This is an account that should be heard of an important struggle: the struggle of a large group of experts who came together at the beginning of the COVID-19 pandemic to warn the world about the risk of airborne transmission and the consequences of ignoring it. We alerted the World Health Organization about the potential significance of the airborne transmission of SARS-CoV-2 and the urgent need to control it, but our concerns were dismissed. Here we describe how this happened and the consequences. We hope that by reporting this story we can raise awareness of the importance of interdisciplinary collaboration and the need to be open to new evidence, and to prevent it from happening again. Acknowledgement of an issue, and the emergence of new evidence related to it, is the first necessary step towards finding effective mitigation solutions.@en

People living in urban and industrialized societies, which are expanding globally, spend more than 90% of their time in the indoor environment, breathing indoor air (IA). Despite decades of research and advocacy, most countries do not have legislated indoor air quality (IAQ) performance standards for public spaces that address concentration levels of IA pollutants (1). Few building codes address operation, maintenance, and retrofitting, and most do not focus on airborne disease transmission. But the COVID-19 pandemic has made all levels of society, from community members to decision-makers, realize the importance of IAQ for human health, wellbeing, productivity, and learning. We propose that IAQ standards be mandatory for public spaces. Although enforcement of IAQ performance standards in homes is not possible, homes must be designed and equipped so that they could meet the standards.@en

A new design method is proposed to calculate outdoor air ventilation rates to control respiratory infection risk in indoor spaces. We propose to use this method in future ventilation standards to complement existing ventilation criteria based on the perceived air quality and pollutant removal. The proposed method makes it possible to calculate the required ventilation rate at a given probability of infection and quanta emission rate. Present work used quanta emission rates for SARS-CoV-2 and consequently the method can be applied for other respiratory viruses with available quanta data. The method was applied to case studies representing typical rooms in public buildings. To reduce the probability of infection, the total airflow rate per infectious person revealed to be the most important parameter to reduce the infection risk. Category I ventilation rate prescribed in the EN 16798-1 standard satisfied many but not all type of spaces examined. The required ventilation rates started from about 80 L/s per room. Large variations between the results for the selected case studies made it impossible to provide a simple rule for estimating the required ventilation rates. Consequently, we conclude that to design rooms with a low infection risk the newly developed ventilation design method must be used.@en

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.@en

During the 2020 COVID-19 pandemic, an outbreak occurred following attendance of a symptomatic index case at a weekly rehearsal on 10 March of the Skagit Valley Chorale (SVC). After that rehearsal, 53 members of the SVC among 61 in attendance were confirmed or strongly suspected to have contracted COVID-19 and two died. Transmission by the aerosol route is likely; it appears unlikely that either fomite or ballistic droplet transmission could explain a substantial fraction of the cases. It is vital to identify features of cases such as this to better understand the factors that promote superspreading events. Based on a conditional assumption that transmission during this outbreak was dominated by inhalation of respiratory aerosol generated by one index case, we use the available evidence to infer the emission rate of aerosol infectious quanta. We explore how the risk of infection would vary with several influential factors: ventilation rate, duration of event, and deposition onto surfaces. The results indicate a best-estimate emission rate of 970 ± 390 quanta/h. Infection risk would be reduced by a factor of two by increasing the aerosol loss rate to 5 h−1 and shortening the event duration from 2.5 to 1 h.@en

During the 2020 COVID-19 pandemic, an outbreak occurred following attendance of a symptomatic index case at a weekly rehearsal on 10 March of the Skagit Valley Chorale (SVC). After that rehearsal, 53 members of the SVC among 61 in attendance were confirmed or strongly suspected to have contracted COVID-19 and two died. Transmission by the aerosol route is likely; it appears unlikely that either fomite or ballistic droplet transmission could explain a substantial fraction of the cases. It is vital to identify features of cases such as this to better understand the factors that promote superspreading events. Based on a conditional assumption that transmission during this outbreak was dominated by inhalation of respiratory aerosol generated by one index case, we use the available evidence to infer the emission rate of aerosol infectious quanta. We explore how the risk of infection would vary with several influential factors: ventilation rate, duration of event, and deposition onto surfaces. The results indicate a best-estimate emission rate of 970 ± 390 quanta/h. Infection risk would be reduced by a factor of two by increasing the aerosol loss rate to 5 h−1 and shortening the event duration from 2.5 to 1 h.@en

Although the interpersonal distance represents an important parameter affecting the risk of infection due to respiratory viruses, the mechanism of exposure to exhaled droplets remains insufficiently characterized. In this study, an integrated risk assessment is presented for SARS-CoV-2 close proximity exposure between a speaking infectious subject and a susceptible subject. It is based on a three-dimensional transient numerical model for the description of exhaled droplet spread once emitted by a speaking person, coupled with a recently proposed SARS-CoV-2 emission approach. Particle image velocimetry measurements were conducted to validate the numerical model. The contribution of the large droplets to the risk is barely noticeable only for distances well below 0.6 m, whereas it drops to zero for greater distances where it depends only on airborne droplets. In particular, for short exposures (10 s) a minimum safety distance of 0.75 m should be maintained to lower the risk below 0.1%; for exposures of 1 and 15 min this distance increases to about 1.1 and 1.5 m, respectively. Based on the interpersonal distances across countries reported as a function of interacting individuals, cultural differences, and environmental and sociopsychological factors, the approach presented here revealed that, in addition to intimate and personal distances, particular attention must be paid to exposures longer than 1 min within social distances (of about 1 m).@en

Household air pollution is ranked the 9th largest Global Burden of Disease risk (Forouzanfar et al., The Lancet 2015). People, particularly urban dwellers, typically spend over 90% of their daily time indoors, where levels of air pollution often surpass those of outdoor environments. Indoor air quality (IAQ) standards and approaches for assessment and control of indoor air require measurements of pollutant concentrations and thermal comfort using conventional instruments. However, the outcomes of such measurements are usually averages over long integrated time periods, which become available after the exposure has already occurred. Moreover, conventional monitoring is generally incapable of addressing temporal and spatial heterogeneity of indoor air pollution, or providing information on peak exposures that occur when specific indoor sources are in operation. This article provides a review of new air pollution sensing methods to determine IAQ and discusses how real-time sensing could bring a paradigm shift in controlling the concentration of key air pollutants in billions of urban houses worldwide. We also show that besides the opportunities, challenges still remain in terms of maturing technologies, or data mining and their interpretation. Moreover, we discuss further research and essential development needed to close gaps between what is available today and needed tomorrow. In particular, we demonstrate that awareness of IAQ risks and availability of appropriate regulation are lagging behind the technologies.@en

Household air pollution is ranked the 9th largest Global Burden of Disease risk (Forouzanfar et al., The Lancet 2015). People, particularly urban dwellers, typically spend over 90% of their daily time indoors, where levels of air pollution often surpass those of outdoor environments. Indoor air quality (IAQ) standards and approaches for assessment and control of indoor air require measurements of pollutant concentrations and thermal comfort using conventional instruments. However, the outcomes of such measurements are usually averages over long integrated time periods, which become available after the exposure has already occurred. Moreover, conventional monitoring is generally incapable of addressing temporal and spatial heterogeneity of indoor air pollution, or providing information on peak exposures that occur when specific indoor sources are in operation. This article provides a review of new air pollution sensing methods to determine IAQ and discusses how real-time sensing could bring a paradigm shift in controlling the concentration of key air pollutants in billions of urban houses worldwide. We also show that besides the opportunities, challenges still remain in terms of maturing technologies, or data mining and their interpretation. Moreover, we discuss further research and essential development needed to close gaps between what is available today and needed tomorrow. In particular, we demonstrate that awareness of IAQ risks and availability of appropriate regulation are lagging behind the technologies.@en

Household air pollution is ranked the 9th largest Global Burden of Disease risk (Forouzanfar et al., The Lancet 2015). People, particularly urban dwellers, typically spend over 90% of their daily time indoors, where levels of air pollution often surpass those of outdoor environments. Indoor air quality (IAQ) standards and approaches for assessment and control of indoor air require measurements of pollutant concentrations and thermal comfort using conventional instruments. However, the outcomes of such measurements are usually averages over long integrated time periods, which become available after the exposure has already occurred. Moreover, conventional monitoring is generally incapable of addressing temporal and spatial heterogeneity of indoor air pollution, or providing information on peak exposures that occur when specific indoor sources are in operation. This article provides a review of new air pollution sensing methods to determine IAQ and discusses how real-time sensing could bring a paradigm shift in controlling the concentration of key air pollutants in billions of urban houses worldwide. We also show that besides the opportunities, challenges still remain in terms of maturing technologies, or data mining and their interpretation. Moreover, we discuss further research and essential development needed to close gaps between what is available today and needed tomorrow. In particular, we demonstrate that awareness of IAQ risks and availability of appropriate regulation are lagging behind the technologies.@en

During the rapid rise in COVID-19 illnesses and deaths globally, and notwithstanding recommended precautions, questions are voiced about routes of transmission for this pandemic disease. Inhaling small airborne droplets is probable as a third route of infection, in addition to more widely recognized transmission via larger respiratory droplets and direct contact with infected people or contaminated surfaces. While uncertainties remain regarding the relative contributions of the different transmission pathways, we argue that existing evidence is sufficiently strong to warrant engineering controls targeting airborne transmission as part of an overall strategy to limit infection risk indoors. Appropriate building engineering controls include sufficient and effective ventilation, possibly enhanced by particle filtration and air disinfection, avoiding air recirculation and avoiding overcrowding. Often, such measures can be easily implemented and without much cost, but if only they are recognised as significant in contributing to infection control goals. We believe that the use of engineering controls in public buildings, including hospitals, shops, offices, schools, kindergartens, libraries, restaurants, cruise ships, elevators, conference rooms or public transport, in parallel with effective application of other controls (including isolation and quarantine, social distancing and hand hygiene), would be an additional important measure globally to reduce the likelihood of transmission and thereby protect healthcare workers, patients and the general public.@en