Turning shipping containers into COVID-19 hospital wards
An international team of designers, engineers and medical professionals has invented mobile intensive care units for COVID-19 patients built inside shipping containers. Easy and fast to deploy, they offer a safe alternative to hospital tents. Read More
Max Tomasinelli
CURA, a mobile hospital ward built inside a shipping container, holds an entire intensive care unit for two COVOD-19 patients. © Max Tomasinelli Some pictures become symbols because they record a reality it would otherwise be impossible to imagine. The pictures taken of New York City’s Central Park during the first wave of the COVID-19 pandemic are burned into the public memory.
As hospitals quickly hit capacity, a field hospital was set up on the green fields of New Yorkers’ favorite recreational area. It would be hard to find another image that better captures the horror of the pandemic than the doctors and health-care workers covered head-to-toe in PPEs fighting to save the lives of the deathly ill in this beloved park. Many would later succumb to virus themselves.
After a two-months battle, numbers finally began dropping and the state of emergency ended, for the time being at least. The tents were cleaned, taken down and packed away. Hospitals had enough capacity to care for all the patients again; the first huge COVID-19 wave had passed. That is typical of a pandemic: it comes in waves and can overwhelm the health-care system quite suddenly, only to retreat a few weeks later.Globally, countries and communities began preparing to meet a wave of their own. The central challenge was how to get proper health care up and running as quickly as possible. Most communities focused on field hospitals. But treating coronavirus patients takes more than just intensive care beds and respirators. Negative pressure rooms are essential to keeping the virus from spreading beyond a patient’s room and also pretty impossible to set up inside a tent thrown up during an emergency.
Open-source intensive care unit
In Europe, Northern Italy was the first area to be hit particularly hard by the pandemic. Here is where a new idea was born; a clever way to solve some of the problems associated with temporary treatment rooms: mobile hospital wards built inside shipping containers, known as “connected units for respiratory ailments” or CURA, easy to transport and fast to deploy. Outfitted with two ICU beds, biocontainment equipment, ventilators, monitors, intravenous fluid stands and syringe drivers, each six-meter-long intermodal shipping container can hold an entire intensive care unit for two COVID-19 patients.
An international team of designers, engineers and medical professionals worked together to develop the concept. These included the Turin-based Carlo Ratti design studio and Milan architect Italo Rota, the MIT Senseable City Lab, Jacobs Engineering and health-tech giant Philips, to name just a few. “CURA can be mounted and moved much faster than any other type of ICU structure,” designer Carlo Ratti explains. “It comes fully equipped and only needs to be connected to power and other utilities. A tent hospital, for example, requires more time, as all of the medical equipment needs to be mounted on site.” CURA is also safer than a tent and complies with the same safety standards as an indoor hospital isolation ward. The solid walls of the container ensure that no air is exchanged with the outside world and an extractor creates negative pressure inside the room.
“CURA can be mounted and moved much faster than any other type of ICU structure.”
An entire ICU unit is fitted into the container, including two beds, biocontainment equipment, ventilators, monitors, intravenous fluid stands and syringe drivers. © Max Tomasinelli 
A large window to each of the long sides of the container allow doctors to observe patients from the outside. © Max Tomasinelli
The designers say that one of their main goals was to make sure there was as much freedom of movement for doctors inside the limited space to make sure medical personnel can intubate patients. They also added a large window to each of the long sides so doctors and relatives on the outside could observe patients and the monitors tracking their vital signs.
Treating patients in CURA in Italy
The first CURA prototype is already out for field testing and COVID-19 patients have been treated in a CURA container installed in Northern Italy since April 2020. As the Piedmont region has been severely affected by COVID-19, Italian health authorities decided to set up a temporary hospital in a former industrial complex in the city of Turin. The 8,900 square meter plot now offers more than 90 beds – mainly for corona patients in sub-intensive care – as well as one CURA ICU unit for up to two patients who need intensive care. “Since it was installed at the makeshift hospital in Turin in April, the doctors there have been extremely pleased with it,” Ratti says.
In future, entire temporary hospitals could even be built from CURA containers, according to the developers’ plans. The individual pods can be connected to one another using inflatable tubes, creating interconnected structures of more than 40 beds as needed. Even an expanded unit, a container that could hold four intensive care beds or serve as operating theatre, could be added.
The CURA development team released the open source plans for converting containers as soon as they were done. Since then, people in other parts of the world have worked on and improved them. The CURA community shares the results on Instagram, showing ICUs set up and ready for operation in the United Arab Emirates and Canada, for example. “Beyond the UAE and Canada, we are aware of other initiatives in the US, Qatar and the UK,” Ratti says. “What makes us really proud of CURA is that it is a flexible solution, so it can be used in many different places, supporting medical personnel in any kind of situation.” There might be one downside if it is to be used for other purposes though: CURA’s compactness. “A plus in terms of outdoor space utilization, it leads to relatively limited indoor dimensions compared to standard hospitals. CURA is optimized for COVID-19 patients but might be too small for some other types of ICU procedures.”
