, along with a checklist and guide to converting existing buildings into COVID-19 hospitals. It’s a language of architecture that bypasses formal qualities for raw function, delivered with improvisational shoehorning.

Using expertise from architects, engineers, scientists, health-care professionals, and hospital facility operators, the checklist offers guidance specific to COVID-19. The document is meant for a wide range of audiences; it’s an easily explicable resource that will be ready for organizations (such as schools) that are pressed into service and that don’t have the assets or technical sophistication of the government.

“I think this will influence all levels of the built environment, and all architects will be impacted by this,” Scanlon says. Here, she shares her thoughts on how designers can use their skills to change the world in an emergency without parallel.

1. It’s okay if no one needs architects to draw

There might not be much room for the painterly delineation of space when rushing to adapt buildings for COVID-19 hospital conversion, but architects have many other useful skills. As multidimensional thinkers who manage complex projects, architects, even those without health-care experience, “could be very helpful as facility managers,” Scanlon says.

Architects’ value here comes from their holistic understanding of how buildings work, ensuring that individual systems, programs, and procedures (many functioning in spaces never intended for them) can work together. While HVAC or MEP (mechanical, electrical, and plumbing) engineers may know how to press an existing building’s systems into health-care use, they might not understand how these changes could impact other operations, such as circulation—exceptionally critical to prevent spreading a deadly virus. Similarly, epidemiologists will have guidelines for triage choke points but may not know which materials are durable enough to withstand heavy use. An architect would likely know or could find a way to accommodate these requirements.

2. There’s no clear hierarchy of spaces for adaptive reuse—yet

hospital conversion isolating workers prepping room for patient
In a pandemic, isolating patients is critical.

At this early stage, it’s unclear which types of buildings typically requisitioned for emergency response make the best pandemic quarantine hospitals. Buildings fall into two broad categories: open-bay buildings (sports arenas, convention centers) and closed-bay buildings (hotels, college dorms), which are seemingly better for COVID-19 patients requiring isolation.

Scanlon says a key factor in determining if a space is appropriate for reuse is its potential application—whether it would be used for covering the surge capacity for COVID-19 patients or the surge capacity for non–COVID-19 patients displaced from hospitals by the pandemic.

“I think we’re going to know which type of use is best when it’s over,” Scanlon says. Images disseminated by the media often show beds in a row in open-bay spaces, “like cots after a flood,” Scanlon says. “We’re not responding to a flood. We’re responding to a pandemic that requires isolation of patients.”

3. In crisis, the distinction between “bonus” and “essential” is nuanced

The AIA task force guide worked to define what is “essential” in an emergency adaptive-reuse health-care setting—and what is not. But there are instances when “essential” overlaps with human comfort and relaxation.

For example, the guide includes a checkbox for daylight access. Daylighting is often regarded as a mood enhancer in public spaces or an experiential bonus in art studios. Here, it’s closer to a necessity. “There’s plenty of evidence that allowing daylighting and views of nature reduces stress and complements healing,” Scanlon says. “It can maintain circadian rhythms so people can rest appropriately. It can give you a sense of night and day.”

These daylighting benefits are vital for patients and staff, considering the duration of coronavirus hospital stays. “I think people are not realizing that the health-care staff and patients are in this for extended periods of time; COVID-critical patients can be in this situation for 14 days,” Scanlon says. “Being in a setting like that can cause psychological issues. We’re in this for days and weeks.”

4. Supporting patients and families is key

Included in the checklist are reminders that designing for a pandemic is not just a series of technocratic deliberations. The list outlines functional end-of-life concerns with architectural ramifications—and emphasizes an essential focus on human compassion during a global crisis of historic proportions. Issues include accommodating family visitation with proper quarantine procedures when possible and considerations for Wi-Fi–enabled tablets for virtual video communication when it’s not possible.

“It was very concerning to the task force that we be able to deal with end-of-life issues in which a family member is not going to see a patient,” Scanlon says. The checklist also suggests windows in quarantine wards where patients are conscious. “We’re going to lose a lot of people, and we didn’t want loss of life in an undignified way,” Scanlon says.

5. Consider a world after COVID-19

Once COVID-19 is not an immediate existential threat; surge-capacity thresholds are understood; and there is ample time for research, analysis, and grief, a number of architectural responses seem intuitive. Scanlon anticipates more formalized systems for mobile pop-up COVID-19 testing and some form of prefabricated hospitals, per the examples in China. But, she says, smaller interventions will impact more intimate details of people’s lives, bringing the reality of pandemic into home designs. (Imagine your mudroom having a decontamination shower next to the coatrack.)

Beyond that, architects are asking the same daunting questions as everyone else: “Is there any interim model where people could go to school and function at work?” Scanlon says. “Could we go to a different model where all of society doesn’t shut down? And what role does the built environment play in that model? That’s the question the future has to answer.” When designers finally have time to draw, they will be tasked with creating for a world that looks very different.

The appearance of U.S. Department of Defense (DoD) visual information does not imply or constitute DoD endorsement.

Zach Mortice

About Zach Mortice

Zach Mortice is an architectural journalist based in Chicago.

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