Before, During, and After – Thoughts on our COVID-19 Response Resilient Design Thinking In a natural disaster, maintaining hospital function is critical to an effective response. For several years now, LS3P, a regional architecture, interiors, and planning firm with eight offices in the Southeast, has been working with hospitals and other critical infrastructure to bolster Resiliency Preparedness plans. The strategies which emerged from these plans focused on rapid recovery after hurricanes, floods, or snowstorms. Suggestions typically involved hardened HVAC systems in strategic locations; bolstered IT systems; hurricane resistant exterior wall, window, and roof systems; and so forth. Then COVID-19 hit. In the disquiet of scattering our staff to their 345 respective homes, we thought, “How can we help our clients’ resiliency during the many societal and hospital events occurring during this ALL-encompassing COVID-19 outbreak?” No previous calamity had prepared us for this – no recent snowstorm, flu, or hurricane. Or had they? As healthcare architects, we dive deeply into the daily functions of hospitals – patient flow, material flow, building expansion, obsolescence, and reimbursement. The list never ends, and it continues to surge with the coronavirus on its unfamiliar trajectory. Even in this unfamiliar world, we are in constant communications with our colleagues and clients with texts, emails, and Zoom meetings, developing creative responses for addressing hospital campus and facility needs as they evolve. In this fast-moving and evolving situation, architects can advocate for more global design thinking that addresses a macro focus on the big picture for now, with details to be filled in later. From the Outside In Oftentimes we discuss healthcare design as an inside first, outside second mentality, form follows function. With this in mind, and by way of example, we are proposing an outside first approach for several of our long-standing clients. While the emergency departments, drive-through testing tents, and ICUs treat patients immediately, we are proposing next steps from the outside in, from the site towards the buildings. Moreover, the possible strategies listed below could be applied to not only hospital campuses, but also to adjacent properties such as assisted living, medical office, and retail properties proximal to hospitals: Site and Surface Parking: Surface parking areas can be used for drive-through testing and overflow parking for the hospital and MOBs. Use level parts of the site such as level grassed areas for vehicles, material staging, and/or tent placement. Parking Decks: Structured parking can be used for drive-through testing, temporary tent facilities on the flat plates and in the sheltered under-slabs of the parking deck, and materials staging and storage. These areas may also accommodate tent or mobile living quarters for staff and community members who need direct access to the hospital or caregivers, particularly if care providers need to be quarantined away from family or patients. Parking decks can also be used for food trucks, mobile/field kitchens, and other mobile services such as media, government agencies, police or fire department command centers that may need access to the campus during the event. Kitchen Facilities: If institutional-scale food service support exists nearby, these facilities may be used to augment the hospital’s food service, particularly if hospital cafeterias are closed and potentially being utilized for medical uses (ED overflow, screening, clinics, administration, wards, etc.). Offsite kitchens can feed hospital staff and/or patients as well as community members in need, first responders, local/state/national personnel, or volunteers. Housing: Assisted living facilities, apartments, hotels, and other multibed facilities could potentially be used to house hospital staff or others working at the hospital – the non-sick first, with progressive care following as needed. These facilities could also serve as new clinics for non-symptomatic outpatients, office and clinic offloading from the hospital, or any that can free up hospital space for COVID-19 responses and other patients requiring acute care. Offloading or off-siting non-essential people is important in terms of distancing and separation. Other building types such as malls and functioning underutilized buildings Offloading office and hospital-based services away from the hospital can be accomplished in nearby available buildings. The urgency is to free up space in the hospital so that hospitals can accommodate the most acute/COVID-19 patients. Healthcare systems may be able to work with developers and owners to facilitate such usage. Hospital beds for Acute, non COVID-19 Hospital Overflow If patients need to be located away from the hospital, medical gases and other life support equipment would need to be in place for these patients. As this is an extreme situation, such facilities would need to be planned accordingly and in concert with other hospital services. We are seeing hospital systems transitioning specific facilities to all COVID-19 patients, while other facilities locate the remaining non COVID-19 patients separately. Hospitals for COVID patients The worst-case scenario is complete conversion to an all COVID-19 facility, both in existing hospitals and temporary facilities such as tented wards, with support coming from an adjacent/connected hospital or emergency response units deployed to available sites. Lessons Learned and Future Planning: These and other potential strategic responses will be critical for healthcare systems in surging capacity to address the COVID-19 crisis. After the pandemic passes, we will be in a mode of recovery, lessons learned, and future planning. What was damaged, what broke, what needs updating, and what new buildings and infrastructure do we need for the next event? The inexhaustive strategies discussed here, and other innovations that emerge from this crisis response, will begin a dialogue in terms of working with clients in the future so that we are all better prepared for the next event. From our experiences with Covid-19, how can we plan for the unthinkable? And what are the facility, financial, and agency implications? As we work together to develop effective strategies to address this evolving situation, we remember that our collective strength lies in our ability to collaborate, innovate, and address complex and daunting problems through integrated and united responses. The knowledge we share with each other today may well save lives in the future. About Willy Willy brings over 25 years of healthcare experience in programming, planning, design, project management, and construction as LS3P’s firmwide Healthcare Practice Leader. His previous professional experience includes roles as Director of Healthcare Architecture, Principal, and Office Director at firms in South Carolina, Texas, California, Arizona; he was also President and Founder of Anthrotects, a firm he established to design the keystone services of a new “medical city” featuring a 300 bed hospital, cancer center, and MOB now under construction in Addis Ababa, Ethiopia. Willy serves as an invaluable resource offering expertise and support to all eight offices. Willy is a frequent conference speaker and presenter on a variety of healthcare design topics, and has served on the Board of Directors and Education Chair of the AIA Academy or Architecture for Health; and Founding Chairman of the AIA South Atlantic Region Architecture for Health Inaugural Conference, now in its second decade.