New York City Weighs Turning Hotels into Hospitals | Hacker News Reader

New York City Weighs Turning Hotels into Hospitals

wsj.com

134 pointsJumpCrisscross103 comments

In Ohio they had the head of the state association of hospitals float the idea at a press conference. He seemed to talking about the possibility taking floors of existing hotels and using them for non COVID19 patients that didn't require super urgent care so that wouldn't be in danger of getting infected if/when the hospitals begin to fill up with people dealing with COVID19. They also asked doctors, dentists and vets to not perform and non-essential operations so we could preserve the stockpile if protective gear. I hope other states take more of the actions that Ohio has been doing and find it insane that 3 states held in person primaries during a pandemic whereas Ohio delayed it as a public health emergency and Georgia did something similar a week or so ago. Public health matters.

Ohioan here. DeWine (governor of Ohio) actually ordered the primary halted in defiance of a court order on Monday.

It was only later that night that the Ohio Supreme Court sided with him, but the election was kind of already thrown into disarray by then.

We need more leaders like him who are willing to take personal risks during this crisis. I say this as a Democrat by the way.

100% agreed. Fellow democratic Ohioan, and I am extremely proud of the way DeWine is handling this situation. It really helps me and my family breathe a sigh of relief to know our state government puts our health interests first.

And here we find a way to actually sustain those businesses while they don’t have any non-Healthcare clients

We need to stop worrying about business owners and start worrying about our fellow workers. Let the state nationalize them if need be.

Worrying about businesses = worrying about workers

No.

That sounds like a good idea.

I hope one thing comes out of this pandemic: that our governments, local and federal, stockpile portable tent hospitals and equipment that can be put in place quickly for future problems. I doubt this will happen in the USA, but that is what I hope happens. I think health infrastructure is part of national security and should receive appropriate resources.

Totally agree but not to be pedant, but state governments should have some sort of emergency provisions as well. Some people forget we're the United States for a reason. Each state is actually it's own "functional" government. Maybe we should start training state troopers as well for some of these possibilities.

By 'local' I meant local and state governments, i.e., non-federal. Sorry, I didn't phrase that well.

I look at it the other way. Why does it all have to be done at a state level? Because that's how things have always been? Meh. There are very clear efficiencies to be gained by coordinating response to events like this at a national level, and it's not like individual states are about to declare independence. Over time the structure of the US could end up being more of a weakness than a strength. It's not as if the virus respects state borders.

Because the nature of response varies so much in between different locations and local expertise is often best poised to deal with local problems. Federal resources are better for things like logistics (ship 500,000 masks to where they're needed), but New York probably knows how to get aid to New York best.

Ignoring local expertise to blindly chase efficiency of large-scale enterprise is perilous.

> Because the nature of response varies so much in between different locations and local expertise is often best poised to deal with local problems.

Is that really true here? I can certainly see an urban vs rural divide, but beyond that I can’t see what makes individual states all that different.

Don't want to get too political here, but if you consolidated the response to COVID-19 to the federal government and didn't allow states and county public health officials to act, we'd probably be in much worse shape.

I don't like the idea of consolidating pandemic readiness to a single entity that may or may not be up to the challenge of addressing it.

It's really true everywhere.

Think about: Setting up temporary hospitals; where is the available capacity, where is the existing capacity. Knowing where people live and how they move around. Who in the area is most at risk and how can their needs best be met? Knowing what logistics capabilities exist. Speaking the local dialect and being able to effectively communicate emergency plans such that they're followed. Who do you talk to to mobilize some local resource?

These are all things that are best implemented locally.

Population density. Climate - so far COVID 19 seems to thrive better in cold and dry conditions. Culture - not all measures will be easily sold to all. Medical fatalities - availability and capacity.

Most of those are true within states as well, though. Most contain both cities and rural areas. So why is it better to separate one state’s rural areas from anothers?

Pretty much the entire root cause of the US’s weak response to the pandemic can be attributed to the poor coordination of the CDC and the FDA. That the state and local governments were able to step up and do their thing will probably be what ends up saving us.

Because a response would look different in the everglades in florida, densely populated NYC, LA, snow covered Wisconsin, sparse Wyoming and Alaska and the Rocky Mountains ...

And federal solutions tend to gravitate to one size fits all. Or you must have 50 teams on federal payroll to tailor solution for each state - in which case they will probably duplicate already existing organizations.

There is a role for the federal government - to make sure that scarce resources are procured and distributed, to fund R&D, to disseminate knowledge and know how.

There are both pros and cons to a federal system vs a unitary system, but this is not really the time to debate whether or not we chose the right system of government, nor do I think the logistics for responding to global pandemics is the most important criteria for selecting a form of government.

portable tent hospitals

Santa Clara County Regional Medical Center put up their tents last week.

California has enough disasters each year that the emergency systems are ready to go.

> That sounds like a good idea.

Keep in mind the "hotels" that NYC contracts for things like this are usually overrun with bed bugs and meth-addled hookers. Not exactly the kind of place you'd want to go to avoid a nosocomial infection.

C.f.: https://www.nydailynews.com/new-york/nyc-routinely-put-homel...

We actually do have emergency hospitals, though we've historically used ships and been liberal in sending them to aid foreign countries.

Obviously we should further extend that strategy for the continental US.

That's one thing I think the Navy will start to do. We will probably begin deploying our ships to coastal cities to provide much needed relief, and I think it was already mentioned that one will be deployed to New York to help out.

The USA only has two hospital ships, it's good to have but it's not going to make a big difference outside of two cities.

On the other hand, do we really want to be exposing the military to the virus in these uncertain times?

I read that the president ordered US hospital ships to be ready near the east and west coasts.

I would argue that getting the military exposed to the virus early during peacetime in a staggered way is exactly what we should do. There can’t be many elderly or immunocompromised stationed on those ships and if the entire ship is exposed once, the ship is more resilient in the future. In a few months, the sailors are then much less likely to suffer from infection in a time of active crisis.

Now the uncertainty is around whether there is the possibility for re-infection or if there are multiple strains which can infect a person who was recently infected with another strain.

There's also the fact that Naval ships are built with countermeasures against Nuclear/Biological/Chemical threats in mind, they probably are designed better against a viral threat than a civilian ship, including better air filtration capabilities

These aren't really naval vessels. They're converted tankers, with civilian grade construction. I doubt they have NBC protection, though they should have what you'd find in a normal hospital.

There was a guy on here a few days ago who owns some hotels.

He said he would be fine with this as long as they:

paid to move his current customers to his other hotels,

cleaned the rooms and returned them to their original condition when they were done,

provided safety gear to his employees that would need to keep working,

and provide paychecks for his employees that are furloughed.

I think. I can't find the comment now but that was the gist of it.

They're probably not going to be in any position to make demands like that.

I don't think they can just take over a hotel without any input from the owner. This is still the US. We do still have some rule of law.

IANAL but I'm pretty sure the Defense Production Act [0] (which he invoked today) allows him to do just that.

[0] https://en.wikipedia.org/wiki/Defense_Production_Act

I usually avoid snark here but: isn’t there someone higher government that owns a bunch of hotels that are not in disrepair in major cities that likely have few if any clients currently?

Even “rule of law” in peacetime allows for commandeering of property with Due Process and in times of national security allows for extraordinary measures that are not legal during peacetime.

You may be right if it were peacetime, but the president just announced a War on the Virus and is using the law as if we are at war.

They absolutely can. The rule of law permits things like martial law in emergencies, as well as a lot of powers in the various steps that lead up to that.

The risk of malicious compliance is a tremendous motivator in ensuring that the government upholds their end of a fair and equitable deal in times of crisis.

And I know this sounds toxic in times of crisis but it's important that the government maintain some semblance of fair dealing in these times otherwise their proclivity to do otherwise may increase.

Perhaps, but financial analysts predict that the hotel industry will go bankrupt by May without extraordinary intervention. The hotelier can choose not to comply, but that is likely to risk the government at all levels denying support he will imminently need.

How is the hotel owner going to maliciously comply in this scenario?

"Yeah with all the stress of this situation I must have forgotten to tell my employees who are working without pay to perform that costly work that you ordered me to with no discussion of renumeration."

Among countless other possibilities. From trivial like rude graffiti in the halls to criminal like direct sabotage. There are documented cases of this whenever shtf and people are forced to keep working. It's the reason that liquidators bring in scabs to replace displaced staff during store closures at announcement.

"Sorry I need to do critical maintenance we're gonna shut off the power for three days and stop renting rooms".

That was yesterday. Listen to Bill Ackman today. Hilton goes to zero if this doesn't get stopped.

If you own a hotel today, you should be begging the government to pay you a per diem.

Those seem like reasonable expectations. The first one seems a bit iffy depending on what exactly is meant by “paying to move”.

But if he didn’t list them paying for use of the rooms themselves as a condition, that actually seems like a pretty fair attitude.

Was it Trump?

No, actually it was a guy who owns some restaurants and hotels in SF and was trying to figure out how to keep paying all his employees despite his business cratering.

So kinda the complete opposite.

His hotels are already providing lodging for Coronavirus patients. There's been 3 confirmed cases from there.

Gov. Cuomo a couple days ago asked cities in the NY state to identify where they could fit improvised beds. The quota for NYC was 5,000. Seems like hotels are an obvious choice, given their optimal layout and how empty they are

https://cornellsun.com/2020/03/16/cuomo-proposes-converting-...

I assume you meant hotels, not hospitals.

Yes, sorry, fixed, thanks!

Sounds like they could bail them out along the way by reimbursing them later

Hospitals rely on 100% outside. Meaning they don't recycle existing air already circulated. Pretty sure hotels don't have that kind of HVAC.

I wonder if NYC hotels can do this but a lot newer HVAC system allow changing the percentage of outside air. Its advantageous for varies reasons (energy consumption, etc) to use partial recycle air but I wouldn't be surprised if certain builds have 100% outside air capabilities.

Pretty sure we're not going to find perfect solutions, only usable ones.

Perhaps filters can be jury-rigged on the vents. Maybe you only staff them with people who've already survived. Maybe you turn off the HVAC and open up the windows. Maybe it's the last resort option.

I don't think there is any evidence that recyling air has any use here given that these wards would be filled with already sick patients and healthcare professionals.

Many cheaper hotels do that as well. They have an HVAC unit per room.

I hear NYU and Columbia's dorms are empty.

I am posting this while sitting in my NYU dorm room. They are kicking students out and will likely become a temporary hospital according to some emails we received.

For a reason. Dorms are shared everything. Not really a great place for isolating people.

Isolation isn't necessary if they're all infected with the same virus.

Does isolation reduce viral load?

They're only shared everything if they're full. Could easily isolate lots of people, just with much lower capacity than the dorms hold in normal times.

Most dorms have a single shared bathroom per floor.

Yeah but renting just one of those dorm rooms would use up more than half of the stimulus budget

Madrid, Spain just announced 40 hospitals will be turned to hospital rooms. 9,000 beds.

> hospitals will be turned to hospital rooms

There is a logical mistake in this sentence.

A fun fact: "hospital", "hostel", and "hotel" all come from the same Latin root (brought into French and then English at different times https://en.wiktionary.org/wiki/hospital#Etymology).

I'll be honest, it won't be much work, and should be done quickly.

Turning a hospital into a hospital room? That’s going to require some serious Time Lord engineering.

They could tear down all internal walls to make each hospital into one large room. That would be very counterproductive, but they could.

All the malls that have closed?

Well, they have a lot of the infrastucture. The beds are different.

Right now there are 53k hospital beds in the state of New York, and 3k of them are ICU beds. The prediction [1] is that in 45 days we'll need 55k-110k beds for the severe cases of Covid19, from which up to 37k ICU beds. Now, maybe you can't make ICU beds in hotels, but maybe you can make regular hospital beds. They'll be useful too.

[1] https://www.cnbc.com/2020/03/18/cuomo-says-trump-is-dispatch...

https://archive.md/ns6uG

public school gymnasiums?

Convention centers

Cruise ships aren't bad options either.

I hear they're a bit underutilized

I like the spirit of the idea (keeping them away from others), but other than that, it's not a wise idea:

>Keeping all the passengers on board instead of letting them disembark on land is a strategy that can backfire, however, according to experts, because the ventilation systems and close quarters of cruise ships make them ideal places for illness to jump from one person to the next.

>“They’re not designed as quarantine facilities, to put it mildly,” said Don Milton, an epidemiologist with the University of Maryland.

>Milton, who studies the spread of virus particles in the air, said recirculating air on a cruise ship’s ventilation system, along with people living in close quarters and in communal settings, make the vessels vulnerable to the spread of infection.

https://www.usatoday.com/story/travel/cruises/2020/03/07/cor...

Those issues assumed a full ship, like the Diamond Princess situation. But, if all of the "passengers" were patients, and you only used balcony rooms (to have extra airflow available), and only used half of even those, would that mitigate the issue?

Are there other options to temporarily retrofit the ventilation system? How much worse is a cruise ship ventilation system from an old hotel's HVAC? Which is harder to retrofit?

There's no concern for the spread of infection if you designate a facility (no matter if it's a sports hall or a cruise ship) for holding and treating only known patients of a single disease.

Yes, they're not suitable for quarantine of possibly infected people - but it seems that we're past that stage, with massive community spread, we're not going to quarantine anyone, we're just going to ask possibly infected people to please try and stay at home if it's not too inconvenient; I mean, most countries don't even bother testing the possibly infected contacts anymore.

That’s what I thought initially, but I remember reading that once pneumonia sets in, those infected with COVID-19 are likely to suffer from secondary infections. Not having an inventory of colds and flus to compound on COVID-19 would be a plus.

I think the parent meant using them as mobile quarantine/treatment centers for confirmed cases.

The point about the recirculating air means that whoever is caring for the sick is also going to get sick.

It's likely possible to install HEPA filters in the ventilation systems, which could effectively prevent cross-contamination(1). While they do restrict airflow more than normal filters, you can fix that problem by simply making them larger. Not so easy to do in your house, but with engineering support on an emergency basis it might not be so hard, especially if you can close part of the ship so your total airflow needs are less. Eg maybe use every other cabin or something.

1) It's a common myth that HEPA filters don't filter viruses because they're too small. In fact, they work basically just as well on small particles as large ones: https://en.wikipedia.org/wiki/HEPA

So turn off the air and open the balcony doors.

I wonder why the air aboard cruise ships has to recirculate so much—it seems like cruise ships are usually about 1/2 surrounded by breathable air at normal atmospheric pressure. Is it about heating and cooling, like, passengers would feel very uncomfortable if the air in their cabins had a lot of fresh sea air mixed into it? Do they do something to filter out the salt from the air intake?

Because fresh air needs to be heated or cooled, and that's expensive when you're running everything off diesel. Heat exchangers do help, but they're not perfect, so every bit of outside ventilation costs money.

This is why fume hoods which exhaust to the outside can be surprisingly expensive to run in cold/hot climates.

I thought cruise ships run off bunker fuel same as container ships.

Ah, yeah, you are correct. Still going to be a lot more expensive than shore power thought.

Virus spread shouldn’t be a huge issue if you only put confirmed cases on the ship.

Who treats them on the ship? It certainly wouldn't be healthy medical professionals.

We'll fairly rapidly have a group of infected-but-functional and (a bit later) recovered medical professionals.

They’ve never solved the sanitation problem. But perhaps small changes could be made to future ship designs, to allow them to be re-purposed

> to allow them to be re-purposed

Or, maybe just to make sure they are not super powerful disease spreaders on normal times.

I imagine they are hard to regulate, but a country can make some seal of approval, and maybe even punish people seeking treatment for transmissible diseases after they come from one without the seal. (Even tough that second one is very heavy handed and hopefully unnecessary.)

Paywalled but judging by the headline, it's honestly an interesting and great idea. Pay the hotels so they can survive, create a conversion plan with certain standards (Changing all filters to MERV-13 or something), and start auditing the process.

yeah - except surplus profits for decades built more destination vacation sites, luxury hotels and shopping malls, and not rank-and-file housing, due to profits.. you are enthusiastically adding to the cash flow of those decisions... when does this end?

It doesn't end. Plutocracy breeds more plutocracy. There's a positive feedback loop because more money buys more governmental influence (i.e., rent seeking), which then gets more money.

I dunno, but if one needs the beds, why not hire them?

Anyway, I doubt investment in tourism infrastructure is a large obstacle for building new houses. I would look elsewhere first.

Man that headline - sensationalism at its finest.

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