Empty Dorms Could Help Solve Coronavirus Hospital Shortages

Colleges and universities in all 50 states are closing in a race to stop the spread of coronavirus. While the closures have created chaos for students, they've also made empty dorm rooms available as quarantine spaces for people with the virus who need medical attention but aren’t among the sickest of hospital patients. Converting dorms could potentially triple hospital capacity in some cities while preventing transmission and freeing up increasingly scarce hospital beds for the seriously sick and dying.

On March 15, New York Governor Andrew Cuomo urged President Trump to use the Army Corps of Engineers to convert empty college dorms “to serve as temporary medical centers.” At a press conference five days later, Lieutenant General Todd T. Semonite, chief of engineers and commanding general of the Army Corps of Engineers, said they were already working to convert dorms in New York and New Jersey, with plans for California and Washington.

Already much of what is needed for a COVID-19 treatment unit is available in a college dorm: a water supply, stable electricity, many private rooms to isolate patients, landlines for communication, refrigeration and air conditioning for supplies, and staff spaces for caregivers to put on and safely take off personal protective equipment. Everything else, such as circulating air, is a headache, but not impossible.

Dorm rooms may help stop the U.S. from running out of hospital beds by May, which was a concern a few weeks ago. This may require governors and colleges to make their own statewide adjustments, in the face of a president who believes governors must “treat [him] well, too” in order to receive aid from the government.

VICE contacted 55 universities to ask if they were planning to convert their dorms into quarantine or treatment spaces. Nine responded that they were in some stage of planning to use dorms as part of the coronavirus response: University of Connecticut, Middlebury College in Vermont, New York University, Ohio University, Tufts University in Boston, Tulane University in New Orleans, University of Connecticut, University of Kentucky, and University of Nebraska.

Most were not beyond the early stages of emptying their dorms and offering their readiness to assist state health organizations. The University of Nebraska, which is converting one dorm into a self-quarantine space for international students or students who do not have another place to live, has been working with their university medical center and county health department to develop protocols; however, Leslie B. Reed, the school's director of public affairs, said that those protocols have not been finalized. Tufts has identified dorms that can be used for self-quarantine, especially ones with individual bathrooms.

Twenty-one schools responded that they were not converting their dorms, for a variety of reasons. Some, such as Louisiana State University and the University of Tennessee, said they haven’t been officially asked, but are prepared to help if requested to do so; others, such as Penn State, Washington University in St. Louis, and Clemson in South Carolina, said the need is not yet great enough in their areas. Twenty-five did not respond.

A VICE review of colleges in three major cities identified enough dorm space for at least 29,047 people in Philadelphia, 42,941 in Los Angeles, and 54,929 in New York. Hospital beds even in these major cities are scarce: Philadelphia only has 10,070 hospital beds; Los Angeles, 19,500; Manhattan, 14,800. And, in each of those cities, even in the time before coronavirus, at least 66 percent of beds were occupied. Dorms could help nearly triple the hospital capacity in Philadelphia.

Not only can using dorms as COVID-19 clinics expand hospital capacity, but it can also prevent transmission of the virus, especially to the elderly and other vulnerable people who are more likely to require intensive care if they contract the disease, according to the Centers for Disease Control and Prevention.

“You can be checked on once a day by a nurse rather than being at home with grandma or with your sister who has a chronic health condition,” said Regan Marsh, an emergency medicine doctor who served as the medical director for Partners in Health’s Ebola response in Sierra Leone. This strategy of isolating family members was also key to lowering the family transmission rate of COVID-19 from 10 percent to 3 percent in China.

Converting dorm rooms into quarantine spaces is not very difficult, as experts with experience building emergency treatment units for cholera and Ebola in Haiti and West Africa told VICE.

For this to work, dorms need areas for screening, triage, observation, treatment. The first step is to make sure dorms can screen people for the virus as best they can, a step that is frustratingly difficult in the absence of widespread and rapid testing.

“If we did point of care, rapid testing, it would be a game changer. We should be able to do that. China did it, South Korea did it, why we are not doing it is beyond me,” said Sheila Davis, the chief executive officer of Partners in Health who led the medical charity’s Ebola response in West Africa.

Without the testing, dorms need to be prepared to screen patients based on symptoms like fever, cough, and shortness of breath, according to David Walton, a physician and cofounder of Build Health International, who helped build the Hôpital Universitaire de Mirebalais after the 2010 earthquake in Haiti, the largest public hospital in the country, “That was very much the case during the Ebola epidemic and cholera epidemic,” Walton said.

Without fast and dependable screening, patients who don’t have COVID-19 might get it because their symptoms are wrongly confused with coronavirus and they are grouped with people with the disease, something that tragically happened during the Ebola outbreak with malaria.

“You want to triage people into confirmed [coronavirus] groups, and also have an area for people who are suspected to have coronavirus,” Marsh said. “In that space you would want to be very strict about keeping patients from coming into contact with each other. Some of these people will just have the flu or cold, and we don’t want to give them COVID.”

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Dorm rooms themselves need to have negative pressure, so that the air flows outside and not around the room. “That would not be that hard,” Marsh said.

Imagine a standard dorm room that is 10 feet by 10 feet with a door and a window. “What you do is put a vent in the bottom of the door and then you put a mechanical whirly bird [turbine] to the outside world and that bird sucks air outside of the room and that creates negative air flow,” Marsh said.

To protect patients and health care providers, the entire volume of air in every dorm room must be refreshed 12 times per hour, per CDC guidelines. Doing so would be a simple math and construction problem: solve for the cubic feet of air in the room and set up an exhaust fan that can move that much air 12 times an hour.

Within the rooms themselves, there needs to be some monitoring equipment that allows nurses and health professionals to keep an eye on patients. This is why dorms cannot be used for intensive care units, because workers can't see the equipment as they're doing rounds—they have to walk inside each room. “In terms of an ICU setting, dorms are the worst possible setting, because they are individual rooms that are purposefully built for privacy,” Davis said.

Replacing the doors with glass so that nurses have a line of sight to patients is one option; another creative solution is to monitor oxygen in the blood and pulse rates via iPhones as opposed to traditional pulse oximeter machines in each room. “Private rooms are great and critical for COVID,” Walton said. “But you can’t have them in a single room with the door closed if you don’t have a pulse oximeter on them.”

What makes dorms especially useful for quarantine is that they are often near hospitals, which would allow for a speedy transfer in the event that a patient gets rapidly worse, something that is common with the sickest coronavirus patients. “There is this weird feature of coronavirus. Some people fall off the cliff late and suddenly,” said Marsh. “As an emergency doc that petrifies me. If you get suddenly sick, how will you get to the hospital?”

Whereas in other disasters, Walton explained, we might need to construct separate treatment centers near a main hospital, many dorms already are located near medical centers and hospitals. This is true in the Philadelphia, Los Angeles, and New York City areas, according to a VICE review of dorms and hospitals.

While dorms offer some built-in structural advantages, such as running water and stable electricity and areas that can be used for staff, one major structural challenge is whether rooms have private bathrooms. It might make sense to save those rooms for patients without confirmed COVID-19 so they do not catch coronavirus from someone who does.

“That’s the needle to thread,” said Walton. “How do we not make the perfect the enemy of the good, and at the same time do things as safely as possible? Dorms are an imperfect solution, but if it is going to help save lives I’m absolutely all for it.”

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