In Ontario, the outbreak of SARS in 2003 led us to change our approach in order to improve the way we dealt with infectious diseases. This placed us in the fortunate position of having new facilities capable of handling COVID patients, particularly in the acute-care setting. Like SARS, the immediate focus with COVID was to separate ambulatory and non-infectious patients from infectious patients. New facilities allowed for this, while older ones didn’t — effectively closing their doors to all but the very sick as many outpatient visits were cancelled. However, even in newer facilities, inpatient services were eventually impacted as elective treatments were deferred in order to create inpatient bed capacity for the forthcoming waves.

With the first wave of COVID, the response of governments and health authorities was to focus on building capacity.

This was reasonable based on what we saw happening in Italy and New York in the spring, where healthcare systems were overwhelmed. At the beginning of the first wave we searched and found new solutions for temporary spaces to cope with the anticipated influx. This included field hospitals and non-traditional intensive care spaces. We didn’t use them all in the first wave of the pandemic. Now that we are in the second wave, with cases approaching numbers not seen in the first, we are starting to activate these spaces, as well as considering transferring patients to less populated facilities. 

COVID has made us think beyond designing for patient care, to how the hospital workplace can support ongoing operations.

This has to address staff needs, since they are both at risk as well as being, themselves, a potential risk. People infected with SARS were not infectious until symptoms occurred, while those with COVID can be infectious while being asymptomatic, making them harder to identify. In our original SARS pandemic planning, we did not focus on administrative areas, workplaces and staff screening. Now we’re asking what social distancing looks like for team and meeting rooms, open offices and elevators. As a result of the current design, many people need to work from home, and everyone is screened before they enter the hospital. Hospitals are not alone in asking what the future workplace will look like. 

Hospital design will also be impacted by new norms, not just in healthcare but on a larger scale in the community.

At the beginning of the pandemic, we quickly established a new normal and now we’re accustomed to washing hands, wearing masks and physical distancing, habits that are integral to the safe operation of all public places. We’ve had to get used to communicating via video, and we will continue in future because we realize it is convenient and helps us to be more productive. Virtual healthcare is another new norm that wasn’t fully valued until the pandemic. COVID has been a major life-changing experience, but I would argue that there are positives to be drawn. If we pick the best parts of what we are learning, we can make our systems more successful. 

As we plan and design the hospitals of the future, we need to carry forward the lessons from COVID, as we did from SARS.

But can we go beyond that and be ready for the next pandemic-like event? There may be a reluctance to spend money on something that might not happen for another 100 years. To put this in perspective, since the Spanish Flu in 1918 there have been seven major potential threats that could have become COVID-type events — so COVID is not just a 100-year event. We need to be proactive. We should invest in regularly playing out pandemic scenarios to enable us to work through emerging technologies and procedures, build on experience, use them as design exercises and incorporate them into our practices. Knowing what we do now about the long-term socio-economic impact of a pandemic, I can’t think of a more valuable investment.