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How the pandemic is reshaping hospital architecture and design

As COVID-19 cases surged in March and April, New York City's Mount Sinai Hospital rapidly transitioned its care spaces to COVID-19 wards in an effort to stave off the virus and protect frontline workers at the epicenter of the outbreak. NewsHour Weekend's Christopher Booker reports on how the hospital's redesign may serve as an example for other medical centers in the future.

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  • Hari Sreenivasan:

    As COVID-19 cases surged in March and April there was a scramble to secure protective equipment for healthcare workers on the frontlines.

    But what about changes to the medical spaces themselves to protect both workers and patients?

    NewsHour Weekend's Christopher Booker has a look at one hospital retrofitting its spaces to fight the virus.

  • Christopher Booker:

    On the afternoon of April 15th, 2013 two pressure cooker bombs detonated near the finish line of the Boston Marathon, killing three and injuring hundreds. Within minutes the hospitals in the area were flooded with patients and quickly responded.

  • John Bucuvalas:

    The hypotheticals were the 9/11 type of hypothetical. The Boston marathon disaster, you know, that tragedy in which there was a huge influx of critically ill people that were going to come in and you know, that that is absolutely in place in this situation.

  • Christopher Booker:

    According to Dr. John Bucuvalas of Mount Sinai hospital, trauma centers prepare for these mass casualty events.

    What isn't in place are plans for how hospitals need to physically change to respond to what the globe is facing now, the outbreak of an airborne pandemic disease.

  • Michael Murphy:

    I think one of the big takeaways is that our medical system is not designed to manage a surge of a pandemic of this nature. And that should kind of awaken all of us to the challenges we have of our healthcare infrastructure. Fullstop.

  • Christopher Booker:

    Michael Murphy is the Executive Director of the socially-minded architecture and design collective, MASS Design Group.

  • Michael Murphy:

    Our hospitals are designed, you know with very tight margins to fill beds and have them largely full all the time. They're not designed to have excess of beds. And what that means during this outbreak and surge is that the system itself has been pushed to its limits.

  • Christopher Booker:

    At doctor Bucuvalas's hospital in New York, the medical center was forced to rapidly transition traditional care spaces to wards exclusively for COVID-19 patients.

  • Neel Shah:

    I think even at baseline, the clinical world has not thought very deliberately about the built environment.

  • Christopher Booker:

    As the pandemic grew, the hospital brought in Dr. Neel Shah of the global health innovation center, Ariadne labs as well as architect, Michael Murphy to study how a hospital redesign could keep patients and health workers safe.

  • Neel Shah:

    Every delivery system in the country and in the world had to adapt on the fly. And New York City at Mount Sinai Hospital was literal ground zero for this global pandemic. For a couple of weeks, it was an extraordinary opportunity to try to figure out how we not only learn what Mount Sinai is doing, but create lessons for the rest of the world very quickly.

  • Christopher Booker:

    Over a three week period in early April, Mount Sinai used remote observers to examine the various spatial changes the hospital implemented. Using GoPro cameras, doctors walked through the medical units to give the outside clinicians and designers a sense of the infection control designs.

  • John Bucuvalas:

    We took video. We interviewed people and they could then peer in, and that allowed us to do, make the observations incredibly quickly.

  • Christopher Booker:

    What were some of those key data points that you learned from this study as it relates to the design of the hospital?

  • John Bucuvalas:

    The infection control protocols usually are used to protect, they're to protect patients. In this situation, we have to protect every one. Providers, the people that do environmental services, the people that work moving in and out, the clerks and things like that. There's a lot of administrative support staff. So it's a whole different mindset.

  • Christopher Booker:

    The shift in mindset meant making strategic changes that could work within the structure of decades old buildings.

    I.V. machines that typically sit inside a patient's room were moved out into hallways to minimize medical staff interacting with infected patients.

    For contagious diseases like COVID-19 the standard of care is negative pressure isolation rooms. These keep contaminated air from spreading. But care units typically have only a few of these. During the surge of COVID-19 patients Mount Sinai converted 260 regular rooms to specialized negative pressure isolation rooms.

  • Michael Murphy:

    We're also able to see where clinicians were also putting tape on the floor, putting up visual cues to try to articulate to staff when they're walking into a red zone in a contaminated zone when they were leaving that zone so that we could be more cognizant of the amount of PPE that we were wearing. And those simple spatial markers are really essential nudges that could allow us to remind ourselves, hey, we're entering a more dangerous zone, be more protected.

  • Christopher Booker:

    MASS Design group has worked in the middle of epidemics in the past. In 2015 it designed a hospital to help fight the cholera outbreak in Haiti. And during the 2014 ebola crisis in West Africa, the firm developed a set of national standards for health infrastructure design in Liberia. Murphy says it's these experiences that influenced the way he thinks about physical space and how it impacts health.

  • Christopher Booker:

    With your understanding of space and the movement of people. What's your response or reaction to photographs of crowded beaches or crowded parks?

  • Neel Shah:

    I mean,Chris, what I think is that, you know, we're going to be seeing those people in a couple of weeks and that's the whole problem.

  • Michael Murphy:

    One of the fundamental things that's changed is not just for hospitals, but for all of us is this incredible spatial awareness. Are we going to be contaminated by leaving our house? Are we going to contaminate others? And that incredible spatial cognition that the spaces around us are potentially infectious or potentially healthier is a significant paradigm shift in the way we think about the world around us, and I think, and should and will shape, the way we design hospitals a little more deliberately in the future. And how we can design for trust are going to be crucial for every one of our public spaces.

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