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MINI REVIEW
published: 03 January 2022
doi: 10.3389/fpubh.2021.763723
Frontiers in Public Health | www.frontiersin.org 1January 2022 | Volume 9 | Article 763723
Edited by:
Shi Zhao,
The Chinese University of Hong
Kong, China
Reviewed by:
Abdulrazaq Habib,
Bayero University Kano, Nigeria
Lefei Han,
Shanghai Jiao Tong University, China
*Correspondence:
Chuanhua Yu
yuchua@whu.edu.cn
Specialty section:
This article was submitted to
Public Health Policy,
a section of the journal
Frontiers in Public Health
Received: 24 August 2021
Accepted: 29 November 2021
Published: 03 January 2022
Citation:
Shi F, Li H, Liu R, Liu Y, Liu X, Wen H
and Yu C (2022) Emergency
Preparedness and Management of
Mobile Cabin Hospitals in China
During the COVID-19 Pandemic.
Front. Public Health 9:763723.
doi: 10.3389/fpubh.2021.763723
Emergency Preparedness and
Management of Mobile Cabin
Hospitals in China During the
COVID-19 Pandemic
Fang Shi 1, Hao Li 2, Rui Liu 3, Yan Liu 1, Xiaoxue Liu 1, Haoyu Wen 1and Chuanhua Yu 1,2
*
1Department of Epidemiology and Biostatistics, School of Public Health, Wuhan University, Wuhan, China, 2Global Health
Institute, Wuhan University, Wuhan, China, 3National Health Commission Key Lab of Radiation Biology, Jilin University,
Changchun, China
The healthcare systems in China and globally have faced serious challenges during the
coronavirus disease (COVID-19) pandemic. The shortage of beds in traditional hospitals
has exacerbated the threat of COVID-19. To increase the number of available beds,
China implemented a special public health measure of opening mobile cabin hospitals.
Mobile cabin hospitals, also called Fangcang shelter hospitals, refer to large-scale
public venues such as indoor stadiums and exhibition centers converted to temporary
hospitals. This study is a mini review of the practice of mobile cabin hospitals in
China. The first part is regarding emergency preparedness, including site selection,
conversion, layout, and zoning before opening the hospital, and the second is on
hospital management, including organization management, management of nosocomial
infections, information technology support, and material supply. This review provides
some practical recommendations for countries that need mobile cabin hospitals to relieve
the pressure of the pandemic on the healthcare systems.
Keywords: mobile cabin hospital, Fangcang shelter hospital, management, COVID-19, China
INTRODUCTION
The coronavirus disease (COVID-19) pandemic has become a health catastrophe, and healthcare
systems worldwide have been overwhelmed by the new surge of infections (1). The substantial
medical needs of the large number of COVID-19 patients are straining the healthcare system in
India, where the wards are limited (2). Dr. Anthony Fauci, a top pandemic expert and the chief
medical advisor of the U.S. government, made the following recommendations to control the
pandemic in India: establishing lockdown for a couple of weeks, setting up emergency units as
hospitals as done in China, and having a central organization (3). The emergency units mentioned
refer to China’s mobile cabin hospitals.
Mobile cabin hospital, also called Fangcang shelter hospital, is a type of modular health
equipment providing multiple functions, such as isolation, triage, basic medical care, frequent
monitoring, rapid referral, and essential living needs (4). Mobile cabin hospitals help solve the
issues of bed shortages and separate mild cases from serious ones (5). According to the clinical
manifestations, COVID-19 cases can be divided into mild, moderate, severe, and critical types (6).
Approximately 80% of the COVID-19 cases are of the mild or moderate types that do not require
intensive care, and these patients are able to walk around by themselves. Without centralized
management, the infection can spread rapidly in the community (7,8). In the early stages of
Shi et al. Mobile Cabin Hospitals in China
the epidemic, medical facilities were insufficient (9). To ensure
early isolation and treatment of mild and moderate cases, the
Chinese government designed and built mobile cabin hospitals
(10). Mobile cabin hospitals provided a large number of
beds for mild and moderate COVID-19 cases, excluding the
elderly, pregnant women, and those with pre-existing health
conditions. This changed the family-based quarantine approach
into group isolation of mild cases, obviating within-household
and community transmissions (11–13).
The World Health Organization has recommended “cohort
nursing” for large outbreaks, such as influenza (14). Cohort
nursing refers to the grouping of patients with the same
laboratory-confirmed pathogen in the same isolated area (15).
The main difference between cohort nursing and mobile cabin
hospitals is that patients are placed in the existing wards in the
former, whereas the latter are usually created by converting large-
scale public venues such as indoor stadiums, conference centers,
or exhibition centers (16). When there are numerous patients and
insufficient wards, mobile cabin hospitals can be recommended
as an alternative strategy to cohort nursing to control the spread
of disease. With the characteristics of rapid construction, massive
scale, and low cost, the mobile cabin hospitals can effectively
relieve the pressure of the pandemic on healthcare systems (4).
For example, the construction of the Hongshan Sports Stadium
mobile cabin hospital took only 37 h and admitted over 1,000
patients (17). Since February 5, 2020, 16 mobile cabin hospitals
were functional in Wuhan, providing more than 13,000 beds and
admitting over 12,000 patients with COVID-19 (16). All patients
of the 16 mobile cabin hospitals were discharged by March 10,
2020, and no deaths were reported (18).
This article aims to review China’s experience in operating
mobile cabin hospitals to provide a reference for other countries
that can utilize mobile cabin hospitals to relieve the pressure
of the COVID-19 pandemic on healthcare systems. The
search terms and literature reviewing process were shown in
Supplementary Materials and Figure 1. We believe that this
experience is valuable even for preparedness against the future
outbreak of other respiratory infectious diseases.
PREPAREDNESS OF MOBILE CABIN
HOSPITALS
Site Selection
To serve as mobile cabin hospitals, the public buildings should
meet the following criteria (10,19–24):
①Road accessibility, for example, proximity to arteries and
main roads;
②Away from the headwaters and densely populated areas;
③Spacious outdoor area and sufficient indoor space;
④Presence of electrical, plumbing, and ventilation systems
and other infrastructure (buildings with mechanical
ventilation systems preferred);
⑤Easy to remodel, such as interior equipment that can be
rapidly removed;
⑥Fireproof degree and firefighting facilities compliant with
fire regulations.
Conversion of Public Venues Into Hospitals
The design and remodeling of mobile cabin
hospitals must meet the standards of infectious
disease hospitals (10). Moreover, minimal building
intervention is essential to ensure rapid project delivery;
hence, the original infrastructure should be fully
utilized (25).
①Electricity systems: The transformation of the power system
should minimize the impact on the fire protection system of the
original site. There should be a reliable high-power electricity
supply system. Additionally, a backup power supply system
and emergency lighting system are necessary (24). Nursing
stations and medical office areas should be equipped with a
certain number of sockets to facilitate the routine work of
the medical staff. Furthermore, the sockets provided in the
hospital bed area should meet the needs of patients to use
low-power electrical equipment, such as mobile phones and
lamps (21).
②Ventilation: The airflow should be blown from
the clean area to the contaminated area (23); therefore,
it is recommended to set up a mechanical ventilation
system to control the airflow in the hospital (19). Besides,
air purifiers can be used in contaminated and semi-
contaminated zones to reduce the possible virus-laden
aerosols (26).
③Toilets: Medical staff and patients’ toilets should
be kept separate, and foam-blocked mobile toilets are
preferred (22). Toilets should be built downwind, away
from the dining areas and water points. All toilet feces
must be strictly disinfected and subjected to concentrated
harmless treatment under the requirements of the infectious
disease hospital, wherein direct discharge is strictly
prohibited (27).
④Water supply: The centralized water supply system
should be equipped with sterilization and disinfection
facilities (28). Furthermore, the pumping house and hot
water room should be set in a clean area. Each nursing
group should set up a water supply point, and drinking
water points for medical staff and patients should be kept
separate (23,29).
⑤Sewage: Sewage from mobile cabin hospitals, including
condensate water from air conditioners, should not be directly
discharged, and temporary tanks for sewage treatment should be
established (30). Additionally, an automatic monitoring system
for water quality should be installed at treated sewage outlets to
ensure that the discharged sewage meets the standards (31).
⑥Fire protection: It is necessary to ensure that the automatic
fire alarm system and fire facilities of the original building can
be used normally (23). There should be at least two safety
exits in different directions in the ward (19). Additionally, each
medical staff member should be equipped with a firefighting
self-rescue respirator (22).
⑦Heating or cooling: It is not recommended to use
centralized air conditioning to adjust the indoor temperature
in order to prevent cross-infection. While split air conditioning
can be used to cool down in summer, electric heating blankets
and electric oil heaters can be used for heating in winter (19).
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Shi et al. Mobile Cabin Hospitals in China
FIGURE 1 | PRISMA flow diagram illustrating the screening process for the literature included in this review.
Additionally, mobile cabin hospitals in Wuhan prepared quilts
and down coats for each patient.
Architectural Layout
The layout of a mobile cabin hospital follows the standards
of infectious disease hospitals, which are partitioned into three
zones (contamination zone, semi-contamination zone, and clean
zone) and two passages (staff passage and patient passage) (4).
The contaminated zone refers to areas where patients reside and
receive treatment, comprising the wards, treatment rooms, waste
rooms, and places of activity. The clean zone includes the medical
staff’s dressing room, catering room, duty room, and warehouse.
The semi-contaminated zone is the area between the clean and
contaminated zones, comprising the medical staff ’s offices, nurse
stations, medical equipment areas, and other areas that may be
contaminated by patients (10). Each zone should be marked and
isolated, and fixed routes must be set for the medical staff to enter
and leave the contaminated zone (22). Partition materials shall be
anti-inflammable with height of at least 1.8 meters (21,24).
Functional Zoning
According to the medical functions, mobile cabin hospitals are
mainly divided into the following sections (32,33):
①Ward: It is the core area of a mobile cabin hospital, which
is divided into different sections for male and female patients and
further divided into the general area and key observation area
according to whether the patients have underlying diseases. In
the patient ward, beds are at least 1.2 m away from each other and
equipped with hand sanitizer at the end of each bed (5). In case
of double-row beds, a distance of at least 1.4 m is maintained
between the ends of close beds (19,21).
②Image testing area: This area is composed of multiple
sets of imaging examination vehicles and various imaging
techniques such as radiography, computed tomography, and
ultrasonography are conducted.
③Routine laboratory testing area: Routine laboratory
inspection tasks, such as routine blood testing of patients, are
performed in this area.
④Virus nucleic acid detection area: It is composed of mobile
P3 laboratories (34).
⑤Intensive observation and treatment area: This area
is equipped with oxygen cylinders, rescue medicines, and
monitoring equipment to provide treatment and nursing for
patients whose conditions worsen during hospitalization (22).
MANAGEMENT OF MOBILE CABIN
HOSPITALS
Organizational Management
Clarifying each person’s responsibilities and ensuring the stability
of the management team are prerequisites for the effective
operation of a mobile cabin hospital. Mobile cabin hospitals
in Wuhan implement a management model led by the district
government, operated by medical institutions, and coordinated
by other relevant units such as electric power and water affairs
departments (35,36). The district government and medical
institutions appoint professional management personnel to form
the mobile cabin hospital headquarter (37), which consists of an
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Shi et al. Mobile Cabin Hospitals in China
information management group, medical group, nursing group,
nosocomial infections control group, logistics group, and other
departments (Figure 2). Each department has clearly defined
responsibilities and division of labor. This flat organizational
structure simplifies the vertical management levels and is suitable
for the temporarily established management team of the mobile
cabin hospital (38).
Management of Nosocomial Infections
Management of nosocomial infections is important to cut off
the transmission route of COVID-19 and reduce cross-infection.
A mobile cabin hospital should set up a nosocomial infections
control team that conducts regular trainings to control hospital
infections for all medical personnel and strengthens personal
protection education for patients (39,40). The training for
medical personnel mainly includes zoning of the hospital, hand
hygiene, wearing and unloading personal protective equipment
(PPE), cleaning and disinfection knowledge, etc. Furthermore,
the strategy of “three zones–two channels” should be strictly
implemented, and the corresponding rules and regulations
for controlling nosocomial infections should be formulated
and followed (32,41). Control measures for nosocomial
infections mainly include personal protection, environmental
health management, management of occupational exposure,
management of discharged patients, and waste disposal.
①Personal protection: Before entering and leaving the
hospital, the medical personnel should wash their hands and
correctly wear and take off the PPE (42). All patients are required
to wear masks, and their daily necessities are cleaned and
disinfected (29). Moreover, all medical personnel and patients
must undergo daily temperature monitoring (43).
②Environmental health management: Daily environmental
disinfection of the air, ground, public facilities, and pollutants
must be performed (43,44). All the disinfection protocols
conducted need to be recorded, including disinfection methods,
disinfectant name, disinfectant concentration, disinfection
frequency, and disinfection time (45).
③Management of occupational exposure: Occupational
exposure involves skin, mucosa, and respiratory exposure
(42). A process for reporting and managing occupational
exposure should be regulated, and the emergency management
of risks, such as mask slipping or goggle loosening, should
be standardized (40).
④Management of discharged patients: All belongings should
be terminally disinfected before the patient leaves the facility.
Additionally, the clothing and daily necessities not taken away
by the patients need to be treated as medical waste and handed
over to the cleaners for centralized incineration (22).
⑤Waste disposal: Mobile cabin hospitals produce a large
amount of waste, such as medical waste, domestic waste, and
patient excrement (feces, respiratory vomit, and other bodily
secretions). All wastes generated in mobile cabin hospitals should
be strictly managed (31). First, the collection, classification,
packaging, sealing, marking, and treatment of waste should be
regulated. Second, the temporary storage of waste, including
storage time and disinfection methods, should be regulated.
Third, the transshipment of waste, including transshipment
time and route, vehicle selection, handover registration, and
information sharing, should be clarified.
Information Technology Support
The information technology support not only improves the
work efficiency of the medical staff, but also reduces the risk
of cross-infection in hospitals (46). In the case of a pandemic,
several aspects can be improved by using state-of-the-art
technology (47,48).
①The establishment of electronic medical record systems,
including the electronic medical records module in the desktop
hospital information system (HIS) and mobile electronic
medical record system, can improve the quality of medical
records (49–51).
②The pharmacy information system is used for maintaining
records of the drug supply in and out of the warehouse, drug
data collection, drug planning, prescription deployment, and
expiration period management (52–58). It can automatically
generate a drug catalog that enables pharmacists to query drug
consumption and inventory quickly.
③Through the HIS remote consultation system, the medical
teams inside and outside the mobile cabin hospital can record
the patient’s vital signs and changes in disease conditions and
perform timely adjustment of the treatment plans based on the
patient’s condition (59).
④The application of high-technological products can reduce
the workload of the medical personnel. For example, smart
wristbands and watches can be used to monitor the patient’s
blood oxygen saturation, heart rate, and blood pressure and
upload the data to the cloud platform, thus facilitating remote
monitoring of patients (60). Notably, the mobile cabin hospitals
of Jianghan developed an online application in which patients can
request life support, healthcare, and other services through their
mobile phones, and the medical staffs can accept these requests
online and provide services to meet the needs of the patients (16).
Material Supply
The basis for the effective operation of mobile cabin hospitals
is adequate material supplies, including medical equipment,
medications, vaccines, PPE, and rapid diagnostic tests (61). The
material supply of mobile cabin hospitals is coordinated and
implemented by the government and medical institutions in
China. To improve the effectiveness and timeliness of medical
material support in China, a national information platform was
built, which was mainly used to collect, analyze, monitor, and
schedule the production, output, inventory, and transportation
of various medical materials (62). The government mobilized
manufacturing to ensure the supply chain of medical equipment
and materials. Preferential financial and tax policies for
supporting the prevention and control of the epidemic were
issued, and the financial support for drug and vaccine research
was increased (63). Furthermore, local government departments
and many hospitals issued donation notices to the whole society,
set up a lead group for donating materials, and gathered
a large number of materials both from internal resources
and abroad (64).
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Shi et al. Mobile Cabin Hospitals in China
FIGURE 2 | Organizational structure of the mobile cabin hospital.
POLICY IMPLICATIONS
Building Emergency Medical Rescue Team
To improve the emergency treatment function of medical
institutions further, the construction of emergency medical
rescue teams, especially personnel training to tackle public health
emergencies, should be strengthened (65).
Establishing Emergency Material Reserve
Mechanism
To avoid the shortage of medical supplies such as drugs and PPE,
during public health emergencies, the state should quickly deploy
and establish an emergency reserve system for medical materials
(62). Under the unified organization of the health administrative
department, each medical institution formulates a material list
according to the actual needs and then procures and stores the
required medical emergency materials.
Design and Construction of Large-Scale
Public Venues
Converting large-scale public venues into mobile cabin
hospitals is an important means of rapidly upgrading the
healthcare system’s capacity (10). Adaptability, convertibility,
and expandability strategies should be included in the
architectural design and construction planning of large-
scale public buildings to allow for venues such as urban stadiums
and exhibition centers to be converted into hospitals rapidly
during major public health emergencies (25). For example, the
interfaces of ventilation installation, sewage treatment systems
and utilities should be reserved during architectural design
and construction (4).
Strengthening the Financial Support of the
Public Health System
The COVID-19 crisis has highlighted the importance of a strong
national public health system. A high-grade public health system
needs sufficient funds; therefore, developing countries need to
invest more in the healthcare sector to manage urgent health
needs, such as establishing testing laboratories, setting up special
wards, and procuring medical supplies (63,66).
OTHER APPLICATION LIMITATIONS TO BE
CONCERNED
The above experience has some limitations. First, this
review aimed to summarize the emergency preparedness
and management of the mobile cabin hospitals during the
COVID-19 pandemic; hence, our findings may contribute only
to the control of the transmission of respiratory pathogens
rather than all pathogens. In the management of patients
with other diseases that spread through contact and / or
enteric transmission, such as cholera, bubonic plague, and
Ebola, the design of the mobile cabin hospital should be
modified accordingly. For instance, the distance mentioned here
between two beds is based on whether it is an airborne
or droplet-transmitted pathogen. Second, mobile cabin
hospitals can easily be erected in high-income countries.
However, in low- and middle-income countries, relative
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Shi et al. Mobile Cabin Hospitals in China
inadequacy of resources and infrastructure may not meet
the requirements for setting up these cabins. Therefore, the
reconstruction and management of mobile cabin hospitals in
these countries should be simplified to avoid cross-infection.
For instance, electronic medical records may be replaced with
paper records in countries that lack electronic information
management systems.
CONCLUSION
Mobile cabin hospitals can be a key component of national
public health responses to major epidemics, providing isolation
and medical care for mild-to-moderate cases. Appropriate
preparation and construction plans are necessary for converting
large-scale public venues into mobile cabin hospitals, and a
detailed management scheme is conducive for the normal
operation of the hospital. This review may provide policymakers
with useful information to upgrade the healthcare system’s
capacity by operating mobile cabin hospitals during the
COVID-19 pandemic and provide a valuable reference for
preparedness for any future such outbreaks.
AUTHOR CONTRIBUTIONS
CY, FS, and HL: conception and design and
manuscript revision. FS, RL, YL, XL, and HW:
literature research. FS and RL: first draft. All
authors contributed to the article and approved the
submitted version.
FUNDING
This work was supported by the National Natural
Science Foundation of China (grant numbers 81773552,
82173626) and the National Key Research and
Development Program of China (grant numbers
2017YFC1200502, 2018YFC1315302).
SUPPLEMENTARY MATERIAL
The Supplementary Material for this article can be found
online at: https://www.frontiersin.org/articles/10.3389/fpubh.
2021.763723/full#supplementary-material
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