Role of ventilation in airborne transmission of infectious agents in the built environment - a multidisciplinary systematic review

Safety and Reverence: How Roman Catholic Liturgy Can Respond to the COVID-19 Pandemic

The current COVID-19 pandemic is a major challenge for many religious denominations. The Roman Catholic Church strongly depends on physical communal worship and sacraments. Disagreements grow concerning the best balance between safety and piety. To address this issue, I review the major transmission risks for the SARS-CoV-2 virus and list certain measures to enhance the safety of the Roman Catholic Liturgy without compromising its intrinsic beauty and reverent spiritual attitude. This can be achieved through assimilation of several traditional elements into the modern liturgy. I emphasize that religious leadership and decision-making should be transparent and based on inclusiveness, pluralism, best scientific evidence and voluntary cooperation.

Three-dimensional simulation of clouds of multi-disperse evaporating saliva droplets in a train cabin

In line with recent ongoing efforts to collect crucial information about the mechanisms of virus diffusion and put them in relation to the effective complexity of the several natural or artificial environments where human beings leave and operate, the present study deals with the dispersion of evaporating saliva droplets in the cabin of an interregional train. A relevant physical model is constructed taking into account the state of the art in terms of existing paradigms and their ability to represent some fundamental aspects related to the evolution in time of a cloud of multi-disperse droplets. Conveniently, such a theoretical framework is turned into a computational one that relies on low Mach-number asymptotics and can therefore take advantage of the typical benefits (relatively low computational cost) associated with pressure-based methods. Numerical simulations are used to predict the flow established in the cabin as a result of the ventilation systems and related settings dictated by considerations on passenger comfort. The solution of two-way coupled Lagrangian evolution equations is used to capture the associated dynamics of the dispersed phase and predict its transport in conjunction with the peculiar topology of the considered flow and morphology of solid surfaces, which bound it (including the human beings). Typical physiological processes such as talking or coughing are considered. An analysis on the impact of the multiplicity of droplet sources is also conducted, thereby providing some indications in terms of potential risks for the cabin occupants.

Transmissibility and transmission of respiratory viruses

Human respiratory virus infections lead to a spectrum of respiratory symptoms and disease severity, contributing to substantial morbidity, mortality and economic losses worldwide, as seen in the COVID-19 pandemic. Belonging to diverse families, respiratory viruses differ in how easy they spread (transmissibility) and the mechanism (modes) of transmission. Transmissibility as estimated by the basic reproduction number (R0) or secondary attack rate is heterogeneous for the same virus. Respiratory viruses can be transmitted via four major modes of transmission: direct (physical) contact, indirect contact (fomite), (large) droplets and (fine) aerosols. We know little about the relative contribution of each mode to the transmission of a particular virus in different settings, and how its variation affects transmissibility and transmission dynamics. Discussion on the particle size threshold between droplets and aerosols and the importance of aerosol transmission for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and influenza virus is ongoing. Mechanistic evidence supports the efficacies of non-pharmaceutical interventions with regard to virus reduction; however, more data are needed on their effectiveness in reducing transmission. Understanding the relative contribution of different modes to transmission is crucial to inform the effectiveness of non-pharmaceutical interventions in the population. Intervening against multiple modes of transmission should be more effective than acting on a single mode.

Assessing the Risk in Urban Public Transport for Epidemiologic Factors

Pandemics have presented new challenges for public transport organisers and operators. New diseases (e.g., influenza H1N1, severe acute respiratory syndrome—SARS, as well as, more recently, SARS-CoV-2) increase the need for new protection measures to prevent epidemic outbreaks in public transport infrastructure. The authors’ goal is to present a set of actions in the area of public transport that are adjusted to different levels of epidemic development. The goal goes back to the following question: how can the highest possible level of passenger safety be ensured and the losses suffered by urban public transport companies kept as low as possible? The sets of pro-active measures for selected epidemic scenarios presented in the article may offer support to local authorities and public transport operators. In the next steps, it is important to develop and implement tools for public transport management to ensure safety and tackle epidemic hazards.

Spread of respiratory infections in student dormitories in China

OBJECTIVES

Student dormitory rooms in China are characterized by small space and high occupancy. This study aims to investigate infection rates for common colds and influenza among college students in a Chinese university and their association with the dormitory environment.

METHODS

This study involved two phases. In Phase I, 2978 students living in 998 dorm rooms in 12 buildings responded to a questionnaire survey on infections in four seasons. In Phase II, based on the data obtained from the questionnaire survey, we selected 242 dorm rooms to measure air temperature, relative humidity and CO₂ concentration in both summer and winter. Ventilation rates at night were calculated based on measured CO₂ concentrations.

RESULTS

We found that students had infections more often in winter, and in rooms with higher occupancy and dampness problems. The median value of the ventilation rate in dorm rooms in summer was 10.7 L/s per person, while it was 4.10 L/s per person in winter. There were significant associations between ventilation rate per person at night and common cold and influenza both in summer and winter (p < 0.05). A combination of dampness and low ventilation rate significantly increased the risk of common colds (adjusted odds ratios, AOR: 1.26-1.91) and influenza (AOR: 1.49-2.20).

CONCLUSION

College students living in a crowded dormitory room with low ventilation and dampness problems had more common colds and influenza infections.

High-Fidelity Simulation of Pathogen Propagation, Transmission and Mitigation in the Built Environment

An overview of high-fidelity modeling of pathogen propagation, transmission and mitigation in the built environment is given. In order to derive the required physical and numerical models, the current understanding of pathogen, and in particular virus transmission and mitigation is summarized. The ordinary and partial differential equations that describe the flow, the particles and possibly the UV radiation loads in rooms or HVAC ducts are presented, as well as proper numerical methods to solve them in an expedient way. Thereafter, the motion of pedestrians, as well as proper ways to couple computational fluid dynamics and computational crowd dynamics to enable high-fidelity pathogen transmission and infection simulations is treated. The present review shows that high-fidelity simulations of pathogen propagation, transmission and mitigation in the built environment have reached a high degree of sophistication, offering a quantum leap in accuracy from simpler probabilistic models. This is particularly the case when considering the propagation of pathogens via aerosols in the presence of moving pedestrians.

Seasonal variation in airborne infection risk in schools due to changes in ventilation inferred from monitored carbon dioxide

The year 2020 has seen the world gripped by the effects of the COVID-19 pandemic. It is not the first time, nor will it be last, that our increasingly globalized world has been significantly affected by the emergence of a new disease. In much of the Northern Hemisphere, the academic year begins in September, and for many countries, September 2020 marked the return to full schooling after some period of enforced closure due to COVID-19. In this paper, we focus on the airborne spread of disease and investigate the likelihood of transmission in school environments. It is crucial to understand the risk airborne infection from COVID-19 might pose to pupils, teachers, and their wider social groups. We use monitored CO₂ data from 45 classrooms in 11 different schools from within the UK to estimate the likelihood of infection occurring within classrooms regularly attended by the same staff and pupils. We determine estimates of the number of secondary infections arising via the airborne route over pre/asymptomatic periods on a rolling basis. Results show that, assuming relatively quiet desk-based work, the number of secondary infections is likely to remain reassuringly below unity; however, it can vary widely between classrooms of the same school even when the same ventilation system is present. Crucially, the data highlight significant variation with the seasons with January being nearly twice as risky as July. We show that such seasonal variations in risk due to changes in ventilation rates are robust and our results hold for wide variations in disease parameterizations, suggesting our results may be applied to a number of different airborne diseases.

Experimental investigation of indoor aerosol dispersion and accumulation in the context of COVID-19: Effects of masks and ventilation

The ongoing COVID-19 pandemic has highlighted the importance of aerosol dispersion in disease transmission in indoor environments. The present study experimentally investigates the dispersion and build-up of an exhaled aerosol modeled with polydisperse microscopic particles (approximately 1 μm mean diameter) by a seated manikin in a relatively large indoor environment. The aims are to offer quantitative insight into the effect of common face masks and ventilation/air purification, and to provide relevant experimental metrics for modeling and risk assessment. Measurements demonstrate that all tested masks provide protection in the immediate vicinity of the host primarily through the redirection and reduction of expiratory momentum. However, leakages are observed to result in notable decreases in mask efficiency relative to the ideal filtration efficiency of the mask material, even in the case of high-efficiency masks, such as the R95 or KN95. Tests conducted in the far field ( 2   m distance from the subject) capture significant aerosol build-up in the indoor space over a long duration ( 10   h ). A quantitative measure of apparent exhalation filtration efficiency is provided based on experimental data assimilation to a simplified model. The results demonstrate that the apparent exhalation filtration efficiency is significantly lower than the ideal filtration efficiency of the mask material. Nevertheless, high-efficiency masks, such as the KN95, still offer substantially higher apparent filtration efficiencies (60% and 46% for R95 and KN95 masks, respectively) than the more commonly used cloth (10%) and surgical masks (12%), and therefore are still the recommended choice in mitigating airborne disease transmission indoors. The results also suggest that, while higher ventilation capacities are required to fully mitigate aerosol build-up, even relatively low air-change rates ( 2   h - 1 ) lead to lower aerosol build-up compared to the best performing mask in an unventilated space.

Methodology for risk assessment of COVID-19 pandemic propagation

This paper proposes a methodology to perform risk analysis of the virus spread. It is based on the coupling between CFD modelling of bioaerosol dispersion to the calculation of probability of contact events. CFD model of near-field sneeze droplets dispersion is developed to build the SARS-CoV-2 effect zones and to adequately capture the safe distance. The most shared classification of droplets size distribution of sneezes was used.

Droplets were modeled through additive heating/evaporation/boiling laws and their impact on the continuous phase was examined. Larger droplets move behind the droplet nuclei front and exhibit greater vertical drop due to the effect of gravity. CFD simulations provided the iso-risk curves extension (i.e., the maximum distance as well as the angle) enclosed by the incident outcome effect zone. To calculate the risk indexes, a fault tree was developed and the probability of transmission assuming as of the top event “COVID-19 infection” was calculated starting from the virus spread curve, as main base case. Four phases of virus spread evolution were identified: initiation, propagation, generalised propagation and termination. For each phase, the maximum allowable close contact was computed, being fixed the values of the acceptable risk index. In particular, it was found that during the propagation case, the maximum allowable close contacts is two, suggesting that at this point lockdown should be activated. The here developed methodology could drive policy containment design to curb spread COVID-19 infection.

Indoor Environmental Quality in Dwellings and Lifestyle Behaviors during the COVID-19 Pandemic: Russian Perspective

The novel coronavirus (COVID-19) outbreak is a public health emergency of international concern, and as a response, public health authorities started enforcing preventive measures like self-isolation and social distancing. The enforcement of isolation has consequences that may affect the lifestyle-related behavior of the general population. Quarantine encompasses a range of strategies that can be used to detain, isolate, or conditionally release individuals or populations infected or exposed to contagious diseases and should be tailored to circumstances. Interestingly, medical students may represent an example of how the COVID-19 pandemic can form new habits and change lifestyle behaviors. We conducted a web-based survey to assess changes in lifestyle-related behavior of self-isolated medical students during the COVID-19 pandemic. Then we analyzed the sanitary-hygienic regulations of the Russian Federation to determine the requirements for healthy buildings. Results showed that during the pandemic, the enforcement of isolation affects medical students’ lifestyle-related behavior and accompanies an increase in non-communicable diseases (NCDs). Indoor environmental quality (IEQ) and healthy buildings are cutting-edge factors in preventing COVID-19 and NCDs. The Russian sanitary-hygienic regulations support improving this factor with suitable requirements for ventilation, sewage, waste management, and disinfection. Herein, assessing isolation is possible through the hygienic self-isolation index.

An assessment of outpatient clinic room ventilation systems and possible relationship to disease transmission

BACKGROUND

With healthcare shifting to the outpatient setting, this study examined whether outpatient clinics operating in business occupancy settings were conducting procedures in rooms with ventilation rates above, at, or below thresholds defined in the American National Standards Institute/American Society of Heating, Refrigerating and Air-Conditioning Engineers/American Society for Health Care Engineering Standard 170 for Ventilation in Health Care Facilities and whether lower ventilation rates and building characteristics increase the risk of disease transmission.

METHODS

Ventilation rates were measured in 105 outpatient clinic rooms categorized by services rendered. Building characteristics were evaluated as determinants of ventilation rates, and risk of disease transmission was estimated using the Gammaitoni-Nucci model.

RESULTS

When compared to Standard 170, 10% of clinic rooms assessed did not meet the minimum requirement for general exam rooms, 39% did not meet the requirement for treatment rooms, 83% did not meet the requirement for aerosol-generating procedures, and 88% did not meet the requirement for procedure rooms or minor surgical procedures.

CONCLUSIONS

Lower than standard air changes per hour were observed and could lead to an increased risk of spread of diseases when conducting advanced procedures and evaluating persons of interest for emerging infectious diseases. These findings are pertinent during the SARS-CoV-2 pandemic, as working guidelines are established for the healthcare community.

Assessment of CO2 and aerosol (PM2.5, PM10, UFP) concentrations during the reopening of schools in the COVID-19 pandemic: The case of a metropolitan area in Central-Southern Spain

Public health authorities have been paramount in guaranteeing that adequate fresh air ventilation is promoted in classrooms to avoid SARS-CoV-2 transmission in educational environments. In this work it was aimed to assess ventilation conditions (carbon dioxide, CO2) and suspended particulate matter (PM2.5, PM10 and UFP) levels in 19 classrooms - including preschool, primary and secondary education - located in the metropolitan area of Ciudad Real, Central-Southern Spain, during the school's reopening (from September 30th until October 27th, 2020) after about 7 months of lockdown due to COVID-19 pandemic. The classrooms that presented the worst indoor environmental conditions, according to the highest peak of concentration obtained, were particularly explored to identify the possible influencing factors and respective opportunities for improvement. Briefly, findings suggested that although ventilation promoted through opening windows and doors according to official recommendations is guaranteeing adequate ventilation conditions in most of the studied classrooms, thus minimizing the risk of SARS-CoV-2 airborne transmission, a total of 5 (26%) surveyed classrooms were found to exceed the recommended CO2 concentration limit value (700 ppm). In general, preschool rooms were the educational environments that registered better ventilation conditions, while secondary classrooms exhibited the highest peak and average CO2 concentrations. In turn, for PM2.5, PM10 and UFP, the concentrations assessed in preschools were, on average about 2-fold greater than the levels obtained in both primary and secondary classrooms. In fact, the indoor PM2.5 and PM10 concentrations substantially exceeded the recommended limits of 8hr-exposure, established by WHO, in 63% and 32% of the surveyed classrooms, respectively. Overall, it is expected that the findings presented in this study will assist the establishment of evidence-based measures (namely based on ensuring proper ventilation rates and air filtration) to mitigate preventable environmental harm in public school buildings, mainly at local and national levels.

SARS-Cov-2: The Relevance and Prevention of Aerosol Transmission

Coronavirus disease (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2), has claimed many victims worldwide due to its high virulence and contagiousness. The person-to-person transmission of SARS-Cov-2 when in close contact is facilitated by respiratory droplets containing the virus particles, and by skin contact with contaminated surfaces. However, the large number of COVID-19 infections cannot be explained only by droplet deposition or contact contamination. It seems very plausible that aerosols are important in transmitting SARS-Cov-2. It has been demonstrated that SARS-CoV-2 remains viable in aerosols for hours, facilitating rapid distribution of the virus over great distances. Aerosols may, therefore, also be responsible for so-called super-spreader events. Indirect evidence points to a correlation between ventilation and the transmission and spread of SARS-Cov-2, supporting ventilation as an important factor in preventing airborne transmission. Further actions to avoid transmission of COVID-19 include social distancing, hygiene measures, and barrier measures, such as face-coverings. Professional masks offer better protection than cloth masks. These protection measures are especially relevant to health care workers, when performing endotracheal intubation, but the risk from non-invasive ventilation and nebulizing treatment seems to be moderate.

Performance comparison of heat recovery systems to reduce viral contagion in indoor environments

Strong ventilation increments are currently suggested for containing the airborne diffusion of COVID-19 in indoor environments. However, it can involve an unacceptable growing of energy consumption. Therefore, maximum care must be addressed to improve efficiency of ventilation heat recovery (VHR). For this purpose, this paper investigates the opportunity of a technical solution. Consisting in adding downstream of the most diffuse heat recuperator, a heat pump using exhaust air as a cold source. An autonomous high efficiency air handling unit (HEAHU) was modelled for a school application. By simulation a performance comparison was carried on with two alternative systems based only on an exhaust air heat pump (EAHP) or on a heat recuperator for different weather conditions. Results indicated that the milder climate strongly penalizes heat recuperator and this fact deeply influences the conclusions. HEAHU saving compared to energy consumption of only heat recuperator is between 31% and 46%. For EAHP this saving varies from 2.5% to 48%. Only with a milder climate, EAHP presents a lightly greater saving than HEAHU. Heat pump technology looks to be very performing to foster the efficiency of VHR, especially in presence of high ventilation rates.

Controlling risk of SARS-CoV-2 infection in essential workers of enclosed food manufacturing facilities

The SARS-CoV-2 global pandemic poses significant health risks to workers who are essential to maintaining the food supply chain. Using a quantitative risk assessment model, this study characterized the impact of risk reduction strategies for controlling SARS-CoV-2 transmission (droplet, aerosol, fomite-mediated) among front-line workers in a representative enclosed food manufacturing facility. We simulated: 1) individual and cumulative SARS-CoV-2 infection risks from close contact (droplet and aerosols at 1-3m), aerosol, and fomite-mediated exposures to a susceptible worker following exposure to an infected worker during an 8h-shift; and 2) the relative reduction in SARS-CoV-2 infection risk attributed to infection control interventions (physical distancing, mask use, ventilation, surface disinfection, hand hygiene). Without mitigation measures, the SARS-CoV-2 infection risk was largest for close contact (droplet and aerosol) at 1m (0.96, 95%CI: 0.67-1.0). In comparison, risk associated with fomite (0.26, 95%CI: 0.10-0.56) or aerosol exposure alone (0.05, 95%CI: 0.01-0.13) at 1m distance was substantially lower (73-95%). At 1m, droplet transmission predominated over aerosol and fomite-mediated transmission, however, this changed by 3m, with aerosols comprising the majority of the exposure dose. Increasing physical distancing reduced risk by 84% (1 to 2m) and 91% (1 to 3m). Universal mask use reduced infection risk by 52-88%, depending on mask type. Increasing ventilation (from 0.1 to 2-8 air changes/hour) resulted in risk reductions of 14-54% (1m) and 55-85% (2m). Combining these strategies, together with handwashing and surface disinfection, resulted in <1% infection risk. Current industry SARS-CoV-2 risk reduction strategies, particularly when bundled, provide significant protection to essential food workers.

SIGNIFICANCE STATEMENT

Using mathematical modeling, we find that workers in enclosed food manufacturing facilities are at higher risk of SARS-CoV-2 infection from close contact transmission (exposure to large droplets and small aerosol particles) than fomite transmission. Thus, strategies protecting workers should prioritize close contact transmission pathways, such as physical distancing, universal mask use, and room air changes, with surface disinfection (reducing fomite transmission) and handwashing of secondary importance. Our work supports current international (EU-OSHA), domestic (FDA, OSHA), and food industry-standard guidance for managing COVID-19 transmission in essential workers in the food manufacturing sector. Although our model was designed for an indoor food manufacturing setting, it can be readily adapted to other indoor environments and infectious respiratory pathogens.

Dilution-based evaluation of airborne infection risk - Thorough expansion of Wells-Riley model

Evaluation of airborne infection risk with spatial and temporal resolutions is indispensable for the design of proper interventions fighting infectious respiratory diseases (e.g., COVID-19), because the distribution of aerosol contagions is both spatially and temporally non-uniform. However, the well-recognized Wells-Riley model and modified Wells-Riley model (i.e., the rebreathed-fraction model) are limited to the well-mixed condition and unable to evaluate airborne infection risk spatially and temporally, which could result in overestimation or underestimation of airborne infection risk. This study proposes a dilution-based evaluation method for airborne infection risk. The method proposed is benchmarked by the Wells-Riley model and modified Wells-Riley model, which indicates that the method proposed is a thorough expansion of the Wells-Riley model for evaluation of airborne infection risk with both spatial and temporal resolutions. Experiments in a mock hospital ward also demonstrate that the method proposed effectively evaluates the airborne infection risk both spatially and temporally. The proposed method is convenient to implement for the development of healthy built environments.

The role of respiratory droplet physicochemistry in limiting and promoting the airborne transmission of human coronaviruses: A critical review

Whether virulent human pathogenic coronaviruses (SARS-CoV, MERS-CoV, SARS-CoV-2) are effectively transmitted by aerosols remains contentious. Transmission modes of the novel coronavirus have become a hot topic of research with the importance of airborne transmission controversial due to the many factors that can influence virus transmission. Airborne transmission is an accepted potential route for the spread of some viral infections (measles, chickenpox); however, aerosol features and infectious inoculum vary from one respiratory virus to another. Infectious virus-laden aerosols can be produced by natural human respiratory activities, and their features are vital determinants for virus carriage and transmission. Physicochemical characteristics of infectious respiratory aerosols can influence the efficiency of virus transmission by droplets. This critical review identifies studies reporting instances of infected patients producing airborne human pathogenic coronaviruses, and evidence for the role of physical/chemical characteristics of human-generated droplets in altering embedded viruses' viability. We also review studies evaluating these viruses in the air, field studies and available evidence about seasonality patterns. Ultimately the literature suggests that a proportion of virulent human coronaviruses can plausibly be transmitted via the air, even though this might vary in different conditions. Evidence exists for respirable-sized airborne droplet nuclei containing viral RNA, although this does not necessarily imply that the virus is transmittable, capable of replicating in a recipient host, or that inoculum is sufficient to initiate infection. However, evidence suggests that coronaviruses can survive in simulated droplet nuclei for a significant time (>24 h). Nevertheless, laboratory nebulized virus-laden aerosols might not accurately model the complexity of human carrier aerosols in studying airborne viral transport. In summary, there is disagreement on whether wild coronaviruses can be transmitted via an airborne path and display seasonal patterns. Further studies are therefore required to provide supporting evidence for the role of airborne transmission and assumed mechanisms underlying seasonality.

Dilution-based evaluation of airborne infection risk - Thorough expansion of Wells-Riley model

Evaluation of airborne infection risk with spatial and temporal resolutions is indispensable for the design of proper interventions fighting infectious respiratory diseases (e.g., COVID-19), because the distribution of aerosol contagions is both spatially and temporally non-uniform. However, the well-recognized Wells-Riley model and modified Wells-Riley model (i.e., the rebreathed-fraction model) are limited to the well-mixed condition and unable to evaluate airborne infection risk spatially and temporally, which could result in overestimation or underestimation of airborne infection risk. This study proposes a dilution-based evaluation method for airborne infection risk. The method proposed is benchmarked by the Wells-Riley model and modified Wells-Riley model, which indicates that the method proposed is a thorough expansion of the Wells-Riley model for evaluation of airborne infection risk with both spatial and temporal resolutions. Experiments in a mock hospital ward also demonstrate that the method proposed effectively evaluates the airborne infection risk both spatially and temporally. The proposed method is convenient to implement for the development of healthy built environments.

Performance characteristics of a fan filter unit (FFU) in mitigating particulate matter levels in a naturally ventilated classroom during haze conditions

The performance of a low-cost fan filter unit (FFU) in mitigating hazardous particulate matter (PM) levels in a naturally ventilated school classroom is presented. The FFU can be considered as a simplified mechanical ventilation and air-conditioning system without heating and cooling functions. The FFU improves indoor air quality through introduction of cleaned outdoor air to flush out internally generated heat and moisture and reducing infiltration by maintaining indoor pressurization. Indoor particle number concentrations were reduced between 85% and 95%. The particle removal performance (PRF_FFU ) of the FFU is determined and incorporated into the augmented façade penetration factor (P_aug ). A case-specific recursive dynamic mass balance model is used to characterize the infiltration factor (F_INF ), deposition rate (K), and the penetration efficiency (P_aug ) from continuously monitored indoor and outdoor mass concentration levels. Computed "P_aug " (0.07, 0.09, and 0.13) and "F_INF " (0.06, 0.08, and 0.11), respectively, for PM10, PM2.5, and PM1 suggest that exposure to PM was significantly reduced indoors. The effectiveness of the FFU for reduced "F_INF " and "P_aug " may be attributed to its superior filtration, dilution, and exfiltration mechanisms. In comparison with alternative PM mitigation solutions, the FFU is effective, affordable, and sustainable.

Ventilation and air cleaning to limit aerosol particle concentrations in a gym during the COVID-19 pandemic

SARS-CoV-2 can spread by close contact through large droplet spray and indirect contact via contaminated objects. There is mounting evidence that it can also be transmitted by inhalation of infected saliva aerosol particles. These particles are generated when breathing, talking, laughing, coughing or sneezing. It can be assumed that aerosol particle concentrations should be kept low in order to minimize the potential risk of airborne virus transmission. This paper presents measurements of aerosol particle concentrations in a gym, where saliva aerosol production is pronounced. 35 test persons performed physical exercise and aerosol particle concentrations, CO₂ concentrations, air temperature and relative humidity were obtained in the room of 886 m³. A separate test was used to discriminate between human endogenous and exogenous aerosol particles. Aerosol particle removal by mechanical ventilation and mobile air cleaning units was measured. The gym test showed that ventilation with air-change rate ACH = 2.2 h^-1, i.e. 4.5 times the minimum of the Dutch Building Code, was insufficient to stop the significant aerosol concentration rise over 30 min. Air cleaning alone with ACH = 1.39 h^-1 had a similar effect as ventilation alone. Simplified mathematical models were engaged to provide further insight into ventilation, air cleaning and deposition. It was shown that combining the above-mentioned ventilation and air cleaning can reduce aerosol particle concentrations with 80 to 90% , depending on aerosol size. This combination of existing ventilation supplemented with air cleaning is energy efficient and can also be applied for other indoor environments.

Are Historical Buildings More Adaptive to Minimize the Risks of Airborne Transmission of Viruses and Public Health? A Study of the Hazzazi House in Jeddah (Saudi Arabia)

The coronavirus (COVID-19) pandemic has brought immense challenges to the natural and built environment to develop an antivirus-enabled model for reducing potential risks of spreading the virus at varied scales such as buildings, neighborhoods, and cities. Spatial configurations of structures may hinder or assist the spread of viruses in the built environment. In this study, we have hypothesized that suitable air ventilation in historic buildings may enhance the built environment to combat the spreading of infectious viruses. To provide such quantitative shreds of evidence, we have generated and estimated an integrated model to summarize obtained information by considering natural ventilation, wind speed, inflow and outflow, wind direction, and forecasting the associated risks of airborne disease transmission in a historical building (i.e., the Hazzazi House in particular). Intrinsically, the results have demonstrated that the effectiveness of natural ventilation has directly influenced reducing the risks of transmitting airborne infectious viruses for the selected heritage building in Jeddah (Saudi Arabia). The adopted methods in this research may be useful to understand the potentials of conserving old heritage buildings. Consequently, the results demonstrate that natural air ventilation systems are critical to combat the spread of infectious diseases in the pandemic.

Balancing incomplete COVID-19 evidence and local priorities: risk communication and stakeholder engagement strategies for school re-opening

In the midst of the COVID-19 pandemic, United States (U.S.) educational institutions must weigh incomplete scientific evidence to inform decisions about how best to re-open schools without sacrificing public health. While many communities face surging case numbers, others are experiencing case plateaus or even decreasing numbers. Simultaneously, some U.S. school systems face immense infrastructure challenges and resource constraints, while others are better positioned to resume face-to-face instruction. In this review, we first examine potential engineering controls to reduce SARS-CoV-2 exposures; we then present processes whereby local decision-makers can identify and partner with scientists, faculty, students, parents, public health officials, and others to determine the controls most appropriate for their communities. While no solution completely eliminates risks of SARS-CoV-2 exposure and illness, this mini-review discusses engaged decision and communication processes that incorporate current scientific knowledge, school district constraints, local tolerance for health risk, and community priorities to help guide schools in selecting and implementing re-opening strategies that are acceptable, feasible, and context-specific.

Experimental Investigation of Aerosol and CO2 Dispersion for Evaluation of COVID-19 Infection Risk in a Concert Hall

The dispersion of small aerosols in a concert hall is experimentally studied for estimating the risk of infection with SARS-CoV-2 during a concert. A mannequin was modified to emit an air stream containing aerosols and CO2. The aerosols have a size distribution with a peak diameter (δ) close to 0.3 µm and a horizontal initial particle velocity (vp,x) of 2.4 m/s. The CO2-concentration (c) emitted simultaneously is 7500 ppm. It is investigated, if the spatial dissipation of aerosols and CO2 can be correlated. This would allow the use of technically easier CO2 measurements to monitor compliance with aerosol concentration limits. Both aerosol and CO2 concentrations are mapped by different sensors placed around the mannequin. As a result, no significant enrichment of aerosols and CO2 was obtained outside a radius of 1.5 m when the fresh air ventilation in the concert hall has a steady vertical flow with a velocity of vg,z=0.05 m/s and the installed ventilation system was operating at an air change rate per hour (ACH) of 3, corresponding to an air exchange rate of 51,000 m3/h. A Pearson correlation coefficient of 0.77 was obtained for CO2 and aerosol concentrations measured simultaneously at different positions within the concert hall.

A place-based analysis of COVID-19 risk factors in Bangladesh urban slums: a secondary analysis of World Bank microdata

BACKGROUND

There is a lack of research investigating the confluence of risk factors in urban slums that may make them accelerators for respiratory, droplet infections like COVID-19. Our working hypothesis was that, even within slums, an inverse relationship existed between living density and access to shared or private WASH facilities.

METHODS

In an exploratory, secondary analysis of World Bank, cross-sectional microdata from slums in Bangladesh we investigated the relationship between intra-household population density (crowding) and access to private or shared water sources and toilet facilities.

RESULTS

The analysis showed that most households were single-room dwellings (80.4%). Median crowding ranged from 0.55 m² per person up to 67.7 m² per person. The majority of the dwellings (83.3%), shared both toilet facilities and the source of water, and there was a significant positive relationship between crowding and the use of shared facilities.

CONCLUSION

The findings highlight the practical constraints on implementing, in slums, the conventional COVID19 management approaches of social distancing, regular hand washing, and not sharing spaces. It has implications for the management of future respiratory epidemics.

Direct numerical simulation of turbulent dispersion of evaporative aerosol clouds produced by an intense expiratory event

Airborne particles are a major route for transmission of COVID-19 and many other infectious diseases. When a person talks, sings, coughs, or sneezes, nasal and throat secretions are spewed into the air. After a short initial fragmentation stage, the expelled material is mostly composed of spherical particles of different sizes. While the dynamics of the largest droplets are dominated by gravitational effects, the smaller aerosol particles, mostly transported by means of hydrodynamic drag, form clouds that can remain afloat for long times. In subsaturated air environments, the dependence of pathogen-laden particle dispersion on their size is complicated due to evaporation of the aqueous fraction. Particle dynamics can significantly change when ambient conditions favor rapid evaporation rates that result in a transition from buoyancy-to-drag dominated dispersion regimes. To investigate the effect of particle size and evaporation on pathogen-laden cloud evolution, a direct numerical simulation of a mild cough was coupled with an evaporative Lagrangian particle advection model. The results suggest that while the dispersion of cough particles in the tails of the size distribution are unlikely to be disrupted by evaporative effects, preferential aerosol diameters (30-40 μm) may exhibit significant increases in the residence time and horizontal range under typical ambient conditions. Using estimations of the viral concentration in the spewed fluid and the number of ejected particles in a typical respiratory event, we obtained a map of viral load per volume of air at the end of the cough and the number of virus copies per inhalation in the emitter vicinity.

Multi-Scale Airborne Infectious Disease Transmission

Airborne disease transmission is central to many scientific disciplines including agriculture, veterinary biosafety, medicine, and public health. Legal and regulatory standards are in place to prevent agricultural, nosocomial, and community airborne disease transmission. However, the overall importance of the airborne pathway is underappreciated, e.g.,, US National Library of Medicine's Medical Subjects Headings (MESH) thesaurus lacks an airborne disease transmission indexing term. This has practical consequences as airborne precautions to control epidemic disease spread may not be taken when airborne transmission is important, but unrecognized. Publishing clearer practical methodological guidelines for surveillance studies and disease outbreak evaluations could help address this situation.To inform future work, this paper highlights selected, well-established airborne transmission events - largely cases replicated in multiple, independently conducted scientific studies. Methodologies include field experiments, modeling, epidemiology studies, disease outbreak investigations and mitigation studies. Collectively, this literature demonstrates that airborne viruses, bacteria, and fungal pathogens have the capability to cause disease in plants, animals, and humans over multiple distances - from near range (< 5 m) to continental (> 500 km) in scale. The plausibility and implications of undetected airborne disease transmission are discussed, including the notable underreporting of disease burden for several airborne transmitted diseases.

Transmission and reduction of aerosols in classrooms using air purifier systems

SARS-CoV-2 (COVID-19) as an airborne respiratory disease led to a bunch of open questions: how teaching in classrooms is possible and how the risk of infection can be reduced, e.g., by the use of air purifier systems. In this study, the transmission of aerosols in a classroom is analyzed numerically and experimentally. The aerosol concentration in a classroom equipped with an air purifier system was measured with an aerosol spectrometer (optical particle sizer, TSI Incorporated) at different locations. The transient reduction of the aerosol concentration, which was artificially generated by an aerosol generator (di-ethyl hexyl sebacate-atomizer, detected particle size ranging from 0.3 to 10 μm), was monitored. The experimental results were used to validate a numerical simulation model of the classroom using the Open Source Computational Fluid Dynamics code OpenFOAM® (version 6). With the numerical simulation model, different scenarios with infected persons in the room have been analyzed, showing that the air purifier system leads to a significant reduction of airborne particles in the room dependent on the location of the infected person. The system can support additional ventilation strategies with fresh air, especially in cold seasons.

Three-dimensional analysis of the effect of human movement on indoor airflow patterns

Human activity is known to leave significant effects on indoor airflow patterns. These patterns are carefully designed for many facilities such as cleanrooms, pharmaceutical settings, and healthcare environments, where human-induced wakes contribute to the transport of contaminants. Therefore, the knowledge about these wakes as it relates to indoor air quality is critical. As a result, a series of experiments were conducted in a controlled chamber to study the three-dimensional effects of true human walking on airflow. Experiments were designed to capture the effect of human walking under three different flow conditions, and for two different walking schemes. The results show that the effect of walking on the airflow is not negligible and can sustain up to 10 seconds after the moving body has passed. Walking on a straight line creates significant change in the velocity normal to the walking path and vertical to the plane of walking movement. These changes were detectable till 1.0 m away from the walking track. Also, the similarity between airflow patterns of walking once and twice illustrated a promising opportunity of predicting the flow patterns of random walk from a set of base cases.

A dynamical overview of droplets in the transmission of respiratory infectious diseases

The outbreak of the coronavirus disease has drawn public attention to the transmission of infectious pathogens, and as major carriers of those pathogens, respiratory droplets play an important role in the process of transmission. This Review describes respiratory droplets from a physical and mechanical perspective, especially their correlation with the transmission of infectious pathogens. It covers the important aspects of (i) the generation and expulsion of droplets during respiratory activities, (ii) the transport and evolution of respiratory droplets in the ambient environment, and (iii) the inhalation and deposition of droplets in the human respiratory tract. State-of-the-art experimental, computational, and theoretical models and results are presented, and the corresponding knowledge gaps are identified. This Review stresses the multidisciplinary nature of its subject and appeals for collaboration among different fields to fight the present pandemic.

Health, work performance, and risk of infection in office-like environments: The role of indoor temperature, air humidity, and ventilation

Epidemiological and experimental studies have revealed the effects of the room temperature, indoor air humidity, and ventilation on human health, work and cognitive performance, and risk of infection. In this overview, we integrate the influence of these important microclimatic parameters and assess their influence in offices based on literature searches. The dose-effect curves of the temperature describe a concave shape. Low temperature increases the risk of cardiovascular and respiratory diseases and elevated temperature increases the risk of acute non-specific symptoms, e.g., dry eyes, and respiratory symptoms. Cognitive and work performance is optimal between 22 °C and 24 °C for regions with temperate or cold climate, but both higher and lower temperatures may deteriorate the performances and learning efficiency. Low temperature may favor virus viability, however, depending on the status of the physiological tissue in the airways. Low indoor air humidity causes vulnerable eyes and airways from desiccation and less efficient mucociliary clearance. This causes elevation of the most common mucous membrane-related symptoms, like dry and tired eyes, which deteriorates the work performance. Epidemiological, experimental, and clinical studies support that intervention of dry indoor air conditions by humidification alleviates symptoms of dry eyes and airways, fatigue symptoms, less complaints about perceived dry air, and less compromised work performance. Intervention of dry air conditions by elevation of the indoor air humidity may be a non-pharmaceutical treatment of the risk of infection by reduced viability and transport of influenza virus. Relative humidity between 40 and 60% appears optimal for health, work performance, and lower risk of infection. Ventilation can reduce both acute and chronic health outcomes and improve work performance, because the exposure is reduced by the dilution of the indoor air pollutants (including pathogens, e.g., as virus droplets), and in addition to general emission source control strategies. Personal control of ventilation appears an important factor that influences the satisfaction of the thermal comfort due to its physical and positive psychological impact. However, natural ventilation or mechanical ventilation can become sources of air pollutants, allergens, and pathogens of outdoor or indoor origin and cause an increase in exposure. The "health-based ventilation rate" in a building should meet WHO's air quality guidelines and dilute human bio-effluent emissions to reach an acceptable perceived indoor air quality. Ventilation is a modifying factor that should be integrated with both the indoor air humidity and the room temperature in a strategic joint control to satisfy the perceived indoor air quality, health, working performance, and minimize the risk of infection.

Indoor Air Quality: Rethinking rules of building design strategies in post-pandemic architecture

To effectively reduce the spread of SARS-CoV-2, it is crucial to highlight the effectiveness of building design strategies in mitigating threats to occupants. The ongoing pandemic research and actions focus on how poor Indoor Air Quality (IAQ) amplifies the effects of airborne viruses. This review aims to draw architects' attention toward the high risk of airborne transmission of diseases by providing the latest updates and solutions to understand better the environmental and health issues associated with COVID-19. Based on the complexity of the problem and the need for interdisciplinary research, this study presents a conceptual model that addresses the integration of engineering controls, design strategies and, air disinfection techniques required to achieve a better IAQ.

Community evidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission through air

BACKGROUND

Nine COVID-19 (Corona Virus Disease, 2019) cases were observed in one community in Guangzhou. All the cases lived in three vertically aligned units of one building sharing the same piping system, which provided one unique opportunity to examine the transmission mode of SARS-CoV-2.

METHODS

We interviewed the cases on the history of travelling and close contact with the index patients. Respiratory samples from all the cases were collected for viral phylogenetic analyses. A simulation experiment in the building and a parallel control experiment in a similar building were then conducted to investigate the possibility of transmission through air.

RESULTS

Index patients living in Apartment 15-b had a travelling history in Wuhan, and four cases who lived in Apartment 25-b and 27-b were subsequently diagnosed. Phylogenetic analyses showed that virus of all the patients were from the same strain of the virus. No close contacts between the index cases and other families indicated that the transmission might not occur through droplet and close contacts. Airflow detection and simulation experiment revealed that flushing the toilets could increase the speed of airflow in the pipes and transmitted the airflow from Apartment 15-b to 25-b and 27-b. Reduced exhaust flow rates in the infected building might have contributed to the outbreak.

CONCLUSIONS

The outbreak of COVID-19 in this community could be largely explained by the transmission through air, and future efforts to prevent the infection should take the possibility of transmission through air into consideration. A disconnected drain pipe and exhaust pipe for toilet should be considered in the architectural design to help prevent possible virus spreading through the air.

Lagrangian modeling of inactivation of airborne microorganisms by in-duct ultraviolet lamps

There has been increasing interest in modeling the UV inactivation on airborne microorganisms via the Lagrangian approach as a result of its outstanding features in calculating UV dose with particle trajectory. In this study, we applied the Lagrangian method to model the disinfection performance of in-duct UV lamps on three bacteria: Pseudomonas alcaligenes, Salmonella enterica and Escherichia coli, respectively. For modeling, the airborne bacteria's inactivation was determined by critical survival fraction probability (CSFP) and maximal bearable UV dose (MBUD) methods, respectively. The results indicated that Lagrangian modeling utilizing the MBUD method needs to appropriately evaluate the maximal UV dose (D _mb ), which is bearable for airborne microorganisms. The disinfection efficacy obtained by using the CSFP method agreed well with experimental measurements. Within the Lagrangian framework, the recommended empirical value for critical survival fraction (F _sc ) was 0.4 for modeling the disinfection efficacy of in-duct UV lamps. Besides, the disinfection efficacies of in-duct UV lamps with full luminous length on P. alcaligenes and E. coli were 100% with Re within the range of 4.11 × 10⁴ to 8.22 × 10⁴. Moreover, the present numerical model was also applied for further validation with inactivation measurements of in-duct UV lamps performed by the U.S. Environmental Protection Agency (EPA). Based on the results, the UV disinfection efficacies obtained by the present modeling method had a closed agreement with EPA experimental results. It deserved to pay more investigations on the optimal value of F _sc in further for accurately applying Lagrangian modeling on air UV disinfection.

Numerical Study of Three Ventilation Strategies in a prefabricated COVID-19 inpatient ward

Prefabricated inpatient wards have been proven to be an efficient alternative to quickly extend the caring capacity for patients. In this study, three typical ventilation strategies were studied using computational fluid dynamics in a prefabricated Coronavirus disease 2019 double-patient ward. Pollutants are the respiratory droplets and aerosols injected from two manikins. They are modelled as particles with different diameters (3 μm, 6 μm, 12 μm, 20 μm, 45 μm and 175 μm) by the Eulerian-Lagrangian model. Three ventilation strategies with an identical air change rate of 12.3 h^-1 but different layouts of inlets and outlets are implemented. The flow field, flow structures and particle trajectories have been analysed and compared among the three ventilation strategies. The fate of particles is analysed and compared quantitatively. It is found that small particles (<20 μm) can move along with the main flow streams. Most of them are removed by ventilation to the outlet(s). Large particles (>45 μm) cannot move with the flow streams over a long path. Most of them deposit on solid surfaces in different regions of the ward in each ventilation strategy. Health workers should pay close attention to these polluted areas. Targeted cleaning of the polluted areas is necessary in a prefabricated inpatient ward. To promote the removal of some large particles (e.g., 45 μm) by the outlet(s), the outlet(s) should be installed inside the landing area of large particles and close to the polluted source(s).

Biosafety during a pandemic: shared resource laboratories rise to the challenge

Biosafety has always been an important aspect of daily work in any research institution, particularly for cytometry Shared Resources Laboratories (SRLs). SRLs are common‐use spaces that facilitate the sharing of knowledge, expertise, and ideas. This sharing inescapably involves contact and interaction of all those within this working environment on a daily basis. The current pandemic caused by SARS‐CoV‐2 has prompted the re‐evaluation of many policies governing the operations of SRLs. Here we identify and review the unique challenges SRLs face in maintaining biosafety standards, highlighting the potential risks associated with not only cytometry instrumentation and samples, but also the people working with them. We propose possible solutions to safety issues raised by the COVID‐19 pandemic and provide tools for facilities to adapt to evolving guidelines and future challenges.

Nursing Homes in Spain and Their High Number of Deaths by COVID-19 as an Alarm in the Study of Indoor Air Quality

Nursing homes have been one of the most prominent targets of the COVID-19 coronavirus in Spain. The factors that have determined that this is the case are very diverse. In this study, physical agents and chemical pollutants, population density, and different capacities of the residences are analyzed to see their influence on the number of elderly people who have died in the geriatric centres in the different autonomous communities (AACC) of Spain. A statistical analysis has been carried out on the variables observed. The conclusions show that in many places where this overflow of deaths has occurred, the residences were private, with some exceptions. The influence of physical agents and pollutants has been shown to be a determining factor, especially for the communities of Extremadura and Castilla-La Mancha, although it is true that the large number of factors makes the study complicated. The dilemma between air quality and energy efficiency is of great importance, especially when human health is at stake.

Experimental and numerical study on the transport of droplet aerosols generated by occupants in a fever clinic

The outbreak of the corona virus disease 2019 (COVID-19) infection has spread to a large number of countries worldwide. The early diagnosis of COVID-19 is complicated by its strong transmission characteristics and no obvious symptoms in the incubation period. Due to the relatively sealed indoor environment and the existing ventilation system, the patients and doctors in the fever clinics of the major hospitals are faced with a huge risk of infection. This study aims to investigate the transport of droplet aerosols generated by both doctors and patients to seek measures to reduce the risk of infection. Taking a typical fever clinic as an object of study, two links in the actual diagnosis and treatment process are selected in this manuscript for investigation by experimental and numerical methods. The effects of different cases of coughing and talking, as well as different contact distances, on the inhalation rate of human droplet aerosols are studied. The purification capacity of the ventilation is evaluated by the analysis results of the particle diffusion track and regional concentration of the entire indoor area and breathing zones. The results show that purification of the same number of droplet aerosols and purification by ventilation work better for coughing than for talking. The best ventilation performance appeared for the case of a patient sitting and coughing (PSC), while the case of a patient lying and talking (PLT) was the worst. Corresponding measures are suggested to improve the air purification effect and reduce the risk of cross infection.

Temporal evolution, most influential studies and sleeping beauties of the coronavirus literature

Following the outbreak of SARS-CoV-2 disease, within less than 8 months, the 50 years-old scholarly literature of coronaviruses grew to nearly three times larger than its size prior to 2020. Here, temporal evolution of the coronavirus literature over the last 30 years (N = 43,769) is analysed along with its subdomain of SARS-CoV-2 articles (N = 27,460) and the subdomain of reviews and meta-analytic studies (N = 1027). The analyses are conducted through the lenses of co-citation and bibliographic coupling of documents. (1) Of the N = 1204 review and meta-analytical articles of the coronavirus literature, nearly 88% have been published and indexed during the first 8 months of 2020, marking an unprecedented attention to reviews and meta-analyses in this domain, prompted by the SARS-CoV-2 pandemic. (2) The subset of 2020 SARS-CoV-2 articles is bibliographically distant from the rest of this literature published prior to 2020. Individual articles of the SARS-CoV-2 segment with a bridging role between the two bodies of articles (i.e., before and after 2020) are identifiable. (3) Furthermore, the degree of bibliographic coupling within the 2020 SARS-CoV-2 cluster is much poorer compared to the cluster of articles published prior to 2020. This could, in part, be explained by the higher diversity of topics that are studied in relation to SARS-CoV-2 compared to the literature of coronaviruses published prior to the SARS-CoV-2 disease. (4) The analyses on the subset of SARS-CoV-2 literature identified studies published prior to 2020 that have now proven highly instrumental in the development of various clusters of publications linked to SARS-CoV-2. In particular, the so-called "sleeping beauties" of the coronavirus literature with an awakening in 2020 were identified, i.e., previously published studies of this literature that had remained relatively unnoticed for several years but gained sudden traction in 2020 in the wake of the SARS-CoV-2 outbreak. This work documents the historical development of the literature on coronaviruses as an event-driven literature and as a domain that exhibited, arguably, the most exceptional case of publication burst in the history of science. It also demonstrates how scholarly efforts undertaken during peace time or prior to a disease outbreak could suddenly play a critical role in prevention and mitigation of health disasters caused by new diseases.

Supplementary Information

The online version contains supplementary material available at 10.1007/s11192-021-04036-4.

Stop the leak!: Mitigating potential exposure of aerosolized COVID-19 during laparoscopic surgery

BACKGROUND

Viral particles have been shown to aerosolize into insufflated gas during laparoscopic surgery. In the operating room, this potentially exposes personnel to aerosolized viruses as well as carcinogens. In light of circumstances surrounding COVID-19 and a concern for the safety of healthcare professionals, our study seeks to quantify the volumes of gas leaked from dynamic interactions between laparoscopic instruments and the trocar port to better understand potential exposure to surgically aerosolized particles.

METHODS

A custom setup was constructed to simulate an insufflated laparoscopic surgical cavity. Two surgical instrument use scenarios were examined to observe and quantify opportunities for insufflation gas leakage. Both scenarios considered multiple configurations of instrument and trocar port sizes/dimensions: (1) the full insertion and full removal of a laparoscopic instrument from the port and (2) the movement of the scope within the port, recognized as "dynamic interaction", which occurs nearly 100% of the time over the course of any procedure.

RESULTS

For a 5 mm instrument in a 5 mm trocar, the average volume of gas leaked during dynamic interaction and full insertion/removal scenarios were 43.67 and 25.97 mL of gas, respectively. Volume of gas leaked for a 5 mm instrument in a 12 mm port averaged 41.32 mL and 29.47 for dynamic interaction vs. instrument insertion and removal. Similar patterns were shown with a 10 mm instrument in 12 mm port, with 55.68 mL for the dynamic interaction and 58.59 for the instrument insertion/removal.

CONCLUSIONS

Dynamic interactions and insertion/removal events between laparoscopic instruments and ports appear to contribute to consistent leakage of insufflated gas into the OR. Any measures possible taken to reduce OR gas leakage should be considered in light of the current COVID-19 pandemic. Minimizing laparoscope and instrument removal and replacement would be one strategy to mitigate gas leakage during laparoscopic surgery.

Engineering Solutions for Preventing Airborne Transmission in Hospitals with Resource Limitation and Demand Surge

Among the various strategies for the prevention of airborne transmission, engineering measures are placed high in the hierarchy of control. Modern hospitals in high-income countries have mechanical systems of building ventilation also called HVAC (heating, ventilation, and air-conditioning) but installation and maintenance of such systems is a challenging and resource-intensive task. Even when the state-of-the-art technology was used to build airborne infection isolation rooms (AIIRs), recommended standards were often not met in field studies. The current coronavirus disease-2019 pandemic has highlighted the need to find cost-effective and less resource-intensive engineering solutions. Moreover, there is a need for the involvement of interdisciplinary teams to find innovative infection control solutions and doctors are frequently lacking in their understanding of building ventilation-related problems as well as their possible solutions. The current article describes building ventilation strategies (natural ventilation and hybrid ventilation) for hospitals where HVAC systems are either lacking or do not meet the recommended standards. Other measures like the use of portable air cleaning technologies and temporary negative-pressure rooms can be used as supplementary strategies in situations of demand surge. It can be easily understood that thermal comfort is compromised in buildings that are not mechanically fitted with HVAC systems, therefore the given building ventilation strategies are more helpful when climatic conditions are moderate or other measures are combined to maintain thermal comfort.

Culture Media and Sampling Collection Method for Aspergillus spp. Assessment: Tackling the Gap between Recommendations and the Scientific Evidence

Culturing is still the most widely used method for determining fungal growth. Thus, is important to identify the most suitable culture media to assess Aspergillus spp. The aim of this study was to analyze data obtained from previous studies, aiming at identifying the most suitable culture media (malt extract agar (MEA) or dichloran-glycerol agar (DG18) to assess Aspergillus spp. isolation and growth. This study was conducted by using environmental samples (n = 1153). Most of the active sampling methods (air samples) were impacted directly onto both culture media. As for passive sampling methods, fungi were extracted from environmental matrices inoculated onto both media. Overall, total Aspergillus counts were higher in MEA (n = 617, 53.5%) than in DG18 (n = 536, 46.5%). Regarding Aspergillus sections, significant associations were detected with the media (χ2 (7) = 241.118, p < 0.001), the sampling approach (p < 0.001, 95% CI = (0.3 × 10−4), and the indoor environment (p < 0.001, 95% CI = (0.3 × 10−4)). As such, sampling approach and the culture media should be accurately selected when dealing with Aspergillus spp. exposure assessment.

Pragmatic Recommendations for Safety while Caring for Hospitalized Patients with COVID-19 in Low- and Middle-Income Countries

Infection prevention and control measures to control the spread of COVID-19 are challenging to implement in many low- and middle-income countries (LMICs). This is compounded by the fact that most recommendations are based on evidence that mainly originates in high-income countries. There are often availability, affordability, and feasibility barriers to applying such recommendations in LMICs, and therefore, there is a need for developing recommendations that are achievable in LMICs. We used a modified version of the GRADE method to select important questions, searched the literature for relevant evidence, and formulated pragmatic recommendations for safety while caring for patients with COVID-19 in LMICs. We selected five questions related to safety, covering minimal requirements for personal protective equipment (PPE), recommendations for extended use and reuse of PPE, restriction on the number of times healthcare workers enter patients' rooms, hand hygiene, and environmental ventilation. We formulated 21 recommendations that are feasible and affordable in LMICs.

A rapid review of the use of face mask in preventing the spread of COVID-19

Introduction

The original use of face masks was to help protect surgical wounds from staff-generated nasal and oral bacteria. Currently governments across the world have instituted the mandatory use of masks and other face coverings so that face masks now find much broader usage in situations where close contact of people is frequent and inevitable, particularly inside public transport facilities, shopping malls and workplaces in response to the COVID-19.

Objective

We conducted a rapid review to investigate the impact face mask use has had in controlling transmission of respiratory viral infections.

Method

A rapid review was conducted in line with Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidance. Five electronic databases (CINAHL, Embase, Medline, PsycINFO and Global Health) were searched from database inception to date, using pre-defined search terms. We included all studies of any design and used descriptive analysis to report summary statistics of search results. Data were extracted including sample characteristics, study design, respiratory virus being controlled, type of face masks used and their effectiveness.

Results

58 out of 84 studies met the inclusion criteria, of which 13 were classified as systematic reviews and 45 were quantitative studies (comprising randomised controlled trials, retrospective cohort studies, case control, cross-sectional, surveys, observational and descriptive studies). N = 27 studies were conducted amongst healthcare workers wearing face masks, n = 19 studies among the general population, n = 9 studies among healthcare workers the general population and patients wearing masks, and n = 3 among only patients. Face masks use have shown a great potential for preventing respiratory virus transmission including COVID-19.

Conclusion

Regardless of the type, setting, or who wears the face mask, it serves primarily a dual preventive purpose; protecting oneself from getting viral infection and protecting others. Therefore, if everyone wears a face mask in public, it offers a double barrier against COVID-19 transmission.

Negative pressure rooms and COVID-19

The emergence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which causes 2019 novel coronavirus disease (COVID-19), has rapidly developed into a global pandemic and public health emergency. The transmission and virulence of this new pathogen have raised concern for how best to protect healthcare professionals while effectively providing care to the infected patient requiring surgery. Although negative pressure rooms are ideal for aerosol-generating procedures, such as intubation and extubation, most operating theatres are generally maintained at a positive pressure when compared with the surrounding areas. This article compares negative and positive pressure rooms and the advantages of a negative pressure environment in optimising clinical care and minimising the exposure of patients and health care professionals to SARS-CoV-2.

Modeling transient particle transport in transient indoor airflow by fast fluid dynamics with the Markov chain method

It is crucial to accurately and efficiently predict transient particle transport in indoor environments to improve air distribution design and reduce health risks. For steady-state indoor airflow, fast fluid dynamics (FFD) + Markov chain model increased the calculation speed by around seven times compared to computational fluid dynamics (CFD) + Eulerian model and CFD + Lagrangian model, while achieving the same level of accuracy. However, the indoor airflow could be transient, if there were human behaviors involved like coughing or sneezing and air was supplied periodically. Therefore, this study developed an FFD + Markov chain model solver for predicting transient particle transport in transient indoor airflow. This investigation used two cases, transient particle transport in a ventilated two-zone chamber and a chamber with periodic air supplies, for validation. Case 1 had experimental data for validation and the results showed that the predicted particle concentration by FFD + Markov chain model matched well with the experimental data. Besides, it had similar accuracy as the CFD + Eulerian model. In the second case, the prediction by large eddy simulation (LES) was used for validating the FFD. The simulated particle concentrations by the Markov chain model and the Eulerian model were similar. The simulated particle concentrations by the Markov chain model and the Eulerian model were similar. The computational time of the FFD + Markov chain model was 7.8 times less than that of the CFD + Eulerian model.