As soon as the first wave of COVID-19 cases crashed on the United States, public health officials knew the problem was going to get complicated. In New York City, signs were already emerging by March 2020 that some people were continuing to struggle with symptoms long after they were no longer contagious. These so-called long haulers posed a new challenge for the public health system, and officials realized they needed to be able to treat patients not just with acute symptoms but also persistent ones.
So while city and state officials set out to build emergency facilities to triage and treat the first wave, designers from the global design firm Perkins Eastman began a fast-forward project to design and build new public health clinics that were capable of dealing with this very new kind of long-term patient. In collaboration with the New York City Department of Design and Construction, Gilbane Building Company, and the city’s public health care system, they rapidly designed three new community health facilities to accommodate long haulers in some of the hardest hit neighborhoods in the city.
“In less than a year, we designed and built 100,000 square feet of outpatient facilities,” says project manager Rachel Birnboim of Perkins Eastman. “We were doing the design and the construction simultaneously.”
Dubbed COVID-19 Centers of Excellence by the city, the three new clinics were built for $117 million and are located in Jackson Heights, Queens, the Tremont neighborhood in the Bronx, and in Bushwick, Brooklyn. They feature clinical space for typical public health needs, like cancer screenings or checkups with a general practitioner, but also dedicated areas for people experiencing lingering symptoms after a COVID-19 infection. There are specialized services like cardiology and pulmonary care, MRI machines, dental units, and spaces for mental and behavioral health services.
“The client was very forward thinking in not just trying to solve the problem in the moment but looking at the long-term solution to keeping people healthy and helping them through their recovery,” Birnboim says.
After less than nine months of design and construction, the first of the three facilities opened in November–about half the time it would normally take to get a similar project built under normal conditions. The scale of the need meant that design and construction had to happen very differently. Emergency response regulations at the city and state level allowed the projects to move ahead literally overnight, with building permits being issued in just 24 hours. “That’s unheard of for three buildings of this kind of complexity,” says Jeff Brand, healthcare practice leader for Perkins Eastman.
People were working on these projects around the clock, seven days a week, and construction was moving forward on parts of the building sometimes before designs were even complete. “We just had to move forward,” says Brand.
That led to some compromises. For example, materials were in short supply, especially those geared toward health care facilities, which were being built or adapted around the world as the pandemic spread. “We needed doors, hardware, lights. We had to go to Home Depot to get stuff because it wasn’t readily available,” Brand says.
The design of the clinics evolved in real time. Brand says that as health officials better understood the symptoms and challenges facing long haulers, the clinics were adjusted to provide different kinds of services, from negative pressure rooms to pulmonary exam rooms to bathrooms for severely obese patients. “We had to roll with that and say okay, ‘Let’s put a behavioral health ward here, let’s figure this out,'” Brand says. “We were all in, but the evolution of this was every week something else changed.”
Though the timeline for these three clinics was expedited, the designers didn’t lose track of the goal of serving the needs of long-haul patients, some of whom would likely be returning to these clinics multiple times a week for the foreseeable future. “The interior design and the welcoming aspect to it were really important to us, to make sure that people felt that it was safe and non-threatening,” Brand says. “It’s basically saying we will take care of you. You are a long hauler, you are not contagious, but this quadrant in this clinic is for you. Everything is there. It’s a one-stop shop.”