Real estate to the rescue: Identifying and converting temporary space for COVID-19 healthcare needs

Now in its second month in the United States, the COVID-19 pandemic is maturing rapidly nationwide, with daily increases in infection counts in all 50 states and the District of Columbia. Much of the country is now under shelter-in-place laws to reduce community spread, but it will take time for the remediating effect of these measures to appear in the data. For now, new infections are surging, and advanced cases – with complications necessitating ICU care – are expected to peak on a rolling basis until early May. Governments, hospitals and healthcare systems are deep in preparation and execution mode, evaluating their projected caseload against their currently available resources to determine the extent and urgency of their temporary space requirements. The expected shortages vary by location, date and severity, as indicated by the graphs below. The first graph accounts for the midpoint of ICU bed shortages. Scroll to view the second and third graphs to view estimates of the low and high points:

JLL research has identified more than 80 temporary facilities projects encompassing more than 20,000 beds in various locations across the country; this is just a known fraction of the total number currently underway. These projects run the gamut from large arenas and conference centers to dorms, office space, hotels and non-acute areas of existing hospitals, as well as industrial facilities housing additional medical supplies. The use of these temporary facilities have been primarily for COVID-19-specific care (both intensive and step-down/recovery), overflow non-COVID care, medical staff housing, supply storage, quarantining, and homeless shelters. Conference centers and other large spaces can accommodate equipment transport, specialized HVAC requirements such as lowered air pressurization to minimize contagion, and intensive electrical usage. Skilled nursing centers are also prized as converted facilities given their existing medical staff and customized beds and monitors. Hotels and dorms are more valuable for quarantine and sheltering, as it is more difficult to retrofit them for patient care.

Ideal site planning and identification factors:

The identification and conversion of space will be defined by the unique needs of the facilities. In some cases, alternative space is needed most for the surge of COVID-19 patients. In other cases, there are needs for low-acuity patients, physicians and nurses or specialized storage of equipment. To plan for temporary space, here are a few questions that should be addressed:

• Services: What services will be provided at the facility? If it will serve as a hospital, will it serve patients with or without COVID-19 symptoms, or both? Will the facility provide full acute care? Emergency care? Imaging services? The answers to these questions will inform the space requirements.
• Operating Entities:  What entities will be involved contracting and managing the facility?  What entities will provide the clinical care at the site?
• Building integrity: What is the condition of the facility? Are the utilities still on? Are there any environmental issues that require attention, such as mold abatement or air quality?
• Physical distancing: How will distancing measures be executed? What physical barriers and extra security will be needed?
• Food service: Is there adequate kitchen space and the right equipment to prepare and store food?
• Security and safety: What security measures does the building have? How will COVID-19 patients be secured? Are there emergency operations and fire response plans in place?
• Hazardous materials and waste: What systems are in place to dispose of medical, chemical, biohazardous, radioactive and other types of waste?

The questions above are merely a starting point. Healthcare operators should leverage data and analytics from their existing portfolio and the surrounding real estate to ensure the most appropriate facilities are identified within short timelines. For example, an accurate database of medical, hotel, retail and industrial properties coupled with sophisticated GIS mapping and analytics tools can take into consideration the required parameters for location, size, building type and characteristics for alternative space needs.

Federal, state and local governments have taken a lead role establishing temporary COVID facilities.  The CDC has published guidance on “Alternate Care Sites” to help address surge needs in response to COVID-19.  For many of the existing conversions, the process has typically started with a site assessment conducted by the Army Corps of Engineers, who negotiate operating agreements with property owners and then a hand-off to local authorities. JLL is actively sourcing, converting and activating space as a client-service priority for its healthcare clients. The firm is actively in pursuit of warehouse space for a Midwest hospital and research group members. JLL is also helping a hospital in Texas, define future retrofitting with a feasibility analysis for a potential recommission.

 The need for temporary COVID space is flaring sharply now.  Rapid, informed and decisive action are essential in securing and preparing this space.  As chaotic as the situation is, how long the temporary space will be needed is less clear and will be determined by the success in fighting the virus over the next few weeks.