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Asking the Right Questions: Designing for COVID-19

There’s no arguing that the current coronavirus pandemic has changed many facets of life. One such aspect is how architects are now approaching hospital design, and how these projects will be able to impact healthcare workers’ ability to safely treat patients amidst the epidemic. With healthcare workers making up 10% of Canadian COVID-19 cases and 20% of COVID-19 cases in the U.S., Italy and Spain, it is essential that healthcare facilities are safe for patients and staff. COVID-19 is also changing how hospitals can alter their current spaces to handle COVID-19 patients as the virus continues to spread, presenting with a number of complicated considerations.

Initial exploration

Hospitals are undergoing rapid and necessary changes. Initial questions that have to be asked when preparing a facility for the intake and treatment of infectious patients is examining whether there is existing space within the hospital to convert into areas for the triage process and inpatient care. If existing available space is limited, will cancelling and limiting elective procedures and tests provide sufficient room to handle the increase in intake or will additional space be required?

Triage difficulties

This brings us further down the line of questioning. Which patients are to be treated within this reconfigured space or additional facility? There are several factors to consider when determining the types of spaces required to care for COVID-19 patients. Is the need for space for the initial triage of all patients as they arrive for testing, or is the need for accommodation of  post-triage screened patients as they await test results. This second category of patients requires additional separations between patients to prevent those who are negative for coronavirus from becoming infected.

Alternatively, is this space for those who are critically ill and diagnosed with COVID-19? Is there a need for additional critical care beds for patients on ventilators or are these beds for ill patients who don’t require intensive interventions like ventilators? Upper Respiratory Infections (URI) patient care units can be created within existing hospital space, in tents, arenas or convention centres but they require specialized mechanical interventions to make them safe. It’s also important to remember that patients recover better when we pay attention to lighting controls and acoustics, ensuring they can heal and sleep.

With all these options to consider, it’s important to keep in mind the differences in requirements between the different uses, as this can affect factors such as cost, implementation, any additional facilities that may be required, and its future use.

AIR care

Another issue is the lack of AIR care areas in many older existing hospitals in both critical care units and regular patient units. Solutions for adding these to increase the number of patients who can be isolated is not as simple as adding anterooms due to limitations such as the widths of required hospital corridors and existing mechanical systems.

Alternatives include removing exterior windows and installing specialty HEPA filtered fans to create negative pressure in the rooms, which would require minimal changes to existing AHUs. Another option is the creation of modular patient care units; however this also presents with its own challenges.

Modular patient care units

In countries like the U.S., Italy, Spain and others where the population has been heavily impacted by the virus, hospitals have considered purchasing modular patient care units to house patients. These could be located outside the existing hospital in parking garages, in green spaces or in parking lots but hospitals quickly realized a couple of issues: these units take up considerable space. Where were they going to put them and how were they going to bring mechanical and electrical services to them as well as connect them to the hospital for essential services such as food, supplies, etc.? Parking garages and parking lots were considered but many of the modular units need extra protection from the elements, in colder climates and protection from weather events, such as floods and tornados in the southern U.S.

Secondly, what were they going to do with the units after the pandemic subsides? Questions arose related to storage (where and how), and alternative uses. These questions made it clear that there was little opportunity to obtain a return on their investment – nobody would be willing to buy them afterwards as there would be no market.

Evolution in terminology

With all these new issues arising, architectural firms are using new language to describe their teams working with hospitals. ‘Facilities optimization teams’ comprise architects surveying hospitals to optimize the use of existing rooms.

‘Escalate the spaces’ or ‘surge the spaces’ for example, refers to converting spaces from one use to another. Dining rooms, activity rooms and rehab gyms are converted into spaces for multiple patient beds. Single bed rooms can be converted to two bed rooms to double the number of bed spaces in newer hospitals. Offices located in patient rooms in older hospitals can be repatriated back into patient care spaces. With the surge in demand, other areas are also being converted, such as ambulatory care units/clinics, dialysis units, PACUs and Day Surgery/Day Medicine Units into inpatient care areas.

COVID-19 projects

While we’ve identified numerous complications when it comes to the decision making that hospitals currently face, there are many examples of hospitals working with architects specialized in the design of hospitals and other healthcare facilities who have successfully created patient care spaces in this time of crisis.

Multiple projects have supported the intake of sick patients while supporting healthcare workers and ensuring non COVID-19 patients continue to be cared for safely. We are currently working with multiple hospitals to analyze their work processes, available space and potential local opportunities for temporary facilities both within their existing facility and within their community.

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