At press time for our March issue, China reported more than 40,000 confirmed cases of COVID-19, or coronavirus, while the death toll there reached 900—surpassing the number killed by SARS in the early 2000s. To isolate and treat patients, a field hospital was built in an astonishing 10 days, with a second opening just a few days after that. Meanwhile, here in the U.S., 12 cases had been confirmed in six states, according to the Centers for Disease Control and Prevention (CDC).

And while the public health risk in the states is still considered low (and the death rate comparatively lower than SARS so far), I was curious what someone on the forefront of designing for infectious disease was thinking. After all, the headlines continue to report a situation that—even if under control—is concerning. I reached out to Robert Counter, healthcare director and senior associate at Leo A Daly. Counter is currently leading the firm’s Los Angeles studio in designing an Ebola/Special Pathogen Unit that’s part of a national CDC program.

Like many experts, Counter noted that the U.S. healthcare system will likely see a much greater impact from this year’s flu than a coronavirus outbreak and that our stringent building codes as well as CDC guidance are primed to stem the spread of just about any airborne infectious disease.

But how, exactly, can our facilities (and their designs) be responsive to any viral threat? Counter says it starts with evaluating available isolation units. For example, he says, during flu season, occupancy can peak at over 100 percent, even without something like coronavirus infecting patients, too. “There aren’t enough respiratory isolation rooms to accommodate a large influx of infectious patients, but each hospital does have an emergency response plan in case of a large number of new patients,” he says. “In the future, hospitals may want to re-evaluate their isolation ICU unit designs to allow for acuity-adaptive rooms capable of handling higher-acuity patients when the need arrives.”

In fact, acuity-adaptable rooms already have the infrastructure necessary to flex from a standard med/surg space to an isolation ICU room, he says, including everything from medical gasses to space for specialized equipment to materials specified for enhanced cleanability. Counter even suggests that future ICUs might be designed more like a special pathogens unit—for example, with considerations for how materials and staff enter and exit the space, more visualization of patients, and extra sterilization capabilities.

As we watch what unfolds in China and brace for what could escalate at home, take a look at my interview with Counter ( as well as all of our infection control and biocontainment coverage over the years at

Jennifer Kovacs Silvis is editor-in-chief of Healthcare Design. She can be reached at