Learning from COVID 19. A Comparison of Innovative Design Solutions for Human-Centered Healthcare Facilities

The novel 2019 Coronavirus pandemic (COVID-19) has revealed numerous challenges in coordinating and arranging hospital spaces at both national and international level. The overwhelming number of hospital admissions of people affected by COVID-19 has highlighted difficulties in managing, updating, and refurbishing healthcare spaces. The objective of this study is to provide meta-design indications that demonstrate the value of spatial design in containing pandemic health emergencies and improving quality for different healthcare users. Utilized research methods include a review of existing literature on the current state of the art, analysis of design solutions that emerged in response to past pandemics and comparison of existing planning tools on the subject. Additionally, given the contemporaneity of the issue, a cross-sectional survey was used to collect and compare the experiences and design strategies adopted by some selected Italian hospital. The results of the study highlight the most effective and recurrent solutions that have supported health action in the fight against COVID-19. Emphasis was placed on solutions with a human-centered approach, as well as those that seek to promote the physical and psychological well-being of all users involved. In conclusion, the resulting meta-design indications represent a starting point for developing detailed design solution to enhance pandemic readiness. Additional research is needed to support healthcare facilities in becoming more welcoming and efficient while improving COVID-19 patient care and protecting healthcare workers. © 2023, The Author(s), under exclusive license to Springer Nature Switzerland AG.

(Re)thinking the city of proximity for Salutogenic purposes : Andrea Rebecchi

As centres of population and human activities, nowadays urban environments are simultaneously the main cause of and solution to a growing number of health-related challenges. In this setting, COVID-19 pandemic has helped reiterate this and serves as a wake-up call and an opportunity to rethink the way we approach cities. Aim of this paper is to research what today seems the most promising urban model for long-term individual and global resilience: the “city of proximity”, namely about inclusive walkable and cycling environments where people can access all basic destinations within reasonable times and distances from home. Therefore, urban proximity dimension, methodological approach and urban features and functions become the main subject of a quanti-qualitative matrix of comparison of five international case studies centred on the topic, by which it is possible to set out general criteria for such model, along with a methodology to measure all cities in its respect. As a result, residential density, functional mix, pedestrian surface, cycle routes, public transport stops, green areas, schools, cultural facilities, sport facilities, retail services and urban gardens make up the fix components of a comprehensive set of 11+n urban features, whose occurrence is investigated through GIS-based analysis within designated distance ranges, creating a comprehensive assessment framework that is adjustable to all urban contexts worldwide. In the end, the application of such framework to the city of Milan finally helps to validate its effectiveness in providing a picture of city-wide accessibility to proximity services, and in highlighting the value of integrated analysis in view of shaping public policies and informed planning choices which put health and sustainability at the centre.

How breaks in nature can affect the users’ wellbeing: an experience based survey during the lockdown : Marco Gola

Background In the occasion of COVID-19 pandemic in Italy, the life of citizens was greatly disrupted - from healthcare professionals to the smart workers - and consequently also the state of mood. On the basis of the scientific evidences in relation to the relationship between the built environment and health, a research group has promoted an investigation on the benefits that greenery can have on the psychophysical state of the users, especially healthcare staff and users at home. Objectives The methodology adopted is the Profile of Mood States, which provides experiential activity in nature - without any technological distraction- to evaluate the benefits on mood. The methodology adopted refer to the shorter version (34 items) designed by prof. Grove at the University of Western Australia. In relation to the COVID-19 pandemic, the experience based questionnaire is differentiated for healthcare staff and general users. The questionnaire is composed of a few questions, to be completed before and after an experience in nature of 20/30 minutes. The investigation requires to be carried out in private gardens, balcony and/or terrace with greenery, public green areas, etc. Results 300 participants (subdivided into 225 general users and 75 healthcare professionals) took part in the investigations. Data analysis highlighted the higher performances in anxiety, depression, anger, force, fatigue and confusion, in particular for users who had the experience in garden (-50/70%), and among the healthcare staff the best outcomes are related to who did the investigation during or after the workshift (-60/-90%). Conclusions Although it is well-known the benefits that nature affects positively on well-being and stress level of users, the investigation underlines that brief breaks in the nature - especially in period of great stress such as pandemic - can influence the well-being and mental health of users.

Urban Green Spaces and Public Health Outcomes: a systematic review of literature

Background As stressed by COVID-19 pandemic, urbanicity might represent a risk factor for chronic non-communicable diseases or generally impacting on healthy lifestyle, among them physical activity. Methods In light of this, we performed a systematic review aimed to explore the association between urban greenspaces and two important health indicators for both mental and physical health. In particular, our aims were to analyze the association between publicly accessible urban greenspaces exposure, and mental health outcomes (MH) and objectively-measured physical activity (PA). The review was conducted from 2000/01/01 to 2020/09/30 searching in two electronic databases: PubMed/Medline and Excerpta Medica dataBASE (EMBASE). Only articles in English were included. Results Out of 356, a total of 34 studies were included in our review, of which 19 assessed MH outcomes, the remaining dealt with PA. Only a few included studies found a non-effect or a negative effect on MH outcomes, whereas, all the others demonstrated a positive effect of urban greenspace and both MH and PA. However, our results stressed not only the importance of green space presence, but also the importance of maintenance, renovation, closeness to residential areas, the presence of interactive activities, and perceived security aspects. Conclusions To conclude, even some methodological limitations of the included studies, results are concordant in demonstrating that urban greenspaces show potentially beneficial effects on mental health and physical activity. Our results are significant for public health experts and policymakers involved in urban planning, community health promotion, and improvement of health and social equity. Key messages Urban green spaces are important factors, impacting on both physical and mental health. Policymakers involved in urban planning should pay more attention in urban green spaces.

Validation Checklist for Massive Vaccination Centers.

Abstract: Starting from the minimum requirements indicated by Lombardy Region, a validation checklist has been developed by experts in design, healthcare layout planning, hygiene and public health, planning and compliance, in order to provide managers of COVID-19 massive vaccination centers with a useful and easy-to-use tool to ensure quality, safety and efficiency of the different activities performed.

How to foster cities resilient to the COVID-19 pandemic through Urban Health strategies

Background The ongoing pandemic of COVID-19, which nowadays has exceeded 2.5 million notified infections in the world and about 200,000 deaths, is a strong reminder that urbanization has changed the way that people and communities live, work, and interact, and it's necessary to make the systems and local capacities resilient to prevent the spread of infectious diseases. How we can re-design the concept of Public Health in relation to the built environment and the contemporary cities? Methods According to the previous statements and scenario, aim of this paper is to integrate the Urban Health strategic objectives, focusing the possible responses, both immediate and medium-long term, to the current environmental, social, and economic aspects of the “period” of physical distancing. Results Immediate Actions are 01. program the flexibility of city schedules;02. plan a smart and sustainable mobility network;03. define a neighborhood services' plan;04. develop a digitization of the urban context, promoting the smart communities;05. re-think the accessibility to the places of culture and tourism. Medium-long term Actions are 06. design the indoor flexibility of domestic living spaces;07. re-think building typologies, fostering the presence of semi-private or collective spaces;08. renovate the basic care services' network;09. integrate the existing environmental emergency plans, with those related to the health emergencies;10. improve stakeholders' awareness of the factors affecting Public Health in the cities. Conclusions The Decalogue of Public Health opportunities may provide a useful basis for Designers (Architects and Urban Planners), Policy Makers, Public Health experts and Local Health Agencies, in promoting actions and policies aimed to transform our cities in healthier and Salutogenic living environments. Key messages The strategies described in this paper are at the basis of a social and infrastructural rethinking of the city, careful to the Welfare and Public Health needs. The physical distancing imposed, may have amplified population's social and health inequalities.

COVID-19 lockdown: housing built environment’s effects on mental health

Background Since the World Health Organization (WHO) declared the coronavirus infectious disease 2019 (COVID-19) outbreak a pandemic on March 11th, severe 'lockdown' measures have been adopted by the Italian Government. For over two months of stay-at-home, 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 had on mental health and wellbeing. Methods We conducted a large web-based survey on 9261 subjects in Northern Italy, one of the Regions most heavily hit by the pandemic in Europe. Participants were recruited among university staff, faculty and students. The questions included socio-demographic features of the participants;international evaluation scales designed to recognize depressive-, anxiety- and sleep-related symptoms, impulsivity, quality of life;architectural parameters investigating housing physical characteristics. Results As emerges from our analysis poor housing is associated with increased risk of depressive symptoms during lockdown. In particular, living in apartments < 60 m2, with poor quality view and indoor area is associated with, respectively, 1.31 (95CI), 1.368 (95CI), and 2.253 (95CI) time 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). Conclusions Our findings suggest housing played a major role in influencing people mental health and wellbeing during COVID-19 pandemic. We argue strengthened multi-interdisciplinary approach involving urban planning, public mental health, environmental health, epidemiology, and sociology, is needed to inform the planning implementation and monitoring of housing policies centered on population health. Key messages COVID-19 lockdown mitigation measures strongly impacted on Mental Health. Living in apartments < 60 m2, with poor quality view and indoor area significatively increase the risk of moderate and severe depressive symptoms.

SARS-CoV-2 indoor contamination: considerations on anti-COVID-19 management of ventilation systems, and finishing materials in healthcare facilities.

Abstract: Many of the devastating pandemics and outbreaks of last centuries have been caused by enveloped viruses. The recent pandemic of Coronavirus disease 2019 (COVID-19) has seriously endangered the global health system. In particular, hospitals have had to deal with a frequency in the emergency room and a request for beds for infectious diseases never faced in the last decades. It is well-known that hospitals are environments with a high infectious risk. Environmental control of indoor air and surfaces becomes an important means of limiting the spread of SARS-CoV-2. In particular, to preserve an adequate indoor microbiological quality, an important non-pharmacological strategy is represented by Heating, Ventilation and Air Conditioning (HVAC) systems and finishing materials. Starting from the SARS-CoV-2 transmission routes, the paper investigates the hospital risk analysis and management, the indoor air quality and determination of microbial load, surface management and strategies in cleaning activities, HVAC systems' management and filters' efficiency. In conclusion, the paper suggests some strategies of interventions and best practices to be taken into considerations for the next steps in design and management.

From building regulations and local health rules to the new local building codes: a national survey in Italy on the prescriptive and performance requirements for a new performance approach.

BACKGROUND: World Health Organization has highlighted the need to strengthen the relationship between health and built environment factors, such as inappropriate housing conditions. Building Regulations and Local Health Rules provide safety and building hygiene in construction practices. Currently the Italian Government is giving rise to a Building Regulation Type and the paper aims to verify the present contents of recent innovative Local Health Rules and Building Regulations of several Italian municipalities for supporting the performance approach of the future Building Regulations including hygienic issues. METHODS: The analysis examines both Building Regulations and Local Health Rules of a sample of about 550 cities, analysing some specific fields of interest: urban field, outdoor issues, housing features, housing restrictions, and qualitative aspects. RESULTS: The analysis focuses on some specific aspects defining the general data reported in Building Regulations and Local Health Rules, in particular around surfaces, heights, lighting and aeration ratio, basements and semi-basements, gas radon, building greenery, etc. CONCLUSION: The investigation permitted to have a wide vision on the present State of the Art in order to highlight some innovative aspects and design approaches of Building Regulations and Local Health Rules. New perspectives in the new regulations should have a performance approach, starting also from the recent SARS-CoV-2 pandemic.