Could the future of pandemic planning lie in our past? A century ago, there were hundreds of so-called 'fever hospitals' dotted across Britain. These small institutions were built for diseases of a bygone age – smallpox, scarlet fever and typhus – but were designed for precisely the same problems we face today.
They contained isolation wards, separate accommodation for different infections, laboratories, operating theatres and convalescent wards with activities for recovering patients. Given the current problems of the Covid-19 outbreak, we need to re-establish these medical relics.
Fever hospitals were often built so that open-plan wards could be quickly converted into separated isolation rooms at relatively low cost. They were places that were separate from the community and staffed by specialists. Many remained closed except during epidemic outbreaks. Clearly our forebears grasped the need for a flexible response in times of uncertainty and a surge in sickness, a lesson that should surely be resuscitated for our own times.
Larger community intermediate hospitals could be quickly transformed with isolation units installed during an outbreak. These critical care facilities would offer much needed spare capacity. In the non-epidemic downtime, they could be used as places of training for infection control while offering intermediate capacity for the elderly who often need rehabilitative care without the high tech equipment afforded by modern hospitals.
If this solution is not acceptable, the hospitals should be maintained by a skeleton crew, ready for activation at very short notice. Those who read these suggestions and wonder about the expense of mothballing specialist hospitals should look up the latest forecasts by HM Treasury. Or they could ponder the madness of housing infectious and non-infectious patients in the same facilities. No wonder so many people are taking their chances and staying away from A&E right now.
According to a 1929 survey of hospitals and charities, there were once 635 fever hospitals of less than 100 beds in England and Wales. One of the larger fever hospitals was in Monsall, north Manchester. Opened in 1871, it had built around 350 beds just over 20 years later. In 1948, it was adopted by the new Nation Health Service and renamed Monsall Isolation Hospital. By 1993, it was closed.
The development of immunisations and the availability of antibiotics made infectious diseases less common, less serious, and the need for isolation became less of a problem. And so the fever hospitals were eventually closed for good. But it's time to listen to the superintendent of Monsall hospital Donald Sage Sutherland who, in a 1937 lecture, praised the many merits of fever hospitals:
“Regarding the infections of measles and scarlet fever, it is disputable whether isolation at home may not obtain comparable advantages, but for the control and efficient nursing and treatment of the bulk of the common infectious diseases the fever hospital, large or small, still occupies a most important position, and very early removal of cases to hospital should be regarded as the wisest policy both in stamping out the source of infection and in securing the most effective treatment for the individual case.
The establishment of the fever hospitals did not just happen, the lessons that led to their formation were paid for with the lives and suffering of our fellow human beings. Let's learn from history, and bring back Britain's fever hospitals.
Carl Heneghan is a professor and Tom Jefferson is a senior tutor at Oxford's centre for evidence-based medicine. A version of this article first appeared on the Centre for Evidence-Based Medicine blog.