Each day brings news of overwhelmed hospitals and medical staff at risk as they addresss the COVID-19 pandemic. In this context, healthcare facilities at the center of rapid outbreaks must add capacity and adjust existing capacity. Facilities near outbreaks must prepare for spillover needs as well as growing numbers of local cases.

In times like these, there are several principal areas of concern that we must focus on to sustain operations and address the crisis.

Meeting the demand spike. Patient volume and isolation needs require a rapid new supply of beds. The reactivation of mothballed facilities and conversion of existing space while considering codes and regulations serve as excellent options for additional space, however, older hospitals may prove considerably more difficult to convert, requiring the insertion of prefabricated patient environments into the existing structure. Each hospital relocation situation will be different, depending on the availability and quality of the building stock. While it may be possible to bring a mothballed hospital room or an unused licensed bed back online for use as originally designed, it’s much more difficult, time consuming, and expensive to convert a standard patient room’s finishes and HVAC into an isolation or ICU room.

Additional capacity can be gained by moving certain departments off campus to MOB or ambulatory care facilities. In areas of heavy demand, portable enclosures such as tented structures can solve issues of fit between patient rooms and available space. A critical issue in any scenario is maximizing the safety of both the caregiver and patient. Control of air and creating negative pressure in the patient room is highly desirable.

Space for staff training and family bonding. At this time, patients’ families are prevented from visiting admitted infectious relatives, which, while prudent, is very difficult for families in distress. It’s worthwhile to consider infrastructure for offsite communication or Skyping by family members. The benefits of maintaining family bonds, especially during hospitalizations, should not be undervalued within the framework of crisis response.

Additionally, to meet the pandemic head on, many additional healthcare staff will need to be trained, which raises the questions of how and where can this be done? Suitable locations include hotels, dormitories, and classrooms that have been vacated and made available. Also, let’s not forget the office space under direct control of hospital systems, either by direct ownership or lease arrangements.

Flexible patient care areas. Learning from the experience of COVID-19 will yield stronger and effective responses to prepare for the next epidemic. One way to do this is to create even more flexible patient rooms that are able to be converted quickly to positive or negative air flows and air quantities. HVAC management systems can play a huge part in making these quick conversions possible. Virtually every patient and support room should be capable of functioning at a higher level of acuity than its normal design usage. Beyond the mainframe, our hospital system must be prepared to co-op space in non-healthcare building types, which means coping with change and treatment in large-scale civic buildings.

George J. Kimmerle, AIA, NCARB, is founding partner of Kimmerle Group (Morristown, N.J.). He can be reached at GK@kimmerle.com.