NYC has more than doubled its ICU beds from 1,600 to 3,500 to tackle the coronavirus pandemic. Here's how hospitals in the city ramped up.

• New York City more than doubled its ICU capacity in a few short weeks to handle the crush of coronavirus patients.
• Before the outbreak began, studies show the city had around 1,600 ICU beds. As of this week, the city had 3,500 - and counting.
• Part of the increase is due to repurposing specialty wards as coronavirus ICUs, and boosting the capacity of limited equipment, doctors and healthcare workers told Business Insider.
• Visit Business Insider's homepage for more stories.

As patients fall critically ill due to the COVID-19 virus, hospitals have raced to find additional room to treat patients.

But setting up space for critically ill patients isn't as simple as setting up an additional bed. There are hospital beds, and then there are intensive care or ICU beds.

The death toll in New York City, the global epicenter of the outbreak, is still mounting. As of Wednesday, 6,298 New Yorkers had died from the disease - more than double 9/11's death toll in the state - as hospitals across the state scramble to stockpile the necessary masks, protective equipment, and ventilators to care for coronavirus patients. There were 4,504 people in ICUs across the state, with thousands more hospitalized.

New York Gov. Andrew Cuomo said in March the state's hospital system would need as many as 140,000 hospital beds, including 30,000 ICU beds and 40,000 ventilators to absorb the crush of coronavirus patients in the coming weeks.

While New York is far off of Cuomo's initial 30,000 number of ICU beds - and, with an eye toward positive trends in hospital admissions over the past few days, hopefully won't need that many - New York City has made huge strides in doubling the number of available ICU beds in a few short weeks.

In early March, prior to the outbreak, New York City had approximately 1,600 ICU beds, per a study from Kaiser Health News. As of Sunday, the city had around 3,500, with that number still increasing, according to The City's coronavirus tracker.

Part of that increase is due to a couple hundred ICU beds on the USNS Comfort, a Navy hospital ship dispatched to US in March, and at the Jacob K. Javits Convention Center, a trade-show hall on Manhattan's west side that was converted into a temporary hospital by the state and federal troops.

City hospitals have also made huge strides in elevating their ICU capacity, creatively repurposing specialty wards into coronavirus units, and converting equipment to service the ongoing crush.

Here's how they did it.

'This is not normal'

On any given day in NYC, ICU beds are typically hard to come by.

Canceling elective surgeries was the first move to free up space, but even so, early on experts realized it wasn't going to be enough.

"This is not normal," Dr. Craig Coopersmith, interim director of the Emory Critical Care Center, told Business Insider in early March.

In a hospital, there might be a number of intensive care units, focused on specialties like neurology or pediatrics. Those can all be converted into ICUs for COVID-19 patients, Dr. Mitchell Levy, the medical director of the medical intensive care unit at Rhode Island Hospital and a professor of medicine at Brown University told Business Insider. After that, step-down units that typically provide an intermediate level of care between the ICU and the general medicine wards, can also be converted.

A doctor at one New York City hospital told Business Insider that when its initial ICU filled up, the hospital looked for additional space.

For overflow, the hospital converted a unit that was usually used for patients transitioning from intensive care to the general hospital into another ICU. The only problem: Doctors treating patients with COVID-19 in the new unit had to wear full protective gear, sometimes referred to as "bunny suits."

With elective procedures halted, the surgical ICU was lined up for patients once the converted unit was full. Once the surgical ICU filled, the hospital planned to convert more units.

Intensive-care units are designed to treat the sickest patients in the hospital. Beyond being sterile environments, the units are equipped with additional tools, like forced air and oxygen lines used by breathing machines.

The room might also have infusion pumps used to administer medications, have equipment to insert catheters, monitors to keep tabs on blood pressure, heart rate and other vital signs, and a dialysis machine nearby in case patients' kidneys start to shut down during treatment.

A typical hospital bed, Levy said, doesn't have all of that equipment and infrastructure built in.

In Brooklyn, Maimonides Medical Center by the end of March was up to 150 intensive care beds, up from the 60 it regularly operates. The hospital's anticipating it'll eventually need 400 ICU beds on hand.

To help, it's set up rooms in a standalone surgery center to serve as ICU beds, converted its operating rooms into ICU space, and is using areas of its cancer-treatment center for intensive care.

Dr. Craig Smith, the chairman of the Department of Surgery at NewYork-Presbyterian's Columbia University Irving Medical Center, has said that the NewYork-Presbyterian system estimates it'll need 700 to 934 ICU beds.

Smith wrote that starting in March, the organization had converted empty operating rooms into ICU rooms, each holding two to three patients with COVID-19.

Converting equipment

The space to hold patients is one of a number of considerations as the city gets overwhelmed by coronavirus patients. Equipment like ventilators used to help with breathing and staff on hand to help with care are also in limited supply.

At Mount Sinai, they're converting sleep apnea machines donated by Tesla CEO Elon Musk into working ventilators to increase that capacity.

Doctors at Columbia are hooking up two patients to the same ventilator, a decision other health systems are weighing.

In an April 4 update, Smith described seeing "his" operating room, OR 22. Inside, a place where he had done thousands of procedures, were several critically ill patients who were being taken care of by a cardiac surgeon and a cardiac anesthesiologist who had been redeployed, he wrote.

Dr. Mark Jarrett, the chief quality officer at Northwell Health System, which operates 23 hospitals in New York, said in March that the organization was working to turn anesthesiology machines that might otherwise be used during surgeries into ventilators.

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