Upper-room ultraviolet air disinfection might help to reduce COVID-19 transmission in buildings: a feasibility study

Identification of key potential infection processes and risk factors in the computed tomography examination process by FMEA method under COVID-19

PURPOSE

To identify the key infection processes and risk factors in Computed Tomography (CT) examination process within the standard prevention and control measures for the COVID-19 epidemic, aiming to mitigate cross-infection occurrences in the hospital.

METHOD

The case hospital has assembled a team of 30 experts specialized in CT examination. Based on the CT examination process, the potential failure modes were assessed from the perspective of severity (S), occurrence probability (O), and detectability (D); they were then combined with corresponding risk prevention measures. Finally, key infection processes and risk factors were identified according to the risk priority number (RPN) and expert analysis.

RESULTS

Through the application of RPN and further analysis, four key potential infection processes were identified, including "CT request form (A1)," "during the scan of CT patient (B2)," "CT room and objects disposal (C2)," and "medical waste (garbage) disposal (C3)". In addition, eight key risk factors were also identified, including "cleaning personnel does not wear masks normatively (C32)," "nurse does not select the vein well, resulting in extravasation of the peripheral vein for enhanced CT (B25)," "patient cannot find the CT room (A13)," "patient has obtained a CT request form but does not know the procedure (A12)," "patient is too unwell to continue with the CT scan (B24)," "auxiliary staff (or technician) does not have a good grasp of the sterilization and disinfection standards (C21)," "auxiliary staff (or technician) does not sterilize the CT machine thoroughly (C22)," and "cleaning personnel lacks of knowledge of COVID-19 prevention and control (C33)".

CONCLUSION

Hospitals can publicize the precautions regarding CT examination through various channels, reducing the incidence of CT examination failure. Hospitals' cleaning services are usually outsourced, and the educational background of the staff employed in these services is generally not high. Therefore, during training and communication, it is more necessary to provide a series of scope and training programs that are aligned with their understanding level. The model developed in this study effectively identifies the key infection prevention process and critical risk factors, enhancing the safety of medical staff and patients. This has significant research implications for the potential epidemic of major infectious diseases.

Bioaerosol size as a potential determinant of airborneE. coliviability under ultraviolet germicidal irradiation and ozone disinfection

Ultraviolet germicidal irradiation (UVGI) and ozone disinfection are crucial methods for mitigating the airborne transmission of pathogenic microorganisms in high-risk settings, particularly with the emergence of respiratory viral pathogens such as SARS-CoV-2 and avian influenza viruses. This study quantitatively investigates the influence of UVGI and ozone on the viability ofE. coliin bioaerosols, with a particular focus on howE. coliviability depends on the size of the bioaerosols, a critical factor that determines deposition patterns within the human respiratory system and the evolution of bioaerosols in indoor environments. This study used a controlled small-scale laboratory chamber whereE. colisuspensions were aerosolized and subjected to varying levels of UVGI and ozone levels throughout the exposure time (2-6 s). The normalized viability ofE. coliwas found to be significantly reduced by UVGI (60-240μW s cm-2) as the exposure time increased from 2 to 6 s, and the most substantial reduction ofE. colinormalized viability was observed when UVGI and ozone (65-131 ppb) were used in combination. We also found that UVGI reduced the normalized viability ofE. coliin bioaerosols more significantly with smaller sizes (0.25-0.5μm) than with larger sizes (0.5-2.5μm). However, when combining UVGI and ozone, the normalized viability was higher for smaller particle sizes than for the larger ones. The findings provide insights into the development of effective UVGI disinfection engineering methods to control the spread of pathogenic microorganisms in high-risk environments. By understanding the influence of the viability of microorganisms in various bioaerosol sizes, we can optimize UVGI and ozone techniques to reduce the potential risk of airborne transmission of pathogens.

Ultraviolet germicidal irradiation: A prediction model to estimate UV-C-induced infectivity loss in single-strand RNA viruses

Ultraviolet germicidal irradiation (UVGI) disinfection technology is effective in inactivating microorganisms. However, its performance can vary against different microorganisms due to their diverse structural and genomic features. Thus, rapid predictions of UV (254 nm) inactivation kinetics are essential, particularly for highly infectious emerging pathogens, such as SARS-CoV-2, during the extemporary COVID-19 pandemic. In this study, aiming at single-strand RNA (ssRNA) viruses, an improved genomic model was introduced to predict the UV inactivation kinetics of viral genomes using genome sequence data. First, the overall virus infectivity loss in an aqueous matrix was estimated as the sum of damage to both the entire genome and the protein capsid. Then, the "UV rate constant ratio of aerosol and liquid" was used to convert the UV rate constant for viruses in a liquid-based matrix to an airborne state. The prediction model underwent both quantitative and qualitative validation using experimental data from this study and the literature. Finally, with the goal of mitigating potential airborne transmission of ssRNA viruses in indoor environments, this paper summarizes existing in-duct UVGI system designs and evaluates their germicidal performance. The prediction model may serve as a preliminary tool to assess the effectiveness of a UVGI system for emerging or unculturable viruses or to estimate the required UV dose when designing such a system.

Reducing airborne transmission of SARS-CoV-2 by an upper-room ultraviolet germicidal irradiation system in a hospital isolation environment

Upper-room ultraviolet germicidal irradiation (UVGI) technology can potentially inhibit the transmission of airborne disease pathogens. There is a lack of quantitative evaluation of the performance of the upper-room UVGI for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) airborne transmission under the combined effects of ventilation and UV irradiation. Therefore, this study aimed to explore the performance of the upper-room UVGI system for reducing SARS-CoV-2 virus transmission in a hospital isolation environment. Computational fluid dynamics and virological data on SARS-CoV-2 were integrated to obtain virus aerosol exposure in the hospital isolation environment containing buffer rooms, wards and bathrooms. The UV inactivation model was applied to investigate the effects of ventilation rate, irradiation flux and irradiation height on the upper-room UVGI performance. The results showed that increasing ventilation rate from 8 to 16 air changes per hour (ACH) without UVGI obtained 54.32% and 45.63% virus reduction in the wards and bathrooms, respectively. However, the upper-room UVGI could achieve 90.43% and 99.09% virus disinfection, respectively, with the ventilation rate of 8 ACH and the irradiation flux of 10 μW cm-2. Higher percentage of virus could be inactivated by the upper-room UVGI at a lower ventilation rate; the rate of improvement of UVGI elimination effect slowed down with the increase of irradiation flux. Increase irradiation height at lower ventilation rate was more effective in improving the UVGI performance than the increase in irradiation flux at smaller irradiation height. These results could provide theoretical support for the practical application of UVGI in hospital isolation environments.

Effect of ventilation strategy on performance of upper-room ultraviolet germicidal irradiation (UVGI) system in a learning environment

Upper-room ultraviolet germicidal irradiation (UVGI) system is recently in the limelight as a potentially effective method to mitigate the risk of airborne virus infection in indoor environments. However, few studies quantitatively evaluated the relationship between ventilation effectiveness and virus disinfection performance of a UVGI system. The objective of this study is to investigate the effects of ventilation strategy on detailed airflow distributions and UVGI disinfection performance in an occupied classroom. Three-dimensional computational fluid dynamics (CFD) simulations were performed for representative cooling, heating, and ventilation scenarios. The results show that when the ventilation rate is 1.1 h-1 (the minimum ventilation rate based on ASHRAE 62.1), enhancing indoor air circulation with the mixing fan notably improves the UVGI disinfection performance, especially for cooling with displacement ventilation and all-air-heating conditions. However, increasing indoor air mixing yields negligible effect on the disinfection performance for forced-convection cooling condition. The results also reveal that regardless of indoor thermal condition, disinfection effectiveness of a UVGI system increases as ventilation effectiveness is close to unity. Moreover, when the room average air speed is >0.1 m/s, upper-room UVGI system could yield about 90% disinfection effect for the aerosol size of 1 μm-10 μm. The findings of this study imply that upper-room UVGI systems in indoor environments (i.e., classrooms, hospitals) should be designed considering ventilation strategy and occupancy conditions, especially for occupied buildings with insufficient air mixing throughout the space.

Ultrafast inactivation of SARS-CoV-2 by 254-nm UV-C irradiation on porous and non-porous media of medical interest using an omnidirectional chamber

Covid-19 has spurred a renewed interest in decontamination techniques for air, objects and surfaces. Beginning in 2020, urgent effort was done to permit the reuse of UV-C for inactivating SARS-CoV-2. However, those studies diverged widely on the dose necessary to reach this goal; until today, the real value of the sensitivity of the virus to a 254-nm illumination is not known precisely. In this study, decontamination was performed in an original UV-C large decontamination chamber (UVCab, ON-LIGHT, France) delivering an omnidirectional irradiation with an average dose of 50 mJ/cm2 in 60 s. Viral inactivation was checked by both cell culture and PCR test. SARS-CoV-2 was inactivated by UV-C light within 3 s on both porous (disposable gown) and non-porous (stainless steel and apron) surfaces. For the porous surface, an irradiation of 5 min was needed to achieve a completely negative PCR signal. The Z value estimating the sensitivity of SARS-CoV-2 to UV-C in the experimental conditions of our cabinet was shown to be > 0.5820 m2/J. These results illustrate the ability of this apparatus to inactivate rapidly and definitively high loads of SARS-CoV-2 deposited on porous or non-porous supports and opens new perspectives on material decontamination using UV-C.

Impact of supplementary air filtration on aerosols and particulate matter in a UK hospital ward: a case study

BACKGROUND

Aerosol spread of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is a major problem in hospitals, leading to an increase in supplementary high-efficiency particulate air filtration aimed at reducing nosocomial transmission. This article reports a natural experiment that occurred when an air cleaning unit (ACU) on a medicine for older people ward was switched off accidentally while being commissioned.

AIM

To assess aerosol transport within the ward and determine whether the ACU reduced airborne particulate matter (PM) levels.

METHODS

An ACU was placed in a ward comprising two six-bedded bays plus three single-bed isolation rooms which had previously experienced several outbreaks of coronavirus disease 2019. During commissioning, real-time measurements of key indoor air quality parameters (PM1-10, CO2, temperature and humidity) were collected from multiple sensors over 2 days. During this period, the ACU was switched off accidentally for approximately 7 h, allowing the impact of the intervention on PM to be assessed.

FINDINGS

The ACU reduced the PM counts considerably (e.g. PM1 65.5-78.2%) throughout the ward (P<0.001 all sizes), with positive correlation found for all PM fractions and CO2 (r=0.343-0.817; all P<0.001). PM counts rose/fell simultaneously when the ACU was off, with correlation of PM signals from multiple locations (e.g. r=0.343-0.868; all P<0.001) for particulates <1 μm).

CONCLUSION

Aerosols migrated rapidly between the various ward subcompartments, suggesting that social distancing alone cannot prevent nosocomial transmission of SARS-CoV-2 as this fails to mitigate longer-range (>2 m) transmission. The ACU reduced PM levels considerably throughout the ward space, indicating its potential as an effective intervention to reduce the risk posed by infectious airborne particles.

Implementation of an Environmental Cleaning Protocol in Hospital Critical Areas Using a UV-C Disinfection Robot

Improving the cleaning and disinfection of high-touch surfaces is one of the core components of reducing healthcare-associated infections. The effectiveness of an enhanced protocol applying UV-C irradiation for terminal room disinfection between two successive patients was evaluated. Twenty high-touch surfaces in different critical areas were sampled according to ISO 14698-1, both immediately pre- and post-cleaning and disinfection standard operating protocol (SOP) and after UV-C disinfection (160 sampling sites in each condition, 480 in total). Dosimeters were applied at the sites to assess the dose emitted. A total of 64.3% (103/160) of the sampling sites tested after SOP were positive, whereas only 17.5% (28/160) were positive after UV-C. According to the national hygienic standards for health-care setting, 9.3% (15/160) resulted in being non-compliant after SOP and only 1.2% (2/160) were non-compliant after UV-C disinfection. Operation theaters was the setting that resulted in being less compliant with the standard limit (≤15 colony-forming unit/24 cm²) after SOP (12%, 14/120 sampling sites) and where the UV-C treatment showed the highest effectiveness (1.6%, 2/120). The addition of UV-C disinfection to the standard cleaning and disinfection procedure had effective results in reducing hygiene failures.

New dose-response model and SARS-CoV-2 quanta emission rates for calculating the long-range airborne infection risk

Predictive models for airborne infection risk have been extensively used during the pandemic, but there is yet still no consensus on a common approach, which may create misinterpretation of results among public health experts and engineers designing building ventilation. In this study we applied the latest data on viral load, aerosol droplet sizes and removal mechanisms to improve the Wells Riley model by introducing the following novelties i) a new model to calculate the total volume of respiratory fluid exhaled per unit time ii) developing a novel viral dose-based generation rate model for dehydrated droplets after expiration iii) deriving a novel quanta-RNA relationship for various strains of SARS-CoV-2 iv) proposing a method to account for the incomplete mixing conditions. These new approaches considerably changed previous estimates and allowed to determine more accurate average quanta emission rates including omicron variant. These quanta values for the original strain of 0.13 and 3.8 quanta/h for breathing and speaking and the virus variant multipliers may be used for simple hand calculations of probability of infection or with developed model operating with six size ranges of aerosol droplets to calculate the effect of ventilation and other removal mechanisms. The model developed is made available as an open-source tool.

Recommendations for ventilation of remodeled negative-pressure isolation wards for COVID-19 patients: A comparison of international guidelines

This mini-review provides the practice guideline recommendations for ventilation of remodeled negative-pressure isolation wards for COVID-19 Patients. Remodeled "quasi-negative-pressure" isolation wards had been proved a feasible, inexpensive, safe, and effective measure to contain nosocomial outbreaks. We should first determine the minimum required ventilation volume of an isolation ward based on the severity of COVID-19 patients. Mechanical ventilation remains the mainstay for achieving the requirement, while the assistance of recirculation is also helpful. Beyond adequate ventilation volume, the "clean to less-clean" directional airflow remains the golden rule for the solution of indoor ventilation. The virus-laden exhaust should be treated with HEPA/UV device or be kept away from living organisms, buildings, and air inlets.

COVID-19 pandemic lesson learned- critical parameters and research needs for UVC inactivation of viral aerosols

The COVID-19 pandemic highlighted public awareness of airborne disease transmission in indoor settings and emphasized the need for reliable air disinfection technologies. This increased awareness will carry in the post-pandemic era along with the ever-emerging SARS-CoV variants, necessitating effective and well-defined protocols, methods, and devices for air disinfection. Ultraviolet (UV)-based air disinfection demonstrated promising results in inactivating viral bioaerosols. However, the reported data diversity on the required UVC doses has hindered determining the best UVC practices and led to confusion among the public and regulators. This article reviews available information on critical parameters influencing the efficacy of a UVC air disinfection system and, consequently, the required dose including the system's components as well as operational and environmental factors. There is a consensus in the literature that the interrelation of humidity and air temperature has a significant impact on the UVC susceptibility, which translate to changing the UVC efficacy of commercialized devices in indoor settings under varying conditions. Sampling and aerosolization techniques reported to have major influence on the result interpretation and it is recommended to use several sampling methods simultaneously to generate comparable and conclusive data. We also considered the safety concerns and the potential safe alternative of UVC, far-UVC. Finally, the gaps in each critical parameter and the future research needs of the field are represented. This paper is the first step to consolidating literature towards developing a standard validation protocol for UVC air disinfection devices which is determined as the one of the research needs.

Evaluating the efficacy of a rotating upper-room UVC-LED irradiation device in inactivating aerosolized Escherichia coli under different disinfection ranges, air mixing, and irradiation conditions

Cost-effective and safe air disinfection methods are urgently needed in various environmental public settings. A novel UVC-based disinfection system was designed and tested to provide a promising solution because of its effective inactivation of indoor bioaerosols at a low cost. UVC light-emitting diodes (UVC-LEDs) were utilized as the irradiation source. This system has the unique feature of rotating the UVC-LEDs to generate a "scanning irradiation" zone. Escherichia coli was aerosolized into an experimental chamber, exposed to UVC-LEDs, and sampled using an impactor. Effects of air mixing (well-mixed vs. poorly-mixed), transmission range (short vs. long), and irradiation mode (stationary vs. rotating) were evaluated. The system performs significantly well under the poorly-mixed condition. The results obtained from the short disinfection range indicate that the rotating UVC was approximately 70.5 % more effective than the stationary UVC for the poorly-mixed case. Further, we evaluated the performance of the long disinfection range under a poorly-mixed situation, and the disinfection efficacy was 84.6 % higher for the rotating irradiation than that of the stationary. About 0.59-1.34 J/m² UV dose can be used to obtain one-log inactivation of E. coli. In conclusion, the novel rotating upper-room UVC-LED system is effective in reducing indoor pathogen transmission, and our findings are highly significant to a growing field where LEDs are applied for disinfection.

Ceiling impact on air disinfection performance of Upper-Room Germicidal Ultraviolet (UR-GUV)

This study used Computational Fluid Dynamics (CFD) to investigate air disinfection for SARS-CoV-2 by the Upper-Room Germicidal Ultraviolet (UR-GUV), with focus on ceiling impact. The study includes three indoor settings, i.e., low (airport bus), medium (classroom) and high (rehearsal room) ceilings, which were ventilated with 100% clean air (CA case), 80% air-recirculation with a low filtration (LF case), and 80% air-recirculation with a high filtration (HF case). According to the results, using UR-GUV can offset the increased infection risk caused by air recirculation, with viral concentrations in near field (NF) and far field (FF) in the LF case similar to those in the CA case. In the CA case, fraction remaining (FR) was 0.48-0.73 with 25% occupancy rate (OR) and 0.49-0.91 with 45% OR in the bus, 0.41 in NF and 0.11 in FF in the classroom, and 0.18 in NF and 0.09 in FF in the rehearsal room. Obviously, UR-GUV performance in NF can be improved in a room with a high ceiling where FR has a power relationship with UV zone height. As using UR-GUV can only extend the exposure time to get infection risk of 1% (T _1% ) to 8 min in NF in the classroom, and 47 min in NF in the rehearsal room, it is necessary to abide by social distancing in the two rooms. In addition, T _1% in FF was calculated to be 18.3 min with 25% OR and 21.4% with 45% OR in the airport bus, showing the necessity to further wear a mask.

UV-C Light Completely Blocks Aerosol Transmission of Highly Contagious SARS-CoV-2 Variants WA1 and Delta in Hamsters

Behavioral and medical control measures have not been effective in containing the spread of SARS-CoV-2 in large part due to the unwillingness of populations to adhere to "best practices". Ultraviolet light with wavelengths of between 200 and 280 nm (UV-C) and, in particular, germicidal ultraviolet light, which refers to wavelengths around 254 nm, have the potential to unobtrusively reduce the risk of SARS-CoV-2 transmission in enclosed spaces. We investigated the effectiveness of a strategy using UV-C light to prevent airborne transmission of the virus in a hamster model. Treatment of environmental air with 254 nm UV-C light prevented transmission of SARS-CoV-2 between individuals in a model using highly susceptible Syrian golden hamsters. The prevention of transmission of SARS-CoV-2 in a natural system by treating elements of the surrounding environment is one more weapon in the arsenal to combat COVID. The results presented indicate that coupling mitigation strategies utilizing UV-C light, along with current methods to reduce transmission risk, have the potential to allow a return to normal indoor activities.

Elucidating the role of environmental management of forests, air quality, solid waste and wastewater on the dissemination of SARS-CoV-2

The increasing frequency of zoonotic diseases is amongst several catastrophic repercussions of inadequate environmental management. Emergence, prevalence, and lethality of zoonotic diseases is intrinsically linked to environmental management which are currently at a destructive level globally. The effects of these links are complicated and interdependent, creating an urgent need of elucidating the role of environmental mismanagement to improve our resilience to future pandemics. This review focused on the pertinent role of forests, outdoor air, indoor air, solid waste and wastewater management in COVID-19 dissemination to analyze the opportunities prevailing to control infectious diseases considering relevant data from previous disease outbreaks. Global forest management is currently detrimental and hotspots of forest fragmentation have demonstrated to result in zoonotic disease emergences. Deforestation is reported to increase susceptibility to COVID-19 due to wildfire induced pollution and loss of forest ecosystem services. Detection of SARS-CoV-2 like viruses in multiple animal species also point to the impacts of biodiversity loss and forest fragmentation in relation to COVID-19. Available literature on air quality and COVID-19 have provided insights into the potential of air pollutants acting as plausible virus carrier and aggravating immune responses and expression of ACE2 receptors. SARS-CoV-2 is detected in outdoor air, indoor air, solid waste, wastewater and shown to prevail on solid surfaces and aerosols for prolonged hours. Furthermore, lack of protection measures and safe disposal options in waste management are evoking concerns especially in underdeveloped countries due to high infectivity of SARS-CoV-2. Inadequate legal framework and non-adherence to environmental regulations were observed to aggravate the postulated risks and vulnerability to future waves of pandemics. Our understanding underlines the urgent need to reinforce the fragile status of global environmental management systems through the development of strict legislative frameworks and enforcement by providing institutional, financial and technical supports.

Respiratory pandemic preparedness learnings from the June 2020 COVID-19 outbreak at San Quentin California State Prison

PURPOSE

This study aims to characterize the June 2020 COVID-19 outbreak at San Quentin California State Prison and to describe what made San Quentin so vulnerable to uncontrolled transmission.

DESIGN/METHODOLOGY/APPROACH

Since its onset, the COVID-19 pandemic has exposed and exacerbated the profound health harms of carceral settings, such that nearly half of state prisons reported COVID-19 infection rates that were four or more times (and up to 15 times) the rate found in the state's general population. Thus, addressing the public health crises and inequities of carceral settings during a respiratory pandemic requires analyzing the myriad factors shaping them. In this study, we reported observations and findings from environmental risk assessments during visits to San Quentin California State Prison. We complemented our assessments with analyses of administrative data.

FINDINGS

For future respiratory pathogens that cannot be prevented with effective vaccines, this study argues that outbreaks will no doubt occur again without robust implementation of additional levels of preparedness - improved ventilation, air filtration, decarceration with emergency evacuation planning - alongside addressing the vulnerabilities of carceral settings themselves.

ORIGINALITY/VALUE

This study addresses two critical aspects that are insufficiently covered in the literature: how to prepare processes to safely implement emergency epidemic measures when needed, such as potential evacuation, and how to address unique challenges throughout an evolving pandemic for each carceral setting.

Energy efficiency in large office buildings post-COVID-19 in Europe's top five economies

Since the World Health Organization announced the COVID-19 pandemic, indoor airflows became a synonym for virus super-spreaders and the focus point for the scientific community and professional associations across the globe, disrupting all daily life dimensions. Europe's quick response to control the disease led the REHVA board to address mitigation guidelines, reassessed by each member association's following national specifics. The present study aims to quantify the energy consumption and CO₂ emissions of "large office" buildings in top-five European economies under the COVID-19 guidelines under the post-pandemic telework forecast. Methodology resorted to a standard model under Building Energy Simulation assessment to compare prior and posterior scenarios. The latter displays a tendency to increase energy and CO₂ emissions in all locations, in the first form 10.18% (Rome) to 69.48% (Paris); and second 5.80% (Rome) and 120.61% (Paris), which will affect national energy production and imports, urban pollution and business competitiveness. On a different scope, future HVAC guidelines need to address the incoming figures, particularly in highly dense urban areas. Also, to comply with the goals set by the Paris Accord.

Assessing impact of ventilation on airborne transmission of SARS-CoV-2: a cross-sectional analysis of naturally ventilated healthcare settings in Bangladesh

OBJECTIVES

To evaluate the risk of exposure to SARS-CoV-2 in naturally ventilated hospital settings by measuring parameters of ventilation and comparing these findings with results of bioaerosol sampling.

STUDY DESIGN

Cross-sectional study.

STUDY SETTING AND STUDY SAMPLE

The study sample included nine hospitals in Dhaka, Bangladesh. Ventilation characteristics and air samples were collected from 86 healthcare spaces during October 2020 to February 2021.

PRIMARY OUTCOME

Risk of cumulative SARS-CoV-2 infection by type of healthcare area.

SECONDARY OUTCOMES

Ventilation rates by healthcare space; risk of airborne detection of SARS-CoV-2 across healthcare spaces; impact of room characteristics on absolute ventilation; SARS-CoV-2 detection by naturally ventilated versus mechanically ventilated spaces.

RESULTS

The majority (78.7%) of naturally ventilated patient care rooms had ventilation rates that fell short of the recommended ventilation rate of 60 L/s/p. Using a modified Wells-Riley equation and local COVID-19 case numbers, we found that over a 40-hour exposure period, outpatient departments posed the highest median risk for infection (7.7%). SARS-CoV-2 RNA was most frequently detected in air samples from non-COVID wards (50.0%) followed by outpatient departments (42.9%). Naturally ventilated spaces (22.6%) had higher rates of SARS-CoV-2 detection compared with mechanically ventilated spaces (8.3%), though the difference was not statistically significant (p=0.128). In multivariable linear regression with calculated elasticity, open door area and cross-ventilation were found to have a significant impact on ventilation.

CONCLUSION

Our findings provide evidence that naturally ventilated healthcare settings may pose a high risk for exposure to SARS-CoV-2, particularly among non-COVID-designated spaces, but improving parameters of ventilation can mitigate this risk.

Ten questions concerning the paradox of minimizing airborne transmission of infectious aerosols in densely occupied spaces via sustainable ventilation and other strategies in hot and humid climates

Airborne disease transmission in indoor spaces and resulting cross-contamination has been a topic of broad concern for years - especially recently with the outbreak of COVID-19. Global recommendations on this matter consist of increasing the outdoor air supply in the aim of diluting the indoor air. Nonetheless, a paradoxical relationship has risen between increasing amount of outdoor air and its impact on increased energy consumption - especially densely occupied spaces. The paradox is more critical in hot and humid climates, where large amounts of energy are required for the conditioning of the outdoor air. Therefore, many literature studies investigated new strategies for the mitigation of cross-contamination with little-to-no additional cost of energy. These strategies mainly consist of the dilution and/or the capture and removal of contaminants at the levels of macroenvironment room air and occupant-adjacent microenvironment. On the macroenvironment level, the dilution occurs by the supply of large amounts of outdoor air in a sustainable way using passive cooling systems, and the removal of contaminants happens via filtering. Similarly, the microenvironment of the occupant can be diluted using localized ventilation techniques, and contaminants can be captured and removed by direct exhaust near the source of contamination. Thus, this work answers ten questions that explore the most prevailing technologies from the above-mentioned fronts that are used to mitigate cross-contamination in densely occupied spaces located in hot and humid climates at minimal energy consumption. The paper establishes a basis for future work and insights for new research directives for macro and microenvironment approaches.

Southeastern United States Predictors of COVID-19 in Nursing Homes

This study’s aim was to determine nursing home (NH) and county-level predictors of COVID-19 outbreaks in nursing homes (NHs) in the southeastern region of the United States across three time periods. NH-level data compiled from census data and from NH compare and NH COVID-19 infection datasets provided by the Center for Medicare and Medicaid Services cover 2951 NHs located in 836 counties in nine states. A generalized linear mixed-effect model with a random effect was applied to significant factors identified in the final stepwise regression. County-level COVID-19 estimates and NHs with more certified beds were predictors of COVID-19 outbreaks in NHs across all time periods. Predictors of NH cases varied across the time periods with fewer community and NH variables predicting COVID-19 in NH during the late period. Future research should investigate predictors of COVID-19 in NH in other regions of the US from the early periods through March 2021.

UV inactivation of Semliki Forest virus and bacteria by alternative light sources

The quick spreading of the SARS-CoV-2 virus, initiating the global pandemic with a significant impact on economics and health, highlighted an urgent need for effective and sustainable restriction mechanisms of pathogenic microorganisms. UV-C radiation, causing inactivation of many viruses and bacteria, is one of the tools for disinfection of different surfaces, liquids, and air; however, mainly mercury 254 nm line is commonly used for it. In this paper, we report our results of the experiments with newly elaborated special type polychromatic non-mercury UV light sources, having spectral lines in the spectral region from 190 nm to 280 nm. Inactivation tests were performed with both Escherichia coli (E.coli) bacteria and Semliki Forest virus (SFV) as a representative of human enveloped RNA viruses. In addition, the effect of prepared lamps on virus samples in liquid and dry form (dried virus-containing solution) was tested. Reduction of 4 log10 of E.coli was obtained after 10 min of irradiation with both thallium-antimony and arsenic high-frequency electrodeless lamps. High reduction results for the arsenic light source demonstrated sensitivity of E. coli to wavelengths below 230 nm, including spectral lines around 200 nm. For the Semliki Forest virus, the thallium-antimony light source showed virus inactivation efficiency with a high virus reduction rate in the range of 3.10 to > 4.99 log10 within 5 min of exposure. Thus, the new thallium-antimony light source showed the most promising disinfection effect in bacteria and viruses, and arsenic light sources for bacteria inactivation, opening doors for many applications in disinfection systems, including for pathogenic human RNA viruses.

Evaluation of UV-C Radiation Efficiency in the Decontamination of Inanimate Surfaces and Personal Protective Equipment Contaminated with Phage ϕ6

To help halt the global spread of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), appropriate disinfection techniques are required. Over the last years, the interest in Ultraviolet-C (UV-C) radiation as a method to disinfect inanimate surfaces and personal protective equipment (PPE) has increased, mainly to efficiently disinfect and prevent SARS-CoV-2 from spreading and allow for the safe reuse of said equipment. The bacteriophage ϕ6 (or simply phage ϕ6) is an RNA virus with a phospholipid envelope and is commonly used in environmental studies as a surrogate for human RNA-enveloped viruses, including SARS-CoV-2. The present study investigated the use of two new UV irradiation systems ((2)2.4W and (8)5.5W)) constituted by conventional mercury UV-C lamps with a strong emission peak at ~254 nm to potentially inactivate phage ϕ6 on different surfaces (glass, plastic, stainless steel, and wood) and personal protective equipment, PPE, (surgical and filtering facepiece 2, FFP2, masks, a clear acetate visor, and disposable protective clothing). The results showed that both UV-C systems were effective in inactivating phage ϕ6, but the UV-C sterilizing chamber (8)5.5W had the best disinfection performance on the tested surfaces. The inactivation effectiveness is material-dependent on all surfaces, reaching the detection limit of the method at different times (between 60 and 240 s of irradiation). The glass surface needed less time to reduce the virus (30 s) when compared with plastic, stainless, and wood surfaces (60 s). The virus inactivation was more effective in the disposable surgical and FFP2 masks (60 and 120 s, respectively) than in the disposable vest and clear acetate visor (240 s). Overall, this study suggests that UV-C lamps with peak emission at ~254 nm could provide rapid, efficient, and sustainable sanitization procedures to different materials and surfaces. However, dosage and irradiation time are important parameters to be considered during their implementation as a tool in the fight against human coronaviruses, namely against SARS-CoV-2.

Inactivation of Pathogens in Air Using Ultraviolet Direct Irradiation Below Exposure Limits

A method is described for inactivation of pathogens, especially airborne pathogens, using ultraviolet (UV) radiation emitted directly into occupied spaces and exposing occupants to a dose below the accepted actinic exposure limit (EL). This method is referred to as direct irradiation below exposure limits, or DIBEL. It is demonstrated herein that low-intensity UV radiation below exposure limits can achieve high levels of equivalent air changes per hour (ACHeq) and can be an effective component of efforts to combat airborne pathogens such as the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (COVID-19). An ACHeq of 4 h-¹ is presently achievable over a continuous 8 h period for the SARS-CoV-2 virus with UV-C light-emitting diodes (LEDs) having peak wavelength at 275 nm, and future improvements in LED technology and optics are anticipated to enable improvements up to 150 h-¹ in the coming decade. For example, the actinic EL is 60 J/m² at 254 nm, and human coronaviruses, including SARS-CoV-2, have a UV dose required for 90 % inactivation of about 5 J/m² at 254 nm. Irradiation by 254 nm UV-C at the EL is expected to provide 90 % inactivation of these organisms in air in about 40 min when the UV-C is delivered at a constant irradiance over 8 h, or in about 5 min if the UV-C is delivered at a constant irradiance over 1 h. Since the irradiation is continuous, the inactivation of initial contaminants accumulates to 99 % and then 99.9 %, and it also immediately begins inactivating any newly introduced (e.g., exhaled) pathogens at the same rate throughout the 8 h period. The efficacy for inactivating airborne pathogens with DIBEL may be expressed in terms of ACHeq, which may be compared with conventional ventilation-based methods for air disinfection. DIBEL may be applied in addition to other disinfection methods, such as upper room UV germicidal irradiation, and mechanical ventilation and filtration. The ACHeq of the separate methods is additive, providing enhanced cumulative disinfection rates. Conventional air disinfection technologies have typical ACHeq values of about 1 h-¹ to 5 h-¹ and maximum practical values of about 20 h-¹. UV-C DIBEL currently provides ACHeq values that are typically about 1 h-¹ to 10 h-¹, thus either complementing, or potentially substituting for, conventional technologies. UV-C DIBEL protocols are forecast herein to evolve to >100 ACHeq in a few years, potentially surpassing conventional technologies. UV-A (315 nm to 400 nm) and/or UV-C (100 nm to 280 nm) DIBEL is also efficacious at inactivating pathogens on surfaces. The relatively simple installation, low acquisition and operating costs, and unobtrusive aesthetic of DIBEL using UV LEDs contribute value in a layered, multi-agent disinfection strategy.

Review of air disinfection approaches and proposal for thermal inactivation of airborne viruses as a life-style and an instrument to fight pandemics

COVID-19 (Coronavirus Disease 2019) pandemic highlighted the importance of air biosecurity because SARS-CoV-2 is mainly transmitted from person to person via airborne droplets. Preventing infectious droplets from entering the body is one of the best ways to protect against infection. This paper reviews the transmission patterns of airborne pathogens and air disinfection methods. A particular emphasis is put on studies devoted to the thermal inactivation of viruses. These reviews reveal that air heat treatment has not been seriously considered as a possible air disinfection approach. Simple calculations show that the energy input required for thermal disinfection of human's air daily consumption is almost the same as for daily water consumption (by heat treatment from room temperature to 100 °C). Moreover, it is possible to organize a continuous heat recovery from the air already heated during disinfection to the inlet air, thus significantly increasing the energy efficiency. Therefore, I propose a solution for the thermal inactivation of airborne pathogens based on air heating and its subsequent cooling in a heat exchanger with heat recovery. Such a solution could be used to create mobile personal and stationary indoor air disinfectors, as well as heating, ventilation, and air conditioning systems. Thermal disinfection of air to breathe might one day be part of people's daily life like thermal disinfection of drinking water. Aside from limiting infectious disease transmission, thermal inactivation might be the basis for developing inhaled vaccines using thermally inactivated whole pathogens.

Designing Post COVID-19 Buildings: Approaches for Achieving Healthy Buildings

The COVID-19 pandemic forced the accessibility, social gathering, lifestyle, and working environment to be changed to reduce the infection. Coronavirus spreads between people in several different ways. Small liquid particles (aerosols, respiratory droplets) from an infected person are transmitted through air and surfaces that are in contact with humans. Reducing transmission through modified heating, ventilation, and air conditioning (HVAC) systems and building design are potential solutions. A comprehensive review of the engineering control preventive measures to mitigate COVID-19 spread, healthy building design, and material was carried out. The current state-of-the-art engineering control preventive measures presented include ultraviolet germicidal irradiation (UVGI), bipolar ionization, vertical gardening, and indoor plants. They have potential to improve the indoor air quality. In addition, this article presents building design with materials (e.g., copper alloys, anti-microbial paintings) and smart technologies (e.g., automation, voice control, and artificial intelligence-based facial recognition) to mitigate the infections of communicable diseases.

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.

UltraViolet SANitizing System for Sterilization of Ambulances Fleets and for Real-Time Monitoring of Their Sterilization Level

BACKGROUND

The contamination of ambulances with pathogenic agents represents a potential threat for the public health, not only for common pathogens but also for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The aim of this project was to exploits the germicidal effect of the UVC radiation at 254 nm to sanitize the patient's compartment of ambulances with an advanced UltraViolet SANitizing System (UV-SAN) and assess its relevance for avoiding the spread of COVID-19 and other drug resistant pathogens.

METHODS

The system is equipped with UVC lamps that are activated when the ambulance compartment is empty and sanitize the environment in less than 15 min. An Ozone sensor continuously monitors the gas concentration, ensuring it does not exceed threshold value harmful for patients and operators' health. The system is relying on GNSS data and a satellite communication link, which allow to monitor and record traceability (when, where and what) of all the sanitation operations performed. This information is real-time monitored from a dedicated web-application.

RESULTS

UVC irradiation efficiently reduced SARS-CoV-2 virus titer (>99.99%), on inanimate surfaces such as plastic, stainless steel or rubber, with doses ranging from 5.5 to 24.8 mJ/cm2 and the UV-SAN system is effective against multi drug resistant (MDR) bacteria up to >99.99%, after 10 to 30 min of irradiation.

CONCLUSIONS

UV-SAN can provide rapid, efficient and sustainable sanitization procedures of ambulances.

Removal of SARS-CoV-2 using UV+Filter in built environment

Air cleaning is an effective and reliable method in indoor airborne SARS-CoV-2 (Severe Acute Respiratory Syndrome Corona-Virus 2) control, with ability of aerosol removal or disinfection. However, traditional air cleaning systems (e.g. fibrous filter, electrostatic removal system) have some risks in operation process, including re-aerosolization and electric breakdown. To avoid these risks, the current study proposed an UV+Filter (ultraviolet and fibrous pleated filter) system to efficiently capture airborne SARS-CoV-2 aerosols and deactivate them in filter medium. It is challenging to quantitatively design UV+Filter due to complex characteristics of SARS-CoV-2 aerosols (e.g. aerodynamic size, biological susceptibility) and hybrid filtration/disinfection processes. This study numerically investigated the overall performances of different air cleaning devices (e.g. Fibrous-filter, UV+Filter, two-stage ESP (electrostatic precipitator) et al.) for control of SARS-CoV-2 aerosols and compared them in term of filtration efficiency, energy consumption and secondary pollution. The prediction of developed models was validated with the experimental data from literature. UV+Filter is the most reliable and safest, while its energy consumption is highest. The newly proposed design method of air cleaning systems could provide essential tools for airborne diseases control.

Food Safety and Employee Health Implications of COVID-19: A Review

The COVID-19 pandemic has greatly impacted the U.S. food supply and consumer behavior. Food production and processing are being disrupted as illnesses, proactive quarantines, and government-mandated movement restrictions cause labor shortages. In this environment, the food industry has been required to adopt new, additional practices to minimize the risk of COVID-19 cases and outbreaks among its workforce. Successfully overcoming these challenges requires a comprehensive approach that addresses COVID-19 transmission both within and outside the facility. Possible interventions include strategies (i) to vaccinate employees, (ii) to assure that employees practice social distancing, (iii) to assure that employees wear face coverings, (iv) to screen employees for COVID-19, (v) to assure that employees practice frequent hand washing and avoid touching their faces, (vi) to clean frequently touched surfaces, and (vii) to assure proper ventilation. Compliance with these control strategies must be verified, and an overall COVID-19 control culture must be established to implement an effective program. Despite some public misperceptions about the health risk of severe acute respiratory syndrome coronavirus 2 on foods or food packaging, both the virus biology and epidemiological data clearly support a negligible risk of COVID-19 transmission through food and food packing. However, COVID-19 pandemic-related supply chain and workforce disruptions and the shift in resources to protect food industry employees from COVID-19 may increase the actual food safety risks. The goal of this review was to describe the COVID-19 mitigation practices adopted by the food industry and the potential impact of these practices and COVID-19-related disruptions on the industry's food safety mission. A review of these impacts is necessary to ensure that the food industry is prepared to maintain a safe and nutritious food supply in the face of future global disruptions.

COVID-19: The impact in US high-rise office buildings energy efficiency

The COVID-19 pandemic, through stay-at-home orders, forced rapid changes to social human behavior and interrelations, targeting the work environments to protect workers and users. Rapidly, global organizations, US associations, and professionals stepped in to mitigate the virus's spread in buildings' living and work environments. The institutions proposed new HVAC settings without efficiency concerns, as improved flow rates and filtering for irradiation, humidity, and temperature. Current literature consensually predicted an increase in energy consumption due to new measures to control the SARS-CoV-2 spread. The research team assumed the effort of validating the prior published outcomes, applied to US standardized high-rise office buildings, as defined and set by the key entities in the field, by resorting to a methodology based on software energy analysis. The study compares a standard high-rise office building energy consumption, CO₂ emissions and operations costs in nine US climate zones - from 0 to 8, south to north latitudes, respectively -, assessed in the most populated cities, between the previous and post COVID-19 scenarios. The outcomes clarify the gathered knowledge, explaining that climate zones above mixed-humid type tend to increase relative energy use intensity by 21.72%, but below that threshold the zones decrease relative energy use intensity by 11.92%.

Determination of the characteristic inactivation fluence for SARS-CoV-2 under UV-C radiation considering light absorption in culture media

The optical absorption coefficient of culture media is critical for the survival analysis of pathogens under optical irradiation. The quality of the results obtained from experiments relies on the optical analysis of the spatial distribution of fluence which also depends on the geometry of the sample. In this contribution, we consider both the geometrical shape and the culture medium's absorption coefficient to evaluate how the spatial distribution of optical radiation affects pathogens/viruses. In this work, we exposed SARS-CoV-2 to UV-C radiation ([Formula: see text] = 254 nm) and we calculated-considering the influence of the optical absorption of the culture medium-a characteristic inactivation fluence of [Formula: see text] = 4.7 J/m2, or an equivalent 10% survival (D90 dose) of 10.8 J/m2. Experimentally, we diluted the virus into sessile drops of Dulbecco's Modified Eagle Medium to evaluate pathogen activity after controlled doses of UV irradiation. To validate the optical absorption mode, we carried out an additional experiment where we varied droplet size. Our model-including optical absorption and geometrical considerations-provides robust results among a variety of experimental situations, and represents our experimental conditions more accurately. These results will help to evaluate the capability of UV disinfecting strategies applied to a variety of everyday situations, including the case of micro-droplets generated by respiratory functions.

Ultraviolet germicidal irradiation (UVGI) for in-duct airborne bioaerosol disinfection: Review and analysis of design factors

The rapid increase in global cases of COVID-19 illness and death requires the implementation of appropriate and efficient engineering controls to improve indoor air quality. This paper focuses on the use of the ultraviolet germicidal irradiation (UVGI) air purification technology in HVAC ducts, which is particularly applicable to buildings where fully shutting down air recirculation is not feasible. Given the poor understanding of the in-duct UVGI system regarding its working mechanisms, designs, and applications, this review has the following key research objectives:•Identifying the critical parameters for designing a UVGI system, including the characterization of lamp output, behavior of the target microbial UV dose-response, and evaluation of the inactivation performance and energy consumption.•Elucidating the effects of environmental factors (air velocity, air temperature, and humidity) on the UVGI system design parameters and optimization of the in-duct UVGI design.•Summarizing existing UVGI system designs in the literature and illustrating their germicidal and energy performance in light of COVID-19 mitigation.

Severe acute respiratory syndrome coronavirus-2 medical solid waste treatment: A need for efficient and effective strategies in low-resourced settings

Understanding infections related to handling healthcare waste products is of critical importance and the application of simple and low-cost strategies remain a priority in low-income and middle-income countries to protect healthcare workers. We examined the potential effect of relative humidity (RH), air temperature and ultraviolet irradiation (UI) to establish an efficient and effective way to facilitate disposal of medical waste. Literature is emerging on the effect of high RH and high temperature, which would increase airborne mass deposition and decrease the viability of viruses in both airborne particles and on surfaces. On the other hand, severe acute respiratory syndrome coronavirus-2 has been proven to be susceptible to UI when suspended in air like other coronaviruses. An innovative approach utilizing environmental conditions might represent an effective and efficient way to ensure better and sustainable protection of the healthcare workers in low-resourced settings.

The efficacy of ultraviolet light-emitting technology against coronaviruses: a systematic review

The ongoing pandemic of COVID-19 has underlined the importance of adopting effective infection prevention and control (IPC) measures in hospital and community settings. Ultraviolet (UV)-based technologies represent promising IPC tools: their effective application for sanitation has been extensively evaluated in the past but scant, heterogeneous and inconclusive evidence is available on their effect on SARS-CoV-2 transmission. With the aim of pooling the available evidence on the efficacy of UV technologies against coronaviruses, we conducted a systematic review following PRISMA guidelines, searching Medline, Embase and the Cochrane Library, and the main clinical trials' registries (WHO ICTRP, ClinicalTrials.gov, Cochrane and EU Clinical Trial Register). Quantitative data on studies' interventions were summarized in tables, pooled by different coronavirus species and strain, UV source, characteristics of UV light exposure and outcomes. Eighteen papers met our inclusion criteria, published between 1972 and 2020. Six focused on SARS-CoV-2, four on SARS-CoV-1, one on MERS-CoV, three on seasonal coronaviruses, and four on animal coronaviruses. All were experimental studies. Overall, despite wide heterogenicity within included studies, complete inactivation of coronaviruses on surfaces or aerosolized, including SARS-CoV-2, was reported to take a maximum exposure time of 15 min and to need a maximum distance from the UV emitter of up to 1 m. Advances in UV-based technologies in the field of sanitation and their proved high virucidal potential against SARS-CoV-2 support their use for IPC in hospital and community settings and their contribution towards ending the COVID-19 pandemic. National and international guidelines are to be updated and parameters and conditions of use need to be identified to ensure both efficacy and safety of UV technology application for effective infection prevention and control in both healthcare and non-healthcare settings.

SARS-CoV-2 Survival on Surfaces and the Effect of UV-C Light

The aim of this study was to establish the persistence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on inanimate surfaces such as plastic, stainless steel, and glass during UV-C irradiation which is a physical means commonly utilized in sanitization procedures. The viral inactivation rate, virus half-life, and percentage of titer reduction after UV-C irradiation were assessed. Infectivity was maintained on plastic and glass until 120 h and on stainless steel until 72 h. The virus half-life was 5.3, 4.4, and 4.2 h on plastic, stainless steel, and glass, respectively. In all cases, titer decay was >99% after drop drying. UV-C irradiation efficiently reduced virus titer (99.99%), with doses ranging from 10.25 to 23.71 mJ/cm². Plastic and stainless steel needed higher doses to achieve target reduction. The total inactivation of SARS-CoV-2 on glass was obtained with the lower dose applied. SARS-CoV-2 survival can be long lasting on inanimate surfaces. It is worth recommending efficient disinfection protocols as a measure of prevention of viral spread. UV-C can provide rapid, efficient and sustainable sanitization procedures of different materials and surfaces. The dosages and mode of irradiation are important parameters to consider in their implementation as an important means to fight the SARS-CoV-2 pandemic.

Viruses such as SARS-CoV-2 can be partially shielded from UV radiation when in particles generated by sneezing or coughing: Numerical simulations

UV radiation can inactivate viruses such as SARS-CoV-2. However, designing effective UV germicidal irradiation (UVGI) systems can be difficult because the effects of dried respiratory droplets and other fomites on UV light intensities are poorly understood. Numerical modeling of UV intensities inside virus-containing particles on surfaces can increase understanding of these possible reductions in UV intensity. We model UV intensities within spherical approximations of virions randomly positioned within spherical particles. The model virions and dried particles have sizes and optical properties to approximate SARS-CoV-2 and dried particles formed from respiratory droplets, respectively. In 1-, 5- and 9-µm diameter particles on a surface, illuminated by 260-nm UV light from a direction perpendicular to the surface, 0%, 10% and 18% (respectively) of simulated virions are exposed to intensities less than 1/100^th of intensities in individually exposed virions (i.e., they are partially shielded). Even for 302-nm light (simulating sunlight), where absorption is small, 0% and 11% of virions in 1- and 9-µm particles have exposures 1/100^th those of individually exposed virions. Shielding is small to negligible in sub-micron particles. Results show that shielding of virions in a particle can be reduced by illuminating a particle either from multiple widely separated incident directions, or by illuminating a particle rotating in air for a time sufficient to rotate through enough orientations. Because highly UV-reflective paints and surfaces can increase the angular ranges of illumination and the intensities within particles, they appear likely to be useful for reducing shielding of virions embedded within particles.

The ventilation of buildings and other mitigating measures for COVID-19: a focus on wintertime

The year 2020 has seen the emergence of a global pandemic as a result of the disease COVID-19. This report reviews knowledge of the transmission of COVID-19 indoors, examines the evidence for mitigating measures, and considers the implications for wintertime with a focus on ventilation.

Bare-bulb Upper-Room Germicidal Ultraviolet-C (GUV) Indoor Air Disinfection for COVID-19†

Reliable indoor air disinfection could make clinical and other necessary indoor spaces safer during epidemics with airborne transmission like COVID‐19. Low‐dose upper‐room germicidal ultraviolet‐C (GUV 254 nm) is well suited for this because of the SARS‐CoV‐2 virus' sensitivity to GUV inactivation and GUV's relatively easy adaptability to many types of indoor spaces without respect to outside weather conditions. However, most existing upper‐room GUV fixtures are relatively expensive and inefficient at creating an upper‐room disinfection zone due to loss of disinfecting UV‐C photons caused by the casing and louvers designed to protect persons in the occupied space. Presented herein are two moderate‐size restaurant spaces, 900 ft² (83.6 m²) and 630 ft² (58.5 m²), respectively, in which low‐cost bare‐bulb GUV fixtures, without exterior casing, were installed with upward‐pulling ceiling fans to provide upper‐room disinfection and lower‐room safety. Proper safety‐tested installations like these are adaptable to hospital emergency department waiting rooms, clinics, nursing home and prison common areas, public libraries, schools and restaurants.