Emergency Healthcare Scheme

E

M

ERGEN

CY H EALT H CARE SCHEMES

MA ENVIRONMENTAL ARCHITECTURE

YUTONG WU

CONTENT

CONTEXT ENVIRONMENTAL BACKGROUND DESIGN BACKGROUND

PROPOSAL DESIGN CONCEPT

METHOD PROJECT PLAN

RESEARCH CASE STUDY OF EMERGENCY PROPOSALS PILOT STUDY ON EMERGENCY RESPONSE

DESIGN CONCEPT OF DESIGN PROPOSAL

REFERENCE

CONTEXT

ENVIRONMENTAL BACKGROUND

2

016, the World Health Organization has released a profile to indicate a global assessment of the burden of disease attributable to environmental risks, the statistics reported that there were 23% of deaths and 22% disabilityadjusted life years are attributable to the environment which could be avoided by modifying globally. It is noticeable that the environment has played an essential role for directly affecting human beings’ living quality and lifespan.

2020, the virus has become the greatest topic. While the news of locked ancient never-before-seen viruses were discovered in Tibetan glaciers is widely spreading, the COVID-19 pandemic continues to take a heavy toll on families, communities and nations the world over.

The world has been united together to fight the pandemic virus and support the healthcare system, each country has tackled the issue with various medical treatments depending on distinct cultural, economic and political measurements to respond to the virus challenges as this will be a race between medical facilities and virus spreading time.

Covid-19 is the contagious virus which have specific living time on different type of materials, with the knowledge of the “Persistence of coronaviruses on inanimate surfaces and their inactivation with biocidal agents�, the design might be easier to achieve the potential and efficient aim of disease control.

SURFACE TYPE

VIRUS TYPE

TIME

MERS-CoV 48h 8-24h 5d HCoV 2-8h ALUMINIUM C METAL SARS-CoV 5d WOOD SARS-CoV 4d PAPER SARS-CoV 4-5d SARS-CoV 24h 3h <5min GLASS SARS-CoV 4d 5d C PLASTIC SARS-CoV =<5d MERS-CoV 48h 8-24h SARS-CoV 4d SARS-CoV 6-9d 2-6d HCoV 5d PVC HCoV 5d SILICON HCoV RUBBER STEEL

SURGICAL GLOVE

HCoV

DISPOSABLE SARS-CoV GOWN CERAMIC TEFLON

HCoV HCoV

=<8h 2d 24h 1h 5d 5d

Figure 1.

How long does coronavirus live on surfaces.

DESIGN BACKGROUND

R

ecently, the American Institute of Architects has launched a working group to provide technical advice on how to transform existing buildings into temporary medical facilities depends on distinguished condition during the outbreak.

Molly Scanlon, the AlA working group chairman, the environmental health scientist and architect, claimed that during the COVID-19 pandemic, it was unprecedented to adapt buildings to meet the needs of various functions.

Architects, designers and construction professionals have the responsibility to help solve technical problems and provide implementation suggestions.

Several proposals have been tabled and deployed, so as to rethink the relation between urban and healthcare facilities, designers should imagine and propose proper urban planning schemes for further emergency preparedness to reposition healthcare infrastructure within city scale.

PROPOSAL

DESIGN CONCEPT

E

mergency healthcare systems is a great topic with multiple considerations across political, economic, cultural and ecological etc. boundaries. When facing unexpected pandemic disease, quick response and efficient organize nationally or regionally are considered as powerful implementations to ensure the publicâ&#x20AC;&#x2122;s safety and minimize financial losses.

CONVERTION

It is unrealistic for the design or planning to get obvious improvement in such a short period of time, more reasonable urban fabric planning should be put on what kind of preparation the states could conduct in advance of infectious disease as these are c o n n e c t i o n s b e t w e e n e m e rg e n c y healthcare system within urban plan to perform as practical spaces and through platforms as virtual spaces.

This project aims to raise a pilot study on the relation among city, community and emergency healthcare infrastructure briefly and assumed will be resulted in urban planning to reform access toward emergency healthcare facilities, especially for specific communities.

NEW CONSTRUCTION

COVID-19 Figure 2. IRP concept.

Instead of considering the whole healthcare context, the s an opportunity to provide better healthcare provision, des communities, which could be reused in public health prev

COMMUNITY IS THE CLIENT. Communities are vital components to represent a city, inhabitants could be divided by distinguished aspects, for instance location, identity, organization, to identify living quality and access to infrastructures. In different communities, the health and healthcare condition might be different which could be reflected in responding to emergencies.

EMERGENCY IS THE PATIENT.

CONVERTION

Emergency schemes have been implemented in every city to respond to COVID-19 this year, due to the outbreak of contagious disease, urban planning should cooperate with the development of the sanitary system and the decision made for policy or economy, especially to provide potential access to medical care and keep the request of social distance or quarantine.

PROPOSAL

ARCHITECTURE IS THE DOCTOR. NEW INTERVENTION

DISEASE

strategy is to use COVID-19 emergency infrastructure as sign emergency spatial interventions, focusing on specific vision during non-emergency period.

Healthcare facilities provide the supportive insurance for cities and protect inhabitants for better living q u a l i t y. T h e o u t b r e a k i s a t a s k to challenge healthcare material biologically and spatially, architecture and urban planning are the mediation of accessing medical care. Functional architecture or landscape within urban plan could reflect on a larger scale to provide prescient alterations to react to emergencies, to some extent, to reduce the possibility of occurring emergencies.

METHOD

PROJECT

STEP. 1

PLAN By doing the case study of the emergency proposals worldwide to summarize the emergency schemes that are already in use or planned to respond to COVID-19.

STEP. 2

T

he research stage could be raised as a pilot study on the relationship among community, emergency and healthcare infrastructure:

Select 4 cities as a series of pilot study with different social contexts to understand the relationship between community and healthcare infrastructure.

RESEA

ARCH

STEP. 3 Ta k i n g C O V I D - 1 9 e m e r g e n c y infrastructures as examples through each community within city scale to look for research already down by world healthcare organization etc.: Define the community which have poorer health condition or lacks access to healthcare facilities or politically, economically need to be improved for better living conditions; Indicate what lacks in public health or what need to be considered depends on the future plan; What are the specific problems that people have for public health prevision?

DESIGN

STEP. 4 Plan the potential scheme for the specific city on alterations for healthcare (identification of the healthcare: not only includes the specific medical care, but also the related infrastructure of quarantine or other previsions), for instance, transforming, converting or constructing emergency structures as healthcare intervention to provide easier reachable access to healthcare.

RESEARCH

CASE STUDY OF EMERGENCY PROPOSALS Figure 3. NHS Nightingale Hospital.

D

uring the outbreak, there were three main architectural interventions proposed for responding COVID-19 and supporting healthcare (based on personal research and understanding): temporarily converted architecture, newly built constructions and medical mobile modulars.

The discussion around emergency schemes will be reported via three examples and the talks over material and location are both vital aspects.

TEMPORARILY CONVERTED ARCHITECTURE

To convert the space, the discussion could be based on architecture. “‘Flexibility’ in architecture, refers to the ab and even its structure to evolving needs. Achieving such ‘ challenge a number of investigations have tried to take up

The COVID-19 outbreak exposes the problems on urba Service and the flexibility of construction management. H During the outbreak, London has converted the Excel C Intensive Care Unit (ICU) facilities with 4,000 critical Newham. “Plans for the temporary change of use of the (26 March) with the application marked as being ‘of natio

n the flexibility of architecture and the adaptation of the bility of a building to continuously adapt its space layout ‘architectural flexibility’ has been over the past century a p”.

an health planning and challenges both National Health How has London been converted spatially to respond?

Centre into the large temporary mega-hospital to provide beds as the NHS Nightingale Hospital in east London, centre were submitted to Newham Council last Thursday onal importance’”.

Figure 4. Quarantine Hotels.

This example is talking about the flexibility of architecture, under different circumstances there are possibilities to reform the function to achieve the efficient aim. Apart from transforming spaces by taking the advantage of the flexibility of architecture, it also can use the adaptation of architecture.

Due to the property of COVID-19: infectious disease, the requirement of keeping social distance and the restriction of quarantine have a large demand for space. Hotels have popped up to become the perfect choice for quarantine with isolated and wellequipped facilities for individuals. It is interesting to understand that while most cities are forced to lockdown, the designated hotels for quarantine are the “luckiest” economic merchant with income (except the medical related industry).

NEWLY BUILT CONSTRUCTIONS

Since January, there are more than 30 temporary hospitals have been built in total across China, designated specifically to treat patients with COVID-19 symptoms. The speed at which these medical facilities were built was achieved through the hard work of tens of thousands of people working around the clock.

These newly built constructions are mainly prefab hospitals with inflatable structure which the air pressure in the wards is lower than the outside to ensure that fresh air outside could enter the room meanwhile the inside air does not flow back but goes out through the refresh air system.

According to the government's standard, a temporary hospital will be divided into separate zones, each containing 50 beds, with one nurse station for every 250 beds. The doctor-patient workflow is completely independent, and the sewage from the site is treated separately.

However, what will happen to the temporary infectious disease hospital when the epidemic is over?

Figure 5. 17 years of Xiaotangshan Hospital.

According to previous experience, after the epidemic, the newly built infectious disease hospitals will be kept for a period of time according to the requirements of the temporary building and the follow-up observation procedures for the epidemic. When the epidemic situation is completely over, then it can be dismantled under the expert's argument from all parties.

The site could be reused for other constructions after sterilization and disinfection, also can be modified for other purposes.

Xiaotangshan hospital was constructed for SARS in 2003, after the SARS pandemic, this temporary hospital was kept for 7 years as a preparation for other emergency disease but due to the development of surroundings and the lack of management, it was finally demolished in 2010. This year, under the conduct of the government, Xiaotangshan has been reconstructed to treat patients and provide intensive healthcare service.

MEDICAL MOBILE MODULAR

Figure 6. CURA.

In fact, the newly built hospitals could be seen as a combination of medical mobile modular with prefab technique which under the fast and professional request. It could be easier to have standardized construction for packing and assembling during emergencies.

There are modular materials which are already in use or ideal designed and proposed to intervene COVID-19 or as provision for future emergencies.

For instance, Carlo Ratti, uses shipping

containers as intensive-care pods which are easily movable and safe.

The prototype of CURA (Connected Units for Respiratory Ailments) is the biocontainment isolation ward with plug-in Intensive-Care Pods converted by 20-foot (TEU) intermodal containers. â&#x20AC;&#x153;As safe as a regular isolation ward, thanks to biocontainment with negative pressureâ&#x20AC;?, each unit is connected to the rest by an inflatable structure, serves as storage and changing room.

There is another potential to interact with the material to propose interesting structures: Mobile PPS (Personal Protective Space) for Doctors. The Mobile PPS is a pneumatic space where doctors can treat patients in transparent protective space due to the demand of diagnosing and the fact that the virus can live on the surface for different time depending on the type of material.

This proposal gives another perspective of protection as modular medical care.

These examples are more detailed into how architecture would be reformed to cooperate with professionals to respond infectious disease, while interviewing Maria, the Senior Operational Positioning and Advocacy Advisor for MÊdecins Sans Frontières (MSF), she mentioned that it is also important for designers to choose the sites to locate the physical emergency healthcare infrastructure. As the centre of disease control in outbreak, how architects plan could perform as essential as professions to provide safety for both patients and medical staff.

Figure 7. PPS.

PILOT STUDY ON EMERGENCY RESPONSE

U

rban fabric planning could represent the efficient circulation of a city and the plannign itself geographically contributes to the formation of communities. Through my perspective of the relation among nation, city and community, whether communities are smaller grade, they also could be seen as the epitome of the city with different characteristics which are in control of specific groups.

Figure 8. Political Emergency Response of Chengdu.

Before narrowing down to chosen cities with different social contexts to understand the relationship between community and healthcare infrastructure, I took COVID-19 emergency infrastructure and the emergency policy of Chengdu and Jakarta as a comparison in order to understand how policy could interact with infectious index.

It is easy to get the conclusion that the policy of quarantine for observation and travel restrictions are the vital parts to react and control infectious disease, then through taking COVID-19 emergency infrastructure as an example in different community within city scale to indicate what lacks in public emergency health or what need to be considered depends on the future plan and what are the specific problems that people have for public health prevision?

Figure 9. Political Emergency Response of Jakarta.

There are 4 cities have be chosen to raise the pilot study, the motivations for selecting specific cities are: the cities are under totally different social and economic context, during the outbreak, the performance of emergency services have strong connection with nonemergency period and social class which there are obvious inequality in urban health.

The study aims to discuss new directions for future urban planning, to propose the potential scheme for one specific community on alterations for healthcare(identification of the healthcare in this report: not only includes the specific medical care, but also the related infrastructure of quarantine or other previsions) for instance, transforming, converting or constructing emergency structures as healthcare intervention to provide easier reachable access to healthcare.

Intervening to reduce risk of mortality with estabilished diesease.

Intervening through lifestyles and behaviours in medium term.

Intervening to modify social determinants of health in long term.

2010

2015

2020

2025

Figure 10. Health Inequalities: Different Times for Interventions

The 4 pilot researches will be achieved in different considerations based on the performance of COVID-19, the potential design proposals will be nominated as future planning thoughts.

HAVANA, CUBA Keyword: Long-term Community-based Medical Service (Family Medicine) “Despite being a poor country that

Figure 11. Photo of Family Medicine

often experiences shortages — a product of both the economy’s structural flaws and the effects of sixty years of economic embargo by its largest natural trading partner — Cuba was better positioned than most to deal with the coronavirus pandemic… Cuba also boasts 8.2 doctors per 1,000 people — well over three times the rate in the United States (2.6) or South Korea (2.4), almost five times as many as China (1.8), and nearly twice as many as Italy (4.1)”.

The reason why I choose Havana as a case study is because of its excellent performance in COVID-19 and their “Internationalism: For Cuba, medical assistance has been a hallmark of the revolution: helping Chilean earthquake victims in 1963; Nicaraguans and Hondurans devastated by Hurricane Mitch in 1998; Indonesia tsunami victims in 2004; Haitians after the d i s a s t ro u s 2 0 1 0 e a r t h q u a k e a n d subsequent cholera outbreak. Teams were also dispatched to Liberia, Guinea, and Sierra Leone to fight Ebola in 2014”.

“In virtually every critical area of public health and medicine facing poor countries Cuba has achieved undeniable success; these include most prominently – creating a high quality primary care network and an unequaled public health system, e d u c a t i n g a s k i l l e d w o r k f o rc e , sustaining a local biomedical research infrastructure, controlling infectious diseases, achieving a decline in noncommunicable diseases, and meeting the emergency health needs of less developed countries”.

Medical Institutes (12) Hospitals (265) Community Polyclinic (488) Basic Work Team

Family Doctor-and-Nurse Tem

Individual (1500) The key points of Cubaâ&#x20AC;&#x2122;s long-term community-based NHS through environmental architectural perspective: i. Set up the Rural Medical Service. ii. Integrate fragmented health care delivery models into a single public system for emergencies. iii. N ew model of community-based polyclinics, locating essential primary care specialists such as obstetrics and gynecologists, pediatricians, and internists in virtually every Cuban community. iv. F a m i l y p h y s i c i a n a n d n u r s e teams were assigned to live in the neighborhoods where they practiced, literally next door to their patients.

Originally, each team was responsible for improving and maintaining the health status of 600 to 800 people (120â&#x20AC;&#x201C;150 families) in their catchment area. More recently, teams now can be responsible for up to 1500 people, doctors and nurses have also been stationed in large factories and schools, on board ships, child-care centers, and homes for senior citizens, among other settings. v. There are currently 488 polyclinics across the country, each serving a population between 20,000 and 60,000.

Family (375)

Community (1)

Figure 12. The Cuban Health Pyramid

Cubaâ&#x20AC;&#x2122;s scheme of healthcare is exactly what I was looking for which could be seen as a proper combination of professional medical care and urban fabric planning through the perspective of environmental architecture. I do not advocate any other city adopt the Cuban system due to the distinguished cultural, political, and socioeconomic differences and clearly each nation must find its own path to health, however, we may draw from the principles and practices in Cuba to good end, and in particular we suggest the Accountable Care Community (ACC) concept as a viable model to apply such insights in our capitalist context. When researching the background of how this long-term community-based medical service (family medicine) has been formed, there is undoubtful political impact which suggested that whether sanitary system or city planning are political creations.

NEWHAM, LONDON, THE UNITED KINGDOM Keyword: Greener Infrastructure Network

Figure 13. Healthcare Service Distribution and Racial Distribution in London

According to the research, the more unequal health communities in London are located in the east direction while healthcare services in London are quite equally distributed. Among eastern bor oughs, spe c if ic a lly Ne wha m, Hackney, Barking and Dagenham, life expectancy is shorter than others(the data provided by NHS) which have connections with the gathering of ethnic minorities and immigration settlement.

This report is taking Newham as an example to analyse the performance of the emergency healthcare system.

During the outbreak, London has transformed the Excel Centre into a temporary mega-hospital which previously had the function of holding exhibitions and conferences in Newham (see above example for case study on temporarily converted architecture).

Newham is a quite controversial borough as it has the city airport with busy business and transportation routes but also be ranked in the top of shorter life expectancy (male and female)due to inequality of health.

Due to COVID-19, it is possible to reshape the cycle routes for better utility based on the social distance requirement and also reform the greens in communities to offer easy access to physical activities. A comprehensive public transport network provides many health benefits including access to services, reducing social isolation and increasing work and social opportunities. A major benefit of travelling in London is that it enables people to maintain regular physical activity via walking (particularly as part of public transport trips) and cycling.

As the goal of the 10-year strategy set by the Major in The London Health Inequality Strategy has been planned, the community need to be equipped with both mental consultants and physical activities based on a daily basis and then for urban planning perspective to achieve this aim to introduce the infrastructure into inhabitants' lives with more accessible opportunities to interact per my understanding.

The objectives for health services in London demonstrates that London is a greener city where all Londoners have access to good quality greens and other public gardening spaces, existing greens need to be motivated and unplanned greens need to be considered and implemented to meet demands of reconnecting the environment.

"The truth is, when it comes to health and wellbeing, London remains deeply divided, with too many Londoners suffering ill health because of social and economic exclusion… This varies enormously across London - between different boroughs, different postcodes and even from one street to the next…

The Mayor will help support the creation of a green infrastructure network. It will be designed and managed to help reduce inequalities in physical and mental health. Where there is not enough room to create new large parks, other options should be considered, such as pocket parks and greening public areas with tree planting, green roofs and green walls.

These can help to provide shade and shelter, make places less noisy, help people to feel more relaxed, clean the air and cool the city".

Figure 14. Map of COVID-19 Services and Greens and Routes in New

Potential actions: • Designing street environments to encourage walking and • Designing and engineering roads to reduce motor vehicl • Promoting a network of roads and paths that are safe and • Supporting walking and cycling by ensuring that, where • Promoting cycling through information, maps and cycle • Improving safety of heavily trafficked streets where mos

wham

d cycling. le speed and implement 20mph zones where appropriate. d convenient for cycling and walking. e possible, the needs of cyclists and pedestrians are considered before other road users. e hire schemes. st traffic related health risk is concentrated.

XINJIN DISTRICT, CHENGDU, CHINA Keyword: Quarantine and 15-min Health Ring

Figure 15. Map of Xinjin District

Chengdu, the capital city of Sichuan Province in the southwest part of China.

The condition of the healthcare facility is generally following the conduct of the 5-year plan framed by the government, currently, it is in the progress of the 13th 5-year plan. The structure of the healthcare in Chengdu is called â&#x20AC;&#x153;community-based planâ&#x20AC;? that each community should provide basic medical service on a daily basis with the support from the higher grade levelled hospitals or medical centres.

Chengdu is facing the problems as many other fast developing cities in China or worldwide are the inequality of healthcare service distribution, especially in urban and rural transition zones. Chengdu has 20 districts and counties with 5 main districts equipped with the best infrastructure of healthcare such as hospitals and educational institutions. Recently, Xinjin County has been removed and established to Xinjin District which is the best timing for the discussion on future healthcare plans to back up the political change.

During the emergency this year, Chengdu has designated 35 hospitals for curing and observing (Xinjin has one main hospital for receiving patients and serveral quarantine places) and the outbreak has influenced the structure of community-based plan that the new aim is to offer 15-min health ring (according to the service radius of 15 minutes walking distance, roughly 8001000 meters, the planning configuration includes at least one community service centre).

Apart from designating treatment hospitals, under the conduct of travel restriction which has greatly contributed to disease control, the quarantine has played an essential role in response to contagious disease. Economic loss, from the other perspective, is also a serious issue, Xinjin has just been established as a district, it needs development in every aspect to hold a stable political upgrade. Per its perfect location to the airport and other stations, as a tourist area, the wellequipped hotel services have become the priority choice for quarantine.

Combining quarantine the 15-min health ring, there should be discussion on the future plan of taking advantage of the political and economic advantage to provide better schemes on urban and rural transition junctions.

As this district has rich tourism resources, there is also opportunities for it to present a rehabilitation role cooperates with the concept of ecoagricultural garden district. The planning of Agricultural Expo Park provide the potential to reform the connection between urban environment with ecosystem.

Figure 16. Map of Healthcare in Xinjin

Figure 17. Map of Tourism and Potential Quarantine Site in Xinjin

KAMPUNG AKUARIUM, JAKARTA, INDONESIA Keyword: Slum, Inadequate Medical Planning

Jakarta, which is the most complex city I would say, is home to some 10 million people, many of whom live in cramped, adjoined houses or in informal settlements with shared toilets. These densely populated areas of the city are known as kawasan kumuh. “At least 445 of the 2,735 community units (RWs) in the city were categorized as slums

by Statistics Indonesia's (BPS) Jakarta office in 2017. The Agrarian and Spatial Planning Ministry said in 2019 that at least 118 of the 267 subdistricts in the city had slums”.

This epidemic period, there is a controversial issue that in order to contain the transmission of the virus and minimize the impact, the large scale social restrictions (PSBB) have reshape the living conditions, it resulted in many blue-collar workers (who is the main component of type of work in Jakarta) cannot work from home – nor can they afford to take time off, budget and data problems have hampered social aid distribution to the city’s vulnerable populations. Meanwhile, restricting mobility becomes harder in such a social setting. Human-to-human transmission potentially gets faster, the conditions inside a cramped house, the kawasan kumuh, make it more comfortable for people to be outside of the house, even if it is only to hang out.

Figure 18. Healthcare Service Distribution and Slums in DKI Jakarta

a

The discussion on medical service upon kawasan kumuh could be the geographical and spatial intervention in this special type of dwelling environment. It is more practical to understand what the surrounding environment of kawasan kumuh could offer rather than to add new structure into the narrow neighbourhood, moreover, it is considerable to reshape the unplanned land within kawasan kumuh to provide a better atmosphere for living.

Kampung Akuarium is a northern coastal kampung in Jakarta, it is in the argument for demolition or reconstruction. The residents there are mostly fishermen and during the COVID-19, they are largely infected due to the crowded environment. As the former Major has expelled the indegenous people from Kampung and much of its old structures were also razed to the ground in 2016, the present Major has ordered the city government to rebuild Kampung Akuarium and complete the redevelopment by next year, there is potential planning could be conduct to design home for 142 units of 27-square-meter under 4 floors.

Figure 19. The Healthcare Facilities and Issue around Kampung Akuarium.

Figure 21. Historical Line of Kampung Akuarium, North DKI Jakarta.

More than a nice shape A clean city, a city for everyone, a connected city Tangerang-Bekasi Highway

17% social housing

New fishing port

Central Business District

Public sea front

Figure 20. The Great Garuda Project in North DKI Jakarta.

MRT

DESIGN CONCEPT

Figure 22. Design Concept of Community-based Medical Service.

Figure 23 Design Concept of Services in Greens.

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