Healthier Spaces: COVID-19 Prompts Rethink Of Hospital Design

While it may make sense from a business perspective, healthcare facilities should focus on more than just optimizing space. Hospital architecture lessons from a pandemic.

Hospital Saint Camille in Bry sur Marne, France.
Hospital Saint Camille in Bry sur Marne, France.
Isabelle Regnier

PARIS — French hospitals were not prepared for coronavirus. The country's contingency plan — designed to respond to major health crises and terrorist or bacteriological attacks — did not take into account the possibility of such a massive influx of patients for long stays in intensive care. As a result, overstretched hospitals had to rely, at the peak of the epidemic, on medical evacuations organized by regional health agencies and the army.

Day by day, they reorganized themselves, reassigning entire departments to resuscitation, reconfiguring their emergency departments to isolate patients with COVID-19 and doubling the capacity of rooms where possible. The crisis revealed much, in other words, about the structural weaknesses of the country's hospitals, but also highlighted their ability to adapt.

"It is clear that managing this crisis requires space management," says Véronique Toussaint, head of BBG, an architecture firm specializing in hospitals. "Whether we're talking about the city, its housing or local shops, we need to manage space differently. This also applies to hospitals."

And yet space is exactly what's lacking in hospitals.

As early as the 6th century, hospitals were governed by the Church to serve those in need. At the end of the 18th century, the hospital became the doctor's workshop. After World War II and the advent of modern medicine, it became a place of intensive treatment under the reign of engineers and logisticians. More recently, we have moved on to the business hospital and its economic efficiency and cost reduction targets, with the digital and intelligent hospital as the next step. The ratio that imposes a minimum of moving space in relation to the maximum useful surface area has become the be-all and end-all of design.


Inside Sainte Camille Hospital, Bry sur Marne. — Photo: Franck Castel/ZUMA.

"We have to fight more and more to obtain transitional spaces like waiting areas or lounges," Toussaint explains. "But this crisis shows just how necessary they would have been to manage safe social distancing. A parallel can be drawn with tuberculosis. This hyper-contagious infectious disease required long periods of hospitalization and gave rise to sanatoriums, with large terraces open onto the countryside. Patients would stay for several weeks or even months, and the architecture was part of care."

Form and function

Will the major hospital-investment plan that French President Emmanuel Macron promised in late March move us away from this over emphasis on the surface area ratio? Some architects certainly hope so, and point out just how counterproductive the model can sometimes be. If corridors are too narrow for beds, for example, patients are carried on stretchers, which then require more stretcher-bearers on staff.

The increase of hospital space is at the heart of what Matthieu Sibé calls the "loving hospital," a re-humanization program designed to stop the hemorrhage of health professionals to the private sector by creating positive workplaces for medical professionals, whose well-being would reflect onto the quality of care.

As a lecturer in management sciences at the Institute of Public Health, Epidemiology and Development at the University of Bordeaux, Sibé recommends focusing on things like light, acoustics, ergonomics and room design. He also emphasizes the construction of specific spaces dedicated to tasks requiring concentration, relaxation for caregivers, and the care of their children.

These are the principles that inspired the firm Architecture Studio for the university hospital it is currently building in Pointe-à-Pitre, Guadeloupe. Located in an isolated, tropical zone routinely impacted by health crises like dengue, Chikungunya and Zika, this hospital would have been ideally equipped for the coronavirus: 25% of critical care beds and single rooms are equipped for resuscitation and are large enough to increase their capacity if necessary.

In addition, the hospital's car park can be turned into a "crisis cocoon unit" with readily available power supplies, treatment stations, basic reserves and 20 or so additional beds. This state-of-the-art equipment did not prevent the architects from including leisure spaces for the hospital staff, like sports and yoga areas, an on-call room to encourage social interactions for doctors and interns and a restaurant "as least hospital-like as possible."

"Neutral spaces'

For the public health campus that he is developing in Qatar, Reinier de Graaf, an associate architect in Rem Koolhaas' OMA agency, has an abundant luxury of resources and space at his disposal. The concept of medical autonomy has become essential in a country facing international sanctions in the Middle East for allegations of supporting terrorism. The hospital has a farm and can produce its own pharmaceutical products, but well-being and hospitality are also central.

American Red Cross Worker writing letter for American Soldier whose Right Arm is Disabled, Saint Denis 1918. — Photo: JT Vintage/ZUMA.

"In the Islamic world, many hospitals were also farms," says De Graaf. "They were also places where music was played, where all kinds of activities took place. In Europe, apart from a clown who comes once in a while, there is nothing comparable."

Fundamentally determined by its function and the hyper technical nature of its work, hospital architecture is naturally utilitarian. But because the speed of medical progress has become so rapid since the 1960s, such facilities — which can take up to 10 years or more to build — run the risk of being obsolete and overwhelmed when finally completed.

To respond to this need for flexibility and adaptability, Jérôme Brunet developed, with his Brunet Saunier agency, the concept of "monospace and simplicity," with hospitals designed as "homogenous, relatively neutral spaces, where one can deploy all the functions wherever and whenever one wants."

The approach runs counter to the current trend, whereby technology is increasingly taking precedence over patient housing. Brunet says the two activities must be integrated, with buildings no longer separating high-tech surgery and residential spaces.

At Architecture Studio, Laurent-Marc Fisher stands by a split hospital model. "By deploying bridges between the buildings, the hospital regains its human capacity," he says. It also allows for a better response to current health problems, including epidemics and "multi-resistant bacteria, which are complicated to treat," Fisher adds.

The other overarching goal, the architect explains, is to reintegrate the hospital into the city. Modern societies are organized, for the most part, around cities, and so it's important, says Fisher, to create a genuine urban health planning system that is more accessible and more connected to urban medicine.

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7 Ways The Pandemic May Change The Airline Industry For Good

Will flying be greener? More comfortable? Less frequent? As the world eyes a post-COVID reality, we look at ways the airline industry has been changing through a pandemic that has devastated air travel.

Ready for (a different kind of) takeoff?

Carl-Johan Karlsson

It's hard to overstate the damage the pandemic has had on the airline industry, with global revenues dropping by 40% in 2020 and dozens of airlines around the world filing for bankruptcy. One moment last year when the gravity became particularly apparent was when Asian carriers (in countries with low COVID-19 rates) began offering "flights to nowhere" — starting and ending at the same airport as a way to earn some cash from would-be travelers who missed the in-flight experience.

More than a year later today, experts believe that air traffic won't return to normal levels until 2024.

But beyond the financial woes, the unprecedented slowdown in air travel may bring some silver linings as key aspects of the industry are bound to change once back in full spin, with some longer-term effects on aviation already emerging. Here are some major transformations to expect in the coming years:

Cleaner aviation fuel

The U.S. administration of President Joe Biden and the airline industry recently agreed to the ambitious goal of replacing all jet fuel with sustainable alternatives by 2050. Already in a decade, the U.S. aims to produce three billion gallons of sustainable fuel — about one-tenth of current total use — from waste, plants and other organic matter.

While greening the world's road transport has long been at the top of the climate agenda, aviation is not even included under the Paris Agreement. But with air travel responsible for roughly 12% of all CO2 emissions from transport, and stricter international regulation on the horizon, the industry is increasingly seeking sustainable alternatives to petroleum-based fuel.

Fees imposed on the airline industry should be funneled into a climate fund.

In Germany, state broadcaster Deutsche Welle reports that the world's first factory producing CO2-neutral kerosene recently started operations in the town of Wertle, in Lower Saxony. The plant, for which Lufthansa is set to become the pilot customer, will produce CO2-neutral kerosene through a circular production cycle incorporating sustainable and green energy sources and raw materials. Energy is supplied through wind turbines from the surrounding area, while the fuel's main ingredients are water and waste-generated CO2 coming from a nearby biogas plant.

Farther north, Norwegian Air Shuttle has recently submitted a recommendation to the government that fees imposed on the airline industry should be funneled into a climate fund aimed at developing cleaner aviation fuel, according to Norwegian news site E24. The airline also suggested that the government significantly reduce the tax burden on the industry over a longer period to allow airlines to recover from the pandemic.

Black-and-white photo of an ariplane shot from below flying across the sky and leaving condensation trails

High-flying ambitions for the sector

Joel & Jasmin Førestbird

Hydrogen and electrification

Some airline manufacturers are betting on hydrogen, with research suggesting that the abundant resource has the potential to match the flight distances and payload of a current fossil-fuel aircraft. If derived from renewable resources like sun and wind power, hydrogen — with an energy-density almost three times that of gasoline or diesel — could work as a fully sustainable aviation fuel that emits only water.

One example comes out of California, where fuel-cell specialist HyPoint has entered a partnership with Pennsylvania-based Piasecki Aircraft Corporation to manufacture 650-kilowatt hydrogen fuel cell systems for aircrafts. According to HyPoint, the system — scheduled for commercial availability product by 2025 — will have four times the energy density of existing lithium-ion batteries and double the specific power of existing hydrogen fuel-cell systems.

Meanwhile, Rolls-Royce is looking to smash the speed record of electrical flights with a newly designed 23-foot-long model. Christened the Spirit of Innovation, the small plane took off for the first time earlier this month and successfully managed a 15-minute long test flight. However, the company has announced plans to fly the machine faster than 300 mph (480 km/h) before the year is out, and also to sell similar propulsion systems to companies developing electrical air taxis or small commuter planes.

New aircraft designs

Airlines are also upgrading aircraft design to become more eco-friendly. Air France just received its first upgrade of a single-aisle, medium-haul aircraft in 33 years. Fleet director Nicolas Bertrand told French daily Les Echos that the new A220 — that will replace the old A320 model — will reduce operating costs by 10%, fuel consumption and CO2 emissions by 20% and noise footprint by 34%.

International first class will be very nearly a thing of the past.

The pandemic has also ushered in a new era of consumer demand where privacy and personal space is put above luxury. The retirement of older aircraft caused by COVID-19 means that international first class — already in steady decline over the last decades — will be very nearly a thing of the past. Instead, airplane manufacturers around the world (including Delta, China Eastern, JetBlue, British Airways and Shanghai Airlines) are betting on a new generation of super-business minisuites where passengers have a privacy door. The idea, which was introduced by Qatar Airways in 2017, is to offer more personal space than in regular business class but without the lavishness of first class.

Aerial view of Rome's Fiumicino airport

Aerial view of Rome's Fiumicino airport

Hygiene rankings  

Rome's Fiumicino Airport has become the first in the world to earn "the COVID-19 5-Star Airport Rating" from Skytrax, an international airline and airport review and ranking site, Italian daily La Repubblica reports. Skytrax, which publishes a yearly annual ranking of the world's best airports and issues the World Airport Awards, this year created a second list to specifically call out airports with the best health and hygiene standards.

Smoother check-in

​The pandemic has also accelerated the shift towards contactless traveling, with more airports harnessing the power of biometrics — such as facial recognition or fever screening — to reduce touchpoints and human contact. Similar technology can also be used to more efficiently scan physical objects, such as explosive detection. Ultimately, passengers will be able to "check-in" and go through a security screening anywhere at the airports, removing queues and bottlenecks.

Data privacy issues

​However, as pointed out in Canadian publication The Lawyer's Daily, increased use of AI and biometrics also means increased privacy concerns. For example, health and hygiene measures like digital vaccine passports also mean that airports can collect data on who has been vaccinated and the type of vaccine used.

Photo of planes at Auckland airport, New Zealand

Auckland Airport, New Zealand

Douglas Bagg

The billion-dollar question: Will we fly less?

At the end of the day, even with all these (mostly positive) changes that we've seen take shape over the past 18 months, the industry faces major uncertainty about whether air travel will ever return to the pre-COVID levels. Not only are people wary about being in crowded and closed airplanes, but the worth of long-distance business travel in particular is being questioned as many have seen that meetings can function remotely, via Zoom and other online apps.

Trying to forecast the future, experts point to the years following the 9/11 terrorist attacks as at least a partial blueprint for what a recovery might look like in the years ahead. Twenty years ago, as passenger enthusiasm for flying waned amid security fears following the attacks, airlines were forced to cancel flights and put planes into storage.

40% of Swedes intend to travel less

According to McKinsey, leisure trips and visits to family and friends rebounded faster than business flights, which took four years to return to pre-crisis levels in the UK. This time too, business travel is expected to lag, with the consulting firm estimating only 80% recovery of pre-pandemic levels by 2024.

But the COVID-19 crisis also came at a time when passengers were already rethinking their travel habits due to climate concerns, while worldwide lockdowns have ushered in a new era of remote working. In Sweden, a survey by the country's largest research company shows that 40% of the population intend to travel less even after the pandemic ends. Similarly in the UK, nearly 60% of adults said during the spring they intended to fly less after being vaccinated against COVID-19 — with climate change cited as a top reason for people wanting to reduce their number of flights, according to research by the University of Bristol.

At the same time, major companies are increasingly forced to face the music of the environmental movement, with several corporations rolling out climate targets over the last few years. Today, five of the 10 biggest buyers of corporate air travel in the US are technology companies: Amazon, IBM, Google, Apple and Microsoft, according to Taipei Times, all of which have set individual targets for environmental stewardship. As such, the era of flying across the Atlantic for a two-hour executive meeting is likely in its dying days.

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