Like many industries, design can be pushed by unexpected circumstances. Ventilators and facemask manufacturers are being asked to produce more than ever, while other similar companies are pivoting to help in this time of need. As it is often said, “Necessity is the mother of invention” and we are all learning how to “invent” new ways of doing things.
As an architectural firm focused for many decades on the creation of healing environments for the compromised and anxious patient, this time is still different. We are learning every day from our clients, colleagues, and other impressive public figures. Dealing with things so tiny we cannot see them, we trust the bright minds of science to describe this new and prolific enemy: Coronavirus.
Our ideas are also based upon the recent experience of designing a biocontainment critical care unit for an academic medical center. It was a unique intersection of patient care and high-level biocontainment design, integrating the best practices from the world of critical care with laboratory research. This project created an environment to heal patients with everything from Ebola to Zika, as well as any other highly communicable disease.

Key Design Challenges
As we learn more about the coronavirus, in particular, we can design more effective environments. Unfortunately, we do not have the time to spend months or years creating the perfect solution. We are acting now and building upon our past knowledge and the new information we are taking in every day. In the world of small things like bacteria and viruses, we try to learn how they are spread so that we can design the most effective way to minimize their transmission.
The Coronavirus appears to be spread primarily through droplets from coughing and sneezing and not carried for long distances through the air. This means we need to design places are easily cleanable and do not support the life of the virus.

Below are a few questions and issues we have recently addressed with our clients.
Where should the dedicated patient rooms be located?
Most short-term solutions for housing patients with this virus are within existing hospitals. One of the most common challenges is where to place the dedicated area within a typical nursing unit: at the front or the back. My experience says that if you can control the area with doors and proper security measures, then closer to the front is better. This provides a shorter distance to travel for this patient population and can allow for the non-infected patient a path around the dedicated unit. The other option is to place the virus unit at the back, which can provide more separation from the rest of the unit; however, this means that the infected patients must pass by the non-infected patients. Each situation is different and the flow of patients from the elevators should be examined closely to provide the best outcomes for all. If the hospital has the luxury of separate on-stage/off-stage delivery paths, one could temporarily be dedicated to the Corona patient for example.
Another key consideration if you are going to create a code-compliant isolation room/suite is how to add the needed exhaust fans to serve the area. Based on this design issue, we are recommending that the new isolation unit be placed on the top floor of the facility to allow easy access to the roof. This can provide a relatively easy location for additional exhaust fans as well as any other mechanical equipment solutions.

What type of air filtration do you need?
The State of Texas Health and Human Services Commission recently released a memo temporarily allowing patients to be placed within rooms that have a HEPA-filtered mechanical system. Since hospitals are designed with HEPA filters per the typical codes, this allows hospitals to place the patients within most normal in-patient rooms. This would include ICU’s and medical/surgical wings as well as universal care suites. The logic behind this temporary measure seems to support the science that Corona is primarily thought to transmit via droplets and not typically via air-borne methods. This also obviously provides healthcare systems with a temporary but effective way to treat these patients.
In normal times, a true isolation room has higher requirements than just a high-level of filtration like HEPA. This includes more air changes per hour and all of the supply air to the space must be exhausted to the outside. This ensures a more sterile environment but adds significantly to the energy usage of the facility. Isolation rooms are also required to have “monolithic” (read: gypsum board) ceilings to further prevent infections within the rooms. These rooms require seamless flooring like sheet vinyl as well as a continuous coved-base to minimize the opportunity for germs to congregate.