Atractor-trailer rolled around Appleton, Wisconsin, in late 2019, taking hard turns, rumbling over bumpy stretches of road and generally jostling the cargo in back. These were ordinary times for the Boldt Company, a construction services firm based in the city, and this was an ordinary test to see how a new product would hold up during shipping. The product happened to be a prefabricated health care clinic room, a prototype built without a client in mind or contract in hand.

“It was serendipitous that we did that just a few months before we had the call for the COVID crisis,” says Zach Lauria, Boldt’s director of self-performed construction.

On March 15, Boldt’s executive vice president, Ben Bruns, called Kurt Spiering, principal at HGA, an architecture, engineering and design firm. The pandemic had arrived in the United States, and hospitals faced shortages of personal protective equipment (PPE), doctors and nurses, and airborne infection isolation rooms (AIIRs)—the single-patient, negative-pressure spaces engineered to prevent spreading airborne pathogens like the novel coronavirus.

Renderings of The STAAT Mod, modular critical care isolation rooms created through the collaboration between HGA and Boldt in response to COVID-19. The first units were designed, built and shipped to Maryland hospitals by the end of April; the first patients occupied them before the end of May.

Renderings of The STAAT Mod, modular critical care isolation rooms created through the collaboration between HGA and Boldt in response to COVID-19. The first units were designed, built and shipped to Maryland hospitals by the end of April; the first patients occupied them before the end of May.

As infection rates climbed, hospitals jury-rigged triage tents. HGA and Boldt had collaborated for more than 30 years and both had track records serving health care markets. On the phone call, Bruns and Spiering sought an answer to a tricky question: With COVID-19 patients expected to flood hospitals, could the prototype on the back of the truck become an AIIR in a matter of weeks?

The pandemic has compelled many companies to work under once unimaginable circumstances and constraints, as they navigate stay-at-home orders and an economic shutdown to deliver vital equipment to health care workers. The STAAT Mod, a two-bed modular critical care isolation room created through the collaboration between HGA and Boldt, is the result of such nimble thinking. The first units were designed, built and shipped to Maryland hospitals by the end of April; the first patients occupied them before the end of May.

Ultimately, the process validated the companies’ emphasis on prefabrication, an approach that slashes waste and resource use, and that often upgrades the performance of existing hospital facilities at roughly 65% of the cost of similar, conventional construction.

“The market was already moving in that direction, but the COVID-19 crisis has been a catalyst for change,” Spiering says.

The concept for the STAAT Mod began with shipping dimensions both companies knew would work: 10 feet high, 40 feet long and 12 and a half feet wide. (“We called it ‘inside-the-box thinking’,” Spiering says.) But little else was certain at the outset of the pandemic; supply chains were breaking down, so parts had to be readily available, and with social distancing orders in place, HGA and Boldt had to collaborate remotely. Based on past research on inpatient units, however, HGA already knew the essentials to include. The design included donning and doffing stations for health care providers to disinfect before entering and after leaving the room, viewing windows to better monitor patients, individual carts for medical supplies in each room, fixed hookups for oxygen and other medical gases, and ample room to move patients and cart in X-ray machines.

HGA created a virtual reality mockup of the room and recruited nurses in Wisconsin to run through different COVID-19 care scenarios, tweaking features along the way. “PPE gear was extremely scarce,” Spiering says, “so we thought, could we put all the controls for pumps outside the room so [the nurses] didn’t have to go in for an unnecessary alarm?”

The room’s HVAC system, meanwhile, grew out of recommendations by the Centers for Disease Control and Prevention to sequester potential COVID-19 patients, in light of a shortage of AIIRs. “To protect staff, we needed to make each [STAAT Mod] room equivalent to an AIIR,” says Jeff Harris, director of engineering for HGA and a LEED AP, “which means you need a minimum of 12 air changes an hour, and the room had to maintain negative pressure.”

To speed along design and delivery, the HVAC subcontractor, Tweet/Garot Mechanical, employed a standard rooftop system with an attached HEPA filter and exhaust fan to prevent virus aerosols from recirculating. “When the staff weren’t physically in the room, they were in a safer environment than, say, a tent, where you don’t have any control over how the air moves around,” Harris adds.

Meanwhile, just a week after Spiering and Burns spoke, Boldt set up a prefabrication shop in Appleton. Once the design was finalized and after a nine-day startup period, a new unit rolled out of the shop every day.

“We’re building the same thing over and over again, and the standardization and repeatability inherently drive a much more efficient, lower-waste delivery process,” Lauria says. “You’re wasting less material because you can order things in exactly the way you need them. We don’t have to order an extra three inches on a stud just in case something isn’t where it’s supposed to be: Things are always where they’re supposed to be. There’s no magic bullet that slashes waste by 40%, but when you maximize every single, incremental improvement, it yields an impressive result.”

STAAT Mods can serve as stand-alone clinics or link into existing hospital facilities. After publicizing the STAAT Mod, a program manager in Maryland asked for a shipment to Adventist HealthCare Fort Washington Medical Center that arrived on April 24; before then, the hospital separated patients in an open-bay intensive care unit using plastic sheets with zippers.

The prefabrication approach cuts waste and resource use, upgrading the performance of existing hospital facilities at roughly 65% of the cost of similar, conventional construction.

“This is a phenomenal improvement over what they had in their fixed facility,” Spiering says. “In most cases, hospitals [that use the STAAT Mod] are going up in quality in the middle of the crisis.” After pouring foundations and bringing in utilities, installing a 16-bed inpatient unit takes as few as four weeks; similar, conventional construction, Spiering says, could take a year.

The first patients occupied the STAAT Mod rooms in Fort Washington just after Memorial Day. As of late June, 64 beds were operating in Maryland without any problems. Since then, HGA and Boldt have tweaked the STAAT Mod for greater durability and to adhere more strictly to Facility Guidelines Institute (FGI) code.

The future of the STAAT Mod itself is changeable, too. “We’re looking at reconfigurable interiors and mechanical systems, so these units can be plug-and-play on the job site, which opens the possibility of these really being temporary,” Lauria says. “One day they’re high-acuity health care rooms. The next day, with a little effort and labor, they could be commercial office spaces.”

With the extent of the pandemic still uncertain, the STAAT Mod aims to offer some small measure of comfort. “It’s a healing environment for patients,” Harris says. “This is a real, high-quality health care environment that can be installed in six weeks.”

In nine different countries around the world, DuPont manufactures protective garments for health care workers that are made from Tyvek, a fabric-like polyethylene material designed to breathe while keeping out hazardous materials. (A slight variation of the material functions as a weather barrier in home construction.) As the COVID-19 pandemic brought widespread PPE shortages and precarious global supply chains, DuPont launched an initiative called #TyvekTogether, delivering rolls of the material from its production facility in Richmond, Virginia, to domestic manufacturers with idle capacity.

“These are companies that made consumer clothes, automotive upholstery and other things, but the commonality is that they have the capability to cut and sew garments with a little bit of help,” says David Domnisch, global business director of DuPont Personal Protection.

Along with ramping up materials production, the company provided free patterns and technical support to partners like Mirror Manufacturing and Ferrara Manufacturing, in hopes of matching DuPont’s garment manufacturing and expediting equipment to front-line workers. By the end of April, the production of Tyvek protective garments grew to 30 million a month.

Johnson Controls, which manufactures HVAC, fire safety and security equipment for clients in health care markets, began responding to the COVID-19 pandemic at the source. In mid-February, when China was the locus of the pandemic, the company mobilized staff on the ground, erecting a makeshift hospital in Wuhan, providing communication and security technology for 300 hospital beds, and equipping 860 critical care beds in China with nurse call systems.

As the coronavirus spread, “We were running on adrenaline,” says Lisa Roy, a vice president of commercial sales at Johnson Controls. “We had folks from cross-functional teams—project managers, health care experts, technology experts, people from the product side of our business—center on the question, ‘When this hits the United States, what will the needs be and how can we help with the response?’”

Johnson Controls developed designs for temporary hospitals used in a variety of environments, from dorm rooms and hotels to convention centers, and helped health care clients navigate new restrictions and accommodate patient surges. The company manufactured 60 five-ton heating and cooling units for field and pop-up hospitals.

USGBC member companies support hospitals during the pandemic