Viral Load of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in Respiratory Aerosols Emitted by Patients With Coronavirus Disease 2019 (COVID-19) While Breathing, Talking, and Singing.

BACKGROUND: Multiple severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) superspreading events suggest that aerosols play an important role in driving the coronavirus disease 2019 (COVID-19) pandemic. To better understand how airborne SARS-CoV-2 transmission occurs, we sought to determine viral loads within coarse (>5 µm) and fine (≤5 µm) respiratory aerosols produced when breathing, talking, and singing. METHODS: Using a G-II exhaled breath collector, we measured viral RNA in coarse and fine respiratory aerosols emitted by COVID-19 patients during 30 minutes of breathing, 15 minutes of talking, and 15 minutes of singing. RESULTS: Thirteen participants (59%) emitted detectable levels of SARS-CoV-2 RNA in respiratory aerosols, including 3 asymptomatic and 1 presymptomatic patient. Viral loads ranged from 63-5821 N gene copies per expiratory activity per participant, with high person-to-person variation. Patients earlier in illness were more likely to emit detectable RNA. Two participants, sampled on day 3 of illness, accounted for 52% of total viral load. Overall, 94% of SARS-CoV-2 RNA copies were emitted by talking and singing. Interestingly, 7 participants emitted more virus from talking than singing. Overall, fine aerosols constituted 85% of the viral load detected in our study. Virus cultures were negative. CONCLUSIONS: Fine aerosols produced by talking and singing contain more SARS-CoV-2 copies than coarse aerosols and may play a significant role in SARS-CoV-2 transmission. Exposure to fine aerosols, especially indoors, should be mitigated. Isolating viable SARS-CoV-2 from respiratory aerosol samples remains challenging; whether this can be more easily accomplished for emerging SARS-CoV-2 variants is an urgent enquiry necessitating larger-scale studies.

Quantifying the effectiveness of desk dividers in reducing droplet and airborne virus transmission.

The utilization of physical dividers has been recommended as a practical approach to reducing the droplet and aerosol transmissions of the COVID-19 virus (SARS-CoV-2). This study conducted a series of experiments using video recording with a high-speed camera, particle image velocimetry (PIV) technique, and concentration measurements. The effectiveness of Perspex desk dividers impeding the transient transmission during coughing in five representative layouts was investigated. The results showed that the divider effectively protected the exposed person from an infector's cough seated in a face-to-face arrangement at a distance of 1.5 m. The aerosol concentration at the breathing zone was reduced by 99% compared to the layout without dividers. However, the reflection of aerosols from the dividers increased the exposure risk to the person seated beside the infector. Such risk was substantially reduced if the dividers were placed parallel between the infector and exposed person seated side-by-side. When the exposed person was staggered (face-to-face but displaced sideways laterally) to the infector with a 0.55-m lateral distance, the dividers reduced the potential exposure at the breathing zone by 60%. Considering the effectiveness in exposure reduction, the staggered configuration of desk dividers between the infector and exposed persons offers the best reduction to exposure.

Evaluation of aerosol transmission risk during home quarantine under different operating scenarios: A pilot study.

SARS-CoV-2 has been recognized to be airborne transmissible. With the large number of reported positive cases in the community, home quarantine is recommended for the infectors who are not severely ill. However, the risks of household aerosol transmission associated with the quarantine room operating methods are under-explored. We used tracer gas technique to simulate the exhaled virus laden aerosols from a patient under home quarantine situation inside a residential testbed. The Sulphur hexafluoride (SF6) concentration was measured both inside and outside the quarantine room under different operating settings including, air-conditioning and natural ventilation, presence of an exhaust fan, and the air movement generated by ceiling or pedestal fan. We calculated the outside-to-inside SF6 concentration to indicate potential exposure of occupants in the same household. In-room concentration with air-conditioning was 4 times higher than in natural ventilation settings. Exhaust fan operation substantially reduced in-room SF6 concentration and leakage rate in most of the ventilation scenarios, except for natural ventilation setting with ceiling fan. The exception is attributable to the different airflow patterns between ceiling fan (recirculates air vertically) and pedestal fan (moves air horizontally). These airflow variations also led to differences in SF6 concentration at two sampling heights (0.1 m and 1.7 m) and SF6 leakage rates when the quarantine room door was opened momentarily. Use of natural ventilation rather than air-conditioning, and operating exhaust fan when using air-conditioning are recommended to lower exposure risk for home quarantine. A more holistic experiment will be conducted to address the limitations reflected in this study.

Respiratory performance of humans exposed to moderate levels of carbon dioxide.

In a business as usual scenario, atmospheric carbon dioxide concentration (CO2 ) could reach 950 parts per million (ppm) by 2100. Indoor CO2 concentrations will rise consequently, given its dependence on atmospheric CO2 levels. If buildings are ventilated following current standards in 2100, indoor CO2 concentration could be over 1300 ppm, depending on specific ventilation codes. Such exposure to CO2 could have physiological and psychological effects on building occupants. We conducted a randomized, within-subject study, examining the physiological effects on the respiratory functions of 15 persons. We examined three exposures, each 150 min long, with CO2 of: 900 ppm (reference), 1450 ppm (decreased ventilation), and 1450 ppm (reference condition with added pure CO2 ). We measured respiratory parameters with capnometry and forced vital capacity (FVC) tests. End-tidal CO2 and respiration rates did not significantly differ across the three exposures. Parameters measured using FVC decreased significantly from the start to the end of exposure only at the reduced ventilation condition (p < 0.04, large effect size). Hence, poor ventilation likely affects respiratory parameters. This effect is probably not caused by increased CO2 alone and rather by other pollutants-predominantly human bioeffluents in this work-whose concentrations increased as a result.

Performance characteristics of a fan filter unit (FFU) in mitigating particulate matter levels in a naturally ventilated classroom during haze conditions.

The performance of a low-cost fan filter unit (FFU) in mitigating hazardous particulate matter (PM) levels in a naturally ventilated school classroom is presented. The FFU can be considered as a simplified mechanical ventilation and air-conditioning system without heating and cooling functions. The FFU improves indoor air quality through introduction of cleaned outdoor air to flush out internally generated heat and moisture and reducing infiltration by maintaining indoor pressurization. Indoor particle number concentrations were reduced between 85% and 95%. The particle removal performance (PRFFFU ) of the FFU is determined and incorporated into the augmented façade penetration factor (Paug ). A case-specific recursive dynamic mass balance model is used to characterize the infiltration factor (FINF ), deposition rate (K), and the penetration efficiency (Paug ) from continuously monitored indoor and outdoor mass concentration levels. Computed "Paug " (0.07, 0.09, and 0.13) and "FINF " (0.06, 0.08, and 0.11), respectively, for PM10, PM2.5, and PM1 suggest that exposure to PM was significantly reduced indoors. The effectiveness of the FFU for reduced "FINF " and "Paug " may be attributed to its superior filtration, dilution, and exfiltration mechanisms. In comparison with alternative PM mitigation solutions, the FFU is effective, affordable, and sustainable.

Infiltration of fine particles in urban daycares.

Singapore is a tropical country with a high density of day-care facilities whose indoor environments may be adversely affected by outdoor fine particle (PM2.5 ) air pollution. To reduce this problem requires effective, evidence-based exposure-reduction strategies. Little information is available on the penetration of outdoor PM2.5 into day-care environments. Our study attempted to address the following objectives: to measure indoor infiltration factor (Finf ) of PM2.5 from outdoor PM2.5 and to determine the building parameters that modify the indoor PM2.5 . We collected indoor/outdoor 1-min PM2.5 from 50 day-care classrooms. We noted mean Finf  ± SD of 0.65 ± 0.22 in day-care rooms which are naturally ventilated and lower Finf  ± SD values of 0.47 ± 0.18 for those that are air-conditioned: values which are lower than those reported in Singapore residences. The air exchange rates were higher in naturally ventilated rooms (1.47 vs 0.86 h-1 ). However, fine particle deposition rates were lower for naturally ventilated rooms (0.67 ± 0.43 h-1 ) compared with air-conditioned ones (1.03 ± 0.55 h-1 ) presumably due to composite rates linked to the filters within the split unit air-conditioners, higher recirculation rates, and interior surfaces in the latter. Our findings indicate that children remaining indoor in daycares where air-conditioning is used can reduce their PM2.5 exposures during outdoor pollution episodes.

Size-resolved dynamics of indoor and outdoor fluorescent biological aerosol particles in a bedroom: A one-month case study in Singapore.

This study evaluated the interrelations between indoor and outdoor bioaerosols in a bedroom under a living condition. Two wideband integrated bioaerosol sensors were utilized to measure indoor and outdoor particulate matter (PM) and fluorescent biological airborne particles (FBAPs), which were within a size range of 0.5-20 µm. Throughout this one-month case study, the median proportion of FBAPs in PM by number was 19% (5%; the interquartile range, hereafter) and 17% (3%) for indoors and outdoors, respectively, and those by mass were 78% (12%) and 55% (9%). According to the size-resolved data, FBAPs dominated above 2 and 3.5 µm indoors and outdoors, respectively. Comparing indoor upon outdoor ratios among occupancy and window conditions, the indoor FBAPs larger than 3.16 µm were dominated by indoor sources, while non-FBAPs were mainly from outdoors. The occupant dominated the indoor source of both FBAPs and non-FBAPs. Under awake and asleep, count- and mass-based mean emission rates were 45.9 and 18.7 × 106 #/h and 5.02 and 2.83 mg/h, respectively. Based on indoor activities and local outdoor air quality in Singapore, this study recommended opening the window when awake and closing it during sleep to lower indoor bioaerosol exposure.

Indoor environmental quality, occupant satisfaction, and acute building-related health symptoms in Green Mark-certified compared with non-certified office buildings.

Indoor environmental quality (IEQ) has become an important component of green building certification schemes. While green buildings are expected to provide enhanced IEQ, higher occupant satisfaction, and less risks of occupant health when compared with non-green buildings, the literature suggests inconsistent evidence due to diverse research design, small sample size, and weak statistical analysis. This study compared several outcomes pertinent to IEQ performance in green and non-green office buildings in Singapore. Adopting a cross-sectional study design, objective measurements were taken in eight green and six non-green buildings, and satisfaction and acute health symptom risks of 367 occupants were obtained. Green buildings exhibited lower concentration of PM2.5, bacteria, and fungi and maintained temperature and humidity more consistently compared to non-green counterparts. The mean ratings for satisfaction with temperature, humidity, lighting level, air quality, and indoor environment were higher in green buildings (with statistical significance P < 0.05). There was statistically significant reduction in risk of occupants having headache, unusual fatigue, and irritated skin in green buildings. Although matching of buildings and occupant characteristics, survey participation bias, and sampling duration (a 1-week snapshot) of IEQ monitoring remain as limitations, this study offered positive association of green buildings with qualitatively and quantitatively measured performance of IEQ.

Home and day-care microenvironment exposure to Blomia tropicalis allergens and their associations with salivary eosinophilic cationic protein (ECP) among preschool children in Singapore.

To date, exposure studies linking dust-mite allergens with asthma and allergic morbidities have typically relied on sampling from representative locations in the home for exposure assessment. We determine the effects of differing microenvironments allergen exposures on asthma and asthma severity among 25 case and 31 control preschool children in Singapore. Blo t 5 allergen levels in various niches from the children's home and day-care microenvironments as well as their Blo t 5 time-weighted concentrations were determined. Eosinophilic cationic protein (ECP) levels from the children's saliva as markers for airway inflammation were obtained. Salivary ECP levels were higher in children with asthma than those without and the strength of association increased with higher salivary ECP levels. Although there was no relationship between time-weighted Blo t 5 concentrations with salivary ECP levels among the controls, a positive statistically significant relationship was noted among cases, demonstrating the effects of cumulative exposure on asthma severity. Avoidance measures to reduce Blo t 5 allergen exposure should include all microenvironments that asthmatic children are exposed throughout the day.

Mandating indoor air quality for public buildings.

If some countries lead by example, standards may increasingly become normalized.

Influenza A and B Viruses in Fine Aerosols of Exhaled Breath Samples from Patients in Tropical Singapore.

Influenza is a highly contagious respiratory illness that commonly causes outbreaks among human communities. Details about the exact nature of the droplets produced by human respiratory activities such as breathing, and their potential to carry and transmit influenza A and B viruses is still not fully understood. The objective of our study was to characterize and quantify influenza viral shedding in exhaled aerosols from natural patient breath, and to determine their viral infectivity among participants in a university cohort in tropical Singapore. Using the Gesundheit-II exhaled breath sampling apparatus, samples of exhaled breath of two aerosol size fractions ("coarse" > 5 µm and "fine" ≤ 5 µm) were collected and analyzed from 31 study participants, i.e., 24 with influenza A (including H1N1 and H3N2 subtypes) and 7 with influenza B (including Victoria and Yamagata lineages). Influenza viral copy number was quantified using reverse transcription-quantitative polymerase chain reaction (RT-qPCR). Infectivity of influenza virus in the fine particle fraction was determined by culturing in Madin-Darby canine kidney cells. Exhaled influenza virus RNA generation rates ranged from 9 to 1.67 × 105 and 10 to 1.24 × 104 influenza virus RNA copies per minute for the fine and coarse aerosol fractions, respectively. Compared to the coarse aerosol fractions, influenza A and B viruses were detected more frequently in the fine aerosol fractions that harbored 12-fold higher viral loads. Culturable virus was recovered from the fine aerosol fractions from 9 of the 31 subjects (29%). These findings constitute additional evidence to reiterate the important role of fine aerosols in influenza transmission and provide a baseline range of influenza virus RNA generation rates.

SARS-CoV-2 Omicron variant shedding during respiratory activities.

OBJECTIVES: As the world transitions to COVID-19 endemicity, studies focusing on aerosol shedding of highly transmissible SARS-CoV-2 variants of concern (VOCs) are vital for the calibration of infection control measures against VOCs that are likely to circulate seasonally. This follow-up Gesundheit-II aerosol sampling study aims to compare the aerosol shedding patterns of Omicron VOC samples with pre-Omicron variants analyzed in our previous study. DESIGN: Coarse and fine aerosol samples from 47 patients infected with SARS-CoV-2 were collected during various respiratory activities (passive breathing, talking, and singing) and analyzed using reverse transcription-quantitative polymerase chain reaction and virus culture. RESULTS: Compared with patients infected with pre-Omicron variants, comparable SARS-CoV-2 RNA copy numbers were detectable in aerosol samples of patients infected with Omicron despite being fully vaccinated. Patients infected with Omicron also showed a slight increase in viral aerosol shedding during breathing activities and were more likely to have persistent aerosol shedding beyond 7 days after disease onset. CONCLUSION: This follow-up study reaffirms the aerosol shedding properties of Omicron and should guide continued layering of public health interventions even in highly vaccinated populations.

Viable mpox virus in the environment of a patient room.

We conducted a prospective environmental surveillance study to investigate the air, surface, dust, and water contamination of a room occupied by a patient infected with mpox virus (MPXV) at various stages of the illness. The patient tested positive for MPXV from a throat swab and skin lesions. Environmental sampling was conducted in a negative pressure room with 12 unidirectional high efficiency particulate air filter (HEPA) air changes per hour and daily cleaning of the surfaces. A total of 179 environmental samples were collected on days 7, 8, 13, and 21 of illness. Among the days of sampling, air, surface, and dust contamination showed the highest contamination rates on day 7 and 8 of illness, with a gradual decline to the lowest contamination level by day 21. Viable MPXV was isolated from surfaces and dust samples and no viable virus was isolated from the air and water samples.

A preference driven multi-criteria optimization tool for HVAC design and operation.

This paper discusses the issue of selecting the design solution that best accords with an articulated preference of multiple criteria with an acceptable performance band. The application of a newly developed multi-criteria decision-making tool called RR-PARETO2 is presented. An example of HVAC design is used to illustrate how solutions could be selected within a multi-criteria optimization framework. In this example, five criteria have been selected, namely, power consumption, thermal comfort, risk of airborne infection of influenza and tuberculosis and effective differential temperature (Δt eq) of body parts. The goal is to select the optimal air exchange rate that makes reasonable trade-offs among all the objectives. Two scenarios have been studied. In the first scenario, there is an influenza outbreak and the important objective is to prevent the spread of infection. In the second scenario, energy prices are high and the primary objective is to reduce energy. In both scenarios, RR-PARETO2 algorithm selects solutions that make reasonable trade-offs among conflicting objectives. The example illustrates how objectives such as reduction of airborne disease transmission and maximizing thermal comfort can be incorporated in the design of a practical, full-scale HVAC system.

Diurnal trends of indoor and outdoor fluorescent biological aerosol particles in a tropical urban area.

We evaluated diurnal trends of size-resolved indoor and outdoor fluorescent biological airborne particles (FBAPs) and their contributions to particulate matter (PM) within 0.5-20 µm. After a ten-week continuous sampling via two identical wideband integrated bioaerosol sensors, we found that both indoor and outdoor diurnal trends of PM were driven by its bioaerosol component. Outdoors, the median [interquartile range] FBAP mass concentration peaked at 8.2 [5.8-9.9] µg/m3 around sunrise and showed a downtrend from 6:00 to 18:00 during the daytime and an uptrend during the night. The nighttime FBAP level was 1.8 [1.4-2.2] times higher than that during the daytime, and FBAPs accounted for 45 % and 56 % of PM during daytime and nighttime, respectively. Indoors, the rise in concentrations of FBAPs smaller than 1 µm coincided with the starting operation of the heating, ventilation, and air conditioning (HVAC) system at 6:00, and the concentration peaked at 8:00 and dropped to the daily average by noontime. This indicated that the starting operation of the HVAC system dislodged the overnight settled and accumulated fine bioaerosols into the indoor environment. For particles larger than 1 µm, the variation of mass concentration was driven by occupancy. Based on regression modeling, the contributions of indoor PM, non-FBAP, and FBAP sources to indoor mass concentrations were estimated to be 93 %, 67 %, and 97 % during the occupied period.

Home air-conditioning, traffic exposure, and asthma and allergic symptoms among preschool children.

Epidemiological data suggest that traffic exposures can influence asthma and allergic symptoms among preschool children; however, there is no information on risk reduction via home air-conditioning (AC). The aim of this study is to evaluate the associations of self-reported traffic densities with asthma and allergic symptoms among preschool children and determine whether AC is an effect modifier. A cross-sectional study adopting an expanded and modified ISAAC--International Study of Asthma and Allergies in Childhood conducted on randomly selected 2994 children living in homes without any indoor risk factors. Specific information on demographics, indoor home risk factors, and traffic variables were obtained. Adjusted prevalence ratios (PR) and 95% confidence interval (CI) were determined by Cox proportional hazard regression model with assumption of a constant risk period controlled for covariates. We found dose-response significant relationships between validated self-reported traffic densities and asthma and rhinitis symptoms. Among children sleeping in non-air-conditioned homes, there were stronger associations between asthma and rhinitis symptoms studied. PRs for heavy traffic density were 2.06 for wheeze (95% CI 0.97-4.38), 2.89 for asthma (1.14-7.32), 1.73 for rhinitis (1.00-2.99), and 3.39 for rhinoconjunctivitis (1.24-9.27). There were no associations found for children sleeping in air-conditioned homes. Our results suggest that AC in the bedroom modifies the health effects of traffic among preschool children. This finding suggests that attention should also be paid to ventilation characteristics of the homes to remediate health-related traffic pollution problems.

Assessment of Home-Based and Mobility-Based Exposure to Black Carbon in an Urban Environment: A Pilot Study.

The combustion of fossil fuels is a significant source of particulate-bound black carbon (BC) in urban environments. The personal exposure (PE) of urban dwellers to BC and subsequent health impacts remain poorly understood due to a lack of observational data. In this study, we assessed and quantified the levels of PE to BC under two exposure scenarios (home-based and mobility-based exposure) in the city of Trivandrum in India. In the home-based scenario, the PE to BC was assessed in a naturally ventilated building over 24 h each day during the study period while in the mobility-based scenario, the PE to BC was monitored across diverse microenvironments (MEs) during the day using the same study protocol for consistency. Elevated BC concentrations were observed during the transport by motorcycle (26.23 ± 2.33 µg/m3) and car (17.49 ± 2.37 µg/m3). The BC concentrations observed in the MEs decreased in the following order: 16.58 ± 1.38 µg/m3 (temple), 13.78 ± 2.07 µg/m3 (restaurant), 11.44 ± 1.37 µg/m3 (bus stop), and 8.27 ± 1.88 µg/m3 (home); the standard deviations represent the temporal and spatial variations of BC concentrations. Overall, a relatively larger inhaled dose of BC in the range of 148.98-163.87 µg/day was observed for the mobility-based scenario compared to the home-based one (118.10-137.03 µg/day). This work highlights the importance of reducing PE to fossil fuel-related particulate emissions in cities for which BC is a good indicator. The study outcome could be used to formulate effective strategies to improve the urban air quality as well as public health.

How can airborne transmission of COVID-19 indoors be minimised?

During the rapid rise in COVID-19 illnesses and deaths globally, and notwithstanding recommended precautions, questions are voiced about routes of transmission for this pandemic disease. Inhaling small airborne droplets is probable as a third route of infection, in addition to more widely recognized transmission via larger respiratory droplets and direct contact with infected people or contaminated surfaces. While uncertainties remain regarding the relative contributions of the different transmission pathways, we argue that existing evidence is sufficiently strong to warrant engineering controls targeting airborne transmission as part of an overall strategy to limit infection risk indoors. Appropriate building engineering controls include sufficient and effective ventilation, possibly enhanced by particle filtration and air disinfection, avoiding air recirculation and avoiding overcrowding. Often, such measures can be easily implemented and without much cost, but if only they are recognised as significant in contributing to infection control goals. We believe that the use of engineering controls in public buildings, including hospitals, shops, offices, schools, kindergartens, libraries, restaurants, cruise ships, elevators, conference rooms or public transport, in parallel with effective application of other controls (including isolation and quarantine, social distancing and hand hygiene), would be an additional important measure globally to reduce the likelihood of transmission and thereby protect healthcare workers, patients and the general public.

Determinants of indoor allergens in tropical child care centers.

Limited data are available about indoor allergen determinants in child care centers (CCCs) especially in the tropics. This information is important epidemiologically and clinically considering many children attend CCCs. The purpose of this study was to determine the allergen concentrations in CCCs and their associations with CCC characteristics and indoor air quality (IAQ). A panel of indoor allergens including Der p 1, Blo t 5, Fel d 1, Can f 1, Mus m 1, Bla g 1 and Asp f 1 were evaluated from dusts vacuumed from classroom floors of CCCs. Allergen levels were assayed with antibody-based bioplex array or enzyme-linked immunosorbent assays. Indoor temperature, relative humidity and air exchange rates were measured and CCC characteristics inspected. Allergen levels were linearly regressed with CCC characteristics and IAQ. The dominant allergens found in classroom floors were Der p 1, Blo t 5 and Fel d 1. Lower indoor temperatures were associated with higher Der p 1 while lower ventilation rates were associated with higher Blo t 5 concentrations. Prevalence of cat owners was found to be a predictor for Fel d 1 concentrations. Full or partial carpeting is associated with higher dust mite allergen levels. These findings provide information for future indoor allergen exposure assessment studies in CCCs and can be used for intervention with regard to allergen avoidance.