In April 2020, weeks after national sports leagues cleared their calendars, stadiums around the world transformed into makeshift hospitals as health officials scrambled to prepare beds for the growing number of patients hospitalized with COVID-19. The swift transformation from football fields to field hospitals hearken back to the floorplans of hospitals during the 1918 pandemic according to Professor Annmarie Adams, BA鈥�81, architectural historian and Chair of the Department of Social Studies of Medicine at 不良研究所.
In times of health crises, hospitals and healthcare providers have been known to adapt. The stadiums-turned-hospitals look a lot like the open-concept 鈥減avilion plan鈥� associated with nursing pioneer Florence Nightingale and common through the 1918 flu pandemic. These pavilions had rows of beds spaced apart and were designed to minimize contagion by increasing air circulation through large windows. Elsewhere, 鈥渙pen-air鈥� hospitals were camps that treated patients outside with sunlight and fresh air.
Hospitals built before World War I, such as the Royal Victoria Hospital in 1893, were imposing public institutions inspired by workhouses, convents and even prisons. With the war and flu pandemic came an unprecedented number of sick and wounded people, many of whom were also cared for in borrowed buildings.
After 1918, open wards were replaced with smaller rooms and corridors in the style of upscale hotels. St. Mary鈥檚 Hospital first took up residence in the old Shaughnessy House (now part of the Canadian Centre for Architecture). Following World War II, the modern hospitals were built like office towers (witness the Montreal General). The post-1980s superhospitals, such as the 不良研究所 Health Centre Glen site, bring together the shopping-mall experience and specialized wards with single rooms that are still evocative of a hotel room.
Four walls are meant to isolate the sick and provide privacy and comfort. Today, the COVID-19 pandemic is changing the way we think about walls, which suddenly proved useless at preventing the spread of the disease. 鈥淧PE has become the new 鈥榳all鈥� that each staff member has around them,鈥� Adams says of the protective equipment donned by healthcare workers to stop the spread of the virus.
Overnight, Canadian hospitals had to contend with predictions of mass hospitalization: modular units were assembled and field hospitals鈥攕uch as a pandemic response unit in Burlington, Ontario鈥攚ere hastily erected, proving that construction does not always require decades of planning and spending. The virus is a test for healthcare logistics, with superhospitals sharing resources. This is the case at the Glen, where the Montreal Children鈥檚 Hospital is now providing beds in its intensive care unit to adult patients.
In the 1970s, the world had its eyes on the McMaster University Health Sciences Centre, which was intended to be the hospital that could respond to unpredictable medicine. 鈥淭he idea was that you could change it overnight. It was modular and infinitely extendable,鈥� says Adams. 鈥淭hat kind of spirit will, I think, become important again.鈥�
The pandemic has also shocked long-term care facilities, which were seized by rampant outbreaks. People living in these homes have been more likely to die of the disease and are reported to make up 75 per cent of the total death toll in Quebec.
鈥淚t鈥檚 destabilizing, because we like to think of the long-term care home as a safe place where older people are taken care of,鈥� Adams says. 鈥淏ut the images have been nightmarish.鈥�
She hopes the pandemic will be a wake-up call about the importance of design and architecture of these otherwise invisible facilities. This semester, long-term care design is the subject of a third-year studio class taught by Boris Morin-Defoy at 不良研究所鈥檚 Peter Guo-hua Fu鈥檚 School of Architecture. Nursing home design is linked to the quality of life of seniors because it affects their social interaction and mobility. For example, accessibility and traffic in communal areas, or the number of windows and residents per room, can make a difference.
Infection control has always been a paramount concern for long-term care homes and hospitals, says doctoral student Christopher Clarke, who is Chief Architect of the Northwest Territories鈥� department of health. The proliferation of hand-hygiene sinks, sterile rooms and separate ventilation systems is part of a concerted effort to increase efficiency and safety in healthcare facilities.
鈥淭he infection control aspect of healthcare facilities is continually increasing,鈥� Clarke says, and future improvements must be thoughtful and not a reaction to pandemic-induced panic. 鈥淚n long-term care, we could separate the rooms more, like the isolation rooms now,鈥� he says. 鈥淏ut you don鈥檛 want to live your last years in a facility that looks like a clinic.鈥�
For long-term care facilities to embody the meaning of home, the solution may be to mimic multifamily residences and life in the community. A novel example of innovative long-term care design is the 鈥渄ementia village,鈥� a fictional town and controlled environment where people living with dementia can believe life is business as usual. The main streets are not real, the bus stops are fake. 鈥淣obody has any money, but residents pretend they are shopping for dinner,鈥� says Adams. 鈥淚t鈥檚 a completely fake place, and I鈥檓 quite critical of it, because it uses architecture to fool people,鈥� says Adams, 鈥渂ut as others point out, it鈥檚 the best thing we have, because it means people can go outside.鈥� Quebec鈥檚 residential and long-term centres for elderly people (known as CHSLDs), meanwhile, resemble a cross between a hotel and hospital environment where people are isolated in their rooms except when grouped together under supervision for meals and activities.
In the Northwest Territories, nursing homes have rooms for out-of-town families to sleep in. Clarke proposes building camps for elders that recreate life on the land. Clarke, who is from the Treaty 8 Akaitcho Territory 艁煤ts毛l K鈥櫭� Dene First Nation, says patients living with dementia in the territory survived residential schools. Architects and policymakers need to be sensitive to the way facilities often resemble these schools. 鈥淚f it looks like a residential school, somebody who has those memories with dementia鈥攊t could perpetuate their trauma,鈥� he says. 鈥淪ometimes people who try to leave the facilities aren鈥檛 cognitively able to take care of themselves,鈥� he says.
A camp for dementia patients, with teepees, cabins and smokehouse to dry meat and fish could create the experience of living off the land, while still being fenced in by raspberry bushes and monitored by healthcare workers. These sites can also be places of cultural knowledge sharing between older and younger generations. Clarke鈥檚 research to build these facilities, and other architecture that incorporates Indigenous medicines and healing practices, will continue through his PhD studies over the next four years. During this time, he hopes to work with elders and Indigenous doctors around the world to build new wellness centres in a post-pandemic world.
Adams is optimistic that COVID-19 is eye-opening for architects. 鈥淚鈥檓 hoping the architectural profession will become more caring, and I hope I can contribute to that.鈥�
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