COVID-19 highlighted the critical connection between the built environment and human health with hospital and medical center systems leveraging their buildings in new ways to respond to the pandemic. Today, vaccinations are beginning to promise a return to "normal" operations even as hospitals and healthcare spaces begin preparing for how they’ll handle the next public health emergency. 

As we explore the future of hospital design and infection control in the wake of COVID-19, we’re also revisiting lessons from another global health crisis: SARS.

Humber River Hospital and SARS

During the 2003 SARS epidemic, Canada experienced more infections and deaths from the respiratory disease than any nation outside of Asia. The outbreak led to a spike in admissions and left healthcare providers like Humber River Hospital in Toronto searching for a more efficient and flexible solution.


Two years after the outbreak, HOK began working with Humber River Hospital on a consolidation plan for its three Toronto facilities. SARS had exposed the hospital’s lack of negative pressure rooms and emergency department infection control areas. When it came time to design the consolidation, the planning team and hospital leadership prioritized a more strategic approach informed, in part, by the National Advisory Committee's SARS report “Lessons Learned for Infectious Disease Controls.”

The result was a Humber River Hospital that found itself in a much better position to handle COVID-19 than many of its U.S. counterparts.

Infection Control Design Strategies

Opened in 2015, the 1.8 million-sq-ft Humber River Hospital leverages its design to combat infection. Lessons other hospitals could take away from Humber River include:

  • Isolated Spaces: The organization of Humber River Hospital isolates the ambulatory side of the building so it can run independently from the inpatient tower during pandemics, limiting exposure from sick patients to healthier patients.
  • Patient Path of Travel: Elevator design strategies and separate entrances ensure contained patient portals. The emergency department specifically was planned for mass containment with a pandemic center complete with an isolation room near the building’s entrance, male and female showers with water containment, and access to a negative pressure ambulatory bay while patients wait for a room.
  • Negative Pressure: Entire departments are set up to operate under negative pressure, a critical function to mitigating infectious diseases. 85 patient rooms also can operate under negative pressure, as can inpatient care centers for pediatrics, critical care and surgery departments.
  • Sophisticated Technology:  Technology minimizes touch points throughout the hospital. Smart glass windows allow patients to control lighting without the need for shades, providing one less surface to clean. Automated Guided Vehicles (AGVs) distribute clean linens and goods to patient rooms and pneumatic trash and linen systems further reduce the number of staff that must access a unit. Staff badges with real-time locating system (RTLS) technology make it easier to track the whereabouts of medical providers when they are in full PPE and virtually unrecognizable.
  • Fresh Air: The building is a 100% fresh-air building, pulling in outdoor air and leveraging flushing cycles on a regular basis. Not only does this strategy provide the framework for infection control, it also results in a healthier, greener building.

The Past Still Informs the Future

While Canadian and Asian hospitals ramped up their infection control measures following SARS, COVID-19 now brings the same urgency to healthcare systems around the world. Healthcare architects and operators seeking to protect patients and facilities from the next crisis might begin with looking to the past—at events like Ebola, SARS, H1N1—and studying how hospitals such as Humber River responded to the threat.    

Heather Fenniman is is senior medical planner in HOK. Mark Banhollzer is senior healthcare designer there. Both work in the firm's Chicago office.