Pan American Health Organization · Version 5, 2 April 2020
Interim technical guidance on repurposing hotels as extensions of health facilities during pandemic surge capacity crises.
- Issuer
- Pan American Health Organization
- Edition
- Version 5, 2 April 2020
- Audience
- Health authorities, hospital administrators, emergency planners, public health professionals
- Evidence
- Expert consensus based on case studies and pandemic response experience
- Reviewed
- 20 Oct 2026 · GMJ
What this guideline says
GMJ summary
This interim technical document provides a framework for repurposing hotels as extensions of health facilities during the COVID-19 pandemic when hospital capacity is overwhelmed. It describes a three-tier emergency classification system and recommends hotels only be used at 3rd Degree (crisis capacity) when all other alternatives in the health services network have been exhausted.
The guidance specifies that hotels should accommodate non-critically ill COVID-19 patients with mild symptoms or asymptomatic cases, convalescent patients, and those who cannot return home but do not require intensive care or medical equipment. It establishes patient flow pathways from hospitals, emergency departments, primary care, and the community, with clear counter-referral protocols back to hospitals if conditions worsen.
A comprehensive checklist covers administrative arrangements, infrastructure requirements (including minimum 6 square metres per bed in double rooms, elevator dimensions of 2.20 m × 1.20 m × 2.20 m), staffing ratios (one physician and at least two nurses per 30 patients), infection prevention and control measures, technical systems, and logistics. Hotels must be located no farther than 20 km from the closest hospital.
Key points
For clinicians — doses and thresholds as stated in the guideline
- Hotels should only be used at 3rd Degree emergency level (crisis capacity) when demand surpasses contingency capacity and all health network alternatives are exhausted
- Eligible patients: COVID-19 positive with mild/asymptomatic presentation, convalescent non-critical patients, those unable to return home who do not require intensive care or medical equipment
- Hotels must be located no farther than 20 km from the closest hospital with established transfer protocols
- Minimum infrastructure: single rooms preferred; double rooms require minimum 6 square metres per bed, well-ventilated with private toilet and shower
- Staffing ratio: one physician and at least two nurses for every 30 patients, with auxiliary support personnel
- Elevator requirements: minimum interior dimensions of 2.20 m deep, 1.20 m wide, and 2.20 m high for gurney transport
- Water reserve: 300 litres per bed for 3 days minimum; fuel for electric generator for at least 3 days
- Patient referral sources: hospitals (post-recovery), emergency departments (stable patients), primary care, and community (with medical triage)
Emergency Levels and Readiness Actions to Increase Capacity
Table extracted from the guideline
| Classification | Operational Definitions | Readiness Actions |
|---|---|---|
| 1st Degree | Demand for care does not surpass the hospital services network's installed response capacity; care can be provided with existing human resources and materials. | The strategy for the efficient use of resources is activated, if a scenario of limited resources or a progressively increasing emergency has been considered. |
| 2nd Degree | Demand for care surpasses installed capacity, and additional human resources and materials are needed to continue providing medical services. The network of hospital-based services functions with its contingency capacity. | The hospital's emergency management system is activated: Incident Command System or Emergency and Disaster Committee. Nonessential activities, surgeries, and scheduled procedures are suspended; material and human resources are redistributed. Non-urgent admissions are suspended. The first-level or ambulatory services network should be activated. |
| 3rd Degree | Demand for care surpasses contingency capacity; greater human and material resources and additional physical space are required to continue providing medical services. The network of hospital-based services functions with its crisis capacity. | Transfer of patients to other units is necessary. Consider early discharge or transfer to alternate locations (e.g., lower-level hospitals, hotels) of non-seriously ill or convalescent patients. All elective activities are canceled, and human and material resources are reassigned, in a resource-scarce context. Mechanisms are activated to increase staffing, through overtime, longer shifts, contracting, or subcontracting. |
Source: Pan American Health Organization, Considerations for the Use of Hotels during the COVID-19 Pandemic. Reproduced in summary form.
From the guideline
Verbatim
“The decision to use an alternate site, such as a hotel, should be based on each country's administrative, legal, and decision-making context; on the current epidemiological situation of the COVID-19 pandemic; and only when all possible alternatives in the local, regional, and national health services network have been exhausted.”
Editor’s perspective
Why this matters for Georgia and the region
Prof. Giorgi Pkhakadze, MD, MPH, PhD
Editor-in-Chief, Georgian Medical Journal · Chair, Public Health Institute of Georgia · WHO consultant, health and migration
As someone who has worked extensively on health system resilience in Georgia and the region, I recognise this guidance addresses a critical gap in pandemic surge capacity planning that our countries faced acutely during COVID-19. The three-tier emergency classification provides a structured framework that could be integrated into Georgia's National Response Plan for Pandemics, and the specific staffing ratio of one physician and two nurses per 30 patients offers a practical benchmark for resource allocation. I would particularly stress to Georgian colleagues the emphasis that hotels should only be used when all health network alternatives are exhausted—premature expansion without optimising existing hospital capacity and primary care systems will fail. The 20 km proximity requirement poses real challenges for our mountainous regions and smaller cities where referral hospital density is lower, and implementation would require careful mapping of suitable facilities and pre-negotiated agreements with the hospitality sector, ideally coordinated through regional public health centres before the next crisis.
ORCID 0000-0001-7609-4515 · Perspective written for the GMJ Guidelines Library, 20 Oct 2026
Applicability
Georgia and the South Caucasus
For Georgia and the South Caucasus region, this guidance offers a scalable surge capacity strategy relevant to pandemic preparedness planning and health system resilience. Georgian health authorities would need to assess the feasibility within the national context, considering the distribution of hotel facilities in Tbilisi, Batumi, Kutaisi, and regional centres relative to referral hospitals, and ensure alignment with existing emergency response frameworks. The staffing ratios and infrastructure standards provide benchmarks for national adaptation, though rural and mountainous areas may face challenges with the 20 km hospital proximity requirement. Integration with Georgia’s primary healthcare system and the National Centre for Disease Control’s surveillance mechanisms would be essential for effective patient triage and monitoring.
Questions this guideline answers
Quick answers
When should hotels be considered for patient care during a pandemic?
Hotels should only be used at 3rd Degree emergency level (crisis capacity) when demand surpasses contingency capacity and all possible alternatives in the local, regional, and national health services network have been exhausted, including efficient reorganization of hospital-based services and enhanced primary care capacity.
What types of COVID-19 patients can be cared for in hotels?
Hotels can accommodate COVID-19 positive patients with mild symptoms or asymptomatic cases requiring isolation, convalescent hospitalized patients not critically ill, residents of nursing homes with mild symptoms and low complication risk, and patients who cannot be discharged home but do not require intensive care, medical equipment, or assistance with daily activities.
What are the minimum staffing requirements for a hotel facility?
The facility should have one physician and at least two nurses for every 30 patients, with auxiliary support personnel. For every 30 patients, a centrally located nursing station is required. Additionally, an infection prevention and control officer and internal logistics coordinator should be designated.
What infrastructure standards must a hotel meet?
Hotels must be located no farther than 20 km from the closest hospital, have elevator capacity for gurney transport (minimum 2.20 m × 1.20 m × 2.20 m), provide single rooms or double rooms with minimum 6 square metres per bed with well-ventilated toilet and shower per patient, maintain 300 litres water reserve per bed for 3 days, and have an electric generator with fuel for at least 3 days.
- Issuer
- Pan American Health Organization
- Type
- Procedures, manuals, guidelines
- Edition
- Version 5, 2 April 2020
- Status
- Current
- Published
- 2020-01-01
- Scope
- Repurposing hotels as extensions of health facilities during COVID-19 pandemic surge
- Audience
- Health authorities, hospital administrators, emergency planners, public health professionals
- Licence
- CC BY-NC-SA 3.0 IGO
- Evidence
- Expert consensus based on case studies and pandemic response experience
- Record history
- Created 20 Oct 2026 · updated 20 Oct 2026 · next check Apr 2027
Pan American Health Organization. Considerations for the use of hotels during the COVID-19 pandemic. Interim Technical Working Document - Version 5. Washington, D.C.: PAHO; 2 April 2020. (PAHO/IMS/PHE/CPI/COVID-19-20-0016).GMJ Guidelines Library records are original summaries written by the GMJ editorial team from the issuer’s published document and reviewed by a physician. They do not replace the full guideline. The document is the copyright of its issuer and is linked, not hosted. Spotted an error or a newer edition? Tell the Guidelines Desk.
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