ABSTRACT
Addressing indoor air quality (IAQ) and thermal comfort issues in school buildings is challenging but relevant. Firstly, their primary occupants are more vulnerable than adults. Secondly, school buildings are often inadequate being too old or designed to prioritise energy-efficiency targets. Thirdly, occupants have often little control over the indoor environmental quality (IEQ). Lastly, the SARS-CoV-2 pandemic highlighted the complexity and vulnerability of existing decision-making processes in relation to making timely and well-informed decisions about IEQ threats. Standards and guidelines vary over time and among similar countries despite targeting similar occupants, evaluate IAQ and thermal comfort independently, and do not include any specific adaptations to children. Thus, the aim of this research is to compare different available standards to evaluate IAQ and thermal comfort in school buildings. By analysing with different standards (EN16798, BB101, and ASHRAE 55 and 62.1) the data collected in schools in northern Italy, this research evaluated the consequences of different limits and approaches, and proposed improvements. The conclusions are that (i) thresholds and methods inconsistency within the same standard should be avoided;(ii) upper- and lower-bounded operative temperature scales are the most appropriate means to design and verify thermal comfort in classrooms;(iii) IAQ metrics that give an upper limit per a certain amount of consecutive time might prevent the build-up of indoor pollutants, even with high emissions from the building fabric;(iv) no standard proposes a combined IAQ and thermal comfort analysis which could enable more informed trade-off decisions considering IAQ, thermal comfort, and energy targets. © 2023 The Authors
ABSTRACT
OBJECTIVES: To validate the diagnostic accuracy of a Euroimmun SARS-CoV-2 IgG and IgA immunoassay for COVID-19. METHODS: In this unmatched (1:2) case-control validation study, we used sera of 181 laboratory-confirmed SARS-CoV-2 cases and 326 controls collected before SARS-CoV-2 emergence. Diagnostic accuracy of the immunoassay was assessed against a whole spike protein-based recombinant immunofluorescence assay (rIFA) by receiver operating characteristic (ROC) analyses. Discrepant cases between ELISA and rIFA were further tested by pseudo-neutralization assay. RESULTS: COVID-19 patients were more likely to be male and older than controls, and 50.3% were hospitalized. ROC curve analyses indicated that IgG and IgA had high diagnostic accuracies with AUCs of 0.990 (95% Confidence Interval [95%CI]: 0.983-0.996) and 0.978 (95%CI: 0.967-0.989), respectively. IgG assays outperformed IgA assays (p=0.01). Taking an assessed 15% inter-assay imprecision into account, an optimized IgG ratio cut-off > 2.5 displayed a 100% specificity (95%CI: 99-100) and a 100% positive predictive value (95%CI: 96-100). A 0.8 cut-off displayed a 94% sensitivity (95%CI: 88-97) and a 97% negative predictive value (95%CI: 95-99). Substituting the upper threshold for the manufacturer's, improved assay performance, leaving 8.9% of IgG ratios indeterminate between 0.8-2.5. CONCLUSIONS: The Euroimmun assay displays a nearly optimal diagnostic accuracy using IgG against SARS-CoV-2 in patient samples, with no obvious gains from IgA serology. The optimized cut-offs are fit for rule-in and rule-out purposes, allowing determination of whether individuals in our study population have been exposed to SARS-CoV-2 or not. IgG serology should however not be considered as a surrogate of protection at this stage.