Temporal and spatial distancing have been paramount in the fight against infectious diseases for centuries. Is architecture the only true antidote at present?
Presided over by Pope Alexander III and attended by more than three hundred bishops, the Third Council of the Lateran, which met in 1179, decreed that lepers should not only be segregated, but also have the autonomy to design and inhabit their built environments. ‘We decree, in accordance with apostolic charity, that wherever so many are gathered together under a common way of life that they are able to establish a church for themselves with a cemetery and rejoice in their own priest, they should be allowed to have them without contradiction.’ With this dictum, distancing and isolation gave way to a new design sector. It afforded the freedom for these communities to build accommodation, chapels, hospitals and cemeteries, defining the beginnings of a new typology.
Disease and isolation strategies have been implemented for millennia. The epidemic of Justinian of 542, one of the earliest records of a significant spread of bubonic plague, reveals ancient remedies and superstitious methods of dealing with the epidemic, including isolation, both self-imposed and coordinated. Persisting over two centuries, it is estimated that this first outbreak was responsible for the death of over 50 million people. But it was the decree of 1179 which triggered the birth of specifically designed buildings and urban spaces aiming to contain and segregate the infected. By the 1200s, over 1,900 leprosaria could be found in Europe, usually constructed on the edges of cities or on travel routes so that patients could continue to beg from and trade with passers-by, as this was their only source of income.
The ‘hospitals’ themselves were often detached cottages built around a chapel, not as a continuous structure but as isolated elements, managing both the physical and the spiritual needs of the inhabitants. At St Mary Magdalen in Winchester, the earliest known example of a leper hospital dating from between AD 960 and 1030, excavations suggest that cells for the patients were built around the inside of the perimeter walls, while the chapel at Harbledown in Kent, a church of the St Nicholas Hospital for lepers founded in 1084, is characterised by sloping floors from east to west, apparently designed to facilitate regular washing to disinfect the hall.
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When the increase of sea trade coincided, in the 14th century, with successive outbreaks of bubonic plague, also known as the Black Death, spaces of quarantine were cast away from dry land and into the sea. Ships were often vessels for not only goods but diseases too, and cordons sanitaires, enforced by armed guards along city access roads and perimeters, were ineffective in preventing infections spreading at seaports. But to allow trade to continue (resonant with today’s political pressure to relax lockdown strategies for the sake of the economy), while also protecting the city from epidemics, the Great Council of Dubrovnik decreed a 30-day isolation of ships at a safe distance from the harbour, to secure disease-free port access. This was perhaps the most interesting and radical transformation regarding protection from disease: the introduction of time into the spatial equation.
The architectural characteristics of a trading ship, its autonomous and self-sufficient nature and the inaccessibility which a body of water offers, resulted in a robust physical barrier against disease. Ships, designed for free movement and transport of goods, were transformed into a static system of containment and, in some tragic cases, a floating mass-coffin.
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The parallel with modern cruise ships quarantined during the Covid-19 pandemic is obvious, suffering the same stigma and fear from nearby harbours as they did centuries ago – society is often too quick to react by distancing, instead of offering aid. One substantial difference is that today’s ocean liners carry populations of several thousand souls, and are the size of small towns.
The introduction of the 30-day quarantine in 1377 by the authorities in Dubrovnik was not only radical in expanding containment strategies from the purely spatial to the temporal, but it also changed the way seafaring diseases would be dealt with through spatial means. Dubrovnik’s 30-day ship quarantine was increased in Venice in 1423 to 40 (the word quarantine derives from the Italian word quaranta for forty), and containment islands, or lazaretti, were built in the Venetian lagoon to house the infected until deemed healthy or to be buried when dead. Water again became the distancing medium, allowing a transition from vessel to insular architecture; a permanently anchored ship.
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Designed to be self-contained, the lazaretti borrowed from defensive solutions of the time, to create a barrier system for controlled access and isolation. The edge condition between water and island was defined by high walls with a single entrance and rotating shelves at windows to avoid contamination when exchanging goods. Within the walls, hospitals, cell accommodation, chapels, gardens for food production, and cemeteries, were distributed following guidelines of minimum contact between residents, with halls and paths which allowed for servicing cells while respecting barriers and distancing, solutions found in isolation units well into the 1900s.
The lazaretto proved to be a model for isolating disease throughout the following centuries. The Ellis Island immigrant inspection station of 1900 was the result of an architectural competition won by the practice of Edward Lippincott Tilton and William A Boring, and designed in the style of the French Renaissance. The island functioned as receiving station, harbour and, more importantly, a dedicated isolation territory for the infected, with hospital facilities connected along a single spine, and functioning almost as a bridge between two separate wings. The isolation wing, structured around a single corridor, resembles the early Venetian lazaretti, but here surfaces and materials were important in the design to allow for continuous disinfection, with glazed tiles and the use of copper fixtures, which possess antibacterial properties.
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More singular than any other contagious threat of the 20th century was the discovery of a new danger from a radically different territory. In the mid-1900s, when exploration extended towards the cosmos and since its Apollo missions, NASA created a Planetary Protection Officer responsible for protecting the Solar System from contamination by Earth life and vice versa (denominated ‘forward contamination’).
When the Apollo 11 astronauts landed in the Pacific Ocean and were approached by rescue divers, they were immediately dressed in ‘biological isolation garments’ and conveyed into their Mobile Quarantine Facility (MQF), a transformed Airstream trailer. This refined aluminium camper trailer, which in the 1960s symbolised freedom of movement and accommodation for the vehicle-thirsty America of the time, was transformed into a containment vessel for the quarantine of the astronauts returning from the Moon, a streamlined silver version of the quarantined seafaring galleons from six centuries ago. The MQF would then be transported to the final isolation unit in Houston, the Lunar Receiving Laboratory. This purpose-built facility, a 20th-century modern version of the 14th-century lazaretto, housed facilities to support the astronauts and deal with Moon samples in very controlled systems.
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Among many architectural solutions and idiosyncrasies, airlock strategies, rooms of ultraviolet light for destroying bacteria and germs, and automatic lockdown systems were borrowed from Cold War designs for protection against biological warfare. Simultaneously a quarantine facility and viral agent containment, the Lunar Receiving Laboratory was one of the first architectural works that housed several internal boundary systems and formal protocols of access, which later helped define the present Biosafety Levels (BSLs) – graded from 1 to 4 and used today to create laboratories (and improvised field clinics) able to deal with increasingly violent contagious agents, and a critical part of today’s health institutions dealing with patients infected with Covid-19. In this case, containment of possible alien agents was celebrated by a minimalist, modern architectural design, supporting otherwise never imagined functions.
Our current lockdown strategies, closing places of work, education, leisure and other services which usually draw us out of our homes, force populations to stay at home, atomising the lazaretto concept to everyone’s living quarters. During the plague of 1630-31, a lockdown was enforced in the city of Florence, communicating with other cities to help contain the spread of the disease. Systematised efforts to discover patient zero were recognised as efficient methods of containment, and according to historian John Henderson, not much unlike today, the population participated in group mass, talks and song from their balconies.
In 1701, legislation was passed in Massachusetts forcing those infected with smallpox to self-isolate, and more radically yet, during the First World War, the American authorities incarcerated over 300,000 prostitutes in an effort to stop the spread of venereal diseases. The difficult balance between forced isolation, lockdown and infringement of personal rights persists today.
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Shortly after the Danish ministerial ‘recommendation’ for self-isolation on 13 March, including the lockdown of institutions and spaces of gathering, and a minimum 2-metre distancing between individuals in public spaces, I ventured to my local supermarket in Copenhagen for the weekly food shop. Aware of the possible shift in social proximity awareness, I was conscious of the need to be considerate of the people around me as I entered the premises, but I was unprepared for the reactions that the 2-metre virtual bubble would generate. The feedback loop of spatial constraints between user and space produced a chain reaction of unprecedented synchronicity.
The mere pause of an individual cascaded into a sudden paralysis of the surrounding shoppers, in quick ripple effect that resembled a choreographed performance at first, was comical second, and quickly thereafter, grounded the realisation that our perception and use of space had radically changed. A few days later, shelves were rearranged, floor markings added, and entrances haphazardly redesigned. The flexible aspects of architecture were reshaped accordingly, and in turn, the user’s movements were reconditioned.
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From leprosy to the bubonic plague, from tuberculosis to Ebola and coronavirus, containment of individuals has often been a course of action. Intertwined with architecture, these events have defined new functions and typologies and transformed built environments into accepted architectural languages throughout history, the language of cities, harbours, hospitals and housing. Sterile surfaces in health-related institutions and schools, improved ventilation and sun exposure in work and living spaces, and automatic doors are all elements we encounter every day to afford ‘cleaner’ buildings.
The Covid-19 pandemic almost certainly will impact the design of airports, schools and public institutions. Surveillance could become an accepted element in the built environment (in many places it already is) and buildings could track our movements and diagnose us as we meander, undermining democratic and private rights in the name of health.
But the pandemic can also be a moment to reflect on present architectural solutions, revisiting the design of our domestic space towards a more flexible alternative that can aid the cohabitation of many family members, for many hours of the day and many days at a time, while allowing our homes to be a space for privacy, work, education, physical training and disease-free environment. This is not a short order, but as many of us have come to realise, they are functions that our present habitations can hardly support. Given the global impact of this pandemic, which has forced us to reassess our built environment, one could argue that the only antidote against infectious diseases, until a cure or vaccine is developed, is architecture and the walls arounds us.
Lead image: Biosafety Level 4 suits offer the highest possible level of protection against hazardous pathogens. Courtesy of Preston Gannaway / For The Washington Post via Getty
This piece is featured in the AR June 2020 issue on Inside – click here to buy your copy today