What you need to know:
- At the time, an epidemic of extensively drug-resistant tuberculosis emerged and it was a building, the town’s hospital, Church of Scotland Hospital, that took much of the blame.
- According to experts, the mode of transmission, particles so small they suspend in the air making them easily inhaled by patients in the poorly ventilated hospital with overcrowded waiting areas, was proof that something spatial was afoot.
If the previous epidemics before Covid-19 taught us anything, it is that space really matters. In past pandemics, buildings played a big role in the spread of infection, and redesign efforts played a key role in stemming the tide of infectious disease.
In 2006, something happened in the Tugela Ferry region of South Africa that drew the clearest connection between poorly designed and built houses and the spread of infectious diseases.
At the time, an epidemic of extensively drug-resistant tuberculosis emerged and it was a building, the town’s hospital, Church of Scotland Hospital, that took much of the blame.
According to experts, the mode of transmission, particles so small they suspend in the air making them easily inhaled by patients in the poorly ventilated hospital with overcrowded waiting areas, was proof that something spatial was afoot.
Indeed, one health care director was quoted as having stated the hospital was not designed for infection control, and people died because of it.
Kenya’s hospitals were built for worse diseases than Covid-19
Although scientists are leading the global race to find a cure and develop an effective vaccine to counter the new, deadly, and highly infectious coronavirus, such a diagnosis points to the unique role architecture plays in contributing to a cure.
To put it simply, if spaces can be purposefully designed, they can assist in the prevention, containment, and treatment of infectious disease, including Covid-19.
Covid-19 has joined a list of infectious diseases such as the Spanish flu of 1918 and Ebola, which ravaged West Africa in 2014, diseases that left enduring marks on urban spaces.
A look at previous pandemics shows how this one is likely to force architecture and city planning to evolve. The bubonic plague, which wiped out at least a third of Europe’s population in the 14th century, for instance, saw cities clear squalid and cramped living quarters, expanded their borders, developed early quarantine facilities, opened larger and less cluttered public spaces and deployed professionals with specialised expertise, such as surveyors and architects.
Likewise, 18th century yellow fever and 19th century cholera and smallpox outbreaks helped to speed up innovations such as broad boulevards, citywide sewer systems, indoor plumbing, disease mapping and the early suburbs.
In the 20th century, tuberculosis, typhoid, polio and Spanish flu breakouts prompted urban planning, slum clearance, tenement reform, waste management and, on a larger level, Modernism itself, with its airy spaces, single-use zoning (separating residential and industrial areas, for instance), cleaner surfaces (glass and steel) and emphasis on sterility.
When the first case of Covid-19 was reported in Kenya in March, the Architectural Association of Kenya (AAK) set up a collaborative technical advisory committee with partner associations to give advice on repurposing and/or constructing quick and safe, care and treatment centres for Covid-19.
Efforts of team
“The efforts of the team culminated in the publication of the first edition of the ‘Proposed Guidelines on Planning and Design of Covid-19 Quarantine and Treatment Centres and Long-term Infrastructural Interventions for the Kenyan Context,’” Ms Mugure Njendu, AAK president told DN2 Property, adding, “The objective of this document is to provide quick and innovative infrastructure guidelines to public and private health care sector players in response to Covid-19.”
In an effort to understand the role of architecture in fighting a pandemic, Ms Njendu explains the field of architecture and how it relates to public health. She says there are many major societal trends in which architects can contribute health-promoting improvements, and public health is one of them.
She highlights factors such as obesity, housing and social inequities, an aging population, hazardous chemical exposures, urbanisation, nature contact deficit, energy poverty, water shortage and excesses, natural disasters, and climate change.
“For example, an architect can design an attractive stairway that invites use,” she says.
Similarly, she adds, providing day lighting in a school or workplace offers mental health and productivity benefits as well as energy savings. Consequently, creating a transit-oriented development encourages residents to walk, use transit more and drive less, accruing benefits such as increased physical activity, improved air quality, and fewer motor vehicle injuries.
“Healthy architectural design can yield affordable health-promoting housing, featuring fresh air circulation and safe and attractive interior and exterior components,” she notes.
With the current pandemic, she points out that architects have the opportunity to provide innovative design solutions such as container conversion, retrofitting of facilities, and quick provision of isolation units using readily available materials to increase capacity. There is evidence that coronavirus can remain suspended in the air for some time and be inhaled by other people. For architects, this makes airflow both a problem and a solution to design for.
For starters, experts posit that simple retrofits and measures such as opening windows, increasing air movement, introducing filters, avoiding closed-off hallways, waiting areas, and other spaces designed without airflow in mind could go a long way in curbing the spread of the virus.
As people stay away from hospitals for fear of being infected, Mr Musembi Mumo, an architect and a member of the AAK Covid-19 task force, says that unlike the hospital in the South Africa that failed the test, health facilities in Kenya were built right.
“They were built for worse diseases than this,” he says, “So there is not much to change, what needs to change is the way people interact in offices, restaurants, cafes and other social places.”
The spike in number of Covid-19 cases has seen some counties convert fields into hospitals made of large tents - Mr Musembi, who was part of the team that put up the Machakos County field hospital, says basic rules around airflow should act as a guide in putting up such facilities.
“The airflow must work on a negative flow mode,” he explains, “This means that the air comes in from the top and flows downwards past the patient and exits from the bottom of the tent to ensure that the patient breaths in clean air and that the air they exhale leaves from the bottom thus not infecting the other patients next to them.”
During the 2014 Ebola outbreak, architects are credited with having played a major role in renovating isolation units, creating innovative ventilation strategies and designing pathogen-resistant surfaces that helped to keep the disease from spreading. The guidelines and approaches taken before might not work for this particular pandemic, considering that studies are showing that coronavirus is more stable on plastic and steel (up to three days) than on porous fabrics such as cotton, leather, and even cardboard (less than 24 hours).
So, the big question is, what is the role of designers as far as this is concerned? Should they question previous guidelines? Additionally, renovating the isolation units, creating innovative ventilation strategies and designing pathogen-resistant surfaces is their forte, how can designers get us out of the woods as far as this is concerned?
Mr Mumo refers to the comprehensive design guidelines issued by AAK at the onset of the disease in Kenya, saying that they were new and specifically meant for the current pandemic. The guidelines, he says, were also done in close consultation and input from several other professionals including Kenya Medical Association and the Ministry of Health (MOH) representatives.
According to the guidelines, some of the primary aims include to enable quick installations of County Covid-19 coordination centres and to give far-flung areas with no medical facility the capacity to uptake Covid-19 related cases.
Other roles include to offer guidance on putting up mass testing and quarantine centres in the counties, especially suited to public school settings to shore up medical capacity during the emergency. Creation of temporary mortuary facilities for casualties and isolation areas for confirmed cases, primarily to host patients who may face stigma/cause panic when in normal hospital settings.
If the previous epidemics have taught us anything, it is that space really matters. During previous pandemics, buildings played a huge role in the spread of infection, and redesign efforts played a key role in stemming the tide of a pandemic.
One of the reasons AAK suggested stationing a makeshift hospital in a stadium in Machakos County, was due to availability of supporting infrastructure, including washrooms. Evidence from elsewhere in the world shows that if waste management is not done properly, there is a high likelihood that these emergency centres can create another disaster after fighting the current one.
“AAK has developed designs for temporary washroom facilities for all field hospitals. These are turnkey solutions that include an efficient septic waste disposal system. Upon disbandment of the hospital, all the washrooms can be easily removed and the site restored to its original state within three months,” says Mumo.
There is also the matter of inclusive design. For instance, before the pandemic, corners were not working for the deaf in the sense that they could not tell when someone was approaching from the other end through the sound signal. Then, it was also not a big deal if the two people brushed shoulders. In the wake of Covid-19, however, brushing shoulders could mean increased risk of infection.
Time to kill two birds with one stone
The AAK president had a lot to say about inclusive design, observing that this is the time to kill two birds with one stone.
“Looking into the future, Covid-19 offers a unique opportunity for all built environment professionals to design and implement more inclusive and accessible societies to mitigate against its spread, spaces must be perceivable to ensure users with disability perceive the platform with their senses, such as sight, touch, and hearing, the spaces must therefore encapsulate several human senses at any given time.”
It is too soon to talk about lessons, but nonetheless, there are there shortcomings with how we design our houses that Covid-19 is exposing - Ms Njendu explains that modern buildings are generally designed to promote social mixing, from open plan living areas in homes to open offices where many workers share space.
“By promoting interaction and chance encounters, these layouts are thought to generate more creativity and teamwork. Nevertheless, the designs may probably also act as really great agents for spreading viruses around,” she observes.
But buildings form just part of the built environment, there is the surrounding green spaces, recreation areas, roads, walkways and various other spaces. We spoke to Mr Raphael Kazungu, an urban planner, to understand the contribution of the urban areas to the spread and consequent fight against a pandemic.
To begin with, Mr Kazungu was quick to point out that the urban planning profession was born as a response to public health crises in cities at the turn of the century.
The coronavirus is said to have started in a seafood market in Wuhan city, China, a factor that underpins the role of urban centres in the spread of a highly infectious disease. This is an issue Mr Kazungu understands all too well.
He says that the physics principle known as the stack effect perhaps best explains how urban areas are a breeding ground for pathogens. He explains that when human beings exhale, the hot, contaminated and ideally less dense air they breathe out is suspended above the cool air. In normal circumstances, he says, the environment has a natural way of cleaning up the air.
“The built environment, however, affects the movement of that air in the sense that if buildings are not spaced adequately, they affect wind movement by blocking its natural path, therefore, dilution of air does not occur, creating the urban heat island phenomenon, which manifests itself when a city experiences much warmer temperatures than nearby rural areas. And this is just about the right condition for pathogens to thrive,” he observes.
It is perhaps because of this point of view that many experts argue that diseases shape cities - we were curious to know how this particular one is likely to transform the built environment.
Not just about living spaces
“I think today developers are not just thinking about living spaces, right now they are looking at robust, modular and interchangeable spaces, so that someone living in a certain neighbourhood has the space to do physical activity. And it doesn’t have to be an Olympic size pitch,” says Mr Kazungu.
He adds that the current pandemic and the lessons drawn so far from it provides property developers with an opportunity to come together and donate pieces of land for creation of common facilities.
“Considering that almost all the neighbourhoods that are attracting residents at the moment are already subdivided, this is an opportunity for property developers to show they care. There is still an opportunity for land re-plotting and readjustments,” says Mr Kazungu.
“We are now in the information era. What is needed is more research that links this pandemic to the built environment. We need to understand that most of these diseases come from the environment we live in or the environment fuels the infection. So, if this particular one is going to influence policy, let it come from a point of knowledge.”