Cleaning Indoor Air 'Next Frontier' for COVID, Public Health

Marcia Frellick

October 12, 2022

Editor's note: Find the latest COVID-19 news and guidance in Medscape's Coronavirus Resource Center.

The COVID-19 pandemic is driving attention to clean indoor air like never before.

At a White House summit on Tuesday, leaders from government, industry, and education came together to make a case that low-quality indoor air should warrant the same kind of outrage and action as low-quality water.

Ashish Jha, MD, MPH, who heads the White House COVID response team, said, "Indoor air is that next frontier when it comes to thinking about public health for humanity."

"This once-in-a-century pandemic has given us a moment. A moment when we can drive significant structural changes in the air that we all breathe," he said.

The threat is immediate, Jha said, explaining that the return of influenza this year and other circulating respiratory viruses on top of COVID cases could overwhelm the health system.

"We have to bring the burden of respiratory pathogens down and the single biggest structural change we can make as a society is to do for indoor air what we've done for water quality," he said.

Recent Federal Actions

Jha pointed to White House actions toward that end.

On Tuesday, the White House launched a new website asking building owners and operators to sign a pledge for clean air and agree to four principles:

  • Create an action plan

  • Optimize fresh air ventilation

  • Enhance air filtration and cleaning

  • Communicate with building occupants to increase awareness

Those who pledge can download a badge to feature on their website.

In March, the White House launched the Clean Air in Buildings Challenge as a call to action for building owners and operators to improve ventilation, filtration, and facilities for cleaner indoor air.

The government has provided funds that can be used in schools, public buildings, and other locations to improve indoor air quality, including $350 billion for state and local governments and  $122 billion for schools, through the American Rescue Plan.

The Department of Energy is also offering one-on-one consultations to schools to drive air quality.

Calculate Your "Indoor Age"

Joseph Allen, DSc, MPH, director of the Healthy Buildings program and an associate professor at Harvard's T. H. Chan School of Public Health in Boston, Massachusetts, said that the indoor environment has an outsized effect on public health.

He asked people to multiply their age times 0.9. to calculate their “indoor age.”

Allen, 47, said that for him that number is 42 years spent inside spaces.

When most people realize they spend 90% of their time indoors, a startling possibility comes into play: "The person who manages your building has a greater impact on your health than your doctor," he said. "Think about that."

Allen led a team that published a report on four strategies every building should pursue to reduce COVID and other respiratory illnesses.

  • Give every building a tune-up. "We do this for our cars, we don't do it for our buildings," Allen said

  • Maximize outdoor ventilation

  • Upgrade filtration. "We need to move away from filters designed to protect equipment to filters designed to protect people. MERV 13 is the new minimum"

  • Supplement with portable air cleaners

It's not a complete list, he said; "It's where you should start."

Indoor Air Innovations

Others are suggesting innovations in schools and businesses.

Denver (Colorado) Public School Superintendent Alex Marrero, EdD, said that system is implementing an air quality dashboard to display performance on factors such as carbon dioxide levels, particulate matter, and volatile organic compounds in schools.

"When you're deciding what school you're going to visit or even enroll in, you'll have a snapshot of what we're able to gather. Hopefully we'll have something up before the end of the school year," he said.

Shelly L. Miller, PhD, a professor of mechanical engineering in the Environmental Engineering Program at the University of Colorado Boulder, said that germicidal ultraviolet disinfection, used currently in water quality, holds promise for cleaning the COVID virus and other pathogens from indoor air.

"We were looking at germicidal UV way back in the 2000s for an outbreak of tuberculosis. We continue to see that it's effective for measles. Why can't we put a little more emphasis on these technologies?" Miller asks, acknowledging that there is a lack of expertise in designing such systems and in training and maintenance.

"It's not for everybody, but it's for a lot more places than we're using it now," she said.

Legislation Like 1970 Clean Air Act Needed?

Richard Corsi, PhD, dean of the College of Engineering at the University of California, Davis, said that education is lacking on the subject and indoor air quality is taught as a class in only a few universities, including his own.

He suggests starting the education even much earlier, in high school biology, chemistry, and physics courses.

Relative to other fields, he said, research and funding for indoor air quality "has been anemic."

Work on outdoor air quality has seen dramatic improvements over the years because of the 52-year-old Clean Air Act, he noted.

"We need something akin to the Clean Air Act for indoor air quality," Corsi said.

Speakers declared no relevant financial relationships.

Marcia Frellick is a freelance journalist based in Chicago. She has previously written for the Chicago Tribune, Science News, and Nurse.com, and was an editor at the Chicago Sun-Times, the Cincinnati Enquirer, and the St. Cloud (Minnesota) Times. Follow her on Twitter at @mfrellick.

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