The Lancet COVID-19 Commission’s Task Force on Safe School, Safe Work, and Safe Travel sought to answer a basic question:
"What set of measures should every building pursue, that would lead to significant public health benefits immediately and through this fall and winter?"
Note that this is not a complete list of measures we recommend - that was not the intent of this report. Other strategies and considerations can be found at the end of our report and this thread
1. COMMISSION OR RECOMMISSION BUILDING SYSTEMS
Covid: brings building back to the way it was designed; improved ventilation and filtration;
Cobenefits: improved IAQ, energy savings
2. MAXIMIZE OUTDOOR AIR
Covid: dilute/displace respiratory particles; assoc w/ reduced risk of transmission
Cobenefits: lower risk of other infectious diseases; improved cog function/worker perf; less absenteeism
3. UPGRADE AIR FILTERS TO MERV 13
Covid: higher-efficiency filter captures more resp particles; particularly important for in-room systems
Cobenefits: reduction of particles of outdoor origin (pollution; wildfire smoke) and indoor origin (from cooking, cleaning)
4. SUPPLEMENT WITH PORTABLE AIR CLEANERS*
Covid: in-room particle reduction; associated with reduced transmission
Cobenefits: (see prev, + within-room filtration)
*size correctly for the room
OTHER CONSIDERATIONS
In addition to these first four measures to reduce the risk of airborne infectious disease transmission that every building should implement, other technologies such as germicidal ultraviolet (UV) lights may be warranted in many high-risk situations.
When designed correctly, an upper room germicidal UV system consisting of lamps hung in the upper part of a room, or an in-duct system with lamps that radiate the air as it moves past the light, is very effective at inactivating airborne virus and bacteria.
Additionally, indoor air quality or carbon dioxide monitoring networks may be installed in buildings to gain an approximate sense in real time of whether outdoor air ventilation is sufficient for building occupancy.
Simultaneously, real-time CO2 monitoring generates data that can be used to enhance the efficiency of building energy consumption.
Indoor air quality data and information on ventilation and filtration improvements in buildings should also be shared with building occupants when possible to promote transparency regarding health and safety measures in the building.
The First Four Healthy Building Strategies Every Building Should Pursue to Reduce Risk from COVID-19. Lancet COVID-19 Commission Task Force on Safe School, Safe Work, Safe Travel. 2022.
Important paper on wildfire smoke, using cell phones and internet search. When it comes to searching for air quality info, similar for high- and low-income. But when it comes to health protection and staying home to avoid smoke…
“Residents of lower-income neighbourhoods exhibit similar patterns in searches for air quality information but not for health protection, spend less time at home and have more muted sentiment responses.”
2/n
Why care about wildfire smoke?
“During smoke events, indoor particulate matter (PM2.5) concentrations often remain 3–4× above health-based guidelines and vary by 20× between neighbouring households.”
3/n
One of the real challenges in interpreting risk on airplanes is the massive denominator. When a plane crashes, it's rightly front page news, but doesn't mean flying isn't safe. Same issue w/ unruly passenger, jerky comment about masks, some guy playing guitar in the aisle...
1/n
These issues make 'front page news' on social media, but they're wholly unrepresentative. (I flew two days ago, and about 10-20% chose to wear masks, no flight attendants did, and nobody seemed to care either way. It was blissfully boring, and gets lost in the denominator.)
Same goes for transmission risk on airplanes. Can it happen? Yes, of course. Transmission can happen anywhere. But we can't take one-offs and apply generally without accounting for the denominator. 2 million people flew yesterday in the U.S. alone.
Well, this caught my eye. I led point on LD outbreak investigations and thought I’d seen it all, but never saw this. And, after reading it, I’m not buying the conclusion.
First glance issue is the exposure pathway. I’m having a hard time with it - aerosolized washer fluid on windshield that penetrates the truck cab? I guess maybe…
2/n
Then I was hoping to see genotyping but authors note they couldn’t get sample from respiratory secretions from either of the two cases so unable to do genotyping to confirm the washer fluid was actual source.
3/n
THE PROBLEM:
"an important flaw exists in how most buildings operate in that the current standards for ventilation and filtration for indoor spaces, except for hospitals, are set for bare minimums and not designed for infection control"
THE SOLUTION: 🧵👇
"Increasing air changes per hour and air filtration is a simplified but important concept that could be deployed to help reduce risk from within-room, far-field airborne transmission of SARS-CoV-2 and other respiratory infectious diseases."
"While multiple conventions exist to describe ventilation rate (total volumetric flow, volumetric flow per person and area, outdoor air ventilation rates), air exchange rate is frequently used in health care settings and commonly expressed in units of air changes per hour (ACH)"
"just about every building you’ve ever walked into is underventilated with low levels of filtration. That’s b/c the standard that governs ventilation rates is a bare minimum not designed for health."
When we think about the full suite of tools we need to combat covid, now and in the future, we’ve had many successes - vaccines, therapeutics, rapid tests. But amid all these achievements, one of the most important and needed has been ignored: good ventilation and filtration.
2/x
How much of a non-focus are ventilation and filtration? We don’t even include an assessment of the building systems in our outbreak investigations, as our Lancet COVID-19 Commission report pointed out should be done every time.
3/x