Person to person droplets transmission characteristics in unidirectional ventilated protective isolation room: The impact of initial droplet size

Airborne transmission of biological agents within the indoor built environment: a multidisciplinary review

The nature and airborne dispersion of the underestimated biological agents, monitoring, analysis and transmission among the human occupants into building environment is a major challenge of today. Those agents play a crucial role in ensuring comfortable, healthy and risk-free conditions into indoor working and leaving spaces. It is known that ventilation systems influence strongly the transmission of indoor air pollutants, with scarce information although to have been reported for biological agents until 2019. The biological agents' source release and the trajectory of airborne transmission are both important in terms of optimising the design of the heating, ventilation and air conditioning systems of the future. In addition, modelling via computational fluid dynamics (CFD) will become a more valuable tool in foreseeing risks and tackle hazards when pollutants and biological agents released into closed spaces. Promising results on the prediction of their dispersion routes and concentration levels, as well as the selection of the appropriate ventilation strategy, provide crucial information on risk minimisation of the airborne transmission among humans. Under this context, the present multidisciplinary review considers four interrelated aspects of the dispersion of biological agents in closed spaces, (a) the nature and airborne transmission route of the examined agents, (b) the biological origin and health effects of the major microbial pathogens on the human respiratory system, (c) the role of heating, ventilation and air-conditioning systems in the airborne transmission and (d) the associated computer modelling approaches. This adopted methodology allows the discussion of the existing findings, on-going research, identification of the main research gaps and future directions from a multidisciplinary point of view which will be helpful for substantial innovations in the field.

Analysis of the spread of cough droplets and body deposition fraction in the smart classroom in different seasons

Smart classrooms are a relatively confined public space for college students. SARS-COV-2 and other respiratory viruses have been shown to pose a more significant threat to human health in relatively confined spaces. Using numerical simulation method to simulate the transmission and concentration distribution of virus-carrying droplets in smart classrooms in three different seasons (summer, winter, transitional seasons: spring and autumn). The Realizable k-ε model is used to simulate the airflow pattern in the smart classroom, and the Lagrangian method is used to simulate the transmission of droplets. The transmission process of droplets produced from the teacher standing on the platform and the student sitting on the seat is studied. The influence of three kinds of outdoor temperature on droplet transmission and the body deposition fraction of people in the smart classroom is analyzed. The results show that droplet transmission speed is maximum at the temperature of 5 degrees when the outdoor temperature is 5 °C, 20 °C, and 35 °C respectively. At 10 s, the transmission distance of droplets increases by 9.55% compared with that at 20 °C and 10.31% compared with that at 35 °C. In addition, the body deposition fraction is also affected by the location of the vent, with downwind contact being 6 times more likely than upwind contact. The research results can provide suggestions and measures for epidemic prevention and control in smart classrooms.

The emission and dynamics of droplets from human expiratory activities and COVID-19 transmission in public transport system: A review

The public transport system, containing a large number of passengers in enclosed and confined spaces, provides suitable conditions for the spread of respiratory diseases. Understanding how diseases are transmitted in public transport environment is of vital importance to public health. However, this is a highly multidisciplinary matter and the related physical processes including the emissions of respiratory droplets, the droplet dynamics and transport pathways, and subsequently, the infection risk in public transport, are poorly understood. To better grasp the complex processes involved, a synthesis of current knowledge is required. Therefore, we conducted a review on the behaviors of respiratory droplets in public transport system, covering a wide scope from the emission profiles of expiratory droplets, the droplet dynamics and transport, to the transmission of COVID-19 in public transport. The literature was searched using related keywords in Web of Science and PubMed and screened for suitability. The droplet size is a key parameter in determining the deposition and evaporation, which together with the exhaled air velocity largely determines the horizontal travel distance. The potential transmission route and transmission rate in public transport as well as the factors influencing the virus-laden droplet behaviors and virus viability (such as ventilation system, wearing personal protective equipment, air temperature and relative humidity) were also discussed. The review also suggests that future studies should address the uncertainties in droplet emission profiles associated with the measurement techniques, and preferably build a database based on a unified testing protocol. Further investigations based on field measurements and modeling studies into the influence of different ventilation systems on the transmission rate in public transport are also needed, which would provide scientific basis for controlling the transmission of diseases.

Environmental Factors and the Risk of Developing Type 1 Diabetes-Old Disease and New Data

Simple Summary

Despite many studies, the risk factors of type 1 diabetes (T1DM) in children and adolescents are still not fully understood and remain a big challenge. Therefore, an extensive online search for scientific research on factors related to diabetes has been performed for the identification of new factors of unexplained etiology. A better understanding of the role of viral, bacterial, and yeast-like fungi infections related to the risk of T1DM in children and adolescents and the identification of new risk factors, especially those spread by the droplet route, is of great importance for people and families with diabetes.

Abstract

The incidence of type 1 diabetes (T1D) is increasing worldwide. The onset of T1D usually occurs in childhood and is caused by the selective destruction of insulin-producing pancreatic islet cells (β-cells) by autoreactive T cells, leading to insulin deficiency. Despite advanced research and enormous progress in medicine, the causes of T1D are still not fully understood. Therefore, an extensive online search for scientific research on environmental factors associated with diabetes and the identification of new factors of unexplained etiology has been carried out using the PubMed, Cochrane, and Embase databases. The search results were limited to the past 11 years of research and discovered 143 manuscripts published between 2011 and 2022. Additionally, 21 manuscripts from between 2000 and 2010 and 3 manuscripts from 1974 to 2000 were referenced for historical reference as the first studies showcasing a certain phenomenon or mechanism. More and more scientists are inclined to believe that environmental factors are responsible for the increased incidence of diabetes. Research results show that higher T1D incidence is associated with vitamin D deficiency, a colder climate, and pollution of the environment, as well as the influence of viral, bacterial, and yeast-like fungi infections. The key viral infections affecting the risk of developing T1DM are rubella virus, mumps virus, Coxsackie virus, cytomegalovirus, and enterovirus. Since 2020, i.e., from the beginning of the COVID-19 pandemic, more and more studies have been looking for a link between Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) and diabetes development. A better understanding of the role of viral, bacterial, and yeast-like fungi infections related to the risk of T1DM in children and adolescents and the identification of new risk factors, especially those spread by the droplet route, is of great importance for people and families with diabetes.

Challenges in simulating and modeling the airborne virus transmission: A state-of-the-art review

Recently, the COVID-19 virus pandemic has led to many studies on the airborne transmission of expiratory droplets. While limited experiments and on-site measurements offer qualitative indication of potential virus spread rates and the level of transmission risk, the quantitative understanding and mechanistic insights also indispensably come from careful theoretical modeling and numerical simulation efforts around which a surge of research papers has emerged. However, due to the highly interdisciplinary nature of the topic, numerical simulations of the airborne spread of expiratory droplets face serious challenges. It is essential to examine the assumptions and simplifications made in the existing modeling and simulations, which will be reviewed carefully here to better advance the fidelity of numerical results when compared to the reality. So far, existing review papers have focused on discussing the simulation results without questioning or comparing the model assumptions. This review paper focuses instead on the details of the model simplifications used in the numerical methods and how to properly incorporate important processes associated with respiratory droplet transmission. Specifically, the critical issues reviewed here include modeling of the respiratory droplet evaporation, droplet size distribution, and time-dependent velocity profile of air exhaled from coughing and sneezing. According to the literature review, another problem in numerical simulations is that the virus decay rate and suspended viable viral dose are often not incorporated; therefore here, empirical relationships for the bioactivity of coronavirus are presented. It is hoped that this paper can assist researchers to significantly improve their model fidelity when simulating respiratory droplet transmission.

The role of computational fluid dynamics tools on investigation of pathogen transmission: Prevention and control

Transmission mechanics of infectious pathogen in various environments are of great complexity and has always been attracting many researchers' attention. As a cost-effective and powerful method, Computational Fluid Dynamics (CFD) plays an important role in numerically solving environmental fluid mechanics. Besides, with the development of computer science, an increasing number of researchers start to analyze pathogen transmission by using CFD methods. Inspired by the impact of COVID-19, this review summarizes research works of pathogen transmission based on CFD methods with different models and algorithms. Defining the pathogen as the particle or gaseous in CFD simulation is a common method and epidemic models are used in some investigations to rise the authenticity of calculation. Although it is not so difficult to describe the physical characteristics of pathogens, how to describe the biological characteristics of it is still a big challenge in the CFD simulation. A series of investigations which analyzed pathogen transmission in different environments (hospital, teaching building, etc) demonstrated the effect of airflow on pathogen transmission and emphasized the importance of reasonable ventilation. Finally, this review presented three advanced methods: LBM method, Porous Media method, and Web-based forecasting method. Although CFD methods mentioned in this review may not alleviate the current pandemic situation, it helps researchers realize the transmission mechanisms of pathogens like viruses and bacteria and provides guidelines for reducing infection risk in epidemic or pandemic situations.

The efficacy of social distance and ventilation effectiveness in preventing COVID-19 transmission

Social distancing and ventilation were emphasized broadly to control the ongoing pandemic COVID-19 in confined spaces. Rationales behind these two strategies, however, were debated, especially regarding quantitative recommendations. The answers to "what is the safe distance" and "what is sufficient ventilation" are crucial to the upcoming reopening of businesses and schools, but rely on many medical, biological, and engineering factors. This study introduced two new indices into the popular while perfect-mixing-based Wells-Riley model for predicting airborne virus related infection probability - the underlying reasons for keeping adequate social distance and space ventilation. The distance index P_d can be obtained by theoretical analysis on droplet distribution and transmission from human respiration activities, and the ventilation index E_z represents the system-dependent air distribution efficiency in a space. The study indicated that 1.6-3.0 m (5.2-9.8 ft) is the safe social distance when considering aerosol transmission of exhaled large droplets from talking, while the distance can be up to 8.2 m (26 ft) if taking into account of all droplets under calm air environment. Because of unknown dose response to COVID-19, the model used one actual pandemic case to calibrate the infectious dose (quantum of infection), which was then verified by a number of other existing cases with short exposure time (hours). Projections using the validated model for a variety of scenarios including transportation vehicles and building spaces illustrated that (1) increasing social distance (e.g., halving occupancy density) can significantly reduce the infection rate (20-40 %) during the first 30 min even under current ventilation practices; (2) minimum ventilation or fresh air requirement should vary with distancing condition, exposure time, and effectiveness of air distribution systems.

The efficacy of social distance and ventilation effectiveness in preventing COVID-19 transmission

Social distancing and ventilation were emphasized broadly to control the ongoing pandemic COVID-19 in confined spaces. Rationales behind these two strategies, however, were debated, especially regarding quantitative recommendations. The answers to "what is the safe distance" and "what is sufficient ventilation" are crucial to the upcoming reopening of businesses and schools, but rely on many medical, biological, and engineering factors. This study introduced two new indices into the popular while perfect-mixing-based Wells-Riley model for predicting airborne virus related infection probability - the underlying reasons for keeping adequate social distance and space ventilation. The distance index P_d can be obtained by theoretical analysis on droplet distribution and transmission from human respiration activities, and the ventilation index E_z represents the system-dependent air distribution efficiency in a space. The study indicated that 1.6-3.0 m (5.2-9.8 ft) is the safe social distance when considering aerosol transmission of exhaled large droplets from talking, while the distance can be up to 8.2 m (26 ft) if taking into account of all droplets under calm air environment. Because of unknown dose response to COVID-19, the model used one actual pandemic case to calibrate the infectious dose (quantum of infection), which was then verified by a number of other existing cases with short exposure time (hours). Projections using the validated model for a variety of scenarios including transportation vehicles and building spaces illustrated that (1) increasing social distance (e.g., halving occupancy density) can significantly reduce the infection rate (20-40 %) during the first 30 min even under current ventilation practices; (2) minimum ventilation or fresh air requirement should vary with distancing condition, exposure time, and effectiveness of air distribution systems.

Understanding COVID-19 transmission, health impacts and mitigation: timely social distancing is the key

COVID-19 is a highly infectious disease caused by SARS-CoV-2, first identified in China and spread globally, resulting into pandemic. Transmission of virus takes place either directly through close contact with infected individual (symptomatic/asymptomatic) or indirectly by touching contaminated surfaces. Virus survives on the surfaces from few hours to days. It enters the human body through nose, eyes or mouth. Other sources of contamination are faeces, blood, food, water, semen etc. Parameters such as temperature/relative humidity also play an important role in transmission. As the disease is evolving, so are the number of cases. Proper planning and restriction are helping in influencing the trajectory of the transmission. Various measures are undertaken to prevent infection such as maintaining hygiene, using facemasks, isolation/quarantine, social/physical distancing, in extreme cases lockdown (restricted movement except essential services) in hot spot areas or throughout the country. Countries that introduced various mitigation measures had experienced control in transmission of COVID-19. Python programming is conducted for change point analysis (CPA) using Bayesian probability approach for understanding the impact of restrictions and mitigation methods in terms of either increase or stagnation in number of COVID-19 cases for eight countries. From analysis it is concluded that countries which acted late in bringing in the social distancing measures are suffering in terms of high number of cases with USA, leading among eight countries analysed. The CPA week in comparison with date of lockdown and first reported case strongly correlates (Pearson's r = - 0.86 to - 0.97) to cases, cases per unit area and cases per unit population, indicating earlier the mitigation strategy, lesser the number of cases. The overall paper will help the decision makers in understanding the possible steps for mitigation, more so in developing countries where the fight against COVID-19 seems to have just begun.

Influence of pulmonary ventilation rate and breathing cycle period on the risk of cross-infection

This study examined the characteristics of the exhaled airflow pattern and breathing cycle period of human subjects and evaluated the influence of pulmonary ventilation rate and breathing cycle period on the risk of cross-infection. Measurements with five human subjects and a breathing thermal manikin were performed, and the peak exhaled airflow velocity from the mouth and the breathing cycle period were measured. Experiments on cross-infection between two breathing thermal manikins were then conducted in a full-scale test room, in which the pulmonary ventilation rate and breathing cycle period were varied systematically. Both peak flow velocity and breathing cycle length varied considerably between different subjects. The breathing cycle period in a standing posture was 18.9% lower than in a sitting posture. The influence of pulmonary ventilation rate and breathing cycle period extended up to a separation distance of 1.0 m between the two manikins. Increasing the pulmonary ventilation rate of the exposed person greatly increased the risk of cross-infection. Decreasing the breathing cycle period from the widely used "6 second" value led to a considerable increase in the risk of cross-infection. Standing posture resulted in a higher risk of cross-infection than sitting posture.

Human respiratory system as sink for volatile organic compounds: Evidence from field measurements

Human exposure to volatile organic compounds (VOCs) via inhalation might increase the risk of specific diseases. Human breath has been widely investigated as a source of VOCs. However, the role of the human respiratory system as a sink for VOCs is much less studied. In this observational study, the VOC concentrations in inhaled and exhaled air in different environmental conditions were investigated. A total of 98 healthy non-smoking subjects who were exposed to a wide variation in levels of VOCs participated in this study. Individual and statistical results show that human breath could serve as a source for some VOCs and a sink for others, and even when human breath serves as a sink, not all VOCs were 100% absorbed. Interestingly, an increase in inhaled concentrations of toluene was observed to convert human breath from being a source to being a sink. Attention could be given to those VOCs for which humans act as a strong sink.

Airborne transmission between room occupants during short-term events: Measurement and evaluation

This study experimentally examines and compares the dynamics and short-term events of airborne cross-infection in a full-scale room ventilated by stratum, mixing and displacement air distributions. Two breathing thermal manikins were employed to simulate a standing infected person and a standing exposed person. Four influential factors were examined, including separation distance between manikins, air change per hour, positioning of the two manikinsand air distribution. Tracer gas technique was used to simulate the exhaled droplet nuclei from the infected person and fast tracer gas concentration meters (FCM41) were used to monitor the concentrations. Real-time and average exposure indices were proposed to evaluate the dynamics of airborne exposure. The time-averaged exposure index depends on the duration of exposure time and can be considerably different during short-term events and under steady-state conditions. The exposure risk during short-term events may not always decrease with increasing separation distance. It changes over time and may not always increase with time. These findings imply that the control measures formulated on the basis of steady-state conditions are not necessarily appropriate for short-term events.

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.

A simple method for differentiating direct and indirect exposure to exhaled contaminants in mechanically ventilated rooms

Many airborne infectious diseases can be transmitted via exhaled contaminants transported in the air. Direct exposure occurs when the exhaled jet from the infected person directly enters the breathing zone of the target person. Indirect exposure occurs when the contaminants disperse in the room and are inhaled by the target person. This paper presents a simple method for differentiating the direct and indirect exposure to exhaled contaminants in mechanically ventilated rooms. Experimental data for 191 cases were collected from the literature. After analyzing the data, a simple method was developed to differentiate direct and indirect exposure in mixing and displacement ventilated rooms. The proposed method correctly differentiated direct and indirect exposure for 120 out of the 133 mixing ventilation cases and 47 out of the 58 displacement ventilation cases. Therefore, the proposed method is suitable for use at the early design stage to quickly assess whether there will be direct exposure to exhaled contaminants in a mechanically ventilated room.