Designing for Disease: Why We’ve Been Here Before

“Those who cannot remember the past are condemned to repeat it”

– George Santayana

Covid-19 is a new virus, but having to respond to the effects of a widespread pandemic is something the human race has had to do many times.

Tuberculosis pandemics of the late 19th and early 20th centuries forced us to adapt and change. In this way, tuberculosis became a driving force in the development of modernism in architecture.

In our response to the current pandemic, if we re-shape our towns and cities, and change our working patterns, Covid-19 might also leave us with some sort of positive legacy.

How Disease Has Influenced Design

In her book X-Ray Architecture, Beatriz Colomina looks at the parallel development of modernist architecture and the x-ray, which became the primary tool for diagnosing tuberculosis.

A central theme of the book is how tuberculosis, as an overriding concern of its time, became a major influence on the development of modernist architecture. 

Alongside tuberculosis, the x-ray, as a modern diagnostic tool, also influenced architects such as Mies van der Rohe, Colomina argues.

The x-ray made the interior of the body visible, and modernist architects took this notion of visibility and applied it to buildings.

Colomina says that Mies van der Rohe’s aesthetic was an x-ray aesthetic.

The spread of tuberculosis changed the nature of who went to hospitals and sanatoriums. In the early 19th century, these had been places where the poor and destitute ended up.

But tuberculosis spread across demographics, infecting as many as one in three people in crowded cities like Paris.

Consequently, many more people of wealthier backgrounds ended up in sanatoriums, looking for a cure.

Curative effects of these places included sunlight, fresh air and the outdoors.

Modernist architects began incorporating these elements into the designs of their buildings.

Earlier cholera pandemics in the 1800s helped drive the development of better plumbing and sewer systems. Now tuberculosis was having a similar effect on architecture.

Change in Building Design

The sanatorium movement started in Europe in the mid-19th century. There were early resorts in Germany and Switzerland. These began as clusters of cottages in mountainous regions, but evolved into purpose-built structures.

And this is where modernism began, as architects adapted the principles of healthy, outdoor living. Light and air were seen as therapeutic, and therefore architects incorporated them into their buildings.

Le Corbusier’s Five Points of Architecture included:

  • The pilotis, a set of columns that bear the building’s structural load
  • A free ground plan for flexible living, 
  • A façade free of structural constraints
  • Long, horizontal windows for better interior light and views
  • A flat roof with a roof-garden.

And this comes back to Beatriz Colomina’s x-ray theory, with buildings becoming much more visibly structural and skeletal.

There was close collaboration between medical staff and architects. Modern architectural theory reflected the principles and ideas of pioneering doctors and nurses.

Modernist architecture was not simply a pure expression of bold aestheticism. It was serving a very practical purpose, with its key approach of incorporating the outside inside.

But the influence of disease went beyond the clean lines, bright surfaces and wide expanses of glass that we associate with modernist building designs.

Modern furniture was part of this too. The reclining chairs of new sanatoriums were made to elevate the legs to improve circulation. They were designed to be easy to move, and clean, with materials including stainless steel and leather.

Examples of this new furniture design include Le Corbusier’s LC4 chaise lounge.

How Will Covid-19 Change Building Design?

For a great many businesses now, the question isn’t just how to adapt to Covid-19, but how long must they adapt for? Increasingly, there seems to be a recognition that successful change needs to be both strategic and longer-term.

One area where the discussion is focusing on long-term strategy is the built environment, and especially the challenges the office sector faces.

Initial responses to Covid-19 were about taking drastic, but temporary, measures, but the debate is shifting to looking at the long-term viability of current models for commuting and working.

It is throwing the whole notion of what office accommodation should mean open to question, including:

  • Size
  • Purpose, and
  • Location.

The idea of occupying large areas of premium office real estate is no longer attractive or viable for many enterprises and organisations.

The likely outcome, initially, is plenty of vacant office space, and a rush to re-purpose it in some way.

There may, for example, be a focus on converting these buildings to residential spaces. But that begs the further question of what the future city centre might then look like, if greater numbers of people no longer work in it, but live in it.

Reflecting this, aspects of future building design and fit-out might include multi-purpose structures that combine elements of living and co-working.

There is also plenty of thinking around creating third spaces for working that are de-centralised and much closer to where people live.

Why We Must Evolve

The tuberculosis pandemic passed. In modernist buildings, it left a positive legacy.

One day, the current pandemic too will be over, but it is likely to have re-shaped our cities and towns in the process.

Can we return to earlier notions of normal, and should we want to? Large numbers of people have realised the benefits of more flexible working, where the commute no longer dominates the day.

Covid-19 is a threat to all of us and for some, a catastrophe. But it also contains the seeds of change, and the opportunity to design spaces and buildings that better align to how people want to live.

Plus, as the global population continues its inexorable rise, so pandemics are more likely to become a fact of life. Human population growth impinges on wildlife habitats, where bats and other mammal groups are natural carriers of different coronavirus strains. 

Scientists have warned that we have created a perfect storm for wildlife diseases to spread to humans.

Covid-19 is a new pandemic, but it is not the last pandemic. We should be adapting now to better cope with the future.

A Partisan Approach

We’re a Manchester-based brand consultancy, and we support and promote change in our cities and towns. We want to help to find positive solutions that will sustain future development.

For more information, please call us on 0161 860 7010, or email

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