Quantifying Proximity, Confinement, and Interventions in Disease Outbreaks: A Decision Support Framework for Air-Transported Pathogens

The impact of high background particle concentration on the spatiotemporal distribution of Serratia marcescens bioaerosol

Airborne transmission is a well-established mode of dissemination for infectious diseases, particularly in closed environments. However, previous research has often overlooked the potential impact of background particle concentration on bioaerosol characteristics. We compared the spatial and temporal distributions of bioaerosols under two levels of background particle concentration: heavily polluted (150-250 μg/m3) and excellent (0-35 μg/m3) in a typical ward. Serratia marcescens bioaerosol was adopted as a bioaerosol tracer, and the bioaerosol concentrations were quantified using six-stage Andersen cascade impactors. The results showed a significant reduction (over at least 62.9%) in bioaerosol concentration under heavily polluted levels compared to excellent levels at all sampling points. The temporal analysis also revealed that the decay rate of bioaerosols was higher (at least 0.654 min-1) under heavily polluted levels compared to excellent levels. These findings suggest that background particles can facilitate bioaerosol removal, contradicting the assumption made in previous research that background particle has no effect on bioaerosol characteristics. Furthermore, we observed differences in the size distribution of bioaerosols between the two levels of background particle concentration. The average bioaerosols size under heavily polluted levels was found to be higher than that under excellent levels, and the average particle size under heavily polluted levels gradually increased with time. In conclusion, these results highlight the importance of considering background particle concentration in future research on bioaerosol characteristics.

Reactive Chlorine Emissions from Cleaning and Reactive Nitrogen Chemistry in an Indoor Athletic Facility

Indoor gas-phase radical sources are poorly understood but expected to be much different from outdoors. Several potential radical sources were measured in a windowless, light-emitting diode (LED)-lit room in a college athletic facility over a 2 week period. Alternating measurements between the room air and the supply air of the heating, ventilation, and air-conditioning system allowed an assessment of sources. Use of a chlorine-based cleaner was a source of several photolabile reactive chlorine compounds, including ClNO₂ and Cl₂. During cleaning events, photolysis rates for these two compounds were up to 0.0023 pptv min^-1, acting as a source of chlorine atoms even in this low-light indoor environment. Unrelated to cleaning events, elevated ClNO₂ was often observed during daytime and lost to ventilation. The nitrate radical (NO₃), which is rapidly photolyzed outdoors during daytime, may persist in low-light indoor environments. With negligible photolysis, loss rates of NO₃ indoors were dominated by bimolecular reactions. At times with high NO₂ and O₃ ventilated from outdoors, N₂O₅ was observed. Elevated ClNO₂ measured concurrently suggests the formation through heterogeneous reactions, acting as an additional source of reactive chlorine within the athletic facility and outdoors.

Localized and Whole-Room Effects of Portable Air Filtration Units on Aerosol Particle Deposition and Concentration in a Classroom Environment

In indoor environments with limited ventilation, recirculating portable air filtration (PAF) units may reduce COVID-19 infection risk via not only the direct aerosol route (i.e., inhalation) but also via an indirect aerosol route (i.e., contact with the surface where aerosol particles deposited). We systematically investigated the impact of PAF units in a mock classroom, as a supplement to background ventilation, on localized and whole-room surface deposition and particle concentration. Fluorescently tagged particles with a volumetric mean diameter near 2 μm were continuously introduced into the classroom environment via a breathing simulator with a prescribed inhalation-exhalation waveform. Deposition velocities were inferred on >50 horizontal and vertical surfaces throughout the classroom, while aerosol concentrations were spatially monitored via optical particle spectrometry. Results revealed a particle decay rate consistent with expectations based upon the reported clean air delivery rates of the PAF units. Additionally, the PAF units reduced peak concentrations by a factor of around 2.5 compared to the highest concentrations observed and led to a statistically significant reduction in deposition velocities for horizontal surfaces >2.5 m from the aerosol source. Our results not only confirm that PAF units can reduce particle concentrations but also demonstrate that they may lead to reduced particle deposition throughout an indoor environment when properly positioned with respect to the location of the particle source(s) within the room (e.g., where the largest group of students sit) and the predominant air distribution profile of the room.

Practical Indicators for Risk of Airborne Transmission in Shared Indoor Environments and Their Application to COVID-19 Outbreaks

Some infectious diseases, including COVID-19, can undergo airborne transmission. This may happen at close proximity, but as time indoors increases, infections can occur in shared room air despite distancing. We propose two indicators of infection risk for this situation, that is, relative risk parameter (H_r) and risk parameter (H). They combine the key factors that control airborne disease transmission indoors: virus-containing aerosol generation rate, breathing flow rate, masking and its quality, ventilation and aerosol-removal rates, number of occupants, and duration of exposure. COVID-19 outbreaks show a clear trend that is consistent with airborne infection and enable recommendations to minimize transmission risk. Transmission in typical prepandemic indoor spaces is highly sensitive to mitigation efforts. Previous outbreaks of measles, influenza, and tuberculosis were also assessed. Measles outbreaks occur at much lower risk parameter values than COVID-19, while tuberculosis outbreaks are observed at higher risk parameter values. Because both diseases are accepted as airborne, the fact that COVID-19 is less contagious than measles does not rule out airborne transmission. It is important that future outbreak reports include information on masking, ventilation and aerosol-removal rates, number of occupants, and duration of exposure, to investigate airborne transmission.

Practical Indicators for Risk of Airborne Transmission in Shared Indoor Environments and Their Application to COVID-19 Outbreaks

Some infectious diseases, including COVID-19, can undergo airborne transmission. This may happen at close proximity, but as time indoors increases, infections can occur in shared room air despite distancing. We propose two indicators of infection risk for this situation, that is, relative risk parameter (H_r) and risk parameter (H). They combine the key factors that control airborne disease transmission indoors: virus-containing aerosol generation rate, breathing flow rate, masking and its quality, ventilation and aerosol-removal rates, number of occupants, and duration of exposure. COVID-19 outbreaks show a clear trend that is consistent with airborne infection and enable recommendations to minimize transmission risk. Transmission in typical prepandemic indoor spaces is highly sensitive to mitigation efforts. Previous outbreaks of measles, influenza, and tuberculosis were also assessed. Measles outbreaks occur at much lower risk parameter values than COVID-19, while tuberculosis outbreaks are observed at higher risk parameter values. Because both diseases are accepted as airborne, the fact that COVID-19 is less contagious than measles does not rule out airborne transmission. It is important that future outbreak reports include information on masking, ventilation and aerosol-removal rates, number of occupants, and duration of exposure, to investigate airborne transmission.

Experimental evaluation of respiratory droplet spread to rooms connected by a central ventilation system

This article presents results from an experimental study to ascertain the transmissibility of the SARS-CoV-2 virus between rooms in a building that are connected by a central ventilation system. Respiratory droplet surrogates made of mucus and virus mimics were released in one room in a test building, and measurements of concentration levels were made in other rooms connected via the ventilation system. The paper presents experimental results for different ventilation system configurations, including ventilation rate, filtration level (up to MERV-13), and fractional outdoor air intake. The most important finding is that respiratory droplets can and do transit through central ventilation systems, suggesting a mechanism for viral transmission (and COVID-19 specifically) within the built environment in reasonable agreement with well-mixed models. We also find the deposition of small droplets (0.5-4 μm) on room walls to be negligibly small.

Indoor aerosol science aspects of SARS-CoV-2 transmission

Knowledge about person-to-person transmission of SARS-CoV-2 is reviewed, emphasizing three components: emission of virus-containing particles and drops from infectious persons; transport and fate of such emissions indoors; and inhalation of viral particles by susceptible persons. Emissions are usefully clustered into three groups: small particles (diameter 0.1-5 µm), large particles (5-100 µm), and ballistic drops (>100 µm). Speaking generates particles and drops across the size spectrum. Small particles are removed from indoor air at room scale by ventilation, filtration, and deposition; large particles mainly deposit onto indoor surfaces. Proximate exposure enhancements are associated with large particles with contributions from ballistic drops. Masking and social distancing are effective in mitigating transmission from proximate exposures. At room scale, masking, ventilation, and filtration can contribute to limit exposures. Important information gaps prevent a quantitative reconciliation of the high overall global spread of COVID-19 with known transmission pathways. Available information supports several findings with moderate-to-high confidence: transmission occurs predominantly indoors; inhalation of airborne particles (up to 50 µm in diameter) contributes substantially to viral spread; transmission occurs in near proximity and at room scale; speaking is a major source of airborne SARS-CoV-2 virus; and emissions can occur without strong illness symptoms.

Control of airborne infectious disease in buildings: Evidence and research priorities

The evolution of SARS-CoV-2 virus has resulted in variants likely to be more readily transmitted through respiratory aerosols, underscoring the increased potential for indoor environmental controls to mitigate risk. Use of tight-fitting face masks to trap infectious aerosol in exhaled breath and reduce inhalation exposure to contaminated air is of critical importance for disease control. Administrative controls including the regulation of occupancy and interpersonal spacing are also important, while presenting social and economic challenges. Indoor engineering controls including ventilation, exhaust, air flow control, filtration, and disinfection by germicidal ultraviolet irradiation can reduce reliance on stringent occupancy restrictions. However, the effects of controls-individually and in combination-on reducing infectious aerosol transfer indoors remain to be clearly characterized to the extent needed to support widespread implementation by building operators. We review aerobiologic and epidemiologic evidence of indoor environmental controls against transmission and present a quantitative aerosol transfer scenario illustrating relative differences in exposure at close-interactive, room, and building scales. We identify an overarching need for investment to implement building controls and evaluate their effectiveness on infection in well-characterized and real-world settings, supported by specific, methodological advances. Improved understanding of engineering control effectiveness guides implementation at scale while considering occupant comfort, operational challenges, and energy costs.

Modeling the impacts of physical distancing and other exposure determinants on aerosol transmission

Minimization of airborne virus transmission has become increasingly important due to pandemic and endemic infectious respiratory diseases. Physical distancing is a frequently advocated control measure, but the proximity-based transmission it is intended to control is challenging to incorporate into generalized, ventilation-based models. We utilize a size-dependent aerosol release model with turbulent dispersion to assess the impact of direct, near-field transport in conjunction with changes in ventilation, exposure duration, exhalation/inhalation rates, and masks. We demonstrate this model on indoor and outdoor scenarios to estimate the relative impacts on infection risk. The model can be expressed as a product of six multiplicative factors that may be used to identify opportunities for risk reduction. The additive nature of the short-range (proximity) and long-range (background) transmission components of the aerosol transport factor implies that they must be minimized simultaneously. Indoor simulations showed that close physical distances attenuated the impact of most other risk reduction factors. Increasing ventilation resulted in a 17-fold risk decrease at further physical distances but only a 6-fold decrease at shorter distances. Distance, emission rate, and duration also had large impacts on risk (11-65-fold), while air direction and inhalation rate had lower risk impacts (3-4-fold range). Surgical mask and respirator models predicted higher maximum risk impacts (33- and 280-fold, respectively) than cloth masks (4-fold). Most simulations showed decreasing risk at distances > 1-2 m (3-6 ft). The risk benefit of maintaining 2-m distance vs. 1 m depended substantially on the environmental turbulence and ventilation rate. Outdoors, long-range transmission was negligible and short-range transmission was the primary determinant of risk. Temporary passing events increased risk by up to 50 times at very slow walking speeds and close passing distances, but the relative risks outdoors were still much lower than indoors. The current model assumes turbulent dispersion typical of a given room size and ventilation rate. However, calm environments or confined airflows may increase transmission risks beyond levels predicted with this turbulent model.

Risk assessment of airborne COVID-19 exposure in social settings

The COVID-19 pandemic has led to many countries oscillating between various states of lock-down as they seek to balance keeping the economy and essential services running and minimizing the risk of further transmission. Decisions are made about which activities to keep open across a range of social settings and venues guided only by ad hoc heuristics regarding social distancing and personal hygiene. Hence, we propose the dual use of computational fluid dynamic simulations and surrogate aerosol measurements for location-specific assessment of risk of infection across different real-world settings. We propose a 3-tiered risk assessment scheme to facilitate classification of scenarios into risk levels based on simulations and experiments. Threshold values of <54 and >840 viral copies and <5% and >40% of original aerosol concentration are chosen to stratify low, medium, and high risk. This can help prioritize allowable activities and guide implementation of phased lockdowns or re-opening. Using a public bus in Singapore as a case study, we evaluate the relative risk of infection across scenarios such as different activities and passenger positions and demonstrate the effectiveness of our risk assessment methodology as a simple and easily interpretable framework. For example, this study revealed that the bus's air-conditioning greatly influences dispersion and increases the risk of certain seats and that talking can result in similar relative risk to coughing for passengers around an infected person. Both numerical and experimental approaches show similar relative risk levels with a Spearman's correlation coefficient of 0.74 despite differing observables, demonstrating applicability of this risk assessment methodology to other scenarios.

Fates and spatial variations of accumulation mode particles in a multi-zone indoor environment during the HOMEChem campaign

Studying the indoor dynamics that impact particles is crucial in order to understand indoor air chemistry and assess overall human exposure to particles. This work investigates spatial gradients in particle concentration, caused by indoor transport and loss mechanisms. We conducted a variety of cooking experiments during the House Observations of Microbial and Environmental Chemistry (HOMEChem) campaign in June 2018 that allowed us to probe these mechanisms. We measured size-resolved (0.06-1 μm and 0.13-3 μm) particle number concentrations from cooking experiments using optical instruments at four locations throughout the house simultaneously. The particle number concentration in the kitchen was 40 ± 10% and 70 ± 10% higher than the concentrations in the living room and the bedroom, respectively. There was a minor size dependence, with larger differences in the smaller sizes of the accumulation mode (0.1-2.5 μm) than the larger end of the range. Dilution accounts for the majority of these concentration differences. Surface deposition was the dominant fate of particles within a zone, with observed deposition velocities ranging from 0.1 to 0.6 m h-1.

Exhaled CO2 as a COVID-19 Infection Risk Proxy for Different Indoor Environments and Activities

CO2 is co-exhaled with aerosols containing SARS-CoV-2 by COVID-19-infected people and can be used as a proxy of SARS-CoV-2 concentrations indoors. Indoor CO2 measurements by low-cost sensors hold promise for mass monitoring of indoor aerosol transmission risk for COVID-19 and other respiratory diseases. We derive analytical expressions of CO2-based risk proxies and apply them to various typical indoor environments. The relative infection risk in a given environment scales with excess CO2 level, and thus, keeping CO2 as low as feasible in a space allows optimization of the protection provided by ventilation. We show that the CO2 level corresponding to a given absolute infection risk varies by >2 orders of magnitude for different environments and activities. Although large uncertainties, mainly from virus exhalation rates, are still associated with infection risk estimates, our study provides more specific and practical recommendations for low-cost CO2-based indoor infection risk monitoring.