COVID-19 Screening Strategies for Urban Spaces

As COVID-19 continues to reshape our communities, our priorities and our work, the outbreak has highlighted the need for new approaches to patient evaluation and testing.

As the city and state reopen, there is a pressing need to increase coronavirus testing capacity in every region. Since late March, our team has been developing Patient Screening Booths as a response to this need. The booths serve as urban “walk-thru” testing sites, an alternative to the “drive-thru” model adopted in suburban and rural parts of the U.S.

Three months later, we’re continuing to work with frontline healthcare providers to rethink and refine the initial testing booth we developed. We’ve responded to feedback from medical practitioners who tested our first prototype and we have reduced the cost of construction with every iteration. To this end, we’re now strategizing about how to scale production and reduce costs even further, potentially by partnering with local industrial manufacturing for larger production runs.

Given the multidisciplinary nature of this work, we have been collaborating with engineers at Arup to model pedestrian traffic flows at testing sites. Their analysis has allowed us to refine the queuing approach and maximize social distancing while also considering patient comfort. We’re also extending these ideas to other industries, like schools, to help prepare their facilities for safely reopening.

What is the Patient Screening Booth?

Each booth is equipped with an interactive window that separates the medical practitioner and patient while still allowing tests to be administered. As there are various ways samples are collected and examinations are performed, we designed several configurations that can be customized for each medical team in order to best facilitate their workflow. With a range of openings and interactive features, the booth allows full-use of various equipment for evaluation (e.g., stethoscope, pulse-oximeter, swabs, etc.).

Context is everything—and these patient booths are designed to “plug in” to larger testing sites that separate medical practitioners and patients. Often configured as outdoor medical tents or dedicated indoor spaces, medical practitioners occupy a central controlled space reserved solely for staff, thereby reducing the need for personal protective equipment (PPE). On the patients’ side, added walls provide privacy and help prevent contamination between adjacent booths. These outer areas are decontaminated between examinations to mitigate exposure for the next user.

Leveraging our in-house fabrication capabilities, we have been able to rapidly prototype, test and develop the design of these booths for a local hospital. Working with early prototypes led to reduced design complexity and lower production costs. For instance, the booths were initially built with welded frames, but switching to a faster technique using folded sheet metal allowed us to streamline construction. Feedback from hospital staff allowed us to hone the design for their urgent on-the-ground needs.

However, while many testing centers are set up for long-term or permanent use, some centers are mobile or operate on a temporary basis. Each site has different needs, and we have developed iterations of the booth with each of these in mind. The standard full-scale booth is durable for heavy-use, while the “port” version is a collapsible module that provides the same level of safety to smaller or more agile teams. In some cases, a larger medical center isn’t available or feasible, and a “kiosk” module can function as a standalone testing site. With all of these versions, we took a modular approach, so that sizing or additional features can be customized based on local conditions and the needs of the healthcare provider and their patients.

With these booth typologies on hand, we are also developing plans and guidelines for how they’re arranged on site. One of the most critical design challenges is to maintain social distancing at every stage of the process—from when patients arrive and check-in to how they safely exit. Therefore the layout and configuration of booths are important factors, and we have teamed up with transportation engineers at Arup to better understand how our designs can provide proper distancing and keep patients safe.

Using their own custom pedestrian-modeling software, our collaborators at Arup were able to simulate the flow of patients within a space over time. The model tracks the proximity between patients and indicates ‘hot spots’ where people are not staying far enough apart. By analyzing this information, their work deepens our understanding of potential throughput at a given location, and the safest overall queuing approach, all while keeping in mind the patient’s experience and comfort.

Distributed Screening Strategy

While much of the current testing is geographically linked to hospitals and clinics, we are proposing to complement this approach with a distributed network of smaller satellite sites. These booths are designed to be easily and quickly deployable to a range of sites allowing this approach to scale in relation to where it is needed most or moved to new locations as needs change. By situating these clusters across a range of urban spaces, from parks and plazas to ball fields and parking lots, distribution can be focused at the neighborhood level.

Ultimately, we believe establishing new satellite locations for testing will help mitigate the volume of exposure at hospitals, while at the same time reducing the exposure of one patient to another as they are waiting to be evaluated or tested.

This strategy addresses the need to significantly ramp up the quantity of and access to testing across NYC and other urban environments as a necessary step toward lifting restrictions. As has become painfully clear, COVID-19 has affected different populations of the City differently. Many of the most-affected communities cannot access drive-thru testing and commuting by public transit puts them at greater risk. Strategic placement of testing sites within walking distance of dense residential areas could align testing volume with those areas in greatest need—an essential step in ensuring accessibility for all.

We welcome feedback, questions and suggestions on this work (via relief@situ.nyc)—and we will continue to update this page as things progress.