Rachel Kapisak Jones

How can design fight for infection control? It’s a question that architects and design professionals have been asking themselves this year as COVID-19 began a rapid global spread. Suddenly, creating optimal spaces to treat this emerging and still-mysterious illness became the most urgent design problem to solve.

For the international nonprofit MASS Design Group, which has applied design thinking to health care centers in places such as Rwanda, Haiti, and Liberia since 2008, the pandemic provided a unique challenge—and a unique opportunity for innovation.

Through MASS Design Group’s COVID-19 Response Team, which was rapidly assembled in March to combat the growing number of cases in the Boston area and across the United States, MASS was able to compile guidelines for safer health care facilities during the pandemic—both in ad hoc tent facilities thrown together in a matter of days and repurposed spaces in existing hospitals.

“Our intent is not to design buildings; our intent is to help others who have to solve problems, some of which have to do with buildings, with guidelines for best practice,” says Chris Scovel, a director at MASS Design Group. We chatted with Scovel and Michael Murphy, founding principal and executive director, about the organization’s COVID-19 response, their work consulting on tent facilities for Boston’s Healthcare for the Homeless Program, and how this crisis might help us all understand the spaces around us more effectively.

What role can and should architecture play during a health crisis like the one we’re currently experiencing?

Michael Murphy: I think what’s clear to all of us now sitting in isolation and working in our own homes is that the buildings around us are playing a very direct role in the epidemic. It’s the spaces around us that are a container of the possibility of contamination. I think that the role it could play is for us to design [the space], repurpose it, or convert it in a particular way to make us less sick, less contagious, and more healthy, essentially.

We’re talking about spaces that aren’t designed for infection control, nor will they ever be—like your home, or the waiting area of a restaurant. I think the responsibility isn’t on designers alone, but in the same manner that these things are all interrelated, we as designers can pivot and act more urgently to assist our communities in understanding how the space around them is threatening. That spatial literacy that we can provide as a profession offers an enormous amount of opportunity. It’s also an opportunity to reinforce the very intimate relationship that the built environment has to our own ability to live a healthy and protected life. Our health and our buildings are related; they’re not separated. I think that recognition, that awareness, that awakening is happening in the middle of the pandemic.

Chris Scovel: That’s true. The notion that architecture can heal but it can also make people sick has been the root of MASS Design Group as an organization since the beginning. Architecture is an inherently optimistic and idealistic undertaking; it’s future-oriented; it’s about making things better. Architects are idealists, and at this time, we’re trying to find ways that we may have overlooked in the past to follow through on our idealism. Aside from the work that MASS has been doing with enormous energy, we’ve also witnessed colleagues who have been trying to find ways to participate in the COVID-19 response.

We are in this moment in which we are all, as a society, becoming so aware of space and dimension. All of a sudden, the fundamentals of what architects practice and consider—the relationships between people, the relationships that people have to their spaces, to light, and to air—all of those things are front and center in the public consciousness. Everyone knows, all of a sudden, what 6 feet is, what 10 feet is. And so, in a way, it’s an extraordinary moment for architects and for architecture to follow through on that consciousness, and perhaps even use it to heal and to fix some of the systemic flaws and fractures that are so visible to us now as a society.

How did you go about creating the design criteria for the construction of temporary treatment facilities and emergency shelters?

Scovel: MASS is doing an enormous amount of work creating various guidelines, but one of the first we issued was for a tent clinic facility that we helped with in Boston for a long-term client of ours, Boston Healthcare for the Homeless Program, the largest provider of health care to the homeless in the United States. That project came to us out of the blue one morning when the Chief Medical Officer called and let me know that there was this need. I consulted with colleagues at MASS who have experience in infection control, very quickly, in order to help them. We also brought the experience of infectious disease doctors, as well as mechanical engineers and other academic experts in infectious disease.

We brought institutional experience to [that project] because MASS has a deep knowledge and history with handling infection control measures for various contagions and clinical settings. We brought all of that together in a white paper that we wanted to offer very broadly so that it could be used by other decision-makers who would be under enormous time pressure to realize similar kinds of facilities.

What were some of the unique considerations for the Healthcare for the Homeless Program facility?

Murphy: As is becoming widely known, the homeless are uniquely vulnerable to COVID-19 for several reasons. There is a seven times greater likelihood of contracting COVID-19 in Boston if you are homeless. I credit the city of Boston and to folks like the Boston Healthcare for the Homeless Program for planning for the homeless population in unique ways.

One of those ways was for the city to fund this tent clinic that we consulted on. It’s very simple, and it’s very crude—it’s two combinations of multiple tents that house close to 40 patients. These are tents that would otherwise be serving wedding functions in the summertime. When we became involved, there was still an opportunity to re-plan the tents in order to introduce infection control measures and to limit the potential for cross-contamination between patients and to limit, very importantly, the potential for health care providers to be contaminated by patients. We did this with just some basic planning techniques about creating separate entrances for health care providers, creating donning and doffing areas that were well-located, and limiting unplanned interactions between providers and patients. So there were several basic health care planning strategies that were implemented in the tent.

Beyond that, we also introduced some ideas about the cleaning and disinfection of materials, and also some airflow strategies. In this, as in a lot of health care design, airflow should be considered as very important.

Can you tell me about your firm’s experience designing hospitals in the developing world?

Scovel: Basically, we had to repurpose medical facilities that were not designed for infection control and make them applicable and better-functioning to reduce infection without the same tools that we might have, let’s say, in a United States hospital. U.S. hospitals, to a large degree, rely on large-scale mechanical systems and hermetically sealed medical facilities to control, move, and decontaminate air. And because medical facilities in Rwanda or Haiti or Liberia may not have easily available mechanical systems or maintenance teams that can support them as effectively, they may not function as well as they could. So, you have spaces that were not designed for infection control principles really becoming more dangerous, unless we repurpose them.

Our designs in Rwanda were really about repurposing spaces to make them better-performing for airborne disease. Those lessons are completely applicable today because we’re dealing with the same question in all of the spaces around us as we learn how to fight this new illness.

We can’t expect large-scale infection control protocols to be implemented in your home or your apartment building, but we can potentially understand the space around us more effectively to fight this invisible virus and recapture some agency as we control that space.

Murphy: There are no guidelines for COVID-19. Infection control guidelines are really reactionary—they respond to the most recent outbreak, whatever it may be. We saw infection control guidelines change after tuberculosis, after cholera, after Ebola in particular. I think we can learn a lot from those moments of economic outbreak about where we might repurpose and convert spaces into higher-performing ones for this current pandemic. I don’t want to say something is poorly designed; I want to say that we are in a new space that we have to actively readjust to, and do it quickly.