COVID-19 Q&A: Certus experts discuss health care, business trends

Three engineers from Certus Consulting Engineers share knowledge on how COVID-19 has changed their engineering practice

By Kevin Miller, PE, LEED AP; Danna Jensen, PE LEED AP BD+C; and Roger Koppenheffer, LEED AP May 18, 2020

To learn more about how consulting engineers are working, Consulting-Specifying Engineer discussed the COVID-19 crisis virtually with three experts from Certus Consulting Engineers. Both business and engineering trends were covered.

The experts:

  • Kevin Miller, PE, LEED AP, Principal, Certus Consulting Engineers
  • Danna Jensen, PE LEED AP BD+C, Principal, Certus Consulting Engineers
  • Roger Koppenheffer, LEED AP, Principal, Certus Consulting Engineers.

Business trends during COVID-19

How has your staff/team adjusted to the new work-from-home environment? What tips or suggestions do you have to help other firms remain connected while working remotely?

Certus: Fortunately, our business model was already set up to allow the flexibility for our teams to work from anywhere. All team members have laptops, state-of-the-art technology and easy access to the network with proper securities already in place. This allowed the transition to institute a work from home policy to be instant and seamless. Conducting business and completing design tasks remotely and virtually is not really a challenge.

Our focus has been on staying truly connected. We are a small company and our group is made up of collaborators who believe in teamwork and communication and care about one another. It is of the utmost importance to us to ensure that we do not lose that connection in this new social distancing world we have been abruptly thrown into. To remain connected, we ensure that we are maintaining face-to-face communication and do not rely solely on email/instant messages, or other nonhuman connection during this time.

We make it a point for everyone to check-in as a group on a weekly basis where no business talk is permitted. Talk around the coffee pot Monday morning is very important and we have made a conscious effort to not lose that. We talk about how our weekends went, our struggles juggling the new hats we are wearing (e.g., home-school teacher, cafeteria director, etc.). Throughout the week we encourage continuing that communication — video chats, phone calls — they all keep us sane and connected, more so than the constant chatter of email, texting, or instant messages that become even more impersonal at this time.

Is your firm conducting any travel to visit clients or projects? If so, what types of projects are you working on?

Certus: Our projects consist of 99% health care work, so we are considered “essential” staff. However, in the interest of protecting our clients’ clinical staff and patients as well as our own staff, we implemented a policy regarding the COVID-19 pandemic. We directed our staff not to enter any hospital without express consent and direction from the hospital administration. Any and all visits that require access to a hospital that are deemed nonessential were suspended until further notice.

Our work as engineers is to help the hospitals with their utility infrastructure needs especially during this time, so the policy did not apply to projects limited to a central plant or other areas not requiring access thru the hospital proper. In those cases, we directed our staff to park off-site, not enter the hospital proper and follow the hospital’s protocols for screening, etc.

What engineering or technical aspects of the job are now being done remotely?

Certus: In addition to our day-to-day project work, we have been working with our hospital system partners over the past two months on design and implementation of COVID-19 pandemic suites for multiple hospitals. Since each suite is unique based on the individual hospital’s existing systems and capabilities, we have heavily relied on the on-site hospital’s engineering staff to be our “eyes” as we virtually work together toward a solution. We have been in constant communication via video meetings and conference calls as well as creatively obtaining some of required material we need to provide the engineered solutions. We even had one client deliver some existing materials (drawings and data files) needed to complete the design for a project directly to one of our leader’s home mailbox in order to expedite the process without delay.

What supply chain issues are you experiencing? Is your firm dealing with any challenges with materials or products from manufacturers or suppliers?

Certus: It changes daily. As we work to implement solutions for our hospital clients building COVID-19 suites, we are in direct communication with equipment suppliers and contracting partners. A fan that had a lead time of two days yesterday may have a lead time of six weeks today. It requires our engineers to be nimble and creative working with the materials and products that are readily available. One of our clients even joked, “I’m surprised Home Depot has not run out of duct tape and PVC, similar to how Walmart has run out of toilet paper.”

The impact on the supply chain has reached far beyond projects dealing directly with COVID-19. For example, we had condenser water pumps delayed weeks simply because of the supply chain and just-in-time manufacturing. It is critical that the central plant project, started in fall 2019, be complete before the heat of the summer. It took the entire team to adjust schedules, phasing, temporary cooling strategies and setbacks of elective surgery areas in reduced case loads to minimize the impact on the fully operational campus.

What financial implications do you think this will have on the engineering industry as a whole?

Certus: We are optimistic. We have seen a lot of projects canceled or put on hold; however we have also seen a surge of new projects as our clients try to adapt to the “new norm.” We have no doubt that the business will change and fees will become more competitive as we all vie for the same projects that have not been canceled.

However, while this pandemic may affect our industry financially, it bears little similarity to the economic crisis of 2008. As we follow the recommendations of our government leaders and experts in “voluntarily” shutting down the economy, the demand is still high. Once we are able to fully get back to work, we suspect that projects will regain momentum in an effort to recoup lost time. Projects may morph and take new shape, which will require creative thinking, not foregoing the valuable lessons we continue to learn from this pandemic. The teams that will succeed and excel are those that will take these lessons and apply them to a new type of project approach.

Do you expect to see pent-up demand hit once shelter-in-place restrictions have been lifted? How do you think business will trend three to six months after?

Certus: Projects that are funded are moving forward with design. They need to be ready, or those owners will only be farther behind on generating revenue. Projects that are in for funding but not yet funded — there will be a surge when confidence is high that the U.S. is on the downhill slope. We will see a surge of demand for materials — initially at least. A surge where the supply will not be able to meet the demand and we will experience a surge in prices accordingly.

Similar to what we’ve already seen with toilet paper, face masks and even food supply, demand will hit the engineering and construction industry once the restrictions are lifted and projects regain momentum. Many construction materials are coming from factories within and outside of the U.S. that have either slowed down production or shifted their business approaches to assist with COVID-19 demands. It will take time to regain our footing and allow supply and demand to regain an economic balance, however we suspect within the year’s closure (notwithstanding any further shutdowns in the fall), we will see things begin to get back to normal.

Engineering aspects of COVID-19

Have building owners or clients approached you to assist with changes or updates to their building to help protect against COVID-19? What services can you offer?

Certus: We have been called upon by hospital systems to help respond to the evolving needs through this pandemic. First and foremost, as engineers, our primary function is to serve in an advisory role. We must ask the right questions and listen carefully to the answers. Only with an understanding of each facility’s clinical operations and infection prevention policies and procedures can the engineer help develop the best solution.

In helping to develop and implement over a dozen different solutions for COVID-19 pandemic suites, one thing is certain — there is not a “one size fits all” solution. Each solution will differ based on the capabilities and configuration of existing systems and on the specific needs, patient census and health care system strategy.

What test-and-balance or air balancing challenges have you encountered? What unique challenges are you solving?

Certus: This topic is really about much more than air balance.

An engineering partner must understand the operational needs and flow, emergency power and medical gas requirements, etc. Constant interaction with the infection prevention and environment of care leadership is essential as hospital policies evolve through a pandemic.

Negative pressure for a suite can be achieved quickly in this emergency situation. Most major hospitals quickly ensured access to negative air machines and are not overly concerned with noise or with aesthetics in taking out windows to duct the discharge.

In creating negative pressure suites and/or cascading airflow to negative pressure rooms, makeup air is obviously a challenge. In most cases, outside air for the primary air handling unit serving the space needs to be increased. This requires careful evaluation of cooling coil capacity as the ambient conditions have increased. Water balance will be almost always be required. In many cases, the solution will involve pre-treatment of the outside air with supplemental cooling with purchased or rental units.

In some cases, facilities, reacting as quickly as they can, may install HEPA filters in the return from a pandemic suite for an AHU that serves other areas. This can have an adverse effect on other areas with a lower pressure drop in the returns from adjacent areas, causing those areas to go less positive, or even negative. Proportional rebalancing in an occupied hospital, especially with COVID patients, presents unique challenges.

The key is to look at the entire AHU system and, in fact, the entire building. Engineers must consider the impact of a proposed solution on adjacent patient units and the overall system.

A key focus should be to pick up any total coil capacity. Below are only a few specific examples to help illustrate that the overall system must be considered.

  • Can supply air be reduced in any spaces while still meeting code-required air changes per hour? Where can supply air be reduced?
  • Is there any capacity available in units serving elective procedure rooms with reduced case load? Can some of that capacity be used for makeup to the pandemic suite?
  • Can spot coolers be used to offset sensible load in some spaces within the suite? Ducting spot cooler condenser air outside only increases negative pressure within the space.

For hospitals and health care facilities, do you anticipate further demand for specialty or pressurized environments?

Certus: There will definitely be further discussion on specialty pandemic environments. However, pending code and licensure regulation changes in the near future, in most states, the provisions for “switchable pressure” rooms will be limited or prohibited. Hospitals cannot build rooms that will sit empty or that may compromise a patient when in normal use.

What will come out of this, as we are already seeing, is hospitals looking for solutions that can be relatively quickly reimplemented in a new surge or reoccurrence.

We expect to continue to see more interaction between engineering consultant partners, the authorities having jurisdiction and the hospital operations (administration, clinical, infection prevention, environment of care, facilities) so that the collective team can react quickly as needed.

From an engineering standpoint, what other markets or building sectors do you anticipate will grow due to the changes occurring due to the coronavirus? Is there a new engineering sector you plan to focus on to meet these needs?

Certus: None of us know where all of this is heading. Our job as engineers is to help to understand and support the needs. As health care engineers, we intend to continue to support our health care clients to help them meet their needs as they evolve. We know one thing — health care will change.

Just a few key thoughts that will impact the health care business:

  • Dedicated space for emergency department screening (“triage at entrance”).
  • Segregation of triage.
  • Segregation after admission.
  • Swing spaces/pandemic suites (advising code authorities on possible code revisions relating to this).
  • Telemedicine (recognizing new challenges in the density of a call center environment).

As engineers, it is our responsibility to support our clients and the public in helping adapt to what will be an ever-changing world over the coming months and years.

The coronavirus has required several facility managers to remotely control all aspects of their building systems (lighting, HVAC, etc.). What building automation or controls projects are you working on to meet these needs? How will this impact future design?

Certus: This isn’t really applicable. Most of our facilities already have complete remote access to all of these systems in each of their facilities.

What might other engineers/building professionals need to know when tackling COVID-19 projects?

Certus: Some suggestions:

  • Assemble a steering team day one to establish goals and parameters.
  • Do not come in with a preconceived solution. Ask questions and listen. Our mutual clients need a design and construction team that can help them work through their specific situation and develop the right solution for them. We must think beyond engineering and construction — think about our client’s operations, infection prevention procedures, etc. and then apply engineering toward a solution.
  • Our client can read ASHE and ASHRAE papers on their own. There is not a “COVID cookbook.” Engineers do not have all the answers. Engineers know how to help find the answers with the input of the medical professionals. We think like engineers, understand the needs of the hospital and that is what we are hired for.
  • Be careful about the “do the best we can” mentality. When tents are being built all around the country, engineers may be asked to give a hospital “something better than a tent” in designing a suite within an existing hospital. Yes, it is an emergency situation. However, we must always still consider basic hospital and life safety code compliance. We have an obligation to keep all occupants safe. We as engineers cannot lose sight of that focusing only on the “pandemic suite.”

With 21 years of experience, specializing in health care, Kevin Miller is a founding Principal of Certus Consulting Engineers and continues to bring technical expertise and provide creative solutions to the industry.

Danna Jensen is one of the founding principals at Certus. She has extensive experience in the design of reliable and efficient electrical systems for complex health care projects. Jensen is a member of the Consulting-Specifying Engineer editorial advisory board and a 2009 Consulting-Specifying Engineer 40 Under 40 winner.

Roger Koppenheffer is a founding Principal of Certus Consulting Engineers and brings 24 years of experience in the MEP consulting field to manage and engineer a multitude of projects specializing in health care.

Author Bio: With 21 years of experience, specializing in health care, Kevin Miller is a founding Principal of Certus Consulting Engineers and continues to bring technical expertise and provide creative solutions to the industry. Danna Jensen is one of the founding principals at Certus. She has extensive experience in the design of reliable and efficient electrical systems for complex health care projects. Jensen is a member of the Consulting-Specifying Engineer editorial advisory board and a 2009 Consulting-Specifying Engineer 40 Under 40 winner. Roger Koppenheffer is a founding Principal of Certus Consulting Engineers and brings 24 years of experience in the MEP consulting field to manage and engineer a multitude of projects specializing in health care.