Reducing Transmission of Airborne Respiratory Pathogens: A New Beginning as the COVID-19 Emergency Ends.

BACKGROUND: In response to the COVID-19 pandemic, new evidence-based strategies have emerged for reducing transmission of respiratory infections through management of indoor air. OBJECTIVES: This paper reviews critical advances that could reduce the burden of disease from inhaled pathogens and describes challenges in their implementation. DISCUSSION: Proven strategies include assuring sufficient ventilation, air cleaning by filtration, and air disinfection by germicidal ultraviolet (UV) light. Layered intervention strategies are needed to maximize risk reduction. Case studies demonstrate how to implement these tools while also revealing barriers to implementation. Future needs include standards designed with infection resilience and equity in mind, buildings optimized for infection resilience among other drivers, new approaches and technologies to improve ventilation, scientific consensus on the amount of ventilation needed to achieve a desired level of risk, methods for evaluating new air-cleaning technologies, studies of their long-term health effects, workforce training on ventilation systems, easier access to federal funds, demonstration projects in schools, and communication with the public about the importance of indoor air quality and actions people can take to improve it. https://doi.org/10.1289/EHP13878.

A quanta-independent approach for the assessment of strategies to reduce the risk of airborne infection.

The Wells-Riley model is extensively used for retrospective and prospective modelling of the risk of airborne transmission of infection in indoor spaces. It is also used when examining the efficacy of various removal and deactivation methods for airborne infectious aerosols in the indoor environment, which is crucial when selecting the most effective infection control technologies. The problem is that the large variation in viral load between individuals makes the Wells-Riley model output very sensitive to the input parameters and may yield a flawed prediction of risk. The absolute infection risk estimated with this model can range from nearly 0 % to 100 % depending on the viral load, even when all other factors, such as removal mechanisms and room geometry, remain unchanged. We therefore propose a novel method that removes this sensitivity to viral load. We define a quanta-independent maximum absolute before-after difference in infection risk that is independent of quanta factors like viral load, physical activity, or the dose-response relationships. The input data needed for a non-steady-state calculation are just the removal rates, room volume, and occupancy duration. Under steady-state conditions the approach provides an elegant solution that is only dependent on removal mechanisms before and after applying infection control measures. We applied this method to compare the impact of relative humidity, ventilation rate and its effectiveness, filtering efficiency, and the use of ultraviolet germicidal irradiation on the infection risk. The results demonstrate that the method provides a comprehensive understanding of the impact of infection control strategies on the risk of airborne infection, enabling rational decisions to be made regarding the most effective strategies in a specific context. The proposed method thus provides a practical tool for mitigation of airborne infection risk.

Ambient carbon dioxide concentration correlates with SARS-CoV-2 aerostability and infection risk.

An improved understanding of the underlying physicochemical properties of respiratory aerosol that influence viral infectivity may open new avenues to mitigate the transmission of respiratory diseases such as COVID-19. Previous studies have shown that an increase in the pH of respiratory aerosols following generation due to changes in the gas-particle partitioning of pH buffering bicarbonate ions and carbon dioxide is a significant factor in reducing SARS-CoV-2 infectivity. We show here that a significant increase in SARS-CoV-2 aerostability results from a moderate increase in the atmospheric carbon dioxide concentration (e.g. 800 ppm), an effect that is more marked than that observed for changes in relative humidity. We model the likelihood of COVID-19 transmission on the ambient concentration of CO2, concluding that even this moderate increase in CO2 concentration results in a significant increase in overall risk. These observations confirm the critical importance of ventilation and maintaining low CO2 concentrations in indoor environments for mitigating disease transmission. Moreover, the correlation of increased CO2 concentration with viral aerostability need to be better understood when considering the consequences of increases in ambient CO2 levels in our atmosphere.

Ventilation during COVID-19 in a school for students with intellectual and developmental disabilities (IDD).

BACKGROUND: This study examined the correlation of classroom ventilation (air exchanges per hour (ACH)) and exposure to CO2 ≥1,000 ppm with the incidence of SARS-CoV-2 over a 20-month period in a specialized school for students with intellectual and developmental disabilities (IDD). These students were at a higher risk of respiratory infection from SARS-CoV-2 due to challenges in tolerating mitigation measures (e.g. masking). One in-school measure proposed to help mitigate the risk of SARS-CoV-2 infection in schools is increased ventilation. METHODS: We established a community-engaged research partnership between the University of Rochester and the Mary Cariola Center school for students with IDD. Ambient CO2 levels were measured in 100 school rooms, and air changes per hour (ACH) were calculated. The number of SARS-CoV-2 cases for each room was collected over 20 months. RESULTS: 97% of rooms had an estimated ACH ≤4.0, with 7% having CO2 levels ≥2,000 ppm for up to 3 hours per school day. A statistically significant correlation was found between the time that a room had CO2 levels ≥1,000 ppm and SARS-CoV-2 PCR tests normalized to room occupancy, accounting for 43% of the variance. No statistically significant correlation was found for room ACH and per-room SARS-CoV-2 cases. Rooms with ventilation systems using MERV-13 filters had lower SARS-CoV-2-positive PCR counts. These findings led to ongoing efforts to upgrade the ventilation systems in this community-engaged research project. CONCLUSIONS: There was a statistically significant correlation between the total time of room CO2 concentrations ≥1,000 and SARS-CoV-2 cases in an IDD school. Merv-13 filters appear to decrease the incidence of SARS-CoV-2 infection. This research partnership identified areas for improving in-school ventilation.

Optimization of air quality and energy consumption in the cabin of electric vehicles using system simulation.

In electric vehicles, the Heating, Ventilation and Air-Conditioning (HVAC) function is often performed by a heat pump. Heating and cooling the cabin air drains energy directly from the vehicle's battery. In addition, these vehicles may operate in environments with high level of air pollution. In the cabin, passengers are confined to a small space where particles and harmful gases can accumulate. In addition, the ventilation system must also handle the air which does not enter the cabin through blower operation. This "infiltration" is a function of the vehicle speed and allows pollution to enter the cabin without being filtered or thermally treated. The objective of the study is to optimize the competing goals of the HVAC system: achieving the best air quality while maintaining good thermal comfort, at minimum energy costs. A system simulation tool is calibrated to represent the heating and cooling of an electric car. With this model, the influence of key factors is evaluated. Depending on ambient conditions and other parameters (number of occupants, vehicle speed, etc.), the blower flow rate and recirculation ratio can be adjusted to reach the objectives. The management of the proportion of fresh and recirculated air allows to regulate the humidity and carbon dioxide levels. Optimum controls are proposed as good trade-offs to reduce the power consumption, while maintaining a safe and comfortable environment for occupants. Compared to the full fresh air mode, the driving range gains are estimated in cold (-15 °C) and hot (30 °C) scenarios at 9 and 26 km respectively.

Theoretical Threshold for Estimating the Impact of Ventilation on Materials' Emissions.

In new buildings, nonoccupant VOC emissions are initially high but typically decrease within months. Increased ventilation is commonly used to improve indoor air quality, assuming it speeds up VOC off-gassing from materials. However, previous research presents inconsistent results. This review introduces a simplified analytical model to understand the ventilation-emission relationship. By combining factors such as diffusivity, emitting area, and time, the model suggests the existence of a theoretical ventilation threshold beyond which enhanced ventilation has no further influence on emission rates. A threshold of approximately 0.13 L s-1 m-2 emitting area has been found for various VOCs documented in the existing literature, with which the conflicting results are explained. It is also shown that the threshold remains notably consistent across different boundary conditions and model resolutions, indicating its suitability for real-world applications.

Numerical performance of CO2 accumulation and droplet dispersion from a cough inside a hospital lift under different ventilation strategies.

The impact of mechanical ventilation on airborne diseases is not completely known. The recent pandemic of COVID-19 clearly showed that additional investigations are necessary. The use of computational tools is an advantage that needs to be included in the study of designing safe places. The current study focused on a hospital lift where two subjects were included: a healthy passenger and an infected one. The elevator was modelled with a fan placed on the middle of the ceiling and racks for supplying air at the bottom of the lateral wall. Three ventilation strategies were evaluated: a without ventilation case, an upwards-blowing exhausting fan case and a downwards-blowing fan case. Five seconds after the elevator journey began, the infected person coughed. For the risk assessment, the CO2 concentration, droplet removal performance and dispersion were examined and compared among the three cases. The results revealed some discrepancies in the selection of an optimal ventilation strategy. Depending on the evaluated parameter, downward-ventilation fan or no ventilation strategy could be the most appropriate approach.

Working with cattle slurry on farms: emission and dispersion of hydrogen sulfide gas during stirring.

Over the past 15 years, there have been numerous fatalities related to working with animal slurry. Working with cattle slurry releases toxic gases, in particular, hydrogen sulphide (H2S), which can cause acute central nervous system toxicity, breathing difficulties, and death if exposed to high concentrations. Real-time measurements of H2S gas were taken over distance and time, during the stirring of cattle slurry on farms. Gas was measured at eight slurry stores with differing typical configurations of indoor or outdoor stores and with or without slatted flooring. Highest H2S gas levels were measured from indoor stores under slatted floors, and generally at positions closest to the stirrer or the point of maximum stirring, with levels decreasing with distance from source. Most of the data indicate H2S gas levels increase very rapidly after stirring starts, and mostly decline to baseline levels within 30 min post start of stirring. There were, however, circumstances where gas levels remained high and only started to decline once the stirrer had stopped. H2S gas levels at all farms, at all positions measured were consistently below 10 ppm within 30 min of the stirrer being stopped. The current data highlight areas of the farm and ways of working that have the potential for workers and others to be at risk of exposure to toxic slurry gases. The area should be left to ventilate naturally for at least 30 min after the stirrer has been stopped before re-entering buildings. Influencing the design of stirring equipment and future slurry stores would likely reduce the risk of worker exposure to slurry gases.

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.

3D multi-robot olfaction in naturally ventilated indoor environments: Locating a time-varying source at unknown heights.

Source localization is significant for mitigating indoor air pollution and safeguarding the well-being and safety of occupants. While most study focuses on mechanical ventilation and static sources, this study explores the less-explored domain of locating time-varying sources in naturally ventilated spaces. We have developed an innovative 3D localization system that adjusts to varying heights, significantly enhancing capabilities beyond traditional fixed-height 2D systems. To ensure consistency in experimental conditions, we conducted comparative analyses of 2D and 3D methods, using a swinging fan to simulate natural ventilation. Our findings reveal a substantial disparity in performance: the 2D method had a success rate below 46.7% in cases of height mismatches, while our 3D methods consistently achieved success rates above 66.7%, demonstrating their superior effectiveness in complex environments. Furthermore, we validated the 3D strategies in real naturally ventilated settings, confirming their wider applicability. This research extends the scope of indoor source localization and offers valuable insights and strategies for more effective pollution control.

Review of the research status on the transmission and diffusion characteristics of indoor viral aerosol particles.

This study reviews the generation and diffusion characteristics of indoor viral aerosol particles, numerical simulation methods for the diffusion process of viral aerosols, and related research on the impact mechanism of different ventilation methods on the diffusion process of viral aerosols. Research has shown that the selection of initial conditions such as exhalation mode, initial airflow velocity, particle size, turbulence model, and calculation method for the generation of aerosol particles by the human body is of great significance for the numerical simulation of the diffusion process of viral aerosol particles. At the same time, on the basis of selecting appropriate ventilation methods, the reasonable setting of ventilation parameters (temperature, speed, height, etc.) can effectively suppress the spread of viral aerosols. This study can provide a theoretical basis for the study of related respiratory diseases, as well as technical and theoretical support for the selection of indoor ventilation methods to reduce the risk of human exposure caused by viral aerosols in the construction field. It also provides guidance and reference for aerosol transport and environmental protection in indoor atmospheric environments.

Influence of Ventilation on Formation and Growth of 1-20 nm Particles via Ozone-Human Chemistry.

Ozone reaction with human surfaces is an important source of ultrafine particles indoors. However, 1-20 nm particles generated from ozone-human chemistry, which mark the first step of particle formation and growth, remain understudied. Ventilation and indoor air movement could have important implications for these processes. Therefore, in a controlled-climate chamber, we measured ultrafine particles initiated from ozone-human chemistry and their dependence on the air change rate (ACR, 0.5, 1.5, and 3 h-1) and operation of mixing fans (on and off). Concurrently, we measured volatile organic compounds (VOCs) and explored the correlation between particles and gas-phase products. At 25-30 ppb ozone levels, humans generated 0.2-7.7 × 1012 of 1-3 nm, 0-7.2 × 1012 of 3-10 nm, and 0-1.3 × 1012 of 10-20 nm particles per person per hour depending on the ACR and mixing fan operation. Size-dependent particle growth and formation rates increased with higher ACR. The operation of mixing fans suppressed the particle formation and growth, owing to enhanced surface deposition of the newly formed particles and their precursors. Correlation analyses revealed complex interactions between the particles and VOCs initiated by ozone-human chemistry. The results imply that ventilation and indoor air movement may have a more significant influence on particle dynamics and fate relative to indoor chemistry.

Zonal demand-controlled ventilation strategy to minimize infection probability and energy consumption: A coordinated control based on occupant detection.

Due to the outbreak of COVID-19, an increased risk of airborne transmission has been experienced in buildings, particularly in confined public places. The need for ventilation as a means of infection prevention has become more pronounced given that some basic precautions (like wearing masks) are no longer mandatory. However, ventilating the space as a whole (e.g., using a unified ventilation rate) may lead to situations where there is either insufficient or excessive ventilation in localized areas, potentially resulting in localized virus accumulation or large energy consumption. It is of urgent need to investigate real-time control of ventilation systems based on local demands of the occupants to strike a balance between infection risk and energy saving. In this work, a zonal demand-controlled ventilation (ZDCV) strategy was proposed to optimize the ventilation rates in sub-zones. A camera-based occupant detection method was developed to detect occupants (with eight possible locations in sub-zones denoted as 'A' to 'H'). Linear ventilation model (LVM), dimension reduction, and artificial neural network (ANN) were integrated for rapid prediction of pollutant concentrations in sub-zones with the identified occupants and ventilation rates as inputs. Coordinated ventilation effects between sub-zones were optimized to improve infection prevention and energy savings. Results showed that rapid prediction models achieved an average prediction error of 6 ppm for CO2 concentration fields compared with the simulation under different occupant scenarios (i.e., occupant locations at ABH, ABCFH, and ABCDEFH). ZDCV largely reduced the infection risk to 2.8% while improved energy-saving efficiency by 34% compared with the system using constant ventilation rate. This work can contribute to the development of building environmental control systems in terms of pollutant removal, infection prevention, and energy sustainability.

Relationship of solid fuels use with cognitive function and efficacy of switching to cleaner fuels or using ventilation: A systematic review and meta-analysis.

BACKGROUND: A growing number of studies have examined the relation between solid fuels use and cognitive function in the mid-elderly, but results are inconsistent. Therefore, a systematic review and meta-analysis was carried out to evaluate their relevance and the efficacy of switching to cleaner fuels or using ventilation. METHOD: We used PubMed, Web of Science, and Cochrane Library databases to identify 17 studies in which the primary outcome variable was cognitive function decline or cognitive disorders, and the exposure measure was solid fuels use. The final search date of August 31, 2023. The effect size of odds ratio (OR), regression coefficient (ß), and 95% confidence interval (CI) were pooled. Heterogeneity and the possibility of publication bias were assessed by using the Q-statistic and Begg's test, respectively. RESULT: Among the 17 included papers, the study participants were ≥45 years old. Eleven studies assessed the relationship between solid fuels use and cognitive function decline [number of studies (n) = 11, ß = -0.144; I2 = 97.7%]. Five studies assessed the relationship between solid fuels use and cognitive disorders (n = 5, OR = 1.229; I2 = 41.1%). Switching from using solid fuels to clean fuels could reduce the risk of cognitive function decline as compared to those who remained on using solid fuels (n = 2; ß = 0.710; I2 = 82.4%). Among participants using solid fuels, who cooked without on ventilated stoves were correlated with an enhanced risk of cognitive disorders as compared to participants who cooked with ventilated stoves (n = 2; OR = 1.358; I2 = 44.7%). CONCLUSION: Our meta-analysis showed a negative relationship between solid fuels use with cognitive function, and a positive relationship with cognitive disorders. Cleaner fuels, using ventilation, improved cookstoves can reduce the adverse health hazards of solid fuels use.

Study on infection risk in a negative pressure ward under different fresh airflow patterns based on a radiation air conditioning system.

COVID-19 and other respiratory infectious viruses are highly contagious, and patients need to be treated in negative pressure wards. At present, many negative pressure wards use independent air conditioning equipment, but independent air conditioning equipment has problems such as indoor air circulation flow, condensate water accumulation, and improper filter maintenance, which increase the risk of infection for healthcare workers and patients. The radiation air conditioning system relies on the radiation ceiling to control the indoor temperature and uses new air to control the indoor humidity and air quality. The problems caused by the use of independent air conditioning equipment should be avoided. This paper studies the thermal comfort, contaminant distribution characteristics, contaminant removal efficiency, and accessibility of supply air in a negative pressure ward with a radiation air conditioning system under three airflow patterns. In addition, the negative pressure ward was divided into 12 areas, and the infection probability of healthcare workers in different areas was analyzed. The results show that the application of radiation air conditioning systems in negative pressure wards can ensure the thermal comfort of patients. Stratum ventilation and ceiling-attached jets have similar effects in protecting healthcare workers; both can effectively reduce the contaminant concentrations and the risk of infection of healthcare workers. Ceiling-attached jets decreases the contaminant concentrations by 10.73%, increases the contaminant removal efficiency by 12.50%, and decreases the infection probability of healthcare workers staying indoors for 10 min by 23.18%, compared with downward ventilation.

Modeling and identification of the hygro-thermal parameters of mechanically-ventilated broiler house using prediction error: Assessment in cold conditions.

Indoor air temperature and humidity moisture are of the foremost significance in climate control of broilers houses, and their impacts on poultry health and production depend on accurate control. The main objective of this work is to identify and assess a novel state-space model, to rapidly predict the hygro-thermal behavior of the livestock building. To achieve this analysis, various experimental measurements (e.g., ventilation rate, thermal heating, and air temperature and humidity) of two commercial poultry houses placed in the Mediterranean zone were monitored over cold conditions production cycle. The developed model was estimated and validated against a dataset of 25 days acquired under three different operation ventilation modes (min-ven, power and tunnel modes). Through simulation, the results showed that the predicted model and measured data were achieved a satisfactory accuracy with an averaged coefficients of determination R2 were 0.93 and 0.95, respectively, for the indoor air temperature and humidity models, and a root mean squared error (RMSE) of 0.3213 °C and 0.957 %. Additionally, the predictive model shows satisfying performances for the long horizon prediction with a final prediction error (FPE) equal to 0.084, which will prevent the intensely time-consuming process of getting precise physical parameters in regards the poultry house system.

Thermal comfort and ventilation preferences of dairy calves raised in paired outdoor hutches during summertime.

Dairy calves are social creatures who are highly motivated for access to a companion. Additionally, heat stress negatively affects the welfare and productivity of calves housed in outdoor hutches. However, no studies have examined the potential tradeoffs pair-housed calves face between competing motivations for social contact and thermal comfort. We evaluated the effects of hutch ventilation on thermoregulatory and behavioral responses of pair-housed calves in outdoor hutches during a Wisconsin summer. Fifty Holstein-Friesian heifer calves were pair-housed (n = 25 pairs) in adjacent hutches with a shared outdoor area. In each pair of hutches, 1 was ventilated (V) with 2 windows at the rear base and the rear bedding door propped open; the other had no rear windows and a closed bedding door (nonventilated, NV). Calves were exposed to 4 conditions for 1 h each (1100-1200 h and 1230-1330 h on 2 consecutive days during wk 4, 6, and 9 of life) in a 2 × 2 factorial design in a balanced order: individually or in pairs in the NV or V hutch. Immediately before and after the 1 h hutch restriction period, respiration rate (RR) and rectal temperature (RT) were recorded while calves were outside. On the subsequent 3 d in those weeks, the locations of each calf (outdoors or inside a hutch) were recorded at 15-min intervals using time-lapse cameras. Linear mixed models were used to evaluate the fixed effects of ventilation, number of calves inside the hutch, week of life, and their interactions, on change in temperature-humidity index (THI), RR, and RT after 1 h; pair of calves was the subject of the repeated statement. Within weeks, the proportion of time calves spent in each hutch and together were averaged across the 3 d of observation. One-sample t-tests were used to evaluate preferences compared with 50% (chance, no preference): (1) for the V (vs. NV) hutch and (2) to be together (or separate) in either the V or NV hutch as well as overall. The THI gain inside the V hutch after 1 h with calves present was lower relative to the NV hutch (0.90 vs. 1.79 units, respectively, standard error of the mean [SEM] = 0.16). Calves in wk 9 of life increased the hutch THI more than in wk 6 of life (1.81 vs. 0.72 units respectively, SEM = 0.16). After 1 h, RR decreased versus was unchanged, respectively, when calves were in the V versus NV hutch (-14.4 vs. -0.9 breaths/min, respectively, SEM = 1.4 breaths/min). No differences were detected in RT. Calves chose to be together most of the time regardless of location (wk 4, 6, and 9, respectively: 83.1% ± 2.4%, 80.3% ± 2.1%, and 78.0% ± 3.1%). Calves had no hutch preference during wk 4 but developed a preference for the V hutch as they aged (wk 4, 6, and 9, respectively: 47.3% ± 4.5%, 61.2% ± 5.1%, and 72.8% ± 4.3%). This is the first study to demonstrate passive ventilation improves animal welfare by reducing heat stress in pair-housed dairy calves in outdoor hutches.

Equivalent contact temperature (ECT) for personal comfort assessment - analytical description and definition of comfort limits.

This paper introduces the equivalent contact temperature (ECT) model for local thermal comfort assessment in contact areas for non-uniform environmental conditions. It aims to complete the comfort evaluation scheme of the equivalent temperature approach included in ISO 14505-2 by the contact areas back and buttocks that are currently neglected in the standard. For the assessment of local and overall thermal comfort of seated persons, these contact areas are of great importance, especially if exposed to personal comfort systems. Person-oriented climatization systems, such as seat heating and ventilation, are much more energy efficient than conventional HVAC systems and allow to incorporate the human individual into the system's control loop. The ECT-approach is formally defined, analytically as well as mathematically derived and validated by a subject study. The results of the subject study (air temperature of 26 °C and 29 °C) confirm the cooling effect due to the seat ventilation and show fundamental correlations between ECTs and body part specific mean thermal votes for buttocks and back.Practitioner summary:The equivalent contact temperature model for local thermal comfort assessment in contact areas for non-uniform environmental conditions is formally defined, analytically as well as mathematically derived and validated by a subject study. It completes the existing equivalent temperature comfort scheme by both contact areas back a nd buttocks to improve thermal comfort assessment.

Do Saliva-Saturated Spit Hoods Interfere With Ventilation?

ABSTRACT: Spit hoods are used by law enforcement, officers in correctional facilities, and medical personnel during the restraint of agitated subjects that are actively spitting to prevent the transmission of droplet-transmitted pathogens. We could find no studies reporting on the time course of normal breathing to clear saliva from such a saturated spit hood. We purchased samples of 3 popular spit hood models and applied a section over the output of a pneumatic test system. We used a digital anemometer, digital manometer, and an inline controllable fan for back pressure and flow. The pressure was 3 mm Hg to match quiet breathing. The tested area was saturated with artificial saliva, and air pressure was applied while we recorded the pressure and airflow. Within 5 seconds, the spit hoods all cleared sufficient artificial saliva to allow 1 m/s of airflow, which exceeds that of an N95 mask with similar pressure. Commonly used spit hoods offer very low resistance to breathing even after being initially saturated with artificial saliva. Our results do not support the hypothesis that a saliva-filled spit hood might contribute to death.