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Over the last year, the pandemic has transformed how we think of the spaces around us. Common activities such as going to the supermarket or inviting friends into our homes pose new risks to our health. As we learn to live with the threat of Covid-19, we’ll also need to make changes to our spatial environments. But we can breathe a sigh of relief: it’s not the first time societies have had to transform their environments after a public health crisis.
In the 19th century, Britain suffered regular epidemics of diseases such as cholera, scarlet fever, typhoid and smallpox. As growing numbers of people moved into cities, more hospitals were built to house the sick. In these unsanitary, often temporary buildings, high death rates were common, prompting people to think about the role of hospital design. One of these people was Florence Nightingale, aka the Lady with the Lamp, best known for her nursing work during the Crimean war.
In her 1859 book, Notes on Hospitals, Nightingale laid out what she thought made a healthy hospital building, paying particular attention to sanitation, ventilation and air flow. For her, the ideal ward style was a “pavilion” (later renamed “Nightingale wards”). These were barracks-like quarters, detached on three sides like wings from a central corridor building, with windows at equal intervals. They separated patients from one another, reducing crowding and helping clean air to circulate.
At the time, contagious diseases were the greatest cause of death, and patients who had otherwise been recovering well in hospital would have contracted untreatable infections. Physicians and scientists were divided over the emerging field of “bacteriology” pioneered by Louis Pasteur, but there were no effective treatments or cures for these diseases, and their causes weren’t fully understood.
Nightingale’s solution was to remove contaminated air from hospitals and replace it with clean air. “Unless the air within the ward can be kept as fresh as it is without, the patients had better be away”, she wrote. Although Nightingale wasn’t the first or last person to champion the benefits of fresh air, her ideas had a lasting impact on hospital design. While hospitals have moved away from the “pavilion” model, we can still see traces of her impact in modern hospitals, where natural ventilation is recommended to prevent airborne infections.
The recognition by Nightingale and her contemporaries that healthy, well-ventilated environments could help prevent airborne diseases contributed to physicians’ and campaigners’ concerns about the lack of open spaces in crowded cities. In 1878, parliament passed the Open Spaces Act, which mandated the creation of playgrounds, parks, recreation grounds and public gardens. Between 1885 and 1914, more public parks were built in Britain than ever before.
“Light and air” became a key principle in the treatment of tuberculosis and polio during the 20th century. Across Britain, hundreds of sanatoriums for treating tuberculosis were built in the early 1900s. These adopted the model of the “open-air movement” that originated in Germany, which required patients to be outside as much as possible – often on balconies, verandas or in garden huts. Sometimes, sanatoriums were even built in a way to allow patients to sleep outside.
While sleeping outside is no cure for Covid-19, there are still lessons we can learn from the designs of Nightingale and the open-air therapies used to treat TB. Both recognised the connection between a patient’s environment and their health. Last year, we saw how Covid-19 spreads more easily in unventilated spaces, transmitting through aerosols that float on the air, and learned that gathering outside rather than indoors poses a lower risk to our health.
There are several ways we could adapt our environments to cope with the risks of Covid-19. In hospitals, the circulation of air and ventilation will be crucial. To avoid overcrowding, infection control can be improved in hospitals and medical centres by adopting one-way routes in and out of wards. Rather than seeking to build more permanent private rooms on wards, we might instead focus on improving ventilation systems that allow air to flow through them.
Preventing overcrowding in outpatient clinics will also help to reduce the threat of infection. We are likely to see the continuation of remote GP consultations and tele-medicine in the future, and a lot of care could be conducted outside health centres. The use of places such as Salisbury cathedral, with its vaulted draughty spaces, as a vaccination hub, already echoes Nightingale’s suggestions from over 160 years ago.
Outside hospitals, the pandemic has shone a light on the importance of accessible public spaces and green parks. During the lockdowns, many people have yearned for more space, particularly those in overcrowded housing where the threat of catching Covid-19 is greater. For people who don’t have access to a garden, parks and public spaces are an essential resource. Moreover, green spaces planted with plenty of trees help tackle high levels of air pollution, which is shown to exacerbate Covid-19 symptoms. As it was for Nightingale, clean air should be an important aspect in how we deal with Covid-19.
Even if we can’t change our immediate domestic spaces, we can make long-term changes to our actions in the spaces we share with others. Over the next year, we are likely to see the continuation of physical distancing in public places. To prevent transmission, sick people must be properly remunerated to stay at home and employers should be supportive of home working. We will need to rethink how we ventilate workspaces, restaurants and other places where people gather, and it will be crucial that people have adequate access to green spaces. Marshalling the lessons of the past, when societies adapted their environments to prevent the spread of disease, seems like a good place to start.
Source: The Guardian
Keyword: What would Florence Nightingale prescribe to fight Covid? Fresh air | Infectious diseases