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The power of architecture: Covid and the built environment

By Andrew Brose

A new model of architecture is needed to move us beyond neutrality, sustainability, and human-centrism and into an era of carbon positivity, social equity, and planetary health. Our current global crisis presents us with an unprecedented imperative to begin this transition.

Covid-19 has revealed how deeply our health is intertwined with each other and with the health of the ecosystems our extractive practices have continued to encroach upon.

This global pandemic has reinforced what many in the design industry have been advocating for years: the way we live in our cities needs to change to avoid a tipping point in the health of our planet. Now is the time for us to respond to the needs of our communities and push for critical decisions within the planning and design of the built environment which demands a healthier outcome for humans and our planet.

As we begin the injection of capital for job creation, production, and manufacturing in an attempt to revive the post-virus market multi-disciplinary voices are asking to heed the call for a ‘green economy’ and an equitable economy1. Epidemics and disease “roar through vulnerable communities all the time, this time it just happens to be roaring through the entire world” attracting the focus of all our attention, and unless we make critical changes now, we will see these types of events multiplied2.

Cholera Treatment Centre by MASS.

MASS Design Group was founded over a decade ago in response to an epidemic disease — extremely drug-resistant tuberculosis — whose airborne transmission was exacerbated by spatial conditions of hospital wards and waiting areas. Over the past decade, MASS has partnered with organisations working on the frontlines of the world’s major health challenges, from responding to acute epidemics of Ebola in Liberia and cholera in Haiti, to addressing the chronic injustices of structural health inequities around the world. When Covid-19 began to escalate, we saw its impact on our partners and the communities they regularly serve

In the healthcare industry, this is especially pronounced as the space of the hospital itself will continue to facilitate nosocomial (hospital-borne) infection, unless infection control protocols are established and adhered to. As validated protocols designed to prevent Covid-19 transmission do not yet exist, hospitals are having to implement spatial redesigns on the fly, doing their best to learn from protocols based on other diseases. Until we can better understand the virus’ pathways, we won’t be able to confidently redesign our existing spaces to adhere to new and higher standards of infection control guidelines.

In the meantime, hospitals will continue to repurpose and convert their spaces ad-hoc to meet surge demand – adapting idealised infection control protocols to non-ideal spaces and situations. This means healthcare workers and administrators must quickly adapt inflexible spaces, recognising that the resulting adaptations may put healthcare workers and our communities at risk unless we can quickly create site-specific guidelines that are adherable and implementable based on the best available knowledge. While we need research to understand who is at increased risk for complications of Covid-19 and to develop effective vaccines and best therapies, we also need research that identifies how spatial design and awareness can mitigate risk.

This response effort takes root in our work addressing inadequacies in the built environment to aid those working to detect and treat infectious diseases. Just as institutional, sterile spaces may evoke fear, dignified, human-centered spaces can instill trust and hope.

With professionals responding to Covid in various ways through their own practice, what we need is a commitment to humanity in this time of uncertainty.  We have the resources to advocate for basic changes and adaptations to our built environment. Buildings often play an outsized role in the spread of infection — and redesign efforts can play a key role in stemming the tide of a pandemic. Whether it’s providing ample, clean airflow to decrease the presence of contagion, building effective systems to separate waste from water, or designing spaces conducive to infection control, architecture can and should do its part to fight pandemics.

The diagram, from a rapid response study conducted by MASS and Ariadne labs, highlights different interventions that were made to turn an adult ICU wing into one that could treat patients who have tested positive for coronavirus.

Radically simple actions can include making design accommodations for operable windows and doors for increased airflow, easy to clean surfaces, frictionless entries, and decentralisation of HVAC systems. Reciprocally, these strategies have environmental implications and the connection between designing in response to human health is not far afield from many of the green building guidelines currently in practice.

We have seen architects playing an essential role in the here in South Africa and across the world, not only in responding to the immediate needs of temporary tents and retrofits, but in directing resources towards the production of personal protective equipment, rethinking our public spaces, and considering long-term solutions for infection control beyond this pandemic.

Urgency has a tendency to privilege temporary solutions, but one thing we’ve learned about Covid is that the recovery process is long, and thus, people will be staying in these spaces not for days but for weeks and even upwards of a month, with no access to nature and minimal access to the outside world, which can have debilitating effects of their own.

Thus, we need to design with these emotional and psychological factors in consideration. Besides, leading experts are saying that Covid-19 may be a seasonal occurrence and permanent infrastructures adapted to deal with the epidemiological outcomes of this health crisis may be the new normal for the foreseeable future.

A new world

We are all going to have to navigate the world in a new way when we leave our homes. Many of our fundamental understandings about public space will change as a result of Covid-19, in ways we can only begin to imagine. Some are thrilling: what if we kept the cars off the road? What would it mean to rethink our means of food production and distribution? Can we take on climate change with the same all-in vigour that we are demonstrating now across the world? Others will be less optimistic. There will be fear – fears for our future, fear of each other, fear for our livelihoods and economy, fear of gathering, fear of the ideas of community that have sustained us for so long. Architects and designers can play a large role in rebuilding systems of trust through the design of safe and healthy environments.

The construction industry accounts for more than half of annual global GHG emissions and have brought us indirectly into a short-term health crisis and directly into the long-term climate crisis. Can we leverage a slowing down of globalisation to begin establishing more transparent, interconnected, and regional systems of knowledge, labour, and material supply? Can we emerge with a model of practice that understands a building, a landscape, or rail line to be interconnected with all of the ecological systems it engages?

One Health

Seventy-five percent of new or emerging infectious diseases originate in livestock or wildlife, resulting annually in millions of people’s deaths, and billions of dollars of economic impact3. The root causes of those diseases are human in origin, including global trade, changing land use patterns, extractive agricultural practices, unplanned urbanisation, and unprecedented human migration, all exacerbated by a rapidly changing climate. This is One Health: the concept that human, ecological, and animal health are inextricably intertwined.  Covid-19, HIV, and Ebola are examples of the increasing trend of environmental origin pandemics, which will only continue to increase with population and pressure on ecosystems. The science of how One Health systems interlink is clear. We need a new playbook to apply it to the built environment.

At MASS we use the One Health principals as our model to respond to alimentative outcomes. One Health emerged through an interdisciplinary approach to disease prevention uniting medicine, public health, veterinary medicine, agriculture, and ecology4. Mapped onto design practice this holistic approach provides the tools for architects to understand our decisions in their totality, expedite a demand for transparency in our supply chains, and empower a full accounting of short-term and long-term socio-economic, ecologic, and carbon impacts. Environmental degradation, biodiversity loss, climate change, and rapid urban expansion are creating conditions for coronaviruses and other zoonotic diseases to cross over into human populations. These risks, rooted in the landscape, are further exacerbated by socio-ecological factors such as social inequity, occupational exposures, and food insecurity. 

Designing for One Health, or holistically responding to all possible systems of health through design, places us on a path towards carbon positivity, social equity, and planetary restoration. The current crisis has unveiled the fragility to which our regional systems have been thinned down to by relying on highly complex globalised exchanges. We must utilise this opportunity to emerge with practices that account for the full extent of material supply chains, value all forms of life, and replenish our ecological systems. Disrupted routines have presented gaps in the systems of our cities and this disruption gives us the chance to make propositions for radical change towards a more sustainable future.

We believe in the power of architecture to either hurt or heal. If spaces can be purposefully designed, they can assist in the prevention, containment, and treatment of infectious disease, including Covid-19. The spatial decisions we make now will also have long term implications in how we respond to and prepare for the next epidemic. Our work is predicated on the important focus on dignity, and designing for people, not just against pathogens.

As the world continues to grapple with the outbreak, the need for a unified approach for a healthier and more just planet has never been so pronounced. The pandemic has highlighted the inadequacy of the design profession to respond on its own merit, requiring the humility and understanding that our build environment can heavily influence the trajectory of our lives whether due to our proximal connection to infectious disease or the results of a degraded planetary environment. 

Endnotes

  1. Fiona Harvey. “World Has Six Months to Avert Climate Crisis, Says Energy Expert.” The Guardian, June 18, 2020, sec. Environment. https://www.theguardian.com/environment/2020/jun/18/world-has-six-months-to-avert-climate-crisis-says-energy-expert
  2. Barocas, Josh,  MASS Design Group, “Architecture Can Heal – Adapting Healthcare Spaces in Response to COVID-19”. Webinar, Boston, MA, May 12, 2020.’
  3. Asokan, G. V., and R. K. Kasimanickam. “Emerging Infectious Diseases, Antimicrobial Resistance and Millennium Development Goals: Resolving the Challenges through One Health.” Central Asian Journal of Global Health 2, no. 2 (October 1, 2013). https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5927746/
  4. Queenan, Kevin et al. “Roadmap to a One Health agenda 2030.” (2017)

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