Extra pressure on healthcare
The additional pressure from COVID-19 patients on healthcare is already affecting other patients in hospitals. Surgeries are being postponed to accommodate COVID-19 patients. This pressure is not temporary. The wave of patients that will come due to deferred procedures, as well as small or large outbreaks of the coronavirus, is not ruled out.
Modular ICU Units
The study includes a plan and design for modular ICU units that could be realized within a short timeframe of 3-4 weeks. Within these units, each patient has their own space with the necessary facilities in terms of pressure hierarchy, medical gases, isolation, and medical connections. If we consider regular ICU patients, we can create individual rooms; in the specific case of COVID-19 patients, a ward setup can also be built. This would allow us to accommodate virtually every ICU patient. With a substantial number of these modular facilities built, the influx of patients that is yet to come could be managed.
How did others do it?
Architects around the world have proposed various solutions to quickly deploy additional capacity. At the beginning of the pandemic, videos of the construction of two emergency hospitals in China spread worldwide. These hospitals were built within a week. The responsible architect was Prof. Huang Xiqiu from Beijing. He had previous experience building the emergency hospital for SARS patients in 2004, also within a week. This was achieved by proposing that all contractors simply build pavilions using their own construction systems (using the prefab systems they had in storage), which were then connected with a central corridor. Power was supplied by generators, and the rest was supported by tanks and refrigerated trucks. Wastewater was collected in an empty swimming pool next to the construction site, and waste and medical materials were incinerated on-site. The latter two points were aspects that could be improved, and Prof. Huang recommends them as recommendations.
Another possible system was developed by Canadian architect Martin Fiset. It is based on a modular system of interconnected shipping containers. He used this system to create a health center with 30 beds in India. This system was also applied by Dutch aid organizations in the fight against HIV and tuberculosis in South Africa. Operating rooms, delivery rooms, diagnostic spaces – everything was designed to fit the size of a shipping container. The containers were fully equipped in the Netherlands and shipped to South Africa, where they only needed to plug them into electrical outlets, and the facility was operational.
The latest development resulting from this is CURA, an open-source approach where a combination of shipping containers and tent structures can provide both a quick and a long-term solution. The containers are fully equipped ICU rooms that can be set up in a plug-and-play manner. The tent serves as an intermediary between the rooms.
IC Unit in Empty Halls
We have developed an ICU unit with 10 ICU beds and facilitating features that can be quickly installed, for example, in existing sports and exhibition halls, vacant atria, or spaces in and around hospitals. The aim is to have this unit produced and built within 3-4 weeks. By specifically focusing on COVID-19 patients, the beds can be arranged in a ward setup, and individual rooms are not required. This allows the entire unit to be easily placed under negative pressure, and the staff can maintain their protective equipment.
The design involves an ICU unit with 10 ICU beds, as mentioned before. An open layout with nursing stations in the middle provides a good overview. By arranging the beds strategically, multiple patients can be connected to one ventilator in case of a possible shortage. All supporting functions are located within the unit, resulting in very short walking distances for the staff. Both the supply and removal of goods and waste can be done through external doors without disrupting the care process.
The entire unit is built using prefabricated wall elements of standard sizes. This is necessary for quick and cost-effective construction. Additionally, the prefabricated elements are mostly self-supporting, requiring minimal extra construction. To ensure a safe and clean environment, the unit has its own air treatment system.
Call for Collaboration
There are various solutions to quickly establish additional capacity both in the Netherlands and in other countries. It would be beneficial to allocate a portion of the substantial funds currently being injected into the economy by governments, so that we can be well-prepared for future infectious diseases that will continue to occur globally.
We realize that we offer only a part of the puzzle. Therefore, we are seeking other parties interested in participating in this initiative. This includes suppliers of medical equipment, other furnishings, as well as healthcare institutions and government organizations. To bring the entire plan to fruition, an integrated approach will be necessary, with a nearby hospital playing a significant role from a medical responsibility perspective. Despite these challenges, we hope to contribute our share in this endeavor.