With the lessons of last spring’s Covid-19 peak still horrifyingly fresh, New York City’s Health + Hospitals, the largest public health-care system in the US, has taken a comprehensive approach to addressing massive health-care gaps revealed by the pandemic’s ravages. Vowing never to repeat its traumatic experience with overflowing hospitals and refrigerated trucks stacked with the bodies of the dead, the new efforts represent Health + Hospitals’ commitment to “fighting every inch of this virus, from testing to intensive care, and the long-term recovery that many survivors will require,” Senior Vice President for Ambulatory Care Ted Long said in a statement. 

To meet the crushing need for Covid testing, the City’s Department of Design and Construction (DDC) has converted shipping containers to test centers for Health + Hospitals, and has recently begun rapidly deploying ambulance-style trucks fitted out as mobile test centers. These can be moved from neighborhood to neighborhood according to need. “The idea is that the patient need not enter a place that seems hostile, like a hospital or military tent,” says Lucy Wong, a DDC Executive Director who is part of the agency’s test and tracking group. The trucks’ medical team screens patients from windows on both sides, prior to conducting swab tests under an awning extending from the back. Wong says the vehicles have been designed with vaccine-distribution in mind.

The health-care practice of architecture firm Perkins Eastman has been commissioned to design three Centers of Excellence as neighborhood adjuncts to the hospital network. These facilities offer primary care for chronic conditions like heart disease and diabetes to those who cannot afford or readily access services. These are among chronic diseases of poverty (called, chillingly, co-morbidities) that plague hard-hit minority neighborhoods, and have been implicated in high death rates among essential workers and their families.

With anywhere from 20 to almost 50 exam and treatment rooms each, the Centers of Excellence offer a “one-stop shop,” As Jade Bailey, DDC’s site project manager, put it, including cancer screenings, dental and vision care, OBGYN services, behavioral health care, and management of extreme obesity and diabetes. The centers follow a trend to take many ambulatory services out of hospital settings and bring them closer to the community. Such ongoing health support aims not only to reduce the Covid death rate, but to create a path to broader well-being that could help close the yawning life-expectancy gap between the well-off and the poor.

The process was fast-tracked in summer as Health + Hospitals doctors identified treatment needs for “long haulers,” whose symptoms extend long after infection. The design team incorporated these needs on the fly. “We had to pay special attention to respiratory function and therapy due to Covid lung damage,” says Jeffrey Brand, who leads Perkins Eastman’s healthcare practice. 

DDC, famous for its long and costly processes that sometimes add years to projects, was able to streamline delivery thanks to a government “emergency declaration” that cleared bureaucratic hurdles. Instead of a drawn-out timeline for design, bid, and build, the project delivery was led by construction manager Gilbane, and the designers worked closely with the construction manager, since the builders had to start work without fully fleshed-out plans. [Disclaimer: author previously worked at DDC.] More than 40 percent of Gilbane’s subcontractors are minority or women-owned businesses, according to the company’s project manager, Raquel Duran.

On a recent visit to a center nearing completion in Jackson Heights, Queens—a vibrant neighborhood with many immigrants from Latin America and South Asia—carefully distanced Health + Hospitals personnel were installing medical equipment while Gilbane’s subcontractors tended to punch-list items. The first center had been completed in the Bronx in less than six months, with teams of builders on site 18 hours a day, seven days a week. The 28,000-square-foot Queens clinic, occupying the entire second floor of a recently built residential tower, is scheduled to see patients not long after Christmas. DDC would like to make the streamlined procedures permanent, says Nick Mendoza, DDC’s chief contracting officer.

The client wanted Covid-ready rooms, which meant designers worked round the clock to coordinate the installation of advanced filtration and negative air pressure ductwork beneath low ceilings, handing drawings to the subs as they were working.

The design is efficiently businesslike, since the schedule didn’t permit long-lead-time items. There was no leeway for exterior details that could offer a distinctive welcome to populations that sometimes fear official institutions. Nor could upgraded accommodations for staff be designed with calming and therapeutic elements, even as healthcare systems strive to address the needs of stressed and burned-out caregivers. 

Grace notes to reassure anxious patients are focused in waiting areas and include looping LED fixtures and a tactile but restrained palette of white marble tiles, striped cultured stone reception desks, and lounge furniture in a calming shade of blue.

Crises have a way of focusing such a mission, and cities across the nation with spiking infections and hospitalizations may find themselves looking at New York—not in dread, as they were in April—but for solutions.