The Wuhan Coronavirus began, like all new viruses, with a remarkably ordinary moment. In late-November, 2019, someone—it is not yet known who—ate a wild animal that, by chance, carried the novel coronavirus, and days later, started to feel the symptoms of what initially seemed like a bad cold. From there, more individuals were infected—at first through the consumption of other wild animals, but later through direct human-to-human transmission. For the entire month of December, the virus was there, in Wuhan, spreading, but nobody knew it.
The cases, presenting as Pneumonia, were at first considered to be caused by any one of the countless other viruses that can create such symptoms, but eventually, the escalation in cases, and the fact that almost all of the first patients had bought food at one particular wild animal market, caught the Wuhan city government’s attention. The first official confirmation that something was up came on New Year’s Eve, December 31st, when the Municipal Health Commission published a press release acknowledging the situation—over a month after the first transmission.
At the time, this was small, local news—only a few dozen cases of Pneumonia in a city of millions, in a country of a billion. But then came the news that this was not one of the many pre-existing Pneumonia-causing viruses. This was something new. Western media first reported on the novel Coronavirus around January 8th. The New York Times, forebodingly, wrote, “there is no evidence that the new virus is readily spread by humans, and it has not been tied to any deaths.
” That would soon change. On January 21st, when the World Health Organization started tracking the outbreak, there were 282 cases. The next day: 314; the next: 581; then 846; then 1,320; then 2,014; and by the start of the week of January 26th, it was clear that this would not be a quick and painless virus. This would be one for the history books, and it was going to get a lot worse before it got any better. Drastic circumstances called for drastic action.
It was clear, given the trends, that Wuhan’s hospitals would soon be overwhelmed by patients and, in the case of highly infectious viruses like Coronavirus, that makes a bad situation worse as infected individuals will try to recover at home—where the virus can more easily spread. Therefore, the decision was made, on January 23rd, to build a brand new facility capable of treating 1,000 patients at once—Huoshenshan hospital. It was announced that this would be done, fully constructed, by February 2nd—just ten days later. China has experience with such a feat.
In 2003, the country suffered an outbreak of severe acute respiratory syndrome, or SARS, which is also caused by a form of Coronavirus. Much like with the novel Coronavirus, hospitals were overwhelmed and many had to turn away patients. In response, the government decided to build a new hospital. Over six days, 7,000 construction workers brought the Xiaotangshan hospital into reality, and it quickly began accepting patients and relieving the overstressed medical system. Once the outbreak settled down, the Xiaotangshan hospital was hailed as a massive success by both the country itself and the World Health Organization. The statistics speak for themselves.
Overall, SARS had a fatality rate of 9.6%. At the Xiaotangshan hospital, just 1.2% of patients died and not a single staff member was infected. It’s no wonder why China wanted to replicate this and therefore Xiaotangshan was the model for the new coronavirus hospital, but this time would be different. The 2003 hospital began construction over six months after the beginning of the outbreak. The 2020 hospital started construction less than two months after the first case and just days after the seriousness of the outbreak became clear. There was far less time for planning and design. The orders came, and then it was immediately time to start.
Step one was finding a place to put the hospital. The location selected was previously just an open field, about 14 miles or 22 kilometers from central Wuhan. This kept it away from the dense urban core, where further transmission might be easier, but the field in question was also right off a large, preexisting road which made access easy. That road was quickly shut down and turned into, essentially, a parking lot and staging area for the project.
The contract for this project was given to China Construction Third Engineering Bureau Company—a subsidiary of the state-owned China State Construction Engineering Corporation. By revenue, this is the world’s largest construction company and it has experience in enormous projects like Beijing’s new airport, Egypt’s new capital city, and Tesla’s Shanghai gigafactory.
If anyone was going to pull this off, it was them. To begin construction in earnest, they first needed to prepare the selected site. That involved, first, cutting down all the trees and shrubbery, and then perfectly leveling the ground. Out of the 10-day construction timeline, this took longer than one might think—about 48 hours. This was due in part to the fact that the project was significantly understaffed in its first few days as they scrambled to find workers, especially as its start coincided with Chinese New Year’s. Once the land was leveled, though, they moved on to constructing the building foundations by Sunday, January 26th.
For this, they used a layered system. On the bottom, an 8 inch or 20 centimeter layer of sand was placed, then what’s referred to as a geotextile layer,—a form of fabric—then a layer of waterproof plastic, then another geotextile layer, then another layer of sand. On that, they then poured concrete which dried over a few days. But then came the truly impressive element—constructing the buildings themselves in a matter of days.
What made this possible was the use of prefabricated elements. Modular construction such as this has been on the rise recently. It’s now a well-established technique for the construction of buildings large and small. The idea is, simply, that somewhere offsite a number of identical building elements are built. Then, they’re shipped to the construction site and put together. This has plenty of advantages. First and foremost, the use of identical elements, built in a factory system, to construct a larger building lowers cost through economies of scale.
Then, when you actually get to putting the building together, on-site construction time is significantly less, which once again lowers cost. In this case, though, cost was not the primary concern—speed was, and modular construction is the fastest way to build. Most the site used a type of prefabricated, modular construction common with temporary buildings. While it’s not clear which company produced the prefabricated components, it is clear that they existed before the project started. The first building elements started coming together on Monday, January 27—just four days after the project broke ground. They began by building the skeleton of the modular units. Each of these units was about the shape and size of a 20-foot shipping container, and this skeleton form included just the floor, ceiling, and structural supports at each corner.
Throughout this all, separate teams, out of the thousands of workers there, started to hook the site up to utilities like sewage, water, electricity, and internet. Much of this just involved bringing in the state-owned companies responsible for these, but for internet, and the subsequent building-out of an IT system, private companies like Huawei and Lenovo got involved. This was, no doubt, partially because the construction of this hospital drew considerable public attention in China. It came to represent the physical manifestation of the country’s response to the crisis and also of China’s engineering might. The construction process itself was streamed by state-owned broadcasting companies and up to 18 million concurrent viewers watched the process.
Nearly every major broadcaster in China reported from the site, publishing footage like what you’re seeing now, although very few western broadcasters were there. This is part of the reason limited detailed information and footage of the construction exists outside of China’s state-owned broadcasters—where the government can manage the story and what gets out. It was, no doubt, viewed as an opportunity by the Chinese government in a time when it faced intense criticism for its initial response to the outbreak. But of course, to gain that praise, the project needed to be successful. On Tuesday, January 28th, significant portions of the first building were completed, while the rest of the complex’s foundations were finishing up.
Over the 29th, and 30th, more of the overall structure came to be, as the walls were installed on and in the skeletons of buildings, and work then began on turning these empty buildings into a hospital. Each patient room was outfitted with two beds, some medical equipment, and a bathroom. Considering the hospital is built with quarantine in mind, there are some unique aspects to the design of these rooms. For one, the ventilation system is built to keep negative pressure in all quarantine areas so that air will go out through an exhaust system, rather than out under the door into the rest of the hospital.
While, at the time of writing, it’s not entirely known to what extent this Coronavirus can spread through airborne transmission, a ventilation system like this is standard practice for any quarantine ward. In addition to the individual patient rooms, separate areas were designed for patient processing, diagnostic tools like CT scanners were installed, and other crucial aspects like offices, break rooms, and canteens were built in. Over the 31st of January and 1st and 2nd of February, the final areas of the complex were built up, the interior installation was wrapped up, and all the systems were tested to assure that the hospital was ready to bring in patients.
Meanwhile, eight People’s Liberation Army transport planes landed at Wuhan airport carrying the military medical staff who would work the hospital. They moved into the facility throughout the same day—February 2nd—then throughout the night, workers put the finishing touches onto the hundreds of rooms. Then, the next morning, the moment that ten days prior seemed impossible arrived—the first patients, transferred from other facilities, were wheeled into Huoshenshan hospital and thus marked the beginning of its operations.
They started with just a few dozen patients, but in a matter of days this ballooned to hundreds. Huoshenshan Hospital was only the start of China’s plan to ramp up the number of available beds in Wuhan. Just three days after Huoshenshan’s opening, another, even larger hospital called Leishenshan opened. Its 1,600 beds and 32 wards were built in just twelve days.
Meanwhile, other hospitals were converted to isolate and treat Coronavirus patients and stadiums and exhibition centers were turned into hospitals as well. Still, though, even with this swift, decisive action, reports indicate that many of those with milder cases of Coronavirus are getting turned away from hospitals in Wuhan. It unfortunately seems that Coronavirus, with its tremendous severity, is one of the few things that can outpace China.
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