By Dr Jane Repin Carthey
Although the Covid-19 pandemic has been happening for several months, the importance of the physical environment in supporting the increased hospitalisation of patients has not yet been fully documented for Australian hospitals and healthcare facilities. Many peer-reviewed publications have been looking at operational issues for handling Covid-19 patients including admissions procedures, Covid testing, and how to maintain infection prevention and control within facilities. Other articles can be found in on-line trade magazines or in letters to the editor in academic and other journals, and some of these address features of the physical environment that will assist with these identified issues. Quite rightly, many documents concentrate on the need for healthcare workers to stay safe and Covid-free.
Other papers look at the issues of maintaining the everyday work of hospitals for all community members while continuing to treat Covid patients especially those requiring intensive care and/or ventilation. These papers often report on operational approaches to streaming of patients within facilities from the point of approach or entry to diagnosis and treatment areas, so that cross-infection is prevented between those patients with and those without Covid diagnoses. This includes the further dimension of ensuring that staff members remain safe and Covid-free. The recent experience in Victoria has shown how difficult this can be and how easily this task can be derailed in the face of massive Covid admissions due to community transmission of the virus.
Creating and maintaining patient-friendly environments is now an even greater challenge for healthcare designers also faced with the technical requirements for keeping people safe and Covid-free. Can we satisfy the requirements for salutogenic and healing environments whilst all responding to the urgent needs of addressing this current pandemic. As designers, are we up to it?
Where do the current resources mainly come from?
This post lists some useful resources that I have discovered in the last week or so. Some result from a literature review, others from google searches, and reviews of healthcare design sites. Other resources or references are available from the National Health Service of the UK (NHS), and from professional bodies such as the Royal Institute of British Architects (RIBA) and the American College of Healthcare Architects (ACHA).
How about Australia? I just interrupted my writing to check if the Australian Institute of Architects (AIA) has published anything on this subject for its Australian members – but no, it doesn’t appear that they have so far. Hopefully, we will get some local content in the near future from the AIA and our other professional design organisations that address our local condition and needs.
My colleague Warren Kerr is the Immediate Past President of the Union of International Architects Public Health Group (UIA-PHG). The UIA-PHG has been pulling together resources from countries around the world and you can find this list of resources at https://www.uia-phg.org/covid-2. You may have to register to access this site, but it is free and easy to do.
The role of architecture and design in managing the pandemic
An open letter to the Health Environments Research and Design (HERD) journal was written in March and published by the journal in July this year. (Hercules, Anderson, & Sansom, 2020) It has also appeared online in Canadian Architect, Architect Magazine, and SALUS Global Knowledge Exchange. All these sites have other articles relating to Covid-19 design responses – some may be reviewed by this blog in the future.
The open letter was written jointly by an architect, a doctor/architect and a knowledge researcher to emphasise the need for urban designers and architects to be engaged in developing solutions to deal with pandemics like COVID-19. The authors note the sometimes-clumsy improvisations that have been used to address the current situation. They argue that the built environment is critical for responding appropriately to pandemics and to assist the community in being prepared for all types of emergencies including climate related ones.
Although other locations may be considered for treating very ill patients such as hotels, and even cruise ships, utilising existing hospital infrastructure should always be the preferred approach. However, “surge capacity” in existing hospitals is often insufficient partly due to health system changes in recent years that saw major reductions in bed numbers and the move of diagnostic and treatment services to community settings. The need to repurpose parts of a hospital to cope with an influx of patients e.g., converting recovery spaces to intensive care spaces, or creating more isolation rooms is a challenge that Australia may not yet have had to face to a great extent. It will definitely be something we need to respond to in the future.
Building hospitals in a few days as happened in China set a precedent in pandemic design responses and clearly required careful planning and strong, pre-established supply chains. Yet this type of hospital would probably not meet current design standards in most first world countries. Equipping and staffing these facilities quickly is another challenge to be overcome.
The path forward may create a better built environment ready to respond to emergency situations
Urban planning and city design must respond to the possibility of future pandemics and public health input is critical for this to happen. The responses that we have seen to date including the use of digital technologies have encouraged long-awaiting innovation in areas such as telehealth. Shutting down cities and quarantining residents has been another response but this is a blunt and crude instrument that damages local and global economies and requires a long recovery time for any community. Yet at present this second approach is the only strategy that seems to truly cut diseases off close to source without infecting large numbers of people or worse still, the whole healthcare system.
So, the path forward requires bringing together policy makers with qualified medical and design professionals to ensure our cities and healthcare system can cope with the next pandemic (and rest assured, there will be one!). There are various practical solutions available that include: modular buildings and components, 3-D printing for building modules and equipment, and quickly creating field type hospitals on playing fields and in public car parks. Future articles on this topic will look at some of these solutions plus others that policy makers, clinicians and architects could consider for implementation in the Australian setting.
Suggested further reading in the meantime
Hercules, W. J., Anderson, D. C., & Sansom, M. (2020). Architecture—A Critical Ingredient of Pandemic Medicine: An Open Letter to Policy Makers. HERD: Health Environments Research & Design Journal, 13(3), 247-252. https://doi:10.1177/1937586720928432
Kacik, A. (2020). Pandemic prompts flexible healthcare design. Modern Healthcare, 50(20), 2
Edwards, N. (2020). Here to stay? How the NHS will have to learn to live with coronavirus. Nuffield Trust. https://www.nuffieldtrust.org.uk/resource/here-to-stay-how-the-nhs-will-have-to-learn-to-live-with-coronavirus
Noble, J., Degesys, N. F., Kwan, E., Grom, E., Brown, C., Fahimi, J., & Raven, M. (2020). Emergency department preparation for COVID-19: accelerated care units. Emergency Medicine Journal, 37(7), 402-406. https://doi:10.1136/emermed-2020-209788