Have you had to delay your return-to-office (RTO) date due to surges of COVID-19 in your community? If your employees have already returned, are you worried about the spread of the Omicron variant? Are you skeptical about the value of indoor air quality, or instead, have you wondered about adding portable air cleaners? Have you hoped life at work would just “go back to normal”?

Welcome to the new, new normal.

Ventilation and the science of transmission

COVID-19 is caused by the SARS-CoV-2 virus and is transmitted when someone breathes in small droplets or particles containing SARS-CoV-2, according to the Centers for Disease Control and Prevention (CDC).

The EPA explains that people infected with COVID-19 release particles and droplets of respiratory fluids containing the SARS-CoV-2 virus when they exhale through breathing, coughing, exercising, singing, or speaking. Very fine droplets or particles can continue to spread through the air in the room or space and can accumulate in spaces with poor ventilation.

The CDC recommends avoiding poorly ventilated spaces to help slow the spread of COVID-19, along with hand-washing, mask-wearing, and physical distancing.

One of the first documented outbreaks of COVID-19 in the United States was an indoor superspreading event affecting members of the Skagit Valley Chorale in Skagit Valley, Washington. Following a March 10, 2020, choir rehearsal, 53 members among the 61 attending were confirmed or suspected to have contracted COVID-19 from a single member experiencing cold-like symptoms. Two choir members later died.

The American Conference of Governmental Industrial Hygienists (ACGIH) points out that building ventilation systems are designed for comfort and general air quality and not the removal of particles from an infectious source. The placement of system inlets and outlets can even lead to a concentrated buildup of infectious particles.

The evidence linking poorly ventilated indoor spaces and respiratory infections was established decades before the COVID-19 pandemic. Ventilation problems may even be responsible for higher sick leave costs and lost productivity. In an often-cited December 2000 study, researchers analyzed the sick leave use among employees of a large manufacturer and established a clear risk of increased sick leave use among workers assigned to poorly ventilated spaces. Researchers suggested that the employer could have seen net savings of $400 per employee per year by increasing ventilation. They also concluded that the existing recommendations for outdoor air supply accounted for increased illness and lost productivity.

Earlier this year, a Harvard public health researcher pointed out that current heating, ventilation, and air conditioning (HVAC) standards for air changes per hour for buildings other than hospitals are not designed for infection control. Existing standards are designed for diluting odors and maintaining a basic level of acceptable indoor air quality. The commentary in the Journal of the American Medical Association recommended increasing the number of air changes per hour through increased outdoor air ventilation, recirculated air passed through a filter with at least a minimum efficiency rating value (MERV) of 13, or the use of portable air cleaners with high-efficiency particulate air (HEPA) filters to limit COVID-19 transmission.

The Occupational Safety and Health Administration (OSHA) has advised employers to consult a qualified HVAC professional to ensure optimal building ventilation and that HVAC systems are operating as intended. Ventilation and filtration are part of the agency’s guidance for employers on mitigating and preventing the spread of COVID-19 in the workplace, along with facilitating vaccination, ensuring that workers infected with COVID-19 stay home, implementing physical distancing in communal work areas, providing face coverings or surgical masks as a method of infection source control, training workers in both COVID-19 risks and control methods, and performing routine cleaning and disinfection.

OSHA’s ventilation recommendations are based on the American Society of Heating, Refrigerating, and Air-Conditioning Engineers’ (ASHRAE) guidelines for building operations and industrial settings during the COVID-19 pandemic and the CDC’s Ventilation in Buildings guidelines. The AHSRAE’s recommendations include improving building air filtration to MERV 13 or the highest filter compatible with the system’s filter rack and sealing edges of the filter to limit bypass; keeping systems running for longer hours—24/7 if possible; considering the use of portable air cleaners with HEPA filters; and considering installation of ultraviolet germicidal irradiation (UVGI).

A layered approach

The CDC has described improvements to building ventilation as part of a layered approach to controlling the spread of COVID-19. That layered approach also includes hand hygiene, physical distancing, vaccination, and wearing face masks. The CDC also cautioned that barriers to shield employees, customers, or visitors from infectious respiratory droplets sometimes can hinder good ventilation, unintentionally interrupting the airflow distribution within a space, which can allow a concentration buildup of aerosol particles. However, protective barriers can assist with improved ventilation when used to facilitate directional airflows or desired pressure differentials between clean and less clean spaces.

Methods to improve ventilation include increasing the introduction of outdoor air, using fans to increase the effectiveness of open windows, ensuring ventilation systems operate properly, and increasing air filtration.

Employer guidance from Washington’s Division of Occupational Safety and Health (DOSH) on ventilation in the workplace includes:

• Ensuring that you have an administrative system in place to prevent sick employees from being present at work.
• Ensuring all HVAC systems are fully functional, especially those shut down or operating at reduced capacity during the pandemic. Also, demand-controlled ventilation may have been adjusted or disabled, hindering the flow of maximum outdoor air.
• Using HVAC system filters with a MERV rating of 13 or higher where feasible. Ninety percent of particles are captured in filters with a MERV rating of 13.
• Inspecting filters and seals monthly, eliminating gaps around filters that allow nonfiltered air to recirculate, and changing filters and cleaning the system as needed.
• Bringing in as much fresh air as possible by increasing the HVAC system’s outdoor air intake and reducing recirculated air, as well as opening windows or other sources of fresh air where possible when weather permits.
• Ensuring that exhaust air is not pulled back into the building’s HVAC air intakes or open windows.
• Turning off ceiling fans or adjusting them to pull air up rather than down to reduce particle dispersal.
• Removing or redirecting personal fans to avoid blowing air from one worker to another.
• Considering the use of portable HEPA fan/filtration systems to increase clean air, especially in higher-risk areas.
• Ensuring that when building maintenance personnel change system filters, they wear appropriate personal protective equipment (PPE), including a respirator such as an N95 filtering facepiece respirator (FFR); eye protection such as safety glasses, goggles, or face shields; and disposable gloves.
• Ensuring that exhaust fans in restrooms are fully functional, operating at maximum capacity, and set to remain on.

DOSH recommends avoiding the use of ionizers or air purifiers that generate ozone, a health hazard itself.

Portable air cleaners

Federal OSHA also recommends considering the use of portable air cleaners with HEPA filters in spaces with high occupancy or limited ventilation in its COVID-19 employer guidance. The EPA states that portable air cleaners with HVAC filters can help reduce airborne contaminants, including viruses, in a building or small space when used properly.

Portable air cleaners are useful in providing additional ventilation when outdoor air ventilation is not possible or preferable due to outside humidity, temperature, or air pollution.

However, air cleaning is not a substitute for source control (the use of masks) and ventilation, according to the EPA. In July, the CDC concluded that portable HEPA air cleaners can reduce exposure to SARS-CoV-2 aerosols in indoor spaces, especially when combined with universal masking.

The EPA cautioned that while bipolar ionization or “needlepoint bipolar ionization” is marketed as a technology that helps remove viruses, including SARS-CoV-2, and facilitates surface disinfection, it is an emerging technology. As an emerging technology, there is little research so far on its efficacy and safety outside of lab conditions. The efficacy and safety of established technology like filtration are well documented.

Portable air cleaners can supplement HVAC systems’ air filtration and ventilation, especially in indoor spaces, where it is difficult to achieve adequate ventilation. However, while using portable air cleaners adds a layer of protection, there is not a consensus that air cleaners are enough by themselves to protect building occupants from COVID-19 exposures.

Researchers at the University of Bristol looked at the existing literature on commercially available HEPA filters and respiratory infections. While they found evidence that indoor air filters did capture bacteria, there was not yet evidence that they could satisfactorily capture viruses like SARS-CoV-2.

Getting assistance from building, facilities managers

The National Institute of Environmental Health Sciences (NIEHS) recommends the use of portable air cleaners to supplement increased outdoor air ventilation and HVAC air system filtration.

In its guidance to portable air cleaners, the NIEHS also offered a series of questions you can ask an HVAC consultant, your building manager, or a facilities engineer about your building’s systems:

• Does the building have a mechanical or natural ventilation system? If it has a natural ventilation system, then you may want to consider the use of portable air cleaners.
• How do the systems work?
• How many air changes per hour of outside air are brought into the building or produced by filters in the HVAC equipment, and where does the outside air enter the building?
• What is the MERV rating of the filters used in this building?
• Can the building’s current systems function with filters rated MERV 13 or higher?
• How often are the filters changed?
• Have renovations changed conditions in some of the rooms, and how is the filtered air distributed to the occupied spaces?
• How many zones and thermostats are used by the HVAC system?
• Are fans set to the “on” position to ensure outside air is introduced to rooms when cooling and heating are not required?

Your options for limiting COVID-19 infections in your workforce follow the traditional industrial hygiene hierarchy of controls: elimination, including ensuring that sick employees or visitors do not occupy your facilities; substitution, such as offering your employees the option to work remotely; engineering controls like increased ventilation and filtration and the use of portable air cleaners; administrative controls like workplace policies requiring face coverings; and PPE, including respirators.

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The ongoing rise of COVID-19 cases has many school districts taking action. KCRA 3 spoke with representatives from several school districts within the southern part of our region. Here’s a look at how they’re responding:Lodi UnifiedIn an email, a spokeswoman wrote, “We have experienced staffing shortages but thankfully there have been no interruptions to services at this time.”The Lodi Unified School District has been actively recruiting substitute teachers by offering higher wages. Stockton UnifiedLike all schools in California, the Stockton Unified School District has updated how it contact traces, according to the new state guidelines.”We used to call people who were exposed. Now, it’s the entire classroom. An email, letters, sent out. We just want them to be able to take care of themselves as soon as possible,” Melinda Meza, a spokeswoman with the Stockton Unified School District told KCRA 3. You can find SUSD’s COVID-19 dashboard here. Manteca UnifiedIn an email, Manteca Unified School District released this information:”We are seeing higher numbers of positive cases as the virus and its variants continue to impact San Joaquin County. Importantly, Manteca Unified is doing everything possible to prioritize student learning while following state and local health guidance. We are grateful for our staff who continue to persevere despite the challenges, and families for doing their part as their children transition to and from the classroom when necessary. In fall 2020, MUSD worked proactively to create a hiring strategy for permanent staff and substitutes to counter temporary staff outages. Additionally, we worked early on to ensure that all teachers and students had the tools and resources necessary to be successful as many would transition in and out of the classroom. We believe these proactive measures play an integral role when prioritizing academic success, especially as daily operations become strained. Our day-to-day operations continue to follow state and local guidance as outlined in our COVID-19 Safety Plan: www.mantecausd.net/csp. Mitigations such as universal mask wearing, indoor air filtration systems, daily self-screening, and clear communication with families help to prevent school outbreaks while keeping student learning at the forefront. Recently the District distributed the at-home rapid testing kit, provided by the state, to all students and encouraged families to test by using the at-home kit or one of our free testing centers for students, staff, and their immediate family members. Positive test results, or symptoms, are reported via our Daily Self-Screening Survey which helps to keep the dashboard current and further, communicate appropriate guidance and support to staff/students experiencing illness. Manteca Unified has prioritized and operated in-person learning since October 2020, none of which would be possible without the commitment from our staff, students, and families.”Modesto City SchoolsIn an email, Modesto City Schools said:”You can view our COVID-19 dashboard on our website at: https://www.mcs4kids.com/district/covid-19. We update the dashboard with COVID+ cases for each site on a daily basis, and then we do a weekly update every Tuesday with the positivity percentages. The data includes both student and staff positive cases.In terms of district operations, all Modesto City Schools’ sites returned to in-person learning on Monday, January 10 after our winter break. As MCS has done since the beginning of this school year, our school sites and District Offices continue to have many robust health and safety protocols in place to ensure a healthy and safe learning environment for our students, teachers and staff.”| RELATED | COVID-19 in California: Find testing info, omicron updates, vaccine rates and boosters

The ongoing rise of COVID-19 cases has many school districts taking action.

KCRA 3 spoke with representatives from several school districts within the southern part of our region. Here’s a look at how they’re responding:

Lodi Unified

In an email, a spokeswoman wrote, “We have experienced staffing shortages but thankfully there have been no interruptions to services at this time.”

The Lodi Unified School District has been actively recruiting substitute teachers by offering higher wages.

Stockton Unified

Like all schools in California, the Stockton Unified School District has updated how it contact traces, according to the new state guidelines.

“We used to call people who were exposed. Now, it’s the entire classroom. An email, letters, sent out. We just want them to be able to take care of themselves as soon as possible,” Melinda Meza, a spokeswoman with the Stockton Unified School District told KCRA 3.

You can find SUSD’s COVID-19 dashboard here.

Manteca Unified

In an email, Manteca Unified School District released this information:

“We are seeing higher numbers of positive cases as the virus and its variants continue to impact San Joaquin County. Importantly, Manteca Unified is doing everything possible to prioritize student learning while following state and local health guidance. We are grateful for our staff who continue to persevere despite the challenges, and families for doing their part as their children transition to and from the classroom when necessary.

In fall 2020, MUSD worked proactively to create a hiring strategy for permanent staff and substitutes to counter temporary staff outages. Additionally, we worked early on to ensure that all teachers and students had the tools and resources necessary to be successful as many would transition in and out of the classroom. We believe these proactive measures play an integral role when prioritizing academic success, especially as daily operations become strained.

Our day-to-day operations continue to follow state and local guidance as outlined in our COVID-19 Safety Plan: www.mantecausd.net/csp. Mitigations such as universal mask wearing, indoor air filtration systems, daily self-screening, and clear communication with families help to prevent school outbreaks while keeping student learning at the forefront.

Recently the District distributed the at-home rapid testing kit, provided by the state, to all students and encouraged families to test by using the at-home kit or one of our free testing centers for students, staff, and their immediate family members. Positive test results, or symptoms, are reported via our Daily Self-Screening Survey which helps to keep the dashboard current and further, communicate appropriate guidance and support to staff/students experiencing illness.

Manteca Unified has prioritized and operated in-person learning since October 2020, none of which would be possible without the commitment from our staff, students, and families.”

Modesto City Schools

In an email, Modesto City Schools said:

“You can view our COVID-19 dashboard on our website at: https://www.mcs4kids.com/district/covid-19. We update the dashboard with COVID+ cases for each site on a daily basis, and then we do a weekly update every Tuesday with the positivity percentages. The data includes both student and staff positive cases.

In terms of district operations, all Modesto City Schools’ sites returned to in-person learning on Monday, January 10 after our winter break. As MCS has done since the beginning of this school year, our school sites and District Offices continue to have many robust health and safety protocols in place to ensure a healthy and safe learning environment for our students, teachers and staff.”

| RELATED | COVID-19 in California: Find testing info, omicron updates, vaccine rates and boosters

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They’re flying off the shelves as Australia grapples with record infection rates due to Omicron, but whether or not you need one is a different story. 

One of the first signs of a worsening COVID-19 diagnosis is having low oxygen in the blood. In fact, some people can suffer from low oxygen without becoming short of breath or dizziness.

That’s when a pulse oximeter steps in.

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What is a pulse oximeter?

A peg-like device that clips to your finger, the oxygen monitor beams light through the finger to read the colour of your blood to determine levels.

“The oxygen transporters in blood reflect light differently depending on how much oxygen they contain,” the Therapeutic Goods Administration explains.Commonly used in GP clinics and hospitals, they’re becoming more popular in the homes as a way of monitoring the symptoms.

Do I need a pulse oximeter?

Just like a thermometer can come in handy for unwell family members, particularly the younger generation, a pulse oximeter will monitor a COVID patient’s health without clogging doctors’ waiting rooms and hospitals.

They can also we shared within the household, after a thorough clean with an antiseptic wipe.

We do, however, recommend you do seek the help of a health professional at your own discretion.

Can everyone use a pulse oximeter?

According to the TGA, no.

“Recent reports have highlighted that multiple factors, including skin pigmentation, can impact the accuracy of pulse oximeters,” the TGA can confirm.

“Over-reliance on pulse oximeters could lead to suboptimal management of patients whose oxygen levels are below normal. This risk is higher in persons with darker skin.”

A pulse oximeter can also give an inaccurate blood oxygen reading if the monitored area is obstructed by tattoos, nail polish or false fingernails.

Are all oxygen monitors created equal?

Again, the TGA says no.

“Remember that not all pulse oximeters are of the same quality and accuracy,” the health authority explains.

“One US study showed that some cheaper devices without regulatory approval sold to consumers were significantly less accurate than approved devices used in healthcare settings.”

Is there supply to meet demand?

We predict pulse oximeters will fly off the shelves, à la rapid antigen tests, however last month the Federal Government announced it would contribute $22.3 million to the National Medical Stockpile to secure supplies of pulse oximeters to assist patients recuperating in the community rather than hospital.

Thankfully, they’re not a one-time-use device, and as mentioned, can be shared amongst others in your household.

Their popularity builds as GPs plea with the Federal Government for Medicare to fund RATs and pulse oximeters, The Age reports, as health professionals struggle with the 000 crisis.

The other devices becoming more popular in the age of Covid

Of course we’re well aware of the demand for rapid antigen tests and now pulse oximeters, but there’s one more device starting to gain popularity. Residents are also now reaching for CO2 monitors in order to tell if the area they’re in is well ventilated, the ABCreports.

Humans breathe in oxygen and breathe out carbon dioxide. When in a room that has poor ventilation, that carbon dioxide accumulates. The thinking is that where carbon dioxide accumulates, so would Covid. Thus , by using the CO2 monitors, concerned citizens can made a decision whether or not they feel comfortable staying in that location for more than 15 minutes.

“Even if you’re physically distancing and washing hands, COVID transmits in the air, so we need to make sure we have good indoor air quality,” says Ms Cole, who is also president-elect of the Australian Institute of Occupational Hygienists told the ABC.

Any products featured in this article are selected by our editors, who don’t play favourites. If you buy something, we may get a cut of the sale. Learn more.

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USA: Johnson Controls has partnered with the Asthma and Allergy Foundation of America (AAFA) to support asthma sufferers by raising awareness of the connection between indoor air quality and health.

As many as 25 million Americans suffer from asthma. It is one of the country’s most common and costly diseases, affecting about 8% of adults and 7% of children. There is no cure for asthma, but it can be managed with a combination of asthma medication treatments and by reducing or avoiding exposure to things that can trigger asthma attacks. Healthy indoor environments are a key part of asthma management.

“While important for everyone, well-managed indoor environments are critical for the health and well-being of the asthma and allergy community,” said Ganesh Ramaswamy, president of Global Services at Johnson Controls. 

“We appreciate that Johnson Controls understands that clean, healthy air in indoor environments is one of the most important ways to reduce and prevent asthma attacks and allergy symptoms,” said said Kenneth Mendez, AAFA’s CEO and president. We are grateful for the support provided by Johnson Controls to help AAFA with our programmatic work, especially in schools.”

Initial work between Johnson Controls and AAFA will include supporting the asthma and allergy community, collaborating on patient education and awareness as well as advocacy and public policy initiatives – including those to improve air quality in schools.

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