When Italy became the second country in the world and the first in Europe to be hit by the coronavirus pandemic, it had to equip itself in a short time with preventive measures that put the national health system in crisis. Despite the spike in the pandemic, the system has held up and become a model for other European and non-European countries, from behavioral rules such as wearing masks to the implementation of dedicated and innovative health spaces for virus treatment, spread containment, and testing.
The Design & Health Lab at Politecnico di Milano, in Milano, Lombardy, Italy, which works with Italian and international centers for healthcare planning, studied and supported different healthcare organizations in understanding best ways that the built environment could help address the pandemic. The lab’s research resulted in a peer-reviewed study published in the scientific journal Acta Biomedica and several national and international webinars.
“All countries and populations must be ready to respond to health emergencies that can occur at any time and in any form. In general terms, preventive planning for epidemics is therefore needed,” says Stefano Capolongo, architect and director of the department of architecture, built environment and construction engineering (DABC) and research coordinator of the Design & Health Lab, at Politecnico di Milano.
In this Q+A with Healthcare Design magazine, Capolongo discusses his view on Italy’s handling of the coronavirus pandemic, the healthcare design solutions that have worked, and some lessons that have emerged in Italy that could prove useful in the U.S.
Healthcare Design: Tell us a bit about your role at the Politecnico di Milano and your approach to healthcare planning education.
Capolongo: I’m both a professor at Politecnico of Milano, where I deal with public health and, in particular, the relationship between the built environment and health, and director of the architecture, built environment, and construction engineering department where the theme of health is treated with particular reference to the design of healthcare facilities and hospitals. In this context, both the department and the university offer numerous degrees in the field of hospital design to create professionals who know how to manage the complexity of the hospital structure at 360 degrees.
This training is based on a multidisciplinary approach that’s not only linked to construction but also with programming, planning, and infection-control aspects of healthcare facilities. I like saying that the healthcare design project is the translation of a series of social issues, therefore the architect’s job is to receive data, information, and multidisciplinary approaches and to know how to transform them into spatial physical space.
HCD: In the aftermath of COVID-19, how do you see healthcare planning and design changing for good?
Capolongo: The sensitivity and perception by operators of the risk that hospitals have in the spread of infections will change a lot. This pandemic gave us more awareness of the fact that infections are an important topic that requires not only organizational but structural responses made through layout, space design, and building materials.
Today, much work is being done on the research and application of innovative materials with antibacterial and antiviral properties. The sanitary space becomes the place of prevention. The epidemic taught us that medicine in the last century has made great strides in terms of discoveries, diagnoses, treatment, and prevention, but has been weaker on some issues such as infection control. To address the COVID-19 epidemic, hospitals had to use physical space through isolation, social distancing, and hygiene. Going forward, the concept of hospital flexibility will evolve toward the provision of redundant and isolable spaces, with predetermined spatial, technological, and functional configurations that could be rapidly put in place.
HCD: In the United States, many patients delayed necessary medical care because they were/are afraid to go to healthcare facilities. How do you educate students to think about this problem?
Capolongo: During emergencies, hospitals also have to continue to carry out scheduled health activities in order to prevent people from giving up medical care that’s critical for survival. In this sense, the creation of autonomous spatial and organizational clusters will enable the isolation of specific areas while allowing ordinary activities to carry on. For example, this can be achieved by providing redundant vertical and horizontal connections that can avoiding cross-contamination paths.
Educating students on this theme is important because we believe healthcare design professionals play a central role in terms of health promotion. First, we design places for healthy people and we must ensure that people do not get sick and, second, because in hospitals, apart from during the emergency period, users are more healthy than ill, so we have to make sure they don’t get sick.
HCD: Specifically, how should the design industry plan to re-equip healthcare facilities to better respond to a future epidemic/pandemic?
Capolongo: One solution could be “sanitary hotel,” which are located in close proximity of a hospital main building where patients’ relatives can stay overnight. During a pandemic, the hotel could be transformed easily to manage patients in discharge, post-acute phase, or rehabilitation, leaving the intensive care and inpatient beds for the most serious patients. Those spaces could also be dedicated to medical doctors and nurses who could not spend time at their places for infection risks spreading.
Moreover, in some countries there are hospitals where underground parking garages can be transformed in 72 hours to become areas dedicated to emergencies. In this case, the spaces should be equipped with systems and technologies, including medical gases and electrical outlets, that allow the transformation in a very short time. This certainly entails additional initial costs but guarantees flexibility and adaptation in the long run.
In the future, everything must be more technological and flexible to enable rapid responses to disease and to avoid the aggravations that have occurred during this emergency, such as beds saturation in ICUs, insufficient oxygen provision, or unclear chain of command at the organizational level. It will be necessary to act promptly, before the critical phase, with a punctual control by the local and regional health system.
HCD: COVID-19 has strengthened the use of technology in care delivery. How do you see this evolving?
Capolongo: The management of the patients’ acute phase required devices and equipment as well as care spaces correctly designed to accommodate those tools. For example, it was essential to have environments with imaging diagnostics located near intensive care, in order to be able to continuously monitor the evolving acute phase of the disease.
In the future, I think hospitals will utilize tools that can detect overcrowding and the presence of viruses and bacteria, while drones will be used to travel to hospitals and monitor risk situations. The giant steps that technology is making in this current pandemic, such as the wide diffusion of telemedicine, will definitely have an impact on the architecture of the hospital as well.
HCD: What design lessons have emerged in Italy that you think could be useful for designers and healthcare organizations in the U.S.?
Capolongo: Italy was the first industrialized country to face the pandemic and the approaches taken by the hospitals have been very different. Some facilities have transformed traditional wards into COVID-19 departments, others have created adjoining units with containers or tents, and still others have created hubs far from central hospitals.
COVID-only hospitals become risky because when the pathology of the disease creates complications, such as cardiological and neurosurgical, patients need quick access to other specializations. Therefore, my advice is not to create separate structures but to implement solutions at existing facilities.
Other countries may also learn from Italy that behavioral rules, such as wearing face masks, regularly washing hands, and interpersonal distance are fundamental, even among healthcare workers. In fact, those who worked in COVID-19 wards had a lower incidence of disease than the other wards because they were prepared and had more protective devices available.