Planes, Trains, and Automobiles: Use of Carbon Dioxide Monitoring to Assess Ventilation During Travel

Transmission of Severe Acute Respiratory Syndrome Coronavirus 2 Among Residents and Employees in a Veterans Affairs Community Living Center: A 42-Month Prospective Cohort Study

Background

Understanding routes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission in long-term care facilities is essential for the development of effective control measures.

Methods

Between March 1, 2020, and August 31, 2023, we identified coronavirus disease 2019 (COVID-19) cases among residents and employees in a Veterans Affairs community living center that conducted routine screening for asymptomatic COVID-19. Contact tracing was conducted to identify suspected transmission events, and whole genome sequencing was performed to determine the relatedness of SARS-CoV-2 samples.

Results

During the 42-month study period, 269 cases of COVID-19 were diagnosed, including 199 employees and 70 residents. A total of 48 (24.1%) employees and 30 (42.9%) residents were asymptomatic. Sequencing analysis provided support for multiple events in which employees transmitted SARS-CoV-2 to co-workers and residents. There was 1 episode of likely transmission of SARS-CoV-2 from one resident to another resident, but no documented transmissions from residents to employees.

Conclusions

Transmission of SARS-CoV-2 in the community living center predominantly involved transmission from employees to co-workers and residents. There is a need for improved measures to prevent transmission of SARS-CoV-2 by healthcare personnel.

Indoor Air Quality and COVID-19: A Scoping Review

Objectives: The COVID-19 pandemic has been a major public health concern for the past 3 years. Scientific evidence on the relationship between SARS-CoV-2 infection and indoor air quality still needs to be demonstrated. This scoping review aims to study the association between air quality indoors and COVID-19. Methods: A scoping review analyzing the association between indoor air quality and epidemiological outcomes was conducted. Papers published between 1 January 2020 and 31 October 2022 were included. Hospital settings were excluded from the study. Results: Eight relevant articles met the inclusion criteria. Indoor settings included workplaces, schools, restaurants, and public transport. Types of ventilation used to improve indoor air quality were dilution methods (opening windows) and mechanical systems with or without filtration or purifier. CO2 sensors were employed in one study. All the studies showed a positive association between indoor air quality and its improvement and epidemiological indicators. Conclusion: The findings of this scoping review indicate that indoor air quality, which can be improved with ventilation methods, may reduce the risk of developing COVID-19. Ventilation could thus be viewed as a possible effective mitigating method.

Carbon Dioxide Monitoring Demonstrates Variations in the Quality of Ventilation on Public Transportation Buses and University Student Shuttle Vans and Identifies Effective Interventions

Background

There is a risk for transmission of severe acute respiratory syndrome 2 (SARS-CoV-2) and other respiratory viruses in motor vehicles, particularly if ventilation is inadequate.

Methods

We used carbon dioxide monitoring to examine the quality of ventilation in several public transportation buses and in university student shuttle vans in the Cleveland metro area during peak and non-peak travel times. Carbon dioxide levels above 800 parts per million (ppm) were considered an indicator of suboptimal ventilation for the number of people present. In the shuttle vans, we evaluated the impact of an intervention to improve ventilation.

Results

In large articulated buses with 2 ventilation systems, carbon dioxide concentrations never exceeded 800 ppm, whereas in standard buses with 1 ventilation system concentrations rose above 800 ppm during peak travel times and on some trips during non-peak travel times. In shuttle vans, the ventilation system was not turned on during routine operation, and carbon dioxide levels rose above 800 ppm on all trips during peak and non-peak travel times. In the shuttle vans, an intervention involving operation of the existing ventilation system resulted in a significant reduction in carbon dioxide levels (mean concentration, 1,042 no intervention versus 785 with intervention; P < 0.001).

Conclusions

Our findings demonstrate substantial variability in the quality of ventilation in public transportation buses and university shuttle vans. There is a need for efforts to assess and optimize ventilation in motor vehicles used for public transportation to reduce the risk for aerosol-mediated transmission of respiratory viruses. Carbon dioxide monitoring may provide a useful tool to assess and improve ventilation.

High technology and low technology measures to reduce risk of SARS-CoV-2 transmission

During the coronavirus disease 2019 (COVID-19) pandemic, a variety of low technology and high technology measures have been proposed to reduce the risk for transmission. Identifying those measures likely to be useful in reducing viral transmission without undue expense or potential for adverse effects has been a challenge for infection control programs. The challenge has been compounded by the lack of tools that can be used to assess the risk for viral transmission in different settings. This review discusses practical tools that can be used to assess ventilation and airflow and evaluates some of the low technology and high technology measures that have been proposed as control measures for COVID-19. Some typical questions posed to infection control programs during the pandemic are presented to illustrate real-world application of the concepts being discussed.

A systematic review of ventilation conditions and airborne particulate matter levels in urban offices

Many working activities are carried out in office buildings that are located in urban areas. Several studies have shown that these workplaces are likely to present poor indoor environmental quality (IEQ) due to inadequate ventilation rates, compromised thermal comfort conditions, and/or high concentration of air pollutants, such as particulate matter. This study aimed to review ventilation conditions, based on carbon dioxide (CO₂ ) concentrations, and indoor airborne particulate matter (PM_2.5 and PM₁₀ ) levels assessed in offices worldwide. The approach carried out in this work followed Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Six databases (Scopus, Web of Science, PubMed, Inspec, Science Direct, and Dimensions) were used to search for peer-reviewed articles on the subject of IEQ, in particular, those reporting data for the levels of CO₂ and particulate matter in offices, published during the last decade. Firstly, 394 records were identified, resulting in 23 articles included in the review after the screening process and the implementation of eligibility criteria. Based on the results and considering the mean concentration reported, office environments present, in general, acceptable ventilation conditions (mean: 665 ppm). However, the few cases of studies that reported CO₂ values exceeding 1000 ppm identified situations of high occupancy density and inadequate operation of heating, ventilation, and air conditioning (HVAC) systems as the unequivocal causative factors. In turn, PM_2.5 and PM₁₀ seemed to be IEQ parameters that are even more critical to be tackled in offices, with the reported overall mean values (36 and 63 μg/m³ ) exceeding the current World Health Organization (WHO) guidelines (15 and 45 μg/m³ ). The highest aerosol concentrations were typically found in naturally ventilated buildings and were mostly associated with the influence of high levels of particles introduced indoors through the outdoor air. Overall, measures for improving IEQ in offices toward promoting healthy and safe environments for workers include strategies to periodically control IEQ, ensure the adequate percentage of fresh air and maintenance of the mechanical ventilation systems (operation, maintenance, and air filtration efficiency), and adjust occupancy to the room dimensions and ventilation conditions.