Hospital systems across the United States have endured an unprecedented surge in patients in the wake of the novel coronavirus (COVID-19) pandemic—and that has meant having to embrace short-term crisis options to save lives, even as the future remains murky.
Perhaps the biggest challenge of all: Where to safely house the influx of coronavirus patients without exposing others to the highly infectious disease?
The deadly coronavirus has forced hospital task forces to improvise, from converting conference rooms and nontraditional intensive care wings into COVID-19 war rooms to erecting triage tents and marshaling resources to extinguish newly emerging hotspots. And as they contend with a deluge of patients inside the hospital, they’ve had to make decisions about how to staff make-shift centers, further stretching crucial resources.
It’s also required a significant decline in traditional services, including the cancellation of elective surgeries at some institutions and the suspension of volunteer privileges, among other programs.
If you’re looking for a word to describe the crisis, nothing better characterizes the frenetic response than “chaos”—but that hasn’t stopped hospitals from doing their part to contain the spread of the disease.
However, before the full weight of the pandemic came down on these hospital systems, executives warned of an insufficient amount of personal protective gear (PPE) and ventilators to combat the disease. The cost of taking on this challenge and hunting for resources has only added more stress to these institutions, potentially imperiling them financially, especially those in rural areas.
As a result, hospital executives have had to consider many of the aforementioned short-term options even as they forecast for the future, however difficult that is. So, what will the future of healthcare crisis response look like when the pandemic comes to an end? It could mean stockpiling resources for emergencies or investing in emerging medical solutions to modernize hospital operations, such as prefabricated modular units.
Here’s a look at how hospital systems and governments have responded to the crisis and decisions they can make now—and in the long-term—to help combat such insidious diseases.
Challenges In Finding ICU Beds
No state has been more deeply affected than New York. With more than 24,000 COVID-19-related deaths (as of this writing), it is at the center of the pandemic. So that’s where we’ll focus most of our attention. As the situation worsened, officials said they lacked ICU capacities and potentially life-saving ventilators.
Space quickly emerged as a critical need. As a result:
- The U.S. Army Corps of Engineers converted Jacob Javits Center, a trade-show hall on the westside of Manhattan, into a make-shift hospital equipped for upward of 2,500 patients.
- The USNS Comfort arrived in Manhattan on March 30 to much fanfare. But after only accepting around a dozen non-COVID-19 patients, it was later approved to treat those who were infected.
- A 14-tent field hospital assembled in New York’s famed Central Park filled up within days of opening. A nurse who volunteered in Iraq reportedly compared the improvised hospital to a “war zone.”
- Hospital systems resorted to erecting triage tents in parking lots and converted conference rooms or storage spaces into ICU units.
- New York City said it would lease space at area hotels for non-intensive care for patients suffering from the disease.
New York Gov. Andrew Cuomo said from the outset of the crisis that the shortage of ICU beds in New York would constrain hospitals, underscoring the need for alternative spaces. Although New York has been under the spotlight, the ICU bed shortage is not unique to the Empire State.
One of the biggest obstacles is the fact that ICU beds are unevenly distributed across the country, with 90 percent of ICU beds (90,561) located in metropolitan areas. According to Kaiser Health News, “18 million people live in counties that have hospitals but no ICU.”
Additionally, a study released in March by the Harvard Global Health Institute found that 40 percent of hospital markets “would not be able to make enough room for all the patients who became ill with COVID-19, even if they could empty their beds of other patients,” according to The New York Times.
“They don't build capacity that they don't need,” Cuomo said of the state’s hospitals, many of which are private. “They don't build extra ICU beds just in case. An intensive care bed is very expensive. They don't build a wing of ICU beds that sit vacant for 10 years on the off-chance that there's going to be a public health emergency and you'll need the beds... so we don't have them. We have the capacity that people use day-in and day-out. And that's not just New York. That's every state in the United States. You now have this influx, you can't handle it."
In a piece for Harvard Business Review, Dr. David Blumenthal and Shanoor Seervai, both of the Commonwealth Fund, a private foundation that aims to improve access to healthcare, said the US healthcare system has a “lack of reserve capacity to handle” a crisis such as the coronavirus pandemic.
“For example,” they wrote, “the system’s supply of hospital beds has been declining for the past two decades because of hospital closures and mergers.”
The segmented nature of hospital systems exposed another fault: How can a state government effectively coordinate a singular response when communicating with myriad organizations amid a pandemic?
New York decided to place all hospitals—both public and private—under a centralized system led by the state’s Department of Health. This would allow providers to share supplies, staff, and resources, and, in theory, make it easier for hospitals that need assets to receive them, the state said.
In early April, overly stressed New York City hospitals began transferring coronavirus patients to upstate facilities that hadn’t yet experienced a rise in cases.
One upstate New York county executive said hospitals would accept patients from downstate regions as long as they could also care for local patients. “We’re all New Yorkers,” he said.
Around that time, Albany Medical Center also began taking on coronavirus patients from hard-hit New York City hospitals and said it would accept additional cases if needed.
“The reason we take those transfers is, No. 1, that is our mission,” Albany Med President and CEO Dennis McKenna said. “That has always been our mission, and we’re always happy to do that and we know that we can provide the care that’s needed.”
Finding space to treat patients hasn’t been the only problem. The virus came on hard and fast and meant more nurses would be needed to deal with the influx of cases.
Officials publicly called on retirees to return to service and appealed to nurses from less-affected regions to aid their colleagues—an incredibly selfless act considering many dozens of nurses and doctors have died combating the disease.
With demand high for healthcare professions, colleges are allowing early graduation for fourth-year medical students, which could mean more help is on its way to fight the disease.
Well before the coronavirus pandemic’s arrival, experts were warning of a significant physician shortage in the United States, largely due to the country’s growing and aging population. Combined with a lack of ICU beds and having to come up with out-of-the-box solutions for treatment areas, the COVID-19 pandemic has underscored the dexterity of the healthcare industry. But at the same time, it’s made clear that many hospitals don’t have the capacity to handle an emergency of this magnitude—thus the unique measures being adopted.
A More Efficient Way Forward: Modular Healthcare Units
While officials debate the merits of potentially reopening the economy, the consensus is that social distancing measures will continue in order to “flatten the curve,” prevent new hotspots, and to stop a second wave of the virus from paralyzing the country yet again.
While the aforementioned stop-gap measures have been useful in mitigating the disease’s impact, these are only considered temporary solutions. Modernizing resources as the crisis unfolds may present a more sustainable solution while also providing immediate relief.
Modular healthcare units have emerged as popular alternatives to constructing new building add-ons or creating new facilities from the ground up. Not only can modular units be mobilized within weeks, but they’re adaptable and, if constructed properly, meet often stringent regulatory hurdles. Adding to the appeal: Hospital systems can more easily separate those infected with COVID-19 from other patients, especially those who have compromised immune systems.
While some have already been used to isolate COVID-19 patients from general admissions, Modular MD announced it can produce 300 modular units per month outfitted for ICU use.
Modular MD is a joint venture between healthcare design and construction firm Central Consulting & Contracting, Inc. and iBUILT Group, one of the country’s leading modular manufacturers.
The units are made to meet all regulatory requirements and can house up to six patient beds, including a bathroom once the unit is delivered and assembled. Production is expected to triple by the third quarter of 2020.
These prefabricated units provide healthcare facilities a more affordable solution without sacrificing treatment. Medical modulars also eliminate the need to erect temporary field hospitals or to lease out private buildings to provide care. And in the long run, modular units can be deployed for future emergencies or to be added to a hospital’s existing infrastructure to increase efficiency. Modular MD, for example, offers storage and financing solutions to enable hospitals from accessing the units as they need them.
Over the last decade, hospital construction costs have been on the rise, though it has leveled off in recent years. As of February 2020, spending reached nearly $43 billion. Hospitals say their appetite for better facilities is out of a desire to improve satisfaction among patients. With the average cost of hospital construction at $400 per square foot—and much higher in New York City, for example—identifying ways to reduce costs has become paramount.
Hospitals emerging from this crisis may never look the same again. The first obvious challenge is helping staffers cope with the devastating and life-altering consequences of the coronavirus pandemic and the countless lives it took, including many of their colleagues. Helping nurses and doctors recover from the mental anguish associated with this battle will likely also be front and center.
Beyond the human consequences, executives may consider modernizing operations, which could mean identifying cost-saving measures while also improving healthcare services.