Pandemics are not new to humankind. As human population increased, aided by widespread trade and interaction, humankind has experienced and survived many pandemics. One of the most notorious is the Black Death (Bubonic Plague) in 1347 to 1351 where it was estimated that 200 million people perished. In the last century alone, the world has seen no less than 10 pandemics from the Spanish Flu (1918 to 1919) to HIV/AIDS (1981 to present) and SARS (2002 to 2003).
COVID-19 will not be the last pandemic we will face. The world crossed the grim milestone of over 1 million deaths from COVID 19 in end September 2020 (28 Sep 2020) and the number is still climbing as we speak (1.035 million as of 5 Oct 2020). With over 35 million confirmed cases as of 5 Oct 2020, there is an urgent need for sustainable health emergency preparedness to deal with the next pandemic.
During the onset of COVID-19 pandemic earlier this year, major lockdowns all over the world were implemented to minimise human interactions in the hope of curbing the spread of the outbreak. As a result, a few trends emerged:
The Future Positioning of Design
COVID-19 has challenged status quo and transformed people’s perception of places and spaces where we work and play. For those who are part of designing and developing the new built environment, we are not only tasked with ensuring the health and safety of people, it will be critical for us to design future healthcare buildings, to be pandemic resilient, sustainable and adaptable for different uses and users.
In designing future healthcare buildings, there are some premises we should acknowledge. Firstly, it is important to understand that we cannot cater to anything and everything, because the next pandemic may very well be different from what we have experienced. While we cannot hope to be pandemic-proof with our future designs, what we can do is to learn from past lessons and make our designs as flexible as possible, so that when the next pandemic hits, we can deal with it readily.
What we have learnt from WFH over the last few months is that when faced with a situation of being confined to certain spaces, both mental and physical well-being of occupants will be put to test. It is thus essential for designs to not just be functional when executed, but also able to address the physical and mental health of occupants, which can be facilitated through smart technology and enhanced by biophilic design concepts. Let’s look at some design considerations for building pandemic resilient healthcare facilities.
Design Considerations for Pandemic Resilient Healthcare Facilities
1. Adaptability & Flexibility
It is good practice for hospital wards to be designed as modular units that use the same structural grid and share service stacks so that they can be easily converted, for example, from a 2 single-bedder ward to a 4-bedder cohort ward and vice versa. To extend that concept, these modular units must be able to have the flexibility of being able to convert to deal with the different requirements that may arise from a pandemic. One such idea is to convert naturally ventilated cohort wards into air-conditioned isolation rooms or add anterooms to single-bedder wards for conversion into isolation rooms. Mechanical and electrical systems would need to be designed for, and installed in selected wards, to accommodate such future conversions. With careful planning, more beds could also be added to make provision for surge capacity.
In the National Centre for Infectious Diseases [NCID] (a 330-bed purpose-built facility inaugurated in 2019 to strengthen Singapore’s capabilities in infectious disease management and prevention) which CPG designed, ward rooms are designed in modules that are used for the various types of ward configurations such as Cohort, Negative Pressure Rooms (NEP), Intensive Care Units and Isolation rooms. The rooms are designed with the ability for conversion, such that in the event of a severe outbreak, the total number of beds can be increased from 330 beds to 586 beds, with additional beds being added to the various types of wards.
Such flexibility proved to be immensely useful for Singapore during the COVID-19 pandemic. Upon confirmed diagnosis of the first COVID-19 patient in Singapore on 23rd January 2020, the protocols for NCID ward conversion were immediately activated. Within a week after the World Health Organisation (WHO) declared COVID 19 as a global emergency on 30 January 2020, the NCID ward conversion started and was completed in 9 days. An additional 4 wards consisting of 32 rooms were commissioned in this short period of time, a feat that could only be achieved because the facility was designed with good medical planning.
Compartmentalisation of zones in healthcare facilities would allow the segregation of different departments, for the purpose of infection control, security and privacy. More important is the consideration for healthcare facilities to compartmentalise so that in the event of a lockdown during a pandemic, certain zones can be cordoned off, while other zones continue functioning. A common design strategy would be for the wards in a hospital to be designed with the ability to zone into 2 wings – low and high risk wings. Depending on the severity of the outbreak, isolation and lockdown can occur in one ward, an entire floor, a whole wing or the building total.
3. Space Provision for Mass Screening
COVID-19 sees the setting up of temporary shelters and queue lines across all building typologies for temperature screening and contact tracking procedures to be implemented. With the COVID-19 precedent, we now know a screening area is indispensable, thus future healthcare facilities will need to be designed with the provision of space to screen patients, visitors, staff and vendors. Such space provision must be carefully considered and strategically located to maximise control and minimise manning resources. To avoid wastage of space, these spaces can be planned and designed for multi-use during the non-pandemic mode.
4. Standard Operating Procedures (SOP)
The best designs will not work if the operators in healthcare facilities do not have an established SOP that maps out all the possible scenarios. Frequent drills and exercises must be conducted to familiarise all staff, and these SOPs must be reviewed on a regular basis for keeping up with the best international practices.
5. Importance of Technology
COVID-19 is the single biggest disrupter for the workplace. Even as people were initially faced with anxieties and doubts about WFH, as soon as technologies proved to facilitate remote working and virtual conferencing, most of these uncertainties were cast away. With time, existing platforms that enable remote communication will only get more sophisticated and become more user-friendly. More technological advancements will also appear in the future to support the WFH notion.
Besides technologies associated with WFH, many other forms of new technologies were also adopted for screening and contact tracking purposes. With the advent of more such technologies, we will begin to see how these can all be utilised to ‘compartmentalize’ different parts of the hospital, while still enabling communication and control. In the area of telemedicine, we foresee great potential in the future for E-consult, especially for patients with chronic diseases, who will benefit from the convenience of not needing to commute, or for patients who cannot commute during lockdowns.
6. Nature & Wellness
Many have experienced severe frustrations when confined at home during the lockdown period of COVID-19. The frustration is the same for patients who need to be isolated or healthcare workers who are stressed and exhausted from the tough demands of work during a pandemic. In such times, areas of respite with access (even if it is only visual access) to greenery is a big boost to improving one’s state of mind. By considering to incorporate biophilic designs into health facilities, we are also demonstrating pandemic resilience in design, because it is not merely the physical aspect of human beings that we need to take care of in times of pandemic, but the psychological aspect as well.
7. Choice of materials and finishes
There is now an increased awareness of the choice of materials and finishes that are anti-microbial and anti-bacterial. A health facility that is pandemic resilient should be designed and made with a choice of materials that allow repeated disinfection processes. They must withstand numerous wipe downs and hold out against strong disinfecting agents without deteriorating. In the future, we can expect the development and fabrication of more materials that possess these properties, besides being aesthetically pleasing.
In our upcoming blogposts, we shall also be exploring more on the pandemic resilient design framework, as well as some of the history and topics in the Singapore healthcare context.
Alice Park (2020), “One Million People have died of COVID-19, it’s a reminder that we still have so much to do”, TIME, 28 Sept 2020. Available here.
(2020) “WHO Coronavirus (COVID-19) Disease Dashboard”, World Health Organisation. Available here.