As beds go unfilled, states scale back Army Corps makeshift hospitals
By PAUL SONNE AND MISSY RYAN | The Washington Post | Published: April 25, 2020
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The U.S. Army Corps of Engineers has sprung into action in response to COVID-19, fanning out across the country to convert dozens of conference centers, dorms and hotels into makeshift hospitals in a herculean aid effort for American cities.
But as the engineers and contractors take their hammers and hard hats to the front lines of the evolving pandemic, social distancing measures are reducing estimates of hospital overload, raising questions about how many of the facilities constructed as part of the Corps' broader $1.7 billion COVID-19 response effort will ultimately be used at anywhere near capacity - or even at all.
The Corps says it is building at least 32 facilities through contractors, 17 of which the Pentagon says have been completed as of Friday, including at New York City's Jacob K. Javits Convention Center. The Corps says it is providing designs for another 52 temporary hospitals that states are erecting on their own. In total, the sites would add more than 33,000 beds nationwide, at a cost of hundreds of millions of dollars.
States are already beginning to scale back. New York has pulled the brakes on opening three of the makeshift facilities the Army Corps of Engineers has completed in Westchester County and on Long Island, and has scrapped construction on another four. Virginia paused plans for three large field hospitals in Richmond, Hampton and Fairfax counties that it was planning to build using Army Corps plans. And Michigan downsized a Corps-built facility outside Detroit from 1,110 to 250 beds.
Sites that have opened so far have seen low occupancy rates. The first Corps-built makeshift hospital to come online, at the Javits Center, is about 20% occupied; it has roughly 200 patients at the moment, down from a little over 400 at its peak, according to a state official. Only about 33 patients have been treated at a 970-bed Army Corps-built facility at the TCF Center, a convention center in Detroit, since it opened on April 10, after hospitals in the area surged their capacity.
"Regarding the convention center beds that the Army Corps of Engineers are building, they are building those in response to requests from governors in states," Air Force Gen. John Hyten, vice chairman of the Joint Chiefs of Staff and the No. 2 officer at the Pentagon, said in a briefing Wednesday. "I've been asked, 'Does it bother you when you look at those convention centers and you see that the beds are empty?' For gosh sakes, no. That's what I want to see."
Federal, state and local officials have echoed Hyten. They say the possibility that such facilities will not be fully occupied or even opened should be seen as an indication of success - a testament to the impact of social distancing restrictions, as well as measures hospitals have taken to free up and add beds, including by pausing elective surgeries.
Some officials also note that the makeshift hospital sites will now be ready if the nation faces a second wave of COVID-19 infections later in the year, which could stress hospitals even more if it coincides directly with the start of flu season.
The New York state official, who spoke on the condition of anonymity because he wasn't authorized to speak publicly, said the state can get the Corps-built facilities that stopped short of opening running in 10 to 14 days and will do so at the first sign the numbers are moving in the wrong direction.
Michigan is also watching closely. "A surge has hit and what we saw was hospitals were in a better position to manage the patient load last week, and so we are continuing to watch the situation closely," said Michelle Grinnell, a spokeswoman for the alternative-care facilities in Michigan.
"We want to make sure [we have] the resources and the beds should the need be."
It isn't only overflow facilities the Army Corps of Engineers built that so far have seen low usage.
The military has also deployed two massive hospital ships, the USNS Comfort and USNS Mercy, to the East and West coasts, and sent Army field hospitals to the country's hardest-hit areas.
The Comfort, originally sent to treat non-covid patients but later converted to handle those infected with the virus, is expected to leave New York City as early as late April after treating about 180 patients over three weeks.
Some of the personnel from the USNS Mercy, currently in Los Angeles, have been reassigned to a skilled nursing facility in California's Orange County.
The Army, after establishing its first COVID-19 field hospital in Seattle earlier this month, shuttered that facility without seeing a single patient.
"They were prepared for a situation where they wouldn't have the capacity in their hospitals, and so we built that capacity in record time," Army Chief of Staff Gen.Charles McConville said in a recent media briefing. "And then when they realized that they had flattened the curve in Washington state, they decided they no longer needed that capability. We basically boxed that hospital back up."
The race to increase the number of hospital beds began in many states in March, when New York Gov. Andrew Cuomo, a Democrat, said his state, the hardest hit in the nation, would be operating under a "prepare for the worst, hope for the best" approach. New York, according to the state official, set a goal to expand the number of hospital beds for COVID-19 patients in the state to 110,000.
That effort focused primarily on existing facilities. According to the New York state official, the governor directed hospitals to increase their capacity by 50%, with some medical centers converting cafeterias, lobbies and physical therapy units to spaces that could handle COVID-19 patients.
At the same time, hospitals stopped taking elective surgery patients to free up beds. Patients that normally might have been admitted out of caution in some cases stayed home.
All told, New York scaled up to about 90,000 available beds over a few weeks, up from 53,000 initially, the official said. That occurred as the Army Corps of Engineers built alternative facilities such as the one at the Javits Center, initially designed to take non-virus patients as a "relief valve" for local hospitals but later converted to a virus facility.
Social distancing restrictions began impacting the infection rate, and ultimately New York peaked with about 20,000 COVID-19 patients admitted to hospitals. Today, that number is down to about 15,500, the official said.
In a statement, the Federal Emergency Management Agency said that when the Army Corps facilities were commissioned at the request of individual states, modeling data indicated that hospitals could be overwhelmed.
But aggressive social distancing decreased the need for the makeshift facilities, FEMA explained in the statement, adding that "they remain a viable response option if needed in the future."
Some of the models officials were relying on changed. On April 5, the Institute for Health Metrics and Evaluation at the University of Washington's School of Medicine - one of the main modelers officials have been consulting - revised its forecast for needed hospital beds down.
"People are relying a lot on models, and we already know the models are problematic because they're based on assumptions about a virus pathogen that we're still learning about," said Peter Jay Hotez, dean of the Baylor College of Medicine's National School of Tropical Medicine.
President Trump praised the Corps' construction blitz on Monday at the White House, saying its commander, Lt. Gen. Todd Semonite, was doing an incredible job in assisting the virus response.
"We're creating a lot of space for people, just in case," the president said. "In some cases, they probably will be using them."
Semonite said what's important is to have a very "agile plan" when it comes to additional hospital beds, because "the virus gets a vote."
The Army Corps of Engineers said it couldn't provide the cost of the 32 makeshift hospitals it is building across the nation, because some of the contracts aren't finalized yet.
The cost of the facilities contracted out so far has varied. For example, in New York, the initial contract for construction of a makeshift hospital at the Westchester County Center amounted to $15 million. Though completed, it isn't slated to open yet, the New York state official said.
In a statement, Army Corps of Engineers spokesman Eugene Pawlik said the $1.7 billion budget the Corps has received from FEMA for its COVID-19 response includes not only the construction of the 32 sites but also other mission assignments, such as a fusion cell at Corps headquarters for response planning.
"It is a good news story for the states that the levels of potentially needed health care augmentation have not been reached at the existing alternate care facilities," Pawlik said.
The U.S. military, meanwhile, is increasingly sending uniformed medical personnel directly into local hospitals to help overburdened health-care workers handle the influx of COVID-19 patients and keeping alternative health-care facilities at convention centers on standby with fewer staff.
As of April 21, the military had more than 500 Army, Navy and Air Force medical personnel embedded in 10 hospitals in New York City. Many are part of what the military is calling Urban Augmentation Medical Task Forces - groups of about 85 people each, including emergency physicians, pulmonologists, internists and nurses - who have been deployed there and to New Jersey, Massachusetts, Louisiana, Michigan and Texas. Nationally, the number of personnel embedded in hospitals is 900.
In some cases, the military medical personnel are embedding in hospitals, and in other cases they are operating their own wards.
For example, according to Northern Command Commander Gen. Terrence O'Shaughnessy, military medical forces are manning a pod on the seventh floor of Bennett Medical Center in Stamford, Connecticut, where 35 military medical personnel are staffing up to 56 beds. A Navy medical unit composed of about 75 personnel is similarly augmenting a city hospital in Baton Rouge, Louisiana.
Lt. Gen. Laura Richardson, commander of U.S. Army North, said military medical task forces are going into Tewksbury Hospital in Massachusetts and Atlantic City and Salem Medical Centers in New Jersey. They may also integrate into hospitals in Philadelphia, she said, or staff a makeshift hospital set up in a Temple University arena.
As of April 21, more than 50,000 service members have taken part in the COVID-19 response effort, including at least 4,200 medical personnel in the United States. That figure includes personnel on the two hospital ships, Northern Command said.
The U.S. military at the same time is grappling with the impact of the virus on its own personnel. The force has more than 3,900 confirmed cases as of Thursday, of which more than 1,200 have recovered.
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