You won't see rows of parked cars on the first floor of the James A. Haley Veterans' Hospital parking garage in Tampa. Instead, the garage is filled with hospital beds, computers, medication carts and an X-ray machine.
The medical center has begun seeing more patients after it initially sharply restricted care at the beginning of the COVID-19 pandemic. But to do that, it has moved most of its emergency department outside.
Patients with minor issues like sprained ankles can receive treatment in the garage and never have to step foot inside the hospital.
"The goal of setting this up out here was to protect our very vulnerable patients inside and our staff," said Dr. Timothy McGuirk, who runs the hospital's emergency room.
Tampa stands out even among other VA medical centers with its parking garage setup; this is one of the few that has moved its emergency services outdoors. But all of the agency's facilities are taking steps to prevent the spread of COVID-19.
While many civilian health facilities have allowed patients to come in for routine care for months and even opened for visitors, that's still largely off-limits at many VA's.
McGuirk said VA patients are typically older and sicker than the general population, making potential outbreaks more dangerous.
"They have heart disease, they have kidney disease, they have liver disease, they have lung disease that makes them more at risk," he said. "Plus, we don't have pediatrics here, we don't have young healthy people for the most part."
Navy veteran David Tootle, 62, pulled into the garage with severe back pain. Because of the pandemic, his other doctor's visits lately have been remote.
"Telephone but not video," he said, adding with a laugh, "I'm not 'techno' like that."
While the VA has increased virtual care by nearly 1500 percent since March, many veterans have been anxious to return to face-to-face visits.
Some outpatient and specialty clinics that were shut down for months have gradually started welcoming patients who need hands-on procedures or can't use virtual care.
Facilities are also taking steps to limit the number of people inside. Most aren't accepting walk-in patients yet except for outdoor services like drive-thru flu shots. Many have also cleared furniture from their waiting rooms and are telling vets to wait in their cars until staff contacts them to come in for their appointment.
"Just decreasing risk of exposure, so cars have been a great extension of our facility space in a lot of these efforts, whether it's drive-thru services or using them as an extension of our waiting rooms," said Dr. Kameron Matthews, Chief Medical Officer for the Veterans Health Administration.
Down the block from the main hospital, the Tampa VA's audiology clinic is offering drive-up hearing aid repair.
On a recent morning, Army Reserve veteran Michael Kelly pulled up in his car, and a staff member wearing a mask and gloves asked him to hand her his hearing aid through the window.
He needed her to change the tube behind the device, so she brought it inside and returned shortly after. Had this service not been available, Kelly might have had to mail in his hearing aid for repair and waited weeks to get it back.
At 80 years old, Kelly said he's very concerned about getting COVID-19 and is grateful for the drive-up option.
"There's no contact, and I feel very safe," he said.
This was a rare outing for Kelly, who has spent most of this year home with his wife.
"You know you feel confined, but we're following the rules basically," he said. "Hopefully it'll be all over soon, but you don't know. We're going to just continue and do what we have to do."
Coronavirus cases have spiked in many parts of the country, and among VA patients.
Paula Myers, chief of the Tampa VA's Audiology section, said she's not ready to ease restrictions in the seven regional clinics she oversees.
"Flu season is just around the corner, bars have just opened in our community, we don't know if there's going to be a huge second wave all of a sudden," she said.
VA officials say despite the need for caution, it's important veterans don't avoid care. They encourage vets to stay in touch with their providers to ensure they get the help they need.
"This is not just about prioritizing COVID care," said Matthews.
Her message to veterans: "If there is an urgent need that you have that may not be related to COVID, if there is anything at all that you need, please call us and get in touch with us. We do not want you delaying care out of fear or out of wanting to avoid coming into our facilities."
This story was produced by the American Homefront Project, a public media collaboration that reports on American military life and veterans. Funding comes from the Corporation for Public Broadcasting.
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