What does it take to convert a hotel bedroom into a COVID-19 care room?

As hospitals around the country prepare for an increased number of coronavirus patients and potential bed shortages, local officials seek hotel rooms and dorms as alternate housing for coronavirus patients with less severe symptoms.

In L.A. County, the Fairplex Sheraton Hotel has been designated a medical shelter and had 25 COVID-19 patients as of Friday.

San Francisco has secured leases for over 300 hotel rooms for this purpose. It has plans to finalize the leases of 3,000 more this week.

In New York, local officials and the U.S Army Corps of Engineers are touring hotels and State University of New York residence halls.

But how do you turn a hotel room into a health care room?

The first step is understanding that coronavirus is primarily spread via respiratory droplets.

Dr. Peter Chin-Hong, an infectious disease specialist at the University of California, San Francisco, likened its transmission to a droplet of water, which is heavy and falls downward onto a surface. By comparison, airborne diseases such as measles are more like dandelion seeds, which are light and can linger in the air. The latter requires much more complex measures.

The next step is determining what kind of patients are going to be housed. A person who tested positive but only needs to be isolated to reduce spread has different needs from someone who’s intubated and on a ventilator.

The U.S. Army Corps of Engineers issued guidance, called the “Hotel to Healthcare Concept,” that local and state governments can rely on to prepare rooms for a range of patients. (The USACE’s concepts are implemented by contractors and paid for by money from the Federal Emergency Management Agency.)

To handle patients with more serious COVID-19 symptoms, USACE recommends adding the following items to rooms: a bedside table or cabinet that can hold a ventilator, an over-bed table or tray for patients, a mobile work station for medical personnel, an IV stand, a linen hamper for soiled items, a puncture-proof box for needles and gloves, a receptacle for infectious waste and a hand sanitizer station.

It also recommends several more labor-intense changes, including adding privacy curtains near the front door, removing carpet to cut down on contamination, installing vinyl flooring and adding electrical outlets and emergency back-up power.

This model shows the U.S. Army Corps of Engineers’ recommended changes for hotel rooms housing COVID-19 patients.U.S. Army Corps of Engineers

COVID-19 isn’t typically spread through airborne transmission, but certain procedures such as intubations can make the respiratory droplets more aerosolized. For patients who need this level of care, hotel rooms and dorms with their own individual air conditioning units can be converted into negative pressure rooms.

Todd Semonite, commanding general of the USACE, said in press briefings that the “relatively simple” conversion process involves adjusting the air conditioning to suck more air out of the room through the vents. A big piece of plastic with a zippered entry would be placed over the door and the resulting negative pressure would prevent contaminated air from escaping the room.

The USACE’s “Hotel to Healthcare Concept” also includes suggestions beyond those for individual rooms.

Nurse stations should be set up near the elevators on each floor and generators should be brought in. Patient screening tents and exterior pharmacies should be set up and medical waste disposal areas should be designated.

The concept is meant to inform local public officials, but it’s obviously not feasible to implement every change in hotel rooms or dorms before they’re needed. Many of them are also unnecessary if the site is only admitting patients with less severe symptoms.

But regardless of the type of COVID-19 patient, every hotel or residence hall should have security, medical personnel and food and laundry services on site to care for patients.

Those are four measures the Fairplex Sheraton implemented immediately, according to Helen Chavez, the assistant director of the Los Angeles County Office of Emergency Management.

The hotel didn’t undergo an extensive makeover, but so far it’s only been tasked with admitting COVID-19 patients who aren’t in critical condition and people with symptoms who are awaiting test results.

Dr. Chin-Hong said that even for less serious COVID-19 patients, rooms still need a minimum number of key things.

Personal protective equipment such as masks, gloves, gowns and hand sanitizer as well as inexpensive bins for disposing of infectious waste should be in each room. Few personal items should be allowed besides a phone or computer that connect patients to the outside world and can be easily disinfected. Signs with basic reminders and protection steps should be posted around the building.

Rooms should be as bare as possible. (More comfort for hotel guests and students means more surfaces for contamination.) Since it’s not always possible to remove excess furniture, deep cleaning is crucial before and after each new patient.

Cleaners would focus on disinfecting high-touch surface areas such as door knobs, handles and light switches. Since it’s not an operating suite, there’s no need to clean the ceilings or walls, said Pratik Shinde, who owns a Service Master franchise that offers health care sanitization.

He said properly decontaminating a standard hotel room (about 320 square feet) takes about 30 minutes. The average hotel room is 325 square feet and the average dorm is less than half that.

It’s important to note that medical, government and hospitality experts who spoke with NBC News agreed that the most critical cases should ideally be housed in hospitals. But for those with less severe symptoms, alternate housing is a viable solution that could cut down on hospital numbers and help isolate the infected.

As coronavirus continues to impact more of the country, the USACE has been working closely with more local authorities to quickly prepare for the worst.

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