Lessons from the first wave of COVID-19 in Italy: A collection of design strategies to face pandemic situations in healthcare facilities.

OBJECTIVES: This study aims to provide metadesign indications for the improvement of healthcare facilities, emphasizing the role of spatial design in the management of epidemic health emergencies. STUDY DESIGN: A parallel mixed-method study including literature reviews, survey creation, and survey distribution was performed. METHODS: Data were collected between August and October 2020 capturing information related to the first wave of the COVID-19 pandemic, utilizing a review of existing literature, a comparison of existing hospital planning guidelines and assessment tools, and distribution of a survey to analyze design changes within selected Italian hospitals. RESULTS: Among the changes identified, the most frequently identified included the conversion of space into intensive care units, space expansion, and the usage of wayfinding strategies for the reduction of cross-contamination risks. There was limited attention given to solutions with a human-centered approach, and those that addressed physical and psycho-logical well-being of all users, including healthcare staff. The solutions were collected and systematized into a list of metadesign guidelines. CONCLUSIONS: The resulting indications represent a starting point for developing design solutions to aid healthcare facilities in facing future epidemics.

Lessons from the first wave of COVID-19 in Italy: A collection of design strategies to face pandemic situations in healthcare facilities.

OBJECTIVES: This study aims to provide metadesign indications for the improvement of healthcare facilities, emphasizing the role of spatial design in the management of epidemic health emergencies. STUDY DESIGN: A parallel mixed-method study including literature reviews, survey creation, and survey distribution was performed. METHODS: Data were collected between August and October 2020 capturing information related to the first wave of the COVID-19 pandemic, utilizing a review of existing literature, a comparison of existing hospital planning guidelines and assessment tools, and distribution of a survey to analyze design changes within selected Italian hospitals. RESULTS: Among the changes identified, the most frequently identified included the conversion of space into intensive care units, space expansion, and the usage of wayfinding strategies for the reduction of cross-contamination risks. There was limited attention given to solutions with a human-centered approach, and those that addressed physical and psychological well-being of all users, including healthcare staff. The solutions were collected and systematized into a list of metadesign guidelines. CONCLUSIONS: The resulting indications represent a starting point for developing design solutions to aid healthcare facilities in facing future epidemics.

Explorative Study on Urban Public Space Renovation during COVID-19: Test of a Visual Web-Based Survey about the City of Saint German en Laye, France

Background: The complex socio-epidemiological situation caused by the COVID-19 pandemic forced cities to rapidly adapt to new prevention distancing measures. Several interventions have been made but specific tools are needed to rapidly verify the suitability of such design proposals. This study aims to describe the process of development and testing of a visual web-based survey to assess potential user feedback on Urban Public Space renovation for the city of Saint Germain-En-Laye (SGL), France during the pandemic. The renovation included pedestrianization strategies for the city center and the design and installation of new street furniture. Method: After an exploration of the literature and stakeholder interaction, an online survey composed of three sections and seven questions evaluating the project was developed to rapidly validate the design solution before its actual installation and compare the pre- and post-situation trough visual insights on a 5-point Likert scale. Data was collected through a Google Form and analyzed with descriptive statistics. Results: We received 371 full replies from Italian and French respondents. The survey results showed that the Urban Public Space proposal improved the baseline situation for different reasons, such as safety, sustainability, and accessibility. In fact, Solution A (the existing situation) obtained an average score of 2.08 while Solution B (the design solution) obtained 4.13. Conclusions: The features identified allowed for timely comparisons and possible insights, and the approach can be implemented in other medium-sized European cities dealing with Urban Public Space transformation during COVID-19.

Gender Differences in COVID-19 Lockdown Impact on Mental Health of Undergraduate Students.

Background: Prolonged university closures and social distancing-imposed measures due to the COVID-19 pandemic obliged students to at-home learning with online lectures and educational programs promoting potential social isolation, loneliness, hopelessness, and episodes of clinical decompensation. Methods: A web-based cross-sectional survey was carried out in a university institute in Milan, Northern Italy, to assess the COVID-19 lockdown impact on the mental health of the undergraduate students. We estimated the odds ratios (OR) and the corresponding 95% confidence intervals (CI) using adjusted logistic regression models. Results: Of the 8,177 students, 12.8% reported depressive symptoms, 25.6% anxiety, 8.7% insomnia, and 10.6% reported impulsive tracts, with higher proportions among females than males. Mental health symptoms were positively associated with caring for a person at home, a poor housing quality, and a worsening in working performance. Among males compared with females, a poor housing quality showed a stronger positive association with depressive symptoms and impulsivity, and a worsening in the working performance was positively associated with depressive and anxiety symptoms. In addition, the absence of private space was positively associated with depression and anxiety, stronger among males than females. Conclusions: To our knowledge, this is the first multidisciplinary consortium study, involving public mental health, environmental health, and architectural design. Further studies are needed to confirm or refute our findings and consequent recommendations to implement well-being interventions in pandemic conditions.

Effect of Housing Quality on the Mental Health of University Students during the COVID-19 Lockdown.

COVID-19 outbreak imposed rapid and severe public policies that consistently impacted the lifestyle habits and mental health of the general population. Despite vaccination, lockdown restrictions are still considered as potential measures to contrast COVID-19 variants spread in several countries. Recent studies have highlighted the impacts of lockdowns on the population's mental health; however, the role of the indoor housing environment where people spent most of their time has rarely been considered. Data from 8177 undergraduate and graduate students were collected in a large, cross-sectional, web-based survey, submitted to a university in Northern Italy during the first lockdown period from 1 April to 1 May 2020. Logistic regression analysis showed significant associations between moderate and severe depression symptomatology (PHQ-9 scores ≥ 15), and houses with both poor indoor quality and small dimensions (OR = 4.132), either medium dimensions (OR = 3.249) or big dimensions (OR = 3.522). It was also found that, regardless of housing size, poor indoor quality is significantly associated with moderate-severe depressive symptomatology. Further studies are encouraged to explore the long-term impact of built environment parameter modifications on mental health, and therefore support housing and public health policies.

Flexibility during the COVID-19 Pandemic Response: Healthcare Facility Assessment Tools for Resilient Evaluation.

Healthcare facilities are facing huge challenges due to the outbreak of COVID-19. Around the world, national healthcare contingency plans have struggled to cope with the population health impact of COVID-19, with healthcare facilities and critical care systems buckling under the extraordinary pressures. COVID-19 has starkly highlighted the lack of reliable operational tools for assessing the level sof flexibility of a hospital building to support strategic and agile decision making. The aim of this study was to modify, improve and test an existing assessment tool for evaluating hospital facilities flexibility and resilience. We followed a five-step process for collecting data by (i) doing a literature review about flexibility principles and strategies, (ii) reviewing healthcare design guidelines, (iii) examining international healthcare facilities case studies, (iv) conducting a critical review and optimization of the existing tool, and (v) assessing the usability of the evaluation tool. The new version of the OFAT framework (Optimized Flexibility Assessment Tool) is composed of nine evaluation parameters and subdivided into measurable variables with scores ranging from 0 to 10. The pilot testing of case studies enabled the assessment and verification the OFAT validity and reliability in support of decision makers in addressing flexibility of hospital design and/or operations. Healthcare buildings need to be designed and built based on principles of flexibility to accommodate current healthcare operations, adapting to time-sensitive physical transformations and responding to contemporary and future public health emergencies.

Covid-19 Massive Vaccination Center Layouts.

BACKGROUND AND AIM OF THE WORK: The rapid evolution of Covid-19 and the availability of numerous vaccines led countries to set up Massive Vaccination campaign in a very short time. Since December 2020, due to the lack of specific guidelines, multidisciplinary groups started to investigate the minimum requirements for Massive Vaccination Centers (MVC). The aim of the paper is to shed light on the process of development of a scalable model for MVC layout design and implementation. METHODS: The methodology included two phases and six steps: 1)Study of MVC with i) acquisition of process data from experimental study on an early set up vaccination hub; ii) review of scientific literature on MVC; iii) review of existing available guidelines and international examples; 2) Design proposal with iv) functional and space requirements collection; v) standard MVC layout design and vi) scalable model definition. RESULTS: The resulting layout is compact, has a good wayfinding and address safety reducing cross-contamination risks. Different vaccine lines have been designed with a central dilution area for process efficiency. Healthcare staff wellbeing is guaranteed by the provision of resting spaces, short distances, and the correct sizing of space for the different activities. To ensure optimal vaccination capacity at the peak of vaccination, a modular and scalable model of different sizes has been designed ranging from 400 to 12000 m2. CONCLUSIONS: The modular layout has been used as basic model in the regional legislation, disclosed with the Deliberation n° XI / 4353 of 24/02/2021. Further research is encouraged to compare different national and international layouts.

Hospital Construction Cost Affecting Their Lifecycle: An Italian Overview.

The need for 24/7 operation, and the increasing requests of high-quality healthcare services contribute to framing healthcare facilities as a complex topic, also due to the changing and challenging environment and huge impact on the community. Due to its complexity, it is difficult to properly estimate the construction cost in a preliminary phase where easy-to-use parameters are often necessary. Therefore, this paper aims to provide an overview of the issue with reference to the Italian context and proposes an estimation framework for analyzing hospital facilities' construction cost. First, contributions from literature reviews and 14 case studies were analyzed to identify specific cost components. Then, a questionnaire was administered to construction companies and experts in the field to obtain data coming from practical and real cases. The results obtained from all of the contributions are an overview of the construction cost components. Starting from the data collected and analyzed, a preliminary estimation tool is proposed to identify the minimum and maximum variation in the cost when programming the construction of a hospital, starting from the feasibility phase or the early design stage. The framework involves different factors, such as the number of beds, complexity, typology, localization, technology degree and the type of maintenance and management techniques. This study explores the several elements that compose the cost of a hospital facility and highlights future developments including maintenance and management costs during hospital facilities' lifecycle.

COVID-19 Lockdown: Housing Built Environment's Effects on Mental Health.

Since the World Health Organization (WHO) declared the coronavirus infectious disease 2019 (COVID-19) outbreak a pandemic on 11 March, severe lockdown measures have been adopted by the Italian Government. For over two months of stay-at-home orders, houses became the only place where people slept, ate, worked, practiced sports, and socialized. As consolidated evidence exists on housing as a determinant of health, it is of great interest to explore the impact that COVID-19 response-related lockdown measures have had on mental health and well-being. We conducted a large web-based survey on 8177 students from a university institute in Milan, Northern Italy, one of the regions most heavily hit by the pandemic in Europe. As emerged from our analysis, poor housing is associated with increased risk of depressive symptoms during lockdown. In particular, living in apartments <60 m2 with poor views and scarce indoor quality is associated with, respectively, 1.31 (95% CI: 1046-1637), 1.368 (95% CI: 1166-1605), and 2.253 (95% CI: 1918-2647) times the risk of moderate-severe and severe depressive symptoms. Subjects reporting worsened working performance from home were over four times more likely to also report depression (OR = 4.28, 95% CI: 3713-4924). Housing design strategies should focus on larger and more livable living spaces facing green areas. We argue that a strengthened multi-interdisciplinary approach, involving urban planning, public mental health, environmental health, epidemiology, and sociology, is needed to investigate the effects of the built environment on mental health, so as to inform welfare and housing policies centered on population well-being.

COVID-19 and Healthcare Facilities: a Decalogue of Design Strategies for Resilient Hospitals.

BACKGROUND AND AIM: The COVID-19 pandemic has upended the global healthcare systems. The surge in infections and sick critically ill patients has tested the resilience of healthcare infrastructures and facilities forcing organizations to quickly adapt and embrace emergency solutions. The paper proposes a decalogue of design strategies applicable both to new hospitals and to the refurbishment of existing hospitals. METHODS: The authors conducted observations at hospitals, during public health webinars and through experts working groups from March to May 2020. RESULTS: In this commentary, the authors present a list of strategies for creating critical care surge capacity and exploring design strategies for healthcare design for resilient hospital facilities. The strategies are organized into two tiers: I) design and II) operations. The (I) Design phase strategies are: 1) Strategic Site Location; 2) Typology Configuration; 3) Flexibility; 4) Functional program; 5) User-centerdness. The (II) Operation phase strategies are: 6) Healthcare network on the territory; 7) Patient safety; 8) HVAC and indoor air quality; 9) Innovative finishing materials and furniture; 10) Healthcare digital innovation. CONCLUSIONS: Hospitals, health care systems, and institutions urgently need to assess their resources, identify potential bottlenecks, and create strategies for increasing critical care surge capacity. The COVID-19 pandemic disrupted healthcare operations and accelerated the processes of innovation and transformation. The design and operational strategies can enable the achievement of resilient hospital facilities. Further multidisciplinary researches is needed  to validate the strategies empirically.