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

Indoor Air Quality Management After COVID-19

This presentation, provided by the Building Efficiency for a Sustainable Tomorrow (BEST) Center, is from the BEST Center's 2022 Annual Institute. During the presentation, William Bahnfleth, professor of architectural engineering at Pennsylvania State University, provides a detailed analysis of air contaminants and the need to improve indoor air quality (IAQ) in a post-COVID-19 world. The presentation gives an introduction to IAQ, air contaminants, including their sources and effects, and discusses the need to improve standards for acceptable IAQ, especially when considering the COVID-19 pandemic. Other topics discussed include the effects of poor IAQ and lack of ventilation on productivity, how the COVID-19 pandemic highlights the importance of IAQ control, the connection between IAQ and disease transmission, and more. Additional videos from the BEST 2022 Institute are available to view separately.This video runs 1:06:46 minutes in length

Control of airborne infectious disease in buildings: Evidence and research priorities.

The evolution of SARS-CoV-2 virus has resulted in variants likely to be more readily transmitted through respiratory aerosols, underscoring the increased potential for indoor environmental controls to mitigate risk. Use of tight-fitting face masks to trap infectious aerosol in exhaled breath and reduce inhalation exposure to contaminated air is of critical importance for disease control. Administrative controls including the regulation of occupancy and interpersonal spacing are also important, while presenting social and economic challenges. Indoor engineering controls including ventilation, exhaust, air flow control, filtration, and disinfection by germicidal ultraviolet irradiation can reduce reliance on stringent occupancy restrictions. However, the effects of controls-individually and in combination-on reducing infectious aerosol transfer indoors remain to be clearly characterized to the extent needed to support widespread implementation by building operators. We review aerobiologic and epidemiologic evidence of indoor environmental controls against transmission and present a quantitative aerosol transfer scenario illustrating relative differences in exposure at close-interactive, room, and building scales. We identify an overarching need for investment to implement building controls and evaluate their effectiveness on infection in well-characterized and real-world settings, supported by specific, methodological advances. Improved understanding of engineering control effectiveness guides implementation at scale while considering occupant comfort, operational challenges, and energy costs

Critical review of standards for indoor thermal environment and air quality

Quality of the indoor environment has become an important parameter to account for in new and existing buildings due to the increasing number of people spending most of their time indoors. Generally, the design and evaluation of indoor environments in buildings rely on appropriate guidelines and recommendations. National and international IEQ standards specify indoor environmental conditions considered acceptable to most occupants. This publication reviews and critically compares the requirements for indoor thermal environment and ventilation for acceptable air quality across international standards such as ISO, EN and ASHRAE and national standards of China, India, Singapore, and Australia.The critical analysis of IEQ standards demonstrates that regional differences and diversity factors due to factors such as climate, building typology, demographics, and culture might not be appropriately addressed both in national and international standards, limiting the feasibility of universal indoor environmental criteria. In addition to that, most of the standards provide recommendations for various categories of thermal comfort and air quality by focusing on the perception of IEQ by occupants rather than productivity and wellness as quantitative criteria. The review shows that thermal comfort and air quality parameters are treated separately and without an integrated assessment of various environmental quality-related dimensions. Therefore, there is a need for a method to combine various indoor environmental factors into a combined indicator. (C) 2020 Elsevier B.V. All rights reserved