Q&A / Evolving Statement on COVID-19 Preparedness & Response

Updated: May 8, 2020

This page locks in a placeholder for content that may guide decision-making for leaders in the education and university-affiliated healthcare facility industry.   It address three issues:

• Temporary use of student dormitories for contagious patient care
• Sudden uptick in broadband demand for off-campus learning and working
  
• Power and ICT technology issues likely to be emerge from changed use patterns as economic activity in education communities increases.

At the moment, this page is a re-direct from the IEEE Education & Healthcare Facilities Committee until the content can be formatted for the IEEE content management systems.  Time sensitive content informing the global COVID-19 response challenges the business models of many non-profit organizations.   “Pardon Our Dust” as we are fond of saying.

We provide this information on this website temporarily until subject matter experts in the various IEEE Societies are drawn into the conversation.  We place “lorem ipsum” in passages that will be receiving more detailed response in the near future.

Q1.  To what degree, if any, should now empty square-footage in student residence facilities be used for COVID-19 response?

A. (Mike Anthony).  At the risk of discouraging anyone’s imagination and best intent I would steer decision-makers away from this option for inpatient contagious respiratory disease care.   Such use would likely be more suited to housing healthcare support personnel; not direct patient care.   Dormitories have facilities that can provide child care to front line caregivers.

Military-style “pop up” facilities are built quickly for the type of care needed for military injuries; not necessarily for influenza care (though military biohazard facilities would likely be tricked out in a manner needed for treating patients with less contagious forms of influenza).   Nothing is impossible, however.  Where there is a will, there’s a way.  Local Authorities Having Jurisdiction will have to be in the mix because local building codes will likely be challenged.

A. (Jim Harvey).   Should Student Housing be used in Covid-19 patients?   Before that can truly be answered there is another question.  And that question is, medically, how will the housing rooms be used.  There are a number of medical areas to consider:

1. ICU rooms,
2. Step-down patient rooms,
3. Normal patient rooms,
4. Triage Rooms, or Emergency Rooms.
5. Testing Areas

If resident rooms are to be considered ‘patient care rooms’ in the broader sense; items 4 and 5 should be removed from consideration since these are normally ‘transitory’ functions.
ICU rooms should be removed from also since the infrastructure needs are to great.   Only Step-down rooms (2), or normal patient rooms (3) might be accommodated in the resident rooms – if the power and data infrastructure is ‘close’ to the needs.
As noted below in the power and data questions, older resident halls may be poor choices since they are often underpowered, and/or lack even minimal data infrastructure backbones.

A. (Mike Anthony).  To add to Jim’s point:  We assume that conformity to the power system reliability criteria found in NFPA 99 and NEC Articles 517 and 701 would be relaxed by local Authorities Having Jurisdiction.  Some of the CMS K-TAG requirements might be worth revisiting; (www.iccsafe.org content) linked below:

KTAGS_Group-B_existing-hospitals3

The most knowledgeable people for a temporary conversion will likely be front-line healthcare facility engineering experts such as Jim Harvey, Matt Dozier and Jonathan Flannery.  All of them are contributing content to this page.

A. (Robert G. Arno).   The HVAC systems found in medical facilities have a distinctive design criteria to limit the spread of infectious disease. Included is the standard requirements, such as IEEE White  Book requirements for emergency power, are specific requirements for a sustainable system. These are designed to limit the spread of disease while providing for the best care to the patient. Dormitories are not designed to these specific requirements and usually have HVAC systems common to the entire facility. Unless significant modifications are imposed the risk of spreading a air born disease is not curtailed. If dormitories have separate HVAC systems for each room similar to modern Hotels this maybe a consideration, but the common areas would need to be limited accessibility for medical personnel only.

A. (Richard Robben).   Re-purposing a portion of a dormitory requires attention to air handling systems; notably air management system requirements for contagious diseases.   Also, patient care settings have space set aside for staging patient care.    Typical dormitory room arrangements do not have this; though workarounds are possible.

A. (Jonathan Flannery).  The use of hotels for contagious patient care may be more appropriate than college and university dormitories.    The American Society of Healthcare Engineers will soon have recommendation to facility leaders contemplating use of student dormitories for contagious patient care.   CLICK HERE

A. (Glenn Keates).   I see that the use of dorms as an overnight, acute care facility is being seriously considered as a viable of resolving the current “bed count” issue.  I could not disagree more with this concept!  Let us assume, for this review that no standards exist for the health care environment, for which we can deal with later.  Let’s look at the practically of it:

1. 1. 1. The space in which to work on a patient is not there – just moving a patient that is non-ambulatory (i.e. on a gurney), would not be practical in the limited corridor of a typical dorm hallway.
      2. The ventilation that is so vital in the health care environment is not present nor is it easily obtainable.  Cross contamination would most likely result from such an endeavor.
      3. Medical gases are not present and would have to be portable tanks, causing their own set of problems.
      4. There is no physical space for operating suites or treatment areas and with that, the necessary air changes and electrical requirements for such functions.

Those items, in and by themselves, would negate the practical use of a dorm as a health care facility.  Now let’s review the technical side of this concept from an electrical viewpoint.  These include:

1. 1. 1. A patient room must have a reference grounding point, not only for safety, but for the practical use of sensitive medical devices such as ECG’s.  A dorm room does not have that reference.  A difference in the ground and neutral potentials can cause an electrical interference in the tracings.
      2. The capacity of the circuits in a dorm room, which are known to be minimal at best, must be examined to ensure they are not exceeded with normal hospital loads.
      3. The use of any invasive equipment, such as what might be found in an typical intensive care unit, could result in an electrical injury to the patient because of a lack of proper grounding.
      4. Also note that the electrical circuits in a dorm are not divided into “Essential” and “Normal” branches as they are in a hospital setting, where emergency power systems are available in case of such a loss.  The failure of an electrical system (source) could easily result in a loss of life.
      5. A fire/smoke alarm system is not present in the typical dorm setting – this is clearly a requirement where we have compromised patients.
      6. The need for a nurse call system is not present.
      7. The power required for a radiology suite again, notwithstanding the space and shielding requirements, are not present.

As can be seen, the basic needs required to operate a safe acute care, overnight stay health care facility are not present nor are attainable in the dormitory environment and therefore, we cannot responsibly recommend such a plan.

Q2.  How do we prepare for step function uptake in bandwidth demand (i.e. “internet pressure”) on curriculum and business operations?

A. (Mike Hiler).  Campus environments differ (Choose wisely) in the way bandwidth is delivered. I know of one University who use infrastructure provided by others to facilitate between healthcare facilities.  Others have developed a self-sufficient topology interconnecting their university-affiliated healthcare facilities.  More detail to follow.

A. (Mike Anthony)  I know of at least one Australian University (Monash University) that is measuring internet pressure that may guide decisions (i.e capitalization decisions) but, to the best of my knowledge, this simply identifies the current state of internet traffic.   Recall the adage: “If you can measure it, you can improve it”.   Such is the raison d’être of the National Institute of Standards and Technology.

The FCC has a measurement program for broadband performance which includes the performance of residential access but I do not know of any actionable information that would, for example, improve access speeds now.   It is likely that data gathered from FCC and Monash University programs will inform capitalization decisions by internet service providers.

Keep in mind that many research universities run de-facto public utilities for information technology and “may” be able to steer away some educational communities away from global bandwidth stress.   Since it is likely that off-site learning will be changed forever after this, please forward any anecdotal information to @IEEECampus so that the question may be re-directed to a subject matter expert.

Standards Michigan was aware of at least one educational unit that did not have access to teleconferencing facilities so it made its teleconferencing facility available to any educational unit 24/7 outside of its own daily 11 AM/EDT teleconferences.  That offer still stands.

If there are bandwidth bottlenecks, instructors should consider rationing video conferencing and move at least some instruction time on telephone conferences.  Virtual private networks may be a partial solution.

A. William McCoy (Verizon).  What should be considered is equipment and technology should be evolved not revolved and managing to lifecycle cost and not first cost should be the approach. Wireless and the 5G technology is the basis of the future for IoT which should more than address the needs of the healthcare industry.

A. (Jim Harvey).  ‘Nurse station’ patient monitoring, patient-nurse communications (nurse call), medical equipment’s data monitoring, and electronic patient records (among other things) and all essential services in modern hospitals. Most of these need to be provided, at least in rudimentary form.  This means data cabling of at least Cat 3 (?), reasonably sized communication rooms on all floors, and a reasonably sized BDF (Building Distribution Frame) should be in place.  Ideally each such room have (or be sized to accept) a local, rack-mounted UPS to support minimal services

A. (IEEE Communications Society).  Lorem ipsum

A.  (Mike Anthony)  Some countries, such as Portugal recently — CLICK HERE — have begun to use public broadcasting networks to mend communication links between students and instructors.   We may likely see more of this.   Even so, there is bandwidth on cable channels, though a paid subscription would be required.   It might not be a bad idea to inquire with your local television station — the free one with picks up broadcast signals from antennas or from the community cabling system itself — to expand their formal curricula to public broadcasting networks.

Q3. How do we configure the virtual private network to reduce bottlenecks in internet use for instructional purposes?

A. (Mike Hiler). The switching equipment found on Major Universities can be configured to accomplish this.   More detail to follow.

Q4.  What type of power system modifications would be involved re-purposing dormitories for direct patient care?

A. (Jim Harvey)  There are a number of issues to be aware of in re-purposing student dorm rooms to Covid-19 rooms relating to electrical power:

– Dorm rooms, especially in older dorms, likely may not have more than one dedicated circuit.  When more than one circuit is present, it is likely shared with an adjacent room.
– Following up on the above comment, even recovering patients might be on ventilators and other medical equipment which might load up a floor panel.
– Normally there is little, if any, emergency power in dorm rooms – either for power or lighting.

Q5.  What would workarounds for reconfiguring fairly standard residential class electric service (in a typical dormitory) to meet an elevated requirement for reliability of outlets at patient bedside? 

A. (Robert G. Arno).   I have no doubt that the USACE can configure dormitories into make shift hospitals but will the electrical infrastructure support the necessary load?. These facilities were not build to Hospital standards especially for emergency power. What medical equipment will be necessary to support infected patients to ensure that the correct treatment is being applied. What is a typical load requirements. Article 517 of the NFPA has a series of requirements for health care facilities that dormitories do not. For example in Part II of 517 it identifies requirements for wiring and protection in patient care areas (defined in 516.2). It does not apply to business offices, corridors, waiting rooms or similar areas in clinics, medical and dental offices, and outpatient facilities, nursing home and limited care facility areas used exclusively for patient sleeping. A major goal of Part II is to prevent electrical shock. In healthcare applications, people’s bodies are often in direct contact with energized equipment. Thus, Part II provides extensive grounding and bonding requirements-even for something as ordinary as a receptacle. The bottom line is Article 517 identifies a completely different power infrastructure that what is required for dormitories. Mike Holt Industries has published a summary that goes into more detail and some of there comments are referenced here.

Anytime you visit a hospital you will notice the red receptacles. These are emergency power receptacle designed to maintain power the medical equipment even during a power outage. These emergency power systems have a high Reliability requirement to not only provide emergency power but also supply that power in a matter of seconds. In article 708 of the NEC code it describes the suggested requirements for Critical Operating Power systems. Reliability is a major consideration for critical systems and hospitals being part of that system.

Dormitories are just not built to these standards and unless the infrastructure is modified present a concern to the safety of the patients. In emergency situations you must do what is best for the population. But I think everyone should be aware of the issues as pointed out.

IEEE Education & Healthcare Facilities Committee

@IEEECampus 

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Bibliography:  Note that some content originates at a single source and is distributed to local subscribers with some local modifications.

Climate-informed HVAC increases in relative humidity may fight COVID-19 and other pandemics

Converting alternative structures for COVID-19 patients

Colleges offering dorms as hospital overflow for virus cases

How the US Army Corps of Engineers is converting hotels and dorms to hospitals

The University Libraries increases sanitization of facilities in response to COVID-19

Army Corps may convert Detroit’s TCF center, Wayne State dorms for coronavirus relief efforts

Why the coronavirus lockdown is making the internet stronger than ever https://t.co/HMyfOeH96b

— IEEECampus (@IEEECampus) April 15, 2020

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