SARS-CoV-2, other respiratory viruses and bacteria in aerosols: Report from Kuwait's hospitals

The role of airborne particles in the spread of severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) is well explored. The novel coronavirus can survive in aerosol for extended periods, and its interaction with other viral communities can cause additional virulence and infectivity. This baseline study reports concentrations of SARS-CoV-2, other respiratory viruses, and pathogenic bacteria in the indoor air from three major hospitals (Sheikh Jaber, Mubarak Al-Kabeer, and Al-Amiri) in Kuwait dealing with coronavirus disease 2019 (COVID-19) patients. The indoor aerosol samples showed 12–99 copies of SARS-CoV-2 per m³ of air. Two non-SARS-coronavirus (strain HKU1 and NL63), respiratory syncytial virus (RSV), and human bocavirus, human rhinoviruses, Influenza B (FluB), and human enteroviruses were also detected in COVID-positive areas of Mubarak Al Kabeer hospital (MKH). Pathogenic bacteria such as Mycoplasma pneumonia, Streptococcus pneumonia and, Haemophilus influenza were also found in the hospital aerosols. Our results suggest that the existing interventions such as social distancing, use of masks, hand hygiene, surface sanitization, and avoidance of crowded indoor spaces are adequate to prevent the spread of SARS-CoV-2 in enclosed areas. However, increased ventilation can significantly reduce the concentration of SARS-CoV-2 in indoor aerosols. The synergistic or inhibitory effects of other respiratory pathogens in the spread, severity, and complexity of SARS-CoV-2 need further investigation.     

Predictions and measurements of the stack effect on indoor airborne virus transmission in a high-rise hospital building

As the viral diseases such as Severe Acute Respiratory Syndrome (SARS) and Influenza A (H1N1) occur in many countries recently, the epidemic of those influenza viruses causes many human casualties. Moreover, the second infection from infected patients particularly within general hospitals frequently takes places due to improperly hospitalized and/or quarantined patients. Accordingly, it becomes a great concern to accommodate safer ventilation system in general hospital wards against such airborne transmitted viruses. It is also a recent trend that many urban general hospitals are designed and constructed as high-rises. If a virus is transmitted through uncontrolled air movement within a hospital and then infected other patients or healthy visitors, it might be impossible to control the spread of the disease. Thus research has been preceded scrutinizing stack effect on the indoor airborne virus transmission in large hospitals by conducting both the field measurement and numerical analysis according to the outdoor temperature and the releasing vertical points of the tracer gas assumed as a viral contaminant. In the field measurement of a high-rise hospital, the indoor airflow was affected by the stack effect of vertical chute of the building. The numerical simulation was verified by comparing its prediction results and the field measurement data. In result, very high possibility has witnessed that the airborne contaminant emitted from the infected patients in the lower floors could be transported to the higher floors through the airflow driven by the stack effect.     

Removing indoor particles using portable air cleaners: Implications for residential infection transmission

Reducing indoor exposure to influenza particles can be an important strategy to manage residential infections. Many portable air cleaning (PAC) technologies are currently employed in residential environments but very little research has been performed to evaluate and compare their performance in terms of particle removal associated with influenza. This study evaluates the effectiveness of portable air cleaners at removing airborne NaCl particles as an analogue to the influenza virus and applies the results to an IAQ mass balance model to evaluate the performance in controlling residential exposures and mitigating infection risks. Various devices representing different PAC technologies were tested using a pull down particle challenge in a full scale stainless steel chamber. Particle generation and measurement were conducted using a 6-jet atomizer and a paired aerodynamic particle sizer (APS)-scanning mobility particle sizer (SMPS), respectively. PAC incorporating HEPA filtration, electrostatic precipitation, ion generation and electret filtration were tested. We found that particle exposures released during a cough or sneeze event in a typical Quebec City residential room in Canada can significantly be reduced using HEPA, electrostatic precipitation and electret filtration PACs when compared with a situation where no PAC is being used. Modelling analysis demonstrates that the use of these PACs can mitigate the risks of influenza infection via airborne route for a caregiver or a spouse sharing the same room. The implications of this study are significant considering low ventilation rates of Quebec City residences.     

Viruses as the causative agent related to 'dampness' and the missing link between allergen exposure and onset of allergic disease

Asthma and asthma-like symptoms occur more often among people living in humid indoor climates. It has been postulated that the higher concentration of allergens in these environments is the cause for the increase in the number of affected people. However, poor correlations between allergen concentration and symptoms indicate a missing link between allergen exposure and onset of asthma. Respiratory viruses have been identified in up to 85% cases of asthma or exacerbations of asthma. The missing link between respiratory diseases and humid indoor climates could therefore be attributed to viruses. The infectious effectiveness of respiratory viruses depends strongly on the environment where the viruses are spread. For respiratory viruses, survival and infectivity are dependent on temperature and relative humidity. A direct link between virus-induced inflammation and the asthmatogenic process has been proposed. Therefore, a more effective spreading of viral infections in damp indoor climates is likely to represent the main cause for the increased prevalence of asthma in these environments. Moreover, the incidence of viral infections is higher in patients with asthma compared with that in control subjects. Therefore, a humid indoor climate could also represent a higher risk for persons already sensitized to one or more allergens. PRACTICAL IMPLICATIONS: In epidemiological studies where the relationship between moisture in the indoor climate, respiratory symptoms and exposure to allergens is investigated it will be necessary to analyze the role of respiratory viruses in relation to respiratory symptoms. Today, the necessary techniques to address the presence of viruses [e.g. polymerase chain reaction (PCR), antibodies] are highly sensitive. In order to further our understanding of why the frequency of asthma and atopic diseases is still increasing, it is mandatory to implement these methods.     

A methodology for estimating airborne virus exposures in indoor environments using the spatial distribution of expiratory aerosols and virus viability characteristics

This study investigated the feasibility of using the spatial distribution of expiratory aerosols and the viability functions of airborne viruses to estimate exposures to airborne viruses in an indoor environment under imperfectly mixed condition. A method adopting this approach was tested in an air-conditioned hospital ward. Artificial coughs were produced by aerosolizing a simulated respiratory fluid containing a known concentration of benign bacteriophage. The bacteriophage exposures estimated on the basis of the spatial aerosol distributions and its viability function were in reasonable agreement with those measured directly by biological air sampling and culturing. The ventilation flow and coughing orientation were found to play significant roles in aerosol transport, leading to different spatial distribution patterns in bacteriophage exposure. Bacteriophage exposures decreased with lateral distance from the infector when the infector coughed vertically upward. In contrast, exposures were constant or even increased with distance in the case of lateral coughing. The possibility of incorporating the proposed exposure estimation into a dose-response model for infection risk assessment was discussed. The study has also demonstrated the potential application of viability functions of airborne viral pathogens in exposure assessment and infection risk analysis, which are often unavailable in literature for some important communicable diseases. PRACTICAL IMPLICATIONS: The proposed method makes use of the viability function of the virus and the spatial distribution of the expiratory aerosols for virus exposure estimation. Spatial differences in aerosol distribution and its influences on virus exposure in an air space can be determined. Variations in infectious dose with carrier aerosol size could also be considered. The proposed method may serve as a tool for further investigation of ventilation design and infection control in clinical or other indoor environments.     

In-flight particulate matter concentrations in commercial flights are likely lower than other indoor environments

Air quality in indoor environments can have significant impacts on people's health, comfort, and productivity. Particulate matter (PM; also referred to as aerosols) is an important type of air pollutant, and exposure to outdoor PM has been associated with a variety of diseases. In addition, there is increasing recognition and concern of airborne transmission of viruses, including severe acute respiratory syndrome corona-virus 2 (SARS-CoV-2), especially in indoor environments. Despite its importance, indoor PM data during the COVID-19 pandemic are scarce. In this work, we measured and compared particle number and mass concentrations in aircraft cabins during commercial flights with various indoor environments in Atlanta, GA, during July 2020, including retail stores, grocery stores, restaurants, offices, transportation, and homes. Restaurants had the highest particle number and mass concentrations, dominated by cooking emissions, while in-flight aircraft cabins had the lowest observed concentrations out of all surveyed spaces.     

On-site quantification of re-entry ratio of ventilation exhausts in multi-family residential buildings and implications

Abstract Abstract In the worldwide spread of Severe Acute Respiratory Syndrome (SARS) in 2003, cluster of cases occurred in a number of large high‐rise residential building blocks, especially in Hong Kong. In this study, we examined one of the most likely virus‐spread mechanisms, which is related to the inter‐flat or inter‐zonal airflow through open‐windows caused by buoyancy effects. Dual tracer gases of CO₂ and SF₆ are employed simultaneously to quantify the amount of the exhaust air coming out of the upper part of the window of a floor that re‐enters the lower part of the open‐window at the immediate upper floor. It was found that the room air could contain up to 7% of the exhaust air from the lower floor, and this occurs at low wind conditions with a combination of indoor–outdoor temperature difference. The results can well explain the earlier governmental finding that DNA strings of SARS Corono‐Virus were detected within the sampled deposits on the window sills of the upper floors of the two index patients’ flats. The preliminary and yet alarming conclusion may be that, in high‐rise buildings, windows flush with a flat façade can be a major route for the vertical spread of pathogen‐containing aerosols.     

Survival of surrogate coronaviruses in water

The emergence of a previously unknown coronavirus infection, Severe Acute Respiratory Syndrome (SARS), demonstrated that fecally contaminated liquid droplets are a potential vehicle for the spread of a respiratory virus to large numbers of people. To assess potential risks from this pathway, there is a need for surrogates for SARS coronavirus to provide representative data on viral survival in contaminated water. This study evaluated survival of two surrogate coronaviruses, transmissible gastroenteritis (TGEV) and mouse hepatitis (MHV). These viruses remained infectious in water and sewage for days to weeks. At 25 °C, time required for 99% reduction in reagent-grade water was 22 days for TGEV and 17 days for MHV. In pasteurized settled sewage, times for 99% reduction were 9 days for TGEV and 7 days for MHV. At 4 °C, there was <1 log₁₀ infectivity decrease for both viruses after four weeks. Coronaviruses can remain infectious for long periods in water and pasteurized settled sewage, suggesting contaminated water is a potential vehicle for human exposure if aerosols are generated.     

A study of the dispersion of expiratory aerosols in unidirectional downward and ceiling-return type airflows using a multiphase approach

Dispersion characteristics of expiratory aerosols were investigated in an enclosure with two different idealized airflow patterns: the ceiling-return and the unidirectional downward. A multiphase numerical model, which was able to capture the polydispersity and evaporation features of the aerosols, was adopted. Experiments employing optical techniques were conducted in a chamber with downward airflow pattern to measure the dispersion of aerosols. Some of the numerical results were compared with the chamber measurement results. Reasonable agreement was found. Small aerosols (initial size 相似文献   

Evidence of inadequate ventilation in portable classrooms: results of a pilot study in Los Angeles County

The prevalence of prefabricated, portable classrooms (portables) for United States public schools has increased; in California, approximately one of three students learn inside portables. Limited research has been conducted on indoor air and environmental quality in American schools, and almost none in portables. Available reports and conference proceedings suggest problems from insufficient ventilation due to poor design, operation, and/or maintenance of heating, ventilation and air conditioning (HVAC) systems; most portables have one mechanical, wall-mounted HVAC system. A pilot assessment was conducted in Los Angeles County, including measurements of integrated ventilation rates based on a perfluorocarbon tracer gas technique and continuous monitoring of temperature (T) and relative humidity (RH). Measured ventilation rates were low [mean school day integrated average 0.8 per hour (range: 0.1-2.9 per hour)]. Compared with relevant standards, results suggested adequate ventilation and associated conditioning of indoor air for occupant comfort were not always provided to these classrooms. Future school studies should include integrated and continuous measurements of T, RH, and ventilation with appropriate tracer gas methods, and other airflow measures. PRACTICAL IMPLICATIONS: Adequate ventilation has the potential to mitigate concentrations of chemical pollutants, particles, carbon dioxide, and odors in portable and traditional classrooms, which should lead to a reduction in reported health outcomes, e.g., symptoms of 'sick building syndrome', allergies, asthma. Investigations of school indoor air and environmental quality should include continuous temperature and relative humidity data with inexpensive instrumentation as indicators of thermal comfort, and techniques to measure ventilation rates.     

Microanalysis of indoor aerosols and the impact of a compact high-efficiency particulate air (HEPA) filter system

Aerosol particles in municipal atmospheres are of increasing public health concern; however, since most of our time is spent indoors, indoor aerosols must be researched in counterpart. Compact High-Efficiency Particulate Air (HEPA) filter systems are commonly employed in residences to alleviate airborne dust concentrations. In this study, a detailed and original methodology was used to determine concentrations and types of submicrometer aerosols, as well as of large (> 4 microns) dust particles. Scanning electron microscopy was used to quantify and characterize ambient aerosols collected from filtered and non-filtered rooms. Particle concentrations were significantly lower in samples collected in the presence of the filter system (mean 23 to 8 coarse particles liter-1, 63% reduction; 13 to 3 inorganic submicron particles cm-3, 76% reduction; 85 to 33 total submicron particles cm-3, 62% reduction; all P < 0.05). This study provides a new methodology for analysis of indoor aerosols and new data on their physico-chemical characteristics. Since the filter systems are effective at reducing submicron aerosol concentrations, they may improve the health of individuals such as asthmatics, who experience health problems caused by anthropogenic fine particles.     

Experimental measurements and large eddy simulation of expiratory droplet dispersion in a mechanically ventilated enclosure with thermal effects

Understanding of droplet transport in indoor environments with thermal effects is very important to comprehend the airborne pathogen infection through expiratory droplets. In this work, a well-resolved Large Eddy Simulation (LES) was performed to compute the concentration profiles of monodisperse aerosols in non-isothermal low-Reynolds turbulent flow taking place in an enclosed environment. Good care was taken to ensure that the main dynamical features of the continuous phase were captured by the present LES. The particle phase was studied in both Lagrangian and Eulerian frameworks. Steady temperature and velocity were measured prior to droplet emission. Evolution of aerosol concentration was measured by a particle counter. Results of the present LES were to compare reasonably well with the experimental findings for both phases.     

Numerical study of the transport of droplets or particles generated by respiratory system indoors

The outbreak of atypical pneumonia, referred to as severe acute respiratory syndrome (SARS), has spread to many countries in the world. SARS may infect human bodies by the tiny droplets or particles carrying various virus and bacteria, which are generated by the respiratory system of infected patients. This paper presents the numerical analysis of the influence of generating ways of the droplets or particles on the transport and distribution of the droplets or particles indoors. The drift flux model, which considers the settling of particles or droplets under the effect of gravitational sedimentation, is adopted to simulate the droplets transport and distribution indoors during respiration and sneezing or coughing process, while the simplified model for solving the continuous fluid flow is combined. Two different cases considering the normal respiration and coughing or sneezing are studied, respectively, and two different outlet velocities from the mouth for the sneezing or coughing process are considered. The results show that droplets or particles generated by normal breathing process transport a relatively short distance, while droplets or particles generated during coughing or sneezing may travel much longer distances, which may pose adverse effect on human bodies for defending the SARS or other infectious diseases.     

Indoor aerosols: from personal exposure to risk assessment

Motivated by growing considerations of the scale, severity, and risks associated with human exposure to indoor particulate matter, this work reviewed existing literature to: (i) identify state‐of‐the‐art experimental techniques used for personal exposure assessment; (ii) compare exposure levels reported for domestic/school settings in different countries (excluding exposure to environmental tobacco smoke and particulate matter from biomass cooking in developing countries); (iii) assess the contribution of outdoor background vs indoor sources to personal exposure; and (iv) examine scientific understanding of the risks posed by personal exposure to indoor aerosols. Limited studies assessing integrated daily residential exposure to just one particle size fraction, ultrafine particles, show that the contribution of indoor sources ranged from 19% to 76%. This indicates a strong dependence on resident activities, source events and site specificity, and highlights the importance of indoor sources for total personal exposure. Further, it was assessed that 10–30% of the total burden of disease from particulate matter exposure was due to indoor‐generated particles, signifying that indoor environments are likely to be a dominant environmental factor affecting human health. However, due to challenges associated with conducting epidemiological assessments, the role of indoor‐generated particles has not been fully acknowledged, and improved exposure/risk assessment methods are still needed, together with a serious focus on exposure control.     

The effectiveness of stand alone air cleaners for shelter-in-place

Stand-alone air cleaners may be efficient for rapid removal of indoor fine particles and have potential use for shelter-in-place (SIP) strategies following acts of bioterrorism. A screening model was employed to ascertain the potential significance of size-resolved particle (0.1-2 microm) removal using portable high efficiency particle arresting (HEPA) air cleaners in residential buildings following an outdoor release of particles. The number of stand-alone air cleaners, air exchange rate, volumetric flow rate through the heating, ventilating and air-conditioning (HVAC) system, and size-resolved particle removal efficiency in the HVAC filter were varied. The effectiveness of air cleaners for SIP was evaluated in terms of the outdoor and the indoor particle concentration with air cleaner(s) relative to the indoor concentration without air cleaners. Through transient and steady-state analysis of the model it was determined that one to three portable HEPA air cleaners can be effective for SIP following outdoor bioaerosol releases, with maximum reductions in particle concentrations as high as 90% relative to conditions in which an air cleaner is not employed. The relative effectiveness of HEPA air cleaners vs. other removal mechanisms was predicted to decrease with increasing particle size, because of increasing competition by particle deposition with indoor surfaces and removal to HVAC filters. However, the effect of particle size was relatively small for most scenarios considered here. PRACTICAL IMPLICATIONS: The results of a screening analysis suggest that stand-alone (portable) air cleaners that contain high efficiency particle arresting (HEPA) filters can be effective for reducing indoor fine particle concentrations in residential dwellings during outdoor releases of biological warfare agents. The relative effectiveness of stand-alone air cleaners for reducing occupants' exposure to particles of outdoor origin depends on several factors, including the type of heating, ventilating and air-conditioning (HVAC) filter, HVAC operation, building air exchange rate, particle size, and duration of elevated outdoor particle concentration. Maximum particle reductions, relative to no stand-alone air cleaners, of 90% are predicted when three stand-alone air cleaners are employed.     

Impact of placement of portable air cleaning devices in multizone residential environments

An advantage of portable air cleaners is that they can be positioned in different parts of a building and used where air cleaning is needed. This makes them a popular choice for use in residential buildings. In typical indoor particle modeling efforts, perfect air mixing and uniform contaminant concentration distribution are assumed. However, nonuniform spatial concentrations of particles are more reflective of most environments. Using experiments to validate computational fluid dynamic and particle tracking models and applying these models in numerical based parametric analysis, this paper analyzes the overall contaminant removal in a multi-room residential building. Simulations varied (1) particle size (0.74, 3.4 and 10 μm), (2) clean air delivery rate (CADR) of the air cleaner (50 m³/h and 500 m³/h), and (3) position of portable air cleaner in different rooms. The results show very large variation of the overall particle removal for different positions of portable cleaning device. In extreme cases, the effective positioning of cleaning device can result in a factor of 2.5 change in overall particle removal and, consequently, strongly affect occupant exposure to particles.     

室内人体飞沫传播的数值研究

人体口腔飞沫容易携带许多病毒和细菌微生物。针对飞沫产生的不同条件 (如呼气、喷嚏等 ) ,对其在室内的传播和扩散过程进行数值模拟分析。模拟结果说明 ,适当的换气次数可以有效削弱由正常呼吸产生的口腔飞沫 ,但是一般的空调通风系统不能有效削弱由于剧烈咳嗽或打喷嚏而产生的口腔飞沫。     

Inhalation of expiratory droplets in aircraft cabins

Airliner cabins have high occupant density and long exposure time, so the risk of airborne infection transmission could be high if one or more passengers are infected with an airborne infectious disease. The droplets exhaled by an infected passenger may contain infectious agents. This study developed a method to predict the amount of expiratory droplets inhaled by the passengers in an airliner cabin for any flight duration. The spatial and temporal distribution of expiratory droplets for the first 3 min after the exhalation from the index passenger was obtained using the computational fluid dynamics simulations. The perfectly mixed model was used for beyond 3 min after the exhalation. For multiple exhalations, the droplet concentration in a zone can be obtained by adding the droplet concentrations for all the exhalations until the current time with a time shift via the superposition method. These methods were used to determine the amount of droplets inhaled by the susceptible passengers over a 4-h flight under three common scenarios. The method, if coupled with information on the viability and the amount of infectious agent in the droplet, can aid in evaluating the infection risk. PRACTICAL IMPLICATIONS: The distribution of the infectious agents contained in the expiratory droplets of an infected occupant in an indoor environment is transient and non-uniform. The risk of infection can thus vary with time and space. The investigations developed methods to predict the spatial and temporal distribution of expiratory droplets, and the inhalation of these droplets in an aircraft cabin. The methods can be used in other indoor environments to assess the relative risk of infection in different zones, and suitable measures to control the spread of infection can be adopted. Appropriate treatment can be implemented for the zone identified as high-risk zones.     

Sampling Rate Evaluation Of NO2 Badge: (I) In Indoor Environments

The sampling rate of a nitrogen dioxide (NO²) passive sampling badge was evaluated in indoor environments including an unoccupied research house, residential houses, and an office. Measurements from the NO² badges were compared with those of a chemiluminescent analyzer the EPA reference method, by placing them near to the sample inlet of the chemiluminescent analyzer In this study, we used a new sampling rate for the NO² badge placed in indoor environments (an overall mass transfer coefficient of 0.10 cm/s) smaller than the rate previously reported for the badge when used outdoors. The new rate provides more accurate measurements of NO, concentrations in indoor environments. Indoor NO² concentrations were also measured with the NO² badges exposed to a constant wind velocity provided by a wind tunnel. Since the measurements of the badge with a constant wind velocity agreed well with the reference method, the badges could be assumed to be a secondary reference measurement. With the badges used as the secondary reference measurement, we developed a portable wind tunnel to evaluate a personal exposure measurement by the badge. The results are presented in Environment International (Lee et al., 1993). Precision of the badge measurements was as good as an intraclass correlation coefficient of 0.9779. It was determined that placement of the badge should be at least 10 cm out from an indoor wall surface to avoid undersampling due to NO² gradients near the surface.     

A chemical dynamic model for the infiltration of outdoor size-resolved ammonium nitrate aerosols to indoor environments

In the present study, we developed a chemical dynamic model to describe the infiltration of size-resolved ammonium nitrate aerosols from outdoor to indoor environments. This model considered the penetration factor, deposition rate, and the reversible reaction process, which was quantified by the diffusive molar flux on the surface of ammonium nitrate aerosols depending on indoor temperature, humidity, and concentrations of nitric acid (HNO₃) and ammonia (NH₃). To verify the model, we employed a single-particle aerosol mass spectrometer with an automated switching system to simultaneously measure size-resolved outdoor and indoor ammonium nitrate aerosols. Comparisons between the predicted and measured concentrations of these aerosols showed a mean relative error of 4.8 ± 18.3%. To analyze the sensitivity of model parameters, several parameters were perturbed. This analysis indicated that parameters related to HNO₃ were more sensitive than those related to NH₃ because the indoor gas phase concentration of NH₃ was much higher than that of HNO₃.