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Tang JW, Marr LC, Tellier R, Dancer SJ. Airborne transmission of respiratory viruses including severe acute respiratory syndrome coronavirus 2. Curr Opin Pulm Med 2023; 29:191-196. [PMID: 36866737 PMCID: PMC10090298 DOI: 10.1097/mcp.0000000000000947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/04/2023]
Abstract
PURPOSE OF REVIEW The coronavirus disease 2019 pandemic has had a wide-ranging and profound impact on how we think about the transmission of respiratory viruses This review outlines the basis on which we should consider all respiratory viruses as aerosol-transmissible infections, in order to improve our control of these pathogens in both healthcare and community settings. RECENT FINDINGS We present recent studies to support the aerosol transmission of severe acute respiratory syndrome coronavirus 2, and some older studies to demonstrate the aerosol transmissibility of other, more familiar seasonal respiratory viruses. SUMMARY Current knowledge on how these respiratory viruses are transmitted, and the way we control their spread, is changing. We need to embrace these changes to improve the care of patients in hospitals and care homes including others who are vulnerable to severe disease in community settings.
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Affiliation(s)
- Julian W. Tang
- Clinical Microbiology, University Hospitals of Leicester NHS Trust
- Respiratory Sciences, University of Leicester, Leicester, UK
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2
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Chang Y, Wang Y, Li W, Wei Z, Tang S, Chen R. Mechanisms, Techniques and Devices of Airborne Virus Detection: A Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20085471. [PMID: 37107752 PMCID: PMC10138381 DOI: 10.3390/ijerph20085471] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/13/2023] [Revised: 03/13/2023] [Accepted: 04/03/2023] [Indexed: 05/11/2023]
Abstract
Airborne viruses, such as COVID-19, cause pandemics all over the world. Virus-containing particles produced by infected individuals are suspended in the air for extended periods, actually resulting in viral aerosols and the spread of infectious diseases. Aerosol collection and detection devices are essential for limiting the spread of airborne virus diseases. This review provides an overview of the primary mechanisms and enhancement techniques for collecting and detecting airborne viruses. Indoor virus detection strategies for scenarios with varying ventilations are also summarized based on the excellent performance of existing advanced comprehensive devices. This review provides guidance for the development of future aerosol detection devices and aids in the control of airborne transmission diseases, such as COVID-19, influenza and other airborne transmission viruses.
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Affiliation(s)
- Yuqing Chang
- Beijing Key Laboratory of Occupational Safety and Health, Institute of Urban Safety and Environmental Science, Beijing Academy of Science and Technology, Beijing 100054, China; (Y.C.); (Y.W.); (S.T.)
| | - Yuqian Wang
- Beijing Key Laboratory of Occupational Safety and Health, Institute of Urban Safety and Environmental Science, Beijing Academy of Science and Technology, Beijing 100054, China; (Y.C.); (Y.W.); (S.T.)
| | - Wen Li
- Department of Biomedical Engineering, School of Life Science, Beijing Institute of Technology, Beijing 100081, China; (W.L.); (Z.W.)
| | - Zewen Wei
- Department of Biomedical Engineering, School of Life Science, Beijing Institute of Technology, Beijing 100081, China; (W.L.); (Z.W.)
| | - Shichuan Tang
- Beijing Key Laboratory of Occupational Safety and Health, Institute of Urban Safety and Environmental Science, Beijing Academy of Science and Technology, Beijing 100054, China; (Y.C.); (Y.W.); (S.T.)
| | - Rui Chen
- Beijing Key Laboratory of Occupational Safety and Health, Institute of Urban Safety and Environmental Science, Beijing Academy of Science and Technology, Beijing 100054, China; (Y.C.); (Y.W.); (S.T.)
- Correspondence:
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Vita G, Woolf D, Avery-Hickmott T, Rowsell R. A CFD-based framework to assess airborne infection risk in buildings. BUILDING AND ENVIRONMENT 2023; 233:110099. [PMID: 36815961 PMCID: PMC9925846 DOI: 10.1016/j.buildenv.2023.110099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Revised: 01/31/2023] [Accepted: 02/12/2023] [Indexed: 06/18/2023]
Abstract
The COVID-19 pandemic has prompted huge efforts to further the scientific knowledge of indoor ventilation and its relationship to airborne infection risk. Exhaled infectious aerosols are spread and inhaled as a result of room airflow characteristics. Many calculation methods and assertions on risk assume 'well-mixed' flow conditions. However, ventilation in buildings is complex and often not showing well-mixed conditions. Ventilation guidance is typically based on the provision of generic minimum ventilation flow rates for a given space, irrespective of the effectiveness in the delivery of the supply air. Furthermore, the airflow might be heavily affected by the season, the HVAC ventilation, or the opening of windows, which would potentially generate draughts and non-uniform conditions. As a result, fresh air concentration would be variable depending upon a susceptible receptor's position in a room and, therefore, associated airborne infection risk. A computational fluid dynamics (CFD) and dynamic thermal modelling (DTM) framework is proposed to assess the influence of internal airflow characteristics on airborne infection risk. A simple metric is proposed, the hourly airborne infection rate (HAI) which can easily help designers to stress-test the ventilation within a building under several conditions. A case study is presented, and the results clearly demonstrate the importance of understanding detailed indoor airflow characteristics and associated concentration patterns in order to provide detailed design guidance, e.g. occupancy, supply air diffusers and furniture layouts, to reduce airborne infection risk.
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Affiliation(s)
- Giulio Vita
- Wirth Research Ltd, Charlotte Avenue, Bicester, OX27 8BL, United Kingdom
- University of Birmingham School of Engineering Edgbaston, Birmingham, B15 2TT, United Kingdom
| | - Darren Woolf
- Wirth Research Ltd, Charlotte Avenue, Bicester, OX27 8BL, United Kingdom
| | | | - Rob Rowsell
- Wirth Research Ltd, Charlotte Avenue, Bicester, OX27 8BL, United Kingdom
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Sachs JD, Karim SSA, Aknin L, Allen J, Brosbøl K, Colombo F, Barron GC, Espinosa MF, Gaspar V, Gaviria A, Haines A, Hotez PJ, Koundouri P, Bascuñán FL, Lee JK, Pate MA, Ramos G, Reddy KS, Serageldin I, Thwaites J, Vike-Freiberga V, Wang C, Were MK, Xue L, Bahadur C, Bottazzi ME, Bullen C, Laryea-Adjei G, Ben Amor Y, Karadag O, Lafortune G, Torres E, Barredo L, Bartels JGE, Joshi N, Hellard M, Huynh UK, Khandelwal S, Lazarus JV, Michie S. The Lancet Commission on lessons for the future from the COVID-19 pandemic. Lancet 2022; 400:1224-1280. [PMID: 36115368 PMCID: PMC9539542 DOI: 10.1016/s0140-6736(22)01585-9] [Citation(s) in RCA: 248] [Impact Index Per Article: 124.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 07/01/2022] [Accepted: 08/11/2022] [Indexed: 02/03/2023]
Affiliation(s)
- Jeffrey D Sachs
- Center for Sustainable Development, Columbia University, New York, NY, United States.
| | - Salim S Abdool Karim
- Mailman School of Public Health, Columbia University, New York, NY, United States
| | - Lara Aknin
- Department of Psychology, Simon Fraser University, Burnaby, BC, Canada
| | - Joseph Allen
- Department of Environmental Health, Harvard T H Chan School of Public Health, Boston, MA, United States
| | | | - Francesca Colombo
- Health Division, Organisation for Economic Co-operation and Development, Paris, France
| | | | | | - Vitor Gaspar
- Fiscal Affairs Department, International Monetary Fund, Washington, DC, United States
| | | | - Andy Haines
- Department of Public Health, Environments and Society, London School of Hygiene and Tropical Medicine, London, UK; Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
| | - Peter J Hotez
- National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Phoebe Koundouri
- Department of International and European Economic Studies, Athens University of Economics and Business, Athens, Greece; Department of Technology, Management and Economics, Technical University of Denmark, Kongens Lyngby, Denmark; European Association of Environmental and Resource Economists, Athens, Greece
| | - Felipe Larraín Bascuñán
- Department of Economics and Administration, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Jong-Koo Lee
- National Academy of Medicine of Korea, Seoul, Republic of Korea
| | - Muhammad Ali Pate
- Department of Global Health and Population, Harvard T H Chan School of Public Health, Boston, MA, United States
| | | | | | | | - John Thwaites
- Monash Sustainable Development Institute, Monash University, Clayton, VIC, Australia
| | | | - Chen Wang
- National Clinical Research Center for Respiratory Diseases, Chinese Academy of Medical Sciences, Peking Union Medical College, Beijing, China; National Clinical Research Center for Respiratory Diseases, China-Japan Friendship Hospital, Beijing, China
| | | | - Lan Xue
- Schwarzman College, Tsinghua University, Beijing, China
| | - Chandrika Bahadur
- The Lancet COVID-19 Commission Regional Task Force: India, New Delhi, India
| | - Maria Elena Bottazzi
- National School of Tropical Medicine, Baylor College of Medicine, Houston, TX, United States
| | - Chris Bullen
- National Institute for Health Innovation, University of Auckland, Auckland, New Zealand
| | | | - Yanis Ben Amor
- Center for Sustainable Development, Columbia University, New York, NY, United States
| | - Ozge Karadag
- Center for Sustainable Development, Columbia University, New York, NY, United States
| | | | - Emma Torres
- United Nations Sustainable Development Solutions Network, New York, NY, United States
| | - Lauren Barredo
- United Nations Sustainable Development Solutions Network, New York, NY, United States
| | - Juliana G E Bartels
- Center for Sustainable Development, Columbia University, New York, NY, United States
| | - Neena Joshi
- United Nations Sustainable Development Solutions Network, New York, NY, United States
| | | | | | | | - Jeffrey V Lazarus
- Barcelona Institute for Global Health (ISGlobal), Hospital Clinic, University of Barcelona, Barcelona, Spain
| | - Susan Michie
- Centre for Behaviour Change, University College London, London, UK
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Duval D, Palmer JC, Tudge I, Pearce-Smith N, O'Connell E, Bennett A, Clark R. Long distance airborne transmission of SARS-CoV-2: rapid systematic review. BMJ 2022; 377:e068743. [PMID: 35768139 PMCID: PMC9240778 DOI: 10.1136/bmj-2021-068743] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 05/04/2022] [Indexed: 12/22/2022]
Abstract
OBJECTIVES To evaluate the potential for long distance airborne transmission of SARS-CoV-2 in indoor community settings and to investigate factors that might influence transmission. DESIGN Rapid systematic review and narrative synthesis. DATA SOURCES Medline, Embase, medRxiv, Arxiv, and WHO COVID-19 Research Database for studies published from 27 July 2020 to 19 January 2022; existing relevant rapid systematic review for studies published from 1 January 2020 to 27 July 2020; and citation analysis in Web of Science and Cocites. ELIGIBILITY CRITERIA FOR STUDY SELECTION Observational studies reporting on transmission events in indoor community (non-healthcare) settings in which long distance airborne transmission of SARS-CoV-2 was the most likely route. Studies such as those of household transmission where the main transmission route was likely to be close contact or fomite transmission were excluded. DATA EXTRACTION AND SYNTHESIS Data extraction was done by one reviewer and independently checked by a second reviewer. Primary outcomes were SARS-CoV-2 infections through long distance airborne transmission (>2 m) and any modifying factors. Methodological quality of included studies was rated using the quality criteria checklist, and certainty of primary outcomes was determined using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) framework. Narrative synthesis was themed by setting. RESULTS 22 reports relating to 18 studies were identified (methodological quality was high in three, medium in five, and low in 10); all the studies were outbreak investigations. Long distance airborne transmission was likely to have occurred for some or all transmission events in 16 studies and was unclear in two studies (GRADE: very low certainty). In the 16 studies, one or more factors plausibly increased the likelihood of long distance airborne transmission, particularly insufficient air replacement (very low certainty), directional air flow (very low certainty), and activities associated with increased emission of aerosols, such as singing or speaking loudly (very low certainty). In 13 studies, the primary cases were reported as being asymptomatic, presymptomatic, or around symptom onset at the time of transmission. Although some of the included studies were well conducted outbreak investigations, they remain at risk of bias owing to study design and do not always provide the level of detail needed to fully assess transmission routes. CONCLUSION This rapid systematic review found evidence suggesting that long distance airborne transmission of SARS-CoV-2 might occur in indoor settings such as restaurants, workplaces, and venues for choirs, and identified factors such as insufficient air replacement that probably contributed to transmission. These results strengthen the need for mitigation measures in indoor settings, particularly the use of adequate ventilation. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42021236762.
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Affiliation(s)
- Daphne Duval
- COVID-19 Rapid Evidence Service, UK Health Security Agency, London, UK
| | - Jennifer C Palmer
- COVID-19 Rapid Evidence Service, UK Health Security Agency, London, UK
- MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
- Population Health Science, Bristol Medical School, University of Bristol, Bristol, UK
| | - Isobel Tudge
- COVID-19 Rapid Evidence Service, UK Health Security Agency, London, UK
| | | | - Emer O'Connell
- COVID-19 Advice and Guidance, UK Health Security Agency, London, UK
| | - Allan Bennett
- Biosafety, Air, and Water Microbiology Group, Research and Evaluation, UK Health Security Agency, Porton, UK
| | - Rachel Clark
- COVID-19 Rapid Evidence Service, UK Health Security Agency, London, UK
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Duchaine C, Roy CJ. Bioaerosols and airborne transmission: Integrating biological complexity into our perspective. THE SCIENCE OF THE TOTAL ENVIRONMENT 2022; 825:154117. [PMID: 35218821 PMCID: PMC8865953 DOI: 10.1016/j.scitotenv.2022.154117] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/15/2021] [Revised: 02/17/2022] [Accepted: 02/20/2022] [Indexed: 05/22/2023]
Abstract
There is broad consensus that airborne disease transmission continues to be the thematic focus of COVID-19, the complexities and understanding of which continues to complicate our attempts to control this pandemic. Masking used as both personal protection and source reduction predominates our society at present and, other than vaccination, remains the public health measure that will faithfully reduce aerosol transmission and overall disease burden (Gandhi and Marr, 2021). Early in the advent of the COVID-19 pandemic, and especially after preliminary recognition of airborne transmission, there was considerable efforts in the application of computational fluid dynamics (CFD) modeling aerosols as well as risk models calculations, the products of which were detailed in the literature (Morawska et al., 2020; Buonanno et al., 2020a) and even disseminated in media destined for the public. As the respiratory pathway emerged as the dominant exposure pathway for SARSCoV-2 transmission, much of what was promoted from CFD was applied to risk models to estimate community infection and in some cases expected clinical outcome. COVID-19 proved to fit the profile of an obligate respiratory-transmitted pathogen, and the plausibility of using aerosol modeling when silhouetted with emerging COVID-19 epidemiology provided ample evidence for promotion of masking and ventilation optimization as a required public health measure. Masking is often included as a factor in developed risk models and it remains an essentially important part of our response to this airborne threat, and ultimately will agnostically reduce disease burden although efforts to improve ventilation in indoor spaces remain a challenge. Arguably the most important concept in the airborne transmission of infectious agents is the biologically active componentry that comprises the aerosol particle and the functional dynamic nature of particle contents. Specifically, the innate generation, transport, and ultimate deposition/disposition of bioaerosols; the aerosol particles that nearly exclusively harbor bioactive components, including viruses, when disease agents are transmitted through the air.
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Affiliation(s)
- Caroline Duchaine
- Centre de recherche de I'institut universitaire de cardiologie et de pneumologie de Quebec-Université Laval, Quebec City, Canada; Department of Biochemistry, Microbiology and Bio-informatics, Université Laval, Canada; Tier-1 Canada Research Chair on Bioaerosols, Canada
| | - Chad J Roy
- Department of Microbiology and Immunology, Tulane School of Medicine, New Orleans, LA, United States of America; Infectious Disease Aerobiology at Tulane National Primate Research Center, United States of America.
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Pathak EB, Menard JM, Garcia RB, Salemi JL. Joint Effects of Socioeconomic Position, Race/Ethnicity, and Gender on COVID-19 Mortality among Working-Age Adults in the United States. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:5479. [PMID: 35564872 PMCID: PMC9102098 DOI: 10.3390/ijerph19095479] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 04/25/2022] [Accepted: 04/26/2022] [Indexed: 12/29/2022]
Abstract
Substantial racial/ethnic and gender disparities in COVID-19 mortality have been previously documented. However, few studies have investigated the impact of individual socioeconomic position (SEP) on these disparities. Objectives: To determine the joint effects of SEP, race/ethnicity, and gender on the burden of COVID-19 mortality. A secondary objective was to determine whether differences in opportunities for remote work were correlated with COVID-19 death rates for sociodemographic groups. Design: Annual mortality study which used a special government tabulation of 2020 COVID-19-related deaths stratified by decedents' SEP (measured by educational attainment), gender, and race/ethnicity. Setting: United States in 2020. Participants: COVID-19 decedents aged 25 to 64 years old (n = 69,001). Exposures: Socioeconomic position (low, intermediate, and high), race/ethnicity (Hispanic, Black, Asian, Indigenous, multiracial, and non-Hispanic white), and gender (women and men). Detailed census data on occupations held by adults in 2020 in each of the 36 sociodemographic groups studied were used to quantify the possibility of remote work for each group. Main Outcomes and Measures: Age-adjusted COVID-19 death rates for 36 sociodemographic groups. Disparities were quantified by relative risks and 95% confidence intervals. High-SEP adults were the (low-risk) referent group for all relative risk calculations. Results: A higher proportion of Hispanics, Blacks, and Indigenous people were in a low SEP in 2020, compared with whites. COVID-19 mortality was five times higher for low vs. high-SEP adults (72.2 vs. 14.6 deaths per 100,000, RR = 4.94, 95% CI 4.82-5.05). The joint detriments of low SEP, Hispanic ethnicity, and male gender resulted in a COVID-19 death rate which was over 27 times higher (178.0 vs. 6.5 deaths/100,000, RR = 27.4, 95% CI 25.9-28.9) for low-SEP Hispanic men vs. high-SEP white women. In regression modeling, percent of the labor force in never remote jobs explained 72% of the variance in COVID-19 death rates. Conclusions and Relevance: SARS-CoV-2 infection control efforts should prioritize low-SEP adults (i.e., the working class), particularly the majority with "never remote" jobs characterized by inflexible and unsafe working conditions (i.e., blue collar, service, and retail sales workers).
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Affiliation(s)
- Elizabeth B. Pathak
- Women’s Institute for Independent Social Enquiry (WiiSE), Olney, MD 20832, USA; (J.M.M.); (R.B.G.)
| | - Janelle M. Menard
- Women’s Institute for Independent Social Enquiry (WiiSE), Olney, MD 20832, USA; (J.M.M.); (R.B.G.)
| | - Rebecca B. Garcia
- Women’s Institute for Independent Social Enquiry (WiiSE), Olney, MD 20832, USA; (J.M.M.); (R.B.G.)
- Premise Health, Brentwood, TN 37027, USA
| | - Jason L. Salemi
- College of Public Health, University of South Florida, Tampa, FL 33620, USA;
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Ishmatov A. "SARS-CoV-2 is transmitted by particulate air pollution": Misinterpretations of statistical data, skewed citation practices, and misuse of specific terminology spreading the misconception. ENVIRONMENTAL RESEARCH 2022; 204:112116. [PMID: 34562486 PMCID: PMC8489301 DOI: 10.1016/j.envres.2021.112116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Revised: 09/14/2021] [Accepted: 09/21/2021] [Indexed: 05/03/2023]
Abstract
In epidemiology, there are still outdated myths associated with the spread of respiratory infections. Recently, we have witnessed the origination of a new misconception, to the effect that SARS-CoV-2 is transmitted in the open air by way of particulate air pollution (atmospheric particulate matter (PM)). There is no evidence to support the idea behind this misconception. Nevertheless, more and more people are involved in animated debate and the number of studies concerning atmospheric PM as a carrier of SARS-CoV-2 is growing rapidly. In this work, the origin of the misconception was investigated, and the published papers which have contributed to the spread of this myth were analyzed. The results show that the following factors lie behind the origin and spread of the misconception: a) The specific terminology is not always clearly defined or consistently used by scientists. In particular, the terms 'particulate matter', 'atmospheric aerosol particles', 'air pollutants', and 'atmospheric aerosols' need to be clarified, and besides they are often equated to 'infectious aerosols', 'virus-bearing aerosols', 'bio-aerosols', 'virus-laden particles', 'respiratory aerosol/droplets', and 'droplet nuclei'. b) Authors misinterpret statistical data and information from other sources. Interpretation of the correlation between PM levels and the increasing incidence and severity of COVID-19 infection, is often changed from "PM may reflect the indirect action of certain atmospheric conditions that maintain infectious nuclei suspended for prolonged periods, parameters that also act on atmospheric pollutants" to "PM could cause an increase in infectious droplets/aerosols containing SARS-CoV-2." This is a dramatic change to the meaning. Moreover, it is often not taken into account that PM may reflect activities in areas with high population density and this population density at the same time contributes to the spread COVID-19. c) Skewed citation practices. Many authors cite a hypothetical conclusion from an original study, then other authors cite the papers of these authors as primary sources. This practice leads to the effect that there are many witnesses to a 'phenomenon' that did not ever occur. Thus, the terminology used in interdisciplinary communications should be more nuanced and defined precisely. Authors should be more careful when citing unconfirmed data (and hypotheses) as well as in interpreting statistical data so as to avoid confusion and spreading false information. This is especially important now in the era of the COVID-19 pandemic.
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Affiliation(s)
- Alexander Ishmatov
- Research Institute of Experimental and Clinical Medicine, Timakova St., Bild. 2., Novosibirsk, 630117, Russian Federation; Kazan Federal University, Kremlyovskaya St. 18, Kazan, 420008, Russian Federation; Togliatti State University, Belorusskaya St. 14, Togliatti, 445020, Russian Federation.
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Bueno de Mesquita PJ, Delp WW, Chan WR, Bahnfleth WP, Singer BC. Control of airborne infectious disease in buildings: Evidence and research priorities. INDOOR AIR 2022; 32:e12965. [PMID: 34816493 DOI: 10.1111/ina.12965] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 10/07/2021] [Accepted: 11/11/2021] [Indexed: 06/13/2023]
Abstract
The evolution of SARS-CoV-2 virus has resulted in variants likely to be more readily transmitted through respiratory aerosols, underscoring the increased potential for indoor environmental controls to mitigate risk. Use of tight-fitting face masks to trap infectious aerosol in exhaled breath and reduce inhalation exposure to contaminated air is of critical importance for disease control. Administrative controls including the regulation of occupancy and interpersonal spacing are also important, while presenting social and economic challenges. Indoor engineering controls including ventilation, exhaust, air flow control, filtration, and disinfection by germicidal ultraviolet irradiation can reduce reliance on stringent occupancy restrictions. However, the effects of controls-individually and in combination-on reducing infectious aerosol transfer indoors remain to be clearly characterized to the extent needed to support widespread implementation by building operators. We review aerobiologic and epidemiologic evidence of indoor environmental controls against transmission and present a quantitative aerosol transfer scenario illustrating relative differences in exposure at close-interactive, room, and building scales. We identify an overarching need for investment to implement building controls and evaluate their effectiveness on infection in well-characterized and real-world settings, supported by specific, methodological advances. Improved understanding of engineering control effectiveness guides implementation at scale while considering occupant comfort, operational challenges, and energy costs.
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Affiliation(s)
| | - William W Delp
- Indoor Environment Group, Lawrence Berkeley National Laboratory, Berkeley, California, USA
| | - Wanyu R Chan
- Indoor Environment Group, Lawrence Berkeley National Laboratory, Berkeley, California, USA
| | - William P Bahnfleth
- Department of Architectural Engineering, Pennsylvania State University, State College, Pennsylvania, USA
| | - Brett C Singer
- Indoor Environment Group, Lawrence Berkeley National Laboratory, Berkeley, California, USA
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