Healthcare facilities are facing huge challenges due to the outbreak of COVID-19. Around the world, national healthcare contingency plans have struggled to cope with the population health impact of COVID-19, with healthcare facilities and critical care systems buckling under the extraordinary pressures. COVID-19 has starkly highlighted the lack of reliable operational tools for assessing the level sof flexibility of a hospital building to support strategic and agile decision making. The aim of this study was to modify, improve and test an existing assessment tool for evaluating hospital facilities flexibility and resilience. We followed a five-step process for collecting data by (i) doing a literature review about flexibility principles and strategies, (ii) reviewing healthcare design guidelines, (iii) examining international healthcare facilities case studies, (iv) conducting a critical review and optimization of the existing tool, and (v) assessing the usability of the evaluation tool. The new version of the OFAT framework (Optimized Flexibility Assessment Tool) is composed of nine evaluation parameters and subdivided into measurable variables with scores ranging from 0 to 10. The pilot testing of case studies enabled the assessment and verification the OFAT validity and reliability in support of decision makers in addressing flexibility of hospital design and/or operations. Healthcare buildings need to be designed and built based on principles of flexibility to accommodate current healthcare operations, adapting to time-sensitive physical transformations and responding to contemporary and future public health emergencies.

Background. Urban planning is a key tool to promote health in cities. The COVID-19 emergency accelerated several social, environmental, and digital challenges, stressing the importance of some issues regarding housing, urban mobility, green areas, and health service networks, urban health policies, and actions. These issues were the subject of an intensive residential course (the 57th) held in Erice, Sicily, in June 2021 in the “International School of Epidemiology and Preventive Medicine G. D’Alessandro”, and the main findings are described here. Methods. Lectures presented the topics, subsequently developed them, and argued them in parallel practical sessions using the World Café technique, since it is well suited for the interaction of participants and the involvement of groups. Results. The World Café provides new insights into how to improve the livability and health of urban spaces, and a set of strategies and actions were proposed for each topic. Discussion and Conclusions. All attendees agreed on the importance of participation in the planning processes, but also on the need for strong political support to ensure the resources needed and a full integration of health with other local policies. A multidisciplinary approach to developing systemic operational capacities and health literacy is considered pivotal to raising awareness and participation.

The immense impact of the coronavirus disease 2019 (COVID-19) pandemic on older adults living in nursing homes (NH) and other long-term care facilities, who at baseline are at increased risk of infection due to fragility, cognitive impairments, and complex comorbidities, has renewed the attention of researchers to the unmet needs of this population. It is well known that the built environment can significantly influence human health, a reality which is often overlooked in the setting of NHs. Recognizing how qualities of the NH built environment can influence resident outcomes, particularly in the context of the COVID-19 pandemic, can provide architects and medical professionals implementable strategies. As such, we conducted a systematic literature review from May to November 2021 to identify components of the NH built environment and their potential impacts on the health and well-being of NH residents during the COVID-19 pandemic. Relevant articles were identified with a search of Scopus, Web of Science, and PubMed scientific databases, as well as a search of gray literature. The initial search resulted 481 articles, though after the application of eligibility criteria and full-text screening, 17 articles remained for inclusion. From these, a total of 24 built environment features were identified, divided across four domain levels of NHs: Overall Facility, Building, Service Space, and Residential Room. These features were differentially linked to improved facility infection control, decreased COVID-19 incidence and mortality from COVID-19, better air quality, and enhanced resident health, quality of life, and socialization. This research defines a set of design/architecture strategies that NHs may implement to improve COVID-19-related outcomes as well as the overall health and quality of life of their residents. Additional research utilizing primary data and testing these identified interventions is needed to provide stronger evidence-based suggestions.