At a TED talk in 2016, Michael Murphy, founding principal and executive director of MASS design group, described a hospital in Tugela Ferry, South Africa in which a person could walk-in with a broken leg and leave with a drug-resistant strain of tuberculosis . This hospital became the center of a tuberculosis outbreak. Why? Unventilated hallways and overcrowded waiting areas. A poorly designed hospital became a hub for the airborne virus, tuberculosis . A building meant for its patients to heal was putting their health at a greater risk.
In healthcare design, every decision matters. The floorplan, the materials, and the circulation can all impact the functioning of a building as a space for treatment, recovery, and healing. Understanding what went wrong in hospitals such as the one in Tugela Ferry can give insight into how buildings can be customized to limit the spread of disease. With the help of Dr. Paul Farmer, a leading global health activist, and Bruce Nizeye, a skilled local engineer, Murphy designed a hospital in Butaro, Rwanda with simple changes that allow the hospital to protect the health of its patients [2, 3]. Hallways were moved to the outside, natural ventilation was incorporated throughout the hospitals, and all patients were given a view of the natural surrounding area . Murphy claims a simple view of nature can drastically improve health outcomes .
Designing spaces for disease control is particularly important during the current coronavirus pandemic. Similar to tuberculosis, the coronavirus is an airborne disease that can be transmitted via aerosolization. This means that the coronavirus not only spreads through close contact, but it also stays suspended in the air. In order to mitigate close-contact transmission, spaces must be designed to adapt for social distancing. If possible, communal spaces could be redesigned to be outdoors such as the hallways in Butaro District Hospital in Rwanda . There must also be effective ventilation systems to prevent aerosol transmission. Open windows, air filtration and fans are all effective ways to maintain air circulation and limit the spread of disease .
At Washington University, professor of advanced building systems and architectural design, Hongxi Yin, is exploring ways to effectively filter air before it leaves a building . He explains that hospital operating rooms have negative air pressure, meaning that more air enters than leaves the room . This is done so that the exhaust from the room can be collected and released outside from one main place in order to avert the contaminations from spreading throughout the rest of the building . However, in densely populated places like Wuhan, China, the emission of the virus from buildings may be contributing to the spread of the coronavirus . Yin has been exploring one way to prevent this: by exposing the exhaust to extremely high temperatures . Although more research is needed, this is one potentially extremely effective possibility for treating the exhaust before it is taken out of the building.
Another consideration in COVID-era design is transmission via contaminated surfaces. Traditionally, hospitals are designed with non-porous materials such as plastic and stainless steel . This is because these materials are easy to clean for controlling the spread of infectious diseases. Porous materials such as wood, fibers and cotton are rarely used in hospitals. However, the coronavirus has been found to persist on porous surfaces for only about 24 hours compared to non-porous surfaces in which it can last much longer . Thus, porous surfaces must be cleaned more often. What may have worked for previous infectious diseases may not work for the coronavirus. Design needs to adapt and respond to present realities.
Beyond practical physical changes to our built environment, the MASS design group is representative of a timely shift in the way we think about architecture. Architecture needs to put the health of people and their environment first. Buildings can be powerful. A clinic in Haiti with a focus on water filtration could prevent the spread of cholera . A birthing center in Malawi could encourage safe birthing and prevent maternal and infant mortality . An educational center in the Congo could protect biodiversity . These projects by MASS represent the importance of design in mitigating health crises and prioritizing the well-being of its inhabitants.
In this global health crisis and any potential future ones, architecture must be resilient, adaptive and designed with intention and care. Ultimately, the buildings we inhabit need to be places of refuge, inspiration and healing. With cultural sensitivity and empathy, designers play an important role in the way we face health crises. In particular, architects must consider seemingly small details and larger systems that prioritize health.
Edited by Neha Adari