3 examples of modular and prefab hospitals constructed to fight COVID-19

Since the beginning of the coronavirus pandemic, the architecture, engineering, and construction (AEC) industries have supported those serving on the front lines of rapid-response health care. Building ad hoc, modular, and prefab hospitals for communities facing unprecedented clinical demand turned AEC experts into emergency responders, delivering high-quality projects amid exceptional circumstances.

These new practices will serve the construction industry in future crises—and perhaps even in the course of returning to more normal business modalities. Here, projects in three countries—China, Mexico, and England—illustrate what this extraordinary situation demanded, how teams mobilized, and the knowledge they gained.

Wuhan, China, emerged as the world’s first coronavirus hot spot in January 2020. With cases and deaths quickly climbing, the local government assembled an all-star team of designers and builders for a monumental task: Build a temporary, 1,000-bed hospital in just 10 days.

On Jan. 23, 2020, two days before the start of Lunar New Year, Wuhan officials announced a citywide lockdown. By afternoon, the phone was ringing at CITIC General Institute of Architectural Design and Research (CITIC ADI) and China State Construction 3rd Bureau Engineering (CSCEC-3), which designed and built the Huoshenshan Hospital, respectively, using prefabrication construction methods.

“Under the leadership of the headquarters, a design team of more than 60 people was assembled for the Huoshenshan project in about one hour,” says Jiqiang Hu, director of CITIC ADI’s Digital Design Research Center. “Within 30 minutes, our designers were already on their way to the site for a field survey. We were all eager to take part in this project and contribute to the fight against the epidemic.”

A project so large would typically take six months to design and up to three more years to build. “We had to race against time, as people’s lives were at stake,” Hu says. CITIC ADI submitted a ground-leveling scheme in five hours, finalized a design plan in 24 hours, and delivered construction drawings in 60 hours.

CITIC ADI attributes its speed largely to its methodology. It used a “relay” approach to design, with personnel working two shifts for continuous design progress. Construction was done concurrently instead of consecutively. “We pushed forward various procedures in parallel or even reverse order,” Hu says. “Basically, we were doing designing, construction, scheme modification, and adjustment all at the same time.”

Technology also was key. Upon receiving the project, the project coordinator issued a company-wide call for assistance via WeChat. Using building information modeling (BIM)—including Autodesk Revit and Navisworks for digital modeling, Enscape for model rendering, and Civil 3D for field leveling and site planning—allowed the teams to visualize designs, integrate specialties, and share data in real time, all of which accelerated the work.

BIM also facilitated rapid construction of a testing lab to provide screening and diagnosis support to Wuhan and its surrounding communities. On Jan. 29, CCCC Second Harbour Engineering Company was tasked with building the Fire Eye laboratory in just six days. The inflatable, 6,000-square-foot structure, one of eight operated by the Beijing Genomics Institute (BGI), required complex air-pressure and pollutant-discharge systems, which presented construction challenges.

“The project team decided to use BIM technology for virtual design and construction,” says Fuqiang Chen, deputy general manager of CCCC Wuhan Zhixing International Engineering Consulting. “With the help of the BIM model, the design intention of the new lab was fully expressed, and the integration of electromechanical pipeline was deepened. The model assisted site technical personnel as they communicated with designers and the owner, avoiding collisions and rework of the electromechanical pipeline and saving as much construction time as possible.”

As the hospital’s general contractor, CSCEC-3 achieved success through diligent planning—down to the hour and, in some cases, the minute. “For example, immediately after the field is leveled, the ground-laying work and the transportation of the prefab modules must get started,” says Yewen Wu, CSCEC-3’s Huoshenshan and Leishenshan hospital field BIM engineer. “If it is too early, it will cause congestion, and if it is too late, it will delay the schedule. Every step needs to be precisely planned, with the right schedule for labor, equipment, transportation, and materials.”

Expert planning helped CSCEC-3 quickly erect a second 1,600-bed temporary hospital in Wuhan, Leishenshan Hospital, using the same prefab approach. It was designed by the Central-South Architectural Design Institute (CSADI), which assembled more than 80 designers—40 recruited at warp speed on Lunar New Year’s Eve—who produced construction drawings in three days.

“This project is a single building, which was built quickly by way of container-box and steel-frame assembly,” says Songmin Zhang, deputy chief architect of CSADI and director of the Leishenshan Hospital Project. “The challenge was that the design drawings needed to be adjusted in real time in coordination with the deployment of construction personnel, materials, and machines. Within the three-day construction-drawing time limit, most of the drawings had been completed by CSADI, but the designer still needed to monitor construction progress to revise the drawings on-site.” Thanks in no small part to CSADI’s dynamic design process, construction was completed in only 13 days.

The novel coronavirus arrived in Mexico in late February 2020. By mid-March, CEMEX—a Mexican manufacturer and distributor of building materials—realized that to meet the coming demand for critical care, Mexico would need more hospital beds. But CEMEX was not directly involved in the hospital business.

“We really wanted to support in some way,” says Enrique Rodríguez, manager of engineering and infrastructure and government projects at CEMEX. “However, the projects we were involved in on a day-to-day basis—roads, dams, or wind farms—are not directly related to fighting the pandemic. The idea arose that an internal project, where we would develop prefabricated subsidized housing for employees working on remote sites, could evolve into a concept for manufacturing and installing prefabricated hospitals. Knowing the country’s need, this idea would really serve the population.”

CEMEX carried out a laser survey of its subsidized housing project and re-created the design in Revit, leading with its technological business unit, called Construhub. This became the starting point for a mobile hospital model, developed in collaboration with Mexican companies seeking to add value to the project. Teams worked together on the design to mitigate late-breaking change orders, even providing opportunities for public-health institutions to virtually walk through the site before construction began.

The BIM model took less than three weeks to perfect. Work then commenced on hospitals in Monterrey, Nuevo León; Ciudad Juárez, Chihuahua; Culiacán, Sinaloa; Fresnillo, Zacatecas; Tlalnepantla, state of Mexico; and Puebla, Puebla. The efficiencies gained from BIM helped expedite these six temporary hospitals, which were built using prefabricated antibacterial concrete and installed in 15 days.

“BIM helped us not lose the project’s essence: prefabricated, durable, intelligent, and affordable hospitals,” Rodríguez says. “This represented a great effort to achieve the best design-build proposal from the group of interdisciplinary companies that participated. We always maintained fluid and transparent communication with our clients, which was the key to achieving a functional hospital model meeting the needs of patient care and medical staff.”

When it became clear how easily COVID-19 could spread, governments banned large gatherings, meetings, and events. As a result, convention centers worldwide sat empty—including those in the United Kingdom. The UK government turned to the vacant convention centers to support the National Health Service (NHS) and establish temporary hospitals in the event of a surge in demand arising from the pandemic.

Named for Florence Nightingale, the founder of modern nursing, these so-called Nightingale Hospitals were conceived on March 24, 2020, when the NHS announced its first field hospital at East London’s ExCeL London convention center. Just a few days later, on March 28, the NHS selected Interserve Construction to develop its second field hospital: the NHS Nightingale Hospital Birmingham at the National Exhibition Centre (NEC).

Interserve was a rational choice because it had helped build the NEC, and its offices were located nearby. “We were told that the NHS needed 800 critical-care beds within two weeks,” says Project Director Vince Kesterton. “It was pretty nerve-racking because there aren’t projects of that scale that you turn over in two weeks. It just doesn’t happen.”

To make an unprecedented task manageable, Kesterton made a list of everything that had to be accomplished, then worked backward to determine what resources and schedule would be required. “It quickly became apparent that we needed three eight-hour working shifts, 24 hours a day, seven days a week, and that we needed to use our entire supply chain working together.” Kesterton asked subcontractors to cease work on other projects and send as much labor to Birmingham as possible. The resulting team of more than 450 Interserve employees and contractors, plus 60 Gurkhas from the British Army, worked more than 90,000 construction hours building a temporary hospital spanning the equivalent of 11 soccer fields.

“Naturally, people want to work a standard day,” Kesterton says. “But we had to be very strict with our trades to make sure we had three shifts that were productive around the clock. The average person worked 10 or 11 hours a day, but people wanted to put in the time because of the project’s purpose. There was a lot of goodwill.”

The project was divided across five exhibition halls, where activity was carefully orchestrated using PlanGrid, an Autodesk cloud solution, to document progress and communicate issues. While flooring was being laid in one hall, walls were being installed in the next and service cables in another. Whenever an issue was discovered in one hall that might affect progress in another, a picture was taken and shared in the cloud for resolution.

“It was a good method for speeding things up, rather than using paper,” Kesterton says, adding that working this way meant constant progress without requiring contractors to step all over each other, essential to observing government-mandated social-distancing rules.

“Social distancing was difficult because we often had 400 or 500 workers on-site at one time,” says Kesterton, who appointed a health and safety manager with a team of designated “spotters” whose job was to enforce social distancing. “We’re very fortunate: We didn’t have anybody test positive for coronavirus.”

On April 16, just two weeks after work began, Interserve delivered 800 beds to the NHS, which already had commissioned a second phase with another 400 beds that was delivered two weeks later. Fortunately, Kesterton says, none of the beds has ever been used. “It’s strange,” he says. “Everybody worked really hard on this project, but nobody wanted it to actually be used. And, thankfully, it wasn’t.”

The COVID-19 pandemic is an extraordinary circumstance that has demanded an extraordinary response. When the dust finally settles, the designers and builders who met the moment will have many learned lessons that promise to outlast it. Responses to future challenges—whether ordinary construction conundrums or international emergencies—promise increased speed and efficiency.

In Wuhan, the value of technology shines brighter thanks to the success of Huoshenshan and Leishenshan hospitals. “Technology is the king,” says CSCEC-3’s Wu. “Technicians are constantly improving the construction plan on-site, and the process needs to be as simple as possible while not compromising existing functions.”

Simplicity breeds efficiency, says Hu, who emphasizes the importance of BIM to the process. “Using BIM to create an information-sharing platform for owners, management companies, construction contractors, construction teams, and other units to realize data sharing on the same platform makes communication more convenient, collaboration closer, and management more effective,” he says.

For CSADI, designing Leishenshan Hospital showed the value of working in the cloud. “At present, the general situation in China is that remote collaboration has not formed at scale,” Zhang says. “When an emergency comes, there is no efficient coordination mechanism. In this project, the concept of the cloud has gradually become popular, such as remote offices and video conferencing. Because of this opportunity, CSADI is preparing to establish a private cloud enterprise-collaboration mechanism.”

In Mexico, CEMEX learned the value of collaboration through technology, which has the potential to streamline future projects by aligning builders and clients. “The fact that the client can virtually walk through a project and make recommendations is great,” says CEMEX Manager of Segment Development and New Business Eileen Hernández. “The expectation is very close to what we are delivering, because the client was involved from the beginning.”

But technology alone won’t increase speed and collaboration; according to Kesterton, relationships are also crucial. Kesterton attributes the NHS Nightingale Hospital Birmingham’s success largely to the strong rapport he had with employees, contractors, and the client. “You need to get to know people on a personal level,” he says. “Then, if there are times when things get difficult, those people will be more flexible to help you overcome issues.”

Which leads to perhaps the most powerful lesson of all: When stakeholders work as a team, anything is possible. “The biggest learning for me is what you can achieve if you have to achieve it,” Kesterton says. “If someone said to me a few months back that we were going to install 1,200 critical-care beds for £30 million over a three- to four-week period, I would have said it wasn’t possible. But when you actually accomplish that level of output and production, it makes you realize what can be achieved when everybody pulls together to work toward the same outcome.”

What is modular building?

Modular building is a building constructed with prefabricated components, constructed offsite. Examples of these preconstructed components can include premade steel frames, container boxes, concrete walls, and more.

What are the advantages of modular building?

Some advantages of the modular hospitals constructed for first responders include:

• Speed of construction

• Low waste

• Ability to repurpose components

This article has been updated. It was originally published in July 2020.