ARCHITECTURE & DESIGN
additional capacity, but to do so very quickly indeed.
At some point in the future, there will certainly be an analysis of each country’s actions in the face of the COVID-19 crisis, and time will tell which strategies and public health measures were the most effective in controlling the spread of the virus and saving lives. Regardless of the conclusions of the experts, however, it’s already clear that the rapid construction of a large hospital from vacant site to operational healthcare building within a fortnight will be one of the major achievements of the pandemic. We must learn from it as part of any future planning for crises, conflicts, or natural disasters, to leverage any potential to be similarly fast to respond to an urgent and severe requirement for increased healthcare capacity.
One of the reasons that it’s important that we learn lessons from the Wuhan hospital construction project now is that it’s clear that the construction of a hospital of this size and scope in such a short period of time must have involved a significant level of readiness to implement an existing plan.
Disaster planning key
Disaster planning should be part of any country’s resilience strategy, and the NHS already tests scenarios for major incidents such as terror attacks and natural disasters. However, the scale of the COVID-19 crisis demonstrates that there is not just a need for operational planning; there is also an imperative to consider what built assets and infrastructure will be required. With the rapid construction of the hospital in Wuhan, the Chinese Government has demonstrated that this was in place.
It is evident that ground conditions for the site must have been pre-established, because land surveys alone (Topo, GPR, CCTV) take weeks to carry out and process. Clearly, earmarking a site for the potential development of a large-scale crisis response hospital is more challenging in the UK, due to population density and a lack of available development plots. As we have seen during the pandemic, it is the most densely populated areas that are most at risk of increased infection rates, exacerbating the challenge of increasing capacity where there is most need. The UK’s response to this for COVID-19 has been to transform conference centres into field hospitals, and these have been turned around with impressive speed. However, these have been constructed for one purpose only, to fight COVID-19. There are many NHS Trusts that do have land assets, often within the grounds of an existing hospital, which could potentially be sites for rapid construction of new, more flexible hospital buildings in
58 Health Estate Journal September 2020
Stantec said: “We cannot predict the future, but, through considered design best practice, we can ensure that we equip hospitals with the agility required to respond quickly and effectively to unexpected and severe patient needs.”
response not only to a pandemic, but also to any other healthcare crisis or large- scale terror attacks, provided the legwork is done in advance. This would need to include preliminary land surveys to inform the design process in advance, and expedite the construction programme should an emergency hospital build project ever need to be implemented.
Complex site selection requirements It’s important to note that requirements for site selection are more complex than simply assessing where there is available land. In addition to identifying sites that are located close to existing services, transport infrastructure, and major population centres, any analysis of potential emergency response hospital construction programmes must also consider the ground conditions and topography. The two-week build programme in Wuhan was only achievable because the site allowed for minimal cut and fill requirements, and the topography and ground conditions enabled a fast installation and rapid curing foundation solution. Similar conditions compatible with speed of construction must also be considered in any crisis response hospital construction planning here in the UK.
In terms of the building itself, the speed of construction implies that the design for the hospital was pre-existing, and that it was constructed as a scalable, off-the-shelf modular design. Clearly, the new facility was designed specifically as a large-scale, emergency response hospital because it did not require construction of any support structure; instead modules were simply stacked on top of each other like a giant Lego project. This allowed the authorities to build the hospital to the scale required of the crisis.
Offsite elements built and commissioned in advance
The offsite modular construction elements were probably built and commissioned in advance, then stored ready for deployment an emergency. The resilience planning involved in this is, in itself, impressive, and, given the size of the facility, the planning involved in producing and storing so many modules in advance is even more extraordinary. I would estimate that all of the design and 90 per cent of the construction were done in advance, but this should not detract from the achievement of creating a functioning hospital in two weeks. If anything it’s a testament to what can be achieved when designing and preparing for a very specific scenario, and demonstrates that lessons have been learned from the SARS epidemic. Indeed, it’s interesting to compare the response to COVID-19 from countries previously affected by the SARS and MERS outbreaks and contrast this with Europe and the US. The lessons learned from previous epidemics are clearly not the only factor, as cultural, financial, and demographic factors are also involved, but it’s clear that both existing infrastructure and pre-planned response have been significant in South Korea, Taiwan, and Singapore.
Building on the experience of Singapore
Singapore was among the countries hardest hit by the SARS epidemic in 2003, and the country has focused on preparedness for the next epidemic during the intervening years, establishing a prevention and response plan: the Disease Outbreak Response System Condition (DORSCON). The system is designed as an approach to support improved prevention and infection control, with a colour-coded alert system to highlight the
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