The Coronavirus: To Build, or Not to Build?

Updated: Apr 28

How should healthcare systems across the US react as they develop long-term capital and facility plans?



Source: The Center for Systems Science and Engineering (CSSE) at Johns Hopkins University - https://www.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6


Current State

I am sure we have all seen the headlines, here’s the latest reporting (as of March 2, 2020):

  • 89,000+ confirmed cases worldwide, 3,000+ deaths and 45,000+ patients recovered

  • China constructed two temporary hospitals adding 2,600 patient beds in the city of Wuhan

  • The COVID-19 virus, the scientific label for coronavirus, has unique aspects that scientist around the world are studying:

  • It initially appears that the virus has a lower mortality rate compared to SARS and MERS but a higher infection velocity or R Naught value

  • CDC recommends avoiding travel to ‘Level 3’ countries, China, South Korea, Iran and Italy. Currently, Japan is the only ‘Level 2’ status

  • Human trials for treatment are currently underway at University of Nebraska Medical Center

When compared to other historical disease outbreaks, the Coronavirus is not as infectious as other diseases (Measles or Small Pox for example) and still has a wide R Naught range (1.4-4.08), this could evolve as time passes and more data becomes available.

R Naught: ‘The basic reproduction number (R0), also called the basic reproduction ratio or rate or the basic reproductive rate, is an epidemiologic metric used to describe the contagiousness or transmissibility of infectious agents’


Source: University of Michigan, School of Public Health: https://sph.umich.edu/pursuit/2020posts/how-scientists-quantify-outbreaks.html


Do Historical Trends Predict Future Events?

With all this information available, as a strategic healthcare facility planner, one has to question – so what? Do historical trends of a new viral outbreaks every 2-3 years dictate future events? Should we follow China and construct massive outbreak centers? Or should we have faith that modern medicine, treatment, vaccines and hygiene practices will run its course? Until now, Bird Flu, MERS, SARS, ZIKA and Ebola outbreaks have been out of the headlines for years… many would not expect that in 2019, there were still 30,000+ ZIKA cases worldwide.


How Should Such Events Impact Long Term Healthcare Capital and Facility Planning?

As we partner with clients across the country conducting strategic master facility planning, we study local, regional, state and national trends while sensitivity testing future scenarios to drive future capacity, space, and capital needs. We work with our clients to create alternative operational and facility-based scenarios to meet these future strategic or market needs and often do come across episodic events that create a paradigm where data, trends, and models can only get you so far. Enter COVID-19.


From a facility-capital strategy viewpoint, I see the facilities China has constructed and wonder:

  • How is the quality of the structures?

  • Can they be long-term investments?

  • What will be the maintenance and upkeep cost?

  • Can they be used/repurposed after this event has subsided?

  • Could other facilities have been repurposed to provide equivalent capacity?


As we are currently not experiencing the infection levels that triggered the decision-making pathway that Wuhan has pursued, I would like to believe there are more cost-effective pathways the US can pursue to mitigate extensive capital expenditure and future risk. Here are a few ideas that come to mind:

  • Following the 2016 Ebola outbreak, 55 hospitals across the country were designated as ‘Ebola Designated Treatment Centers’. Such facilities should be studied, how these isolation rooms are being utilized today, whether we can use them for this outbreak, and the effect it will have on hospital operations.

  • The United States is quite capable of erecting emergency facilities the way China did, but will that be necessary? We have mobile military hospitals ready to deploy as needed that could be considered as viable resources.

  • Most hospitals are required to have an emergency disaster plan that could incorporate designated treatment positions over available/adjacent space. Could such facilities handle COVID-19 patient activity, and if not, could specialized equipment/resources be provided to support such a conversion?

  • Hospitals, assisted living facilities and nursing homes continue to close across the country. Can we use existing infrastructure assuming we can properly contain and managed possible close proximities to neighboring communities?


These may or may not be feasible actions to undertake, but as we work with health systems across the country, we must consider the role of the health system and the market dynamics. We do not expect every community hospital in the country to be equipped to handle such episodic events, but regional or quaternary providers in metropolitan markets should absolutely have or begin immediately considering alternative solutions for such events.


With all the unknowns about COVID-19, the next few weeks and months will be quite telling. I must admit, every morning I check the Johns Hopkins Coronavirus dashboard out of curiosity. I recall in 2016 while studying the ongoing Ebola outbreak reading an article analyzing the potential of the next ‘super virus’. The article described key traits of the likelihood of it being zoonotic (transmitting from animals to human), sourced from a mammal species, known for living in close proximities to humans and in an area of high population densities. The article identified areas across the world that meet these criteria…the comparison to COVID-19 is quite uncanny!



Thank you for reading,

-Chris Vishey



Sources

  1. The Center for Systems Science and Engineering (CSSE) at Johns Hopkins University - https://www.arcgis.com/apps/opsdashboard/index.html#/bda7594740fd40299423467b48e9ecf6

  2. Center for Disease Control and Prevention (CDC) - https://wwwnc.cdc.gov/eid/article/25/1/17-1901_article

  3. Center for Disease Control and Prevention (CDC) - https://www.cdc.gov/coronavirus/2019-ncov/travelers/index.html

  4. Center for Disease Control and Prevention (CDC) - https://www.cdc.gov/zika/reporting/2019-case-counts.html

  5. World healthcare Organization (WHO) - https://www.who.int/emergencies/diseases/novel-coronavirus-2019

  6. National Center for Biotechnology Information (NCHI) -https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4809931/

  7. Pan American Health Organization (PAHO) - http://www.paho.org/data/index.php/en/?option=com_content&view=article&id=524:zika-weekly-en&Itemid=352

  8. Nebraska Medicine, University of Nebraska: https://www.nebraskamed.com/

  9. University of Michigan, School of Public Health: https://sph.umich.edu/pursuit/2020posts/how-scientists-quantify-outbreaks.html

  10. Forbes - https://www.forbes.com/sites/ninashapiro/2020/02/22/sex-does-matter-when-it-comes-to-coronavirus/#77397190a436


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