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Healthcare in the Pandemic Era
The number of confirmed cases and deaths attributed to the COVID-19 pandemic continues to climb. Hospital systems that were able to distribute care through the summer are once again in danger of being overwhelmed. Front-line health care workers have been challenged continuously for the better part of a year, and now they are asked to risk even greater exposure as the number of patients in ICU’s and ER’s swell. As the next wave of infections caused by the SARS COVID-19 virus washes through the general population, it is easy to imagine that the strategy of locking down populations and closing businesses that require close interaction between individuals is not working. Have the State-mandated restrictions not been applied aggressively enough? Perhaps. But we believe it more likely that some decisions made early in the fight against this disease have shaped our current approach. It is not too late to correct these unfortunate choices. But before we discuss the potential solutions, we should look all the way back to the Spring of 2020.
What Do We Know?
First, throughout history and especially in a global economy driven at jet-speed, the spread of infectious diseases as cyclical pandemics inevitable.
It is difficult, if not impossible to predict where viral diseases will be most prevalent. https://news.stanford.edu/2020/03/26/understanding-spread-covid-19/
What Have We Learned?
The reaction of government at all levels is to go BIG early and scale back services as meaningful data is collected and the picture of the epidemic becomes clearer. This strategic decision to plan for the “worst case” healthcare challenge often leads to a misallocation of resources. https://www.longislandpress.com/2020/04/22/2-temporary-hospitals-that-feds-built-on-long-island-amid-coronavirus-pandemic-put-on-hold/
Accurate data collection and identification of vulnerable populations is critical in determining the strategy for combatting the effects of an epidemic. https://www.cdc.gov/coronavirus/2019-ncov/php/principles-contact-tracing.html
When the traditional hospitals are used for treatment of virus sufferers and ‘elective’ procedures are postponed, the business of healthcare delivery and hospitals suffer as well. https://www.thefederalist.com/2020/04/23/instead-of-flattening-the-curve-we-flattened-hospitals-doctors-and-the-u-s-health-care-system/
Government mandated ‘shelter-in-place’ and ‘self-quarantine’ helps alleviate the pressure on intensive care services, but the isolation of otherwise healthy persons has devastating economic and mental health costs. https://www.washingtontimes.com/news/2020/mar/26/widespread-isolation-and-stopping-all-human-intera/
If we were to synthesize these facts, it is difficult to conclude anything but the obvious: the strategies that we are employing are not working. We should be pursuing the goals and objectives that accept the realities of the demographics of the COVID-19 pandemic. We should release the younger, least vulnerable men and women to pursue their social and economic lives. We should
create healthcare systems that protect the most vulnerable in our society. Finally, we should separate and isolate the existing general health care system from the pandemic-specific challenges.
The first two of these goals require a political solution: only our elected leaders and their designees in the permanent bureaucracy are able to enact the policies that can release the healthy back into the flow of society. Because there is a facilities-based solution to the challenge of creating a pandemic-scale healthcare delivery system, the last two are the focus of our thoughts.
The challenges of a facilities-based solution would be profound. However, we can define the terms under which we could comfortably declare success. The ideal Pandemic Hospital would be designed to emulate a large, urban hospital ICU in function, but be small enough to take advantage of an ideal patient/caregiver ratio. It would have all the technology of a modern hospital, but none of the space-eating support facilities, such as kitchens and laundries. Through the careful selection of materials and systems, it would require the minimum effort to maintain a clean environment for both caregivers, staff and patients. It would concentrate itself first and foremost to patient care.
In addition to these core requirements for success, we would add that the capital cost for the Pandemic Hospital must be less per square foot than any comparable hospital. The design of such a facility must be easily scalable and capable of reproduction using pre-engineered principals. Inasmuch as the Pandemic Hospitals cannot be pre-positioned to meet unpredictable demands, the hospital must be able to be deployed to a wide range of locations and climates without losing operational efficiency. Finally, the Pandemic Hospital must be a part of the national healthcare system and capable of sharing patient health information into the national CDC database in real time.
The Pandemic Hospital Solution
Meeting the criteria required above is a monumental challenge, but the elements of the solution are clear.
- The structure and the building envelope should be pre-engineered and easily repeatable.
- Building systems should be pre-fabricated and replaceable supplies pre-manufactured.
- The ideal ratio of patients to caregivers should be pre-determined and the design of the facility based on those ideal numbers.
- The individual Pandemic Hospital should be designed to be scalable vertically or horizontally.
- The spatial organization should be layered and air control systems cascaded.
- Connections to the CDC national database should be created either by satellite or fiber-optic connection.
- The Pandemic Hospital must be able to be dismantled and relocated to alternate sites or stored for later use.
These goals are achievable and preliminary work has begun to include these design elements into a functioning healthcare delivery system. To learn more, contact us at Meier Architecture • Engineering, Kennewick, WA.