Dismantling myths on the airborne transmission of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2).

The coronavirus disease 2019 (COVID-19) pandemic has caused untold disruption throughout the world. Understanding the mechanisms for transmission of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is key to preventing further spread, but there is confusion over the meaning of 'airborne' whenever transmission is discussed. Scientific ambivalence originates from evidence published many years ago which has generated mythological beliefs that obscure current thinking. This article collates and explores some of the most commonly held dogmas on airborne transmission in order to stimulate revision of the science in the light of current evidence. Six 'myths' are presented, explained and ultimately refuted on the basis of recently published papers and expert opinion from previous work related to similar viruses. There is little doubt that SARS-CoV-2 is transmitted via a range of airborne particle sizes subject to all the usual ventilation parameters and human behaviour. Experts from specialties encompassing aerosol studies, ventilation, engineering, physics, virology and clinical medicine have joined together to produce this review to consolidate the evidence for airborne transmission mechanisms, and offer justification for modern strategies for prevention and control of COVID-19 in health care and the community.

Intermittent occupancy combined with ventilation: An efficient strategy for the reduction of airborne transmission indoors.

It is important that efficient measures to reduce the airborne transmission of respiratory infectious diseases (including COVID-19) should be formulated as soon as possible to ensure a safe easing of lockdown. Ventilation has been widely recognized as an efficient engineering control measure for airborne transmission. Room ventilation with an increased supply of clean outdoor air could dilute the expiratory airborne aerosols to a lower concentration level. However, sufficient increase is beyond the capacity of most of the existing mechanical ventilation systems that were designed to be energy efficient under non-pandemic conditions. We propose an improved control strategy based on source control, which would be achieved by implementing intermittent breaks in room occupancy, specifically that all occupants should leave the room periodically and the room occupancy time should be reduced as much as possible. Under the assumption of good mixing of clean outdoor supply air with room air, the evolution of the concentration in the room of aerosols exhaled by infected person(s) is predicted. The risk of airborne cross-infection is then evaluated by calculating the time-averaged intake fraction. The effectiveness of the strategy is demonstrated for a case study of a typical classroom. This strategy, together with other control measures such as continuous supply of maximum clean air, distancing, face-to-back layout of workstations and reducing activities that increase aerosol generation (e.g., loudly talking and singing), is applicable in classrooms, offices, meeting rooms, conference rooms, etc.

Airborne spread of expiratory droplet nuclei between the occupants of indoor environments: A review.

This article reviews past studies of airborne transmission between occupants in indoor environments, focusing on the spread of expiratory droplet nuclei from mouth/nose to mouth/nose for non-specific diseases. Special attention is paid to summarizing what is known about the influential factors, the inappropriate simplifications of the thermofluid boundary conditions of thermal manikins, the challenges facing the available experimental techniques, and the limitations of available evaluation methods. Secondary issues are highlighted, and some new ways to improve our understanding of airborne transmission indoors are provided. The characteristics of airborne spread of expiratory droplet nuclei between occupants, which are influenced correlatively by both environmental and personal factors, were widely revealed under steady-state conditions. Owing to the different boundary conditions used, some inconsistent findings on specific influential factors have been published. The available instrumentation was too slow to provide accurate concentration profiles for time-dependent evaluations of events with obvious time characteristics, while computational fluid dynamics (CFD) studies were mainly performed in the framework of inherently steady Reynolds-averaged Navier-Stokes modeling. Future research needs in 3 areas are identified: the importance of the direction of indoor airflow patterns, the dynamics of airborne transmission, and the application of CFD simulations.

Particle deposition in a realistic geometry of the human conducting airways: Effects of inlet velocity profile, inhalation flowrate and electrostatic charge.

Understanding the multitude of factors that control pulmonary deposition is important in assessing the therapeutic or toxic effects of inhaled particles. The use of increasingly sophisticated in silico models has improved our overall understanding, but model realism remains elusive. In this work, we use Large Eddy Simulations (LES) to investigate the deposition of inhaled aerosol particles with diameters of dp=0.1,0.5,1,2.5,5 and 10µm (particle density of 1200kg/m(3)). We use a reconstructed geometry of the human airways obtained via computed tomography and assess the effects of inlet flow conditions, particle size, electrostatic charge, and flowrate. While most computer simulations assume a uniform velocity at the mouth inlet, we found that using a more realistic inlet profile based on Laser Doppler Anemometry measurements resulted in enhanced deposition, mostly on the tongue. Nevertheless, flow field differences due to the inlet conditions are largely smoothed out just a short distance downstream of the mouth inlet as a result of the complex geometry. Increasing the inhalation flowrate from sedentary to activity conditions left the mean flowfield structures largely unaffected. Nevertheless, at the higher flowrates turbulent intensities persisted further downstream in the main bronchi. For dp>2.5µm, the overall Deposition Fractions (DF) increased with flowrate due to greater inertial impaction in the oropharynx. Below dp=1.0µm, the DF was largely independent of particle size; it also increased with flowrate, but remained significantly lower. Electrostatic charge increased the overall DF of smaller particles by as much as sevenfold, with most of the increase located in the mouth-throat. Moreover, significant enhancement in deposition was found in the left and right lung sub-regions of our reconstructed geometry. Although there was a relatively small impact of inhalation flowrate on the deposition of charged particles for sizes dp<2.5µm, impaction prevailed over electrostatic deposition for larger particles as the flowrate was increased. Overall, we report a significant interplay between particle size, electrostatic charge, and flowrate. Our results suggest that in silico models should be customized for specific applications, ensuring all relevant physical effects are accounted for in a self-consistent fashion.

Advanced air distribution: improving health and comfort while reducing energy use.

Indoor environment affects the health, comfort, and performance of building occupants. The energy used for heating, cooling, ventilating, and air conditioning of buildings is substantial. Ventilation based on total volume air distribution in spaces is not always an efficient way to provide high-quality indoor environments at the same time as low-energy consumption. Advanced air distribution, designed to supply clean air where, when, and as much as needed, makes it possible to efficiently achieve thermal comfort, control exposure to contaminants, provide high-quality air for breathing and minimizing the risk of airborne cross-infection while reducing energy use. This study justifies the need for improving the present air distribution design in occupied spaces, and in general the need for a paradigm shift from the design of collective environments to the design of individually controlled environments. The focus is on advanced air distribution in spaces, its guiding principles and its advantages and disadvantages. Examples of advanced air distribution solutions in spaces for different use, such as offices, hospital rooms, vehicle compartments, are presented. The potential of advanced air distribution, and individually controlled macro-environment in general, for achieving shared values, that is, improved health, comfort, and performance, energy saving, reduction of healthcare costs and improved well-being is demonstrated. Performance criteria are defined and further research in the field is outlined.

Use of personalized ventilation for improving health, comfort, and performance at high room temperature and humidity.

UNLABELLED: The effect of personalized ventilation (PV) on people's health, comfort, and performance in a warm and humid environment (26 and 28°C at 70% relative humidity) was studied and compared with their responses in a comfortable environment (23°C and 40% relative humidity). Thirty subjects participated in five 4-h experiments in a climate chamber. Under the conditions with PV, the subjects were able to control the rate and direction of the supplied personalized flow of clean air. Subjective responses were collected through questionnaires. During all exposures, the subjects were occupied with tasks used to assess their performance. Objective measures of tear film stability, concentration of stress biomarkers in saliva, and eye blinking rate were taken. Using PV significantly improved the perceived air quality (PAQ) and thermal sensation and decreased the intensity of Sick Building Syndrome (SBS) symptoms to those prevailing in a comfortable room environment without PV. Self-estimated and objectively measured performance was improved. Increasing the temperature and relative humidity, but not the use of PV, significantly decreased tear film quality and the concentration of salivary alpha-amylase, indicating lower mental arousal and alertness. The use of PV improved tear film stability as compared to that in a warm environment without PV. PRACTICAL IMPLICATIONS: In practice, the supply of clean, cool, and less humid air by PV at each workstation will make it possible to raise room temperatures above the upper comfortable limit suggested in the present standards without adversely affecting the occupants' health [Sick Building Syndrome (SBS) symptoms], comfort (thermal and perceived air quality), and performance. This may lead to energy savings.

Ceiling-mounted personalized ventilation system integrated with a secondary air distribution system--a human response study in hot and humid climate.

UNLABELLED: The benefits of thermal comfort and indoor air quality with personalized ventilation (PV) systems have been demonstrated in recent studies. One of the barriers for wide spread acceptance by architects and HVAC designers has been attributed to challenges and constraints faced in the integration of PV systems with the work station. A newly developed ceiling-mounted PV system addresses these challenges and provides a practical solution while retaining much of the apparent benefits of PV systems. Assessments of thermal environment, air movement, and air quality for ceiling-mounted PV system were performed with tropically acclimatized subjects in a Field Environmental Chamber. Thirty-two subjects performed normal office work and could choose to be exposed to four different PV airflow rates (4, 8, 12, and 16 L/s), thus offering themselves a reasonable degree of individual control. Ambient temperatures of 26 and 23.5 degrees C and PV air temperatures of 26, 23.5, and 21 degrees C were employed. The local and whole body thermal sensations were reduced when PV airflow rates were increased. Inhaled air temperature was perceived cooler and perceived air quality and air freshness improved when PV airflow rate was increased or temperature was reduced. PRACTICAL IMPLICATIONS: The newly developed ceiling-mounted PV system offers a practical solution to the integration of PV air terminal devices (ATDs) in the vicinity of the workstation. By remotely locating the PV ATDs on the ceiling directly above the occupants and under their control, the conditioned outdoor air is now provided to the occupants through the downward momentum of the air. A secondary air-conditioning and air distribution system offers additional cooling in the room and maintains a higher ambient temperature, thus offering significant benefits in conserving energy. The results of this study provide designers and consultants with needed knowledge for design of PV systems.

Methods for air cleaning and protection of building occupants from airborne pathogens.

This article aims to draw the attention of the scientific community towards the elevated risks of airborne transmission of diseases and the associated risks of epidemics or pandemics. The complexity of the problem and the need for multidisciplinary research is highlighted. The airborne route of transmission, i.e. the generation of pathogen laden droplets originating in the respiratory tract of an infected individual, the survivability of the pathogens, their dispersal indoors and their transfer to a healthy person are reviewed. The advantages and the drawbacks of air dilution, filtration, ultraviolet germicidal irradiation (UVGI), photocatalytic oxidation (PCO), plasmacluster ions and other technologies for air disinfection and purification from pathogens are analyzed with respect to currently used air distribution principles. The importance of indoor air characteristics, such as temperature, relative humidity and velocity for the efficiency of each method is analyzed, taking into consideration the nature of the pathogens themselves. The applicability of the cleaning methods to the different types of total volume air distribution used at present indoors, i.e. mixing, displacement and underfloor ventilation, as well as advanced air distribution techniques (such as personalized ventilation) is discussed.

Personalized ventilation.

UNLABELLED: The thermal environment and air quality in buildings affects occupants' health, comfort and performance. The heating, ventilating and air-conditioning (HVAC) of buildings today is designed to provide a uniform room environment. However, large individual differences exist between occupants in regard to physiological and psychological response, clothing insulation, activity, air temperature and air movement preference, etc. Environmental conditions acceptable for most occupants in rooms may be achieved by providing each occupant with the possibility to generate and control his/her own preferred microenvironment. Furthermore, HVAC systems should be designed to protect occupants from airborne transmission of infectious agents that may be present in exhaled air. Personalized ventilation is a new development in the field of HVAC and has the potential to fulfill the above requirements. This paper reviews existing knowledge on performance of personalized ventilation (PV) and on human response to it. The airflow interaction in the vicinity of the human body is analyzed and its impact on thermal comfort and inhaled air quality is discussed together with control strategies and the application of PV in practice. Performance criteria are defined. Recommendations for design of PV that would be in compliance with the criteria are given. Future research needed on the topic is outlined. PRACTICAL IMPLICATIONS: Personalized ventilation can improve occupants' comfort, decrease SBS symptoms and reduce the risk of transmission of contagion between occupants in comparison with total volume ventilation. However in order to perform efficiently in rooms in practice, the design (air distribution, control, etc.) has to be carefully considered together with type of occupant activity (occupancy rate, occupied density, etc.).