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Two Point Hospital's main campaign (15 hospitals), DLC (each has 3 more hospitals), and sandbox mode are all single-player. I have over 900 hours on this account put into the game, and I have never needed friends to do so. In fact, I put in most of those hours long before I even had friends on Steam.
Much appreciated.
No. I didn't take part in the last Superbug Initiative and I was able to get the unlocked stuff.
Three achievements have to do with the superbug.
Icebreaker: Complete Superbug Project "Hair Removal" (you do this project by yourself).
Strength in Numbers: Complete Superbug Project "Learning Machine Learning" (requires you to complete all five local superbug challenges, meaning that you need help from at least 3 steam friends). You can join a steam group to find others with the same problem as you.
https://steamcommunity.com/groups/TwoPointHospitalCollaboration
Serial Collaborator: Complete 50 Research Nodes (easiest way is to participate in the global superbug projects. Project no. 2 is wrapping up now, but both project 1 and 2 had more than 25 nodes). Completing the five local projects with steam friends will give you at least 20 of these points. You can also replay Hair Removal yourself a lot of times.
Small tip: it is safest to host local projects. If one of your team mates loses interest, you can kick him from the project and replace him with a new person. You don't have that option if you participate in someone else's project.