On the Development of Health-Based Ventilation Guidelines : Principles and Framework

This paper summarizes the results of HealthVent project. It had an aim to develop health-based ventilation guidelines and through this process contribute to advance indoor air quality (IAQ) policies and guidelines. A framework that allows determining ventilation requirements in public and residential buildings based on the health requirements is proposed. The framework is based on three principles: 1. Criteria for permissible concentrations of specific air pollutants set by health authorities have to be respected; 2. Ventilation must be preceded by source control strategies that have been duly adopted to improve IAQ; 3. Base ventilation must always be secured to remove occupant emissions (bio-effluents). The air quality guidelines defined by the World Health Organization (WHO) outside air are used as the reference for determining permissible levels of the indoor air pollutants based on the principle that there is only one air. It is proposed that base ventilation should be set at 4 L/s per person; higher rates are to be used only if WHO guidelines are not followed. Implementation of the framework requires technical guidelines, directives and other legislation. Studies are also needed to examine the effectiveness of the approach and to validate its use. It is estimated that implementing the framework would bring considerable reduction in the burden of disease associated with inadequate IAQ

Dismantling myths on the airborne transmission of severe acute respiratory syndrome coronavirus (SARS-CoV-2)

The Covid-19 pandemic has caused untold disruption and enhanced mortality rates around the world. Understanding the mechanisms for transmission of SARS-CoV-2 is key to preventing further spread but there is confusion over the meaning of “airborne” whenever transmission is discussed. Scientific ambivalence originates from evidence published many years ago, which has generated mythological beliefs that obscure current thinking. This article gathers together and explores some of the most commonly held dogmas on airborne transmission in order to stimulate revision of the science in the light of current evidence. Six ‘myths’ are presented, explained, and ultimately refuted on the basis of recently published papers and expert opinion from previous work related to similar viruses. There is little doubt that SARS-CoV-2 is transmitted via a range of airborne particle sizes subject to all the usual ventilation parameters and human behaviour. Experts from specialties encompassing aerosol studies, ventilation, engineering, physics, virology and clinical medicine have joined together to present this review, in order to consolidate the evidence for airborne transmission mechanisms and offer justification for modern strategies for prevention and control of Covid-19 in healthcare and community

What were the historical reasons for the resistance to recognizing airborne transmission during the COVID‐19 pandemic?

The question of whether SARS‐CoV‐2 is mainly transmitted by droplets or aerosols has been highly controversial. We sought to explain this controversy through a historical analysis of transmission research in other diseases. For most of human history, the dominant paradigm was that many diseases were carried by the air, often over long distances and in a phantasmagorical way. This miasmatic paradigm was challenged in the mid to late 19th century with the rise of germ theory, and as diseases such as cholera, puerperal fever, and malaria were found to actually transmit in other ways. Motivated by his views on the importance of contact/droplet infection, and the resistance he encountered from the remaining influence of miasma theory, prominent public health official Charles Chapin in 1910 helped initiate a successful paradigm shift, deeming airborne transmission most unlikely. This new paradigm became dominant. However, the lack of understanding of aerosols led to systematic errors in the interpretation of research evidence on transmission pathways. For the next five decades, airborne transmission was considered of negligible or minor importance for all major respiratory diseases, until a demonstration of airborne transmission of tuberculosis (which had been mistakenly thought to be transmitted by droplets) in 1962. The contact/droplet paradigm remained dominant, and only a few diseases were widely accepted as airborne before COVID‐19: those that were clearly transmitted to people not in the same room. The acceleration of interdisciplinary research inspired by the COVID‐19 pandemic has shown that airborne transmission is a major mode of transmission for this disease, and is likely to be significant for many respiratory infectious diseases