A Model for Hotels to Hospitals (H2H ©) During an Unprecedented Era

During the early months of 2020, once it was apparent that the novel coronavirus (COVID19) was a global pandemic, people everywhere started to think of creative solutions to help ease the problems of the virus. One solution was to convert hotels into hospitals (H2H ©) and into housing for healthcare workers. With the virus halting travel, many hotels were left close to vacant. On top of that, many healthcare professionals were worried about traveling back and forth between work and home, at the risk of infecting their household. Therefore, hotel managers came up with the idea of opening their doors to healthcare workers to solve two problems at once: limiting the spread of the virus and helping compensate for lost revenue. Another solution that hotel leaders offered was to turn their hotels into temporary hospitals, or alternative care sites (ACS). The American Hospital Association has projected that 30% of the US population (96 million) will test positive for COVID19, and 5% (4.8 million) will be hospitalized. [6] With so many people predicted to need hospitalization in a short time span, figuring out adequate accommodation is vital.

As of June 23^rd, 2020, hotels across the US offered over 3.4 million hotel rooms to healthcare workers. The Four Seasons New York was the first New York City hotel to put up medical personnel. The hotel had to undergo many shifts to be able to serve healthcare workers rather than tourists, so the stay was toned down and not as luxurious as a typical Four Seasons stay. The ballroom became a disinfecting zone; room service and the restaurant were closed, instead guests were given boxed meals; and there was no daily housekeeping, each guest was given their linens at the beginning of their stay. [1]

The US Army Health Facilities Planning Agency and Defense Health Agency put together a Concept of Operations document. In it, they detail how a Hotel to Health Care (H2HC) facility should be organized. For instance, the first floor will be for administrators only; patients arriving to the facility will use the "dirty" elevator. This "dirty" elevator will also serve as the exit for patients, nurses, and staff. Staff will enter the H2HC facility through a designated "clean" entrance. There will be designated showers for staff to use at the beginning and end of their shifts. There may also be sleep spaces for staff on the ground floor. Patients will be individuals that are 18 years of age and older, and they will be assigned to their own individual rooms. Each room will have negative pressure isolation. The document also addresses potentially difficulties with staffing shortages. It suggests that physicians that do not regularly work with ICU patients can augment those who do in these H2H © facilities. Facilities will have a clean area for staff to be able to consume meals and, depending on the size of the facility, meals will either be prepared on site or delivered via a clean entry. [6]

There are various other guidelines posted online that can help hotels as they navigate their way to housing healthcare workers or patients. The US Army Corps of Engineers has eight basic steps for turning a site into an ACS. First, identify potential sites; second, conduct site assessments; third, secure funding; fourth, secure property; fifth, convert site for healthcare use; sixth, secure wrap around services; seventh, staff, equip, and supply site; and eighth, operate site. [2]

When setting up the site, sanitation must be taken into consideration. This means making sure that all the furniture in the room can be thoroughly sanitized. This is especially important during the "restore site" step, as the hotel will be opening back up for regular hotel guests. The Japanese company HKS put together an overview on converting hotels to hospitals. In it, they provide two sample layouts of guest rooms for COVID19 patients:

More than just room setup, the setup of the entire hotel will need to be changed as well. From the outside, some things to consider will be traffic flow, a screening entrance, a red bag disposal area, and perimeter fencing. The US Army Corps of Engineers drew the following diagram:

On the inside, the ground floor will need to be changed to accommodate this new function as a healthcare facility. The ground floor will need spaces for on-duty staff, dining, food preparation, etc. There will also need to be designated clean rooms for personal protective equipment (PPE), sterile storage rooms, nurse stations, separate rooms for dirty and clean linens, a break room, a pharmacy, and more. [7] If the hotel does not have a generator, a working one with adequate capacity should be added to the facility. [7]

Aside from setup and sanitation, there are countless other items to take into consideration. Hotel owners must consider the legal issues that may arise with housing COVID19 patients. One important question is what happens if something goes wrong with a patient and they want to sue the hotel? Will the hotel's insurance policy cover the hotel, even though this hotel is suddenly now acting as a hospital? [5] Underwriters normally ask for current and future use of the property they are insuring and have cancellation clauses if the property owners decided to place themselves at greater risk than originally intended. [5] One would hope that hotels and insurance companies could come together to find common ground, because hotels that are converting into hospitals are working to help the greater community. In addition, insurance representatives should be there to help their clients, rather than just sell the policy. However, there are still many unanswered questions because these are unprecedented times. H2H © can help during this era of uncertain and complex times.

[1] https://www.cnn.com/travel/article/hotels-swap-tourists-for-medical-workers/index.html?utm_source=hotel-online
[2] https://www.usace.army.mil/coronavirus/alternate-care-sites/
[3] ACS Toolkit PDF (linked here: https://www.usace.army.mil/coronavirus/alternate-care-sites/)
[4] HKS PDF (linked here: https://www.hksinc.com/how-we-think/research/covid-19-conversions-facility-transformation-to-alleviate-overburdened-health-systems/)
[5] https://www.hotelmanagement.net/operate/how-converting-a-facility-affects-insurance
[6] https://www.usace.army.mil/Portals/2/docs/Contracting/AlternateCareSites/H2HC%20Acute%20or%20Non%20Acute-%20Concept%20of%20Operations-%202020%2003%2026.pdf
[7] https://www.ahla.com/sites/default/files/US%20Army%20Corps%20of%20Engineers-%20Hotel%20to%20Healthcare%20Concept.pdf

Fred DeMicco
Northern Arizona University