As the United States moves into a more concerted testing approach to defeat the novel coronavirus, the built environment has a critical role to play in the fight. Research laboratories and testing facilities are paramount to teaching us more about how this virus behaves and, ultimately, how it can be defeated. The rapid design and deployment of a facility begin with understanding which types, and the volumes, of testing that need to be done. This defines what is being tested, the lab testing and patient processes, and the duration and function of the testing facility.

The key aspect of the rapid deployment strategy is the accelerated procurement of the testing equipment, as this may present the longest lead time in the process. Right now the focus is on polymerase chain reaction, or PCR, testing, and some serological testing. As new testing flow processes are developed to keep up with the growing demand, it is critical to develop facilities that accommodate this increased throughput.

Testing Processes Determine Design Processes
The patient processing and lab testing processes should define the types of facilities required. A building will have different intake protocols if a courier delivers samples or if the patient’s blood is drawn on site. If the patient comes to the site, we must map the process from patient arrival to registration and waiting, and provide secure locations for testing, waiting for results, and after-testing directions.

For the lab facilities, sample processing involves accessioning, aliquoting, testing, recording, and reporting. Space, equipment, and engineering requirements are determined by equipment selections, sample storage, and data management. Currently, there are three types of tests in use, but each has its challenges with regard to accuracy, equipment availability, test sample supplies, and technical expertise. In general, at the present time, the testing facilities do not require extreme isolation other than what would be required of any general diagnostic lab. However, they will need to be flexible enough to adapt to differing test platforms as these come to the forefront of the clinical community. The design challenge is how to get these facilities on line as soon as possible while adhering to industry standards for safety and operations.

Finally, we recommend space for technicians and scientists to safely don and doff their work clothes, store their belongings, and utilize a sterile and comfortable area for a break. As testing continues to ramp up and demand for these specialized technicians increases, providing a safe place for these front-line staff to take a break will be critical to keeping them safe and healthy, too.

When we consider the most effective approach to designing and building these lab facilities, we can analyze this in two fashions:

1. Program-driven space: If we can define the volume and test, we can identify the necessary requirements.
2. Space-driven program: If we can identify the available space, we can determine the capacity the space can handle.

We can apply either of these scenarios to new or renovated buildings, to temporary spaces within an existing building, or to a temporary stand-alone facility such as a trailer. The temporary installation of laboratories to accommodate demand could be a viable solution at this time.

Availability of construction resources, such as prefabricated modular structures, MEP units, and specialty trades, will continue to be a moving target. A key element of the development of multiple test lab strategies is the MEP systems commissioning and the lab testing equipment support requirements to ensure that labs are set up according to the appropriate industry standards. In addition, all federal and local government regulations must be met irrespective of the availability of oversight agency staff.

“What’s next” remains an open-ended question as geography drives how issues will be resolved. The answer may be any permutation of flexibility, nimbleness, and the resources that can responsive to specific needs. We remain poised to do that.