The Race to Build New Hospitals

Todd Semonite was sent to Iraq 17 years ago to work on getting the power back on across the country. Three years ago, after Hurricane Maria ravaged Puerto Rico, he had to figure out how to get thousands of power poles onto the island and across mountains to get the grid lit up again. Now, after 41 years in the Army, the past four spent in charge of the Army Corps of Engineers, his focus is all over the United States. As COVID-19 cases have mounted, states have been running out of hospital beds, and Semonite’s Corps has stepped in with a solution. At sites across the country, the Corps is converting hotels, dorm rooms, and massive convention centers into makeshift hospitals. The first was in New York’s Javits Center—where Hillary Clinton expected to have her presidential victory party a lifetime ago. It’s now a 2,000-bed hospital. The Corps is building or has built close to 30 similar projects around the country, in Illinois and New Mexico, Colorado and California, with more on the way.

Semonite spoke to me recently in between trips to scope out new sites and consult with governors, mayors, and the president. We discussed how his career took him from power plants in Baghdad to hospital beds in New York, and planning for possible pandemic peaks in the future. Our conversation has been edited and condensed for length and clarity.

Kathy Gilsinan: You’re watching the COVID-19 crisis gather in China and then in the U.S. At what point do you start to realize that this is going to become your problem too?

Todd Semonite: It was about five weeks ago, when New York Governor [Andrew] Cuomo went to the president of the United States and said, “I am short [of hospital] beds.” So we got our guys together and got the secretary of the Army’s plane, and we flew into Albany, New York, the day after [Cuomo asked], and we were sitting with the governor—me and my engineering team, I’m talking about mechanical, electrical, my guys who design hospitals. Cuomo said, “I want you to come in and build these out in a big field.” And we said, “You can’t build a hospital in three weeks in a field.”

But [we can] go into a place that already has electricity, it has fire [safety], it has clean water, it has sewage, it has all of the places to be able to bring in supplies—a hotel, a college dorm, or a convention center. They all were empty. They all had their staff that weren’t being put to work. So then we’d come into that existing facility, and we’d build an ICU-like facility inside.

We said, “Here’s our concept of what we can do for you.” It really went back to this idea of trying to have a standard design. What we wanted to do was design [facilities for] COVID and non-COVID [patients]—to be able to convert a two- or three-story hotel into an alternative care facility. Or a large space, [like] a convention center, a great big indoor auditorium.

And then when Cuomo looks me in the eye and he goes, “Okay, General Semonite, what do you need from me?,” I said, “I need a building by tonight. I need three buildings by tomorrow night. I need a list of all the places you want to build by the weekend.” And he immediately turned around and said, “Go hot on [the Javits Center].”

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Gilsinan: What happened when you realized the problem was going to be much bigger than New York?

Semonite: When I was flying back [from New York], and I knew that New York had thousands of beds that were short, I said to my guys in the plane, “We’re going to have this problem in Chicago. We’re going to have this problem in Miami.” This whole idea that this virus is a little bit harder on older people, I said, think about Miami [and] the retired community down there. Think about these urban centers where you just don’t have enough hospitals.

So that’s where we really started thinking, We can’t let every one of these cities call us. We need to have this planned. It is a universal plan. And then we adapt it to what the requirement is by the local mayor. We had the standard design, but it’s not like the mayor of Detroit called us up and said, “We need help.” I have 43 colonels who command what’s called Corps of Engineer districts. I told our colonels, “You go find the mayors and the governors, and you walk in and say, ‘Here is a capability we can do for you. Do you need this or not?’”

We have no agenda here. We don’t care whether we build these or not. But I tell mayors when they don’t know which way to go—you don’t want the ambulance to pull in the back of the city hospital and the guy on the loading dock says, “We’re full.” And now the ambulance has nowhere to go.

Gilsinan: How’d you get into this line of work?

Semonite: I’ve been in the Army 41 years next month, and most of our engineers are what we call combat engineers. They’re the guys that go fight in wars. So I was a battalion commander, [and later] a brigade commander, mainly where you worry about commanding soldiers on the battlefield.

But we have another side of the Army called the Army Corps of Engineers. It is [more than 32,000] employees, and it’s 99.5 percent civilian. I was assigned to the Corps of Engineers, and they needed a No. 2 guy to take about 100 people and $1 billion, and to stand up the electricity in Iraq right after our forces attacked Baghdad.

I went into Afghanistan in 2014. We had a two-star [general] assassinated [Harold J. Greene, killed by an Afghan soldier at a training academy in Kabul], and I volunteered to go over and backfill, and I was the commander in charge of building the Afghan police and the Afghan army. So there, the challenge is, how do you figure out where the Afghan army needs to go? What do they need for uniforms? What do they do for weapons? How do you train them? How do you feed them?

When Puerto Rico got hit by [Hurricane] Maria [in 2017], we were asked to go in and get the grid up and running. And then you’ve got to figure out, How do we rebuild Puerto Rico? We needed to bring in 66,000 power poles.

Today, the problem is, I don’t know what the enemy’s going to do. If you go back to smallpox, that particular pandemic actually had three peaks. So right now I’m preparing for peak one.

And you’ve seen the curves. We’d [stay] home, we’d flatten the curve, and God willing, there’s going to be some time when that peak goes away. And I don’t know whether it’s going to be May, April, June, July—we’re going to stay aggressive until we get over peak one. Then what happens if this thing comes back when fall comes—October, November—what do we want these facilities [that we built] to look like?

Do we keep them up, and how do we do all that? And then God knows what’s going to happen next summer, the summer after that.

We don’t have a problem that’s cleanly defined, and every single day, I’ve got to continue to be able to reassess. I’ve got a whole modeling team right now that is looking not just statewide, but we’re looking citywide, to try to be able to figure out, when do we think the peak’s coming in?

Gilsinan: It strikes me that what a lot of these things have in common is you’re running into a situation where you have this enormous problem, and I’m curious about how you even begin to conceptualize it. What is the first step there? Or what is the first step when you’re in Puerto Rico trying to deliver electrical poles, but the ports aren’t even functioning?

Semonite: Today, right now—and these numbers change every day—we’re building 27 different facilities and we are creating 15,500 beds. In the next week, we expect to put in about another 14 facilities and potentially up to another 4,600 beds.

We have designed a bunch of facilities, and then given those designs to states and cities. I flew into Miami last week, and I met with the mayor of Miami and the governor of Florida. And my guys said, “We probably need to build out the Miami convention center, and this is about 450 beds.” We needed about ’til the 27th of April to get that one done. There was probably about 21 days we needed.

The governor looked at his medical guys and said, “When’s the peak day?” And their medical guys said April 21. And then I told my guys, “Well, then we’re going to be done by the 20th. You don’t have 21 days. Now you have 14 days to get it done. So now go back and come up with a plan.”

The whole point here is that we don’t have time for the perfect solution.

Gilsinan: Are the projects going fast enough to handle the need?

Semonite: It is on all the ones we’re building. But let’s assume that the peak for [a] particular city is the 24th of April, and the 24th was the day all along [when] we thought that a lot of these might peak. Today I’m checking, it’s the 16th, so if we need 10 days to build, and [a] mayor hasn’t made a decision, then when we go in, we say we don’t have the ability anymore to do it in six days.

I don’t want to get anybody nervous or threatened; I just want to be able to be honest. There’s some things you can do really, really fast. You can fly in a thousand people to a city if they’re really short on doctors and nurses and have them there in probably 48 hours. Well, you can’t go into a convention center and build 3,000 beds overnight.

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Gilsinan: You were in Iraq; you were responding to hurricanes. Have you ever seen anything like this?

Semonite: Yes, I have. This is not something simple, where you have only one or two variables. A good example is Puerto Rico. All the electricity, all of the generating plants and power plants were in the south of Puerto Rico. All the people live in the north, San Juan. Puerto Rico is an island. So the only way to get the electricity from the south to the north is to go over a mountain range [with] all of those power poles, 66,000.

It’s all complicated—same thing in Iraq. As much as we tried to get the electricity on, all the power plants ran off of oil. All the refineries were blown up, or they were taken out. Although you might have the power plant up and running, it’s kind of like having a gas station go with no gas.

So we had to get the refineries up and running to be able to get the rest of it going. [Seventeen years after the U.S. invasion, much of Iraq suffers from frequent power outages, particularly in the summer months.]

Gilsinan: What’s your best story from the ground so far?

Semonite: The best one’s in Detroit. We went into a convention center. Now, you have 970 beds built in a great big, gigantic thing the size of a football field. Every one of those bed spaces had an oxygen feed, just like water pipes in your house. The nurse could just plug in the oxygen mask right into a wall, just like in a hospital room, and you had piped oxygen in there.

Everyone had a nurse call station, a little string like by your bed; you pull it and right outside the light goes on. You had a light in there for someone to read by. You had wireless so they can check their phone. You had everything else they needed: showers, bathrooms, all the rest. And what makes my heart feel good is that when my guys got done, about four hours later, a patient arrived.

It doesn’t have to have a patient to say it’s a success. If we built a facility and no one ever uses it, that’s great, because that means that all the other parts of the system—the social distancing, the flattening of the curve—work.

But when we know that there’s somebody that’s alive today because the Corps of Engineers was able to get a facility done, it’s a big deal.