Five weeks ago I walked along the north bank of the Thames, past a number of cheap-and-cheerful chain hotels that dot the waterside, and bounded up the concrete stairs to ExCeL London, one of the UK’s biggest convention centres.
The ExCeL is a soulless place: one vast, long corridor lined with overpriced restaurants serving lacklustre meals. It takes ten minutes to walk from one end of the cavernous corridor to the other, and that’s before even looking in at the 100,000 square metres of convention flooring that flank the main drag.
Opened in November 2000, it attracts four million people to more than 400 events every year; it supports 37,600 jobs and generates £4.5 billion for the economy. I was there for one of the 400 or so events due to be hosted there in 2020: VidCon London, where huge crowds of overexcited teenagers prowled the convention floor playing games and seeking out a glimpse of their favourite YouTubers or TikTokers. How times change.
For the foreseeable future there will be no more conventions at the ExCeL. It has been dragooned into serving as the new frontline against the coronavirus crisis in the UK, the site of a vast field hospital designed to help stymie the spread of the disease, and to try and save lives. Opening next week with 500 beds, and with plans to expand to 4,000, it shows the sheer scale of the fight against the global pandemic.
“We are proud to be able to accommodate the increasing demand for hospital beds and will work with the NHS to facilitate this request,” says Jeremy Rees, CEO of ExCeL London, which for the duration of the battle against the coronavirus will be rebranded as NHS Nightingale.
Defence secretary Ben Wallace says the “ambitious project is just one example of what can be achieved when they come together to help the nation”.
On Friday, NHS chief Simon Stevens said that the government was making 33,000 hospital beds available for virus patients, and would be building two further temporary hospitals in Birmingham and Manchester, in addition to one in London. The Manchester Central Convention Complex, or GMEX and Birmingham’s National Exhibition Centre in Birmingham will join London’s ExCeL Centre in further boosting NHS capacity. But how do you transform a convention centre into a hospital?
“I didn’t take this virus very seriously until I saw this,” explains the contractor making up cables on the convention floor of the ExCeL. “This morning, I come in and this is the size of the hall,” he says, turning his smartphone camera out of selfie mode to look at the 600-metre long stretch of space where 2,000 beds will eventually lie waiting for the infected to be treated. Another ward of an equal size will be constructed in the opposite hall.
“If you’re not taking it seriously like I wasn’t, I think we really need to start, because they’re preparing for an absolute high death toll here,” the contractor says.
As well as the 4,000 beds for treatment, there will be two morgues installed in the hospital, according to the contractor – though a leaked plan of the project published by the Daily Mail indicates there is one mortuary on the site, right where the main exhibition space of VidCon London was. (ExCeL London and the Department of Health and Social Care declined to participate in this story. A spokesperson for NHS England said the project was “a very fast moving piece of work”.)
“The benefit of using an existing facility is that it’s much quicker,” says Eric Pitts of Doctors Without Borders, which has set up field hospitals across the world. “You already have the foundation and the structure, and with existing facilities it usually just requires renovations for something that is hygienic for a medical facility.” The biggest challenge, says Pitts, is managing patient flow to prevent infection.
According to the plans, the hospital will have two mirrored paths: patients will be triaged on entry at the eastern end of the conference hall, after passing the Aloft Hotel. They’ll then move on to either invasive or non-invasive ventilation areas (the former involving intubation, the latter wearing a face or nose mask), or to an area for patients showing minor signs and symptoms. Each section of the 600-metre long convention hall will be broken up by partition walls that are being installed right now by contractors.
Those who have been treated in time and survived will move on to a recovery ward, then be discharged, leaving through the west entrance.
Preparations for NHS Nightingale started with scoping out the site. “It’s probably one of the biggest covered spaces in London and therefore as a location that gives you maximum flexibility for how you might use it, it’s probably one of the best in London,” says Martin Bricknell, professor of conflict, health and military medicine at King’s College London, and an expert in the design and function of field hospitals.
Planners check the characteristics of potential sites, including access, public services that are supplied to the site, the scale of it, the ability to flex demand as needed, and location in relation to the rest of the health system.
The ExCeL is a boon because of its large convention halls. “You’ll have a large open space, and different levels of circulation where you can control the flow of people coming in and out,” says Pitts. Another major difficulty – providing enough power to the facility to keep thousands of ventilators running, as well as the lights and other services, shouldn’t be much of a problem given the volume of people and stage facilities the ExCeL is used to running.
“I would imagine that [the Nightingale hospital] has been focused on respiratory support, so it will probably function like an evacuation hospital, with the wider NHS hospital services still being the primary point of contact for decision making,” says Bricknell. Patients most in need will be transported to the Nightingale via ambulances – the ExCeL has a waiting area for 300 vehicles, and drive-in doorways allowing loading and unloading of equipment easily – while it seems likely some of the more than half a million volunteers through the government’s call for support will help transport others through the healthcare system. “We might start using taxis or minibuses as other forms of transport to move lower acuity patients,” says Bricknell.
The ExCeL is also incredibly close to London City Airport, which has been co-opted for use by the armed forces, meaning that patients from across the country could theoretically be moved to the new Nightingale hospital. The Department of Health says between ten and 13 others could be set up around the country, including the two additional hospitals announced Friday.
The way in which the Nightingale Hospital will slot into the healthcare system is only one part of the decision-making process. Once organisers agreed to go ahead with the plans — which it appears the government decided at some point over the weekend, given reported visits to the site to scope out the area — you start looking at things like the provision of light and power, feeding arrangements, and heating and air conditioning. “If you’ve been to ExCeL, it’s a vast site that’s very well-serviced,” says Bricknell. “It’s capable of maintaining thousands of people for conferences.”
But entertaining conference goers and looking after patients are two very different things. For one thing, the entire site is being repurposed. According to the leaked plans, as well as the partitioned walls being hastily thrown up to delineate the different areas of the field hospital, new corridors are being built to add to the catacombs of the behind-the-scenes web of ways to get around the ExCeL. And this isn’t just a case of putting beds and some walls up: planners are designing a working hospital from scratch in a matter of days.
“Exactly how this will operate with clinical protocols, I’m sure the team is thinking through,” says Bricknell. “This is novel, so it’s not easy. But it’s this type of crisis that brings out the best in people, and the most innovative answers.”
One of the biggest challenges is designing the building to be as hygienic as possible to prevent infection – a challenge when dealing with coronavirus, which has been shown to last long on surfaces in the form of droplets. “You need to look at how to properly lay out the patient flow to guarantee infection flow, and how to design the walls and floors so they’re easy to clean,” says Pitts. “The main challenge in adapting an existing structure is how the existing structure is set out.”
“This will be a model of care never needed or seen before in this country, but our specialist doctors are in touch with their counterparts internationally who are also opening facilities like this, in response to the shared global pandemic,” says NHS chief executive Sir Simon Stevens.
The UK’s plans for the ExCeL follow examples elsewhere; Wuhan built a 1,000 bed, 645,000 square foot hospital in a matter of weeks to treat its patients, while a similar conference centre in Madrid has been co-opted into a hospital designed to treat the ill in the Spanish capital, which has seen two-thirds of the entire country’s cases.
One of the most important areas of the new London hospital won’t be the treatment sections, but the command and control arrangements. Staff working at the new Nightingale Hospital are being asked to leave their families and live on or around the site for weeks, so they need to be housed and catered for. A hospital management cell, and a non-clinical space, will sit in the middle of the ExCeL’s central corridor, while the operations and briefing rooms, as well as the liaison office and location for contractors on the site, will sit near the mortuary.
“You have to look at logistics in terms of medical equipment, pharmaceutical supplies and in this case, oxygen supply,” says Bricknell.
At lunchtime on March 26, the BBC spotted vast white oxygen tanks being installed outside the ExCeL, providing source material for the ventilators that will keep patients alive. One anaesthetist says that at a minimum, each bed space should have 35 litres per minute of suction and oxygen at four times atmospheric pressure. There’ll also need to be laboratory support — not just for diagnoses of coronavirus, which presumably will have been carried out before arriving at the hospital, but haematology and biochemistry tests.
That’s not all that’s required. A patient tracking system will need to be installed and maintained, as well as a communications network, not just for staff, but also for families to speak to their hospitalised relatives, especially given access is likely to be restricted. Then there’s the challenge of staffing out the hospital, combining military doctors and personnel with NHS and private hospital staff. According to NHS England, the majority of the workers will be NHS staff, with London hospital trusts asking for volunteers who would be willing to work in the new pop-up hospital. Hundreds of people will be needed, says Bricknell.
That collaboration between the military and the NHS and others is vital, he reckons. The military already have experience of setting up and maintaining field hospitals, with three in existence across the UK already for non-coronavirus treatment.
“I’m sure that there is very good civil military collaboration, including I’m sure some military personnel who are being brought in to provide a bit of a spine for putting in the processes, but inside the NHS there will be people with a huge amount of additional experience,” he says. “You’ll find people with pre-existing managerial experience and pre-existing humanitarian experience will come through. You may find British Red Cross and St John’s can provide some structure around the provision of personnel.”
The experts are all in agreement: setting up something like this is a challenge. “There’s no template for doing this,” says Bricknell. “But it not only has to be done, but there’ll be immense amounts of energy and commitment to ensuring if it is humanly possible to do it, it will be done.” And it’s not necessarily unprecedented.
Look back through photographs of the 1918-19 influenza pandemic and you’ll see images of warehouses and school buildings housing sick patients. We also have more recent experience in the UK of setting up field hospitals in Sierra Leone to help tackle the Ebola crisis.
“I would say it’s eminently deliverable,” says Bricknell. “The rate-limiting factor won’t be any lack of ingenuity. It’s just what is possible to achieve when you’ve got this weight of organisational commitment to make the impossible possible.”
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This article was originally published by WIRED UK
