Prediction and control of aerosol transmission of SARS-CoV-2 in ventilated context: from source to receptor

Quantitative evaluation of water, sanitation, and hygiene measures on COVID-19 pandemic peak reduction in the Philippines

New cases of coronavirus disease 2019 (COVID-19) are continually being recorded worldwide, despite global efforts in implementing non-pharmaceutical interventions and establishing vaccination programs. This trend highlights the need to identify the factors associated with the continued spread of COVID-19. The World Health Organization recommends hand washing as a cost-effective intervention for preventing COVID-19, indicating that water, sanitation, and hygiene (WaSH) are central to the prevention of the disease. However, low- and middle-income countries lack adequate access to WaSH, which increases the risk of contracting COVID-19. The aim of this study was to identify the WaSH factors associated with the incidence of COVID-19 and quantitatively estimate the effects of improvements in WaSH on reducing the incidence of COVID-19 during the peak of the pandemic. Lasso regression and extreme gradient boosting models were used to identify the WaSH factors. Distinct estimation models were developed to assess the effect of WaSH in rural regions under two assumptions: increasing regional basic sanitation coverage up to 25 % and 50%. The reduction in the incidence of COVID-19 during the peak of the pandemic was calculated for each rural region. The results of the analyses indicated that basic sanitation is important for reducing the incidence of COVID-19 in rural regions compared to urban regions in the Philippines. In addition, the results suggested that increasing basic sanitation coverage could reduce the incidence of COVID-19 by 2-66 %, alleviating the burden on healthcare facilities. This study indicates that improved basic sanitation infrastructure are needed in rural Philippines. The results of this study emphasise the significance of WaSH as an indicator of COVID-19 incidence, highlighting the need for its enhancement to enable the achievement of sustainable disease prevention and pandemic preparedness goals.

Creating respiratory pathogen-free environments in healthcare and nursing-care settings: a comprehensive review

Hospital- and nursing-care-acquired infections are a growing problem worldwide, especially during epidemics, posing a significant threat to older adults in geriatric settings. Intense research during the COVID-19 pandemic highlighted the prominent role of aerosol transmission of pathogens. Aerosol particles can easily adsorb different airborne pathogens, carrying them for a long time. Understanding the dynamics of airborne pathogen transmission is essential for controlling the spread of many well-known pathogens, like the influenza virus, and emerging ones like SARS-CoV-2. Particles smaller than 50 to 100 µm remain airborne and significantly contribute to pathogen transmission. This review explores the journey of pathogen-carrying particles from formation in the airways, through airborne travel, to deposition in the lungs. The physicochemical properties of emitted particles depend on health status and emission modes, such as breathing, speaking, singing, coughing, sneezing, playing wind instruments, and medical interventions. After emission, sedimentation and evaporation primarily determine particle fate. Lung deposition of inhaled aerosol particles can be studied through in vivo, in vitro, or in silico methods. We discuss several numerical lung models, such as the Human Respiratory Tract Model, the LUng Dose Evaluation Program software (LUDEP), the Stochastic Lung Model, and the Computational Fluid Dynamics (CFD) techniques, and real-time or post-evaluation methods for detecting and characterizing these particles. Various air purification methods, particularly filtration, are reviewed for their effectiveness in healthcare settings. In the discussion, we analyze how this knowledge can help create environments with reduced PM2.5 and pathogen levels, enhancing safety in healthcare and nursing-care settings. This is particularly crucial for protecting older adults, who are more vulnerable to infections due to weaker immune systems and the higher prevalence of chronic conditions. By implementing effective airborne pathogen control measures, we can significantly improve health outcomes in geriatric settings.

Analysis of the airflow features and ventilation efficiency of an Ultra-Clean-Air operating theatre by qDNS simulations and experimental validation

Ultra-Clean-Air (UCA) operating theatres aim to minimise surgical instrument contamination and wound infection through high flow rates of ultra-clean air, reducing the presence of Microbe Carrying Particles (MCPs). This study investigates the airflow patterns and ventilation characteristics of a UCA operating theatre (OT) under standard ventilation system operating conditions, considering both empty and partially occupied scenarios. Utilising a precise computational model, quasi-Direct Numerical Simulations (qDNS) were conducted to delineate flow velocity profiles, energy spectra, distributions of turbulent kinetic energy, energy dissipation rate, local Kolmogorov scales, and pressure-based coherent structures. These results were also complemented by a tracer gas decay analysis following ASHRAE standard guidelines. Simulations showed that contrary to the intended laminar regime, the OT's geometry inherently fosters a predominantly turbulent airflow, sustained until evacuation through the exhaust vents, and facilitating recirculation zones irrespective of occupancy level. Notably, the occupied scenario demonstrated superior ventilation efficiency, a phenomenon attributed to enhanced kinetic energy induced by the additional obstructions. The findings underscore the critical role of UCA-OT design in mitigating MCP dissemination, highlighting the potential to augment the design to optimise airflow across a broader theatre spectrum, thereby diminishing recirculation zones and consequently reducing the propensity for Surgical Site Infections (SSIs). The study advocates for design refinements to harness the turbulent dynamics beneficially, steering towards a safer surgical environment.

The multi-dimensional challenges of controlling respiratory virus transmission in indoor spaces: Insights from the linkage of a microscopic pedestrian simulation and SARS-CoV-2 transmission model

SARS-CoV-2 transmission in indoor spaces, where most infection events occur, depends on the types and duration of human interactions, among others. Understanding how these human behaviours interface with virus characteristics to drive pathogen transmission and dictate the outcomes of non-pharmaceutical interventions is important for the informed and safe use of indoor spaces. To better understand these complex interactions, we developed the Pedestrian Dynamics-Virus Spread model (PeDViS), an individual-based model that combines pedestrian behaviour models with virus spread models incorporating direct and indirect transmission routes. We explored the relationships between virus exposure and the duration, distance, respiratory behaviour, and environment in which interactions between infected and uninfected individuals took place and compared this to benchmark 'at risk' interactions (1.5 metres for 15 minutes). When considering aerosol transmission, individuals adhering to distancing measures may be at risk due to the buildup of airborne virus in the environment when infected individuals spend prolonged time indoors. In our restaurant case, guests seated at tables near infected individuals were at limited risk of infection but could, particularly in poorly ventilated places, experience risks that surpass that of benchmark interactions. Combining interventions that target different transmission routes can aid in accumulating impact, for instance by combining ventilation with face masks. The impact of such combined interventions depends on the relative importance of transmission routes, which is hard to disentangle and highly context dependent. This uncertainty should be considered when assessing transmission risks upon different types of human interactions in indoor spaces. We illustrated the multi-dimensionality of indoor SARS-CoV-2 transmission that emerges from the interplay of human behaviour and the spread of respiratory viruses. A modelling strategy that incorporates this in risk assessments can help inform policy makers and citizens on the safe use of indoor spaces with varying inter-human interactions.

Reducing airborne transmission of SARS-CoV-2 by an upper-room ultraviolet germicidal irradiation system in a hospital isolation environment

Upper-room ultraviolet germicidal irradiation (UVGI) technology can potentially inhibit the transmission of airborne disease pathogens. There is a lack of quantitative evaluation of the performance of the upper-room UVGI for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) airborne transmission under the combined effects of ventilation and UV irradiation. Therefore, this study aimed to explore the performance of the upper-room UVGI system for reducing SARS-CoV-2 virus transmission in a hospital isolation environment. Computational fluid dynamics and virological data on SARS-CoV-2 were integrated to obtain virus aerosol exposure in the hospital isolation environment containing buffer rooms, wards and bathrooms. The UV inactivation model was applied to investigate the effects of ventilation rate, irradiation flux and irradiation height on the upper-room UVGI performance. The results showed that increasing ventilation rate from 8 to 16 air changes per hour (ACH) without UVGI obtained 54.32% and 45.63% virus reduction in the wards and bathrooms, respectively. However, the upper-room UVGI could achieve 90.43% and 99.09% virus disinfection, respectively, with the ventilation rate of 8 ACH and the irradiation flux of 10 μW cm-2. Higher percentage of virus could be inactivated by the upper-room UVGI at a lower ventilation rate; the rate of improvement of UVGI elimination effect slowed down with the increase of irradiation flux. Increase irradiation height at lower ventilation rate was more effective in improving the UVGI performance than the increase in irradiation flux at smaller irradiation height. These results could provide theoretical support for the practical application of UVGI in hospital isolation environments.

Effect of ventilation strategy on performance of upper-room ultraviolet germicidal irradiation (UVGI) system in a learning environment

Upper-room ultraviolet germicidal irradiation (UVGI) system is recently in the limelight as a potentially effective method to mitigate the risk of airborne virus infection in indoor environments. However, few studies quantitatively evaluated the relationship between ventilation effectiveness and virus disinfection performance of a UVGI system. The objective of this study is to investigate the effects of ventilation strategy on detailed airflow distributions and UVGI disinfection performance in an occupied classroom. Three-dimensional computational fluid dynamics (CFD) simulations were performed for representative cooling, heating, and ventilation scenarios. The results show that when the ventilation rate is 1.1 h-1 (the minimum ventilation rate based on ASHRAE 62.1), enhancing indoor air circulation with the mixing fan notably improves the UVGI disinfection performance, especially for cooling with displacement ventilation and all-air-heating conditions. However, increasing indoor air mixing yields negligible effect on the disinfection performance for forced-convection cooling condition. The results also reveal that regardless of indoor thermal condition, disinfection effectiveness of a UVGI system increases as ventilation effectiveness is close to unity. Moreover, when the room average air speed is >0.1 m/s, upper-room UVGI system could yield about 90% disinfection effect for the aerosol size of 1 μm-10 μm. The findings of this study imply that upper-room UVGI systems in indoor environments (i.e., classrooms, hospitals) should be designed considering ventilation strategy and occupancy conditions, especially for occupied buildings with insufficient air mixing throughout the space.

An overview of SARS-CoV-2 transmission and engineering strategies to mitigate risk

The spread of the COVID-19 pandemic has profoundly affected every aspect of our lives. To date, experts have acknowledged that airborne transmission is a key piece of the SARS-CoV-2 puzzle. Nevertheless, the exact mechanism of airborne transmission of SARS-CoV-2 remains unclear. Recent works have shown the spreading of SARS-CoV-2 through numerical modeling and experimental works, but the successful applications of engineering approaches in reducing the spread of SARS-CoV-2 are lacking. In this review, the environmental factors that influence the transmission risk of SARS-CoV-2, such as ventilation flow rates, humidity, and temperature, are discussed. Besides, additional macro and micro weather factors, regional and global transmission, and the variants of the spread of SARS-CoV-2 are also reviewed. Engineering approaches that practically reduce the risks of SARS-CoV-2 transmissions are reported. Given the complex human behavior, environmental properties, and dynamic nature of the SARS-CoV-2 virus, it is reasonable to summarize that SARS-CoV-2 may not be eradicated even with the timely implementation of interventions. Therefore, more research exploring the potential cost-effective ways to control the transmission rate of SARS-CoV-2 may be a worthwhile pursuit to moderate the current crisis.

A coupled experimental and statistical approach for an assessment of SARS-CoV-2 infection risk at indoor event locations

Indoor event locations are particularly affected by the SARS-CoV-2 pandemic. At large venues, only incomplete risk assessments exist, whereby no suitable measures can be derived. In this study, a physical and data-driven statistical model for a comprehensive infection risk assessment has been developed. At venues displacement ventilation concepts are often implemented. Here simplified theoretical assumptions fail for the prediction of relevant airflows for airborne transmission processes. Thus, with locally resolving trace gas measurements infection risks are computed more detailed. Coupled with epidemiological data such as incidences, vaccination rates, test sensitivities, and audience characteristics such as masks and age distribution, predictions of new infections (mean), situational R-values (mean), and individual risks on- and off-seat can be achieved for the first time. Using the Stuttgart State Opera as an example, the functioning of the model and its plausibility are tested and a sensitivity analysis is performed with regard to masks and tests. Besides a reference scenario on 2022-11-29, a maximum safety scenario with an obligation of FFP2 masks and rapid antigen tests as well as a minimum safety scenario without masks and tests are investigated. For these scenarios the new infections (mean) are 10.6, 0.25 and 13.0, respectively. The situational R-values (mean) - number of new infections caused by a single infectious person in a certain situation - are 2.75, 0.32 and 3.39, respectively. Besides these results a clustered consideration divided by age, masks and whether infections occur on-seat or off-seat are presented. In conclusion this provides an instrument that can enable policymakers and operators to take appropriate measures to control pandemics despite ongoing mass gathering events.

Enhanced Filtration Efficiency of Natural Materials with the Addition of Electrospun Poly(vinylidene fluoride-co-hexafluoropropylene) Fibres

Pollutants and infectious diseases can spread through air with airborne droplets and aerosols. A respiratory mask can decrease the amount of pollutants we inhale and it can protect us from airborne diseases. With the onset of the COVID-19 pandemic, masks became an everyday item used by a lot of people around the world. As most of them are for a single use, the amount of non-recyclable waste increased dramatically. The plastic from which the masks are made pollutes the environment with various chemicals and microplastic. Here, we investigated the time- and size-dependent filtration efficiency (FE) of aerosols in the range of 25.9 to 685.4 nm of five different natural materials whose FE was enhanced using electrospun poly(vinylidene fluoride-co-hexafluoropropylene) (PVDF) fibres. A scanning electron microscope (SEM) was used to determine the morphology and structure of the natural materials as well as the thickness of the PVDF fibres, while the phase of the electrospun fibres was determined by Raman spectroscopy. A thin layer of the electrospun PVDF fibres with the same grammage was sandwiched between two sheets of natural materials, and their FE increased up to 80%. By varying the grammature of the electrospun polymer, we tuned the FE of cotton from 82.6 to 99.9%. Thus, through the optimization of the grammage of the electrospun polymer, the amount of plastic used in the process can be minimized, while achieving sufficiently high FE.

Mechanisms controlling the transport and evaporation of human exhaled respiratory droplets containing the severe acute respiratory syndrome coronavirus: a review

Transmission of the coronavirus disease 2019 is still ongoing despite mass vaccination, lockdowns, and other drastic measures to control the pandemic. This is due partly to our lack of understanding on the multiphase flow mechanics that control droplet transport and viral transmission dynamics. Various models of droplet evaporation have been reported, yet there is still limited knowledge about the influence of physicochemical parameters on the transport of respiratory droplets carrying the severe acute respiratory syndrome coronavirus 2. Here we review the effects of initial droplet size, environmental conditions, virus mutation, and non-volatile components on droplet evaporation and dispersion, and on virus stability. We present experimental and computational methods to analyze droplet transport, and factors controlling transport and evaporation. Methods include thermal manikins, flow techniques, aerosol-generating techniques, nucleic acid-based assays, antibody-based assays, polymerase chain reaction, loop-mediated isothermal amplification, field-effect transistor-based assay, and discrete and gas-phase modeling. Controlling factors include environmental conditions, turbulence, ventilation, ambient temperature, relative humidity, droplet size distribution, non-volatile components, evaporation and mutation. Current results show that medium-sized droplets, e.g., 50 µm, are sensitive to relative humidity. Medium-sized droplets experience delayed evaporation at high relative humidity, and increase airborne lifetime and travel distance. By contrast, at low relative humidity, medium-sized droplets quickly shrink to droplet nuclei and follow the cough jet. Virus inactivation within a few hours generally occurs at temperatures above 40 °C, and the presence of viral particles in aerosols impedes droplet evaporation.

The Skagit County choir COVID-19 outbreak - have we got it wrong?

OBJECTIVES

Over time, papers or reports may come to be taken for granted as evidence for some phenomenon. Researchers cite them without critically re-examining findings in the light of subsequent work. This can give rise to misleading or erroneous results and conclusions. We explore whether this has occurred in the widely reported outbreak of SARS-CoV-2 at a rehearsal of the Skagit Valley Chorale in March 2020, where it was assumed, and subsequently asserted uncritically, that the outbreak was due to a single infected person.

STUDY DESIGN

Review of original report and subsequent modelling and interpretations.

METHODS

We reviewed and analysed original outbreak data in relation to published data on incubation period, subsequent modelling drawing on the data, and interpretations of transmission characteristics of this incident.

RESULTS

We show it is vanishingly unlikely that this was a single point source outbreak as has been widely claimed and on which modelling has been based.

CONCLUSION

An unexamined assumption has led to erroneous policy conclusions about the risks of singing, and indoor spaces more generally, and the benefits of increased levels of ventilation. Although never publicly identified, one individual bears the moral burden of knowing what health outcomes have been attributed to their actions. We call for these claims to be re-examined and for greater ethical responsibility in the assumption of a point source in outbreak investigations.

Can nonvolatile tastants be smelled during food oral processing?

While accumulating evidence implied the involvement of retro-nasal sensation in the consumption of nonvolatile taste compounds, it is still unclear whether it was caused by the taste compounds themselves, and if so, how can they migrate from the oral to nasal cavity. At first, we proposed aerosol particles as an alternative oral-nasal mass transfer mechanism. The high-speed camera approved that aerosol particles could be generated by the typical oral and pharynx actions during food oral processing; while the narrow-band imaging of nasal cleft and mass spectrometry of nostril-exhaled air approved the migration of aerosol within the oral-nasal route. Then, the "smelling" of taste compounds within the aerosol particles was testified. The four-alternative forced choices (4AFC) approved that the potential volatile residues or contaminants within the headspace air of pure taste solution cannot arouse significant smell, while the taste compounds embedded in the in vitro prepared aerosol particles can be "smelled" via the ortho route. The "smell" of sucrose is very different from its taste and the "smell" of quinine, implying its actual olfaction. The sweetness intensity of sucrose solution was also reduced when the volunteers' noses were clipped, indicating the involvement of retro-nasal sensation during its drinking. At last, the efficiency of aerosol as a mechanism of oral-nasal mass transfer was demonstrated to be comparable with the volatile molecules under the experimental condition, giving it the potential to be a substantial and unique source of retro-nasal sensation during food oral processing.

Development of a non-contact mobile screening center for infectious diseases: Effects of ventilation improvement on aerosol transmission prevention

Under the global landscape of the prolonged COVID-19 pandemic, the number of individuals who need to be tested for COVID-19 through screening centers is increasing. However, the risk of viral infection during the screening process remains significant. To limit cross-infection in screening centers, a non-contact mobile screening center (NCMSC) that uses negative pressure booths to improve ventilation and enable safe, fast, and convenient COVID-19 testing is developed. This study investigates aerosol transmission and ventilation control for eliminating cross-infection and for rapid virus removal from the indoor space using numerical analysis and experimental measurements. Computational fluid dynamics (CFD) simulations were used to evaluate the ventilation rate, pressure differential between spaces, and virus particle removal efficiency in NCMSC. We also characterized the airflow dynamics of NCMSC that is currently being piloted using particle image velocimetry (PIV). Moreover, design optimization was performed based on the air change rates and the ratio of supply air (SA) to exhaust air (EA). Three ventilation strategies for preventing viral transmission were tested. Based on the results of this study, standards for the installation and operation of a screening center for infectious diseases are proposed.

Experimental Methods of Investigating Airborne Indoor Virus-Transmissions Adapted to Several Ventilation Measures

This study introduces a principle that unifies two experimental methods for evaluating airborne indoor virus-transmissions adapted to several ventilation measures. A first-time comparison of mechanical/natural ventilation and air purification with regard to infection risks is enabled. Effortful computational fluid dynamics demand detailed boundary conditions for accurate calculations of indoor airflows, which are often unknown. Hence, a suitable, simple and generalized experimental set up for identifying the spatial and temporal infection risk for different ventilation measures is more qualified even with unknown boundary conditions. A trace gas method is suitable for mechanical and natural ventilation with outdoor air exchange. For an accurate assessment of air purifiers based on filtration, a surrogate particle method is appropriate. The release of a controlled rate of either trace gas or particles simulates an infectious person releasing virus material. Surrounding substance concentration measurements identify the neighborhood exposure. One key aspect of the study is to prove that the requirement of concordant results of both methods is fulfilled. This is the only way to ensure that the comparison of different ventilation measures described above is reliable. Two examples (a two-person office and a classroom) show how practical both methods are and how the principle is applicable for different types and sizes of rooms.

Public Health Issue of Indoor Dilution Ventilation for Disease Prevention Versus PM2.5 in Intake Air in Auditoriums of Premier Engineering Institutes in India

Background: Dilution ventilation by enhancing fresh air intake has been prescribed to reduce airborne infection spread during the COVID-19 pandemic. This is all the more important in assembly spaces like auditoriums. Premier technology institutes have large campuses with large auditoriums for academic and cultural events in India. These institutes serve as role models for society, where gatherings are essential, but there is also the possibility of transmission of all airborne respiratory infections, including tuberculosis, into the community. The fresh air taken in should also be filtered for pollution to prevent other lung issues.

Aims: Fresh air intake and filtration have been studied in order to understand whether the outside air supplied indoors is filtered for PM2.5, which is a major ambient polluter in India.

Settings and design/methods: In this study, the Right to Information Act of 2005 has been used to obtain first-hand information from the institutes with respect to the heating, ventilation, and air conditioning (HVAC) systems in their auditoriums. Twelve of the 19 institutes fall in cities with non-attainment of ambient air quality standards.

Results: Eleven out of all those had recently integrated fresh air supply, and six replied in the negative. Only one out of all of them had appropriate filters.

Conclusion: This study highlights the need for a possible trade-off between the use of air conditioners for thermal comfort + assumed protection against PM2.5, which is the switching off of air conditioners and manually opening up windows and using fans for ventilation. Indian HVAC design for gathering spaces, especially educational institutes, needs to factor in fresh air for dilution ventilation as well as PM2.5 filtration.