HOW TO TACKLE INFECTION FROM ARCHITECTURAL PERSPECTIVE by Ying Fan

Plauge

Quarantine

Medical

Architecture

CONTENT 4-15

SITUATION & SEVERITY WORLD STATUS | TREND |

16-25

DEFENSIVE MEASURES TECNIQUE | TIMELINE OF ISO-HOSPITAL

26-39

PRECEDENTS CASE-STUDIES | NARRATE STORIES

RESEARCH PROGRAM FOR 7100 YÂ·F

40-47

STRATEGIES GUIDLINES US | WORLD RANGE

Prefabricated infectious hospital design UNDER CORONA VIRUS SCALE Raging speed of virus

Prefabricated building

Mathematical model of virus growth

From the perspective of the patient's life experience

Person-to-person close contact within about 6 feet

Populous province

contact with infected objects

LOCATION & QUANTITY

location

REQUIREMENT

Transportation hub city

0.2M

How the virus spread Isolation

TASK looking for the fastest and best way to build infectious hospitals to prepare for the outbreak of Corona Virus

Aerogel propagation Ways to prevent virus transmission

quantity

ventilation

Population mobility

Back ground: Demand for prefabricated infectious disease hospitals

From the perspective of the work experience of medical staff

60KM

disinfection Requirements for infectious disease hospitals

SITUATION SITUATION & & SEVERITY SEVERITY

By comparing relevant numbers between hard hit cities like total infected people, hospitalized people, death, and recovered, the author sifted out cities who better contains the spread. These enable further and deeper analysis of infection prevention tactics employed by the cities, and provide cases for research and study.

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Chart Source: The New York Times

Conformmed Cases in US . by State and Tamperary

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BloomBerg.com

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SITUATION & SEVERITY WORLD STATUS | TREND |

JOHNSHOPKINS CSSE In a broad view of the whole world, the number of reported cases by March 22 was still rising. We donâ&#x20AC;&#x2122;t have enough awareness of defensive against the new infectious disease. Some government s may conceal data in prevention of destabilizing society or may deliberately play down the efficiency of disease spreading ă&#x20AC;&#x201A;Considering that some infection media can pass disease without causing any symptoms , we may miss the opportunity of isolating the first vectors which is a simple and easy method, instead, people often have to take remedial measures after a major breakout. These measures often results in large scale home isolation.

Chart Source: The New York Times: up to March 22

Imperial College London

The nation`s intensive care beds

For cities with lurking vectors medical conditions play an important role in breaking infection chains.By collecting information from hospitals, the author sifted high vulnerability cities in face of pandemics, and also sifted out cities with poorer isolation environment(it would be inappropriate to represent this purely by the number of isolation ward rooms). These cities need to prepare more to cope with outbreaks, this is especially true when infectious disease spread rapidly and undetected .

Areas requiring special care

After ďź&#x161;Imperial College London

SITUATION & SEVERITY WORLD STATUS | TREND |

WHY DO WE NEED QUARANTINE SHELTER "Home isolation is an important alternative to hospital isolation, which requires behaviour change but no additional infrastructure investment. Chinese policy makers decided against home isolation of patients with mild to moderate COVID-19 for a number of important reasons. First, home isolation puts patients' family members at risk. Early epidemiological evidence in China showed that more than half of all patients with COVID-19 had at least one family member with the disease, and 75â&#x20AC;&#x201C;80% of all clustered infections were within families, suggesting high rates of intrafamily transmission. Second, patients can find home isolation psychologically taxing, because they know that they are putting those they care about most at risk of contracting the disease. Third, home isolation is unlikely to be fully effective because it cannot be strictly enforced. Patients might break with the mandated behaviour to stay at home and go outside for errands, entertainment, or exercise. Lastly, it is difficult to organise medical care, frequent monitoring of disease progression, and timely referral to hospital care for thousands of patients in home isolation. COVID-19 can deteriorate from mild or moderate to severe illness, requiring rapid referral to hospital care. In home isolation in Wuhan, before the introduction of the Fangcang shelter hospitals, the time from onset of severe symptoms to admission to a tertiary hospital for intensive care was up to 10 days. The Fangcang shelter hospitals substantially reduced these delays. Hospital isolation of the growing numbers of COVID-19 patients in Wuhan was not feasible, and home isolation was not desirable. China thus needed a novel approach to control the COVID-19 outbreak in Wuhan. In response, Chinese officials and experts developed the Fangcang shelter hospital: large healthcare facilities that were built overnight and provided isolation, triage, medical care, monitoring and referral, shelter, and social engagement. The hospitals were built in existing public venues by installing beds, sheltered space, and the three zones and two passages (san qu liang tong dao) of hospital isolation wards. , <Health Policy > THE LANCET Published online April 2, 2020

Case studies are often effective when facing pandemics. From the previous chart, we can see Wuhan as the first city with COVID -19 outbreaks did a good job in containing spread and pressing down patient numbers. So the author chose Wuhan to have a deep case study of infection prevention measures. By analyzing ward rooms of Wuhan, the author drew out critics for isolating patients. These critics can serve as design guidance to we architects in the perspective of infections prevention .

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30744-3/fulltext

KNOWLEDGE KNOWLEDGE ABOUT ABOUT THE THE PLAUGE PLAUGE

DEFENSIVE MEASURES TECNIQUE | TIMELINE OF ISO-HOSPITAL

How Coronavirus Spreads

How to Protect Yourself ·There is currently no vaccine to prevent coronavirus disease 2019 (COVID-19).

The virus is thought to spread mainly from person-to-person.

Person-to-person spread

·Between people who are in close contact with one another (within about 6 feet). ·Through respiratory droplets produced when an infected person coughs or sneezes. These droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs.

·The best way to prevent illness is to avoid being exposed to this virus.

Know How it Spreads

·These droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs.

·People are thought to be most contagious when they are most symptomatic (the sickest).

Can someone spread the virus without being sick?

·The virus is thought to spread mainly from person-to-person. Between people who are in close contact with one another (within about 6 feet). Through respiratory droplets produced when an infected person coughs or sneezes.

·Some spread might be possible before people show symptoms; there have been reports of this occurring with this new coronavirus, but this is not thought to be the main way the virus spreads.

Clean your hands often ·Wash your hands often with soap and water for at least 20 seconds especially after you have been in a public place, or after blowing your nose, coughing, or sneezing.

S p re a d f ro m c o n t a c t w i t h co n t a m i n a t e d s u r fa ce s o r objects

How easily the virus spreads

It may be possible that a person can get COVID-19 by touching a surface or object that has the virus on it and then touching their own mouth, nose, or possibly their eyes, but this is not thought to be the main way the virus spreads.

Ta k e s t e p s t o ·If soap and water are not readily available, use a hand sanitizer that protect yourself contains at least 60% alcohol. Cover all surfaces of your hands and rub them together until they feel dry. ·Avoid touching your eyes, nose, and mouth with unwashed hands.

How easily a virus spreads from personto-person can vary. Some viruses are highly contagious (spread easily), like measles, while other viruses do not spread as easily. Another factor is whether the spread is sustained, spreading continually without stopping. The virus that causes COVID-19 seems to be spreading easily and sustainably in the community (“community spread”) in some affected geographic areas.

·Stay home if you are sick, except to get medical care. Learn what to do if you are sick.

·If you are sick: You should wear a facemask when you are around other people (e.g., sharing a room or vehicle) and before you enter a healthcare provider’s office. If you are not able to wear a facemask (for example, because it causes trouble breathing), then you should do your best to cover your coughs and sneezes, and people who are caring for you should wear a facemask if they enter your room. Learn what to do if you are sick. ·If you are NOT sick: You do not need to wear a facemask unless you are caring for someone who is sick (and they are not able to wear a facemask). Facemasks may be in short supply and they should be saved for caregivers.

Stay home if you’re sick

Wear a facemask if you are sick

·Cover your mouth and nose with a tissue when you cough or sneeze or use the inside of your elbow. ·Throw used tissues in the trash. ·Immediately wash your hands with soap and water for at least 20 seconds. If soap and water are not readily available, clean your hands with a hand sanitizer that contains at least 60% alcohol.

Cover coughs and sneezes

Avoid close contact

Ta k e s t e p s t o protect yourself

·Clean AND disinfect frequently touched surfaces daily. This includes tables, ·Avoid close contact with people who are doorknobs, light switches, countertops, sick handles, desks, phones, keyboards, ·Put distance between yourself and other toilets, faucets, and sinks. people if COVID-19 is spreading in your community. This is especially important ·If surfaces are dirty, clean them: Use for people who are at higher risk of detergent or soap and water prior to getting very sick. disinfection.

Clean disinfect

and

DEFENSIVE MEASURES

Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings 1. Minimize Chance for Exposures

2. Adhere to Standard and TransmissionBased Precautions

3. Patient Placement

4. Take Precautions When Performing Aerosol-Generating Procedures (AGPs)

TECNIQUE | HOSPITAL CHECK LIST

Comprehensive Hospital Preparedness Checklist

for Coronavirus Disease 2019 (COVID-19)

Planning for a community outbreak of Coronavirus Disease 2019 (COVID-19) is critical for maintaining healthcare services during a response. The Centers for Disease Control and Prevention (CDC), with input from partners, has developed a checklist to help hospitals (acute care facilities) assess and improve their preparedness for responding to a community-wide outbreak of COVID-19. Because of variability of outbreaks, as well as differences among hospitals (e.g., characteristics of the patient population, size of the hospital/community, scope of services), each hospital will need to adapt this checklist to meet its unique needs and circumstances. This checklist should be used as one of several tools for evaluating current plans or in developing a comprehensive COVID-19 preparedness plan. Additional information can be found at www.cdc.gov/coronavirus. An effective COVID-19 hospital preparedness plan will incorporate information from state, regional, tribal and local health departments, emergency management agencies/authorities, hospital associations, and suppliers of resources. In addition, hospitals should refer to state and federal pandemic influenza plans to inform their response (available at https://www.cdc. gov/flu/pandemic-resources/pdf/pan-flu-report-2017v2.pdf). Hospitals will also need to ensure their plans comply with applicable state and federal regulations and with standards set by accreditation organizations, such as the Joint Commission on Accreditation of Healthcare Organizations (JCAHO). Comprehensive COVID-19 planning can also help facilities plan for other emergency situations.

6. Manage Visitor Access and Movement Within the Facility

All U.S. hospitals should be prepared for the possible arrival of patients with COVID-19. All hospitals should ensure their staff are trained, equipped and capable of practices needed to: (1) Prevent the spread of COVID-19 within the facility; (2) Promptly identify and isolate patients with possible COVID-19 and inform the correct facility staff and public health authorities; (3) Care for a limited number of patients with confirmed or suspected COVID-19 as part of routine operations; (4) Potentially care for a larger number of patients in the context of an escalating outbreak while maintaining adequate care for other patients; (5) Monitor and manage any healthcare personnel that might be exposed to COVID-19; and (6) Communicate effectively within the facility and plan for appropriate external communication related to COVID-19.

7. Implement Engineering Controls

Interim Infection Prevention and Control Recommendations for Patients with Confirmed Coronavirus Disease 2019 (COVID-19) or Persons Under Investigation for COVID-19 in Healthcare Settings: https://www.cdc.gov/coronavirus/2019-ncov/infection-control/control-recommendations.html

5. Collection of Diagnostic Respiratory Specimens

Strategies to Prevent the Spread of COVID-19 in Long-Term Care Facilities (LTCF) and a nursing home checklist can be found here: https://www.cdc.gov/coronavirus/2019-ncov/healthcare-facilities/prevent-spread-in-long-term-care-facilities.html

8. Monitor and Manage Ill and Exposed Healthcare Personnel

9. Train and Educate Healthcare Personnel

10. Implement Environmental Infection Control 11. Establish Reporting within and between Healthcare Facilities and to Public Health Authorities CS316105 March 24, 2020 4:30 PM

12. Appendix

DEFENSIVE MEASURES DECELOPMENT | TIMELINE OF ISO-HOSPITAL

PRECEDENTS CASE-STUDIES | NARRATE STORIES

1) More attention needs to be paid to power supply guarantee, drainage, exhaust safety and impact on surrounding residents; 2) A fishbone-like layout with a symmetrical axis can be used. In the later stages, it can be continuously extended as needed (buildings that will grow);

3) It can be arranged by multiple H-shaped modules. Among them, the office area and the passage of medical staff are arranged along the central axis. Each center module is responsible for 4 nursing units. Two rows of wards are arranged in the nursing unit. Patients enter and exit the ward from the periphery of the ward, and medical staff enters the ward through layers of dressing and sanitation through the 020/3/24core of the central axis for examination, treatment and care.Huoshenshan Hospital construction in Wuhan - Anadolu Agency Such a functional structure can strictly control the clean steps of the air, effectively protect the health safety of medical staff, and effectively carry out     medical treatment work; EDITI N 4) There should be a height difference on the floor of the ward to prevent standing water. The patient aisle should not be open-air, and it is best to add a shelter. Humid climate conditions may be conducive to the survival and spread of the virus, and also impose higher requirements on the waterproof work of the hospital;



5) If you use electric air conditioners for heating, the indoor temperature rise may breed bacteria, but also increase ventilation.

Photo

Huoshenshan Hospital construction in Wuhan

PRECEDENTS CASE-STUDIES | NARRATE STORIES | FANGCANG SHELTER

FANGCANG SHELTER

CONCEPT The term Fangcang, which sounds similar to Noah's Ark in Chinese, was borrowed from military field hospitals,2, 3 but it refers to a novel concept: large, temporary hospitals built by converting public venues, such as stadiums and exhibition centres, into health-care facilities to isolate patients with mild to moderate symptoms of an infectious disease from their familes and communities, while providing medical care, disease monitoring, food, shelter, and social activities.

Development of Fangcang shelter hospitals in Wuhan At the beginning of February, 2020, Wuhan had no beds available for COVID-19 patients in the hospitals designated for treating the virus.8 Thousands of patients with mild to moderate COVID-19 had to be sent home for isolation and observation. With a shortage of hospital beds, Wuhan needed an approach to rapidly and massively scale its capacity to isolate and care for patients with mild to moderate COVID-19. As the outbreak in Wuhan reached its most severe point, with thousands of new infections per day, the city opened three Fangcang shelter hospitals on Feb 5, 2020, by converting exhibition centres and stadiums. Over the following weeks, Wuhan opened an additional 13 Fangcang shelter hospitals.9 Figure 1 shows the progression of bed capacity and occupancy of the Fangcang shelter hospitals over time. As the epidemic in Wuhan subsided and bed occupancy moved towards zero, the Fangcang shelter hospitals were successively suspended. The first hospital closed on March 1, 2020; by March 10, all Fangcang shelter hospitals had been suspended.10, 1

Figure 1Fangcang shelter hospital patient flows during the coronavirus disease 2019 outbreak in Wuhan, China

Figure 2 shows one of the Fangcang shelter hospitals in Wuhan with three zones—a contaminated zone where patients live, a semi-clean zone where health workers put on and take off their protective suits, and a clean zone where supplies are received— and two passages, one for patients and the other for health workers. Although Fangcang shelter hospitals have some historic precedents, such as makeshift hospitals, emergency field hospitals, emergency shelters, and hospital isolation wards, they have three distinct characteristics and five functions that set them apart from facilities that have previously been used for the control of public health emergencies.“

Three key characteristics and five functions of Fangcang shelter hospitals

Figure 2 Zones and passages in a Fangcang shelter hospital in Wuhan, China

https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30744-3/fulltext

Critical considerations for the running of Fangcang shelter hospitals As part of an epidemic control strategy, Fangcang shelter hospitals require several supportive strategies and solutions, including a human resources strategy, a communication and public engagement strategy, a governance structure, and measures to prevent nosocomial infections and provide patients with a degree of privacy. Human resources As mentioned previously, Fangcang shelter hospitals can increase the efficiency of the COVID-19 response, because they release patients who do not require intensive or complex care from the more highly staffed traditional hospitals to the less highly staffed shelter hospitals. These efficiency gains are likely to lessen health worker shortfalls in a given epidemic situation, but additional health workers will probably be required to staff the Fangcang shelter hospital beds that are needed for an effective response to a rapidly growing epidemic. China mobilised health workers from across the country for the COVID-19 response in Wuhan, to the extent that the majority of health workers in the Fangcang shelter hospitals came from outside of Hubei province.6 All of these health workers were either qualified as medical doctors or nurses.6 Before being deployed in Fangcang shelter hospitals, these medical professionals received specific education on the natural course of COVID-19 and the current evidence and best practices regarding COVID-19 diagnosis, treatment, prevention of co-infection, and protection from COVID-19 transmission. Health workers and clerical staff were also specifically trained in the electronic patient record system, medication supply management, and discharge and referral management of the Fangcang shelter hospitals.6

Prevention of nosocomial infection To reduce the risk of nosocomial infections in Fangcang shelter hospitalsâ&#x20AC;&#x201D;both among patients and between patients and health workersâ&#x20AC;&#x201D;all patients were required to test positive for COVID-19 and negative for influenza before admission (table). In the hospitals, patients received one to two protective masks per day, which they were required to wear to lower the risk of transmission and acquisition of infectious respiratory diseases. Further measures to reduce nosocomial infections included intensive training for health workers and standard operating procedures and protocols guiding the use of protective equipment and passage across the contaminated, semi-clean, and clean zones.6 These measures ensured that the risk of nosocomial infections in Fangcang shelter hospitals was not higher than in traditional hospitals. Privacy To ensure some degree of privacy similar to that provided in traditional hospitals, Fangcang shelter hospitals contained partitions that separated bed units into spaces resembling hospital rooms and wards (figure 5). In addition, men and women lived in different areas. For example, in one of the Fangcang shelter hospitals, women lived on the first floor and men lived on the second floor.

Communication and public engagement China realised early on in the COVID-19 response that a strong communication and public engagement strategy would be key to ensuring that the population knew about Fangcang shelter hospitals and supported their use. Chinese government officials made several public announcements and held press conferences to inform the public about Fangcang shelter hospitals.5, 50 In addition, government officials and health workers gave interviews explaining the purpose and functions of the hospitals.9, 51, 52, 53 Shortly after the Fangcang shelter hospitals began operating, patients and health workers started publishing accounts of their experiences in the hospitals in both traditional and social media,48, 49, 54, 55 complementing news items and feature articles on the hospitals.5, 9, 42, 56, 57, 58 Governance To coordinate the COVID-19 response, the Chinese Central Government convened a Central Leadership Group for Epidemic Response, led by the premier, and a subordinated Central Leadership Group for Hubei Province, led by the vice premier, who relocated to Wuhan to guide the control initiatives during the epidemic.16, 59, 60 China also established the Joint Prevention and Control Mechanism of the State Council to coordinate epidemic control initiatives across government sectors. The National Health Commission led the Joint Prevention and Control Mechanism and convened multiple working groups for the national COVID-19 response, including for scientific research, clinical treatment, and medical supplies.16, 35, 61 The Central Leadership Group for Hubei Province decided to build Fangcang shelter hospitals and the National Health Commission guided their design and implementation. Finally, the Wuhan Municipal Headquarters for COVID-19 Prevention and Control built the Fangcang shelter hospitals and managed their day-to-day operations, including clinical care, sourcing and supply of health-care products and food, utilities, and security.

www.thelancet.com

Fangcang shelter hospitals as part of the COVID-19 response in other countries As the COVID-19 pandemic spreads globally, countries other than China are experiencing shortages of beds in traditional hospitals caring for the rapidly growing numbers of patients with the disease.68, 69 For example, in Italy, local authorities in some regions have asked hospital managers to free up intensive care unit beds for patients with COVID-19 and to reduce their elective surgeries by 70%.70 By March 10, 2020, more than 80% of the hospital beds in the Italian region of Lombardy were occupied by patients with COVID-19.69, 71 China has started to support other countries, such as Italy, Iran, and Serbia, in formulating policies to control the COVID-19 pandemic and conceiving and constructing Fangcang shelter hospitals for their national contexts. As part of this international cooperation, China has translated all policies, management manuals, and clinical guidelines related to Fangcang shelter hospitals into the languages of other countries facing rapidly growing COVID-19 outbreaks. China has also sent experts with direct experience in constructing and running Fangcang shelter hospitals to other countries to provide consultancy services to national and local governments.72, 73 Similar to China, Serbia is building Fangcang shelter hospitals by converting public venues into healthcare facilities to isolate and treat patients with mild to moderate COVID-19.74, 75 Iran, the USA, the UK, and Spain are implementing measures that are similar to Fangcang shelter hospitals.76, 77, 78, 79, 80 It is likely that many other countries, including in sub-Saharan Africa and Asia, will also need to adopt such measures to ensure sufficient capacity to both effectively isolate and care for the large numbers of people who will experience mild to moderate COVID-19.

www.thelancet.com

PRECEDENTS CASE-STUDIES | NARRATE STORIES | FANGCANG SHELTER

In New Zealand: Campervans set up in Auckland, Christchurch for Kiwi travellers to self-isolate Hundreds of campervans have been set up by the Government in Auckland and Christchurch for those returning from overseas with nowhere to self-isolate. At Auckland's ASB Showgrounds in Greenlane more than 100 campervans are set up in the carpark, which a Ministry of Health spokeswoman said was part of a "precautionary approach" to ensure travellers returning to New Zealand during Alert Level 4 were able to isolate.

At the self-contained campervan sites, such as the ASB showgrounds and the Canterbury Agricultural Park, caterers will supply food, and people will be able to use online shopping. In Auckland the campervans have not yet been used and remain as a precautionary option, the spokeswoman said. "The safety of all staff at the campervan sites and hotels being used is one of the priorities - all staff will be issued with PPE and will have received training," she said.

Tent hospital temporarily built in Central Park, New York

Spain Madrid Convention and Exhibition Center transformed into a square cabin hospital https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(20)30744-3/fulltext

STRATEGIES GUIDLINES US | WORLD RANGE

Business

Carnival Offers Cruise Ships to Relieve Strain on Hospitals By Justin Sink and Jonathan Levin 2020年3月19日 GMT-4 下午12:57 Updated on 2020年3月19日 GMT-4 下午6:03 Company would seek reimbursement for essential costs Carnival draws on $3 billion credit line to bolster ﬁnances Terms of Service Do Not Sell My Info (California)Trademarks Privacy Policy ©2020 Bloomberg L.P. All Rights Reserved Contact Us Help Careers Made in NYC Advertise Ad Choices

Carnival Corp. is making its cruise ships available as floating hospitals to help relieve stress on the health-care system, an offer that President Donald Trump said he would discuss with governors. In remarks Thursday, Trump said he had received the offer from Carnival Chairman Micky Arison. The company said later in a statement

that ships could be quickly turned

into hospitals with as many as 1,000 beds. The idea would be to treat non-Covid-19 patients, freeing up hospitals to address the pandemic.

020-03-19/carnival-offers-cruise-ships-for-virus-response-trump-says

1/3

By Justin Sink and Jonathan Levin bloomberg.com

Bubble diagram commonly used in architectural discipline that cannot be easily comprehended by medical professionals https://www.researchgate.net/publication/238512201_Design_of_Rapidly_Assembled_Isolation_Patient_Ward_-_IT-Supported_Collaborative_Design_Process_between_Architects_and_Medical_Officers

Schematic diagram of air circulation simulation in the ward sources : China State Construction

sources : China State Construction

tent clinics should pay particular attention to the following opportunities to promote health.

Guidelines for Limiting Contagion in COVID-19 Tent Clinics

Limit droplet spread between people.

Created by Jasfart from the Noun Project

Toilets, Showers, and Hand Washing Stations

Toilets and showers will likely be rented mobile units vulnerable to Created by Ralf Schmitzer from the Noun Project

Because experts best understand that COVID-19 is transmitted between people via direct contact with respiratory droplets, clinic designs should allow individuals to separate by a minimum of 6’. Basic planning ideas presented here can help minimize direct respiratory

the three modes of contagion outlined previously. These rental units are spatially tight, and direct droplet contagion should primarily be

addressed by patient management. Surface contamination must be addressed by cleaning between patients. Toilet and shower units

should have passive or active ventilation systems. Ideally, different

patient populations should not share the same units, and healthcare providers must have separate facilities. Be sure to install separate hand

droplet spread. 6

You can find a more detailed plan on p. 4 >

washing stations for patients and providers within the tents, whether mobile units or ones constructed on site.

1 Create separate entrances for health care providers and patients. This helps prevent close contact between patients and providers not wearing Personal Protective Equipment (PPE), both inside and outside the tent.

2 Providers should enter directly into a donning vestibule or room, where they can put on their PPE before interacting with patients. (Re-donning supplies within the tent allow PPE to be refreshed.)

3 Use a work surface of simple materials such as medium density overlay (MDO), plastic laminate, or draped plywood to provide a cleanable and disinfectable buffer between a provider and an ambulatory patient at key locations. Page 6 shows one example of a simple site-built workstation.

4 Since tents come in fixed dimensions, it can be difficult to achieve plan arrangements that facilitate social distancing, but it is crucial. When possible, strive for larger aisle dimensions than the 6’ between partitions and 5’ between beds shown here.

5 Centralizing clinical staff spaces (e.g., workstations, storage, and donning and doffing areas) will make clinical work more efficient and limit uncontrolled interaction between providers and patients.

6 Separation of beds by a partition or tensioned vinyl screen of 8’ high can help limit cross-contamination between patients and guide the flow of contaminated air. 7 A stand-alone 10’ x 10’ conditioned tent (not shown) can serve as a staff break area.

The CDC understands that contaminated

Materials and surfaces should be deployed and installed to minimize touching, to make

high-touch surfaces may be a transmission route for COVID-19. In a tent clinic, doors (often supplied with the tents), doorknobs, bed linens, partitions between beds, outlets,

touch points obvious, and with the understanding that they must be frequently cleaned and disinfected.

storage containers, counter tops, toilets, and sinks are examples of high touch surfaces.

Control for airborne infection.

• The CDC advises that cleaning of visibly dirty surfaces followed by disinfection is best practice for prevention of COVID-19. • Cleaning removes dirt and most germs, while disinfection kills germs. The CDC recommends using a bleach solution, a 70% alcohol-based spray or wipe, or other proper disinfectant. • A storage area for cleaning supplies and other non-PPE items should be provided.

Created by lastspark from the Noun Project

Created by Fahmi Ramdani from the Noun Project

The COVID-19 virus may become aerosolized by certain procedures such as intubation, positive-pressure airway ventilation, or a high-flow nasal cannula. Tent clinics that might eventually be treating patients needing aerosolizing procedures should plan for airborne infection control. Airborne infection control systems require specialized equipment best specified by a mechanical/HVAC engineer. A few hours of time from an engineer in your community who understands your climate and locally available equipment and contractors can help incorporate the principles presented on the right into your tent clinic.

Source Control: Trap droplets before they spread Beyond use of PPE for providers for droplet protection, the CDC recommends standard face masks, such as surgical masks, for confirmed and suspected patients. Aerosolizing procedures such as intubation should be source controlled with a portable HEPA filter/fan unit.

MASSDESIGNGROUP.ORG/COVIDRESPONSE

from the Noun Project pole, or fire hydrant. If necessary, for power, rent a mobile diesel generator that meets the amperage and phasing requirements for HVAC and other equipment. If water is transported to

site and stored, anticipate a pump or gravity feed system.

must have the conditioning, ventilation, and control capacity to maintain consistent air flow and temperature, which is beyond the capability of many construction-grade fans and heaters.

Dignity and Efficacy

Tent clinics might offer the following to promote patient dignity, comfort and security:

Beyond stopping pathogens, tent clinics patients who are contagious might leave clinics and further

A legible, obvious ventilation strategy (see p. 7 for an example) that clearly

Created by Pham Thi Dieu Linh must people. Voluntary from thesupport Noun Project

Created by Gerardo Martín Martínez from the Noun Project

demonstrates environmental safety

spread COVID-19 if the clinics seem unsafe to them, are uncomfortable, or are undignified. This is especially true for asymptomatic and untested close-contact observation populations who might perceive themselves as being at greater risk and discomfort within a clinic than outside of it.

Partitions between beds for privacy and contagion control

Individual lockable storage for valuables, electronics, and medications

Created by ibrandify from the Noun Project

Covered large storage, such as a plastic tub, for clothing and Created by celine labaume from the Noun Project

WIFI, power, and USB charging ports at patient beds Created by i cons from the Noun Project

Created by Creative Art from the Noun Project

personal items Screens and access to streaming services like Netflix or Hulu for patients who lack these

Dilution: Decrease the number of contaminants in the air

Created by ing.mixa from the Noun Project

Contaminated air is diluted when it is combined with clean air. HEPA-filters or ultra-violet germicidal irradiation (UVGI) equipment can efficiently clean and then recirculate conditioned (heated/cooled/dehumidified) air. However, HEPA-filtration and UVGI strategies require specialized equipment and expertise. Alternatively, contaminated air can be diluted by adding fresh outside air (please note: while this is a technically simpler approach, it can be less efficient because it can require additional cost and energy to keep the air properly conditioned). While tent clinics should strive to meet CDC guidelines of 12 air changes per hour (ACH), 6 ACH or even 4 ACH will provide benefits over fewer air changes. Limits on equipment, ductwork, and power may in turn limit the number of achievable ACH. Airflow Direction: Remove contaminated air before it spreads Pressurizing the tent by installing vestibules, carefully sealing all the gaps between tent panels, supplying clean air through registers in ducts above the center aisle of the tent, and then exhausting air to the outdoors through a vent next to each patient’s head at the tent perimeter may lessen the risk of contagion to providers and patients. See one possible perimeter vent detail on p. 5. With this airflow strategy, clean air only becomes contaminated immediately before it leaves the tent next to an individual sick patient’s head. Conversely, airflow that stirs contaminated air within the tent, or pushes or pulls it past healthy people, may heighten the risk of contagion.

For water and power, tent clinics can most easily tie into an available adjacent building, utility Created by Atif Arshad

Almost certainly a mobile HVAC unit will be required for three critical reasons: to provide comfort, to dilute air to as many as 12 ACH, and to create directional air flow. The HVAC unit

Mitigate contagion via surfaces. Created by Adrien Coquet from the Noun Project

Water, Power, and Ventilation

Contributors

•

These guidelines are offered within rapidly evolving clinical and research contexts. MASS is grateful to the experts who have advised on them. They do not represent the opinions or full understanding of any one person.

Edward Nardell, MD, Professor of Medicine. Departments of Environmental Health and Immunology and Infectious Diseases, Harvard School of Public Health. Harvard Medical School. Brigham and Women’s Hospital.

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Jessie M. Gaeta, MD; Assistant Professor of Medicine, Boston University School of Medicine; CMO Boston Health Care for the Homeless Program

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Joshua Barocas, MD; Assistant Professor of Medicine, Boston University School of Medicine; Infectious Diseases physician, Boston Medical Center

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Nahid Bhadelia, MD, MA: Medical Director of Special Pathogens Unit, Boston University School of Medicine; Infectious Diseases physician, Boston Medical Center

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Jim Crabb, PE, Principal, Mazzetti

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James Petersen,PE, Petersen Engineering

Arrange prefabricated container wards across the country, and through the existing railway connection, can respond quickly when the epidemic breaks out and isolate and handle the epidemic

MASSDESIGNGROUP.ORG/COVIDRESPONSE

Through the railway transportation system, when this epidemic broke out in a likely (or random) city, the quarantine hospital was quickly established, and the medical resources of one city in another city could be quickly concentrated to the severely epidemic area.

https://massdesigngroup.org/sites/default/files/multiple-file/2020-04/Guidelines%20for%20Limiting%20Contagion%20in%20COVID-19%20Tent%20Clinics_MASS%20Design%20Group_200401.pdf

Guidelines for Limiting Contagion in COVID-19 Tent Clinics

Additional Resources

Guidelines for Limiting Contagion in COVID-19 Tent Clinics

Perimeter Vent Detail (example)

Ventilation Strategy — Butaro Hospital, 2011, Ward Section

Additional Resources

WOOD KNEE WALL ACHIEVES VENT NEAR HEAD LEVEL AND ABOVE ITEMS ON FLOOR. OTHER DETAILS ARE POSSIBLE.

INSECT SCREEN

2’ 1 VENT ADJACENT TO PATIENT HEAD 6” X 12” (VERIFY WITH MECHANICAL ENGINEER)

1 EXTERIOR CIRCULATION

PAINTED MEDIUM DENSITY OVERLAY OR PLYWOOD

2 CROSS VENTILATION 3 INOPERABLE VENTS 4 INDUSTRIAL FANS

FLOORING SYSTEM POSSIBLY SUPPLIED WITH TENT

5 ULTRA-VIOLET GERMICIDAL LIGHTS

Guidelines for Limiting Contagion in COVID-19 Tent Clinics

Additional Resources 5

Healthcare Provider Workstation (example) MASSDESIGNGROUP.ORG/COVIDRESPONSE

MASSDESIGNGROUP.ORG/COVIDRESPONSE

HOLE FOR POWER

CLEANABLE & DISINFECTABLE SURFACE

4 3/4”

POWER & USB

3’ 6”

PLYWOOD OR MDO

2’

1’

6’ 6”

4’ 6” 3’

4’

MASSDESIGNGROUP.ORG/COVIDRESPONSE

https://massdesigngroup.org/sites/default/files/multiple-file/2020-04/Guidelines%20for%20Limiting%20Contagion%20in%20COVID-19%20Tent%20Clinics_MASS%20Design%20Group_200401.pdf