Recent advancements in the measurement of pathogenic airborne viruses

Hunting for a viral proxy in bioaerosols of swine buildings using molecular detection and metagenomics

There are limited biosecurity measures directed at preventing airborne transmission of viruses in swine. The effectiveness of dust mitigation strategies such as oil sprinkling, to decrease risk of airborne virus transmission are unknown. Metagenomics and qPCR for common fecal viruses were used to hunt for a ubiquitous virus to serve as a proxy when evaluating the efficiency of mitigation strategies against airborne viral infectious agents. Air particles were collected from swine buildings using high-volume air samplers. Extracted DNA and RNA were used to perform specific RT-qPCR and qPCR and analyzed by high-throughput sequencing. Porcine astroviruses group 2 were common (from 102 to 105 genomic copies per cubic meter of air or gc/m3, 93% positivity) while no norovirus genogroup II was recovered from air samples. Porcine torque teno sus virus were detected by qPCR in low concentrations (from 101 to 102 gc/m3, 47% positivity). Among the identified viral families by metagenomics analysis, Herelleviridae, Microviridae, Myoviridae, Podoviridae, and Siphoviridae were dominant. The phage vB_AviM_AVP of Aerococcus was present in all air samples and a newly designed qPCR revealed between 101 and 105 gc/m3 among the samples taken for the present study (97% positivity) and banked samples from 5- and 15-year old studies (89% positivity). According to the present study, both the porcine astrovirus group 2 and the phage vB_AviM_AVP of Aerococcus could be proxy for airborne viruses of swine buildings.

Microfluidics-based condensation bioaerosol sampler for multipoint airborne virus monitoring

To facilitate rapid monitoring of airborne viruses, they must be collected with high efficiency and concentrated in a small volume of a liquid sample. In addition, the development of low-cost miniaturized samplers is essential for multipoint monitoring. Thus, in an attempt to fulfill these requirements, this study developed a microfluidic condensation bioaerosol sampler (MCBS). The developed sampler comprised two parts: a virus growth section and a virus droplet-to-liquid sample conversion section, each of which was fabricated on a chip using microfluidic technology. The condensation nucleus growth technique used in the virus growth section grew nanometer-sized airborne viruses into micro-sized droplets, making it possible to collection of viruses easier and with high efficiency. In addition, the virus droplet-to-liquid sample conversion section controlled the transport of droplets based on electrowetting technology. This enabled the collected airborne viruses to be concentrated in tens of microliters of the liquid sample. To evaluate the performance of both the sections, the virus dropletization, virus collection efficiency, and virus droplet-to-liquid sample conversion efficiency were evaluated through quantitative experiments. H1N1 and HCOV-229E viruses were used to conduct quantitative experiments on MCBS. We could obtain virus liquid samples with at 72.8- and 89.9-times higher concentration through 1:1 evaluation with a commercial sampler. Thus, the developed sampler facilitated efficient collection and concentration of airborne viruses in a compact, cost-effective manner. This is expected to facilitate rapid and accurate multipoint monitoring of viral aerosols.

Filling the knowledge gap: Scoping review regarding sampling methods, assays, and further requirements to assess airborne viruses

Assessment of occupational exposure to viruses is crucial to identify virus reservoirs and sources of dissemination at an early stage and to help prevent spread between employees and to the general population. Measuring workers' exposure can facilitate assessment of the effectiveness of protective and mitigation measures in place. The aim of this scoping review is to give an overview of available methods and those already implemented for airborne virus' exposure assessment in different occupational and indoor environments. The results retrieved from the different studies may contribute to the setting of future standards and guidelines to ensure a reliable risk characterization in the occupational environments crucial for the implementation of effective control measures. The search aimed at selecting studies between January 1st 2010 and June 30th 2023 in the selected databases. Fifty papers on virus exposure assessment fitted the eligibility criteria and were selected for data extraction. Overall, this study identified gaps in knowledge regarding virus assessment and pinpointed the needs for further research. Several discrepancies were found (transport temperatures, elution steps, …), as well as a lack of publication of important data related to the exposure conditions (contextual information). With the available information, it is impossible to compare results between studies employing different methods, and even if the same methods are used, different conclusions/recommendations based on the expert judgment have been reported due to the lack of consensus in the contextual information retrieved and/or data interpretation. Future research on the field targeting sampling methods and in the laboratory regarding the assays to employ should be developed bearing in mind the different goals of the assessment.

Optimal environmental sampling conditions for electrostatic aerosol-to-hydrosol collection of airborne viruses

Due to adverse effects of viral outbreaks on human health, accurate detection of airborne pathogens is essential. Among many methods available for bioaerosol sampling, electrostatic precipitation (ESP) has been used to directly collect bioaerosols as hydrosols. The performance of an ESP sampler depends on its design, operational and environmental parameters such as air relative humidity (RH), air temperature, sampling liquid type and liquid temperature. Thus, it is essential to identify and maintain optimal conditions throughout sampling process to operate the sampler at its highest capacity. This study provides crucial insights into parameters that affect the collection efficiency of the aerosol-to-hydrosol ESP sampler and its virus recovery. The results indicate that air temperature does not affect collection efficiency, meanwhile, air RH, sampling liquid temperature, and salt concentration are the main parameters that significantly affect collection efficiency. Likewise, when deionized water is used as sampling liquid, hydrogen peroxide concentration increases proportionally with increasing air RH, resulting in significant decrease of virus viability. Consequently, for ESP samplers similar to our study, the following conditions are recommended: air RH of 55-65%, air and sampling liquid temperature of 37 °C, and a mixture of 10-20 mM ascorbic acid in PBS as sampling liquid.

Gel-confined fabrication of fully bio-based filtration membrane for green capture and rapid detection of airborne microbes

Air filtration has become a desirable route for collecting airborne microbes. However, the potential biotoxicity and sterilization of current air filtration membranes often lead to undesired inactivation of captured microbes, which greatly limits microbial non-traumatic transfer and recovery. Herein, we report a gel-confined phase separation strategy to rationally fabricate a fully bio-based filtration membrane (SGFM) using soluble soybean polysaccharide and gelatin. The versatile SGFM features fascinating honeycomb micro-nano architecture and hierarchical interconnected porous structures for microbial capture, and achieves a lower pressure drop, higher interception efficiency (99.3%), and superior microbial survivability than commercial gelatin filtration membranes. Particularly, the water-dissolvable SGFM can greatly simplify the elution and extraction process after bioaerosol sampling, thereby bringing about maximum sample transfer and vigorous recovery of collected microbes. Meanwhile, green capture coupled with ATP bioluminescence endows the SGFM with rapid and quantitative detection capability for airborne microbes. This work may pave the way for designing green protocols for the detection of bioaerosols.

Sampling and analysis methods of air-borne microorganisms in hospital air: a review

Pathogenic microorganisms can spread in the air as bioaerosols. When the human body is exposed to different bioaerosols, various infectious diseases may occur. As indoor diagnosis and treatment environments, hospitals are relatively closed and have a large flow rate of people. This indoor environment contains complex aerosol components; therefore, effective sampling and detection of microbial elements are essential in airborne pathogen monitoring. This article reviews the sampling and detection of different kinds of microorganisms in bioaerosols from indoor diagnostic and therapeutic settings, with a particular focus on microbial activity. This provides deeper insights into bioaerosols in diagnostic and therapeutic settings.

Improved measurement of airborne viruses using a two-stage highly virus-enriching electrostatic particle concentrator with electric-field-enhancing wire electrodes

High enrichment of airborne viruses during sampling is critical for their rapid measurement and requires a high sampling flow rate (or velocity), small collection areas, and high collection efficiency; however, high collection efficiency can rarely be achieved at high flow velocities and in small collection areas in electrostatic sampling. Herein, we present improved measurement of airborne viruses using a two-stage highly virus-enriching electrostatic particle concentrator (HEPC) with wire electrodes and high values of the-inlet-velocity-to-collection-electrode-width ratio. This sampler was evaluated using MS2 viruses and 0.05-2.0 µm diameter polystyrene latex particles at 20 liters/min. Computer simulations and experiments agreed well, showing that the wire electrodes increased collection efficiency (by up to 37 % than the without-wire-electrodes case) without high viability losses through local electric field enhancement for high-flow-velocity regions over the collection electrode and minimization of local corona discharge. The relative infectious virus concentrations of the HEPC were 41-70 times higher than those of the BioSampler. Airborne influenza A viruses at field-level concentrations (1.8 × 105 and 2.6 × 104 copies/m3) were also detected at 10-min sampling due to the high enrichment capability of HEPC. The HEPC has strong potential as a rapid airborne virus monitoring system in the field.

Determination of airborne influenza virus and coronavirus infectivity using capsid integrity polymerase chain reaction

Accurate airborne virus monitoring is important for preventing the spread of infectious diseases. Although standard reverse transcription-quantitative polymerase chain reaction (RT-qPCR) can efficiently detect viral ribonucleic acid (RNA), it cannot determine whether the RNA is associated with active (infectious) or inactive (non-infectious) viruses. Plaque assay is the gold standard for determining viral infectivity but is laborious and time-consuming. This study explored the viral infectivity of H1N1 influenza virus and human coronavirus (HCoV-229E) using capsid integrity RT-qPCR, where virus samples were pretreated with reagents penetrating viruses with damaged capsids, impeding amplification by binding to their RNA. Therefore, the amplified signals corresponded solely to active viruses with undamaged capsids. Propidium monoazide (PMA) and platinum (IV) chloride (PtCl4) were used to investigate the effects of reagent concentration. Feasibility tests revealed that PtCl4 was more efficient than PMA, with optimal concentrations of 125-250 μM and 250-500 μM for H1N1 influenza virus and HCoV-229E, respectively. The results of percentage of active virus showed that capsid integrity RT-qPCR provided a trend similar to that of plaque assay, indicating an accurate measure of viral infectivity. Virus sampling in the laboratory and field highlighted the precision of this methodology for determining viral infectivity. Therefore, this methodology enables rapid and accurate detection of infectious airborne H1N1 influenza virus and HCoV-229E, allowing swift response to outbreaks.

Airborne microbes: sampling, detection, and inactivation

The human living environment serves as a habitat for microorganisms and the presence of ubiquitous airborne microbes significantly impacts the natural material cycle. Through ongoing experimentation with beneficial microorganisms, humans have greatly benefited from airborne microbes. However, airborne pathogens endanger human health and have the potential to induce fatal diseases. Tracking airborne microbes is a critical prerequisite for a better understanding of bioaerosols, harnessing their potential advantages, and mitigating associated risks. Although technological breakthroughs have enabled significant advancements in accurately monitoring airborne pathogens, many puzzles about these microbes remain unanswered due to their high variability and environmental diffusibility. Consequently, advanced techniques and strategies for special identification, early warning, and efficient eradication of microbial contamination are continuously being sought. This review presents a comprehensive overview of the research status of airborne microbes, concentrating on the recent advances and challenges in sampling, detection, and inactivation. Particularly, the fundamental design principles for the collection and timely detection of airborne pathogens are described in detail, as well as critical factors for eliminating microbial contamination and enhancing indoor air quality. In addition, future research directions and perspectives for controlling airborne microbes are also suggested to promote the translation of basic research into real products.

Versatile filter membrane for effective sampling and real-time quantitative detection of airborne pathogens

Construction of air filter membranes bearing prominent collecting and transferring capability is highly desirable for detecting airborne pathogens but remains challenging. Here, a hyaluronic acid air filter membrane (HAFM) with tunable heterogeneous micro-nano porous structures is straightforwardly constructed through the ethanol-induced phase separation strategy. Airborne pathogens can be trapped and collected by HAFM with high performance due to the ideal trade-off between removal efficiency and pressure drop. By exempting the sample elution and extraction processes, the HAFM after filtration sampling can not only directly disperse on the agar plate for colony culture but also turn to an aqueous solution for centrifugal enrichment, which significantly reduces the damage and losses of the captured microorganisms. The following combination with ATP bioluminescence endows the HAFM with a real-time quantitative detection function for the captured airborne pathogens. Benefiting from high-efficiency sampling and non-traumatic transfer of airborne pathogens, the real-world bioaerosol concentration can be facilely evaluated by the HAFM-based ATP assay. This work thus not only provides a feasible strategy to fabricate air filter membranes for efficient microbial collection and enrichment but also sheds light on designing advanced protocols for real-time detection of bioaerosols in the field.

Protective face mask: an effective weapon against SARS-CoV-2 with controlled environmental pollution

Masks are face coverings that give protection from infectious agents, airborne pathogens, bacteria, viruses, surgical fog, dust, and other chemical hazards by acting as a barrier between the wearer and the environment. In the COVID-19 pandemic, this major personal protective equipment's became essential part of our daily life. The aim of this review is to analyze and discuss the different types of masks with their pros and cons, manufacturing procedures, evaluation criteria, and application with some of the sterilization process for reuse and smart mask. The review used a thorough examination of the literature to analyze the preventive effects of surgical, N95, smart mask, and potential environmental damage from those masks. Several studies and evidence were also examined to understand the efficiency of different mask on different environment. N95 respirators are capable of filtering out non-oil-based 95% air-born particles, and surgical masks act as a protective barrier between the wearer and the environment. The application of spoon bond and melt blown techniques in the fabrication process of those masks improves their protective nature and makes them lightweight and comfortable. But the high demand and low supply forced users to reuse and extend their use after sterilizations, even though those masks are recommended to be used once. Universal masking in the SARS-COV-2 pandemic increased the chance of environmental pollution, so the application of smart masks became essential because of their high protection power and self-sterilizing and reusing capabilities.

A Comparative Investigation of Aerosol Generation and Exposure Risk During Access Cavity Preparation With or Without Rubber Dam Application

BACKGROUND

Aerosols generated during dental procedures have taken the forefront of discussion in dentistry. Due to the nature of their work, dental professionals face a significant risk of exposure to various biological hazards, such as saliva, blood, aerosols, and droplets. Aerosols, which are tiny particles with a diameter of less than 50µm, have a unique property that allows them to stay suspended in the air for extended periods. This is primarily due to their small size and lightweight nature which makes them highly susceptible to air currents and prevents them from quickly settling down. As a result, these aerosols can linger in the atmosphere, creating a potential risk for respiratory infections.

AIM

The aim is to evaluate and compare the efficacy of rubber dams in preventing aerosols generated cross-contamination.

METHODS AND MATERIAL

This in-vivo experimental study comprised 60 individuals who were suggested for root canal treatment in the mandibular first permanent molar tooth. The passive air sampling technique using "settle plates" was applied to investigate microbial fallout during access opening with and without rubber dam application. Sheep blood agar plates were used to do the colony forming unit (CFU) count. All patients were randomly divided into two groups comprising 30 patients each based on usage of rubber dam application or not, i.e., Group I: Without rubber dam application and Group II: With rubber dam application.

RESULTS

Using a rubber dam while performing an endodontic procedure significantly impacts decreased aerosol generation at 0.5-m and 2-m distances than its counterpart with a p-value < 0.01.

CONCLUSION

Using a rubber dam during endodontic procedures reduces the likelihood of aerosol generation, thereby decreasing the risk of cross-contamination and lowering the susceptibility of dental professionals to respiratory illnesses.

Recovery and Quantification of Norovirus in Air Samples from Experimentally Produced Aerosols

Norovirus is the leading cause of acute gastroenteritis in humans across all age groups worldwide. Norovirus-infected patients can produce aerosolized droplets which play a role in gastroenteritis transmission. The study aimed to assess bioaerosol sampling in combination with a virus concentrating procedure to facilitate molecular detection of norovirus genogroup (G) II from experimentally contaminated aerosols. Using a nebulizer within an experimental chamber, aerosols of norovirus GII were generated at known concentrations. Air samples were then collected in both 5 mL and 20 mL water using the SKC BioSampler at a flow rate of 12.5 L/min, 15 min. Subsequently, the virus in collected water was concentrated using speedVac centrifugation and quantified by RT-qPCR. The optimal distances between the nebulizer and the SKC BioSampler yielded high recoveries of the virus for both 5 and 20 mL collections. Following nebulization, norovirus GII RNA was detectable up to 120 min in 5 mL and up to 240 min in 20 mL collection. The concentrations of norovirus GII RNA recovered from air samples in the aerosol chamber ranged from 102 to 105 genome copies/mL, with average recoveries of 25 ± 12% for 5 mL and 22 ± 19% for 20 mL collections. These findings provide quantitative data on norovirus GII in aerosols and introduce a novel virus concentrating method for aerosol collection in water, thus enhancing surveillance of this virus.

Sampling efficiency and nucleic acid stability during long-term sampling with different bioaerosol samplers

Aerosol microbiome studies have received increased attention as technological advancements have made it possible to dive deeper into the microbial diversity. To enhance biomass collection for metagenomic sequencing, long-term sampling is a common strategy. While the impact of prolonged sampling times on microorganisms' culturability and viability is well-established, its effect on nucleic acid stability remains less understood but is essential to ensure representative sample collection. This study evaluated four air samplers (SKC BioSampler, SASS3100, Coriolis μ, BioSpot-VIVAS 300-P) against a reference sampler (isopore membrane filters) to identify nucleic acid stability during long-term sampling. Physical sampling efficiencies determined with a fluorescent tracer for three particle sizes (0.8, 1, and 3 μm), revealed high efficiencies (> 80% relative to reference) for BioSampler, SASS3100, and BioSpot-VIVAS for all particle sizes, and for Coriolis with 3 μm particles. Coriolis exhibited lower efficiency for 0.8 μm (7%) and 1 μm (50%) particles. During 2-h sampling with MS2 and Pantoea agglomerans, liquid-based collection with Coriolis and BioSampler showed a decrease in nucleic acid yields for all test conditions. BioSpot-VIVAS displayed reduced sampling efficiency for P. agglomerans compared to MS2 and the other air samplers, while filter-based collection with SASS3100 and isopore membrane filters, showed indications of DNA degradation for 1 μm particles of P. agglomerans after long-term sampling. These findings show that long-term air sampling affects nucleic acid stability in both liquid- and filter-based collection methods. These results highlight bias produced by bioaerosol collection and should be considered when selecting an air sampler and interpreting aerosol microbiome data.

Laboratory studies on the infectivity of human respiratory viruses: Experimental conditions, detections, and resistance to the atmospheric environment

The environmental stability of infectious viruses in the laboratory setting is crucial to the transmission potential of human respiratory viruses. Different experimental techniques or conditions used in studies over the past decades have led to diverse understandings and predictions for the stability of viral infectivity in the atmospheric environment. In this paper, we review the current knowledge on the effect of simulated atmospheric conditions on the infectivity of respiratory viruses, mainly focusing on influenza viruses and coronaviruses, including severe acute respiratory syndrome coronavirus 2 and Middle East respiratory syndrome coronavirus. First, we summarize the impact of the experimental conditions on viral stability; these involve the methods of viral aerosol generation, storage during aging and collection, the virus types and strains, the suspension matrixes, the initial inoculum volumes and concentrations, and the drying process. Second, we summarize and discuss the detection methods of viral infectivity and their disadvantages. Finally, we integrate the results from the reviewed studies to obtain an overall understanding of the effects of atmospheric environmental conditions on the decay of infectious viruses, especially aerosolized viruses. Overall, this review highlights the knowledge gaps in predicting the ability of viruses to maintain infectivity during airborne transmission.

Advancements in Airborne Viral Nucleic Acid Detection with Wearable Devices

Wearable health sensors for an expanding range of physiological parameters have experienced rapid development in recent years and are poised to disrupt the way healthcare is tracked and administered. The monitoring of environmental contaminants with wearable technologies is an additional layer of personal and public healthcare and is also receiving increased focus. Wearable sensors that detect exposure to airborne viruses could alert wearers of viral exposure and prompt proactive testing and minimization of viral spread, benefitting their own health and decreasing community risk. With the high levels of asymptomatic spread of COVID-19 observed during the pandemic, such devices could dramatically enhance our pandemic response capabilities in the future. To facilitate advancements in this area, this review summarizes recent research on airborne viral detection using wearable sensing devices as well as technologies suitable for wearables. Since the low concentration of viral particles in the air poses significant challenges to detection, methods for airborne viral particle collection and viral sensing are discussed in detail. A special focus is placed on nucleic acid-based viral sensing mechanisms due to their enhanced ability to discriminate between viral subtypes. Important considerations for integrating airborne viral collection and sensing on a single wearable device are also discussed.

Bioaerosols in the atmosphere: A comprehensive review on detection methods, concentration and influencing factors

In the past few decades, especially since the outbreak of the coronavirus disease (COVID-19), the effects of atmospheric bioaerosols on human health, the environment, and climate have received great attention. To evaluate the impacts of bioaerosols quantitatively, it is crucial to determine the types of bioaerosols in the atmosphere and their spatial-temporal distribution. We provide a concise summary of the online and offline observation strategies employed by the global research community to sample and analyze atmospheric bioaerosols. In addition, the quantitative distribution of bioaerosols is described by considering the atmospheric bioaerosols concentrations at various time scales (daily and seasonal changes, for example), under various weather, and different underlying surfaces. Finally, a comprehensive summary of the reasons for the spatiotemporal distribution of bioaerosols is discussed, including differences in emission sources, the impact process of meteorological factors and environmental factors. This review of information on the latest research progress contributes to the emergence of further observation strategies that determine the quantitative dynamics of public health and ecological effects of bioaerosols.

Research advances in microfluidic collection and detection of virus, bacterial, and fungal bioaerosols

Bioaerosols are airborne suspensions of fine solid or liquid particles containing biological substances such as viruses, bacteria, cellular debris, fungal spores, mycelium, and byproducts of microbial metabolism. The global Coronavirus disease 2019 (COVID-19) pandemic and the previous emergence of severe acute respiratory syndrome (SARS), Middle East respiratory syndrome (MERS), and influenza have increased the need for reliable and effective monitoring tools for bioaerosols. Bioaerosol collection and detection have aroused considerable attention. Current bioaerosol sampling and detection techniques suffer from long response time, low sensitivity, and high costs, and these drawbacks have forced the development of novel monitoring strategies. Microfluidic technique is considered a breakthrough for high performance analysis of bioaerosols. In recent years, several emerging methods based on microfluidics have been developed and reported for collection and detection of bioaerosols. The unique advantages of microfluidic technique have enabled the integration of bioaerosol collection and detection, which has a higher efficiency over conventional methods. This review focused on the research progress of bioaerosol collection and detection methods based on microfluidic techniques, with special attention on virus aerosols and bacterial aerosols. Different from the existing reviews, this work took a unique perspective of the targets to be collected and detected in bioaerosols, which would provide a direct index of bioaerosol categories readers may be interested in. We also discussed integrated microfluidic monitoring system for bioaerosols. Additionally, the application of bioaerosol detection in biomedicine was presented. Finally, the current challenges in the field of bioaerosol monitoring are presented and an outlook given of future developments.

Risk mitigation to healthcare workers against viral and bacterial bioaerosol load in laparoscopic surgical exhaust with a new flow mode in hollow fiber membranes-based filter

Laparoscopy of COVID-19-infected/suspected patients needs to be performed with the utmost care due to the chances of virus carryover through the pneumoperitoneum gas. In this study, polysulfone/polyvinyl-pyrrolidone hollow fiber membranes (HFMs) were fabricated by phase inversion process, and these HFMs were bundled into a module consisting of tortuous, circular-helical arrangement. Further, copper (Cu) and zinc (Zn) nanoparticles (NPs), known to have antimicrobial and antiviral properties, were flow-coated on the lumen side of the HFMs. To test functional efficiency, the modules were challenged with wet aerosol and bioaerosols. Wet aerosol removal efficiency was ∼98%. Bioaerosol-containing bacteria E. coli strain K-12, showed 2.6 log (∼99.8%), and 2.1 log (∼99.3%) removal efficiency for Cu NPs and Zn NPs coated HFMs modules, respectively, and 1.6 log (∼97%) removal for plain (uncoated) HFMs. Bioaerosols containing SARS-CoV-2 surrogate virus (MS2 bacteriophage) showed ∼5-7 log reduction of bacteriophage for plain HFMs, 3.9 log, and 2.3 log reduction for Cu and Zn coated HFMs, respectively. The flow of aerosols entirely through the HFM lumen helps in attaining a low ΔP of < 1 mm Hg, thus rendering its usefulness, particularly for exhausting pneumoperitoneum gases where high upstream pressures could lead to barotrauma. STATEMENT OF ENVIRONMENTAL IMPLICATION: Surgical smoke is generated during minimally invasive surgical (MIS) procedure such as laparoscopy when electrosurgical devices are used to cut any tissues. This smoke is a hazard as it contains toxic volatile compounds, mutagens, carcinogens, bacteria, and virus-laden aerosols. Infection to healthcare professionals through the bioaerosols containing smoke is well reported in literature. The limitation of using hypochlorite and pleated/HEPA filter, led us to design a low pressure drop bioaerosol filter, which can remove smoke, tissue fragments, and COVID-19 virus. It provides a much safer operation theatre environment during MIS procedures as well as in general for bioaerosol removal.

The Next Generation of Drug Delivery: Harnessing the Power of Bacteriophages

The use of biomaterials, such as bacteriophages, as drug delivery vehicles (DDVs) has gained increasing interest in recent years due to their potential to address the limitations of conventional drug delivery systems. Bacteriophages offer several advantages as drug carriers, such as high specificity for targeting bacterial cells, low toxicity, and the ability to be engineered to express specific proteins or peptides for enhanced targeting and drug delivery. In addition, bacteriophages have been shown to reduce the development of antibiotic resistance, which is a major concern in the field of antimicrobial therapy. Many initiatives have been taken to take up various payloads selectively and precisely by surface functionalization of the outside or interior of self-assembling viral protein capsids. Bacteriophages have emerged as a promising platform for the targeted delivery of therapeutic agents, including drugs, genes, and imaging agents. They possess several properties that make them attractive as drug delivery vehicles, including their ability to specifically target bacterial cells, their structural diversity, their ease of genetic manipulation, and their biocompatibility. Despite the potential advantages of using bacteriophages as drug carriers, several challenges and limitations need to be addressed. One of the main challenges is the limited host range of bacteriophages, which restricts their use to specific bacterial strains. However, this can also be considered as an advantage, as it allows for precise and targeted drug delivery to the desired bacterial cells. The use of biomaterials, including bacteriophages, as drug delivery vehicles has shown promising potential to address the limitations of conventional drug delivery systems. Further research is needed to fully understand the potential of these biomaterials and address the challenges and limitations associated with their use.

Sensitive and highly rapid electrochemical measurement of airborne coronaviruses through condensation-based direct impaction onto carbon nanotube-coated porous paper working electrodes

Rapid detection of indoor airborne viruses is critical to prevent the spread of respiratory diseases. Herein, we present sensitive, highly rapid electrochemical measurement of airborne coronaviruses through condensation-based direct impaction onto antibody-immobilized, carbon nanotube-coated porous paper working electrodes (PWEs). Carboxylated carbon nanotubes are drop-cast on paper fibers to make three-dimensional (3D) porous PWEs. These PWEs have higher active surface area-to-volume ratios and electron transfer characteristics than conventional screen-printed electrodes. The limit of detection and detection time of the PWEs for liquid-borne coronaviruses OC43 are 65.7 plaque-forming units (PFU)/mL and 2 min, respectively. The PWEs showed sensitive and rapid detection of whole coronaviruses, which can be ascribed to the 3D porous electrode structure of the PWEs. Moreover, water molecules condense on airborne virus particles during air sampling, and these water-encapsulated virus particles (<4 µm) are impacted on the PWE for direct measurement without virus lysis and elution. The whole detection takes ∼10 min, including air sampling, at virus concentrations of 1.8 and 11.5 PFU/L of air, which can be due to the highly enriching and minimally damaging virus capture on a soft and porous PWE, demonstrating the potential for the rapid and low-cost airborne virus monitoring system.

"Dramatic Growth" of Microbial Aerosols for Visualization and Accurate Counting of Bioaerosols

While the global COVID-19 pandemic has subsided, microbial aerosol detection has become of high concern. Timely, accurate, and highly sensitive monitoring of microbial aerosols in indoor air is the basis for effective prevention and control of infectious diseases. At present, no commercial equipment or reliable technology can simultaneously control the detection time and limit at 6 h and 102 CFU/mL, respectively. Based on the "safety size range" of particulate matter in the air, we propose a new method of microbial dilation detection, which enables the pathogen to grow rapidly and dramatically into a polymeric microsphere, larger in size than the coexisting aerosol particles. "Like a crane standing among chickens", the microorganism can be easily visualized and counted. Different from routine chemical and biological sensing technologies, this method can achieve absolute counting of microbial particles, and the simple principles can be developed into devices for different life scenarios.

Real-time 4D tracking of airborne virus-laden droplets and aerosols

There is currently no real-time airborne virus tracking method, hindering the understanding of rapid virus changes and associated health impacts. Nano-digital in-line holographic microscopy (Nano-DIHM) is a lensless technology that can directly obtain the interference patterns of objects by recording the scattered light information originating from the objects. Here, we provide evidence for real-time physicochemical tracking of virus-laden droplets and aerosols in the air using desktop label-free Nano-DIHM. The virus interference patterns, as single and ensemble particles, were imaged by the Nano-DIHM with 32.5 ms resolution. The next-generation Stingray and Octopus software was used to automate object detection, characterization and classification from the recorded holograms. The detection system was demonstrated to detect active MS2 bacteriophages, inactivated SARS-CoV-2 and RNA fragments, and an MS2 mixture with metallic and organic compounds. This work demonstrates the feasibility of using Nano-DIHM to provide rapid virus detection to improve transmission management in real time.

Devendra Pal and coworkers report an imaging system using Nano-Digital in-line Holographic Microscopy (NanoDIHM) to detect airborne viruses in droplets and aerosols in real time. This system is able to detect various viruses in air, water and heterogeneous matrices within one minute, enabling real-time tracking of pollutant particles for efficient epidemic management.

Toward a global virus genomic surveillance network

The COVID-19 pandemic galvanized the field of virus genomic surveillance, demonstrating its utility for public health. Now, we must harness the momentum that led to increased infrastructure, training, and political will to build a sustainable global genomic surveillance network for other epidemic and endemic viruses. We suggest a generalizable modular sequencing framework wherein users can easily switch between virus targets to maximize cost-effectiveness and maintain readiness for new threats. We also highlight challenges associated with genomic surveillance and when global inequalities persist. We propose solutions to mitigate some of these issues, including training and multilateral partnerships. Exploring alternatives to clinical sequencing can also reduce the cost of surveillance programs. Finally, we discuss how establishing genomic surveillance would aid control programs and potentially provide a warning system for outbreaks, using a global respiratory virus (RSV), an arbovirus (dengue virus), and a regional zoonotic virus (Lassa virus) as examples.

Perspectives on Sampling and New Generation Sequencing Methods for Low-Biomass Bioaerosols in Atmospheric Environments

Bioaerosols play essential roles in the atmospheric environment and can affect human health. With a few exceptions (e.g., farm or rainforest environments), bioaerosol samples from wide-ranging environments typically have a low biomass, including bioaerosols from indoor environments (e.g., residential homes, offices, or hospitals), outdoor environments (e.g., urban or rural air). Some specialized environments (e.g., clean rooms, the Earth's upper atmosphere, or the international space station) have an ultra-low-biomass. This review discusses the primary sources of bioaerosols and influencing factors, the recent advances in air sampling techniques and the new generation sequencing (NGS) methods used for the characterization of low-biomass bioaerosol communities, and challenges in terms of the bias introduced by different air samplers when samples are subjected to NGS analysis with a focus on ultra-low biomass. High-volume filter-based or liquid-based air samplers compatible with NGS analysis are required to improve the bioaerosol detection limits for microorganisms. A thorough understanding of the performance and outcomes of bioaerosol sampling using NGS methods and a robust protocol for aerosol sample treatment for NGS analysis are needed. Advances in NGS techniques and bioinformatic tools will contribute toward the precise high-throughput identification of the taxonomic profiles of bioaerosol communities and the determination of their functional and ecological attributes in the atmospheric environment. In particular, long-read amplicon sequencing, viability PCR, and meta-transcriptomics are promising techniques for discriminating and detecting pathogenic microorganisms that may be active and infectious in bioaerosols and, therefore, pose a threat to human health.

Supplementary Information

The online version contains supplementary material available at 10.1007/s41745-023-00380-x.

Research progress of severe acute respiratory syndrome coronavirus 2 on aerosol collection and detection

The outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in late 2019 has negatively affected people's lives and productivity. Because the mode of transmission of SARS-CoV-2 is of great concern, this review discusses the sources of virus aerosols and possible transmission routes. First, we discuss virus aerosol collection methods, including natural sedimentation, solid impact, liquid impact, centrifugal, cyclone and electrostatic adsorption methods. Then, we review common virus aerosol detection methods, including virus culture, metabolic detection, nucleic acid-based detection and immunology-based detection methods. Finally, possible solutions for the detection of SARS-CoV-2 aerosols are introduced. Point-of-care testing has long been a focus of attention. In the near future, the development of an instrument that integrates sampling and output results will enable the real-time, automatic monitoring of patients.

Conductive Thread-Based Immunosensor for Pandemic Influenza A (H1N1) Virus Detection

Infectious agents such as viruses pose significant threats to human health, being transmitted via direct contact as well as airborne transmission without direct contact, thus requiring rapid detection to prevent the spread of infectious diseases. In this study, we developed a conductive thread-based immunosensor (CT-IS), a biosensor to easily detect the presence of airborne viruses. CT-IS utilizes an antibody that specifically recognizes the HA protein of the pandemic influenza A (pH1N1) virus, which is incorporated into the conductive thread. The antigen-antibody interaction results in increased strain on the conductive thread in the presence of the pH1N1 virus, resulting in increased electrical resistance of the CT-IS. We evaluated the performance of this sensor using the HA protein and the pH1N1 virus, in addition to samples from patients infected with the pH1N1 virus. We observed a significant change in resistance in the pH1N1-infected patient samples (positive: n = 11, negative: n = 9), whereas negligible change was observed in the control samples (patients not infected with the pH1N1 virus; negative). Hence, the CT-IS is a lightweight fiber-type sensor that can be used as a wearable biosensor by combining it with textiles, to detect the pH1N1 virus in a person's vicinity.

Kinetics and magnitude of viral RNA shedding as indicators for Influenza A virus transmissibility in ferrets

The ferret transmission model is routinely used to evaluate the pandemic potential of newly emerging influenza A viruses. However, concurrent measurement of viral load in the air is typically not a component of such studies. To address this knowledge gap, we measured the levels of virus in ferret nasal washes as well as viral RNA emitted into the air for 14 diverse influenza viruses, encompassing human-, swine-, and avian-origin strains. Here we show that transmissible viruses display robust replication and fast release into the air. In contrast, poorly- and non-transmissible viruses show significantly reduced or delayed replication along with lower detection of airborne viral RNA at early time points post inoculation. These findings indicate that efficient ferret-to-ferret transmission via the air is directly associated with fast emission of virus-laden particles; as such, quantification of viral RNA in the air represents a useful addition to established assessments of new influenza virus strains.

High enrichment and near real-time quantification of airborne viruses using a wet-paper-based electrochemical immunosensor under an electrostatic field

Conventional airborne virus measurement usually requires appreciable sampling and detection times. Viral aerosols should also be collected or prepared in a liquid medium whose volume typically ranges from milliliters to tens of milliliters; hence, many sampling and detection steps need to be taken with the unit horizontal or immobile. Moreover, viral aerosols need to be sufficiently enriched, which makes real-time monitoring difficult. Herein, we present a near real-time enrichment and quantification system of airborne viruses that consists of a wet-paper-based electrochemical immunosensor with a gel electrolyte and a modified electrostatic particle concentrator. A small amount of phosphate-buffered saline flowed on the electrode, which resulted in sensor electrodes that are barely wet (covered in a thin buffer film measuring several micrometers) to ensure antigen-antibody interaction and the removal of non-target particles on the electrode surface. This system ensures that airborne viruses are highly enriched on the working electrode of the immunosensor, and it is possible to measure the MS2 virus particle concentrations every 10 min for 60 min stably and selectively against non-target airborne viruses and bacteria at horizontal and tilted measurement configurations. This system thus has the potential to be used in the real-time mobile monitoring of airborne microorganisms.

Improved Recovery of Captured Airborne Bacteria and Viruses with Liquid-Coated Air Filters

The COVID-19 pandemic has revealed the importance of the detection of airborne pathogens. Here, we present composite air filters featuring a bioinspired liquid coating that facilitates the removal of captured aerosolized bacteria and viruses for further analysis. We tested three types of air filters: commercial polytetrafluoroethylene (PTFE), which is well known for creating stable liquid coatings, commercial high-efficiency particulate air (HEPA) filters, which are widely used, and in-house-manufactured cellulose nanofiber mats (CNFMs), which are made from sustainable materials. All filters were coated with omniphobic fluorinated liquid to maximize the release of pathogens. We found that coating both the PTFE and HEPA filters with liquid improved the rate at which Escherichia coli was recovered using a physical removal process compared to uncoated controls. Notably, the coated HEPA filters also increased the total number of recovered cells by 57%. Coating the CNFM filters did not improve either the rate of release or the total number of captured cells. The most promising materials, the liquid-coated HEPA, filters were then evaluated for their ability to facilitate the removal of pathogenic viruses via a chemical removal process. Recovery of infectious JC polyomavirus, a nonenveloped virus that attacks the central nervous system, was increased by 92% over uncoated controls; however, there was no significant difference in the total amount of genomic material recovered compared to that of controls. In contrast, significantly more genomic material was recovered for SARS-CoV-2, the airborne, enveloped virus, which causes COVID-19, from liquid-coated filters. Although the amount of infectious SARS-CoV-2 recovered was 58% higher, these results were not significantly different from uncoated filters due to high variability. These results suggest that the efficient recovery of airborne pathogens from liquid-coated filters could improve air sampling efforts, enhancing biosurveillance and global pathogen early warning.

Detection and characterization of bioaerosol emissions from wastewater treatment plants: Challenges and opportunities

Rapid population growth and urbanization process have led to increasing demand for wastewater treatment capacity resulting in a non-negligible increase of wastewater treatment plants (WWTPs) in several cities around the world. Bioaerosol emissions from WWTPs may pose adverse health risks to the sewage workers and nearby residents, which raises increasing public health concerns. However, there are still significant knowledge gaps on the interplay between process-based bioaerosol characteristics and exposures and the quantification of health risk which limit our ability to design effective risk assessment and management strategies. This review provides a critical overview of the existing knowledge of bioaerosol emissions from WWTPs including their nature, magnitude and size distribution, and highlights the shortcoming associated with existing sampling and analysis methods. The recent advancements made for rapid detection of bioaerosols are then discussed, especially the emerging real time detection methods to highlight the directions for future research needs to advance the knowledge on bioaerosol emissions from WWTPs.

Detection of SARS-COV-2 by functionally imprinted micelles

The near real-time detection of airborne particles-of-interest is needed for avoiding current/future threats. The incorporation of imprinted particles into a micelle-based electrochemical cell produced a signal when brought into contact with particle analytes (such as SARS-COV-2), previously imprinted onto the structure. Nanoamp scales of signals were generated from what may've been individual virus-micelle interactions. The system showed selectivity when tested against similar size and morphology particles. The technology was compatible with airborne aerosol sampling techniques. Overall, the application of imprinted micelle technology could provide near real-time detection methods to a host of possible analytes of interest in the field.

Graphical abstract

Supplementary Information

The online version contains supplementary material available at 10.1557/s43579-022-00242-0.

A full-face mask for protection against respiratory infections

BACKGROUND

Aerosols and droplets are the transmission routes of many respiratory infectious diseases. The COVID-19 management guidance recommends against the use of nebulized inhalation therapy directly in the emergency room or in an ambulance to prevent possible viral transmission. The three-dimensional printing method was used to develop an aerosol inhalation treatment mask that can potentially prevent aerosol dispersion. We conducted this utility validation study to understand the practicability of this new nebulizer mask system.

RESULTS

The fit test confirmed that the filter can efficiently remove small particles. The different locations of the mask had an excellent fit with a high pressure making a proper face seal usability. The full-face mask appeared to optimize filtration with pressure and is an example of materials that perform well for improvised respiratory protection using this design. The filtering effect test confirmed that the contamination of designated locations could be protected when using the mask with filters. As in the clinical safety test, a total of 18 participants (10 [55.6%] females; aged 33.1 ± 0.6 years) were included in the final analysis. There were no significant changes in SPO2, EtCO2, HR, SBP, DBP, and RR at the beginning, 20th, 40th, or 60th minutes of the test (all p >.05). The discomfort of wearing a mask increased slightly after time but remained within the tolerable range. The vision clarity score did not significantly change during the test. The mask also passed the breathability test.

CONCLUSION

The results of our study showed that this mask performed adequately in the fit test, the filtering test, and the clinical safety test. The application of a full-face mask with antiviral properties, together with the newly designed shape of a respirator that respects the natural curves of a human face, will facilitate the production of personal protective equipment with a highly efficient filtration system.

METHODS

We conducted three independent tests in this validation study: (1) a fit test to calculate the particle number concentration and its association with potential leakage; (2) a filtering effect test to verify the mask's ability to contain aerosol spread; and (3) a clinical safety test to examine the clinical safety, comfortableness, and visual clarity of the mask.

Efficient measurement of airborne viable viruses using the growth-based virus aerosol concentrator with high flow velocities

Growth tube collectors (GTCs) are used to sample virus aerosols because of their superior viable virus recovery among air samplers. However, a major limitation of such samplers is that they operate at low flow rates compared to many inertia-based air samplers. Herein, we demonstrated efficient measurements of airborne MS2 and T3 viruses using a GTC that can implement high flow velocities for higher flow rates per tube, which we refer to as the growth-based virus aerosol concentrator (GVC), via qPCR and the plaque assay technique. The GVC exhibited a flow rate of up to 6 L/min, where the average sampling flow velocity was 5.09 m/s, 22 times higher than those used in the GTCs, for a single tube with a diameter of 5 mm. The count median diameter of the size-increased particles at the exit of the initiator was measured to be 1.44 µm at 6 L/min, considerably smaller than those observed in conventional GTCs. Nevertheless, the measurement of airborne MS2 and T3 viruses using the GVC showed a high concentration (high enrichment ratio of 109,458 at 10-min sampling) of viruses in a sampling medium, with a high viable virus percentage (> 90%) and physical collection efficiency (> 90%) at 6 L/min, which shows the potential for rapid on-site detection of airborne viruses.

Emerging Bioanalytical Devices and Platforms for Rapid Detection of Pathogens in Environmental Samples

The development of robust bioanalytical devices and biosensors for infectious pathogens is progressing well with the advent of new materials, concepts, and technology. The progress is also stepping towards developing high throughput screening technologies that can quickly identify, differentiate, and determine the concentration of harmful pathogens, facilitating the decision-making process for their elimination and therapeutic interventions in large-scale operations. Recently, much effort has been focused on upgrading these analytical devices to an intelligent technological platform by integrating them with modern communication systems, such as the internet of things (IoT) and machine learning (ML), to expand their application horizon. This review outlines the recent development and applications of bioanalytical devices and biosensors to detect pathogenic microbes in environmental samples. First, the nature of the recent outbreaks of pathogenic microbes such as foodborne, waterborne, and airborne pathogens and microbial toxins are discussed to understand the severity of the problems. Next, the discussion focuses on the detection systems chronologically, starting with the conventional methods, advanced techniques, and emerging technologies, such as biosensors and other portable devices and detection platforms for pathogens. Finally, the progress on multiplex assays, wearable devices, and integration of smartphone technologies to facilitate pathogen detection systems for wider applications are highlighted.

A novel CO2-based demand-controlled ventilation strategy to limit the spread of COVID-19 in the indoor environment

Ventilation is of critical importance to containing COVID-19 contagion in indoor environments. Keeping the ventilation rate at high level is recommended by many guidelines to dilute virus-laden respiratory particles and mitigate airborne transmission risk. However, high ventilation rate will cause high energy use. Demand-controlled ventilation is a promising technology option for controlling indoor air quality in an energy-efficient manner. This paper proposes a novel CO2-based demand-controlled ventilation strategy to limit the spread of COVID-19 in indoor environments. First, the quantitative relationship is established between COVID-19 infection risk and average CO2 level. Then, a sufficient condition is proposed to ensure COVID-19 event reproduction number is less than 1 under a conservative consideration of the number of infectors. Finally, a ventilation control scheme is designed to make sure the above condition can be satisfied. Case studies of different indoor environments have been conducted on a testbed of a real ventilation system to validate the effectiveness of the proposed strategy. Results show that the proposed strategy can efficiently maintain the reproduction number less than 1 to limit COVID-19 contagion while saving about 30%-50% of energy compared with the fixed ventilation scheme. The proposed strategy offers more practical values compared with existing studies: it is applicable to scenarios where there are multiple infectors, and the number of infectors varies with time; it only requires CO2 sensors and does not require occupancy detection sensors. Since CO2 sensors are very mature and low-cost, the proposed strategy is suitable for mass deployment in most existing ventilation systems.

Implementing Silica Nanoparticles in the Study of the Airborne Transmission of SARS-CoV-2

Aerosol transmission constitutes one of the major transmission routes of the SARS-CoV-2 pathogen. Due to the pathogen's properties, research on its airborne transmission has some limitations. This paper focuses on silica nanoparticles (SiO2) of 40 and 200 nm sizes as the physicochemical markers of a single SARS-CoV-2 particle enabling experiments on the transmission of bioaerosols in public spaces. Mixtures of a determined silica concentration were sprayed on as an aerosol, whose particles, sedimented on dedicated matrices, were examined by scanning electron microscopy (SEM) and transmission electron microscopy (TEM). Since it was not possible to quantitatively identify the markers based on the obtained images, the filters exposed with the AirSampler aspirator were analyzed based on inductively coupled plasma optical emission spectroscopy (ICP-OES). The ICP-OES method enabled us to determine the concentration of silica after extracting the marker from the filter, and consequently to estimate the number of markers. The developed procedure opens up the possibility of the quantitative estimation of the spread of the coronavirus, for example in studies on the aerosol transmission of the pathogen in an open environment where biological markers-surrogates included-cannot be used.

Evaluation of Virucidal Efficacy of Human Norovirus Using Combined Sprayed Slightly Acidic Electrolyzed Water and Ultraviolet C-Light-Emitting Diode Irradiation Treatment Based on Optimized Capture Assay for Quantitative RT-qPCR

Slightly acidic electrolyzed water (SAEW), an effective non-thermal virucidal treatment, is used widely to prevent infectious viral cross-contamination. Surface disinfection technologies using ultraviolet C-light-emitting diode (UVC-LED) irradiation have recently attracted considerable attention. The SAEW sprayer technique is an efficient approach to preventing the spread of infectious viral pathogens in the public healthcare sector. Therefore, we investigated a small-scale system comprising sprayed SAEW disinfection combined with UVC-LED irradiation to inactivate the human norovirus (HuNoV) in the environment. A stainless-steel surface was inoculated with a HuNoV genogroup II genotype 4 (GII.4) to achieve maximum reduction values of 3.21 log10 genomic copies. For optimal disinfection conditions, the response surface methodology based on the Box–Behnken design revealed that the specific treatment conditions for inactivation of HuNoV GII.4 were an SAEW droplet volume of 180 μL, 30 ppm available chlorine concentration of SAEW, and a UVC-LED exposure dose of 2 mJ/cm². The results indicate that the combined disinfection treatment could efficiently prevent the spread of HuNoVs in environment. Furthermore, the quadratic polynomial equations of the 3-D response surface can be employed to predict the effects of combined disinfection treatment on HuNoV contamination on environmental surfaces. Therefore, sprayed SAEW disinfection combined with UVC-LED irradiation proposed in this study may offer insights for designing optimal control strategies and techniques to prevent the transmission of infectious diseases, particularly HuNoV.

Paper-based electrochemical immunosensor for label-free detection of multiple avian influenza virus antigens using flexible screen-printed carbon nanotube-polydimethylsiloxane electrodes

Many studies have been conducted on measuring avian influenza viruses and their hemagglutinin (HA) antigens via electrochemical principles; most of these studies have used gold electrodes on ceramic, glass, or silicon substrates, and/or labeling for signal enhancement. Herein, we present a paper-based immunosensor for label-free measurement of multiple avian influenza virus (H5N1, H7N9, and H9N2) antigens using flexible screen-printed carbon nanotube-polydimethylsiloxane electrodes. These flexible electrodes on a paper substrate can complement the physical weakness of the paper-based sensors when wetted, without affecting flexibility. The relative standard deviation of the peak currents was 1.88% when the electrodes were repeatedly bent and unfolded twenty times with deionized water provided each cycle, showing the stability of the electrodes. For the detection of HA antigens, approximately 10-μl samples (concentration: 100 pg/ml–100 ng/ml) were needed to form the antigen–antibody complexes during 20–30 min incubation, and the immune responses were measured via differential pulse voltammetry. The limits of detections were 55.7 pg/ml (0.95 pM) for H5N1 HA, 99.6 pg/ml (1.69 pM) for H7N9 HA, and 54.0 pg/ml (0.72 pM) for H9N2 HA antigens in phosphate buffered saline, and the sensors showed good selectivity and reproducibility. Such paper-based sensors are economical, flexible, robust, and easy-to-manufacture, with the ability to detect several avian influenza viruses.

International consensus on lung function testing during the COVID-19 pandemic and beyond

Coronavirus disease 2019 (COVID-19) has negatively affected the delivery of respiratory diagnostic services across the world due to the potential risk of disease transmission during lung function testing. Community prevalence, reoccurrence of COVID-19 surges and the emergence of different variants of SARS-CoV-2 have impeded attempts to restore services. Finding consensus on how to deliver safe lung function services for both patients attending and for staff performing the tests are of paramount importance. This international statement presents the consensus opinion of 23 experts in the field of lung function and respiratory physiology balanced with evidence from the reviewed literature. It describes a robust roadmap for restoration and continuity of lung function testing services during the COVID-19 pandemic and beyond. Important strategies presented in this consensus statement relate to the patient journey when attending for lung function tests. We discuss appointment preparation, operational and environmental issues, testing room requirements including mitigation strategies for transmission risk, requirement for improved ventilation, maintaining physical distance and use of personal protection equipment. We also provide consensus opinion on precautions relating to specific tests, filters, management of special patient groups and alternative options to testing in hospitals. The pandemic has highlighted how vulnerable lung function services are and forces us to re-think how long-term mitigation strategies can protect our services during this and any possible future pandemic. This statement aspires to address the safety concerns that exist and provide strategies to make lung function tests and the testing environment safer when tests are required.