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Military members install the rest of the support elements; beds, signage, bedding, and shelves to hold the medical supplies and equipment to treat patients at the Jacob K. Javits Convention Center in New York City, April 3, 2020. (U.S. Air National Guard photo by Major Patrick Cordova)

As cases of COVID-19 continue to increase rapidly in the United States, hospitals and morgues are facing the harsh reality that there simply is not enough space. New York State alone is forecasted to lose more than 13,307 people to the virus before August 4th, 2020, equalling 22% of the nation’s total estimated deaths. American Hospital Association records show that there are 924,000 staffed hospital beds in the country, and given that many of those beds are utilized on a day-to-day basis, researchers predicted that the US’s peak resource usage was on April 10th, 2020, and experienced a shortage of 10,867 hospital beds and 13,851 ventilators. The majority of the resource shortages stem from New York State but Boston Medical Center has also experienced deficits in ICU availability, and at times has had to direct patients to the city’s other hospitals. 

In order to increase treatment capacity, many cities are repurposing publicly-funded spaces by transforming universities, convention centers, sports arenas, and even parks into field hospitals, temporary morgues, and temporary housing. Budgetary breakdowns show that retrofitting non-medical areas to accommodate patients is $1.85 million cheaper (per bed) than constructing new hospitals. Suffolk University and New York University, among others, have announced that vacant dormitories can be used for scenarios like housing homeless patients and relieving spatial stressors for hospitals and local emergency response officials. Massachusetts is starting to transition nursing homes with existing medical infrastructure into treatment facilities. Manhattan’s Pier 90 is now home to the U.S.N.S. Comfort, a ship that recently began accepting COVID-19 patients. The NFL’s Seattle Seahawks are converting their stadium into an overflow hospital for patients not experiencing coronavirus symptoms, and the State of New Jersey is enacting a similar strategy via the transformation of three convention centers. Central Park offers what is perhaps the most visible metamorphosis, as Mount Sinai Hospital and the evangelical Christian organization Samaritan’s Purse are treating patients beneath large white tents on the East Meadow. 

Members of the West Virginia National Guard’s Task Force Chemical, Biological, Radiological and Nuclear (CBRN) Response Enterprise (CRE) (TF-CRE) and Task Force Sustainment (TF-Sustainment), unload medical equipment to build statewide medical surge capacity during on-going COVID-19 pandemic response, April 9, 2020. (U.S. Army National Guard photo by Edwin L. Wriston)

While developing field hospitals solves the issue of space, it simultaneously presents a new complication: a very unconcealed, prominent display of human suffering. This is especially apparent in the establishment of temporary morgues. After surpassing its daily death toll threshold of 200, New York City received a shipment of 85 refrigerated trailers from FEMA, otherwise known as Body Collection Points (BCPs) to be utilized for deceased victims of COVID-19. These trailers, which can accommodate 9-44 bodies, are parked on street corners outside of hospitals and medical centers, and are connected to the sidewalk by makeshift wooden ramps to ease access for gurneys and stretchers. Furthermore, should the situation exacerbate, the city’s Pandemic Influenza Surge Plan outlines a contingency plan that involves temporary burials on the Bronx’s Hart Island, where two mass graves dug by incarcerated persons are prepped for over 19,000 bodies. In hopes of avoiding this outcome, mayors, like Boston’s Marty Walsh, are expediting permits for hospitals looking to expand existing mortuaries. 

Looking ahead, private corporations are also beginning to mobilize around this initiative. Hotels are expected to be the next sector offering spaces, if not for patients in isolation, then for healthcare workers or people experiencing homelessness. Private colleges and universities are getting involved as well, with Northeastern University, Tufts University, Vanderbilt University, and Middlebury College already contributing now-vacant buildings to the response efforts. As we prepare ourselves for the reality that this will not be the last time we face a pandemic of this proportion, teams of public health officials, emergency managers, and urban designers are already developing codes and standards for newly constructed buildings to better facilitate potential adaptations in times of crisis. History indicates that adopting resilience best practices earlier rather than later can make a world of difference and will save countless valuable lives. 




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