GRACELAND ARCHITECTS RESPONSE TO COVID-19 OUTBREAK Prepared for: Advanced Draft

Prepared by: Graceland Architects

09 March 2020

Proposal number: 0001/GA/R0

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Introduction 3

Graceland Architects and the design of HLIU and Public Health Laboratories 3

HIGHLY INFECTIOUS DISEASE DEFINITION 3

HIGH LEVEL ISOLATION UNIT DESIGN CONSIDERATIONS 3

EUNID: ISOLATION ROOMS FOR HID: AN INVENTORY OF CAPABILITIES IN EUROPEAN COUNTRIES 4

WHO: ADVANCED DRAFT SEVERE ACUTE RESPIRATORY INFECTIONS TREATMENT CENTRE 5

Conclusion 5

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INTRODUCTION The President of the Republic of South Africa declared the COVID-19 outbreak a State of National Disaster. This categorisation triggers several responses at all levels of society.

The president outlined stringent measures to curb the spread of infection within the republic and has asked the citizens of South Africa to stand together against the worldwide pandemic and now, the local epidemic.

In response to the president’s directives, Graceland Architects has prepared a protocol document identifying and defining the company’s response to the COVID-19 outbreak as well as a primer for the ongoing research currently underway at Graceland Architects regarding the design and construction of High Level Isolation Units

GRACELAND ARCHITECTS AND THE DESIGN OF HLIU AND PUBLIC HEALTH LABORATORIES Highly contagious outbreaks in the future are without doubt. The response to these outbreaks will determine the recovery of patients.

Graceland Architects’ goal of designing for health has led to researching the requirement for the design of High Level Isolations Units(HLIUs) and attendant Public Health Laboratories.

The following is a brief summary of research currently underway at Graceland Architects to ensure we understand the design requirements for HLIUs and BSL 3 and BSL 4 containment facilities.

Response to the design and construction of HLIUs should be risk responsive, that is to say that designers should not carry out ‘checklist design methods’ but rather understand the contextual risk response management plan. This allows for a far more responsible approach to the design and construction of HLIU facilities.

The move away from ‘checklist design methods’ to risk responsive design methods have been borne out through discussions held with the Centre for Scientific and Industrial Research.

Highly Infectious Disease Definition The WHO defines Highly Infectious Diseases as:

“Infectious diseases are caused by pathogenic microorganisms, such as bacteria, viruses, parasites or fungi; the diseases can be spread, directly or indirectly, from one person to another. Zoonotic diseases are infectious diseases of animals that can cause disease when transmitted to humans.”

High Level Isolation Unit Design Considerations Graceland Architects is researching and familiarising itself with the studies carried out by the EUNID and the WHO. The documents outline responses to the design of HLIU units with specific focus on developed and developing nations. Further to this desktop research, consultation with the CSIR has been carried out.

A brief synopsis of the EUNID study is outlined below. A summary of the WHO advanced Draft will follow shortly.

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EUNID: Isolation rooms for HID: an inventory of capabilities in European countries The European Network for Infectious Diseases (EUNID) co-funded a study with the European Commission involving 16 member states of the European Union.

The study revealed several key areas that require attention when designing and constructing an HLIU and attendant BSL 3 and BSL 4 Laboratory.

• Be colocated with a tertiary referral hospital, either in an entirely separate building on the same site, or as a separate unit (with a secure, controllable, entrance/exit route) within the hospital

• Be designed and constructed in compliance with relevant national, and local regulations and codes

• Have a separate, securable, entrance; double, inter-locking doors are ideal

• Be designed internally so that movement of “clean” and “contaminated” staff, patients, and equipment through the unit ensures segregation of “clean” and “dirty” areas

• Have integral autoclave facilities, or safe access to pre- identified, dedicated autoclave facilities

• Have an integral BSL3 or equivalent laboratory, or access to one in close proximity on the same campus

• Have an adequate storage area for large equipment

• Have adequate storage space for supplies of personal protective equipment, pharmaceuticals (including controlled drugs), and clinical supplies

• Have a sealable area for decontamination of large equipment

• Have a designated area for handling and packaging clinical waste

• Have an area for the temporary safe-keeping of deceased patients, large enough to contain and decontaminate trolleys, sealable coffins, and other mortuary equipment

• Have a staff rest area

• Have a staff office area

• Have staff changing and showering facilities

• Have a decontamination shower

• Be designed and constructed for ease of cleaning and decontamination (eg, seamless floors and walls, solid horizontal surfaces)

• Have building, electrical, ventilation, and other systems that are designed and constructed for easy and safe access for maintenance

• Have a safe, securable pathway for emergency evacuation of staff and patients

• Have a connection to an emergency power-generating system

• Have standard life-safety systems (eg, automatic sprinkler systems) with an independent airflow shutdown system

Further detail in the design of isolation cubicles has been identified and the following should be incorporated:

Patient isolation rooms in the HLIU should:

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• Be large enough to contain the specialist equipment (eg, mechanical ventilator, haemofiltration machine, monitoring equipment) needed for critical care, and to allow free movement by staff wearing personal protective equipment

• Have a self-closing door, with well-fitted, durable, door seals

• Have a non-hand operated wash basin for clinical use in the patient’s room

• Have a non-hand operated wash basin for clinical use in the anteroom

• Have an en-suite bathroom (toilet, hand basin, and shower); entrance to bathroom should be from within the patient’s room, not the anteroom

• Have a system for visually monitoring the patient and room from the outside, which is flexible enough to maintain patient privacy, dignity, and safety

• Have a high-quality patient–clinician communication system

• Have a high-quality clinician–clinician communication system

• Have an emergency alarm system so that help can be summoned immediately if need be

• Have an anteroom (or equivalent designated area) large enough to store immediately necessary personal protective equipment and clinical supplies (eg, intravenous fluids and tubing, syringes, dressings, specimen containers)

• Have an adequate area for packaging clinical specimens and for decontaminating outer specimen containers

• Be designed and constructed for ease of cleaning and decontamination

• Have sealed windows

• Be designed and constructed to be as airtight as possible (ie, monolithic ceilings, tightly fitting doors and windows, door grill designed for a controlled air path); other design features that enhance the functionality of the ventilation system may also be desirable (eg, interlocking door system, with clinician controlled override function, which ensures that the patient room–anteroom door and anteroom–corridor door cannot both be opened at the same time)

WHO: Advanced Draft Severe Acute Respiratory Infections Treatment Centre A February 2020 version of the World Health Organisation’s Advanced Draft Severe Acute Respiratory Infections Treatment Centre in Developing countries was released for review.

We are currently in the process of dissecting the document and making sure we understand the requirements put forward by the WHO. The draft document concentrates on developing nations, therefore this document will have direct impact on the South African response to Highly Infectious Diseases

CONCLUSION Graceland Architects designs for health. With that in mind we have to respond to global trends and requirements regarding healthcare provision.

Our research into High Level Isolation Units and Bio Safety Level 3 and 4 Laboratories allows us to respond the needs of Patients, patient visitors, Healthcare Workers and Hospital Operators.

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