In the Midst of Outbreak; Could California Build a Hospital in Ten Days?

What happens if you get infected with Corona virus and the hospitals are full? The medical system is at capacity, and even seeking antivirals and mild attention is an impossible task. Where do you go? What do you do?

In January, 2020, China built a hospital in ten days. The project was funded and organized by the Chinese government, involving over 7,500 workers on site every day assembling almost exclusively pre-fabricated components. The project was executed in response to China’s rapidly growing number of patients infected with the infamous COVID-19. The hospital has 1,000 patient beds equipped for handling Corona virus infections. Even with the newly built hospital, and another 1,600 bed hospital on the way, China’s healthcare system still doesn’t have enough beds for its Corona patients.

Many states in the U.S., including California, also lack the medical resources needed to handle a full on pandemic. It doesn’t make economic sense for the medical system to maintain more resources than are needed on a regular basis. COVID-19 may very well test the limits of what the healthcare system can handle. The first step in pandemic situations is to convert other public-use facilities, such as stadiums, into treatment facilities. But what if that is not enough? Could California build a hospital in ten days?

The short answer is, “no.” Acquiring the legal permits just to begin the construction of a new hospital in California typically takes over a year. But hypothetically, in an emergency situation where the government accelerated the necessary permitting and made special exceptions for seismic and other safety regulations, could the state build a hospital in ten days? It would be a colossal undertaking, like in China, and would likely require the cooperation and coordination of at least three major general contracting firms just to assemble the necessary raw materials and manpower. Typically, the bidding and negotiations for a government project of that magnitude would take years. Even assuming that the bidding process was drastically accelerated, the challenges don’t stop there.

In China, the pre-fabricated components used to construct the ten-day hospital made the building process more like an assembly than a true-to-form build. China is a country that thrives on manufacturing power. California is a wealthy state, but manufacturing only accounts for 10% of its $2.7 trillion GDP, compared to 44% of China’s $12.2 trillion GDP. China had no issue acquiring the building components for its ten-day hospital on short notice. In California, that timeline would pose more of a challenge. Ironically, the best solution may be to put the materials on the fastest boat from China.

So far, we bypassed the permitting, made exceptions on safety and regulations, amicably gathered three of the country’s largest construction firms, gathered pre-fabricated building materials from China, and found a suitable site for our hospital. Now it’s time to build. China had workers and machines working around the clock for nearly two weeks during their build. In China, the highest minimum wage comes to about $1.65 an hour. In California, it’s $12 an hour and $18 an hour for overtime. Assuming everyone worked for minimum wage and shifts were organized such that no one qualified for overtime, ten days of labor for a workforce of 7,500 around the clock workers would cost $21.6 million in wages, not counting insurance or taxes. Assuming the project could build for that amount, it would actually be remarkably cheap. The reality would likely be much different. Construction workers are typically paid about $17 an hour or more in California, and hospitals typically cost north of $400 million to build with three quarters of the total cost going towards manual labor. One benefit of rushing an emergency hospital project is that it could end up costing less than a traditional build.

Building a hospital in ten days is a colossal undertaking. In the best case scenario, it would likely take at least a month to build a Corona response hospital. Examining all of the variables that need to come together for a project to start and finish within a ten day period shows what an incredible accomplishment it was for China. It is unlikely that California could do the same. Fortunately, unlike China, the state has plenty of other buildings that are suitable for temporary hospital retrofitting. The obvious advice, though, is to do everything we can to avoid needing more hospital beds in the first place.