Informing Building Strategies to Reduce Infectious Aerosol Transmission Risk by Integrating DNA Aerosol Tracers with Quantitative Microbial Risk Assessment.

Using aerosol-based tracers to estimate risk of infectious aerosol transmission aids in the design of buildings with adequate protection against aerosol transmissible pathogens, such as SARS-CoV-2 and influenza. We propose a method for scaling a SARS-CoV-2 bulk aerosol quantitative microbial risk assessment (QMRA) model for impulse emissions, coughing or sneezing, with aerosolized synthetic DNA tracer concentration measurements. With point-of-emission ratios describing relationships between tracer and respiratory aerosol emission characteristics (i.e., volume and RNA or DNA concentrations) and accounting for aerosolized pathogen loss of infectivity over time, we scale the inhaled pathogen dose and risk of infection with time-integrated tracer concentrations measured with a filter sampler. This tracer-scaled QMRA model is evaluated through scenario testing, comparing the impact of ventilation, occupancy, masking, and layering interventions on infection risk. We apply the tracer-scaled QMRA model to measurement data from an ambulatory care room to estimate the risk reduction resulting from HEPA air cleaner operation. Using DNA tracer measurements to scale a bulk aerosol QMRA model is a relatively simple method of estimating risk in buildings and can be applied to understand the impact of risk mitigation efforts.

Implementing a negative pressure isolation space within a skilled nursing facility to control SARS-CoV-2 transmission.

BACKGROUND: Isolation space must be expanded during pandemics involving airborne transmission. Little to no work has been done to establish optimal design strategies and implementation plans to ease surge capacity and expand isolation capacity over long periods in congregate living facilities. The COVID-19 pandemic has an airborne transmission component and requires isolation, which is difficult to accomplish in skilled nursing facilities. METHODS: In this study we designed, implemented, and validated an isolation space at a skilled nursing facility in Lancaster, PA. The overall goal was to minimize disease transmission between residents and staff within the facility. We created an isolation space by modifying an existing HVAC system of the SNF. We measured pressure on-site and performed computational fluid dynamics and Lagrangian particle-based modeling to test containment and possible transmission extent given the isolation space is considered negative rather than individual rooms. RESULTS: Pressure data shows the isolation space maintained an average (standard deviation) hourly value of -2.3 Pa (0.12 Pa) pressure differential between it and the external hallway connected to the rest of the facility. No transmission of SARS-CoV-2 between residents isolated to the space occurred, nor did any transmission to the staff or other residents occur. The isolation space was successfully implemented and, as of writing, continues to be operational through the pandemic. CONCLUSION: Skilled nursing facilities can be retrofitted to provide negative pressure isolation space in a reasonable time frame and a cost effective manner to minimize airborne disease transmission within that space.

Impact of air quality on the gastrointestinal microbiome: A review.

BACKGROUND: Poor air quality is increasingly associated with several gastrointestinal diseases suggesting a possible association between air quality and the human gut microbiome. However, details on this remain largely unexplored as current available research is scarce. The aim of this comprehensive rigorous review was to summarize the existing reports on the impact of indoor or outdoor airborne pollutants on the animal and human gut microbiome and to outline the challenges and suggestions to expand this field of research. METHODS AND RESULTS: A comprehensive search of several databases (inception to August 9, 2019, humans and animals, English language only) was designed and conducted by an experienced librarian to identify studies describing the impact of air pollution on the human gut microbiome. The retrieved articles were assessed independently by two reviewers. This process yielded six original research papers on the animal GI gastrointestinal microbiome and four on the human gut microbiome. ß-diversity analyses from selected animal studies demonstrated a significantly different composition of the gut microbiota between control and exposed groups but changes in α-diversity were less uniform. No consistent findings in α or ß-diversity were reported among the human studies. Changes in microbiota at the phylum level disclosed substantial discrepancies across animal and human studies. CONCLUSIONS: A different composition of the gut microbiome, particularly in animal models, is associated with exposure to air pollution. Air pollution is associated with various taxa changes, which however do not follow a clear pattern. Future research using standardized methods are critical to replicate these initial findings and advance this emerging field.

Biomarkers and indoor air quality: A translational research review.

INTRODUCTION: Air pollution is linked to mortality and morbidity. Since humans spend nearly all their time indoors, improving indoor air quality (IAQ) is a compelling approach to mitigate air pollutant exposure. To assess interventions, relying on clinical outcomes may require prolonged follow-up, which hinders feasibility. Thus, identifying biomarkers that respond to changes in IAQ may be useful to assess the effectiveness of interventions. METHODS: We conducted a narrative review by searching several databases to identify studies published over the last decade that measured the response of blood, urine, and/or salivary biomarkers to variations (natural and intervention-induced) of changes in indoor air pollutant exposure. RESULTS: Numerous studies reported on associations between IAQ exposures and biomarkers with heterogeneity across study designs and methods. This review summarizes the responses of 113 biomarkers described in 30 articles. The biomarkers which most frequently responded to variations in indoor air pollutant exposures were high sensitivity C-reactive protein (hsCRP), von Willebrand Factor (vWF), 8-hydroxy-2'-deoxyguanosine (8-OHdG), and 1-hydroxypyrene (1-OHP). CONCLUSIONS: This review will guide the selection of biomarkers for translational studies evaluating the impact of indoor air pollutants on human health.

Testing the single-pass VOC removal efficiency of an active green wall using methyl ethyl ketone (MEK).

In recent years, research into the efficacy of indoor air biofiltration mechanisms, notably living green walls, has become more prevalent. Whilst green walls are often utilised within the built environment for their biophilic effects, there is little evidence demonstrating the efficacy of active green wall biofiltration for the removal of volatile organic compounds (VOCs) at concentrations found within an interior environment. The current work describes a novel approach to quantifying the VOC removal effectiveness by an active living green wall, which uses a mechanical system to force air through the substrate and plant foliage. After developing a single-pass efficiency protocol to understand the immediate effects of the system, the active green wall was installed into a 30-m3 chamber representative of a single room and presented with the contaminant 2-butanone (methyl ethyl ketone; MEK), a VOC commonly found in interior environments through its use in textile and plastic manufacture. Chamber inlet levels of MEK remained steady at 33.91 ± 0.541 ppbv. Utilising a forced-air system to draw the contaminated air through a green wall based on a soil-less growing medium containing activated carbon, the combined effects of substrate media and botanical component within the biofiltration system showed statistically significant VOC reduction, averaging 57% single-pass removal efficiency over multiple test procedures. These results indicate a high level of VOC removal efficiency for the active green wall biofilter tested and provide evidence that active biofiltration may aid in reducing exposure to VOCs in the indoor environment.

Implementing a negative-pressure isolation ward for a surge in airborne infectious patients.

BACKGROUND: During a large-scale airborne infectious disease outbreak, the number of patients needing hospital-based health care services may exceed available negative-pressure isolation room capacity. METHODS: To test one method of increasing hospital surge capacity, a temporary negative-pressure isolation ward was established at a fully functioning hospital. Negative pressure was achieved in a 30-bed hospital ward by adjusting the ventilation system. Differential pressure was continuously measured at 22 locations, and ventilation airflow was characterized throughout the ward. RESULTS: The pressure on the test ward relative to the main hospital hallway was -29 Pa on average, approximately 10 times higher than the Centers for Disease Control and Prevention guidance for airborne infection control. No occurrences of pressure reversal occurred at the entrances to the ward, even when staff entered the ward. Pressures within the ward changed, with some rooms becoming neutrally or slightly positively pressurized. CONCLUSIONS: This study showed that establishing a temporary negative-pressure isolation ward is an effective method to increase surge capacity in a hospital.

Impacts of flood damage on airborne bacteria and fungi in homes after the 2013 Colorado Front Range flood.

Flood-damaged homes typically have elevated microbial loads, and their occupants have an increased incidence of allergies, asthma, and other respiratory ailments, yet the microbial communities in these homes remain under-studied. Using culture-independent approaches, we characterized bacterial and fungal communities in homes in Boulder, CO, USA 2-3 months after the historic September, 2013 flooding event. We collected passive air samples from basements in 50 homes (36 flood-damaged, 14 non-flooded), and we sequenced the bacterial 16S rRNA gene (V4-V5 region) and the fungal ITS1 region from these samples for community analyses. Quantitative PCR was used to estimate the abundances of bacteria and fungi in the passive air samples. Results indicate significant differences in bacterial and fungal community composition between flooded and non-flooded homes. Fungal abundances were estimated to be three times higher in flooded, relative to non-flooded homes, but there were no significant differences in bacterial abundances. Penicillium (fungi) and Pseudomonadaceae and Enterobacteriaceae (bacteria) were among the most abundant taxa in flooded homes. Our results suggest that bacterial and fungal communities continue to be affected by flooding, even after relative humidity has returned to baseline levels and remediation has removed any visible evidence of flood damage.

Ambient Coarse Particulate Matter and Human Health: A Systematic Review and Meta-Analysis.

Airborne particles have been linked to increased mortality and morbidity. As most research has focused on fine particles (PM2.5), the health implications of coarse particles (PM10-2.5) are not well understood. We conducted a systematic review and meta-analysis of associations for short- and long-term PM10-2.5 concentrations with mortality and hospital admissions. Using 23 mortality and 10 hospital admissions studies, we documented suggestive evidence of increased morbidity and mortality in relation to higher short-term PM10-2.5 concentrations, with stronger relationships for respiratory than cardiovascular endpoints. Reported associations were highly heterogeneous, however, especially by geographic region and average PM10-2.5 concentrations. Adjustment for PM2.5 and publication bias resulted in weaker and less precise effect estimates, although positive associations remained for short-term PM10-2.5 concentrations. Inconsistent relationships between effect estimates for PM10-2.5 and correlations between PM10-2.5 and PM2.5 concentrations, however, indicate that PM10-2.5 associations cannot be solely explained by co-exposure to PM2.5. While suggestive evidence was found of increased mortality with long-term PM10-2.5 concentrations, these associations were not robust to control for PM2.5. Additional research is required to better understand sources of heterogeneity of associations between PM10-2.5 and adverse health outcomes.

Seasonal variability in bacterial and fungal diversity of the near-surface atmosphere.

Bacteria and fungi are ubiquitous throughout the Earth's lower atmosphere where they often represent an important component of atmospheric aerosols with the potential to impact human health and atmospheric dynamics. However, the diversity, composition, and spatiotemporal dynamics of these airborne microbes remain poorly understood. We performed a comprehensive analysis of airborne microbes across two aerosol size fractions at urban and rural sites in the Colorado Front Range over a 14-month period. Coarse (PM10-2.5) and fine (PM2.5) particulate matter samples were collected at weekly intervals with both bacterial and fungal diversity assessed via high-throughput sequencing. The diversity and composition of the airborne communities varied across the sites, between the two size fractions, and over time. Bacteria were the dominant type of bioaerosol in the collected air samples, while fungi and plants (pollen) made up the remainder, with the relative abundances of fungi peaking during the spring and summer months. As bacteria made up the majority of bioaerosol particles, we analyzed the bacterial communities in greater detail using a bacterial-specific 16S rRNA gene sequencing approach. Overall, bacterial taxonomic richness and the relative abundances of specific bacterial taxa exhibited significant patterns of seasonality. Likewise, airborne bacterial communities varied significantly between sites and across aerosol size fractions. Source-tracking analyses indicate that soils and leaves represented important sources of bacteria to the near-surface atmosphere across all locations with cow fecal bacteria also representing an important source of bioaerosols at the more rural sites during early fall and early spring. Together, these data suggest that a complex set of environmental factors, including changes in atmospheric conditions and shifts in the relative importance of available microbial sources, act to control the composition of microbial bioaerosols in rural and urban environments.

Errors in coarse particulate matter mass concentrations and spatiotemporal characteristics when using subtraction estimation methods.

In studies of coarse particulate matter (PM10-2.5), mass concentrations are often estimated through the subtraction of PM2.5 from collocated PM10 tapered element oscillating microbalance (TEOM) measurements. Though all field instruments have yet to be updated, the Filter Dynamic Measurement System (FDMS) was introduced to account for the loss of semivolatile material from heated TEOM filters. To assess errors in PM10-2.5 estimation when using the possible combinations of PM10 and PM2.5 TEOM units with and without FDMS, data from three monitoring sites of the Colorado Coarse Rural-Urban Sources and Health (CCRUSH) study were used to simulate four possible subtraction methods for estimating PM10-2.5 mass concentrations. Assuming all mass is accounted for using collocated TEOMs with FDMS, the three other subtraction methods were assessed for biases in absolute mass concentration, temporal variability, spatial correlation, and homogeneity. Results show collocated units without FDMS closely estimate actual PM10-2.5 mass and spatial characteristics due to the very low semivolatile PM10-2.5 concentrations in Colorado. Estimation using either a PM2.5 or PM10 monitor without FDMS introduced absolute biases of 2.4 microg/m3 (25%) to -2.3 microg/m3 (-24%), respectively. Such errors are directly related to the unmeasured semivolatile mass and alter measures of spatiotemporal variability and homogeneity, all of which have implications for the regulatory and epidemiology communities concerned about PM10-2.5. Two monitoring sites operated by the state of Colorado were considered for inclusion in the CCRUSH acute health effects study, but concentrations were biased due to sampling with an FDMS-equipped PM2.5 TEOM and PM10 TEOM not corrected for semivolatile mass loss. A regression-based model was developed for removing the error in these measurements by estimating the semivolatile concentration of PM2.5 from total PM2.5 concentrations. By estimating nonvolatile PM2.5 concentrations from this relationship, PM10-2.5 was calculated as the difference between nonvolatile PM10 and PM2.5 concentrations.