Trajectories of large respiratory droplets in indoor environment: A simplified approach

Quantitative evaluation of precautions against the COVID-19 indoor transmission through human coughing

In this work, we focus on the dispersion of COVID-19-laden droplets using the transient computational fluid dynamics (CFD) modeling and simulation of the coughing process of virus carriers in an enclosure room, aiming to set up the basic prototype of popular precautionary strategies, i.e., face mask, upward ventilation, protective screen, or any combination thereof, against the indoor transmission of COVID-19 and other highly contagious diseases in the future. A multi-component Eulerian-Lagrangian CFD particle-tracking model with user-defined functions is utilized under 8 cases to examine the characteristics of droplet dispersion concerning the mass and heat transfer, droplet evaporation, air buoyancy, air convection, air-droplet friction, and turbulent dispersion. The result shows that implementing upward ventilation is the most effective measure, followed by wearing face masks. Protective screens can restrict the movement of the coughing droplets (though it will not reduce viral load). However, applying protective screens arranged with lean can be counterproductive in preventing the spread of COVID-19 when it is inappropriately placed with ventilation. The soundest solution is the combination of the face mask and upward ventilation, which can reduce the indoor infectious concentration by nearly 99.95% compared with the baseline without any precautionary strategies. With the resumption of school and work in the post-epidemic era, this study would provide intelligence-enhancing advice for the masses and rule-makers to curb the pandemic.

Transport Characteristics and Transmission Risk of Virus-Containing Droplets from Coughing in Outdoor Windy Environment

Particle dispersions have been widely studied inside rooms, but few databases have examined the transmission risk of respiratory droplets outdoors. This study investigated the wind effect on the dispersion of coughed droplets and the influence of social distancing on the infection risk in different susceptible persons using computational fluid dynamics simulations. Infection risk was evaluated based on direct depositions and exposure fractions. The results indicated that a reverse and upward flow formed in front of an infected man, and it enhanced as the wind strengthened, which transported more medium particles higher and increased the deposition on both infected and susceptible persons. Small particles moved above the neck, and they rarely deposited on the body. Medium particles larger than 60 μm were more likely to deposit and could reach the head of a healthy person under stronger winds. The exposure fraction achieved peak values when numerous particles passed the breathing zone. Although longer social distancing could alleviate the particle deposition on the face and delay the most dangerous time, its effect on infection risk was ambiguous. The infection risk was larger for a shorter susceptible person because more particles were deposited on the face, and the exposure fraction contributed by particles above the neck was larger.

Coughing Intensity and Wind Direction Effects on the Transmission of Respiratory Droplets: A Computation with Euler–Lagrange Method

Studies on droplet transmission are needed to understand the infection mechanism of SARS-CoV-2. This research investigated the effects of coughing intensity and wind direction on respiratory droplets transportation using the Euler–Lagrange method. The results revealed that both coughing intensity and wind conditions considerably influence the transmission of small and medium droplets but had little effect on large droplets. A stronger coughing intensity resulted in small and medium droplets traveling farther in a calm wind and spreading widely and rapidly in a windy environment. The droplets do not travel far in the absence of ambient wind, even with stronger coughing. Medium droplets spread in clusters, and small droplets drifted out of the domain in the band area in different wind conditions except for 60° and 90° wind directions, in which cases, the droplets were blown directly downstream. In 0° wind direction, many droplets were deposited on the human body. The fast and upward movement of particles in 60° and 90° directions could cause infection risk with short exposure. In 180° wind direction, droplets spread widely and traveled slowly because of the reverse flow downstream, prolonged exposure can result in a high risk of infection.

Pathogen-Repellent Plastic Warp with Built-In Hierarchical Structuring Prevents the Contamination of Surfaces with Coronaviruses

Amidst the COVID-19 pandemic, it is evident that viral spread is mediated through several different transmission pathways. Reduction of these transmission pathways is urgently needed to control the spread of viruses between infected and susceptible individuals. Herein, we report the use of pathogen-repellent plastic wraps (RepelWrap) with engineered surface structures at multiple length scales (nanoscale to microscale) as a means of reducing the indirect contact transmission of viruses through fomites. To quantify viral repellency, we developed a touch-based viral quantification assay to mimic the interaction of a contaminated human touch with a surface through the modification of traditional viral quantification methods (viral plaque and TCID50 assays). These studies demonstrate that RepelWrap reduced contamination with an enveloped DNA virus as well as the human coronavirus 229E (HuCoV-229E) by more than 4 log 10 (>99.99%) compared to a standard commercially available polyethylene plastic wrap. In addition, RepelWrap maintained its repellent properties after repeated 300 touches and did not show an accumulation in viral titer after multiple contacts with contaminated surfaces, while increases were seen on other commonly used surfaces. These findings show the potential use of repellent surfaces in reducing viral contamination on surfaces, which could, in turn, reduce the surface-based spread and transmission.

A simplified tempo-spatial model to predict airborne pathogen release risk in enclosed spaces: An Eulerian-Lagrangian CFD approach

COVID19 pathogens are primarily transmitted via airborne respiratory droplets expelled from infected bio-sources. However, there is a lack of simplified accurate source models that can represent the airborne release to be utilized in the safe-social distancing measures and ventilation design of buildings. Although computational fluid dynamics (CFD) can provide accurate models of airborne disease transmissions, they are computationally expensive. Thus, this study proposes an innovative framework that benefits from a series of relatively accurate CFD simulations to first generate a dataset of respiratory events and then to develop a simplified source model. The dataset has been generated based on key clinical parameters (i.e., the velocity of droplet release) and environmental factors (i.e., room temperature and relative humidity) in the droplet release modes. An Eulerian CFD model is first validated against experimental data and then interlinked with a Lagrangian CFD model to simulate trajectory and evaporation of numerous droplets in various sizes (0.1 μm-700 μm). A risk assessment model previously developed by the authors is then applied to the simulation cases to identify the horizontal and vertical spread lengths (risk cloud) of viruses in each case within an exposure time. Eventually, an artificial neural network-based model is fitted to the spread lengths to develop the simplified predictive source model. The results identify three main regimes of risk clouds, which can be fairly predicted by the ANN model.

Risk assessment of COVID infection by respiratory droplets from cough for various ventilation scenarios inside an elevator: An OpenFOAM-based computational fluid dynamics analysis

Respiratory droplets-which may contain disease spreading virus-exhaled during speaking, coughing, or sneezing are one of the significant causes for the spread of the ongoing COVID-19 pandemic. The droplet dispersion depends on the surrounding air velocity, ambient temperature, and relative humidity. In a confined space like an elevator, the risk of transmission becomes higher when there is an infected person inside the elevator with other individuals. In this work, a numerical investigation is carried out in a three-dimensional domain resembling an elevator using OpenFoam. Three different modes of air ventilation, viz., quiescent, axial exhaust draft, and exhaust fan, have been considered to investigate the effect of ventilation on droplet transmission for two different climatic conditions (30  °C , 50% relative humidity and 10  °C , 90% relative humidity). The risk assessment is quantified using a risk factor based on the time-averaged droplet count present near the passenger's hand to head region (risky height zone). The risk factor drops from 40% in a quiescent scenario to 0% in an exhaust fan ventilation condition in a hot dry environment. In general, cold humid conditions are safer than hot dry conditions as the droplets settle down quickly below the risky height zone owing to their larger masses maintained by negligible evaporation. However, an exhaust fan renders the domain in a hot dry ambience completely safe (risk factor, 0%) in 5.5 s whereas it takes 7.48 s for a cold humid ambience.

Humidification of indoor air for preventing or reducing dryness symptoms or upper respiratory infections in educational settings and at the workplace

BACKGROUND

Indoor exposure to dry air during heating periods has been associated with dryness and irritation symptoms of the upper respiratory airways and the skin. The irritated or damaged mucous membrane poses an important entry port for pathogens causing respiratory infections.

OBJECTIVES

To determine the effectiveness of interventions that increase indoor air humidity in order to reduce or prevent dryness symptoms of the eyes, the skin and the upper respiratory tract (URT) or URT infections, at work and in educational settings.

SEARCH METHODS

The last search for all databases was done in December 2020. We searched Ovid MEDLINE, Embase, CENTRAL (Cochrane Library), PsycINFO, Web of Science, Scopus and in the field of occupational safety and health: NIOSHTIC-2, HSELINE, CISDOC and the In-house database of the Division of Occupational and Environmental Medicine, University of Zurich. We also contacted experts, screened reference lists of included trials, relevant reviews and consulted the WHO International Clinical Trials Registry Platform (ICTRP).

SELECTION CRITERIA

We included controlled studies with a parallel group or cross-over design, quasi-randomised studies, controlled before-and-after and interrupted time-series studies on the effects of indoor air humidification in reducing or preventing dryness symptoms and upper respiratory tract infections as primary outcomes at workplace and in the educational setting. As secondary outcomes we considered perceived air quality, other adverse events, sick leave, task performance, productivity and attendance and costs of the intervention.

DATA COLLECTION AND ANALYSIS

Two review authors independently screened titles, abstracts and full texts for eligibility, extracted data and assessed the risks of bias of included studies. We synthesised the evidence for the primary outcomes 'dry eye', 'dry nose', 'dry skin', for the secondary outcome 'absenteeism', as well as for 'perception of stuffiness' as the harm-related measure. We assessed the certainty of evidence using the GRADE system.

MAIN RESULTS

We included 13 studies with at least 4551 participants, and extracted the data of 12 studies with at least 4447 participants. Seven studies targeted the occupational setting, with three studies comprising office workers and four hospital staff. Three of them were clustered cross-over studies with 846 participants (one cRCT), one parallel-group controlled trial (2395 participants) and three controlled before-and-after studies with 181 participants. Five studies, all CTs, with at least 1025 participants, addressing the educational setting, were reported between 1963 and 1975, and in 2018. In total, at least 3933 (88%) participants were included in the data analyses. Due to the lack of information, the results of the risk of bias assessment remained mainly unclear and the assessable risks of bias of included studies were considered as predominantly high. Primary outcomes in occupational setting:  We found that indoor air humidification at the workplace may have little to no effect on dryness symptoms of the eye and nose (URT). The only cRCT showed a significant decrease in dry eye symptoms among working adults (odds ratio (OR) 0.54, 95% confidence interval (CI) 0.37 to 0.79) with a low certainty of the evidence. The only cluster non-randomised cross-over study showed a non-significant positive effect of humidification on dryness nose symptoms (OR 0.87, 95% CI 0.53 to 1.42) with a low certainty of evidence. We found that indoor air humidification at the workplace may have little and non-significant effect on dryness skin symptoms. The pooled results of two cluster non-RCTs showed a non-significant alleviation of skin dryness following indoor air humidification (OR 0.66, 95% CI 0.33 to 1.32) with a low certainty of evidence. Similarly, the pooled results of two before-after studies yielded no statistically significant result (OR 0.69, 95% CI 0.33 to 1.47) with very low certainty of evidence No studies reported on the outcome of upper respiratory tract infections. No studies conducted in educational settings investigated our primary outcomes. Secondary outcomes in occupational setting: Perceived stuffiness of the air was increased during the humidification in the two cross-over studies (OR 2.18, 95% CI 1.47 to 3.23); (OR 1.70, 95% CI 1.10 to 2.61) with low certainty of evidence. Secondary outcomes in educational setting: Based on different measures and settings of absenteeism, four of the six controlled studies found a reduction in absenteeism following indoor air humidification (OR 0.54, 95% CI 0.45 to 0.65; OR 0.38, 95% CI 0.15 to 0.96; proportion 4.63% versus 5.08%).

AUTHORS' CONCLUSIONS

Indoor air humidification at the workplace may have little to no effect on dryness symptoms of the eyes, the skin and the URT. Studies investigating illness-related absenteeism from work or school could only be summarised narratively, due to different outcome measures assessed. The evidence suggests that increasing humidification may reduce the absenteeism, but the evidence is very uncertain. Future RCTs involving larger sample sizes, assessing dryness symptoms more technically or rigorously defining absenteeism and controlling for potential confounders are therefore needed to determine whether increasing indoor air humidity can reduce or prevent dryness symptoms of the eyes, the skin, the URT or URT infections at work and in educational settings over time.

Ventilation in worker dormitories and its impact on the spread of respiratory droplets

Most of the COVID-19 cases in Singapore have primarily come from foreign worker dormitories. This people group is especially vulnerable partly because of behavioural habits, but the built environment they live in also plays a significant role. These dormitories are typically densely populated, so the living conditions are cramped. The short lease given to most dormitories also means the design does not typically focus on environmental performance, like good natural ventilation. This paper seeks to understand how these dormitories' design affects natural ventilation and, subsequently, the spread of the COVID-19 particles by looking at two existing worker dorms in Singapore. Findings show that some rooms are poorly orientated against the prevailing wind directions, so there is dominant stagnant air in these rooms, leading to respiratory droplets' long residence times. These particles can hover in the air for 10 min and more. Interventions like increased bed distance and removing upper deck beds only showed limited ventilation improvements in some rooms. Comparatively, internal wind scoops' strategic placement was more effective at directing wind towards more stagnant zones. Large canyon aspect ratios were also effective at removing particles from higher elevations.

Influence of ambient conditions on evaporation and transport of respiratory droplets in indoor environment

Respiratory droplets are playing a significant role in the transmission of any flu type disease as well as SARS-Cov-2 virus. The presence of pathogens affects the evaporation of the liquid droplets along with ambient temperature and relative humidity (rh). Complete evaporation of droplets leads to the formation of aerosol or droplet nuclei which remain suspended in the air for a longer period of time and get spread over larger distances increasing the risk of disease transmission. In present work, a droplet evaporation model has been formulated considering the droplet as a salt solution and the formation of crystals has been taken into account which will be analogous to the aerosol formation. After the establishment of the evaporation model, the trajectories of the droplets are investigated considering a turbulent round jet model during exhalation. Aerosols are found to be spreading over distances of 8 to 9 m which is quite alarming. Large droplets get converted to smaller ones but the viral loading of the large droplets is much higher than the smaller as viral loading is proportional to initial size. This is highlighted by the viral load contour and the mean diameter line contour for a half-height window. Different weather conditions are investigated to observe the evaporation of droplets and the formation of aerosols in order to qualitatively analyse the risks associated with each city in specific weather conditions. Hot and dry conditions are most favourable to aerosol formation.

Weakening personal protective behavior by Chinese university students after COVID-19 vaccination

Personal protective behaviors and their dynamic change are known to play a major role in the community spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causal pathogen of the coronavirus disease 2019 (COVID-19) pandemic. In this study, a total of 3229 students in Chinese universities completed an online survey about their knowledge on transmission and personal protective behavior before and after COVID-19 vaccination. Of the respondents, 87.6% had been vaccinated. Most students believed that the large droplet (97.0%) and short-range airborne (89.3%) routes were the two most likely SARS-CoV-2 transmission routes, whereas only 24.1% considered long-range airborne transmission to be possible. Students who would be expected to possess better knowledge about virus transmission (e.g., students of medicine) reported better personal protective behaviors. Female students reported relatively better personal hygiene practices than male students, so did the confident students than their diffident peers. Students washed their hands on average of 5.76 times per day during the pandemic. Students at universities in southern regions washed their hands more frequently but paid less attention to indoor ventilation than did their northern counterparts. Interestingly, students who are fear of being infected had the bad personal hygiene. University students wore 22% less masks in public indoor environments after vaccination. Chinese university students weakened their personal protective behavior after vaccination and it may increase the potential risk of infection in the new waves of variant virus (e.g. delta).

Estimating the impact of indoor relative humidity on SARS-CoV-2 airborne transmission risk using a new modification of the Wells-Riley model

A novel modified version of the Wells-Riley model was used to estimate the impact of relative humidity (RH) on the removal of respiratory droplets containing the SARS-CoV-2 virus by deposition through gravitational settling and its inactivation by biological decay; the effect of RH on susceptibility to SARS-CoV-2 was not considered. These effects were compared with the removal achieved by increased ventilation rate with outdoor air. Modeling was performed assuming that the infected person talked continuously for 60 and 120 min. The results of modeling showed that the relative impact of RH on the infection risk depended on the ventilation rate and the size range of virus-laden droplets. A ventilation rate of 0.5 ACH, the change of RH between 20% and 53% was predicted to have a small effect on the infection risk, while at a ventilation rate of 6 ACH this change had nearly no effect. On the contrary, increasing the ventilation rate from 0.5 ACH to 6 ACH was predicted to decrease the infection risk by half which is remarkably larger effect compared with that predicted for RH. It is thus concluded that increasing the ventilation rate is more beneficial for reducing the airborne levels of SARS-CoV-2 than changing indoor RH.

PRACTICAL IMPLICATIONS

The present results show that humidification to moderate levels of 40%-60% RH should not be expected to provide a significant reduction in infection risk caused by SARS-CoV-2, hence installing and running humidifiers may not be an efficient solution to reduce the risk of COVID-19 disease in indoor spaces. The results do however confirm that ventilation has a key role in controlling SARS-CoV-2 virus concentration in the air providing considerably higher benefits. The modified model developed in the present work can be used by public health experts, engineers, and epidemiologists when selecting different measures to reduce the infection risk from SARS-CoV-2 indoors allowing informed decisions concerning indoor environmental control.

Comparison of droplet spread in standard and laminar flow operating theatres: SPRAY study group

BACKGROUND

Reducing COVID-19 transmission relies on controlling droplet and aerosol spread. Fluorescein staining reveals microscopic droplets.

AIM

To compare the droplet spread in non-laminar and laminar air flow operating theatres.

METHODS

A 'cough-generator' was fixed to a theatre trolley at 45°. Fluorescein-stained 'secretions' were projected on to a series of calibrated targets. These were photographed under UV light and 'source detection' software measured droplet splatter size and distance.

FINDINGS

The smallest droplet detected was ∼120 μm and the largest ∼24,000 μm. An average of 25,862 spots was detected in the non-laminar theatre, compared with 11,430 in the laminar theatre (56% reduction). The laminar air flow mainly affected the smaller droplets (<1000 μm). The surface area covered with droplets was: 6% at 50 cm, 1% at 2 m, and 0.5% at 3 m in the non-laminar air flow; and 3%, 0.5%, and 0.2% in the laminar air flow, respectively.

CONCLUSION

Accurate mapping of droplet spread in clinical environments is possible using fluorescein staining and image analysis. The laminar air flow affected the smaller droplets but had limited effect on larger droplets in our 'aerosol-generating procedure' cough model. Our results indicate that the laminar air flow theatre requires similar post-surgery cleaning to the non-laminar, and staff should consider full personal protective equipment for medium- and high-risk patients.

Built environment and the metropolitan pandemic: Analysis of the COVID-19 spread in Hong Kong

The COVID-19 reported initially in December 2019 led to thousands and millions of people infections, deaths at a rapid scale, and a global scale. Metropolitans suffered serious pandemic problems as the built environments of metropolitans contain a large number of people in a relatively small area and allow frequent contacts to let virus spread through people's contacting with each other. The spread inside a metropolitan is heterogeneous, and we propose that the spatial variation of built environments has a measurable association with the spread of COVID-19. This paper is the pioneering work to investigate the missing link between the built environment and the spread of the COVID-19. In particular, we intend to examine two research questions: (1) What are the association of the built environment with the risk of being infected by the COVID-19? (2) What are the association of the built environment with the duration of suffering from COVID-19? Using the Hong Kong census data, confirmed cases of COVID-19 between January to August 2020 and large size of built environment sample data from the Hong Kong government, our analysis are carried out. The data is divided into two phases before (Phase 1) and during the social distancing measure was relaxed (Phase 2). Through survival analysis, ordinary least squares analysis, and count data analysis, we find that (1) In Phase 1, clinics and restaurants are more likely to influence the prevalence of COVID-19. In Phase 2, public transportation (i.e. MTR), public market, and the clinics influence the prevalence of COVID-19. (2) In Phase 1, the areas of tertiary planning units (i.e., TPU) with more restaurants are found to be positively associated with the period of the prevalence of COVID-19. In Phase 2, restaurants and public markets induce long time occurrence of the COVID-19. (3) In Phase 1, restaurant and public markets are the two built environments that influence the number of COVID-19 confirmed cases. In Phase 2, the number of restaurants is positively related to the number of COVID-19 reported cases. It is suggested that governments should not be too optimistic to relax the necessary measures. In other words, the social distancing measure should remain in force until the signals of the COVID-19 dies out.

Crowding has consequences: Prevention and management of COVID-19 in informal urban settlements

COVID-19 spreads via aerosols, droplets, fomites and faeces. The built environment that facilitates crowding increases exposure and hence transmission of COVID-19 as evidenced by outbreaks in both cool-dry and hot-humid climates, such as in the US prison system and dormitories in Singapore, respectively. This paper explores how the built environment influences crowding and COVID-19 transmission, focusing on informal urban settlements (slums). We propose policy and practice changes that could reduce COVID-19 transmission. There are several issues on how COVID-19 affects informal urban settlements. Slum populations tend to be younger than the overall population. Lower numbers of older people lessen the morbidity and mortality of the pandemic in slum areas. Second, many slum populations are highly mobile. By returning to their ancestral villages residents can avoid the risks of overcrowding and reduce the population density in a given area but may spread COVID-19 to other areas. Third, detection and registration of COVID-19 cases depends on patients presenting to health care providers. If the risk of visiting a health care centre outweighs the potential benefits patients may prefer not to seek treatment. The control and prevention of COVID-19 in informal urban settlements starts with organizing community infrastructure for diagnosis and treatment and assuring that basic needs (food, water, sanitation, health care and public transport) are met during quarantine. Next, community members at highest risk need to be identified and protected. Low-income, informal settlements need to be recognized as a reservoir and source for persistent transmission. Solutions to overcrowding must be developed for this and future pandemics. In view of the constant risk that slums present to the entire population decisive steps need to be taken to rehabilitate and improve informal settlements, while avoiding stigmatization.

A discussion on implementing pooling detection tests of novel coronavirus (SARS-CoV-2) for a large population

A pooled sample analysis strategy for novel coronavirus (severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2)) is proposed for a large population in this paper. The population to be tested is divided into divisions based on earlier observed detection rate of SARS-CoV-2 first. Samples collected are then grouped in appropriate pooled size. The number of tests per person in that population is expressed as a function of two variables: the observed detection rate and the pooled size or number of samples grouped. The minimum number of tests per person can be further shown to be a function of only one of these two variables, because these two parameters are found to be related at this minimum. A management scheme on grouping the samples is proposed in order to reduce the number of tests, to save time, which is of utmost importance in fighting an epidemic. The proposed testing scheme will be useful for supporting the government in making decisions to handle regular routine detection tests for identifying asymptomatic patients and implementing health code system in large population of millions of citizens. Another important point is to use smaller number of test kits, allowing more resources to speed up the mass screening tests, particularly in places not so rich.

Improving Room Carrying Capacity within Built Environments in the Context of COVID-19

The COVID-19 pandemic that has struck the world since March 2019 has established an unusual modus operandi for all of us. During this transient situation, some of the activities have been severely altered, especially those which are performed in indoor spaces such as classrooms, restaurants, or libraries. As physical distance is mandatory in most countries, the capacity of these places has been severely reduced, causing unsustainable economic and logistical issues. This work aims to analyze the possible ways of distributing seats in symmetrical spaces for different uses and room sizes. For that purpose, the classical seat arrangement in rows and columns is compared with an equilateral triangle-based seat pattern, which is proposed as a better solution in most cases. Results show that a greater number of seats is achieved in most situations using the proposed patterns, with mean increases of 13% and peaks from 25% to 50% in some specific circumstances. A discussion about an optimized layout, shape and size of the furniture used in multiple seat tables is included. The outcome shall generate a positive impact on schools, colleges, restaurants, libraries, and similar built environments where seating capacity is crucial.