How shipping containers are proving adaptable in the fight against coronavirus

UK consortium ready to deliver mobile intensive care units to NHS

Could shipping containers hold the key to helping the NHS with additional capacity during the COVID-19 outbreak?

Shipping containers could hold the answer to some of the capacity issues being faced by the NHS as it struggles to cope with the increase in patients suffering from coronavirus.

With goods shipping slowing down due to unloading hold-ups in China, hundreds of thousands of containers are now available and could be key to the worldwide response to the COVID-19 pandemic, say experts.

With hospitals having hold-ups with space, and needing to keep pace with growing cases in some countries; shipping containers have been found to be easily employable and a new mobile alternative

Johnathan Bulmer, managing director at Cleveland Containers, told BBH: “Demand for healthcare has been significantly hastened by the pandemic.

“With hospitals having hold-ups with space, and needing to keep pace with growing cases in some countries; shipping containers have been found to be easily employable and a new mobile alternative.

“In particular, Intensive Care Units (ICU) beds are in demand, with researchers estimating that the UK will need 200 beds per 100,000 people, while the current UK capacity is under seven per 100,000.

“And some innovative designers have developed ideas which offer a new alternative for ICUs, with shipping containers turned into hospitals to treat COVID-19 patients.

“In one case, called the RUAG Field Hospital, an international network of architects and engineers joined forces to convert shipping containers into two-bed intensive care units. They use a combination of standard ISO shipping containers, along with expandable containers to build field hospitals in record time.”

Another design which has been given funding is named the Connected Units for Respiratory Ailments, or CURA.

In the same way in which pop-up shops and co-working spaces can be turned around quickly, CURA sees all equipment and features of an intensive care unit placed inside a 20ft container. This can then be shipped or taken anywhere, and is ready to help healthcare organisationss in hours, a flexible option for when they need to quickly scale up.

The units are based on an ‘open source’ design perfected by specialists at America’s prestigious Massachusetts Institute of Technology (MIT) and at Milan Polytechnic, and provide all the features of an intensive care unit packed into a single container.

Many NHS trusts have had to set aside intensive care capacity for COVID-19 cases and the CURA units provide them with additional short-term capacity or the potential to redirect existing resources back to other medical conditions

The smaller size and scalability mean they can be easily flexed to meet demand, making them more cost effective than other approaches.

The CURA designs have nowbeen made available free online to allow rapid deployment around the world.

And a British consortium, led by London-based property company, CanCo, and Merseyside contractor, Larnook, has stepped up to make them quickly available to the NHS.

The two companies were busy delivering a container-based retail scheme on Lodge Lane in Toxteth, Liverpool, when the lockdown halted work.

“We have the design and engineering expertise for rapid deployment of containers so when we read about CURA we thought we could put these to good use,” says Larnook managing director, Chris Evans.

Connected Units for Respiratory Ailments (CURA) work in the same way as pop-up shops, providing healthcare organisations with the infrastructure they need to quickly scale up. Image courtesy of CURA

“Our workforce is on stand-by and it’s not a particularly labour-intensive project, so safe-distancing is perfectly manageable with the right controls in place.”

CanCo, part of the wider Midos Group, has agreed to provide the advance funds for purchase, fit-out and construction of two units so that the company can meet immediate demand.

“Many NHS trusts have had to set aside intensive care capacity for COVID-19 cases and the CURA units provide them with additional short-term capacity or the potential to redirect existing resources back to other medical conditions,” says CanCo director, Nathan Schreiber.

“If an area is hit with a particularly-wide outbreak then these containers can be moved and in place within a matter of hours. Think of them as like a mobile field hospital,” he adds.

We’re good to go and want the NHS to know that, should there be a second outbreak, then there’s a resource here that can be deployed quickly to give them the capacity they need

Each container mimics an intensive care room, right down to extractors to create negative air pressure, and includes beds, ventilators and other equipment.

And containers can be joined by vacuum-sealed inflatable corridors and, because of the nature of the design, can be scaled up rapidly to provide additional capacity.

“It’s their rapid deployment and flexibility that makes these such an attractive option for the NHS,” says Schreiber.

The original idea was conceived by Italian architect, Carlo Ratti, who teaches at MIT. He engaged colleagues at Milan Polytechnic; engineers from global consultancy, Jacobs; and a team of leading physicians to advise on the design and clinical aspects. Once the scheme was proven to be medically sound, the designs were made available for others to copy.

Evans said: “Major facilities such as the Nightingale Hospital in London are a good example of a large-scale solution, but we can provide a flexible alternative in a scalable format.

“The extraction systems in each container, and the fact that each patient is isolated, reduces the risk of medical staff getting infected, too.

“We’re good to go and want the NHS to know that, should there be a second outbreak, then there’s a resource here that can be deployed quickly to give them the capacity they need.”

If approved, these could work more effectively than the Nightingale Hospitals being opened across the UK, Bulmer claims.

He said: “While the field hospitals being built overnight in exhibition centres like London’s ExCeL is fantastic, Chinese authorities found that there can be problems with the intense concentration of contaminated air.

“Prefabricated hospitals can instead have full mechanical ventilation, in addition to negative pressure systems.”

And they can be used to provide housing for hospital staff, helping to prevent the spread of the virus further.

ThreeSquared is offering its cargo containers for COVID-19 patient acre rooms and health worker accommodation. Image courtesy of Three Squared

US-based ThreeSquared is already offering its cargo containers as climate-controlled housing units for doctors and nurses to stay in.

What the landscape will look like after the pandemic passes, which it will, eventually, is unclear, but temporary changes to tackle the crisis now may endure into the future, and create a new normal for reactive relief efforts, with design ready made

These hospital staff can then stay close to patients who need them most, while also maintaining necessary social distancing and hygiene protocols, since they are equipped with electricity and fully-equipped bathrooms.

Bulmer said: “Shipping containers have been used as temporary measures for years, but never in such a capacity for healthcare as they are today.

“What the landscape will look like after the pandemic passes, which it will, eventually, is unclear, but temporary changes to tackle the crisis now may endure into the future, and create a new normal for reactive relief efforts, with design ready made.”

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