Construction became the subject of international headlines during the first few weeks of the coronavirus pandemic when builders in Wuhan, China, reportedly established two several-thousand-bed hospitals in a matter of days.
By the time the outbreak gripped the U.S., the general public — along with healthcare and government officials — wanted to know whether the stateside industry would be able to do the same. And all signs pointed to modular: It was a time for the niche segment of the industry to step up and answer the call.
There were high hopes by that time, with modular leaders pledging to help end the war. But now, with the number of confirmed cases in the U.S. at more than 1.1 million and still climbing, and all types of medical facilities in place, of which many are not modular-based, we have a snapshot of the niche’s successes and shortcomings and a revised look at the future.
Competing with the China myth
“There’s a tainted view of what was built in China,” John Buongiorno, director of Axis Construction Corp.'s modular division, told Construction Dive. “Unfortunately, it makes [builders in the U.S.] look incapable.”
The expectation that a full hospital can be built in days is one that the industry is trying to dispel, explained the Modular Building Institute's Executive Director Tom Hardiman. “The Chinese government owned the land and had 50 cranes on standby and the modules were essentially already built, making the idea that it was built in 10 days totally staged.”
The reason the facilities in Wuhan went up so quickly, Horizon North’s President of Modular Solutions, J.P. (Joe) Kiss explained, was that the Chinese government had the foresight to have the prefabricated system prestocked to mobilize quickly rather than retroactively, and that’s because it’s had to take similar measures in the past.
The country’s been engaged with this type of ultra-rapid construction technique since at least 2003, in response to the SARs virus outbreak, according to a MedicalExpo e-Magazine interview with some of the Chinese firms involved.
And calling what China built hospitals, from many stateside builders’ perspective, is not entirely accurate. The main difference between China’s emergency preparedness, and that of the U.S., is that “they did it with flat-packed panelized wall sections, and we did it with tents,” Buongiorno said, referring to the FEMA rapid-response kits delivered to handle triage and testing when hospitals hit capacity.
“There’s a tainted view of what was built in China. Unfortunately, it makes [builders in the U.S.] look incapable.”
Director of Axis Construction Corp.'s modular division
The modular industry helped in its own way in the weeks before and after the surge, delivering existing modules and repurposing other types of builds to serve immediate overflow needs. But what healthcare systems still needed the most was negatively pressurized isolation and intensive care units with HEPA filtration, and the modular industry set out to deliver them.
But as pioneers in the modular COVID-19-related response attested, getting a production facility up and running from the time of a purchase order after a government shutdown of nonessential businesses takes at least several weeks. And like any other manufacturing segment, offsite builders were still subject to supply chain setbacks, especially when it comes to headwalls and medical equipment required for prefabricated patient rooms.
“We're working now with one of our manufacturing partners, a developer and a architectural firm, and we've put together a prototype set of modules that are expandable to, in effect, create full hospital wing with patient rooms, nursing stations and support areas," Buongiorno said. "And we're working on that to roll that out for what we're projecting to be a mid-range and a long-range recovery plan from COVID-19.”
But in terms of meeting the immediate needs, the modular industry was not able to respond in the matter of days that systems needed at the peak.
Instead, hospitals had traditional general contractors, and some modular firms or hybrid firms such as Axis, convert existing spaces in their facilities, such as libraries and cafeterias, into makeshift treatment areas. Contractors, often through the purview of the Army Corps of Engineers, have also converted convention centers and even office buildings with partitions and filtration systems.
Because prefabricated patient rooms are not cheap, can not always be repurposed, and it’s unclear what and where hospital’s needs will be in coming weeks, the demand has sputtered out a bit into a wait-and-see mentality until needs are more clear or until some entity takes the risk and foots the bill, Buongiorno continued.
“The numbers in the hospitals have declined over the last week, and nobody is complaining about that,” he said. “With everything that’s happened over the past months, healthcare systems have enough other expenses to deal with.”
What about next time?
The reality is that China’s government had prepared to meet the need for extra hospital space ahead of time, Grant Geiger, CEO of EIR Healthcare, a firm that specializes in modular healthcare builds, told Construction Dive. “And when [the coronavirus] situation happened, they just pulled the plan off the shelf and said, here's what we're going to do.”
From a government perspective, there are obviously different factors between the U.S. and China at play, he said. “But from an engineering standpoint and from a delivery standpoint,” he continued, “there's no reason why we couldn't do that as well. So I think there'll be a lot more of that type of conversation in the future because healthcare systems don't want to be caught in that situation again, where they don't have enough beds.”
But someone needs to pay for it.
“If the modules were already built and stockpiled, you could turn that around and [stack them onsite for a turnkey solution] almost overnight,” Buongiorno said. “But I’m not going to tell you that it’s something [Axis] is looking to invest in and build and be sitting on a couple-million-dollar asset in the anticipation of another event happening. I don’t think any players in the modular industry are going to just build units on spec like this.”
The U.S. government agency, a healthcare system or venture capitalists would need to invest in a proactive solution to make it reality, he added. But that’s something the Modular Building Institute is actively lobbying for.
“That’s where we want to take it,” Hardiman said. “Once this settles down a little, we do want to have the conversations about how we can be prepared for something like this. For example, FEMA has somewhere in the neighborhood of 10,000 mobile homes in inventory for a disaster. To my knowledge, they have zero medical units, such as an intensive care unit, in inventory. This might change their way of thinking.”
“Essentially the idea is pretty simple,” Geiger said. “We engineer, design and build rooms for clients that sit offsite, in a warehouse facility, and a [government or other entity] is not paying for those rooms upfront, they're paying for, essentially, the opportunity to use them in the future if needed. We test them, commission them, run pressure tests, check them every year to make sure that they're functioning. And then they're deployable and usable to a client at any given time when they need it."
And in the meantime, the industry is collaborating — rather than competing — in unprecedented ways, sources said. "I haven't seen this level of collaboration in the 17 years I've been involved," Hardiman said, noting that over 20 firms agreed to back a design purported by MBI.
Geiger noted that, at the onset, every modular manufacturing firm he knew of was working as collaboratively as possible for a solution to space constraints. "What this has done is create an open-source community among modular builders to try and put their heads together to try and help a situation like this," Buongiorno said. "We'll be more ready if something like this happens again."
Stay tuned to this monthly column as it takes a deeper, nuanced and sometimes more critical look at the modular movement, and feel free to email me your thoughts, concerns and ideas on topics to cover in this series.
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