In February 2020, as COVID-19 unfolded across the globe, E4H Environments for Health Architecture (Burlington, Vt.) had completed decanting more than 10,000 square feet of shell space in Northwell Health’s Cohen Children’s Medical Center main building. The shell space was planned for a 26-bed PACU , but as a surge in COVID-19 patients started, Mark Mazza, director of capital projects at Northwell Health, reached out to E4H with a 48-hour window for the firm to plan how to turn the decanted PACU into a 60-plus-bed COVID-19 care space.

Within two days, the E4H team delivered a conceptual floor plan, door schedule (including needed materials, building components, and equipment), bed layout, and headwall elevations. With a strict budget and a two-week window to complete the design, it was an all-hands-on-deck effort for the project team, including Gilbane Inc. (construction manager) and  Lizardos (engineering), to work with E4H and Northwell Health to deliver an efficient solution for a temporary COVID-19 isolation unit, which would connect the main building of Cohen Children’s by a skybridge.

Using E4H’s proprietary integrated project delivery approach system, planning and design were done remotely in conjunction with virtual meetings. The intimate knowledge of the facility and the long-term partnership between the team members allowed them to work quickly and effectively. The team utilized tools such as Google Earth to help with exterior visuals for HVAC and medical gas coordination and FaceTime to show existing conditions and walk-through solutions.

With the conceptual plan, Gilbane went on-site and chalked out the proposed layout. Then, as the plan was being finalized with the construction manager in the field, Lizardos Engineering focused on the final requirements for medial gasses, HVAC, plumbing, and electrical. Because the initial demolition left a large portion of the existing infrastructure in place, these elements were utilized for the final design, which minimized utility shut-downs and helped expedite the schedule.

To speed construction, the collaborative team sought quick solutions that could be easily implemented, such as using engineered vinyl plank flooring that met New York City building code and could be easily installed. PVC liner wall panels were screwed directly to the metal studs, eliminating the need for drywall, and headwall outlets were surface mounted to quickly implement the required electrical and medical gasses. Additionally, Gilbane reviewed material resources from project sites across its portfolio, redirecting materials from other projects that had been placed on hold.

The isolation unit opened on April 25, allowing for better infection control and providing the critical confidence needed to resume operations at hospitals across the system. As the surge recedes, Northwell Health plans to decant all COVID-19 patients from its other facilities to this unit, allowing other system hospitals to resume non-critical procedures and care.

When planning and designing for surge spaces, it’s important to remember that the space is intended to be temporary. Manage expectations from the beginning so it’s understood that the space will not be perfect nor will it be long term.

Thomas Morris is a partner at E4H (Burlington, Vt.). He can be reached at