Some of the most heartening images of the response to the coronavirus pandemic have come from buildings—namely, the two massive hospitals constructed over 10 days at the epicenter of the outbreak in Wuhan, China. In January and February, millions tuned in all over the world to watch the livestream of the breakneck construction hosted by Chinese state TV. It wasn’t just a grandiose spectacle—the World Health Organization credited the 2,300 new hospital beds with helping to save lives.
The United States missed a critical opportunity to contain the virus after its first case emerged in January, and now the country is facing its own surge of patients, which threatens to overwhelm hospitals and doctors’ offices. This prompts the question: Can we also build new medical facilities to relieve the pressure? The short answer is yes, we have the technical ability, through modular and prefab architecture. The question is whether we can surmount the logistical and regulatory hurdles needed to make it happen quickly enough.
What’s clear is that we are racing against time and extremely bad odds. Based on what is known about the disease, the U.S. Centers for Disease Control and Prevention projected that the virus could infect 160 million to 214 million people across the country, requiring more than 20 million hospitalizations in a system that has less than a million beds. A study by the Harvard Global Health Institute projected that even in a moderate infection scenario, 40% of U.S. markets would not have enough hospital beds. In the event of a more extreme infection rate, many parts of the country would need to add or empty up to 800% more beds, which seems impossible in a system already pushed to its limits.
States like California and Washington have responded by adapting existing buildings like hotels, including converting an EconoLodge near Seattle into a coronavirus quarantine facility. But there are limits to this approach. According to Sara Bayramzadeh, a professor and coordinator of the healthcare design program at Kent State University, retrofitting buildings for healthcare needs, especially during an infectious disease outbreak, requires fulfilling stringent requirements. These include the use of materials that are durable and can be easily cleaned, being able to install negative air pressure systems to prevent the spread of infection, and laying in critical infrastructure like medical gas supply systems.
Because of this, Bayramzadeh suggests that prefabricated healthcare modules may be a helpful tool in constructing new facilities. Modular designs offer the added benefit of being adaptable for a range of scenarios. “Ideally, a flexible infrastructure needs a ‘plug and play’ system to allow components added or removed efficiently and safely,” she wrote in an email.
Prefabricated elements are also particularly well-suited to one of the urgent priorities for the healthcare industry right now: separating potential COVID-19 patients from the rest of the patient population and reducing the risk for medical providers. According to Juliet Rogers, president of Blue Cottage of CannonDesign, which works extensively with healthcare clients, “Modular, prefabricated and mobile units to keep patients quarantined until cleared without already entering facilities containing immune-compromised patients are key in these moments.”
Architecture firms around the country are working urgently to fashion these kinds of solutions for healthcare providers. CannonDesign is partnering with ModularDesign+, an alliance of fabrication, development, and engineering companies with expertise in prefabrication. Sean Studzinski, president of strategic initiatives at ModularDesign+, explained that the alliance could manufacture pod-style units that roll into larger spaces and lock into place within single-story arrangements. These could begin coming off the assembly line in four to eight weeks. The alliance can also fabricate volumetric units, which are structurally stable, load-bearing rooms that can be stacked on top of each other and finished with windows and cladding to create buildings in and of themselves, up to a 10-story medical field hospital. A recent project by CannonDesign and ModularDesign+ added 122 modular exam room pods to a medical center in Wisconsin, in the process saving an average of 10 weeks of construction time.
Some companies, like Factory Blue and Pivotek, also manufacture a range of prefabricated elements for healthcare settings, like restroom pods and hospital room headwalls. Health startup EIR Healthcare takes this a step further with MedModular, a fully prefabricated hospital room that hospitals can order on Amazon (the design won a Fast Company Innovation by Design Award last year). According to CEO Grant Geiger, its manufacturing process can integrate technology to make rooms suitable for intensive care and “coat every nail, screw, and swatch” with antimicrobial sprays to create a cleaner, safer room. The company can also engineer a room that can be adapted from a standard hospital bed to an acute care room, or expand a single bed unit to one that can accommodate double beds.
However, many firms caution that prefabricated healthcare units may not be part of the first wave of emergency responses. EIR Healthcare’s Geiger envisions that in the best case scenario, MedModular units can be mobilized in 60 to 90 days. EIR Healthcare also provides products to the hospitality industry, and has retooled those assembly lines to produce healthcare modules. Geiger estimates that his U.S. manufacturing partners could produce 30 COVID-19-ready, negative-pressure units a week, or 60 standard units a week, if staff worked around the clock in three shifts. The factories outside the U.S. work even faster, with the ability to make 50 negative pressure units or 75 standard hospital rooms a week. Similarly, Studzinski said that while the ModularDesign+ alliance might be able to produce its pod-style units to begin coming off the assembly line in four to eight weeks, a project would normally require a 9- to 12-month production timeline.
Beyond the demands of the design and production process, architects also face regulatory and political constraints that could hinder the rapid construction of prefabricated medical facilities. In designing and constructing three prefabricated healthcare facilities in the Seattle area, Brad Hinthorne, a principal in Perkins and Will’s Seattle office, shared that some of the gains made in the pace of construction due to prefab were sometimes slowed down by different permitting processes, since the prefab building was regulated as a “piece of equipment” rather than as a building, while the construction site was regulated by the municipality. “Even if you had the modules available, finding a site is a challenge in the U.S., particularly in urban environments where the land is highly developed,” says Jean Mah, a Perkins and Will principal and the firm’s Global Healthcare Practice leader. As an example she pointed out that some communities in the United States have already objected to the conversion of vacant hotels into hospitals.
Architecture firms are now exploring the potential for prefabricated designs to fulfill medium and long-term needs that may arise from the coronavirus pandemic. For example, CannonDesign is working with L.A. County on a prefabricated housing solution for homeless patients released from hospitals. The Restorative Care Village, as the project is called, will offer a four-story structure with 96 beds for those needing a place to recover from medical procedures, along with a 64-bed residential treatment program across four buildings. This project might offer a template for other cities seeking to offer spaces of recovery to COVID-19 patients without homes.
Ultimately, the coronavirus pandemic is raising questions about the importance of increasing investment in healthcare infrastructure to have better surge capacity. Flexible rooms and spaces that can be adapted for acute care, quarantined patients, and triage in the event of an emergency would offer much-needed relief in the current circumstances and across the projected life cycle of the virus, which may continue to reinfect the world after this first catastrophic wave of infections. “My guess is it is slightly more expensive to build a hospital that way,” said Jeffrey Levi, a professor of public policy at George Washington University’s school of public health. “But it would be more worth the investment from a public standpoint if you could create that kind of flexibility so that in an emergency, the infrastructure is already there.” Toward that end, prefabricated and modular healthcare designs can be more expensive in the short run, but they may provide a critical advantage in an era when global pandemics seem to be emerging as a norm, not the exception.