Responding to COVID-19: What If You Had to Build a Hospital in Days?

Mar 10, 2020 at 11:55 am by pj

 Q & A with Tony Cowan, Director of Emergency Response Technology,

World Housing Solution, Inc.


Tony Cowan is a health care professional who spent over 25 years working with physician groups in the development of Ambulatory Surgery Centers. In 2014, he designed an EBOLA Response Hospital, and in 2017 he designed clinics that were delivered to Puerto Rico for the hurricane relief effort. Those clinics went on to become accredited medical public health facilities. Now, he is Director of Emergency Response Technology with World Housing Solution (WHS) and is discussing how they have created a rigid, modular Pandemic Response Hospital that can deploy in days.


I understand that WHS designs and manufactures mobile shelters for the Department of Defense, how does that transfer into responding to a pandemic?


T.C. Our manufacturing technology allows us to produce panels that are light enough to move by hand, durable enough to be flat-stacked, then deployed and set-up over and over. Our Rapid to Deploy Structures (RDS) are made of these highly insulated durable and reconfigurable panels. This ability to reconfigure a space allows us to design functionality as needed from use-case to use-case. When we deploy a Work Force Camp, the internal design is very different from a NATO base camp. We took advantage of the inherent versatility of our construction technology to grapple with the unique challenges of responding efficiently to a pandemic using 21st Century Shelter technology that provides equivalency of care that you could never get in a bouncy tent. This approach resulted in the creation of what we call the S.T.A.G.E.™ solution to pandemic response. It truly is a game changer for surge capacity and rapid deployment capability for isolation and quarantine facilities during a pandemic response. A S.T.A.G.E. ™ solution will dramatically improve how we isolate and treat people and ensure quality of care as well as continuity of care wherever it is needed, as we grapple with addressing pandemic care requirements.


How does the S.T.A.G.E. ™ solution improve isolation efforts?


T.C. First, it is a far more modern approach, but more importantly, it is rapidly deployable, sterilizable for reuse, and more effective at stopping the spread of the virus. The acronym S.T.A.G.E.™ stands for Separating, Transmission, As Gestation, Evolves. Basically, our facility allows for people to stay isolated in space-appropriate environments as the risk of infection and transmission are determined. Step one: a person who has been exposed is separated from every other person who has been exposed. This starts the risk clock counting down immediately. Compare that to restarting your isolation clock every time someone else you are housed with becomes a confirmed case. This is significant. Currently, if you are two days from leaving quarantine and two people you have been living with test positive, you have to start your isolation clock all over. Individual isolation is imperative to reducing the risk of repetitive exposures. Step two: the person is either released after testing negative or sadly they join those who are in recovery. Recovery is also segmented, as some people will only need to stay isolated while they are infected but show little symptoms. Others may need intensive care. The RDS S.T.A.G.E.™ system ensures the entire facility is served by HEPA filtered air at negative pressure. Maintaining negative pressure and HEPA filtration with ultraviolet germicidal radiation, secures that the virus does not escape the facility as a result of airborne contaminated particles. This pandemic response facility can have decontamination vestibules for entering and exiting the facility. It will be made up of several wards with increasing life support services, as they are needed up to and including full surgical suits. Ultimately, a person will exit the facility. Our hope is that STAGE™ isolation will reduce suffering and save lives, increasing the number of recovered individuals. It will, without question, be more humane than quarantining people in a hotel or on a cruise ship and waiting to see who gets sick in an environment where they will be constantly exposed - increasing the likelihood for infection as has already occurred.


If the United States is confronted with an outbreak the size and scope of what China is dealing with, can this technology deliver a complete quarantine facility in a week?


T.C. The quick answer is yes, if our building was a deployable asset ready to respond. However, that will require municipal or federal agencies to invest in having the asset ready to deploy. As it is, we have a manufacturing to deployment time of about 90-days depending on logistics. Logistics could be negatively impacted by the pandemic. If the demand was high enough, we could dramatically increase the volume of isolation and intensive care units we are manufacturing to meet the demand. The good and bad news is the COVID-19 pandemic is not going anywhere soon. There is a window of opportunity to invest in our domestic pandemic preparedness. The other good news about our solution is its versatility. These would be rapidly deployable assets to augment the medical/ public health infrastructure for any type of medical surge event. This asset would be of immediate utility in any type of all-hazard event including: forest fires, earthquakes, hurricanes, or terrorist attacks. It is a medical surge asset that can be both positively or negatively pressurized, making it flexible for pandemics or chemical, and/ or radiological response.  


According to the OSHA Influenza Pandemic Planning Guide, health care facilities may have more warning time and response time for pandemic influenza, especially if the initial outbreak develops in another country. Are you finding that to be true and why is that important?


T.C. As we learned from other countries, the time to take advantage of that window of opportunity is now! The large hospital networks that the general public rely on to care for their medical public health must take immediate action. These health care facilities cannot wait until their locations, which are not designed to care for large volumes of highly contagious individuals, are inundated with infected patients. COVID-19 patients would then be making the entire hospital complex the most likely place to contract the infection. If hospitals delay preventative measures, not only will they have unnecessarily exposed their own medical staff to the contagion, but they will have lost the chance to reduce suffering and save lives for the communities they serve.


The report warns that because pandemics are not a contained or local event and by nature is widespread, there will be less federal or state support available to the individual health facility. How does your solution support a local health facility?


T.C. Our Pandemic Response Solution (PRS) gives local hospitals the ability to have a facility that both supports a pandemic program and keeps the delivery of that program away from the primary hospital center. If a hospital uses the same patient capture system for both typical health issues and pandemic issues, they have turned the entire hospital into a hot zone of contagion. With the PRS the hospital will still have to decontaminate with vigilance. However, the day-to-day burden of being a hot zone is at a location where the staff always wears Personal Protective Equipment (PPE) and the patients are already infected, so they do not have to be shrouded in masks or kept in individual containment areas away from each other. 


The OSHA guide goes on to say that unlike a mass casualty or weapons of mass destruction event, emphasis on cohorting or grouping by condition practices, isolation practices, and sterilization procedures is more important for pandemic infection control than decontamination. Is this part of the reason you came up with the S.T.A.G.E.™ system?


T.C. That is exactly why I came up with the S.T.A.G.E.™ system. Our PRS was designed to keep people separated until it is appropriate for cohorting to begin. Because the PRS is segregated using the S.T.A.G.E. ™ system, it reduces the risk of people being exposed to others who may be infected. It also maximizes staffing when medical monitoring is needed. The staff work in Green Zones when not in direct contact with patients. They work in Yellow Zones where logistics and transportation takes place, and finally in Red Zones when they are in direct contact with the patient. This helps everyone to know when they need to be protected and when they can “take a breather”. Wearing PPE is not pleasant: it can cause pain spots, can be claustrophobic, obscures vison, and is exhausting to wear. Working in PPE for a nonstop 8-hour shift would be torture, and is unsustainable for extended numbers of work days. This system gives both patients and staff a place they can be without the need of PPE.


Another point in the OSHA guide states that an influenza pandemic is a sustained crisis and you can expect the response to have a duration of up to 24-months or longer. Unlike an isolated mass casualty scenario, a pandemic may come and go in waves, each of which can last for six-to-eight weeks. Is your solution capable of a 5-year sustained deployment?


T.C. There is no greater reason to acquire the PRS system than the possibility of a sustained crisis. Staff should not be expected to struggle in inadequate facilities for an ongoing, undetermined amount of time, as they deliver care to the suffering. In a PRS system, staff will have all the benefits of working in a brick and mortar facility with none of the issues that arise while working in a tent. COVID-19 may well become endemic and this pandemic could last for the foreseeable future. A system that is structurally capable of maintaining services during a hurricane with a reduced power requirement up to 7-fold is vital. There is no long-term financial value for setting up pandemic response in a tent. 


Do you have any advice for the general public as fears grow over this possible impending pandemic? 


T.C. Yes, I have good news and bad news. The bad news is that this is already a pandemic in all but political posturing and jargon. It is going to continue to spread and there is little the federal or local governments are going to be able to do to stop that. The good news is that you actually have a lot to do with your own risk of exposure. Read the literature available - it is actually as simple as it sounds: wash your hands, stay home if ill, and keep a respectable distance from others, while avoiding large crowded areas as much as possible. Shop during off hours, carry an alcohol-based hand sanitizer and use it regularly. We are going to have to keep ourselves safe and take care of each other during this event.