With cases COVID-19 increasing by the thousands every day in New York City, healthcare infrastructure is breaking under the strain. Last week, Governor Andrew Cuomo predicted that 40,000 cases in the city alone would soon need intensive-care beds—more than 10 times the number of existing rooms. This huge surge in demand is a New York crisis now, but may quickly overwhelm hospitals elsewhere in the U.S.

The projected need is so great that Cuomo has asked every hospital in the state to identify ways to add 50 percent more beds. The Greater New York Hospital Association, which represents more than 160 facilities, has asked Peter Romano, a consultant to medical facilities, to assemble a team that could rapidly evaluate and design new beds for at least 10 sites. His team includes five architecture firms with healthcare specialties, four engineering firms, and four construction managers.

It’s a daunting challenge since major additions to hospitals can take four or more years to get from design through construction—and the need is for new beds to be delivered in weeks. “We’re looking for some projects in construction to see how quickly they can be readied,” Romano said. “We’re looking at old treatment areas that had been converted to office space and whether they can be changed back into patient rooms. We’re looking at a cathedral.”

The team analyzes drawings supplied by the target health facilities, using a programmatic test to see if there is space for a useful number of beds. Increments of 20 to 25 beds, he says, can most efficiently be served by a nursing station. The HVAC and treatment infrastructure must be assessed, including availability of oxygen, nursing call systems, and so on. For feasible sites, architects and engineers on the team will design what is needed, and Romano’s team will estimate costs and hire contractors.

Hospitals have known that pandemic influenza was a real threat, even though not all have been able to prepare. Designing for a pandemic is in the planning guidelines hospitals use, according to James Crispino, the Global Practice Leader in Health at Gensler’s New York City office: “Any epidemiologist worth his salt can tell you how a pandemic like this will play out.” Most states mandate 15 to 20 percent of private rooms in new hospital construction, he explained, to isolate infection.

The Kimmel Pavilion at NYU Langone Health in New York (a project of Ennead with NBBJ) “was designed to handle virtually anything,” says Chris Prochner, health facilities lead with consulting engineer Jaros Baum & Bolles, who is also advising the Health Association group. The technology, services, and HVAC infrastructure of Kimmel permit the conversion of entire floors from conventional medical-surgical rooms to ICU-type rooms capable of containing infections. The hospital has converted seven floors of the new tower to serve COVID-19 patients. The Emergency Department has been expanded and configured to screen and assess potential coronavirus patients in an area separated from general users. NYU Langone has also altered its older buildings in recent weeks, focusing on technology and HVAC enhancements to serve both contagious and non-contagious patients. A decommissioned building has been built-out for large-scale patient testing; a conference room has become a staff testing centers.

Even with rapid transformation achieved at jaw-dropping speed, Romano’s team must look at hotels and college dorm rooms. Those with separate HVAC units can be turned into negative-pressure rooms suitable for COVID-19 patients, if a nursing station can be accommodated.

Is governor Cuomo’s goal doable? “I think the number of beds is achievable,” said Romano. “I don’t think we have any choice but to try and hit the target.”