White House officials said Tuesday they were attempting to inventory the nation's supply of mobile hospital units and potentially pulling in the Defense Department to build more as concerns grow over whether hospitals can handle a surge in capacity, particularly in California, New York and Washington.
"The President has tasked us to evaluate, make available and to consider every request from governors for either field hospitals, expanding facilities or the Army Corps of Engineers that could retrofit existing buildings," Vice President Mike Pence said Tuesday during a press briefing.
New York Gov. Andrew Cuomo has been urging the federal government to enlist the Army Corps to work with states to build temporary medical facilities, and said Monday it "makes all the sense in the world," pointing to the experiences in Italy and China that overwhelmed hospitals.
Hospital business models are not designed for unused capacity, Cuomo added, "they don't build capacity that they don't need."
The U.S. has a total of 5,198 hospitals, which includes academic medical centers, and about 792,000 beds. That includes 65,000 ICU beds, according to data the American Hospital Association provided Healthcare Dive.
Comparing other nations, the U.S. has about 2.8 hospital beds per 1,000 residents compared to China's 4.3 and Italy's 3.2, according to the Organisation for Economic Co-operation and Development.
President Donald Trump's administration seems to be readying to build temporary sites in concert with the Department of Defense. Trump said they're looking at different sites at a few different locations.
"We think we can have quite a few units up very rapidly," Trump said Tuesday, pledging to work with Democrats Cuomo and California Gov. Gavin Newsom.
The American Hospital Association has not addressed use of the Army Corps of Engineers, but it did advocate for federal support to "construct or retrofit separate areas to screen and treat large numbers of persons with suspected COVID-19 infections. This includes construction of isolation facilities in or around hospital emergency departments to assess potentially large numbers of persons under investigation for COVID-19 infection," according to a letter AHA, along with the American Medical Association and American Nurses Association, sent to Congressional leaders Monday.
Department of Defense Secretary Mark Esper said Tuesday the department will make available to HHS up to 5 million N95 masks and 2,000 deployable ventilators, although those require special training to use properly.
"In my conversations with governors and members of Congress about DOD's resources, I've made it clear that we will continue to support the administration's comprehensive efforts and the country every step of the way," he said.
Mobile hospital units have been used across the country in the wake of other national emergencies.
A 60-bed mobile hospital was built in a matter of days after a hospital in Joplin, Missouri, took a direct hit from an F-5 tornado in 2011, killing five patients and one visitor. Six days after the hospital was hit the mobile hospital was up and running with all the capabilities of the medical center before it, including operating rooms, cath labs, and MRIs.
Carolinas Healthcare System has deployed its own mobile facility following disasters, including Hurricane Katrina and more recently Hurricane Matthew, that helped ease hospital burden. The mobile unit, housed on a tractor-trailer, can tend to complicated cases and even has an operating suite, according to North Carolina Health News.
Former California Gov. Arnold Schwarzenegger spent $172 million in 2006 on emergency medical preparedness for a disaster or pandemic that would overwhelm hospitals. The state acquired three 200-bed portable hospitals that could be erected in less than three days, according to previous reporting from the Sacramento Bee.
It's unclear what became of those mobile hospitals, which were stored in warehouses. They were on the chopping block in 2012 when the state was facing budget cuts following the recession. The hospitals were never deployed, according to reporting in 2012 from the Sacramento Bee.
Hospitals across the country are augmenting their campuses to respond to the growing threat of the novel coronavirus. Some have erected tents outside their facilities to help treat and triage patients suspected of having COVID-19, while others have implemented drive through testing sites.
Holy Cross Hospital in Silver Spring, Maryland, is using a tent outside its facility to test and treat patients with COVID-19. It's a way to add capacity and not overrun the current hospital.
Rush Medical Center in Chicago opened a similar tent inside its emergency room, providing an extra defense from the virus spreading as they test patients suspected of having the virus.
Mercy in suburban St. Louis started drive-through testing for COVID-19 on Saturday. Nurses were able to swab 52 patients on Saturday and 31 on Sunday.
"The idea is part of the whole social distancing. If we send people to the drive thru site we keep them out of doctors offices, hospitals and urgent cares," a spokesman for Mercy told Healthcare Dive.