T?chne：面向新冠肺炎的多學(xué)科應(yīng)答
——來自非洲和歐洲的案例

米歇爾·迪馬爾科，瓦萊麗婭·費(fèi)德里吉，盧卡·豐塔納/Michele Di Marco, Valeria Federighi, Luca Fontana

作者單位：米歇爾·迪馬爾科，T?chne，世界衛(wèi)生組織 瓦萊麗婭·費(fèi)德里吉，都靈理工大學(xué) 盧卡·豐塔納，世界衛(wèi)生組織

新冠肺炎治療中心正迅速成為一種新的建筑設(shè)計類型。它誕生于應(yīng)急時刻，又隨著每個新的設(shè)計項(xiàng)目而變得更加高效——每個項(xiàng)目都試圖最大化流線系統(tǒng)和技術(shù)系統(tǒng)在抑制病毒傳播上的潛能。在這場疫情爆發(fā)逾10 個月之后，很顯然，當(dāng)某個社會的整體醫(yī)療體系越脆弱，它所受疫情的影響也越嚴(yán)重。因此，多種設(shè)計策略正在全球不同環(huán)境進(jìn)行測試；它們作為新的健康醫(yī)療設(shè)施概念，在多個層面確立了標(biāo)準(zhǔn)：設(shè)計與建造速度、室內(nèi)空氣流通的組織、通風(fēng)系統(tǒng)與流線系統(tǒng)的創(chuàng)新性整合。2020 年3 月，各類國際組織逐步意識到全球正經(jīng)歷著前所未有的危機(jī)，而國家衛(wèi)生系統(tǒng)——無論國家富有與否——都對于即將到來的挑戰(zhàn)措手不及，世界衛(wèi)生組織為此成立了“醫(yī)療技術(shù)科學(xué)網(wǎng)絡(luò)”（T?chne）：一個為支持其成員國建設(shè)醫(yī)療設(shè)施等特殊任務(wù)的實(shí)操性機(jī)構(gòu)。

成立T?chne 是世衛(wèi)組織應(yīng)對新冠肺炎疫情所采取的諸多措施之一，更準(zhǔn)確地說是為了回應(yīng)快速建造醫(yī)療設(shè)施的廣泛需求，以此收治感染的及傳染性的病人，同時減小醫(yī)護(hù)人員及其他就診人員的內(nèi)部感染風(fēng)險。作為一個多學(xué)科合作平臺，T?chne為各類設(shè)計提供遠(yuǎn)程指導(dǎo)：包括修建新冠肺炎醫(yī)療設(shè)施，將現(xiàn)存建筑改用為隔離、檢測及診療中心，以及新冠疫情常態(tài)化階段的現(xiàn)存醫(yī)療設(shè)施改造——讓醫(yī)療設(shè)施變得更具韌性、更為靈活，從而在應(yīng)急時刻發(fā)揮作用。

在過去的5 個月里，T?chne 逐步成為一個聯(lián)合了世衛(wèi)組織各部門以及全球多所專業(yè)科研機(jī)構(gòu)的合作網(wǎng)絡(luò)。T?chne 的成員包括國際知名的大學(xué)和科研院所，支持世衛(wèi)組織履行職責(zé)并實(shí)現(xiàn)當(dāng)下目標(biāo)。在這些不斷加入的學(xué)術(shù)機(jī)構(gòu)支持下，T?chne 利用自身的技術(shù)優(yōu)勢及特長，為各個向世衛(wèi)組織地方辦公室申請援助的國家機(jī)構(gòu)提供支持。

1 T?chne的新冠疫情支持/COVID-19 T?chne support

2 T?chne的新冠疫情工作模型/COVID-19 T?chne model of work

T?chne 的核心優(yōu)勢是其多學(xué)科協(xié)同路徑，這依托于世衛(wèi)組織內(nèi)部的專業(yè)技能，及其來自建筑、工程、醫(yī)學(xué)等國際學(xué)術(shù)機(jī)構(gòu)的成員帶來的技術(shù)能力及科學(xué)方法。盡管該組織的創(chuàng)建初衷是應(yīng)對新冠肺炎疫情相關(guān)的特定需求，但如今這個不斷壯大的跨學(xué)科團(tuán)體不僅能應(yīng)對疫情，還能夠預(yù)防和最小化復(fù)雜緊急事件和自然災(zāi)害造成的健康后果。

T?chne 背后的創(chuàng)新理念是，醫(yī)療設(shè)施的實(shí)體空間——它的設(shè)計及配置——能夠確保它發(fā)揮正確作用，開展恰當(dāng)?shù)尼t(yī)護(hù)工作，提升社區(qū)的支持能力，減小病人和醫(yī)護(hù)工作者的交叉感染風(fēng)險。同時，空間方面的知識尚未完善：一條結(jié)合設(shè)計、防疫措施、流行病學(xué)知識的多學(xué)科路徑也是必須的。

具體來說，T?chne 的核心目標(biāo)是：

（1）根據(jù)世衛(wèi)組織的最新指導(dǎo)標(biāo)準(zhǔn)，為醫(yī)療設(shè)施及傳染病治療設(shè)施的建設(shè)提供結(jié)構(gòu)及技術(shù)設(shè)計圖紙；

（2）針對世衛(wèi)組織收到的特定求助，協(xié)助制定技術(shù)報告和指導(dǎo)意見；

（3）通過分析與特定設(shè)施的結(jié)構(gòu)相關(guān)的潛在危險因素，協(xié)助設(shè)施的資本化過程；

（4）研究能夠快速建造傳染病治療中心的技術(shù)應(yīng)用；

（5）建立相關(guān)教育項(xiàng)目，培訓(xùn)緊急醫(yī)療設(shè)施的設(shè)計以及突發(fā)性疫情響應(yīng)的管理工作。

T?chne 為應(yīng)對迥異的環(huán)境及特定需求，已發(fā)展出非常多樣的結(jié)構(gòu)類型，經(jīng)過7 個多月的探索，包括了傳統(tǒng)結(jié)構(gòu)（16 個項(xiàng)目請求）、帳篷結(jié)構(gòu)（8個項(xiàng)目請求）、預(yù)制結(jié)構(gòu)或集裝箱（10 個項(xiàng)目請求）。通過這些項(xiàng)目，T?chne 的設(shè)計幫助在南美、非洲、歐洲和澳洲各地建造了1900 個救治新冠肺炎病人的床位（圖1）。

我們的技術(shù)支持被送往世衛(wèi)組織國家會員、衛(wèi)生部及其他部門、聯(lián)合國各部門、國際及國家組織、醫(yī)療管理者，他們通過所在地的世衛(wèi)組織地區(qū)辦公室，與T?chne 進(jìn)行溝通。

一種創(chuàng)新工作模式：4個案例

借助T?chne 的多學(xué)科技術(shù)支持，世衛(wèi)組織得以在8 天內(nèi)就為申請者提供一套完整響應(yīng)方案，包括相應(yīng)的技術(shù)圖紙和示意圖，來新建或?qū)F(xiàn)有設(shè)施改造為能夠滿足新冠肺炎救治最低要求的醫(yī)療中心（圖2、3）。

圖2 展現(xiàn)了不同工作階段的理想工作流程：世衛(wèi)組織的戰(zhàn)略衛(wèi)生行動組（SHO）是世衛(wèi)組織地區(qū)辦公室、申請援助的地方相關(guān)者以及T?chne 的技術(shù)支持網(wǎng)絡(luò)之間復(fù)雜溝通過程的支點(diǎn)。圖3 則追溯了設(shè)計過程中各相關(guān)方之間的溝通流程，包括從行動開始到最終落成過程中的討論和更新。在各個案例中，首先是由申請者向世衛(wèi)組織地區(qū)辦公室發(fā)出

COVID-19 treatment centres are rapidly becoming a new design typology, born in a time of emergency and becoming more effective as each new design attempts to maximise the potential of distributive systems as well as technical systems in containing the spread of the disease. After more than ten months from the onset of the pandemic, it is clear that the more vulnerable the healthcare system is, the harder the impact of the pandemic is on the society as a whole. Therefore, a number of design solutions are being tested in different contexts around the world and, as new healthcare facility concepts, have set the bar in different respects: velocity of design+construction, organisation of internal flows, innovative combination of ventilation and distributive systems. In March 2020, as international institutions of varying nature were grappling with the realisation that the world was undergoing an unprecedented crisis, and that national health systems – in wealthy and less-wealthy countries alike – were unprepared for what was about to come, the World Health Organisation (WHO) established T?chne, an operative branch to support its members in the specific task of readying their healthcare facilities.

T?chne is part of the response of WHO to the COVID-19 pandemic and more precisely to the widespread need to rapidly set up health facilities that are able to hospitalise infected and infectious patients while reducing the risk of nosocomial infections amongst healthcare workers and other patients seeking care. As interdisciplinary platform, T?chne provides remote support for the design process of new COVID-19 facilities, repurposing existing building into self-quarantine, screening and treatment centres as well as reshaping existing healthcare facilities for the COVID-19 post-acute phase in order to make health structures more resilient and flexible therefore able to easily surge in case of need.

In the course of almost five months, T?chne has incrementally shaped as a network of WHO departments together with several technical universities and institutions around the world. T?chne members are internationally recognised universities and institutions that support WHO in implementing its mandated work and achieving its current goal. As we write, T?chne is composed of universities and technical institutions that, as part of a growing network, make their technical knowhow and competencies available for institutions of various nationalities applying for support to WHO regional offices.

T h e c o r e s t r e n g t h o f T ? c h n e i s i t s multidisciplinary approach, which relies on the internal knowhow of WHO as well as the technical competencies and scientific approach brought by T?chne's members, which include international Architecture, Engineering and Medical universities and institutions. W hile the network was conceived to meet specific needs connected to the COVID-19 pandemic, it is now developing into a multidisciplinary group able to respond not only to epidemics, but also to prevent and minimise the health consequences of complex emergencies and natural hazards.

The innovative idea behind T?chne is that the physical space of a healthcare facility, its design and its configuration, are essential to assure a correct functioning, allowing proper medical care, enhancing community support and reducing the risk of nosocomial infections for patients and healthcare workers. At the same time, spatial knowledge is not sufficient: a multidisciplinary approach, combining design, infection prevention and control understanding and an epidemiological overview of the disease, is likewise necessary.

Specifically, T?chne core objectives are:

(a) Supporting WHO in developing structural and technical drawing for healthcare structures and infectious disease treatment facilities according to latest WHO guidance;

(b) Contributing to technical report and guidance for specific ad-hoc support requests received by WHO;

(c) Contributing in the capitalisation process through analysis of potential risks factors linked to the specific facility's structural aspects;

(d) Investigating the use of technology for rapid deployment of infectious disease treatment centre;

(e) Developing education programmes on emergency health facility design and management for different outbreaks preparedness and response.

T?chne already responded to a wide array of context specific needs including a high variability of types of structures, which, after almost 7 months of activity, include traditional structures (16 requests), tent structures (8 requests), prefab structures or containers (10 requests). Through its responses T?chne led to the construction of more than 1900 beds for COVID-19 patients across South America, Africa, Europe and Australia (Fig. 1).

The support is addressed to State Members, Ministries of health and other Ministries, UN agencies International and national organisations, health managers, that apply to their respective WHO regional office which, in turn, manages the exchange with T?chne.

An Innovative Model of Work, in Four Projects

Thanks to its multidisciplinarity and the support coming from T?chne, WHO can provide a complete response within 8 days, delivering to applicants layouts and diagrams to set up or repurpose existing facilities into treatment centres able to meet the COVID-19 minimum requirements (Fig. 2,3).

Figure 2 shows the ideal flow of work through the various phases of work: the WHO Strategic Health Operation Unit (SHO) works as pivot of a complex process of exchange between WHO Regional Office, local stakeholders applying for support, and the technical network of T?chne. Figure 3 traces exchanges between the different actors involved through the design documents that are discussed and updated from the onset of the operation until the final deliverables. In each case, a request technical document is sent from the applicant to the WHO Regional Office, which, in turn, forwards it to the Strategic Health Operation Unit (SHO). The SHO selects one or more local experts to provide details and local technical support, as well as one or more T?chne members that have the required expertise 一份技術(shù)申請文件，這個文件隨后會被發(fā)送至戰(zhàn)略衛(wèi)生行動組。該行動組會選擇一位或多位當(dāng)?shù)貙＜襾硖峁┘夹g(shù)支持申請的相關(guān)細(xì)節(jié)，同時選擇一個或多個具備相關(guān)技能專長的T?chne 成員。這份技術(shù)申請文件會由世衛(wèi)組織地區(qū)辦公室向工作組的所有成員公示。相關(guān)T?chne 成員會和當(dāng)?shù)貙＜乙黄?，提出第一版方案初稿，并交由?zhàn)略衛(wèi)生行動組討論。經(jīng)過必要修改之后，正式方案將擬定為一份技術(shù)報告，呈遞戰(zhàn)略衛(wèi)生行動組，同時作為最終成果移交世衛(wèi)組織地區(qū)辦公室及申請者。在接受技術(shù)報告20天內(nèi)，申請者需要提交一份反饋報告，戰(zhàn)略衛(wèi)生行動組的團(tuán)隊會負(fù)責(zé)修正方案。

這樣的工作模式讓戰(zhàn)略衛(wèi)生行動組作為每一次工作的實(shí)際協(xié)調(diào)者，在多樣性的案例和技術(shù)支持類型中逐步摸索出一個清晰的行動范式。下面的幾個案例是T?chne 在過去幾周支持的項(xiàng)目，也示例呈現(xiàn)了在這樣廣泛的地理多樣性條件下所必須的多種路徑。

1 加納：新冠肺炎臨時救治中心

阿克拉的臨時救治中心臨近機(jī)場，面積超過10 萬m2。它由7 座縱向分布的長帳篷組成，建造僅花費(fèi)3 周時間。阿克拉的救治中心項(xiàng)目是由世衛(wèi)組織與世界糧食計劃署合作的結(jié)果。這座新建筑主要會作為西非和中非國家的聯(lián)合國員工及國際人道主義救援者的應(yīng)急醫(yī)院。在這一過程中，T?chne 接到的任務(wù)是做一項(xiàng)流體力學(xué)分析，讓建筑單元滿足最低力學(xué)要求，并成為設(shè)計深化的基礎(chǔ)單元。

這個項(xiàng)目嚴(yán)格遵照T?chne 的行動流程。在接到請求后，T?chne 成員需要采用計算流體力學(xué)模擬軟件，研究用于收治新冠肺炎輕癥患者的病患空間。他們的任務(wù)是分析設(shè)施中的空氣流向及散布反向——尤其是在病人區(qū)——以確保及時稀釋和排除病人周邊的空氣。這項(xiàng)研究中，還進(jìn)行了不同設(shè)計策略的分析比較，以測試對現(xiàn)有通風(fēng)條件的改良效果。

由于事態(tài)緊急，這座醫(yī)療設(shè)施被設(shè)計為一座輕型結(jié)構(gòu)，一個鋼框架體系支撐著兩層織物表皮，織物之間的空氣隔層確保室內(nèi)外有7℃溫差。這個模數(shù)化結(jié)構(gòu)的運(yùn)行還有賴于機(jī)械通風(fēng)系統(tǒng)，系統(tǒng)配備了高效空氣過濾器，從而滿足新冠肺炎醫(yī)療設(shè)施的最低限通風(fēng)要求。團(tuán)隊完成多項(xiàng)計算通風(fēng)模擬分析，以評估和推薦最合適的建筑體系（圖4）。

每座大帳篷都沿著一條中央廊道展開，這條廊道是建筑流線系統(tǒng)的中樞，兩側(cè)病房由輕質(zhì)隔墻分隔，一系列小帳篷將大帳篷連接起來。

這個項(xiàng)目也成為即將實(shí)行的類似項(xiàng)目的試驗(yàn)場：一座類似結(jié)構(gòu)將在維羅納的空軍基地建造，作為在機(jī)場等地確診的境外輸入病例的救治及隔離設(shè)施。由于申請者要求有一個負(fù)壓獨(dú)立倉，T?chne專門對通風(fēng)系統(tǒng)進(jìn)行反復(fù)校驗(yàn)，確認(rèn)是否需要技術(shù)修正或調(diào)整。所有這類聯(lián)合國設(shè)施都是在意大利布林迪西設(shè)計的，那里有一個世界糧食計劃署的分支機(jī)構(gòu)（聯(lián)合國人道主義應(yīng)急倉庫）。

3 T?chne的工作模型應(yīng)用于4個項(xiàng)目/T?chne model of work applied to four projects

4 臥床病人周圍的通風(fēng)系統(tǒng)分析，定義每個單元和帳篷的總體布局/Analysis of ventilation system around supine patient, defining each unit and the general layout of the pavillions （圖片來源/Courtesy: T?chne）

2 布基納法索：災(zāi)害韌性的新冠肺炎救治中心

這座新冠肺炎救治中心是一棟新建磚砌單層建筑，面積約3300m2。世衛(wèi)組織國家辦公室和該國衛(wèi)生部一起提出請求，由T?chne 設(shè)計一棟永久建筑，需滿足如下條件：核驗(yàn)并隔離外來人員（因叛亂而從其他城市避難至此，或是因工作原因從拉各斯或阿布賈等中心城市來到這里）；識別并隔離無癥狀病例；識別并隔離新冠肺炎的輕癥患者。這個設(shè)計試圖尋找一種創(chuàng)新解決方案，能夠應(yīng)對各類傳播方式不同的傳染病——霍亂、出血熱、空氣傳播疾病等。盡管新冠肺炎在非洲已有超過62 萬病例，但其他傳染病仍是日常威脅，例如在剛果（金）的赤道省正爆發(fā)的埃博拉疫情（圖5）。

在方案討論過程中，出現(xiàn)了最大化自然通風(fēng)以滿足最低限度衛(wèi)生需求的可能性，并發(fā)展為最終方案。這個設(shè)計目前正在等待審批，它采取了一個盡and know-how. The request technical document is presented by the WHO Regional Office to all members of the working group. The specific T?chne members, together with the local experts, work on a first draft proposal which is presented to the SHO for discussion. Following necessary revisions, the proposal is formalised into a technical report which is presented to the SHO and then forwarded to the WHO Regional Office as well as the applicant as final deliverable. Within 20 days from the reception of the technical report the applicant is asked to send a feedback report, which the SHO team is in charge to revise.

This model of work allows SHO, as operative coordinator of each operation, to follow a clear protocol within a wide variety of different cases and types of support requests. The following are a few projects that T?chne supported in the past weeks, and that exemplify the variety of approaches that are necessary in order to work in such geographical variability.

1 Ghana: Temporary COVID-19 Treatment Centre

The treatment centre in Accra is located nearby the airport over a surface of 100,000 square metres. It is organised as a cluster of 7 longitudinal pavilions, it was constructed in the course of 3 weeks. The project for the Accra treatment centre is the result of a joint effort between WHO and World Food Programme (WFP). The newly-built structure is intended to be used as an emergency hospital for UN staff and international humanitarian workers in West and Central African countries. Within this process, T?chne was asked to develop a fluid dynamic analysis that would allow to meet minimum requirements and would work as a base unit for the development of the design.

The project closely followed the basic protocol of T?chne. Upon receiving the request, the T?chne member was asked to investigate the design of the patient space designated for patients with mild symptoms of COVID-19 via the use of computational fluid dynamics (CFD). The task was to analyse the airflow direction and dispersion throughout the facility – and in particular the patient bays – to ensure adequate dilution and extraction of contaminants generated by patients. During the investigation alternate designs were analysed to test improvements to the current ventilation strategies.

Due to the emergency, the facility was designed as a light structure, with a metal frame supporting two strata of fabric that enclose a layer of air providing a thermal difference of 7℃ between the inside and the outside. The modular structure counts as well on a mechanical ventilation system equipped with HEPA filters which allow it to meet the minimum requirements for ventilation within a COVID-19 facility. Several computational fluid dynamic studies have been done to assess and recommend the most suitable systems (Fig. 4).

Each pavilion is organised around a central corridor acting as the main distributive system, light partitions dividing each patient booth, and a series of sub-pavilions connecting each pavilion to the next.

The project also worked as testing ground for similar projects to be implemented: a similar structure will be installed in Verona within the military air force camp, to be used as a treatment and isolation facility for patients identified at points of entry such as airports. As the applicant is requesting an individual room with negative pressure, T?chne is carrying out initial studies on the ventilation system to check whether any adjustments or modifications are needed. All UN structures of this kind are prototyped in Brindisi (Italy) for the World Food Programme that has a spinoff there (UNHRD).

2 Burkina Faso: COVID-19 Treatment Centre Resilient to All-Hazards

This COVID-19 treatment centre is a new brick, one-floor structure of around 3300 square metres. The WHO Country Office, together with the Ministry of Health, asked Techne to give support through the design of a permanent structure which would allow to: identify and isolate new arrivals (which would arrive from another town because of insurgency, or from main centres like Lagos or Abuja because of work); identify and isolate asymptomatic cases; identify and isolate those who are showing early symptoms of COVID-19. The idea was to develop an innovative solution that would be able to respond to a diverse array of infectious diseases regardless of the mode of transmission: cholera, hemorrhagic fevers, airborne diseases, etc. While COVID-19 is impacting Africa with more than 620,000 cases, other communicable diseases are and remain a daily threat, as shown by the ebola outbreak currently ongoing in the Equator Province in the Democratic Republic of Congo (Fig. 5).

In the course of the exchange, the possibility of maximising natural ventilation so as to meet minimum requirements emerged and was turned into a finalised proposal. The design, which is now pending approval, revolves around one layout designed to be as flexible as possible, for responding to several infectious diseases needs without the need of major adjustments. The design material delivered to the applicant included drawings, 3D, video and schemes showing the different flows of patients, healthcare workers and visitors as well as minimum ventilation requirements per area and use of PPE according to the latest WHO guidance.

3 Nigeria : Self-Quarantine for IDP Camps

The International Organisation for Migration (IOM) approached WHO with a request for support in the development of a design for spaces where people and families entering camps can spend a period of quarantine. The main requirement was for the structure to be an emergency-like shelter with integrated washing facilities per unit as well as front porch with cooking options. In the high-medium income settings, quarantine for asymptomatic individuals and mild-moderate cases is generally carried out at home. In most low-income settings, and especially in fragile contexts such as Internally Displaced People (IDP) Camps, informal settlements and refugee camps, quarantine is more difficult to carry out because of an obvious lack of facilities and infrastructures, but necessary in order to avoid the spread of the disease which would then prove even more difficult to be contained in an overcrowded and dense built environment. This project is intended to describe the core objective of a COVID-19 Selfquarantine facility and its functioning as the protective and preventive system for camps and camplike setting, supporting governments in including people affected by humanitarian crises within the outbreak readiness and response strategies.

The facility proposed by the WHO is meant to be placed next to the main camps in order to allows a safe, controlled, dignified and comfortable selfquarantine for new arrivals in order to (a) limit human to human transmission, including reducing secondary infections among close contacts and healthcare workers, preventing transmission amplification events, strengthening health facilities, identifying and provide optimised care for infected patients early, communicating critical risk and information to all communities, and 可能靈活的平面布局，從而在無需顯著調(diào)整的前提下應(yīng)對不同類型的傳染病。提交給申請者的設(shè)計材料包括圖紙、三維模型、視頻及使用方案，展示了病人、醫(yī)護(hù)工作者及訪客的不同流線；以及根據(jù)最新世衛(wèi)組織指導(dǎo)方案，如何滿足單位面積的最低通風(fēng)要求并采取個人防護(hù)措施。

3 尼日利亞：國內(nèi)收容營的自我隔離

國際移民組織向世衛(wèi)組織發(fā)出支持請求，需要設(shè)計一處可供初進(jìn)收容營的個人或家庭進(jìn)行一段時間隔離的設(shè)施。對這座設(shè)施的主要要求是，它應(yīng)該發(fā)揮類似應(yīng)急避難所的作用，每個居住單元應(yīng)配有盥洗設(shè)施以及可用于烹飪的前門廊。對大部分中高收入者而言，無癥狀患者及輕微癥狀患者通常在家進(jìn)行隔離。而對大部分低收入者而言，尤其是在類似收容營、非正規(guī)聚落、難民營這類脆弱環(huán)境下的人群，隔離會較難進(jìn)行，因?yàn)樗麄冿@然缺乏必要的設(shè)備和基礎(chǔ)設(shè)施；但這對于避免疾病傳播又非常必要，而這類過度擁擠和高密度的居住環(huán)境會讓隔離變得更困難。這個項(xiàng)目試圖摸索新冠肺炎自我隔離設(shè)施的基本目標(biāo)，以及它如何成為難民營或類似環(huán)境下的保護(hù)及預(yù)防體系，支持政府去幫助那些受人道主義危機(jī)威脅的人群，賦予其應(yīng)急準(zhǔn)備和回應(yīng)策略。

世衛(wèi)組織建議建造的設(shè)施位于主收容營近旁，為新到者提供了一處安全、受約束、有尊嚴(yán)而舒適的自我隔離場地，以減少人際傳染——包括降低密切接觸者及醫(yī)療工作者的二次感染風(fēng)險，避免可能擴(kuò)大感染范圍的活動，完善醫(yī)療設(shè)施，盡早識別感染患者并提供優(yōu)化治療，將關(guān)鍵風(fēng)險信息傳達(dá)給所有社區(qū)，以及辟謠等。這個項(xiàng)目與T?chne 大部分其他項(xiàng)目不同，其設(shè)計請求是類型化的：T?chne將設(shè)計一個收容營的理想模型，這個圖解式方案將經(jīng)過微調(diào)后應(yīng)用于多個實(shí)際項(xiàng)目（圖6）。

T?chne 提出的方案包括一個居住區(qū)，以及配套的入住、篩查和醫(yī)療區(qū)域。隔離區(qū)域的大片居住區(qū)由一組獨(dú)立結(jié)構(gòu)組成，包括5 座單間單元（每套單間最多可容納兩人）以及兩座雙間單元（每套雙間最多可容納4 人）。每個單元都配備了廚房角、廁所、淋浴設(shè)施、床位及一個面向中心庭院的小平臺。單元之間用矮墻隔開，保持視線溝通的同時確保必要的社交距離。

5 布基納法索治療中心的分布系統(tǒng)/Distributive system of the Burkina Faso treatment center （圖片來源/Courtesy: T?chne）

國際移民組織用本設(shè)計在尼日利亞東北部建造了一處自我隔離設(shè)施。該設(shè)施實(shí)現(xiàn)了設(shè)計中的居住方案，而醫(yī)療區(qū)域則沒有建造。

4 意大利：未來的醫(yī)院

該項(xiàng)目始于博洛尼亞醫(yī)院提出的協(xié)助應(yīng)對新冠肺炎緊急情況的申請，當(dāng)時意大利衛(wèi)生系統(tǒng)正面臨危機(jī)，經(jīng)受著病房人滿為患、醫(yī)護(hù)人員嚴(yán)重不足的考驗(yàn)。在第一次頭腦風(fēng)暴之后，項(xiàng)目的定位提高，希望能設(shè)計一個未來醫(yī)院的示范項(xiàng)目。醫(yī)院要求在應(yīng)急響應(yīng)組織的各個層面提供技術(shù)支持，包括基本醫(yī)療健康層面：為了找出應(yīng)對這種復(fù)雜度的方案，世衛(wèi)組織投入大量時間和人力，包括一位來自戰(zhàn)略衛(wèi)生行動組的專員負(fù)責(zé)流程，與醫(yī)院管理及其技術(shù)部門人員、以及若干位參與設(shè)計工作的T?chne 成員密切合作。這個項(xiàng)目被選為示范項(xiàng)目，主要出于以下原因：它臨近一個新冠肺炎高發(fā)地區(qū)；它能夠比其他類似境況的醫(yī)院更好地控制醫(yī)護(hù)人員感染；它已經(jīng)集聚了一批創(chuàng)新成果，并投資于可再生能源、綠植屋頂?shù)软?xiàng)目。

這座醫(yī)院的城市尺度總平面是在1925 年由工程師朱利奧·馬爾科維吉設(shè)計的，它由25 棟5 層高的建筑組成，容納了不同的病房，自建成以來未經(jīng)歷大幅改造。項(xiàng)目由世衛(wèi)組織與博洛尼亞醫(yī)院合作，試圖通過重新思考使用者的進(jìn)入、離開和移動流線，將其改造為一棟韌性建筑。房間里不會布置超過兩個床位——醫(yī)院的容量會隨之減小，為此地方管理者需合理地應(yīng)對。

第一棟重點(diǎn)改造的建筑是婦產(chǎn)科病房，這一病房是在疫情的第一階段危機(jī)最嚴(yán)重的區(qū)域，僅次于急救室。如今規(guī)范要求，在醫(yī)院外部需設(shè)置一處檢驗(yàn)篩查設(shè)施，包括分診室、等候室、化驗(yàn)室等；此外，還將設(shè)置一條非新冠肺炎患者可以穿行整座醫(yī)院的流線。設(shè)計理念是避免新冠肺炎區(qū)及非新冠肺炎區(qū)之間的空間區(qū)隔，而通過嚴(yán)格但靈活的流線區(qū)分來徹底控制感染，這樣，醫(yī)院也能夠韌性地應(yīng)對其他傳染?。▓D7）。

設(shè)計在控制疫情方面能發(fā)揮怎樣的作用？

在西非疫情爆發(fā)期間，盡管相關(guān)領(lǐng)域的機(jī)構(gòu)和組織仍在建立和改善應(yīng)對埃博拉疫情的經(jīng)驗(yàn)，但科學(xué)界也見證了顯著的研究進(jìn)展，這帶來了專屬的疫苗以及新的實(shí)驗(yàn)性療法。

自此，隨著埃博拉病毒醫(yī)療手段的演進(jìn)以及來自西非地區(qū)的經(jīng)驗(yàn)積累，人們已采取重要的改良措施。在剛果（金）北部基伍和伊圖里爆發(fā)疫情期間，多方行動者及專家積極響應(yīng)，該領(lǐng)域也出現(xiàn)了多項(xiàng)創(chuàng)造性舉措。其中包括卡特瓦醫(yī)療中心的創(chuàng)新設(shè)計，使得更高強(qiáng)度的醫(yī)療措施成為可能，并強(qiáng)化了人類學(xué)和社區(qū)參與的路徑。

新的埃博拉病毒病醫(yī)療中心設(shè)計，采取先進(jìn)的醫(yī)療設(shè)備和擴(kuò)容的員工配置，得以從一個簡單的隔離設(shè)施轉(zhuǎn)型為一個具備更好的個人化醫(yī)護(hù)條件的醫(yī)療中心，能夠進(jìn)行持續(xù)的患者觀察及監(jiān)控，并迅速采取反應(yīng)措施。創(chuàng)新設(shè)計采取透明表皮，低風(fēng)險區(qū)和病房區(qū)直接連通，以便促進(jìn)更先進(jìn)、密集的醫(yī)療措施。

設(shè)計采用私密的獨(dú)立式病房，取代共用的開放式病房，這提升了患者隱私性及護(hù)理工作的強(qiáng)度，即便針對嬰兒和孕婦等弱勢人群也是如此。這是一個根本性轉(zhuǎn)變，從一個隔離及控制性設(shè)施，轉(zhuǎn)變?yōu)橐粋€更全面的、以病人為中心的、精確護(hù)理的設(shè)施，擁有多學(xué)科的員工群體，全部設(shè)施都面向家庭和社區(qū)開放。它允許家庭探望在埃博拉病毒病醫(yī)療中心的親人，這是一項(xiàng)革命性創(chuàng)舉。

這項(xiàng)以病人為中心的設(shè)計，直接應(yīng)用了該領(lǐng)域的技術(shù)及管理創(chuàng)新，充分結(jié)合西非積累的經(jīng)驗(yàn)和專業(yè)技術(shù)，并在新冠肺炎疫情影響下進(jìn)一步發(fā)展，為疫情爆發(fā)的準(zhǔn)備和應(yīng)急響應(yīng)樹立了新的里程碑，也為多項(xiàng)新冠肺炎疫情應(yīng)對響應(yīng)的相關(guān)行動提供了啟示。

6 國內(nèi)收容營方案自我隔離區(qū)中心布局及軸測/Layout of the center and axonometry of self-quarantine area for IDP Camp proposal（圖片來源/Courtesy: T?chne）

今天，我們與世界各地的大學(xué)及科研院所合作，試圖強(qiáng)化這種醫(yī)療部門與建成環(huán)境間的新型多學(xué)科工作模式，以重塑空間與設(shè)計概念，及其在公共健康與突發(fā)衛(wèi)生事件中的實(shí)用性。countering misinformation. Differently from most other Techne projects, the request for this project was typological: T?chne would design a model camp, a diagrammatic layout which could then be applied to a number of real situations with minor modifications (Fig. 6).

The design proposed by T?chne includes a residential sector as well as a registration, screening and medical area. The large residential sector of the quarantine area consists in a series of clusters of independent structures containing five single units (hosting up to two people) and two double units (hosting up to four people). Each unit includes a cooking corner, latrine and shower facilities, bed, and small outside terrace that opens up towards the central courtyard, and is separated from other units by a low fence allowing visual communication while allowing required distancing.

The IOM used the design for the construction of a self-quarantine facility in the Northeast of Nigeria, in which the scheme for the residential sector was applied, while the medical area was not built.

4 Italy: The Hospital of the Future

This project started out as a request of support for the Hospital of Bologna in the face of the COVID-19 emergency, as the Italian health system was struggling with full intensive therapy wards and too little staff to run them. After the first brainstorming phase, the project has gained in ambition, and is now intended to work as a model project for what a hospital should be in the future. The hospital requests technical assistance for the organisation of response at all levels, including at the primary health care level: to work out this level of complexity, the World Health Organisation is investing in it in terms of time and human resources, with one staff from the SHO team working specifically on this process, working closely with the hospital management and its technical department, as well as several T?chne members that will be part of the design task force. This project was chosen as showcase for a number of reasons: because it was close to one of the major COVID-19 hotspots, because it was able to contain the infection of healthcare workers much better than other hospitals in similar conditions, and because there is already a network of innovation that gravitates around it and that has been investing in renewable energies, green roofs, etc.

7 醫(yī)患流線圖/Diagram of patient-staff flow（圖片來源/Courtesy: T?chne）

The Hospital's urban-scale layout was designed in 1925 by Engineer Giulio Marcovigi as a series of twenty-five 5-storeys pavilions hosting different wards, and hasn't been subject to major interventions since. The project carried out by WHO and the Hospital of Bologna intends to turn it into a resilient structure, by a complete rethinking of users' fluxes of entrance, exit and movement throughout. Rooms will have no more than two beds – with a consequent reduction of the hospital's capacity, a factor that the Regional administration will have to cope with creatively.

The first pavilion to undergo major change will be the one hosting the Maternity Ward, which was the ward to have typically the most trouble during the first phase of the pandemic, after the Emergency Room. Norms now require that there be a screening outside of the hospital, that includes triage, waiting room, sampling test; in addition, there will be a non-COVID itinerary that patients can follow throughout the hospital. The idea is to avoid spatial separation between COVID- and non-COVID areas, but to obtain full containment through a strict but flexible separation of distributive fluxes, so that the hospital can be resilient to other infectious diseases as well (Fig. 7).

What Is the Role of Design Towards Containing the Pandemic?

During the Western Africa outbreak, while institutions and organisations working in the field were building and enhancing their own experience in ebola outbreak management, the scientific community witnessed an important research boost which led to specific vaccine and new experimental treatments.

Since then, following the evolving trend of Ebola Virus Diseases (EVD) medical care and based on the West Africa's lessons learned, important steps forward have been made. During the North Kivu and Ituri outbreak in D.R. Congo, with different actors and expertise engaged in the response, several innovations have been seen in the field. Amongst them the innovative design of Katwa treatment centre which allowed more intensive medical care and strengthened the anthropological and community engagement approach.

New Ebola Treatment Centre (ETC) design with advanced medical tools and expanded staff have enabled the transition from a simple isolation facility to a centre which allows better, individualised, patient care through continuous patient observation and monitoring, and fast response. The innovative design, the use of transparent surfaces and the direct access to the patients from the low risk zone have facilitated and enhanced more advanced, intensive care interventions.

The use of private, self-contained rooms instead of shared, open-ward facilities have allowed for patient privacy as well as intensive care, even to the most vulnerable populations, the very young and pregnant. This has been a fundamental change from being an isolation and containment facility to a more holistic, patient-centred, acute-care facility with multi-disciplinary staff, all accessible to families and communities. Allowing families to communicate with their loved ones being cared for in ETCs has been a major milestone.

This patient-oriented approach, supported by technical and management innovations directly developed in the field, nestled in the experience and expertise built from Western Africa and further developed during the current COVID-19 pandemic, placed a new fundamental milestone for outbreaks preparedness and responses and inspired several activities part of the COVID-19 pandemic's preparedness and response.

Today, working with several universities and technical institutions around the world, we are trying to strengthen this new multidisciplinary model of work in between the health sector and building environment reshaping the concept of space, design and its usability within public health and health emergencies.