COVID-19 Research From
A Systems Perspective

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COVID-19 Return to Life 2022 (Part 3)

Please take the COVID-19 Ventilation Survey - Since mid-2020 when it was disclosed that COVID-19 is airborne, the guidance has been to increase ventilation inside public spaces. However, do people know what increasing ventilation means and have they taken steps to properly increase ventilation.

This systems engineering analysis is constantly being updated. This web page is the most current. September 12, 2021 Initial Release. Last Modified: 02/25/2022, 01/26/24

COVID-19 Return To Life 2021 (Part 2 & 3) (PDF) usually out of date

The initial research was started in March 2020 and is documented in the following links:

A book was produced that includes the 2020 COVID-19 research published on this website and additional systems engineering content: COVID-19 A Systems Perspective.

The original research eventually resulted in system architecture solutions to mitigate and eliminate the virus. It was found that the problem is massive within small enclosed spaces, problematic in large spaces, and extremely rare in outdoor spaces. It was also found that the technology exists, is relatively low cost, and is part of the system solution in elite settings. The problem is a social problem where the technology and system solutions must find their way into all facilities especially schools, airports, airplanes, bars, restaurants, etc. where large numbers of people congregate and where the facilities are not properly maintained and use the available technologies to mitigate and eliminate contagions from the air.

Like in the original research, it is unclear where this research may lead. The systems perspective will continue to be the approach used to develop this research. One of the key challenges in systems engineering is to determine the key needs, key analysis, key requirements, and key system architecture approaches that will solve the problem. This is very difficult because there is the important consideration to filter out the irrelevant while not losing what may be the answer. So as this research unfolds topics will surface and they either will be abandoned, delayed, or taken to a logical conclusion.

The following is offered as a definition of Systems Engineering from Systems Engineering Design:

Discipline that concentrates on the design and application of the whole (system) as distinct from the parts. It involves looking at a problem in its entirety, taking into account all the facets and all the variables and relating the social to the technical aspect. -- Simon Ramo.

For the specialists that are working their respective areas, in a systems effort they are represented and sit at the systems engineering table. As they present their analysis findings their work informs other specialists in completely different analysis areas. It is this cross fertilization that allows all specialists to broaden their perspectives and enables them to detect new patterns in their own body of work, especially if they are stuck. Systems engineering is the mechanism that allows specialists to quickly and effectively communicate their analysis to completely different areas and significantly shift the overall results in a positive direction. This systems engineering analysis is offered in that spirit of an effective systems engineering activity.

One of the important elements that the systems perspective provides is that it includes the human condition in the system. The system solution must include the reality that people are part of the system and that they do not behave rationally. So the system must account for irrational human behavior otherwise it will fail or have very poor performance characteristics. Without the systems perspective this is always lost. The purpose of all the analysis is to enable the development of potential architecture and design solutions. Eventually the architecture(s) and design(s) must be selected.

It is important to review and try to understand the research findings from 2020 as part of reviewing this research in 2021. This is a long hard read. Use the table of contents to navigate. It is constantly being updated and follows the natural flow of all systems engineering efforts; some analysis is a dead end and is abandoned, some analysis converges, some analysis diverges, and some analysis stays at a steady state level until new information surfaces, typically from a specialist on the team.

More information on the systems perspective for this problem is available as part of this systems engineering analysis at: Systems Perspective.

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Return To Life P1 2020

Return To Life P2 2021

Return To Life P3 2022

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Table of Contents

  1. COVID-19 Return to Life (2020 to 2021 March research)
  2. COVID-19 Return to Life Part 2 (New research started March 2021)
  3. COVID-19 Return to Life Part 3 (New research started September 2021)
    1. Quick Summary, 09/12/21, 12/21/21
    2. International Perspective 09/12/21, 09/15/21, 09/20/21, 09/22/21
      1. Worst Case By Region And Country 09/12/21, 09/22/21
      2. Monthly By Country 09/12/21, 09/22/21
      3. Vaccinated By Country 09/12/21, 09/22/21
      4. First Confirmed Case By Country 09/12/21, 09/22/21
    3. USA States Perspective 09/23/21
    4. Hawaii 11/14/21
    5. Vaccine and Vaccinations 11/20/21
      1. Press Releases 11/20/21
      2. Unvaccinated Social Response 12/09/21
      3. Vaccine and Vaccinations in Part 2 11/20/21
    6. Ventilation Survey 12/09/21, 12/23/21
    7. Constant COVID-19 Virus Exposure 12/18/21
      1. Vaccinated Constant Virus Exposure 12/18/21
      2. Unvaccinated Constant Virus Exposure 12/18/21
      3. Constant Virus Exposure Mitigation 12/18/21
    8. Previous Contagions Death Rates and Mitigations 12/28/21
    9. Long Haulers and Ventilation 12/18/21, 12/20/21
    10. Airline Ventilation and Masks 12/19/21, 12/21/21
    11. Infection and Body Response 12/26/21, 12/28/21
      1. COVID-19 Body Response 12/26/21
      2. Delta Body Response 12/26/21
      3. Omicron Body Response 12/27/21, 12/29/21, 01/03/22
    12. Stopping Indoor Respiratory Infection 12/30/21
      1. A Paradigm Shift to Combat Indoor Respiratory Infection 12/30/21, 12/31/21, 01/01/22
      2. This Research Attempts to Address Ventilation 12/30/21, 12/31/21, 01/01/22
      3. Building Clean Air Act Proposed Legislation 01/02/22
    13. Virus Infection Testing Approaches 01/14/22
      1. Goldberg Drums Testing 01/16/22, 01/18/22
      2. University of Bristol Aerosol Testing 01/14/22, 07/24/22
      3. Operational Settings Testing 01/16/22
      4. Empirical Data 01/17/22
      5. Virus Infection Testing System Observations 01/16/22
    14. Proposed Ventilation Test and Evaluation Program 01/20/22
      1. A Program for Action 01/20/22, 01/22/22
      2. Technical Roadmap 01/20/22
        1. Test Approach 01/20/22, 02/04/22, 02/05/22, 02/07/22
        2. Test Templates 01/20/22, 02/04/22, 02/05/22, 02/07/22
          1. Classroom Testing
          2. Public Building Testing - Small Space
          3. Public Building Testing - Large Space
          4. Custom Test - Home Owners Association Clubhouse
          5. Airport TSA, Ticket, Gate Areas Testing, and FAA Facilities
          6. Airplane Cabin Testing
        3. Possible Test Results and New Standards 02/07/22
      3. Organization Staffing Levels and Costs 01/20/22, 02/04/22, 02/05/22
      4. Ventilation Products Testing and Cost Tradeoffs 01/27/22, 02/14/22
        1. Mechanical UV PCO systems 01/27/22, 02/14/22
        2. FAR UV Performance 02/22/22
      5. Other Test Activities 02/03/22
        1. MITRE Testing 02/03/22
        2. US Air Force Commercial Aircraft Testing 02/03/22
        3. FAA Testing 02/03/22
        4. MIT Testing 02/03/22
        5. ASHRAE 02/03/22
        6. Military Standards 02/05/22
    15. Clean Air Certificates For Buildings 02/08/22
    16. Building Ventilation In The Age Of Contagions 05/03/22
    17. Living with COVID-19 - Outdoor Indoor ACH Benefits 06/02/22, 07/21/22
      1. Leading Causes of Death 06/02/22, 07/21/22
      2. COVID-19 Cause of Death Ranking - Wells Riley Details 06/02/22, 07/21/22
      3. COVID-19 Cause of Death Ranking - Remaining Virus Perspective 06/02/22, 07/21/22
      4. COVID-19 Cause of Death Ranking - Systems Safety Perspective 06/02/22, 07/21/22
      5. COVID-19 Cause of Death Ranking - Wells Riley-Perspective 06/02/22, 07/21/22
      6. COVID-19 Cause of Death Ranking - All Perspectives Comparisons 06/02/22, 07/21/22
      7. ACH Benefit Analysis 06/02/22, 07/07/2022, 07/16/22, 07/21/22, 07/24/22
      8. ACH Benefit Observations 07/24/22
      9. Vaccine Coverage Versus Proper Ventilation Coverage 07/24/22, 07/26/22
      10. Ventilation Test Procedure Performed By Volunteers 07/31/22
    18. Airborne Contagion Detection Architecture Alternatives 10/02/22
    19. Mask ACH Equivalence 11/17/22
    20. What Should Be The ACH Levels 11/17/22
    21. ACH Measurement Protocols 03/18/23
    22. STEM Ventilation Activities 03/18/23
    23. Ventilation Cost Benefit Analysis 01/26/24
    24. Ukraine Events 02/01/22, 02/02/22, 02/25/22, daily updates


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Quick Summary

There are many COVID-19 systems research areas being addressed by this research in 2021 but probably the most important areas in 2021 are associated with our buildings especially schools. Eventually the concept of building certification surfaced to ensure that people are more safe from COVID-19 and other contagions especially in small indoor spaces. Unfortunately once again the government is hands off in this area so industry, school districts, and local governments are left on their own to figure out what really needs to be done. As always the details are massive and confusing without an entity to vet, filter, and organize the information.

The City of Philadelphia has attempted to address this need with a site survey of all their schools and a restaurant program that identifies what restaurants must do to provide for a more safe space. They made the information public and it is available via the Internet. This is not the first time Philadelphia has taken a lead role in addressing public health.

This research also attempted to address this void by developing a self certification model and software tool to help people understand their facilities from a contagion perspective. This was rejected and the tool and concept never took root. A second attempt was made by using a ventilation survey to first gather data on the current state of ventilation in public spaces and then offer the results. The survey was not accepted and very little data was collected and this is a key finding. The survey was expanded to gather data from everyone and gage their level of knowledge on ventilation. Once again very little data was collected and this is a key finding.

Once the vaccine became available it was expected that this research would wind down. There was an expectation that there would be a small segment of the population that would reject vaccination. However, what has unfolded is beyond reasonable expectations and points to a serious social political problem that this research has tried to avoid and leave to historians and leaders that must dig us out of this hole. This social political problem is embedded throughout the society from politicians sabotaging vaccination efforts to journalists that refuse to ask questions that would immediately expose the toxic players.

The other research topics are shown in the Table of Contents. This is a quick summary of some of the other research areas:

Where Did The Virus Come From?

  1. The USA via the CDC resurrected the 1918 pandemic virus
  2. Gain of function research is being performed around the world, make no mistake about it there are hidden stakeholders driving the research
  3. There is massive technology with very low barriers of entry that is as dangerous as nuclear technology
  4. It does not matter where COVID-19 came from what matters is the response

There is massive social bifurcation and what are the implications?

  1. You can't fix stupid, there will be large numbers of people rejecting the existence of COVID-19 and the vaccine
  2. Some people will live, work, and play in very safe indoor spaces and most will not, making people sick where many will die for decades

There is a post vaccine world.

  1. Some will try to figure out how to build, upgrade, and maintain healthy infrastructure
  2. There will be massive push back on remote work because of powerful stakholders that must fill commercial building space
  3. We are in the middle of a massive mega trend where the civilization is adopting toxic philosophies

COVID-19 is a symptom of a much larger problem, the civilization is in big trouble.

  1. There is toxic legislation
  2. There is toxic management
  3. There are toxic generational choices being made constantly

The International data perspective is providing additional insights into the COVID-19 disaster.

Virus Source Observations - International Data Perspective

  1. The deaths for China are 4,848 or 0.35 per 100,000 people, which is very low, with a death rate of 4.5%, which is relatively high.
  2. The total deaths in China as of September 2021 are 5,683. China has vaccinated 1,095,000,000 people with a very high vaccination rate of 75.8% by September 2021.
  3. The vaccination rates show that China is very concerned about the virus.
  4. China vaccinated the largest number of people on the planet. Yet their death statistics are very low.
  5. If the virus originated in China, then the death statistics should be much higher.
  6. China may not be not reporting the death statistics in the same way as other nations.
  7. If one compromises the numbers, then they should be compromised in a way to not attract attention, the numbers from China attract attention suggesting they are probably real.
  8. If the virus was not detected by other countries early in the outbreak, then an approach to determine the source of the virus may be to go out a few months and examine the numbers.
  9. Going out a few months to examine the numbers is based on the assumption that the virus at that point was being detected. There should be a pattern peak.
  10. If the data for May and June of 2020 is examined, new countries surface as the possible source of the virus and they are: USA, Brazil, UK, Italy, France, and Spain.
  11. Spain and France have lower numbers as time moves forward suggesting that the countries based on early detected deaths drops to four: USA, Brazil, UK, Italy.
  12. Peru has the highest deaths per 100,000 people at 611 versus the USA at 211 and China at 0.35.
  13. Going back to examine the May June 2020 data and the deaths per 100,000 people, Peru is added to the list of countries as a possible virus source: USA, Brazil, UK, Italy, Peru.
  14. This observation is completely out of the box and unexpected.
  15. Future analysis may eventually provide an answer as other data is uncovered and other patterns detected.

Virus and Vaccination Observations - International Data Perspective

  1. Why is the United States performing so poorly with the virus?
  2. What are the implications if the vaccine is not rolled out to the rest of the countries, even if the death per 100,000 people are very low?
  3. Why are the vaccination rates in the Ukraine so low, are they still an agrarian society living outside away from cities and less vulnerable to the virus or is something else happening?
  4. Russia also has a low vaccination rate so the issue in the Ukraine is not related to Russian aggression.
  5. Why are certain countries hit very hard by the virus and others not?
  6. Many countries like Peru, Hungary, Bosnia and Herzegovina, North Macedonia, Montenegro, Czech Republic, Bulgaria, Brazil, San Marino, Argentina, Colombia, Moldova, Slovakia, Paraguay, Belgium, Georgia, Italy, Slovenia, Mexico, Croatia, Tunisia haves deaths per 100,000 people data that are worse than the US.
  7. Many countries have very low deaths per 100,000 people. They tend to be in the Pacific rim and Caribbean.

Ventilation Observations - International Data Perspective

  1. The following is a picture of the city of Lima in Peru.
  2. The image shows that the possibility of the massive COVID-19 deaths in Peru may be associated with the heavy emphasis on indoor spaces.
  3. It is unclear if the HVAC systems share the air flow with different occupants in the various buildings.


Lima Peru - 611 deaths per 100,000 people largest on Earth
Source: https://en.wikipedia.org/wiki/Peru, October 2021


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International Perspective

International Perspective

  1. Worst Case By Region And Country
  2. Monthly By Country
  3. Vaccinated By Country
  4. First Confirmed Case By Country
  5. USA States Perspective

back to TOC

The system boundary for this analysis has been expanded beyond the United States to include the entire world. This section has multiple tables with a large amount of data. So that the key system observations are not lost, they are provided at the front of this section. There is some commentary between the raw data tables.

International Perspective and Key System Observations

The deaths for China are 4,848 or 0.35 per 100,000 people, which is very low, with a death rate of 4.5%, which is relatively high. The total deaths in China as of September 2021 are 5,683. China has vaccinated 1,095,000,000 people with a very high vaccination rate of 75.8% by September 2021. The vaccination rates show that China is very concerned about the virus. They vaccinated the largest number of people on the planet. Yet their death statistics are very low.

Country Vaccinations Vaccination % Death Rate Total Deaths Deaths per 100,000 Detection Date
World (7.9 billion)

3,305,991,786

42.0%

-

4,518,351

57

01 December 2019

United States

209,437,152

62.3%

1.6%

659,970

201.06

20 January 2020

China

1,095,000,000

75.8%

4.5%

4,848

0.35

01 December 2019

Italy

4,606,413

72.5%

2.8%

129,919

215.46

30 January 2020

Greece

6,259,984

60.4%

2.3%

14,169

132.22

26 February 2020

These numbers are important because there are claims that the virus originated in China. The claims are based on early virus data from 2020 that shows China as the first to have deaths from the virus. However, it is possible that it was first detected in China much like the 1918 Spanish Flu was first detected in Spain. If the virus originated in China, then the death statistics should be much higher. An alternative is that China is not reporting the death statistics in the same way as other nations.

Date Country or territory
1 December 2019 China

2020

13 January 2020 Thailand
16 January 2020 Japan
20 January 2020 South Korea, United States
21 January 2020 Taiwan
22 January 2020 Hong Kong, Macau
23 January 2020 Nepal, Singapore, Vietnam
24 January 2020 France
25 January 2020 Australia, Canada, Malaysia
27 January 2020 Cambodia, Germany, Sri Lanka
29 January 2020 Finland, United Arab Emirates
30 January 2020 India, Italy, Philippines
31 January 2020 Russia, Spain, Sweden, United Kingdom
3 February 2020 Belgium
14 February 2020 Egypt
19 February 2020 Iran
21 February 2020 Israel, Lebanon
24 February 2020 Afghanistan, Bahrain, Iraq, Kuwait, Oman
25 February 2020 Algeria, Austria, Brazil, Croatia, Switzerland
26 February 2020 Georgia, Greece, North Macedonia, Norway, Pakistan, Romania
27 February 2020 Denmark, Estonia, Netherlands, Nigeria, San Marino
28 February 2020 Azerbaijan, Belarus, Iceland, Lithuania, Mexico, Monaco, New Zealand
29 February 2020 Ecuador, Ireland, Luxembourg, Qatar
1 March 2020 Armenia, Czech Republic, Dominican Republic, Saint Barthalemy, Saint Martin
2 March 2020 Andorra, Indonesia, Jordan, Latvia, Morocco, Portugal, Saudi Arabia, Senegal, Tunisia
3 March 2020 Argentina, Chile, Gibraltar, Liechtenstein, Ukraine
4 March 2020 Faroe Islands, French Guiana, Hungary, Poland, Slovenia
5 March 2020 Bosnia and Herzegovina, Martinique, Palestine, South Africa
6 March 2020 Bhutan, Cameroon, Colombia, Costa Rica, Peru, Serbia, Slovakia, Togo, Vatican City
7 March 2020 Maldives, Malta, Moldova, Paraguay
8 March 2020 Albania, Bangladesh, Bulgaria
9 March 2020 Brunei, Cyprus, Guernsey, Panama

If the virus was not detected by other countries early in the outbreak, then an approach to determine the source of the virus may be to go out a few months and examine the numbers. This is based on the assumption that the virus at that point was being detected. If the data for May and June of 2020 is examined, new countries surface as the possible source of the virus and they are: USA, Brazil, UK, Italy, France, and Spain. This finding is based on early detected deaths. This is a new observation and does not match what was described in other sections of this analysis: Where Did COVID-19 Come From . WHO Report on Virus Origins . US Intelligence on Virus Origins . Conspiracy Theories and Social Bifurcation.

When this analysis started it was unclear where it would lead. Looking for patterns eventually led to questioning the source of the virus. There are other patterns that are more important. For example:

  1. Why is the United States performing so poorly with the virus?
  2. What are the implications if the vaccine is not rolled out to the rest of the countries, even if the death per 100,000 people are very low?
  3. Why are the vaccination rates in the Ukraine so low, are they still an agrarian society living outside away from cities and less vulnerable to the virus or is something else happening?
  4. Russia also has a low vaccination rate so the issue in the Ukraine is not related to Russian aggression.
  5. Why are certain countries hit very hard by the virus and others not?

There is a great deal to consider with this data. It will be examined for hundreds of years.

International Data and System Observations [spreadsheet-international]

Back To International Perspective

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Worst Case By Region And Country

The following data shows the COVID-19 pandemic by location sorted by deaths per 100,000 people as of September 14, 2021 [1]. These are some observations:

  1. There are many countries with deaths per 100,000 people data that are worse than the US. They are:
  2. It is surprising to see China with such a low 0.35 deaths per 100,000 people while the US and UK are at a very high 201 deaths per 100,000 people.
  3. Brazil is very high and it was part of the countries identified in the May June 2020 data as a possible virus source.
  4. Spain and France have lower numbers suggesting that the original group of six possible virus source countries based on early detected deaths is now four: USA, Brazil, UK, Italy.
  5. Going back to examine the May June 2020 data and the deaths per 100,000 people, Peru is added to the list of countries as a possible virus source: USA, Brazil, UK, Italy, Peru.
  6. This observation is completely out of the box and unexpected. History may eventually provide an answer as other data is uncovered and other patterns detected.

When the data is sorted by Region the worst case deaths per 100,000 people by regions are shown in the following table. The Regional Classifications are from the International Telecommunications Union [2].

[spreadsheet-international]

Region (ITU)

Worst Case
Deaths
per 100,000

South/Latin America

611.38

Europe

307.94

Arab States

206.97

United Kingdom

201.28

North America

201.06

Africa

144.94

Middle east

137.87

Asia & Pacific

77.90

The regions are further decomposed to zero in on areas with a finer level of detail. The region source is  from the List of Countries by Region Adopted from Annex II: Classification of Major Areas and Regions of the Population Division, DESA, United Nations [3]. Some countries were not associated with a region in the United Nations source reference. These countries were associated using data from other sources via the Internet.

When the data is sorted by UN Region + other sources for the missing countries, the worst case deaths per 100,000 people by regions are shown in the following tables.

[spreadsheet-international]

Region (UN+)

Worst Case
Deaths
per 100,000

America South

611.38

Europe Eastern

307.94

Europe Southern

302.79

Europe Western

221.65

Asia Western

220.00

America Central

209.87

Africa Northern

206.97

Europe Northern

201.28

America North

201.06

Region (UN+)

Worst Case
Deaths
per 100,000

Africa Southern

144.94

Asia South-Central

137.87

Caribbean

116.31

Africa Eastern

108.58

Asia South-Eastern

64.82

Oceana Melanesia

60.12

Africa Western

58.19

Asia Eastern

32.43

Africa Middle

18.13

Region (UN+)

Worst Case
Deaths
per 100,000

Oceana Australia

4.33

Oceana New Zealand

0.55

Asia Eastern - China

0.35

Antarctica

0.00

Oceana Micronesia

0.00

Oceana Polynesia

0.00

The following table shows the COVID-19 pandemic by Region and Country sorted by deaths per 100,000 people as of September 14, 2021 [1]. Peru has the highest deaths per 100,000 people as of September 14, 2021.

[spreadsheet-international]

Country

Confirmed
cases

Deaths

Case
rate

Deaths
per 100,000
Population

Region (ITU)

Global (ITU)

Peru 2,161,086 198,764 9.20% 611.38 South/Latin America Global South
Hungary 814,732 30,086 3.70% 307.94 Europe Global North
Bosnia and Herzegovina 220,636 9,995 4.50% 302.79 Europe Global North
North Macedonia 183,523 6,259 3.40% 300.41 Europe Global North
Montenegro 121,908 1,800 1.50% 289.33 Europe Global North
Czech Republic 1,683,179 30,413 1.80% 285.04 Europe Global North
Bulgaria 471,272 19,522 4.10% 279.85 Europe Global North
Brazil 20,999,779 586,851 2.80% 278.06 South/Latin America Global South
San Marino 5,373 90 1.70% 265.8 South/Latin America Global South
Argentina 5,224,534 113,402 2.20% 252.35 South/Latin America Global South
Colombia 4,930,249 125,647 2.50% 249.6 South/Latin America Global South
Moldova 274,812 6,521 2.40% 245.37 Europe Global North
Slovakia 398,690 12,558 3.10% 230.25 Europe Global North
Paraguay 459,257 16,097 3.50% 228.5 South/Latin America Global South
Belgium 1,205,516 25,454 2.10% 221.65 Europe Global North
Georgia 580,869 8,185 1.40% 220 Europe Global North
Italy 4,606,413 129,919 2.80% 215.46 Europe Global North
Slovenia 276,174 4,469 1.60% 214.04 Europe Global North
Mexico 3,511,882 267,748 7.60% 209.87 South/Latin America Global South
Croatia 383,915 8,440 2.20% 207.5 Europe Global North
Tunisia 685,019 24,205 3.50% 206.97 Arab States Global South
United Kingdom 7,259,752 134,525 1.90% 201.28 Europe Global North
United States 40,955,201 659,970 1.60% 201.06 North America Global North
Poland 2,893,649 75,425 2.60% 198.64 Europe Global North
Chile 1,644,071 37,232 2.30% 196.45 South/Latin America Global South
Ecuador 505,278 32,448 6.40% 186.77 South/Latin America Global South
Spain 4,907,461 85,290 1.70% 181.17 Europe Global North
Romania 1,120,804 34,990 3.10% 180.77 Europe Global North
Uruguay 386,701 6,040 1.60% 174.48 South/Latin America Global South
Portugal 1,055,584 17,861 1.70% 173.92 Europe Global North
France 6,990,662 116,124 1.70% 173.16 Europe Global North
Armenia 248,850 5,002 2.00% 169.12 Europe Global North
Andorra 15,083 130 0.90% 168.52 Europe Global North
Lithuania 308,464 4,688 1.50% 168.22 Europe Global North
Panama 462,010 7,131 1.50% 167.93 South/Latin America Global South
Bolivia 495,035 18,587 3.80% 161.44 South/Latin America Global South
Liechtenstein 3,380 60 1.80% 157.82 Europe Global North
Kosovo 157,002 2,795 1.80% 155.78 Europe Global North
South Africa 2,858,195 84,877 3.00% 144.94 Africa Global South
Sweden 1,138,017 14,703 1.30% 142.95 Europe Global North
Iran 5,295,786 114,311 2.20% 137.87 Middle east Global South
Namibia 126,290 3,435 2.70% 137.7 Africa Global South
Latvia 147,193 2,609 1.80% 136.4 Europe Global North
Luxembourg 76,632 834 1.10% 134.54 Europe Global North
Greece 615,157 14,169 2.30% 132.22 Europe Global North
Suriname 33,573 764 2.30% 131.42 South/Latin America Global South
Russia 7,037,435 189,319 2.70% 131.13 Europe Global North
Ukraine 2,419,254 57,772 2.40% 130.16 Europe Global North
Switzerland 808,058 10,952 1.40% 127.72 Europe Global North
Austria 710,030 10,839 1.50% 122.1 Europe Global North
Lebanon 613,498 8,192 1.30% 119.49 Middle east Global South
Bahamas 19,335 453 2.30% 116.31 South/Latin America Global South
Costa Rica 489,784 5,754 1.20% 114 South/Latin America Global South
Germany 4,087,125 92,625 2.30% 111.42 Europe Global North
Serbia 816,912 7,548 0.90% 108.68 Europe Global North
Seychelles 20,593 106 0.50% 108.58 Africa Global South
Netherlands 2,005,532 18,451 0.90% 106.45 Europe Global North
Jordan 807,384 10,548 1.30% 104.42 Middle east Global South
Ireland 366,659 5,155 1.40% 104.32 Europe Global North
Eswatini 44,863 1,172 2.60% 102.08 Africa Global South
Botswana 163,665 2,325 1.40% 100.92 Africa Global South
Estonia 146,707 1,312 0.90% 98.9 Europe Global North
Trinidad and Tobago 47,130 1,376 2.90% 98.64 South/Latin America Global South
Honduras 350,879 9,319 2.70% 95.62 South/Latin America Global South
Belize 17,405 373 2.10% 95.55 South/Latin America Global South
Malta 36,758 449 1.20% 89.33 Europe Global North
Albania 157,026 2,543 1.60% 89.1 Europe Global North
Guyana 27,976 683 2.40% 87.25 South/Latin America Global South
Monaco 3,276 33 1.00% 84.69 Europe Global North
Bahrain 273,743 1,388 0.50% 84.57 Arab States Global South
Oman 303,105 4,089 1.30% 82.19 Middle east Global South
Israel 1,172,253 7,383 0.60% 81.55 Europe Global North
Palestine 369,761 3,817 1.00% 81.47 Arab States Global South
Kazakhstan 915,383 14,423 1.60% 77.9 Asia & Pacific Global North
Guatemala 510,724 12,710 2.50% 76.55 South/Latin America Global South
Canada 1,549,841 27,247 1.80% 72.49 North America Global North
Saint Lucia 9,823 132 1.30% 72.21 South/Latin America Global South
Turkey 6,658,221 59,886 0.90% 71.78 Europe Global North
Libya 323,930 4,427 1.40% 65.32 Middle east Global South
Malaysia 1,979,698 20,711 1.00% 64.82 Asia & Pacific Global South
Azerbaijan 455,044 6,031 1.30% 60.17 Asia & Pacific Global North
Fiji 48,986 535 1.10% 60.12 Asia & Pacific Global South
Jamaica 75,857 1,731 2.30% 58.71 South/Latin America Global South
Cape Verde 36,588 320 0.90% 58.19 Africa Global South
Kuwait 410,784 2,431 0.60% 57.78 Middle east Global South
Cuba 745,202 6,299 0.80% 55.58 South/Latin America Global South
Iraq 1,950,765 21,496 1.10% 54.68 Middle east Global South
Sri Lanka 485,922 11,296 2.30% 51.81 Asia & Pacific Global South
Indonesia 4,167,511 138,889 3.30% 51.32 Asia & Pacific Global South
Antigua and Barbuda 2,166 48 2.20% 49.42 South/Latin America Global South
El Salvador 98,122 3,022 3.10% 46.83 South/Latin America Global South
Denmark 353,803 2,613 0.70% 44.91 Europe Global North
Cyprus 116,209 528 0.50% 44.05 Europe Global North
Maldives 82,822 227 0.30% 42.75 Asia & Pacific Global South
Belarus 503,073 3,917 0.80% 41.38 Europe Global North
Kyrgyzstan 177,158 2,572 1.50% 39.83 Asia & Pacific Global South
Nepal 777,163 10,949 1.40% 38.27 Asia & Pacific Global South
Dominican Republic 353,303 4,014 1.10% 37.38 South/Latin America Global South
Morocco 904,647 13,546 1.50% 37.14 Arab States Global South
Philippines 2,227,367 35,145 1.60% 32.51 Asia & Pacific Global South
Mongolia 257,770 1,046 0.40% 32.43 Asia & Pacific Global South
India 33,264,175 442,874 1.30% 32.41 Asia & Pacific Global South
Zimbabwe 126,269 4,538 3.60% 30.99 Africa Global South
Myanmar 431,833 16,530 3.80% 30.59 Asia & Pacific Global South
Saudi Arabia 545,829 8,610 1.60% 25.13 Middle east Global South
Grenada 2,345 24 1.00% 21.43 South/Latin America Global South
Qatar 234,642 604 0.30% 21.33 Middle east Global South
United Arab Emirates 728,886 2,062 0.30% 21.1 Middle east Global South
Thailand 1,382,173 14,353 1.00% 20.61 Asia & Pacific Global South
Zambia 207,938 3,631 1.70% 20.33 Africa Global South
Finland 133,638 1,047 0.80% 18.97 Europe Global North
Lesotho 14,395 403 2.80% 18.96 Africa Global South
Afghanistan 153,962 7,164 4.70% 18.83 Asia & Pacific Global South
Sao Tome and Principe 2,816 39 1.40% 18.13 Africa Global South
Barbados 5,906 52 0.90% 18.12 South/Latin America Global South
Comoros 4,097 147 3.60% 17.28 Arab States Global South
Egypt 292,957 16,871 5.80% 16.81 Middle east Global South
Mauritania 34,878 754 2.20% 16.66 Arab States Global South
Bangladesh 1,530,413 26,931 1.80% 16.52 Asia & Pacific Global South
Djibouti 11,860 157 1.30% 16.13 Arab States Global South
Vietnam 613,375 15,279 2.50% 15.84 Asia & Pacific Global South
Norway 176,142 827 0.50% 15.46 Europe Global North
Venezuela 346,755 4,192 1.20% 14.7 South/Latin America Global South
Gambia 9,848 328 3.30% 13.97 Africa Global South
Japan 1,641,963 16,814 1.00% 13.32 Europe Global North
Saint Kitts and Nevis 1,464 7 0.50% 13.25 South/Latin America Global South
Algeria 200,068 5,578 2.80% 12.96 Arab States Global South
Cambodia 99,504 2,040 2.10% 12.37 Asia & Pacific Global South
Pakistan 1,207,508 26,787 2.20% 12.37 Asia & Pacific Global South
Syria 29,498 2,077 7.00% 12.17 Asia & Pacific Global South
Malawi 61,113 2,238 3.70% 12.01 Africa Global South
Senegal 73,478 1,831 2.50% 11.24 Africa Global South
Saint Vincent and the Grenadines 2,446 12 0.50% 10.85 South/Latin America Global South
Equatorial Guinea 10,498 131 1.20% 9.66 Africa Global South
Kenya 243,725 4,906 2.00% 9.33 Africa Global South
Rwanda 92,620 1,172 1.30% 9.28 Africa Global South
Iceland 11,247 33 0.30% 9.13 Europe Global North
Dominica 2,280 6 0.30% 8.36 South/Latin America Global South
Gabon 26,638 170 0.60% 7.82 Africa Global South
East Timor 18,515 95 0.50% 7.35 Asia & Pacific Global South
Uganda 121,510 3,095 2.50% 6.99 Africa Global South
Sudan 37,931 2,837 7.50% 6.63 Arab States Global South
Somalia 18,373 1,023 5.60% 6.62 Arab States Global South
Guinea-Bissau 6,022 125 2.10% 6.51 Africa Global South
Mozambique 149,207 1,892 1.30% 6.23 Africa Global South
Yemen 8,414 1,584 18.80% 5.43 Middle east Global South
Cameroon 84,210 1,357 1.60% 5.24 Africa Global South
Haiti 21,162 588 2.80% 5.22 South/Latin America Global South
Liberia 5,727 245 4.30% 4.96 Africa Global South
Brunei 4,163 21 0.50% 4.85 Asia & Pacific Global South
South Korea 274,415 2,360 0.90% 4.56 Asia & Pacific Global South
Ethiopia 323,104 4,929 1.50% 4.4 Africa Global South
Australia 75,323 1,098 1.50% 4.33 Asia & Pacific Global North
Angola 50,446 1,339 2.70% 4.21 Africa Global South
Ghana 123,521 1,096 0.90% 3.6 Africa Global South
Madagascar 42,894 958 2.20% 3.55 Africa Global South
Taiwan 16,088 839 5.20% 3.53 Asia & Pacific Global North
Uzbekistan 164,364 1,153 0.70% 3.43 Asia & Pacific Global South
Congo 13,701 183 1.30% 3.4 Africa Global South
Mauritius 13,114 42 0.30% 3.32 Africa Global South
Nicaragua 12,350 201 1.60% 3.07 South/Latin America Global South
Guinea 30,029 367 1.20% 2.87 Africa Global South
Mali 14,983 543 3.60% 2.76 Africa Global South
Togo 23,618 205 0.90% 2.54 Africa Global South
Papua New Guinea 18,381 196 1.10% 2.23 Asia & Pacific Global South
Central African Republic 11,309 100 0.90% 2.11 Africa Global South
Ivory Coast 58,009 515 0.90% 2 Africa Global South
Sierra Leone 6,385 121 1.90% 1.55 Africa Global South
Tajikistan 17,442 125 0.70% 1.34 Asia & Pacific Global South
Nigeria 199,151 2,598 1.30% 1.29 Africa Global South
DR Congo 56,096 1,068 1.90% 1.23 Africa Global South
Benin 19,841 141 0.70% 1.19 Africa Global South
Chad 5,016 174 3.50% 1.09 Africa Global South
South Sudan 11,610 120 1.00% 1.08 Africa Global South
Singapore 71,687 58 0.10% 1.02 Asia & Pacific Global North
Niger 5,919 199 3.40% 0.85 Africa Global South
Burkina Faso 13,942 171 1.20% 0.84 Africa Global South
New Zealand 3,950 27 0.70% 0.55 Asia & Pacific Global North
Bhutan 2,596 3 0.10% 0.39 Asia & Pacific Global South
China 107,456 4,848 4.50% 0.35 Asia & Pacific Global South
Burundi 14,047 38 0.30% 0.33 Africa Global South
Laos 17,357 16 0.10% 0.22 Asia & Pacific Global South
Tanzania 1,367 50 3.70% 0.09 Africa Global South
Eritrea 6,655 40 0.60% Africa Global South
Aland Islands no data no data no data Europe Global North
American Samoa no data no data no data Asia & Pacific Global South
Anguilla no data no data no data South/Latin America Global South
Antarctica no data no data no data Asia & Pacific Global South
Aruba no data no data no data South/Latin America Global South
Bermuda no data no data no data South/Latin America Global South
Bouvet Island no data no data no data South/Latin America Global South
British Indian Ocean Territory no data no data no data Asia & Pacific Global South
Cayman Islands no data no data no data South/Latin America Global South
Christmas Island no data no data no data Asia & Pacific Global South
Cocos (Keeling) Islands no data no data no data Asia & Pacific Global South
Congo, The Democratic Republic of the no data no data no data Africa Global South
Cook Islands no data no data no data Asia & Pacific Global South
Cote D'Ivoire 58,009 515 0.90% 2 Africa Global South
Falkland Islands (Malvinas) no data no data no data South/Latin America Global South
Faroe Islands no data no data no data Europe Global North
France, Metropolitan no data no data no data Europe Global North
French Guiana no data no data no data South/Latin America Global South
French Polynesia no data no data no data Asia & Pacific Global South
French Southern Territories no data no data no data Asia & Pacific Global South
Gibraltar no data no data no data Europe Global North
Greenland no data no data no data Europe Global North
Guam no data no data no data Asia & Pacific Global South
Guatemala no data no data no data South/Latin America Global South
Guernsey no data no data no data Europe Global North
Heard Island and McDonald Islands no data no data no data Asia & Pacific Global South
Holy See (Vatican City State) no data no data no data Europe Global North
Hong Kong no data no data no data Asia & Pacific Global South
Isle of Man no data no data no data Europe Global North
Jersey no data no data no data Asia & Pacific Global North
Kiribati no data no data no data Asia & Pacific Global South
Korea, Democratic People's Republic of no data no data no data Asia & Pacific Global South
Korea, Republic of no data no data no data Asia & Pacific Global North
Macau no data no data no data Asia & Pacific Global South
Macedonia no data no data no data Europe Global North
Marshall Islands no data no data no data Asia & Pacific Global South
Martinique no data no data no data South/Latin America Global South
Mayotte no data no data no data Africa Global South
Micronesia, Federated States of no data no data no data Asia & Pacific Global South
Montserrat no data no data no data South/Latin America Global South
Nauru no data no data no data Asia & Pacific Global South
Netherlands Antilles no data no data no data South/Latin America Global South
New Caledonia no data no data no data Asia & Pacific Global South
Niue no data no data no data Asia & Pacific Global South
Norfolk Island no data no data no data Asia & Pacific Global South
Northern Mariana Islands no data no data no data Asia & Pacific Global South
Palau no data no data no data Asia & Pacific Global South
Pitcairn Islands no data no data no data Asia & Pacific Global South
Puerto Rico no data no data no data South/Latin America Global South
Reunion no data no data no data Asia & Pacific Global South
Saint Barthelemy no data no data no data South/Latin America Global South
Saint Helena no data no data no data Africa Global South
Saint Pierre and Miquelon no data no data no data North America Global North
Saint Vincent and the Grenadines no data no data no data South/Latin America Global South
Samoa no data no data no data Asia & Pacific Global South
San Marino no data no data no data Europe Global North
Solomon Islands no data no data no data Asia & Pacific Global South
South Georgia and the South Sandwich Islands no data no data no data South/Latin America Global South
Svalbard and Jan Mayen no data no data no data Europe Global North
Swaziland no data no data no data Africa Global South
Timor-Leste no data no data no data Asia & Pacific Global South
Tokelau no data no data no data Asia & Pacific Global South
Tonga no data no data no data Asia & Pacific Global South
Turkmenistan no data no data no data Asia & Pacific Global South
Turks and Caicos Islands no data no data no data South/Latin America Global South
Tuvalu no data no data no data Asia & Pacific Global South
United States Minor Outlying Islands no data no data no data Asia & Pacific Global South
Vanuatu no data no data no data Asia & Pacific Global South
Virgin Islands, British no data no data no data South/Latin America Global South
Virgin Islands, U.S. no data no data no data South/Latin America Global South
Wallis and Futuna no data no data no data Asia & Pacific Global South
Western Sahara no data no data no data Africa Global South

The following is a picture of the city of Lima in Peru. [1] The image shows that the possibility of the massive COVID-19 deaths in Peru may be associated with the heavy emphasis on indoor spaces. It is unclear if the HVAC systems share the air flow with different occupants in the various buildings.

Back To International Perspective

.

Monthly By Country

The following table shows the cumulative COVID-19 deaths on Jan 11, and first day of the other months for 2020. [1]

  1. This table suggests that the virus started in China. However, it is possible that it was first detected in China much like the 1918 Spanish Flu was detected in Spain.
  2. If the virus was not detected by other countries early in the outbreak, then an approach to determine the source of the virus is to go out a few months and examine the numbers.
  3. If the data for May and June is examined, new countries surface as the possible source of the virus and they are: USA, Brazil, UK, Italy, France, and Spain.

[spreadsheet-international]

2020 Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
World 1 259 2,977 40,598 224,172 371,166 508,055 675,060 848,445 1,010,639 1,192,911 1,465,144
Days to double 6 4 16 8 18 37 56 70 80 94 101 110
Countries and territories 1 1 8 125 175 185 186 192 191 193 193 193
USA 0 0 0 2,850 55,337 102,640 126,573 151,265 182,162 204,642 228,185 264,808
Brazil 0 0 0 159 5,466 28,834 58,314 91,263 120,828 142,921 159,477 172,833
India 0 0 0 38 1,147 5,394 17,400 36,511 65,288 98,678 122,111 137,621
Mexico 0 0 0 28 1,732 9,779 27,121 46,000 64,158 77,163 91,289 105,655
UK 0 0 0 1,789 26,771 38,489 43,730 46,119 41,501 42,143 46,555 58,448
Italy 0 0 29 12,430 27,967 33,415 34,767 35,141 35,483 35,894 38,618 56,361
France 0 0 2 3,514 24,342 28,746 29,760 30,147 30,494 31,746 36,473 53,506
Iran 0 0 43 2,898 6,028 7,797 10,817 16,766 21,571 26,169 34,864 48,246
Spain 0 0 0 8,189 24,543 29,045 28,355 28,445 29,141 31,791 35,878 45,069
Russia 0 0 0 17 1,169 4,855 9,536 14,058 17,299 20,891 28,235 40,464
Argentina 0 0 0 24 215 530 1,283 3,466 8,498 16,519 30,792 38,473
Colombia 0 0 0 14 278 890 3,223 9,810 19,364 25,828 31,135 36,584
Peru 0 0 0 24 943 4,371 9,504 19,021 28,788 32,396 34,411 35,923
South Africa 0 0 0 5 103 683 2,657 8,005 14,149 16,734 19,276 21,535
Poland 0 0 0 33 644 1,064 1,463 1,716 2,039 2,513 5,631 17,150
Indonesia 0 0 0 136 792 1,613 2,876 5,131 7,417 10,740 13,869 16,945
Belgium 0 0 0 705 7,594 9,467 9,754 9,841 9,897 10,020 11,734 16,645
Germany 0 0 0 732 6,288 8,511 8,985 9,148 9,302 9,500 10,481 16,636
Chile 0 0 0 12 227 1,054 5,688 9,457 11,289 12,741 14,207 15,410
Turkey 0 0 0 214 3,174 4,540 5,131 5,691 6,370 8,195 10,252 13,746
Ecuador 0 0 0 75 900 3,358 4,527 5,702 6,556 11,355 12,670 13,461
Ukraine 0 0 0 17 272 718 1,173 1,709 2,605 4,193 7,306 12,548
Iraq 0 0 0 50 93 205 1,943 4,741 7,042 9,181 10,910 12,258
Canada 0 0 0 89 3,082 7,092 8,566 8,929 9,117 9,291 10,110 12,032
Romania 0 0 0 69 717 1,262 1,651 2,343 3,621 4,825 6,968 11,331
Netherlands 0 0 0 1,039 4,795 5,956 6,113 6,147 6,215 6,397 7,385 9,363
Bolivia 0 0 0 6 59 310 1,071 2,894 4,966 7,931 8,715 8,952
Philippines 0 0 1 88 568 957 1,266 2,023 3,558 5,504 7,221 8,392
Czechia 0 0 0 31 236 320 349 382 424 655 3,251 8,295
Pakistan 0 0 0 26 385 1,543 4,395 5,951 6,298 6,479 6,806 8,025
Sweden 0 0 0 180 2,586 4,395 5,333 5,743 5,820 5,893 5,938 6,681
Egypt 0 0 0 46 392 959 2,953 4,805 5,421 5,914 6,266 6,650
Bangladesh 0 0 0 6 168 650 1,847 3,111 4,281 5,251 5,923 6,644
Saudi Arabia 0 0 0 10 162 503 1,649 2,866 3,897 4,768 5,402 5,896
Morocco 0 0 0 36 170 205 228 353 1,141 2,152 3,695 5,846
Hungary 0 0 0 16 323 526 585 596 615 781 1,819 4,977
China 1 259 2,873 3,321 4,643 4,645 4,648 4,668 4,730 4,746 4,746 4,750
Portugal 0 0 0 160 989 1,410 1,576 1,735 1,822 1,971 2,507 4,505
Switzerland 0 0 0 373 1,422 1,656 1,683 1,703 1,725 1,782 2,035 4,430
Guatemala 0 0 0 1 16 102 746 1,924 2,760 3,246 3,729 4,171
Bulgaria 0 0 0 8 66 140 230 383 629 825 1,279 4,035
Tunisia 0 0 0 10 41 48 50 50 77 246 1,317 3,260
Panama 0 0 0 24 178 330 620 1,397 1,995 2,364 2,688 3,060
Austria 0 0 0 128 584 668 705 718 733 799 1,097 2,983
Honduras 0 0 0 2 71 201 485 1,312 1,858 2,323 2,669 2,909
Israel 0 0 0 21 223 285 319 493 961 1,543 2,517 2,864
Jordan 0 0 0 5 8 9 9 11 15 61 829 2,751
Bosnia and Herzegovina 0 0 0 12 68 152 185 324 603 849 1,234 2,681
Kazakhstan 0 0 0 2 25 41 188 793 1,878 2,075 2,251 2,477
Algeria 0 0 0 35 450 653 912 1,210 1,510 1,736 1,956 2,431
Greece 0 0 0 49 140 175 192 206 266 391 626 2,406
Dominican Republic 0 0 0 51 301 502 747 1,160 1,710 2,105 2,245 2,331
Moldova 0 0 0 3 119 295 547 778 995 1,320 1,785 2,304
Armenia 0 0 0 3 33 139 453 749 881 963 1,363 2,193
Japan 0 0 5 57 432 892 974 1,011 1,296 1,571 1,766 2,139
Ireland 0 0 0 71 1,232 1,652 1,736 1,763 1,777 1,804 1,913 2,053
Myanmar 0 0 0 1 6 6 6 6 6 310 1,237 1,918
Croatia 0 0 0 6 69 103 107 145 186 280 546 1,786
Afghanistan 0 0 0 4 64 265 774 1,283 1,406 1,458 1,536 1,774
North Macedonia 0 0 0 9 77 133 302 486 603 739 994 1,763
Paraguay 0 0 0 3 9 11 17 47 308 841 1,387 1,743
Ethiopia 0 0 0 0 3 11 103 274 809 1,198 1,469 1,706
Costa Rica 0 0 0 2 6 10 15 140 418 880 1,371 1,690
Serbia 0 0 0 13 179 243 277 573 713 749 820 1,604
Nepal 0 0 0 0 0 8 29 56 228 498 937 1,508
Kenya 0 0 0 1 17 64 148 341 577 711 996 1,469
Oman 0 0 0 1 11 49 176 421 685 935 1,208 1,423
Azerbaijan 0 0 0 5 24 63 213 448 534 591 730 1,392
Georgia 0 0 0 0 6 12 15 17 19 40 335 1,303
Kyrgyzstan 0 0 0 0 8 16 62 1,397 1,060 1,065 1,150 1,275
Sudan 0 0 0 2 31 286 572 746 823 836 837 1,249
Libya 0 0 0 0 3 5 24 74 237 551 857 1,183
Nigeria 0 0 0 1 58 287 590 879 1,013 1,112 1,144 1,173
Belarus 0 0 0 0 89 235 392 559 681 833 985 1,158
El Salvador 0 0 0 0 9 46 174 448 717 843 975 1,114
Puerto Rico 0 0 0 8 54 136 153 219 434 661 822 1,106
Lebanon 0 0 0 12 24 27 34 59 167 361 637 1,018
Kosovo 0 0 0 1 22 30 41 217 515 615 671 1,006
Slovenia 0 0 0 13 91 108 111 117 128 138 231 948
Australia 0 0 0 20 92 103 104 196 652 886 907 908
Venezuela 0 0 0 3 10 14 48 158 381 621 793 894
Kuwait 0 0 0 0 26 212 354 447 531 610 779 880
Slovakia 0 0 0 0 23 28 28 29 33 48 219 839
Denmark 0 0 0 90 452 574 605 615 624 650 721 837
Palestine 0 0 0 1 2 5 11 85 173 368 555 822
Albania 0 0 0 13 31 33 65 157 284 387 509 810
Uzbekistan 0 0 0 2 9 15 26 143 322 471 568 610
Yemen 0 0 0 0 2 81 313 494 567 588 600 606
UAE 0 0 0 6 105 264 315 351 384 416 495 572
South Korea 0 0 18 165 248 271 282 301 324 415 466 526
Lithuania 0 0 0 7 45 70 78 80 86 92 165 519
Montenegro 0 0 0 2 7 9 12 49 100 170 313 499
Cameroon 0 0 0 6 61 191 313 391 414 418 426 441
Syria 0 0 0 2 3 5 9 43 112 197 288 417
Finland 0 0 0 17 211 320 328 329 335 344 358 399
Malaysia 0 0 0 43 102 115 121 125 127 136 249 360
Zambia 0 0 0 0 3 7 24 151 288 332 349 357
Angola 0 0 0 2 2 4 13 51 108 183 284 348
Bahrain 0 0 0 4 8 19 87 148 190 246 321 341
DRC 0 0 0 8 31 71 169 214 258 272 307 333
Senegal 0 0 0 0 9 42 112 205 284 311 324 333
Norway 0 0 0 28 204 236 250 255 264 274 282 332
Ghana 0 0 0 5 17 36 112 182 276 301 320 323
Luxembourg 0 0 0 23 90 110 110 114 124 124 157 312
Zimbabwe 0 0 0 1 4 4 7 67 202 228 243 277
Jamaica 0 0 0 1 7 9 10 10 21 107 206 257
Madagascar 0 0 0 0 0 6 20 106 192 230 244 251
Qatar 0 0 0 2 10 38 113 174 197 214 232 237
Haiti 0 0 0 0 7 41 105 161 201 229 232 233
Latvia 0 0 0 0 15 24 30 32 34 37 71 206
Uganda 0 0 0 0 0 0 0 3 32 75 111 205
Malawi 0 0 0 0 3 4 16 114 175 179 184 185
Mauritania 0 0 0 0 1 23 128 157 159 161 163 172
Bahamas 0 0 0 0 11 11 11 14 43 95 142 163
Nicaragua 0 0 0 1 4 35 74 116 137 151 156 160
Mali 0 0 0 0 26 77 116 124 126 131 136 152
Namibia 0 0 0 0 0 0 0 10 75 121 133 152
Guyana 0 0 0 2 8 12 12 20 37 78 124 150
Guadeloupe 0 0 0 5 12 14 14 14 16 57 139 149
Belize 0 0 0 0 2 2 2 2 13 26 58 147
Malta 0 0 0 0 4 7 9 9 12 34 62 137
Cuba 0 0 0 6 61 83 86 87 94 122 128 135
Cote d'Ivoire 0 0 0 0 14 33 66 102 115 120 124 132
Mozambique 0 0 0 0 0 2 6 11 23 61 92 131
Gambia 0 0 0 1 1 1 2 9 96 112 119 123
Eswatini 0 0 0 0 1 2 11 40 91 109 117 122
Trinidad and Tobago 0 0 0 3 8 8 8 8 22 75 107 120
Estonia 0 0 0 4 52 68 69 69 64 64 73 118
Suriname 0 0 0 0 1 1 13 26 67 104 111 117
Sri Lanka 0 0 0 2 7 10 11 11 12 13 20 116
Somalia 0 0 0 0 28 78 90 93 98 99 104 113
Guam 0 0 0 2 5 5 5 5 10 49 79 112
Cabo Verde 0 0 0 1 1 4 15 23 40 60 95 104
Chad 0 0 0 0 3 65 74 75 77 85 98 101
Congo 0 0 0 0 9 20 41 56 78 89 92 94
Tajikistan 0 0 0 0 0 47 52 60 68 76 82 86
Equatorial Guinea 0 0 0 0 2 12 12 83 83 83 83 85
Liberia 0 0 0 0 16 27 36 75 82 82 82 83
Andorra 0 0 0 12 42 51 52 66 53 53 75 76
Uruguay 0 0 0 1 15 22 27 35 44 48 58 76
Guinea 0 0 0 0 7 23 33 46 59 66 72 76
French Polynesia 0 0 0 0 0 0 0 0 0 7 29 75
Sierra Leone 0 0 0 0 7 46 60 67 70 72 74 74
Niger 0 0 0 3 32 64 67 69 69 69 69 72
French Guiana 0 0 0 0 1 1 15 43 59 66 70 70
Burkina Faso 0 0 0 14 43 53 53 53 55 57 67 68
Togo 0 0 0 1 9 13 14 18 27 48 55 64
Central African Republic 0 0 0 0 0 2 47 59 62 62 62 63
Djibouti 0 0 0 0 2 24 54 58 60 61 61 61
South Sudan 0 0 0 0 0 10 38 46 47 49 59 61
Thailand 0 0 0 12 54 57 58 58 58 59 59 60
Gabon 0 0 0 1 3 17 42 49 53 54 55 59
Cyprus 0 0 0 8 20 17 19 19 21 22 26 49
Mayotte 0 0 0 0 4 23 35 39 40 42 44 49
Rwanda 0 0 0 0 0 1 2 5 16 29 35 49
San Marino 0 0 0 26 41 42 42 42 42 42 42 46
Maldives 0 0 0 0 0 5 8 16 28 34 38 46
Aruba 0 0 0 0 2 3 3 3 10 26 37 45
Lesotho 0 0 0 0 0 0 0 13 31 36 43 44
Benin 0 0 0 0 2 3 21 36 40 41 41 43
Guinea-Bissau 0 0 0 0 1 8 24 27 33 39 41 43
Martinique 0 0 0 2 14 14 14 15 16 21 31 40
Reunion 0 0 0 0 0 1 2 4 5 16 22 40
Vietnam 0 0 0 0 0 0 0 2 34 35 35 35
Jersey 0 0 0 2 20 29 31 31 32 32 32 32
Botswana 0 0 0 0 1 1 1 2 6 16 24 31
Singapore 0 0 0 3 15 23 26 27 27 27 28 29
Iceland 0 0 0 2 10 10 10 10 10 10 12 26
New Zealand 0 0 0 1 19 22 22 22 22 25 25 25
Isle of Man 0 0 0 0 22 24 24 24 24 24 24 25
Sint Maarten 0 0 0 0 13 15 15 15 17 22 22 25
US Virgin Islands 0 0 0 0 4 6 6 8 14 20 21 23
Tanzania 0 0 0 1 17 21 21 21 21 21 21 21
Sao Tome and Principe 0 0 0 0 1 10 11 15 15 15 16 17
Liechtenstein 0 0 0 0 1 1 1 1 1 1 3 15
Other 0 0 6 7 13 13 13 13 13 13 13 13
Guernsey 0 0 0 1 13 13 13 13 13 13 13 13
Saint Martin 0 0 0 2 3 3 3 3 5 8 9 12
Mauritius 0 0 0 5 10 10 10 10 10 10 10 10
Bermuda 0 0 0 0 6 9 9 9 9 9 9 9
Barbados 0 0 0 0 7 7 7 7 7 7 7 7
Comoros 0 0 0 0 0 2 7 7 7 7 7 7
Papua New Guinea 0 0 0 0 0 0 0 2 5 7 7 7
Turks and Caicos 0 0 0 0 1 1 2 2 3 6 6 6
Gibraltar 0 0 0 0 0 0 0 0 0 0 0 5
Curacao 0 0 0 1 1 1 1 1 1 1 1 4
Antigua and Barbuda 0 0 0 0 3 3 3 3 3 3 3 4
Brunei 0 0 0 1 1 2 3 3 3 3 3 3
Monaco 0 0 0 0 1 1 1 1 1 1 2 3
Caribbean Netherlands 0 0 0 0 0 0 0 0 0 1 3 3
Cayman Islands 0 0 0 1 1 1 1 1 1 1 1 2
Northern Mariana Islands 0 0 0 0 2 2 2 2 2 2 2 2
Fiji 0 0 0 0 0 0 0 1 2 2 2 2
Saint Lucia 0 0 0 0 0 0 0 0 0 0 0 2
British Virgin Islands 0 0 0 0 1 1 1 1 1 1 1 1
Burundi 0 0 0 0 1 1 1 1 1 1 1 1
Montserrat 0 0 0 0 1 1 1 1 1 1 1 1

The following table shows the cumulative COVID-19 deaths at the start of each month as of September 2021 [1].

  1. The numbers for the most part have all gone up significantly between January and September 2021.
  2. An interesting item of note is the counties with very low initial numbers have similar increases suggesting that they are reporting the true numbers.
  3. This is important because those countries have some type of characteristic that makes them more protected from the virus.
  4. This study in 2020 saw a similar observation and suggested that the people tend to live more in outdoor settings.

[spreadsheet-international]

2021 Jan 1 Feb 1 Mar 1 Apr 1 May 1 Jun 1 Jul 1 Aug 1 Sep 1
World 1,886,819 2,309,320 2,620,732 2,912,010 3,287,858 3,668,860 3,947,516 4,220,696 4,518,351
United States of America 349,124 446,519 515,214 548,942 570,025 588,756 599,412 608,111 634,415
Brazil 193,875 223,945 254,221 317,646 401,186 461,931 515,985 555,460 579,574
India 148,994 154,392 157,157 162,927 211,853 331,895 399,459 424,351 439,020
Mexico 124,897 158,074 185,257 202,633 216,447 223,507 232,803 240,456 258,491
Peru 93,192 103,396 121,940 142,864 166,382 183,879 192,331 196,291 198,263
Russian Federation 57,555 73,619 86,455 99,233 110,520 121,873 135,886 159,352 184,014
Indonesia 22,329 30,277 36,325 41,054 45,652 50,723 58,995 95,723 133,676
United Kingdom 73,512 106,158 122,849 126,713 127,517 127,782 128,140 129,654 132,535
Italy 74,159 88,516 97,699 109,346 120,807 126,128 127,566 128,063 129,221
Colombia 42,909 53,650 59,660 63,255 73,230 88,282 105,934 120,432 124,883
France 64,254 75,661 85,986 95,062 103,830 108,713 110,162 110,819 112,772
Argentina 43,163 47,931 51,965 55,736 63,508 77,456 93,668 105,586 111,607
Iran (Islamic Republic of) 55,223 57,959 60,073 62,665 71,758 80,156 84,264 90,630 107,794
Germany 33,624 57,120 70,105 76,543 83,082 88,595 90,938 91,659 92,223
Spain 54,116 65,359 74,315 77,324 79,537 80,890 81,486 82,342 84,810
South Africa 28,469 44,164 49,993 52,846 54,350 56,506 60,647 72,013 82,261
Poland 28,956 37,222 43,793 53,665 67,924 73,856 75,044 75,261 75,358
Turkey 20,881 25,993 28,569 31,537 40,131 47,527 49,732 51,332 56,710
Ukraine 18,680 22,768 26,050 33,246 44,436 50,699 52,391 52,951 53,833
Chile 16,608 18,452 20,572 23,135 26,353 29,300 32,545 35,448 36,937
Romania 18,120 21,031 23,245 27,198 31,923 33,933 34,262 34,330 34,633
Philippines 9,244 10,749 12,318 13,297 17,234 20,966 24,662 27,889 33,448
Ecuador 14,034 14,859 15,811 16,847 18,631 20,572 21,560 31,631 32,244
Czechia 12,001 16,847 21,005 27,069 29,634 30,292 30,366 30,380 30,407
Hungary 9,667 12,578 15,058 20,995 27,701 29,762 29,992 30,026 30,059
Canada 15,472 19,942 21,960 22,926 24,169 25,512 26,273 26,592 26,918
Bangladesh 7,576 8,137 8,416 9,105 11,510 12,660 14,646 20,916 26,274
Pakistan 10,105 11,657 12,860 14,434 17,811 20,779 22,281 23,360 25,788
Belgium 19,720 21,282 22,253 23,066 24,270 24,978 25,179 25,249 25,386
Tunisia 4,676 6,754 8,001 8,812 10,722 12,654 14,959 19,858 23,538
Iraq 12,813 13,047 13,406 14,323 15,465 16,375 17,186 18,657 20,830
Bulgaria 7,576 9,045 10,191 13,197 16,399 17,700 18,061 18,213 18,896
Bolivia (Plurinational State of) 9,149 10,330 11,628 12,239 12,951 14,471 16,702 17,806 18,429
Netherlands 11,405 13,981 15,556 16,533 17,145 17,623 17,744 17,826 18,010
Portugal 6,906 12,482 16,317 16,848 16,974 17,025 17,096 17,361 17,743
Egypt 7,631 9,316 10,688 11,995 13,339 15,096 16,169 16,524 16,736
Malaysia 471 760 1,130 1,272 1,506 2,796 5,170 9,024 16,664
Japan 3,460 5,722 7,887 9,162 10,229 13,048 14,781 15,192 16,041
Paraguay 2,242 2,704 3,167 4,161 6,302 9,083 12,763 14,929 15,742
Myanmar 2,697 3,138 3,199 3,206 3,209 3,217 3,347 9,731 15,490
Sweden 9,748 12,230 13,034 13,617 14,196 14,566 14,655 14,670 14,696
Kazakhstan 2,749 3,126 3,389 5,912 6,561 7,321 7,759 9,077 13,732
Greece 4,838 5,872 6,580 8,169 10,457 12,171 12,763 13,016 13,698
Morocco 7,388 8,275 8,623 8,818 9,023 9,147 9,296 9,785 12,649
Slovakia 2,138 4,642 7,288 9,790 11,732 12,353 12,511 12,540 12,548
Guatemala 4,813 5,643 6,393 6,840 7,524 8,165 9,215 10,339 11,926
Thailand 63 77 83 94 224 1,069 2,080 4,990 11,841
Viet Nam 35 35 35 35 35 47 87 1,306 11,064
Nepal 2,767 2,962 3,010 3,031 3,298 7,454 9,145 9,875 10,770
Austria 6,356 7,818 8,531 9,256 10,066 10,418 10,499 10,518 10,570
Switzerland 7,589 9,164 9,602 9,892 10,143 10,287 10,345 10,366 10,463
Jordan 3,834 4,316 4,701 6,858 8,836 9,462 9,750 10,032 10,411
Bosnia and Herzegovina 4,072 4,705 5,096 6,581 8,533 9,235 9,647 9,689 9,803
Sri Lanka 204 323 476 571 687 1,527 3,063 4,451 9,400
Honduras 3,130 3,592 4,141 4,599 5,261 6,316 6,980 7,834 8,850
Saudi Arabia 6,223 6,375 6,494 6,669 6,957 7,362 7,819 8,237 8,545
Croatia 3,961 5,054 5,537 5,967 7,130 8,026 8,209 8,263 8,338
Lebanon 1,455 3,082 4,692 6,234 7,278 7,729 7,851 7,906 8,053
Georgia 2,528 3,194 3,520 3,785 4,130 4,804 5,327 5,853 7,482
Serbia 3,211 4,020 4,443 5,308 6,362 6,865 7,047 7,114 7,292
Afghanistan 2,201 2,404 2,444 2,489 2,631 2,973 4,962 6,737 7,123
Israel 3,372 4,816 5,760 6,211 6,380 6,413 6,421 6,473 7,079
Panama 3,975 5,244 5,831 6,109 6,227 6,370 6,536 6,808 7,054
Republic of Moldova 2,985 3,438 3,949 4,960 5,812 6,107 6,194 6,255 6,401
Uruguay 174 431 603 953 2,563 4,213 5,558 5,959 6,029
North Macedonia 2,503 2,855 3,137 3,781 4,855 5,413 5,484 5,493 5,938
China 4,789 4,825 4,844 4,851 4,857 4,970 5,495 5,635 5,683
Azerbaijan 2,609 3,126 3,218 3,567 4,517 4,913 4,974 5,023 5,636
Costa Rica 2,171 2,612 2,803 2,957 3,217 4,022 4,661 5,030 5,492
Cuba 146 214 322 424 644 958 1,284 2,758 5,303
Algeria 2,756 2,891 2,983 3,093 3,253 3,472 3,716 4,254 5,269
Ireland 2,167 3,249 4,294 4,670 4,894 4,941 4,998 5,035 5,092
Armenia 2,828 3,084 3,195 3,533 4,128 4,445 4,517 4,619 4,857
Slovenia 2,981 3,833 4,158 4,377 4,589 4,704 4,753 4,763 4,783
Kenya 1,670 1,763 1,856 2,153 2,724 3,172 3,634 3,931 4,726
Ethiopia 1,923 2,093 2,365 2,865 3,688 4,165 4,320 4,385 4,675
Lithuania 1,843 2,840 3,253 3,583 3,937 4,276 4,384 4,416 4,569
Zimbabwe 363 1,217 1,463 1,523 1,567 1,596 1,789 3,532 4,419
Libya 1,478 1,877 2,179 2,667 3,029 3,126 3,193 3,509 4,247
Oman 1,499 1,529 1,570 1,678 2,010 2,345 3,100 3,836 4,064
Venezuela (Bolivarian Republic of) 1,025 1,183 1,338 1,589 2,117 2,629 3,101 3,576 4,010
Dominican Republic 2,414 2,666 3,100 3,325 3,480 3,628 3,822 3,963 4,008
occupied Palestinian territory, including east Jerusalem 1,529 2,012 2,259 2,881 3,517 3,765 3,831 3,872 3,948
Belarus 1,424 1,718 1,976 2,247 2,542 2,851 3,143 3,454 3,780
Zambia 388 763 1,091 1,208 1,251 1,281 2,199 3,389 3,602
Namibia 205 352 424 523 643 830 1,521 3,044 3,244
Uganda 251 324 334 335 343 362 1,023 2,690 3,012
El Salvador 1,336 1,623 1,854 2,010 2,124 2,249 2,381 2,629 2,918
Puerto Rico 1,503 1,829 2,036 2,113 2,303 2,502 2,549 2,580 2,860
Sudan 1,576 1,812 1,890 2,087 2,361 2,631 2,760 2,780 2,791
Denmark 1,298 2,125 2,361 2,419 2,485 2,516 2,534 2,549 2,584
Latvia 644 1,202 1,621 1,913 2,139 2,379 2,520 2,556 2,579
Kyrgyzstan 1,356 1,412 1,466 1,500 1,612 1,815 2,009 2,335 2,532
Albania 1,181 1,380 1,796 2,235 2,394 2,451 2,456 2,457 2,498
Kosovo 1,325 1,488 1,589 1,862 2,163 2,233 2,248 2,256 2,494
Nigeria 1,289 1,586 1,907 2,057 2,063 2,099 2,120 2,149 2,455
Kuwait 934 959 1,083 1,313 1,563 1,772 1,969 2,320 2,419
South Korea 917 1,425 1,605 1,735 1,831 1,963 2,021 2,098 2,292
Botswana 40 134 310 568 712 849 1,125 1,569 2,261
Malawi 189 702 1,040 1,117 1,148 1,155 1,196 1,635 2,177
United Arab Emirates 669 850 1,221 1,497 1,587 1,680 1,811 1,949 2,041
Syrian Arab Republic 711 921 1,027 1,265 1,592 1,770 1,876 1,914 2,013
Cambodia 0 0 0 14 96 220 602 1,397 1,903
Mozambique 166 367 641 775 814 836 878 1,434 1,864
Senegal 410 628 872 1,051 1,107 1,139 1,166 1,353 1,765
Montenegro 681 802 999 1,266 1,492 1,583 1,610 1,629 1,720
Jamaica 302 350 422 596 778 948 1,075 1,190 1,518
Yemen 611 616 635 889 1,227 1,321 1,361 1,375 1,472
Bahrain 352 375 449 521 646 980 1,352 1,384 1,388
Cameroon 448 462 551 779 1,064 1,275 1,324 1,334 1,357
Estonia 234 422 598 908 1,166 1,258 1,269 1,272 1,293
Trinidad and Tobago 126 134 139 142 165 479 833 1,070 1,285
Angola 405 466 508 537 596 766 900 1,011 1,217
Eswatini 206 565 652 667 671 673 678 787 1,101
Uzbekistan 614 621 622 630 650 690 740 880 1,088
Rwanda 92 196 261 307 335 353 427 808 1,083
Democratic Republic of the Congo 591 671 707 743 766 782 924 1,038 1,059
Finland 597 702 784 881 932 970 979 999 1,038
Ghana 335 416 607 743 779 785 796 823 1,036
Australia 909 909 909 909 910 910 910 923 1,006
Somalia 130 130 239 529 713 769 775 811 977
Madagascar 261 281 297 409 643 839 909 947 956
Mongolia 0 2 2 8 110 276 563 820 931
Luxembourg 498 580 638 746 796 815 818 822 830
Norway 433 563 622 660 753 783 792 799 814
Suriname 121 154 170 177 201 292 516 645 718
Mauritania 324 418 439 449 455 463 489 562 715
Guyana 164 176 195 231 295 385 468 535 613
Qatar 245 248 258 291 458 556 590 601 602
Haiti 236 245 250 251 254 321 443 558 586
Mali 269 330 353 385 484 517 525 532 539
Guadeloupe 155 157 164 173 211 255 267 283 508
Cyprus 125 199 231 256 312 360 374 421 503
Fiji 2 2 2 2 2 4 21 239 496
Martinique 43 44 45 50 70 95 98 129 460
Cote d'Ivoire 137 154 192 244 286 305 313 329 441
Malta 225 270 315 394 415 419 420 423 441
French Polynesia 114 131 139 141 141 142 142 149 423
Lesotho 50 160 292 315 316 326 329 374 403
Bahamas 170 176 180 188 199 230 246 287 381
Belize 242 301 314 317 323 324 329 337 359
Reunion 42 46 52 115 148 189 237 275 342
Guinea 81 82 89 125 144 161 171 220 335
Gambia 124 128 150 164 174 179 181 213 319
Cabo Verde 113 134 147 168 217 264 286 298 311
Liberia 83 84 85 85 85 86 128 148 245
Maldives 48 52 62 67 73 169 213 221 226
French Guiana 71 76 85 93 100 116 145 187 219
Nicaragua 165 169 173 178 182 186 191 195 200
Niger 102 159 172 187 191 192 193 195 199
Papua New Guinea 9 9 13 60 115 162 174 192 192
Togo 68 77 84 109 123 125 129 152 185
Congo 100 117 128 135 144 153 166 178 183
Mayotte 55 61 110 161 170 173 174 174 175
Chad 104 118 140 164 170 173 174 174 174
Burkina Faso 85 120 142 146 157 166 168 169 171
Gabon 64 68 83 118 139 152 159 164 165
Djibouti 61 63 63 70 143 154 155 156 157
Guam 122 129 131 134 136 139 140 143 149
Comoros 9 93 144 146 146 146 146 147 147
Curacao 14 20 22 33 108 122 126 126 143
Aruba 49 58 71 85 98 107 107 109 139
Andorra 84 101 110 115 125 127 127 128 130
Benin 44 52 70 93 99 101 104 108 128
Tajikistan 90 91 91 91 91 91 91 122 125
Equatorial Guinea 86 86 91 102 112 118 121 123 124
Sierra Leone 76 79 79 79 79 79 100 120 121
South Sudan 63 64 93 112 115 115 117 119 120
Guinea-Bissau 45 45 48 63 67 68 69 76 119
Saint Lucia 5 13 35 60 74 79 84 89 103
Seychelles 0 4 11 21 27 40 57 86 102
Central African Republic 63 63 63 72 88 98 98 98 100
Gibraltar 6 75 93 94 94 94 94 94 97
San Marino 59 67 74 84 90 90 90 90 90
Jersey 42 66 69 69 69 69 69 69 77
Timor-Leste 0 0 0 0 3 16 24 26 72
Liechtenstein 44 53 55 56 56 57 58 58 58
Singapore 29 29 29 30 30 33 36 37 55
United States Virgin Islands 23 24 25 26 27 27 30 37 54
Sint Maarten 27 27 27 27 27 28 33 34 51
Barbados 7 12 33 42 44 47 47 48 50
United Republic of Tanzania 21 21 21 21 21 21 21 21 50
Antigua and Barbuda 5 7 14 28 32 42 42 43 44
Eritrea 3 7 7 10 10 14 23 35 38
British Virgin Islands 1 1 1 1 1 1 1 31 37
Sao Tome and Principe 17 17 29 34 35 37 37 37 37
Monaco 3 13 24 28 32 32 33 33 35
Bermuda 10 12 12 12 27 32 33 33 33
Iceland 29 29 29 29 29 30 30 30 33
Mauritius 10 10 10 12 16 18 18 20 31
Isle of Man 25 25 25 29 29 29 29 29 29
New Zealand 25 25 26 26 26 26 26 26 26
Turks and Caicos Islands 6 9 14 17 17 17 18 18 20
Guernsey 16 16 17 17 17 17 17 17 18
Bonaire 3 3 4 10 16 17 17 17 17
Saint Martin 12 12 12 12 13 15 27 30 17
Lao People's Democratic Republic 0 0 0 0 0 3 3 7 14
Other 13 13 13 13 13 13 13 13 13
Saint Vincent and the Grenadines 0 2 8 10 11 12 12 12 12
Burundi 2 2 3 6 6 6 8 9 10
Brunei Darussalam 3 3 3 3 3 3 3 3 9
Wallis and Futuna 0 0 0 4 7 7 7 7 7
Dominica 0 0 0 0 0 0 0 0 4
Bhutan 0 1 1 1 1 1 1 2 3
Saint Kitts and Nevis 0 0 0 0 0 0 3 3 3
Cayman Islands 2 2 2 2 2 2 2 2 2
Faroe Islands 0 1 1 1 1 1 1 1 2
Northern Mariana Islands (Commonwealth of the) 2 2 2 2 2 2 2 2 2
Grenada 1 1 1 1 1 1 1 1 1
Montserrat 1 1 1 1 1 1 1 1 1
Saint Barthalemy 0 0 0 1 1 1 1 1 1
American Samoa 0 0 0 0 0 0 0 0 0
Anguilla 0 0 0 0 0 0 0 0 0
Cook Islands 0 0 0 0 0 0 0 0 0
North Korea 0 0 0 0 0 0 0 0 0
Falkland Islands (Malvinas) 0 0 0 0 0 0 0 0 0
Greenland 0 0 0 0 0 0 0 0 0
Holy See 0 0 0 0 0 0 0 0 0
Kiribati 0 0 0 0 0 0 0 0 0
Marshall Islands 0 0 0 0 0 0 0 0 0
Micronesia (Federated States of) 0 0 0 0 0 0 0 0 0
Nauru 0 0 0 0 0 0 0 0 0
New Caledonia 0 0 0 0 0 0 0 0 0
Niue 0 0 0 0 0 0 0 0 0
Palau 0 0 0 0 0 0 0 0 0
Pitcairn Islands 0 0 0 0 0 0 0 0 0
Saba 0 0 0 0 0 0 0 0 0
Saint Helena 0 0 0 0 0 0 0 0 0
Saint Pierre and Miquelon 0 0 0 0 0 0 0 0 0
Samoa 0 0 0 0 0 0 0 0 0
Sint Eustatius 0 0 0 0 0 0 0 0 0
Solomon Islands 0 0 0 0 0 0 0 0 0
Tokelau 0 0 0 0 0 0 0 0 0
Tonga 0 0 0 0 0 0 0 0 0
Turkmenistan 0 0 0 0 0 0 0 0 0
Tuvalu 0 0 0 0 0 0 0 0 0
Vanuatu 0 0 0 0 0 0 0 0 0

Back To International Perspective

.

Vaccinated By Country

The following table shows the COVID-19 vaccine distribution by location as of September 2021. [1]

  1. It is surprising to see that the Ukraine has such a low vaccination rate of 13.6%.
  2. China leads the world in the number of people vaccinated and also the vaccination percentage.
  3. This is interesting because the reported deaths from China are very low.
  4. The leadership decided that the vaccine was very important regardless of their actual deaths and how the virus was mitigated using other approaches.

[spreadsheet-international]

Country Vaccinated Percent
Gibraltar 39,787 118.1%
Pitcairn Islands 47 100.0%
United Arab Emirates 8,931,243 89.4%
Portugal 8,825,392 86.8%
Iceland 280,486 81.7%
Malta 417,009 81.0%
Qatar 2,360,308 80.5%
Cayman Islands 52,831 79.5%
Spain 37,126,744 79.4%
Singapore 4,641,315 78.7%
Uruguay 2,706,539 77.7%
Isle of Man 65,427 76.6%
Denmark 4,432,753 76.2%
Faroe Islands 37,277 76.0%
China 1,095,000,000 75.8%
Jersey 76,630 75.8%
Falkland Islands 2,632 75.6%
Seychelles 74,719 75.5%
Chile 14,473,694 75.3%
Aruba 80,343 75.0%
Republic of Ireland 3,733,252 74.9%
Canada 28,363,525 74.5%
Finland 4,079,776 73.5%
Niue 1,184 73.2%
France 49,316,604 73.0%
Belgium 8,478,671 72.9%
Bhutan 567,143 72.7%
Italy 43,774,181 72.5%
Norway 3,957,401 72.4%
Caribbean Netherlands 19,109 72.3%
Saint Helena, Ascension and Tristan da Cunha 4,361 71.8%
Maldives 388,299 71.4%
Greenland 40,553 71.3%
United Kingdom 48,422,588 71.0%
Tokelau 968 70.8%
San Marino 23,989 70.5%
Netherlands 12,030,970 70.1%
Nauru 7,612 70.0%
Bermuda 43,377 69.9%
Sweden 7,006,231 69.0%
Israel 6,043,382 68.8%
Turks and Caicos Islands 26,606 67.8%
Cambodia 11,448,429 67.6%
Mongolia 2,246,005 67.5%
Monaco 26,451 66.9%
Andorra 51,599 66.7%
Brazil 142,138,164 66.4%
Bahrain 1,156,523 66.2%
Germany 55,315,227 65.9%
Cyprus 584,336 65.8%
European Union 293,677,956 65.7%
Panama 2,862,765 65.3%
Malaysia 21,377,353 65.2%
Mauritius 828,108 65.0%
Cook Islands 11,416 65.0%
Luxembourg 411,462 64.8%
South Korea 33,152,722 64.6%
Saudi Arabia 22,784,983 64.5%
Japan 79,835,876 63.3%
Lithuania 1,699,824 63.2%
Argentina 28,706,802 63.0%
Anguilla 9,493 62.8%
Fiji 566,210 62.7%
Sri Lanka 13,458,620 62.6%
United States 209,437,152 62.3%
Austria 5,605,071 62.0%
Kuwait 2,668,082 61.6%
Turkey 51,536,013 60.6%
Hungary 5,840,588 60.6%
British Virgin Islands 18,405 60.5%
Greece 6,259,984 60.4%
Cuba 6,784,652 60.0%
Liechtenstein 22,945 60.0%
Ecuador 10,699,102 59.8%
Costa Rica 3,071,596 59.8%
New Zealand 2,862,765 58.9%
Switzerland 5,121,966 58.8%
Curacao 96,932 58.8%
El Salvador 3,818,524 58.6%
Sint Maarten 25,376 58.4%
Hong Kong 4,340,347 57.5%
Czech Republic 6,006,381 56.0%
Estonia 740,875 55.9%
Australia 14,011,105 54.3%
Dominican Republic 5,912,118 54.0%
Brunei 236,009 53.5%
Morocco 19,884,992 53.2%
Tuvalu 6,167 51.7%
Poland 19,523,117 51.6%
French Polynesia 142,109 50.3%
Macau 329,375 50.0%
Oman 2,592,464 49.6%
Slovenia 1,025,591 49.3%
Taiwan 11,416,544 47.9%
Colombia 24,346,577 47.5%
Samoa 94,441 47.2%
Latvia 880,018 47.1%
Mexico 60,759,845 46.6%
Saint Kitts and Nevis 24,671 46.1%
Wallis and Futuna 4,952 44.6%
Antigua and Barbuda 43,681 44.2%
Azerbaijan 4,507,038 44.1%
Slovakia 2,400,165 44.0%
Serbia 2,960,217 43.5%
Belize 174,978 43.2%
Croatia 1,759,542 43.1%
World 3,305,991,786 42.0%
Cape Verde 236,158 42.0%
Northern Cyprus 160,361 42.0%
Guyana 329,909 41.7%
Barbados 119,702 41.6%
India 563,337,272 40.4%
Thailand 27,194,487 38.9%
Trinidad and Tobago 544,602 38.8%
Tonga 41,130 38.5%
Tunisia 4,536,120 38.0%
Kazakhstan 7,072,523 37.2%
North Macedonia 758,623 36.4%
Laos 2,650,948 35.9%
Suriname 212,346 35.9%
Peru 11,895,988 35.7%
Montenegro 221,080 35.2%
Kosovo 676,755 35.0%
Bolivia 4,113,206 34.8%
Jordan 3,577,708 34.8%
Paraguay 2,439,006 33.8%
Dominica 22,930 31.8%
Russia 45,598,793 31.2%
Albania 895,363 31.2%
New Caledonia 86,125 29.9%
Montserrat 1,466 29.4%
East Timor 389,989 29.0%
Uzbekistan 9,787,973 28.8%
Honduras 2,896,759 28.8%
Romania 5,315,126 27.8%
The Bahamas 105,753 26.6%
Indonesia 72,766,195 26.3%
Vietnam 23,157,067 23.6%
Grenada 26,088 23.1%
Iran 19,467,858 22.9%
Pakistan 51,390,802 22.8%
State of Palestine 1,185,157 22.7%
Georgia (country) 879,384 22.1%
Tajikistan 2,097,435 21.5%
Lebanon 1,447,211 21.4%
Venezuela 6,006,270 20.9%
Guatemala 3,754,114 20.6%
Saint Lucia 36,750 19.9%
Comoros 175,038 19.7%
Nepal 5,773,612 19.5%
Bosnia and Herzegovina 634,063 19.4%
Zimbabwe 2,844,848 18.9%
South Africa 10,720,370 17.9%
Belarus 1,692,439 17.9%
Sao Tome and Principe 38,979 17.4%
Saint Vincent and the Grenadines 19,399 17.4%
Philippines 18,697,647 16.8%
Libya 1,163,013 16.7%
Kiribati 19,589 16.1%
Jamaica 472,444 15.9%
Bulgaria 1,089,066 15.8%
Eswatini 179,200 15.3%
Botswana 355,273 14.8%
Equatorial Guinea 207,723 14.3%
Moldova 573,001 14.2%
Ukraine 5,906,740 13.6%
Rwanda 1,711,757 12.9%
Bangladesh 20,656,175 12.4%
Algeria 5,000,000 11.2%
Kyrgyzstan 737,643 11.1%
Vanuatu 34,753 11.1%
Solomon Islands 62,891 8.9%
Namibia 223,071 8.6%
Myanmar 4,456,857 8.1%
Armenia 215,278 7.2%
The Gambia 179,910 7.2%
Nicaragua 476,308 7.1%
Senegal 1,179,100 6.9%
Egypt 7,076,086 6.8%
Guinea 917,762 6.8%
Mauritania 285,121 6.0%
Ivory Coast 1,506,289 5.6%
Mozambique 1,643,520 5.1%
Togo 414,249 4.9%
Kenya 2,262,968 4.1%
Djibouti 38,634 3.9%
Gabon 84,214 3.7%
Malawi 713,014 3.6%
Republic of the Congo 198,954 3.5%
Angola 1,165,755 3.4%
Lesotho 71,597 3.3%
Ghana 865,422 2.8%
Ethiopia 2,754,008 2.3%
Central African Republic 102,591 2.1%
Sierra Leone 159,793 2.0%
Liberia 104,545 2.0%
Uganda 901,900 1.9%
Afghanistan 773,002 1.9%
Zambia 354,752 1.9%
Nigeria 3,600,858 1.7%
Niger 404,246 1.6%
Sudan 643,569 1.4%
Guinea-Bissau 28,097 1.4%
Cameroon 355,561 1.3%
Somalia 207,256 1.3%
Mali 257,674 1.2%
Benin 152,669 1.2%
Syria 201,379 1.1%
Papua New Guinea 102,739 1.1%
Yemen 298,161 1.0%
Madagascar 210,666 0.7%
Tanzania 350,000 0.6%
Burkina Faso 108,799 0.5%
South Sudan 53,147 0.5%
Turkmenistan 32,240 0.5%
Chad 60,431 0.4%
Haiti 36,583 0.3%
Democratic Republic of the Congo 83,667 0.1%
Iraq 3,754,174
Guernsey 100,957

Back To International Perspective

.

First Confirmed Case By Country

The following table shows the date of the first confirmed COVID-19 cases by country or territory. [1]

  1. China was first then other nations in the pacific rim.
  2. Then there was a jump into the United States, France, and eventually Italy.
  3. These detections match the number of deaths in the countries previously identified that were occuring by May and June: USA, Brazil, UK, Italy, France, and Spain.

[spreadsheet-international]

Date Country or territory
2019
1 December 2019 China
2020
13 January 2020 Thailand
16 January 2020 Japan
20 January 2020 South Korea, United States
21 January 2020 Taiwan
22 January 2020 Hong Kong, Macau
23 January 2020 Nepal, Singapore, Vietnam
24 January 2020 France
25 January 2020 Australia, Canada, Malaysia
27 January 2020 Cambodia, Germany, Sri Lanka
29 January 2020 Finland, United Arab Emirates
30 January 2020 India, Italy, Philippines
31 January 2020 Russia, Spain, Sweden, United Kingdom
3 February 2020 Belgium
14 February 2020 Egypt
19 February 2020 Iran
21 February 2020 Israel, Lebanon
24 February 2020 Afghanistan, Bahrain, Iraq, Kuwait, Oman
25 February 2020 Algeria, Austria, Brazil, Croatia, Switzerland
26 February 2020 Georgia, Greece, North Macedonia, Norway, Pakistan, Romania
27 February 2020 Denmark, Estonia, Netherlands, Nigeria, San Marino
28 February 2020 Azerbaijan, Belarus, Iceland, Lithuania, Mexico, Monaco, New Zealand
29 February 2020 Ecuador, Ireland, Luxembourg, Qatar
1 March 2020 Armenia, Czech Republic, Dominican Republic, Saint Barthalemy, Saint Martin
2 March 2020 Andorra, Indonesia, Jordan, Latvia, Morocco, Portugal, Saudi Arabia, Senegal, Tunisia
3 March 2020 Argentina, Chile, Gibraltar, Liechtenstein, Ukraine
4 March 2020 Faroe Islands, French Guiana, Hungary, Poland, Slovenia
5 March 2020 Bosnia and Herzegovina, Martinique, Palestine, South Africa
6 March 2020 Bhutan, Cameroon, Colombia, Costa Rica, Peru, Serbia, Slovakia, Togo, Vatican City
7 March 2020 Maldives, Malta, Moldova, Paraguay
8 March 2020 Albania, Bangladesh, Bulgaria
9 March 2020 Brunei, Cyprus, Guernsey, Panama
10 March 2020 Bolivia, Burkina Faso, DR Congo, Jamaica, Jersey, Mongolia, Northern Cyprus, Turkey
11 March 2020 Cuba, French Polynesia, Guyana, Honduras, Ivory Coast, Réunion
12 March 2020 Saint Vincent and the Grenadines, Trinidad and Tobago
13 March 2020 Antigua and Barbuda, Aruba, Cayman Islands, Curaçao, Ethiopia, Gabon, Ghana, Guadeloupe, Guatemala, Guinea, Kazakhstan, Kenya, Kosovo, Puerto Rico, Saint Lucia, Sudan, Suriname, U.S. Virgin Islands, Uruguay, Venezuela
14 March 2020 Central African Republic, Congo, Equatorial Guinea, Eswatini, Mauritania, Mayotte, Namibia, Rwanda, Seychelles
15 March 2020 Akrotiri and Dhekelia, Bahamas, Guam, Uzbekistan
16 March 2020 Benin, Greenland, Liberia, Somalia, Tanzania
17 March 2020 Barbados, Gambia, Montenegro, Sint Maarten
18 March 2020 Bermuda, Djibouti, El Salvador, Kyrgyzstan, Mauritius, Montserrat, New Caledonia, Nicaragua, Zambia
19 March 2020 Angola, Chad, Fiji, Haiti, Isle of Man, Niger
20 March 2020 Cape Verde, East Timor, Madagascar, Papua New Guinea, Uganda, Zimbabwe
21 March 2020 Eritrea, Transnistria
22 March 2020 Aland Islands, Dominica, Grenada, Mozambique, Syria
23 March 2020 Belize, Myanmar, Turks and Caicos Islands
24 March 2020 Laos, Libya
25 March 2020 British Virgin Islands, Guinea-Bissau, Mali, Saint Kitts and Nevis
26 March 2020 Anguilla
28 March 2020 Northern Mariana Islands
30 March 2020 Botswana
31 March 2020 Burundi, Donetsk People's Republic, Luhansk People's Republic, Sierra Leone, Sint Eustatius, Somaliland
2 April 2020 Malawi
3 April 2020 Falkland Islands
4 April 2020 Western Sahara
5 April 2020 Saint Pierre and Miquelon, South Sudan
6 April 2020 Sao Tome and Príncipe
7 April 2020 Abkhazia, Artsakh
10 April 2020 Yemen
11 April 2020 Saba
16 April 2020 Bonaire
30 April 2020 Comoros, Tajikistan
6 May 2020 South Ossetia
13 May 2020 Lesotho
25 July 2020 Sahrawi Arab Democratic Republic
7 September 2020 Saint Helena, Ascension and Tristan da Cunha
3 October 2020 Solomon Islands
16 October 2020 Wallis and Futuna
28 October 2020 Marshall Islands
November 2020 British Indian Ocean Territory
9 November 2020 American Samoa
11 November 2020 Vanuatu
18 November 2020 Samoa
21 December 2020 Antarctica
2021
8 January 2021 Federated States of Micronesia
18 May 2021 Kiribati
31 May 2021 Palau

back to TOC

Back To International Perspective

References:

[1] COVID-19 pandemic by country and territory, wikipedia, September 2021. webpage https://en.wikipedia.org/wiki/COVID-19_pandemic_by_country_and_territory, September 2021.

[2] List of countries by regional classification, wikipedia, September 2021. webpage https://meta.wikimedia.org/wiki/List_of_countries_by_regional_classification,

[3] List of Countries by Region Adopted from the Annex II: Classification of Major Areas and Regions of the Population Division, DESA, United Nations, September 2021. webpage https://cies2018.org/wp-content/uploads/List-of-Countries-by-Region-UN-Annex-II.pdf, PDF September 2021.

[4] Peru, wikipedia, October 2021. webpage https://en.wikipedia.org/wiki/Peru, October 2021.

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.

USA States Perspective

The following table shows the US performance by state between January 21, 2020 and September 2021. The data was provided by the  CDC COVID Data Tracker [1].

CDC | Data as of: September 22, 2021 2:02 PM ET. Posted: September 22, 2021 4:30 PM ET

State/Territory

Deaths
per 100,000

New York City* 406
Mississippi 314
New Jersey 306
Louisiana 291
Alabama 278
Arizona 269
Massachusetts 268
Rhode Island 265
Arkansas 248
Florida 241
South Dakota 238
Connecticut 237
Georgia 235
South Carolina 231
Indiana 226
Pennsylvania 226
Nevada 224
New Mexico 224
Michigan 220
Oklahoma 220
Illinois 215
Tennessee 211
Texas 210
North Dakota 209
Iowa 205
Kansas 203
Delaware 197
West Virginia 192
Kentucky 187
New York* 187
Ohio 184
Missouri 183
Montana 177
California 171
Maryland 170
District of Columbia 165
Wyoming 165
North Carolina 150
Wisconsin 149
Idaho 148
Virginia 145
Minnesota 143
Colorado 128
Nebraska 123
Guam 109
New Hampshire 107
Puerto Rico 97
Washington 96
Utah 88
Oregon 85
Maine 74
Virgin Islands 64
Alaska 63
Hawaii 50
Vermont 46
Northern Mariana Islands 3
Palau 0
Republic of Marshall Islands 0
American Samoa N/A
Federated States of Micronesia N/A
New York (Level of Community Transmission)* N/A

*Counts for New York City and New York State are shown separately.

.

Hawaii

The following analysis is as of November 2021.

Hawaii has done a better job at dealing with the COVID-19 disaster than the rest of the USA with the exception of Vermont, see section USA States Perspective. However, Vermont is not as populated or has the same level of visitors as Hawaii. So the system used to deal with the COVID-19 disaster in Hawaii may be the one to highlight and understand to try and mitigate future disease outbreaks. [2]

State of Hawaii

The following are some key system observations on the State of Hawaii [2].

No one can enter the state without an official CDC vaccination card and proof of ID that ties the vaccination to the persons ID. This is accomplished via a website: https://travel.hawaii.gov. At the website the vaccination card is uploaded, the persons license is uploaded, and a picture of the persons face is taken. Using facial recognition technology and database records the face and license are validated. The Vaccine code numbers are also entered and validated. Those who enter Hawaii without filling out the data on https://travel.hawaii.gov are stopped at the airport. They are either redirected to go back on the next flight or sent into quarantine. The local news reported daily the number of people trying to enter Hawaii without proper vaccination or test results. The numbers ranged between 3 to 5 per day during this period.

All restaurants were screening for official CDC vaccination card and proof of ID. The radio stations were playing normal music not the same 3-10 songs on each station like in Southern New Jersey. That means people in Hawaii listen to the FM radio stations.

The radio stations were running legitimate COVID-19 public service announcements every 30-45 minutes - not too often or too long prevent negative reactions. The TV stations were running legitimate COVID-19 public service announcements every 30-45 minutes - not too often or too long prevent negative reactions. The local radio and TV stations engaged in news reporting using standard journalism practices and only reported the COVID-19 facts. They did not ask random people with no credible background their opinion on why they would not get vaccinated or wear a mask. This is the opposite of the USA national level news and the local news in the Philadelphia / Southern New Jersey area.

Aircraft to and from Hawaii

The following are some key system observations of the aircraft flight to and from Hawaii [2].

The aircraft was a A330. The flights to and from Hawaii were full. There was little extra seating. All the seat rows were booked. The individual air vent controls were removed to prevent the free flow of air and or changes in flow direction. The ventilation was always on (at gate, on tarmack, on runway, at takeoff, in flight, during landing). Based on physical observations and rough seat of the pants calculations the aircraft cabin ACH = 22.2. There were visible vents at the top of the cabin measuring approximately 36 X 2 or 3 inches per vent panel. The vent panels ran the entire length of the visible cabin when observed from row 42 (our seating row). Feeling for the airflow (forgot my anemometer), it felt like the vent was producing about 100 CFM, based on limited personal experience of measuring airflow. These are the calculations (Note there were no instrumented measurements or size measurements using a ruler):

The aircraft seat entertainment device clearly displayed that the aircraft cabin air was exchanged every 3 minutes. This translates into an ACH = 20. All passengers were reminded to wear their masks except when eating and drinking. I was personally reminded to place on my mask after I forgot once an eating session ended. There were multiple eating and drinking sessions. This helped with the mask fatigue during the 10 hour direct flight from NY JFK to HI HON and back. The company claim of cabin air exchange every 3 minutes (ACH = 20) was noticed on the flight back from Hawaii. The calculations were performed on the flight to Hawaii (ACH = 22.2). This is an excellent example of validation and how even simple engineering observations and calculations work and are critical to perform when there are mission critical needs.

Airport FAA / TSA

The following are some key system observations of the FAA, TSA, JFK, and Hawaii Airports [2].

I am unable to separate the FAA from the TSA because the FAA is responsible for all aviation activities including what happens in the airport. During TSA screening passengers were crammed into herding pens, exactly as during the pre-pandemic system; There was no change. Passengers were directed to take off their shoes and place all belongings in plastic containers that were not cleaned, exactly as during the pre-pandemic system; There was no change. Upon arrival at JFK, all sections had television screens tuned to FOX cable news. It was very distracting and made it difficult to find relevant airport information. Other FAA public facilities outside the airports also have their TVs tuned to FOX cable news [3]. The airport in Hawaii did not have TV programs. All the Hawaii screens just showed relevant travel and airport information. It appears that the local jurisdictions of the airports decide if they will show television programing and what programs they will show. Hawaii appears to have made the correct choice.

Hawaii Big Picture

A picture is worth a thousand words. The following pictures are from Hawaii [2].

Hawaii Airport No Distracting Screens Only Relevant Flight Information

Hawaii Airport No Distracting Screens Only Relevant Airport Information

The above images show respect for the traveler. It is about their needs and not some cheap hidden agendas.

Beautiful uplifting architecture.

Public Water Fountain

Respect for the people continues by trying to ensure their safety even in the simple case of a public drinking fountain.

Hawaii Table Top

Hawaii Sidewalk

Hawaii Menu

Hawaii Restaurant

Hawaii Elevator Entrance

Hawaii Elevator Waiting Area

Hawaii Elevator

Hawaii Public Restrooms - Massive Natural Ventilation Raised Roof

The design of a public restroom where there is no odor is just another example of respecting the people. The design of the public restroom also mitigates the spread of airborne disease. The total deaths in Hawaii as of November 12, 2021 is 976 people. The biggest takeaway from Hawaii is respect for a deadly contagion with massive mitigation efforts including proper and massive natural and mechanical ventilation in public buildings.

References:

[1] CDC COVID Data Tracker, Centers For Disease Control and Prevention - CDC, September 22, 2021. webpage https://covid.cdc.gov/covid-data-tracker/?CDC_AA_refVal=https%3A%2F%2Fwww.cdc.gov%2Fcoronavirus%2F2019-ncov%2Fcases-updates%2Fcases-in-us.html#cases_deathsper100k, September 2021.

[2] Visit to Hawaii between October 28 and November 08, 2021, Personal experience.

[3] 2020 - 2021 Personal experience.

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.

Vaccine and Vaccinations

.

Press Releases

  1. FDA Press Releases

  2. CDC Press Releases

Date

Agency

Press Releases

Type

Approval

Age

Dec 11, 2020

FDA

FDA Takes Key Action in Fight Against COVID-19 By Issuing Emergency Use Authorization for First COVID-19 Vaccine

EUA

Vaccine

16+

May 10, 2021

FDA

Coronavirus (COVID-19) Update: FDA Authorizes Pfizer-BioNTech COVID-19 Vaccine for Emergency Use in Adolescents in Another Important Action in Fight Against Pandemic

EUA

Vaccine

12-15

Aug 23, 2021

FDA

FDA Approves First COVID-19 Vaccine

Approval

Vaccine

16+

.

Sep 22, 2021

FDA

FDA Authorizes Booster Dose of Pfizer-BioNTech COVID-19 Vaccine for Certain Populations

EUA

Booster

18+

Oct 21, 2021

CDC

CDC Expands Eligibility for COVID-19 Booster Shots

EUA

Booster

18+

Oct 29, 2021

FDA

FDA Authorizes Pfizer-BioNTech COVID-19 Vaccine for Emergency Use in Children 5 through 11 Years of Age

EUA

Vaccine

5-11

Nov 02, 2021

CDC

CDC Recommends Pediatric COVID-19 Vaccine for Children 5 to 11 Years

EUA

Vaccine

5-11

There are system observations that can be made even when examining the titles of the above press releases.

The initial press releases are examples of how the government has been compromised by those who have no clue about the differences between government and industry. They are privatization and deregulation zealots that have caused massive damage including the COVID-19 disaster. The December 11, 2020 and May 10, 2021 press release titles read like marketing announcements from a new company.

The proper titles for December 11, 2020 and May 10, 2021 press release should have been:

  1. FDA Issues Emergency Use Authorization of the Pfizer COVID-19 Vaccine for ages 16+
  2. FDA Issues Emergency Use Authorization of the Pfizer COVID-19 Vaccine for ages 12-15

The other press releases have been purged of marketing words but they are not clear. The lack of clarity is associated with a lack of transparency. Hiding things is another key characteristic of privatization and deregulation zealots because the actions are toxic to all the stakeholders except those that benefit.

In the 1980's, when the US government and the people were driven more by the systems perspective, people in the publications departments of the FDA and CDC would have easily caught and corrected these serious errors. The November 02, 2021 press release title is starting to reflect a normal state of affairs and is representative of a reasonable systems perspective.

The following is the text of the various press releases.

FDA Press Releases

.

FDA Takes Key Action in Fight Against COVID-19 By Issuing Emergency Use Authorization for First COVID-19 Vaccine

Press Release [1]

FDA News Release
FDA Takes Key Action in Fight Against COVID-19 By Issuing Emergency Use Authorization for First COVID-19 Vaccine
Action Follows Thorough Evaluation of Available Safety, Effectiveness, and Manufacturing Quality Information by FDA Career Scientists, Input from Independent Experts

For Immediate Release:
December 11, 2020

Today, the U.S. Food and Drug Administration issued the first emergency use authorization (EUA) for a vaccine for the prevention of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in individuals 16 years of age and older. The emergency use authorization allows the Pfizer-BioNTech COVID-19 Vaccine to be distributed in the U.S.

“The FDA’s authorization for emergency use of the first COVID-19 vaccine is a significant milestone in battling this devastating pandemic that has affected so many families in the United States and around the world,” said FDA Commissioner Stephen M. Hahn, M.D. “Today’s action follows an open and transparent review process that included input from independent scientific and public health experts and a thorough evaluation by the agency’s career scientists to ensure this vaccine met FDA’s rigorous, scientific standards for safety, effectiveness, and manufacturing quality needed to support emergency use authorization. The tireless work to develop a new vaccine to prevent this novel, serious, and life-threatening disease in an expedited timeframe after its emergence is a true testament to scientific innovation and public-private collaboration worldwide.”

The FDA has determined that Pfizer-BioNTech COVID-19 Vaccine has met the statutory criteria for issuance of an EUA. The totality of the available data provides clear evidence that Pfizer-BioNTech COVID-19 Vaccine may be effective in preventing COVID-19. The data also support that the known and potential benefits outweigh the known and potential risks, supporting the vaccine’s use in millions of people 16 years of age and older, including healthy individuals. In making this determination, the FDA can assure the public and medical community that it has conducted a thorough evaluation of the available safety, effectiveness and manufacturing quality information.

The Pfizer-BioNTech COVID-19 Vaccine contains messenger RNA (mRNA), which is genetic material. The vaccine contains a small piece of the SARS-CoV-2 virus’s mRNA that instructs cells in the body to make the virus’s distinctive “spike” protein. When a person receives this vaccine, their body produces copies of the spike protein, which does not cause disease, but triggers the immune system to learn to react defensively, producing an immune response against SARS-CoV-2.

“While not an FDA approval, today’s emergency use authorization of the Pfizer-BioNTech COVID-19 Vaccine holds the promise to alter the course of this pandemic in the United States,” said Peter Marks, M.D., Ph.D., Director of the FDA’s Center for Biologics Evaluation and Research. “With science guiding our decision-making, the available safety and effectiveness data support the authorization of the Pfizer-BioNTech COVID-19 Vaccine because the vaccine’s known and potential benefits clearly outweigh its known and potential risks. The data provided by the sponsor have met the FDA’s expectations as conveyed in our June and October guidance documents. Efforts to speed vaccine development have not sacrificed scientific standards or the integrity of our vaccine evaluation process. The FDA’s review process also included public and independent review from members of the agency’s Vaccines and Related Biological Products Advisory Committee. Today’s achievement is ultimately a testament to the commitment of our career scientists and physicians, who worked tirelessly to thoroughly evaluate the data and information for this vaccine.”

FDA Evaluation of Available Safety Data

Pfizer BioNTech COVID-19 Vaccine is administered as a series of two doses, three weeks apart. The available safety data to support the EUA include 37,586 of the participants enrolled in an ongoing randomized, placebo-controlled international study, the majority of whom are U.S. participants. These participants, 18,801 of whom received the vaccine and 18,785 of whom received saline placebo, were followed for a median of two months after receiving the second dose. The most commonly reported side effects, which typically lasted several days, were pain at the injection site, tiredness, headache, muscle pain, chills, joint pain, and fever. Of note, more people experienced these side effects after the second dose than after the first dose, so it is important for vaccination providers and recipients to expect that there may be some side effects after either dose, but even more so after the second dose.

It is mandatory for Pfizer Inc. and vaccination providers to report the following to the Vaccine Adverse Event Reporting System (VAERS) for Pfizer-BioNTech COVID-19 Vaccine: all vaccine administration errors, serious adverse events, cases of Multisystem Inflammatory Syndrome (MIS), and cases of COVID-19 that result in hospitalization or death.

FDA Evaluation of Available Effectiveness Data

The effectiveness data to support the EUA include an analysis of 36,523 participants in the ongoing randomized, placebo-controlled international study, the majority of whom are U.S. participants, who did not have evidence of SARS-CoV-2 infection through seven days after the second dose. Among these participants, 18,198 received the vaccine and 18,325 received placebo. The vaccine was 95% effective in preventing COVID-19 disease among these clinical trial participants with eight COVID-19 cases in the vaccine group and 162 in the placebo group. Of these 170 COVID-19 cases, one in the vaccine group and three in the placebo group were classified as severe. At this time, data are not available to make a determination about how long the vaccine will provide protection, nor is there evidence that the vaccine prevents transmission of SARS-CoV-2 from person to person.

The EUA Process

On the basis of the determination by the Secretary of the Department of Health and Human Services on February 4, 2020, that there is a public health emergency that has a significant potential to affect national security or the health and security of United States citizens living abroad, and then issued declarations that circumstances exist justifying the authorization of emergency use of unapproved products, the FDA may issue an EUA to allow unapproved medical products or unapproved uses of approved medical products to be used in an emergency to diagnose, treat, or prevent COVID-19 when there are no adequate, approved, and available alternatives.

The issuance of an EUA is different than an FDA approval (licensure) of a vaccine. In determining whether to issue an EUA for a product, the FDA evaluates the available evidence and assesses any known or potential risks and any known or potential benefits, and if the benefit-risk assessment is favorable, the product is made available during the emergency. Once a manufacturer submits an EUA request for a COVID-19 vaccine to the FDA, the agency then evaluates the request and determines whether the relevant statutory criteria are met, taking into account the totality of the scientific evidence about the vaccine that is available to the FDA.

The EUA also requires that fact sheets that provide important information, including dosing instructions, and information about the benefits and risks of the Pfizer-BioNTech COVID-19 Vaccine, be made available to vaccination providers and vaccine recipients.

The company has submitted a pharmacovigilance plan to FDA to monitor the safety of Pfizer-BioNTech COVID-19 Vaccine. The pharmacovigilance plan includes a plan to complete longer-term safety follow-up for participants enrolled in ongoing clinical trials. The pharmacovigilance plan also includes other activities aimed at monitoring the safety profile of the Pfizer-BioNTech COVID-19 vaccine and ensuring that any safety concerns are identified and evaluated in a timely manner.

The FDA also expects manufacturers whose COVID-19 vaccines are authorized under an EUA to continue their clinical trials to obtain additional safety and effectiveness information and pursue approval (licensure).

The EUA for the Pfizer-BioNTech COVID-19 Vaccine was issued to Pfizer Inc. The EUA will be effective until the declaration that circumstances exist justifying the authorization of the emergency use of drugs and biologics for prevention and treatment of COVID-19 is terminated, and may be revised or revoked if it is determined the EUA no longer meets the statutory criteria for issuance.

The FDA, an agency within the U.S. Department of Health and Human Services, protects the public health by assuring the safety, effectiveness, and security of human and veterinary drugs, vaccines and other biological products for human use, and medical devices. The agency also is responsible for the safety and security of our nation’s food supply, cosmetics, dietary supplements, products that give off electronic radiation, and for regulating tobacco products.

Related Information

Pfizer-BioNTech COVID-19 Vaccine EUA Letter of Authorization
Pfizer-BioNTech COVID-19 Vaccine EUA Fact Sheet for Healthcare Providers
Pfizer-BioNTech COVID-19 Vaccine EUA Fact Sheet for Patients
COVID-19 Vaccines
Emergency Use Authorization for Vaccines Explained
Emergency Use Authorization for Vaccines to Prevent COVID-19; Guidance for Industry
Development and Licensure of Vaccines to Prevent COVID-19; Guidance for Industry

###

Inquiries

Media: FDA Office of Media Affairs 301-796-4540 Consumer: 888-INFO-FD

###

Press Releases

.

Coronavirus (COVID-19) Update: FDA Authorizes Pfizer-BioNTech COVID-19 Vaccine for Emergency Use in Adolescents in Another Important Action in Fight Against Pandemic

Press Release [2]

FDA NEWS RELEASE
Coronavirus (COVID-19) Update: FDA Authorizes Pfizer-BioNTech COVID-19 Vaccine for Emergency Use in Adolescents in Another Important Action in Fight Against Pandemic

For Immediate Release:

May 10, 2021

Today, the U.S. Food and Drug Administration expanded the emergency use authorization (EUA) for the Pfizer-BioNTech COVID-19 Vaccine for the prevention of coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) to include adolescents 12 through 15 years of age. The FDA amended the EUA originally issued on Dec. 11, 2020 for administration in individuals 16 years of age and older.

“The FDA’s expansion of the emergency use authorization for the Pfizer-BioNTech COVID-19 Vaccine to include adolescents 12 through 15 years of age is a significant step in the fight against the COVID-19 pandemic,” said Acting FDA Commissioner Janet Woodcock, M.D. “Today’s action allows for a younger population to be protected from COVID-19, bringing us closer to returning to a sense of normalcy and to ending the pandemic. Parents and guardians can rest assured that the agency undertook a rigorous and thorough review of all available data, as we have with all of our COVID-19 vaccine emergency use authorizations.”

From March 1, 2020 through April 30, 2021, approximately 1.5 million COVID-19 cases in individuals 11 to 17 years of age have been reported to the Centers for Disease Control and Prevention (CDC). Children and adolescents generally have a milder COVID-19 disease course as compared to adults. The Pfizer-BioNTech COVID-19 Vaccine is administered as a series of two doses, three weeks apart, the same dosage and dosing regimen for 16 years of age and older.

The FDA has determined that Pfizer-BioNTech COVID-19 Vaccine has met the statutory criteria to amend the EUA, and that the known and potential benefits of this vaccine in individuals 12 years of age and older outweigh the known and potential risks, supporting the vaccine’s use in this population.

“Having a vaccine authorized for a younger population is a critical step in continuing to lessen the immense public health burden caused by the COVID-19 pandemic,” said Peter Marks, M.D., Ph.D., director of the FDA’s Center for Biologics Evaluation and Research. “With science guiding our evaluation and decision-making process, the FDA can assure the public and medical community that the available data meet our rigorous standards to support the emergency use of this vaccine in the adolescent population 12 years of age and older.”

The FDA has updated the Fact Sheets for Healthcare Providers Administering the Vaccine (Vaccination Providers) and for Recipients and Caregivers with information to reflect the use of the vaccine in the adolescent population, including the benefits and risks of the Pfizer-BioNTech COVID-19 Vaccine.

The EUA amendment for the Pfizer-BioNTech COVID-19 Vaccine was issued to Pfizer Inc. The issuance of an EUA is not an FDA approval (licensure) of a vaccine. The EUA will be effective until the declaration that circumstances exist justifying the authorization of the emergency use of drugs and biologics for prevention and treatment of COVID-19 is terminated, and may be revised or revoked if it is determined the EUA no longer meets the statutory criteria for issuance or to protect public health or safety.

FDA Evaluation of Available Safety Data

The available safety data to support the EUA in adolescents down to 12 years of age, include 2,260 participants ages 12 through 15 years old enrolled in an ongoing randomized, placebo-controlled clinical trial in the United States. Of these, 1,131 adolescent participants received the vaccine and 1,129 received a saline placebo. More than half of the participants were followed for safety for at least two months following the second dose.

The most commonly reported side effects in the adolescent clinical trial participants, which typically lasted 1-3 days, were pain at the injection site, tiredness, headache, chills, muscle pain, fever and joint pain. With the exception of pain at the injection site, more adolescents reported these side effects after the second dose than after the first dose, so it is important for vaccination providers and recipients to expect that there may be some side effects after either dose, but even more so after the second dose. The side effects in adolescents were consistent with those reported in clinical trial participants 16 years of age and older. It is important to note that as a general matter, while some individuals experience side effects following any vaccination, not every individual’s experience will be the same and some people may not experience side effects.

The Pfizer-BioNTech COVID-19 Vaccine should not be given to anyone with a known history of a severe allergic reaction, including anaphylaxis—to any component of the vaccine. Since its authorization for emergency use, rare severe allergic reactions, including anaphylaxis, have been reported following administration of the Pfizer-BioNTech COVID-19 Vaccine in some recipients.

FDA Evaluation of Available Effectiveness Data

The effectiveness data to support the EUA in adolescents down to 12 years of age is based on immunogenicity and an analysis of COVID-19 cases. The immune response to the vaccine in 190 participants, 12 through 15 years of age, was compared to the immune response of 170 participants, 16 through 25 years of age. In this analysis, the immune response of adolescents was non-inferior to (at least as good as) the immune response of the older participants. An analysis of cases of COVID-19 occurring among participants, 12 through 15 years of age, seven days after the second dose was also conducted. In this analysis, among participants without evidence of prior infection with SARS-CoV-2, no cases of COVID-19 occurred among 1,005 vaccine recipients and 16 cases of COVID-19 occurred among 978 placebo recipients; the vaccine was 100% effective in preventing COVID-19. At this time, there are limited data to address whether the vaccine can prevent transmission of the virus from person to person. In addition, at this time, data are not available to determine how long the vaccine will provide protection.

Ongoing Safety Monitoring

As part of the original EUA request, Pfizer Inc. submitted a plan to continue monitoring the safety of the vaccine as it is used under EUA. This plan has been updated to include the newly authorized adolescent population, and includes longer-term safety follow-up for participants enrolled in ongoing clinical trials, as well as other activities aimed at monitoring the safety of the Pfizer-BioNTech COVID-19 vaccine and ensuring that any safety concerns are identified and evaluated in a timely manner.

It is mandatory for Pfizer Inc. and vaccination providers to report the following to the Vaccine Adverse Event Reporting System for Pfizer-BioNTech COVID-19 Vaccine: all vaccine administration errors, serious adverse events, cases of Multisystem Inflammatory Syndrome and cases of COVID-19 that result in hospitalization or death.

Related Information

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The FDA, an agency within the U.S. Department of Health and Human Services, protects the public health by assuring the safety, effectiveness, and security of human and veterinary drugs, vaccines and other biological products for human use, and medical devices. The agency also is responsible for the safety and security of our nation’s food supply, cosmetics, dietary supplements, products that give off electronic radiation, and for regulating tobacco products.

Inquiries

Media: FDA Office of Media Affairs 301-796-4540 Consumer: 888-INFO-FDA

Press Releases

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FDA Approves First COVID-19 Vaccine

Press Release [3]

FDA NEWS RELEASE
FDA Approves First COVID-19 Vaccine
Approval Signifies Key Achievement for Public Health

For Immediate Release:

August 23, 2021

Today, the U.S. Food and Drug Administration approved the first COVID-19 vaccine. The vaccine has been known as the Pfizer-BioNTech COVID-19 Vaccine, and will now be marketed as Comirnaty (koe-mir’-na-tee), for the prevention of COVID-19 disease in individuals 16 years of age and older. The vaccine also continues to be available under emergency use authorization (EUA), including for individuals 12 through 15 years of age and for the administration of a third dose in certain immunocompromised individuals.

“The FDA’s approval of this vaccine is a milestone as we continue to battle the COVID-19 pandemic. While this and other vaccines have met the FDA’s rigorous, scientific standards for emergency use authorization, as the first FDA-approved COVID-19 vaccine, the public can be very confident that this vaccine meets the high standards for safety, effectiveness, and manufacturing quality the FDA requires of an approved product,” said Acting FDA Commissioner Janet Woodcock, M.D. “While millions of people have already safely received COVID-19 vaccines, we recognize that for some, the FDA approval of a vaccine may now instill additional confidence to get vaccinated. Today’s milestone puts us one step closer to altering the course of this pandemic in the U.S.”

Since Dec. 11, 2020, the Pfizer-BioNTech COVID-19 Vaccine has been available under EUA in individuals 16 years of age and older, and the authorization was expanded to include those 12 through 15 years of age on May 10, 2021. EUAs can be used by the FDA during public health emergencies to provide access to medical products that may be effective in preventing, diagnosing, or treating a disease, provided that the FDA determines that the known and potential benefits of a product, when used to prevent, diagnose, or treat the disease, outweigh the known and potential risks of the product.

FDA-approved vaccines undergo the agency’s standard process for reviewing the quality, safety and effectiveness of medical products. For all vaccines, the FDA evaluates data and information included in the manufacturer’s submission of a biologics license application (BLA). A BLA is a comprehensive document that is submitted to the agency providing very specific requirements. For Comirnaty, the BLA builds on the extensive data and information previously submitted that supported the EUA, such as preclinical and clinical data and information, as well as details of the manufacturing process, vaccine testing results to ensure vaccine quality, and inspections of the sites where the vaccine is made. The agency conducts its own analyses of the information in the BLA to make sure the vaccine is safe and effective and meets the FDA’s standards for approval.

Comirnaty contains messenger RNA (mRNA), a kind of genetic material. The mRNA is used by the body to make a mimic of one of the proteins in the virus that causes COVID-19. The result of a person receiving this vaccine is that their immune system will ultimately react defensively to the virus that causes COVID-19. The mRNA in Comirnaty is only present in the body for a short time and is not incorporated into - nor does it alter - an individual’s genetic material. Comirnaty has the same formulation as the EUA vaccine and is administered as a series of two doses, three weeks apart.

“Our scientific and medical experts conducted an incredibly thorough and thoughtful evaluation of this vaccine. We evaluated scientific data and information included in hundreds of thousands of pages, conducted our own analyses of Comirnaty’s safety and effectiveness, and performed a detailed assessment of the manufacturing processes, including inspections of the manufacturing facilities,” said Peter Marks, M.D., Ph.D., director of FDA’s Center for Biologics Evaluation and Research. “We have not lost sight that the COVID-19 public health crisis continues in the U.S. and that the public is counting on safe and effective vaccines. The public and medical community can be confident that although we approved this vaccine expeditiously, it was fully in keeping with our existing high standards for vaccines in the U.S."

FDA Evaluation of Safety and Effectiveness Data for Approval for 16 Years of Age and Older

The first EUA, issued Dec. 11, for the Pfizer-BioNTech COVID-19 Vaccine for individuals 16 years of age and older was based on safety and effectiveness data from a randomized, controlled, blinded ongoing clinical trial of thousands of individuals.

To support the FDA’s approval decision today, the FDA reviewed updated data from the clinical trial which supported the EUA and included a longer duration of follow-up in a larger clinical trial population.

Specifically, in the FDA’s review for approval, the agency analyzed effectiveness data from approximately 20,000 vaccine and 20,000 placebo recipients ages 16 and older who did not have evidence of the COVID-19 virus infection within a week of receiving the second dose. The safety of Comirnaty was evaluated in approximately 22,000 people who received the vaccine and 22,000 people who received a placebo 16 years of age and older.

Based on results from the clinical trial, the vaccine was 91% effective in preventing COVID-19 disease.

More than half of the clinical trial participants were followed for safety outcomes for at least four months after the second dose. Overall, approximately 12,000 recipients have been followed for at least 6 months.

The most commonly reported side effects by those clinical trial participants who received Comirnaty were pain, redness and swelling at the injection site, fatigue, headache, muscle or joint pain, chills, and fever. The vaccine is effective in preventing COVID-19 and potentially serious outcomes including hospitalization and death.

Additionally, the FDA conducted a rigorous evaluation of the post-authorization safety surveillance data pertaining to myocarditis and pericarditis following administration of the Pfizer-BioNTech COVID-19 Vaccine and has determined that the data demonstrate increased risks, particularly within the seven days following the second dose. The observed risk is higher among males under 40 years of age compared to females and older males. The observed risk is highest in males 12 through 17 years of age. Available data from short-term follow-up suggest that most individuals have had resolution of symptoms. However, some individuals required intensive care support. Information is not yet available about potential long-term health outcomes. The Comirnaty Prescribing Information includes a warning about these risks.

Ongoing Safety Monitoring

The FDA and Centers for Disease Control and Prevention have monitoring systems in place to ensure that any safety concerns continue to be identified and evaluated in a timely manner. In addition, the FDA is requiring the company to conduct postmarketing studies to further assess the risks of myocarditis and pericarditis following vaccination with Comirnaty. These studies will include an evaluation of long-term outcomes among individuals who develop myocarditis following vaccination with Comirnaty. In addition, although not FDA requirements, the company has committed to additional post-marketing safety studies, including conducting a pregnancy registry study to evaluate pregnancy and infant outcomes after receipt of Comirnaty during pregnancy.

The FDA granted this application Priority Review. The approval was granted to BioNTech Manufacturing GmbH.

Related Information

Comirnaty Prescribing Information
Cormirnaty and Pfizer-BioNTech COVID-19 Vaccine | FDA

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The FDA, an agency within the U.S. Department of Health and Human Services, protects the public health by assuring the safety, effectiveness, and security of human and veterinary drugs, vaccines and other biological products for human use, and medical devices. The agency also is responsible for the safety and security of our nation’s food supply, cosmetics, dietary supplements, products that give off electronic radiation, and for regulating tobacco products.

Inquiries

Media: FDA Office of Media Affairs 301-796-4540 Consumer: 888-INFO-FDA

Press Releases

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FDA Authorizes Booster Dose of Pfizer-BioNTech COVID-19 Vaccine for Certain Populations

Press Release [4]

FDA NEWS RELEASE

FDA Authorizes Booster Dose of Pfizer-BioNTech COVID-19 Vaccine for Certain Populations
For Immediate Release: September 22, 2021

Today, the U.S. Food and Drug Administration amended the emergency use authorization (EUA) for the Pfizer-BioNTech COVID-19 Vaccine to allow for use of a single booster dose, to be administered at least six months after completion of the primary series in:

“Today’s action demonstrates that science and the currently available data continue to guide the FDA’s decision-making for COVID-19 vaccines during this pandemic. After considering the totality of the available scientific evidence and the deliberations of our advisory committee of independent, external experts, the FDA amended the EUA for the Pfizer-BioNTech COVID-19 Vaccine to allow for a booster dose in certain populations such as health care workers, teachers and day care staff, grocery workers and those in homeless shelters or prisons, among others,” said Acting FDA Commissioner Janet Woodcock, M.D. “This pandemic is dynamic and evolving, with new data about vaccine safety and effectiveness becoming available every day. As we learn more about the safety and effectiveness of COVID-19 vaccines, including the use of a booster dose, we will continue to evaluate the rapidly changing science and keep the public informed.”

The Process for Assessing the Available Data

Comirnaty (COVID-19 Vaccine, mRNA), was approved by the FDA on Aug. 23, for the prevention of COVID-19 caused by SARS-CoV-2 in individuals 16 years of age and older. On Aug. 25, 2021, the FDA received a supplement from Pfizer Inc. to their biologics license application for Comirnaty seeking approval of a single booster dose to be administered approximately six months after completion of the primary vaccination series for individuals 16 years of age and older.

As part of the FDA’s commitment to transparency, the agency convened a public meeting of its Vaccines and Related Biological Products Advisory Committee (VRBPAC) on Sept. 17 to solicit input from independent scientific and public health experts on the data submitted in the application. During the meeting, the vaccine manufacturer presented information and data in support of its application. The FDA also presented its analysis of clinical trial data submitted by the vaccine manufacturer. Additionally, the public was also given an opportunity to provide comment; and FDA invited international and U.S. agencies and external groups, including representatives from the Israeli Ministry of Health, the University of Bristol, U.K. and the Centers for Disease Control and Prevention, to present recent data on the use of vaccine boosters, epidemiology of COVID-19, and real-world evidence on vaccine effectiveness.

The FDA considered the data that the vaccine manufacturer submitted, information presented at the VRBPAC meeting, and the committee’s discussion, and has determined that based on the totality of the available scientific evidence, a booster dose of Pfizer-BioNTech COVID-19 Vaccine may be effective in preventing COVID-19 and that the known and potential benefits of a booster dose outweigh the known and potential risks in the populations that the FDA is authorizing for use. The booster dose is authorized for administration to these individuals at least six months following completion of their primary series and may be given at any point after that time.

It’s important to note that the FDA-authorized Pfizer-BioNTech COVID-19 Vaccine is the same formulation as the FDA-approved Comirnaty and the vaccines may be used interchangeably.

“We’re grateful for the advice of the doctors, scientists, and leading vaccine experts on our advisory committee and the important role they have played in ensuring transparent discussions about COVID-19 vaccines. We appreciate the robust discussion, including the vote regarding individuals over 65 years of age and individuals at high risk for severe disease, as well as the committee’s views regarding the use of a booster dose for those with institutional or occupational exposure to SARS-CoV-2,” said Peter Marks, M.D., Ph.D., director of FDA’s Center for Biologics Evaluation and Research. “The FDA considered the committee’s input and conducted its own thorough review of the submitted data to reach today’s decision. We will continue to analyze data submitted to the FDA pertaining to the use of booster doses of COVID-19 vaccines and we will make further decisions as appropriate based on the data.”

Data Supporting Authorization for Emergency Use

To support the authorization for emergency use of a single booster dose, the FDA analyzed safety and immune response data from a subset of participants from the original clinical trial of the Pfizer-BioNTech COVID-19 Vaccine. In addition, consideration was given to real-world data on the vaccine’s efficacy over a sustained period of time provided by both U.S. and international sources, including the CDC, the UK and Israel. The immune responses of approximately 200 participants 18 through 55 years of age who received a single booster dose approximately six months after their second dose were assessed. The antibody response against SARS-CoV-2 virus one month after a booster dose of the vaccine compared to the response one month after the two-dose primary series in the same individuals demonstrated a booster response.

Additional analysis conducted by the manufacturer, as requested by the FDA, compared the rates of COVID-19 accrued during the current Delta variant surge among original clinical trial participants who completed the primary two-dose vaccination series early in the clinical trial to those who completed a two-dose series later in the study. The analysis submitted by the company showed that during the study period of July and August 2021, the incidence of COVID-19 was higher among the participants who completed their primary vaccine series earlier, compared to participants who completed it later. The FDA determined that the rate of breakthrough COVID-19 reported during this time period translates to a modest decrease in the efficacy of the vaccine among those vaccinated earlier.

Safety was evaluated in 306 participants 18 through 55 years of age and 12 participants 65 years of age and older who were followed for an average of over two months. The most commonly reported side effects by the clinical trial participants who received the booster dose of the vaccine were pain, redness and swelling at the injection site, as well as fatigue, headache, muscle or joint pain and chills. Of note, swollen lymph nodes in the underarm were observed more frequently following the booster dose than after the primary two-dose series.

Since Dec. 11, 2020, the Pfizer-BioNTech COVID-19 Vaccine has been available under EUA for individuals 16 years of age and older. The authorization was expanded on May 10, 2021 to include those 12 through 15 years of age, and again on Aug. 12, 2021 to include the use of a third dose of a three-dose primary series in certain immunocompromised individuals 12 years of age and older. EUAs can be used by the FDA during public health emergencies to provide access to medical products that may be effective in preventing, diagnosing, or treating a disease, provided that the FDA determines that the known and potential benefits of a product, when used to prevent, diagnose, or treat the disease, outweigh the known and potential risks of the product.

The amendment to the EUA to include a single booster dose was granted to Pfizer Inc.

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The FDA, an agency within the U.S. Department of Health and Human Services, protects the public health by assuring the safety, effectiveness, and security of human and veterinary drugs, vaccines and other biological products for human use, and medical devices. The agency also is responsible for the safety and security of our nation’s food supply, cosmetics, dietary supplements, products that give off electronic radiation, and for regulating tobacco products.

Inquiries

Media: FDA Office of Media Affairs 301-796-4540 Consumer: 888-INFO-FDA

Press Releases

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FDA Authorizes Pfizer-BioNTech COVID-19 Vaccine for Emergency Use in Children 5 through 11 Years of Age

Press Release [5]

FDA NEWS RELEASE
For Immediate Release: October 29, 2021

Today, the U.S. Food and Drug Administration authorized the emergency use of the Pfizer-BioNTech COVID-19 Vaccine for the prevention of COVID-19 to include children 5 through 11 years of age. The authorization was based on the FDA’s thorough and transparent evaluation of the data that included input from independent advisory committee experts who overwhelmingly voted in favor of making the vaccine available to children in this age group.

Key points for parents and caregivers:

“As a mother and a physician, I know that parents, caregivers, school staff, and children have been waiting for today’s authorization. Vaccinating younger children against COVID-19 will bring us closer to returning to a sense of normalcy,” said Acting FDA Commissioner Janet Woodcock, M.D. “Our comprehensive and rigorous evaluation of the data pertaining to the vaccine’s safety and effectiveness should help assure parents and guardians that this vaccine meets our high standards.”

The Pfizer-BioNTech COVID-19 Vaccine for children 5 through 11 years of age is administered as a two-dose primary series, 3 weeks apart, but is a lower dose (10 micrograms) than that used for individuals 12 years of age and older (30 micrograms).

In the U.S., COVID-19 cases in children 5 through 11 years of age make up 39% of cases in individuals younger than 18 years of age. According to the CDC, approximately 8,300 COVID-19 cases in children 5 through 11 years of age resulted in hospitalization. As of Oct. 17, 691 deaths from COVID-19 have been reported in the U.S. in individuals less than 18 years of age, with 146 deaths in the 5 through 11 years age group.

“The FDA is committed to making decisions that are guided by science that the public and healthcare community can trust. We are confident in the safety, effectiveness and manufacturing data behind this authorization. As part of our commitment to transparency around our decision-making, which included our public advisory committee meeting earlier this week, we have posted documents today supporting our decision and additional information detailing our evaluation of the data will be posted soon. We hope this information helps build confidence of parents who are deciding whether to have their children vaccinated,” said Peter Marks, M.D., Ph.D., director of the FDA’s Center for Biologics Evaluation and Research.

The FDA has determined this Pfizer vaccine has met the criteria for emergency use authorization. Based on the totality of scientific evidence available, the known and potential benefits of the Pfizer-BioNTech COVID-19 vaccine in individuals down to 5 years of age outweigh the known and potential risks.

FDA Evaluation of Available Effectiveness Data

The effectiveness data to support the EUA in children down to 5 years of age is based on an ongoing randomized, placebo-controlled study that has enrolled approximately 4,700 children 5 through 11 years of age. The study is being conducted in the U.S., Finland, Poland and Spain. Children in the vaccine group received two doses of the Pfizer-BioNTech COVID-19 Vaccine containing 10 micrograms of messenger RNA per dose. The FDA analyzed data that compared the immune response of 264 participants from this study to 253 participants 16 through 25 years of age who had two higher doses of the vaccine in a previous study which determined the vaccine to be effective in preventing COVID-19. The immune responses of the younger age participants were comparable to the older participants.

The FDA also conducted a preliminary analysis of cases of COVID-19 occurring seven days after the second dose. In this analysis, among participants without evidence of prior infection with SARS-CoV-2, 3 cases of COVID-19 occurred among 1,305 vaccine recipients and 16 cases of COVID-19 occurred among 663 placebo recipients; the vaccine was 90.7% effective in preventing COVID-19.

FDA Evaluation of Available Safety Data

The available safety data to support the EUA include more than 4,600 participants (3,100 vaccine, 1,538 placebo) ages 5 through 11 years enrolled in the ongoing study. In this trial, a total of 1,444 vaccine recipients were followed for safety for at least 2 months after the second dose.

Commonly reported side effects in the clinical trial included injection site pain (sore arm), redness and swelling, fatigue, headache, muscle and/or joint pain, chills, fever, swollen lymph nodes, nausea and decreased appetite. More children reported side effects after the second dose than after the first dose. Side effects were generally mild to moderate in severity and occurred within two days after vaccination, and most went away within one to two days.

The FDA and CDC safety surveillance systems have previously identified increased risks of myocarditis (inflammation of the heart muscle) and pericarditis (inflammation of tissue surrounding the heart) following vaccination with Pfizer-BioNTech COVID-19 Vaccine, particularly following the second dose, and with the observed risk highest in males 12 through 17 years of age. Therefore, the FDA conducted its own benefit-risk assessment using modelling to predict how many symptomatic COVID-19 cases, hospitalizations, intensive care unit (ICU) admissions and deaths from COVID-19 the vaccine in children 5 through 11 years of age would prevent versus the number of potential myocarditis cases, hospitalizations, ICU admissions and deaths that the vaccine might cause. The FDA’s model predicts that overall, the benefits of the vaccine would outweigh its risks in children 5 through 11 years of age.

Ongoing Safety Monitoring

Pfizer Inc. has updated its safety monitoring plan to include evaluation of myocarditis, pericarditis and other events of interest in children 5 through 11 years of age. In addition, the FDA and the CDC have several systems in place to continually monitor COVID-19 vaccine safety and allow for the rapid detection and investigation of potential safety problems.

It is mandatory for Pfizer Inc. and vaccination providers to report to any serious adverse events, cases of Multisystem Inflammatory Syndrome and cases of COVID-19 that result in hospitalization or death in vaccinated individuals. It is also mandatory for vaccination providers to report all vaccine administration errors to VAERS for which they become aware and for Pfizer Inc. to include a summary and analysis of all identified vaccine administration errors in monthly safety reports to the FDA.

Data Supports New Vaccine Formulation to Improve Stability and Storage Conditions

The FDA today also authorized a manufacturing change for the vaccine to include a formulation that uses a different buffer; buffers help maintain a vaccine’s pH (a measure of how acidic or alkaline a solution is) and stability. This new formulation is more stable at refrigerated temperatures for longer periods of time, permitting greater flexibility for vaccination providers.

The new formulation of the vaccine developed by Pfizer Inc. contains Tris buffer, a commonly used buffer in a variety of other FDA-approved vaccines and other biologics, including products for use in children. The FDA evaluated manufacturing data to support the use of Pfizer-BioNTech COVID-19 Vaccine containing Tris buffer and concluded it does not present safety or effectiveness concerns.

Related Information

Pfizer-BioNTech COVID-19 Vaccine

COVID-19 Vaccines

Emergency Use Authorization for Vaccines Explained

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The FDA, an agency within the U.S. Department of Health and Human Services, protects the public health by assuring the safety, effectiveness, and security of human and veterinary drugs, vaccines and other biological products for human use, and medical devices. The agency also is responsible for the safety and security of our nation’s food supply, cosmetics, dietary supplements, products that give off electronic radiation, and for regulating tobacco products.

Inquiries

Media: FDA Office of Media Affairs 301-796-4540 Consumer: 888-INFO-FDA

Press Releases

References:

[1] FDA Takes Key Action in Fight Against COVID-19 By Issuing Emergency Use Authorization for First COVID-19 Vaccine, FDA News Release, Press Release, US Food and Drug Administration - FDA, December 11, 2020. webpage https://www.fda.gov/news-events/press-announcements/fda-takes-key-action-fight-against-covid-19-issuing-emergency-use-authorization-first-covid-19, November 2021. FDA Takes Key Action in Fight Against COVID-19 By Issuing Emergency Use Authorization for First COVID-19 Vaccine

[2] Coronavirus (COVID-19) Update: FDA Authorizes Pfizer-BioNTech COVID-19 Vaccine for Emergency Use in Adolescents in Another Important Action in Fight Against Pandemic, FDA News Release, Press Release, US Food and Drug Administration - FDA, May 10, 2021. webpage https://www.fda.gov/news-events/press-announcements/coronavirus-covid-19-update-fda-authorizes-pfizer-biontech-covid-19-vaccine-emergency-use, November 2021. Coronavirus (COVID-19) Update: FDA Authorizes Pfizer-BioNTech COVID-19 Vaccine for Emergency Use in Adolescents in Another Important Action in Fight Against Pandemic

[3] FDA Approves First COVID-19 Vaccine, FDA News Release, Press Release, US Food and Drug Administration - FDA, August 23, 2021. webpage https://www.fda.gov/news-events/press-announcements/fda-approves-first-covid-19-vaccine, November 2021. FDA Approves First COVID-19 Vaccine.

[4] FDA Authorizes Booster Dose of Pfizer-BioNTech COVID-19 Vaccine for Certain Populations, FDA News Release, Press Release, US Food and Drug Administration - FDA, Sep 22, 2021. webpage https://www.fda.gov/news-events/press-announcements/fda-authorizes-booster-dose-pfizer-biontech-covid-19-vaccine-certain-populations, November 2021. FDA Authorizes Booster Dose of Pfizer-BioNTech COVID-19 Vaccine for Certain Populations, FDA News Release, Press Release

[5] FDA Authorizes Pfizer-BioNTech COVID-19 Vaccine for Emergency Use in Children 5 through 11 Years of Age, FDA News Release, Press Release, US Food and Drug Administration - FDA, October 29, 2021. webpage https://www.fda.gov/news-events/press-announcements/fda-authorizes-pfizer-biontech-covid-19-vaccine-emergency-use-children-5-through-11-years-age, November 2021. FDA Authorizes Pfizer-BioNTech COVID-19 Vaccine for Emergency Use in Children 5 through 11 Years of Age

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CDC Press Releases

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CDC Expands Eligibility for COVID-19 Booster Shots

Press Release [1]

Media Statement
For Immediate Release: Thursday, October 21, 2021
Contact: Media Relations
(404) 639-3286

Today, CDC Director Rochelle P. Walensky, M.D., M.P.H., endorsed the CDC Advisory Committee on Immunization Practices’ (ACIP) recommendation for a booster shot of COVID-19 vaccines in certain populations. The Food and Drug Administration’s (FDA) authorization and CDC’s recommendation for use are important steps forward as we work to stay ahead of the virus and keep Americans safe.

For individuals who received a Pfizer-BioNTech or Moderna COVID-19 vaccine, the following groups are eligible for a booster shot at 6 months or more after their initial series:

For the nearly 15 million people who got the Johnson & Johnson COVID-19 vaccine, booster shots are also recommended for those who are 18 and older and who were vaccinated two or more months ago.

There are now booster recommendations for all three available COVID-19 vaccines in the United States. Eligible individuals may choose which vaccine they receive as a booster dose. Some people may have a preference for the vaccine type that they originally received, and others may prefer to get a different booster. CDC’s recommendations now allow for this type of mix and match dosing for booster shots.

Millions of people are newly eligible to receive a booster shot and will benefit from additional protection. However, today’s action should not distract from the critical work of ensuring that unvaccinated people take the first step and get an initial COVID-19 vaccine. More than 65 million Americans remain unvaccinated, leaving themselves – and their children, families, loved ones, and communities– vulnerable.

Available data right now show that all three of the COVID-19 vaccines approved or authorized in the United States continue to be highly effective in reducing risk of severe disease, hospitalization, and death, even against the widely circulating Delta variant. Vaccination remains the best way to protect yourself and reduce the spread of the virus and help prevent new variants from emerging.

The following is attributable to Dr. Walensky:

“These recommendations are another example of our fundamental commitment to protect as many people as possible from COVID-19. The evidence shows that all three COVID-19 vaccines authorized in the United States are safe – as demonstrated by the over 400 million vaccine doses already given. And, they are all highly effective in reducing the risk of severe disease, hospitalization, and death, even in the midst of the widely circulating Delta variant.”

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

CDC works 24/7 protecting America’s health, safety and security. Whether disease start at home or abroad, are curable or preventable, chronic or acute, or from human activity or deliberate attack, CDC responds to America’s most pressing health threats. CDC is headquartered in Atlanta and has experts located throughout the United States and the world.

Press Releases

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CDC Recommends Pediatric COVID-19 Vaccine for Children 5 to 11 Years

Press Release [2]

Media Statement
For Immediate Release: Tuesday, November 2, 2021
Contact: Media Relations
(404) 639-3286

Today, CDC Director Rochelle P. Walensky, M.D., M.P.H., endorsed the CDC Advisory Committee on Immunization Practices’ (ACIP) recommendation that children 5 to 11 years old be vaccinated against COVID-19 with the Pfizer-BioNTech pediatric vaccine. CDC now expands vaccine recommendations to about 28 million children in the United States in this age group and allows providers to begin vaccinating them as soon as possible.

COVID-19 cases in children can result in hospitalizations, deaths, MIS-C (inflammatory syndromes) and long-term complications, such as “long COVID,” in which symptoms can linger for months. The spread of the Delta variant resulted in a surge of COVID-19 cases in children throughout the summer. During a 6-week period in late June to mid-August, COVID-19 hospitalizations among children and adolescents increased fivefold. Vaccination, along with other preventative measures, can protect children from COVID-19 using the safe and effective vaccines already recommended for use in adolescents and adults in the United States. Similar to what was seen in adult vaccine trials, vaccination was nearly 91 percent effective in preventing COVID-19 among children aged 5-11 years. In clinical trials, vaccine side effects were mild, self-limiting, and similar to those seen in adults and with other vaccines recommended for children. The most common side effect was a sore arm.

COVID-19 vaccines have undergone – and will continue to undergo – the most intensive safety monitoring in U.S. history. Vaccinating children will help protect them from getting COVID-19 and therefore reducing their risk of severe disease, hospitalizations, or developing long-term COVID-19 complications. Getting your children vaccinated can help protect them against COVID-19, as well as reduce disruptions to in-person learning and activities by helping curb community transmission.

Distribution of pediatric vaccinations across the country started this week, with plans to scale up to full capacity starting the week of November 8th. Vaccines will be available at thousands of pediatric healthcare provider offices, pharmacies, Federally Qualified Health Centers, and more.

The following is attributable to Dr. Walensky:

“Together, with science leading the charge, we have taken another important step forward in our nation’s fight against the virus that causes COVID-19. We know millions of parents are eager to get their children vaccinated and with this decision, we now have recommended that about 28 million children receive a COVID-19 vaccine. As a mom, I encourage parents with questions to talk to their pediatrician, school nurse or local pharmacist to learn more about the vaccine and the importance of getting their children vaccinated.”

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U.S. DEPARTMENT OF HEALTH AND HUMAN SERVICES

Press Releases

References:

[1] CDC Expands Eligibility for COVID-19 Booster Shots, Press Release, Centers For Disease Control and Prevention - CDC, October 21, 2021, webpage https://www.cdc.gov/media/releases/2021/p1021-covid-booster.html, November 2021. CDC Expands Eligibility for COVID-19 Booster Shots

[2] CDC Recommends Pediatric COVID-19 Vaccine for Children 5 to 11 Years, Press Release, Centers For Disease Control and Prevention - CDC, November 2, 2021, webpage https://www.cdc.gov/media/releases/2021/s1102-PediatricCOVID-19Vaccine.html, November 2021. CDC Recommends Pediatric COVID-19 Vaccine for Children 5 to 11 Years

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Unvaccinated Social Response

The following is a social media post showing the frustration level over the unvaccinated rising [1].

December 7 at 10:58 AM

I'm FULLY vaccinated and, no, I don't know what's in it - neither this vaccine, the ones I had as a child, nor in the 11 secret herbs and spices at KFC, or hot dogs, or other treatments, whether it's for cancer, AIDS, pneumonia, or vaccines for infants or children.

I also don't know what's in Ibuprofen, Tylenol, or other meds, it just cures my headaches & my pains.

I don't know what's in the ink for tattoos, vaping, Botox and fillers, or every ingredient in my soap or shampoo or even deodorants.

I don’t know whether or not that restaurant I just ate at REALLY used clean foods and washed their hands.

In short ...

There are a lot of things I don't know and never will. I just know one thing: life is short, very short, and I still want to do something other than just staying locked in my home. I still want to travel and hug people without fear and find a little feeling of life "before."

As a child and as an adult I've been vaccinated for polio, flu, pneumonia, tetanus, and quite a few others; my parents and I trusted the science and never had to suffer through or transmit any of the said diseases.

I'm vaccinated, not to please the government but:

Text copied, feel free to do the same (Thanks)

It is unclear if this frustration level will increase and translate into new policy decisions.

References:

[1] Social media post on the Internet, multiple social media platforms, November 2021.

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Ventilation Survey

Beginning on November 30, 2021 a ventilation survey was released and sent via email to 1,952 COVID-19 researchers and 165 Engineers and Computer Scientists. The group included the following:

Email text

Hello,

Since mid-2020 when it was disclosed that COVID-19 is airborne, the guidance has been to increase ventilation inside public spaces. However, do people know what increasing ventilation means and have they taken steps to properly increase ventilation. This survey attempts to answer these and other ventilation related questions.

Please take this survey and pass it to others.

https://www.cassbeth.com/covid-19/survey-ventilation.html

Let us know if you have suggestions to improve the survey.

Thank You

Survey Content

The survey content is provided at the end of this section.

Response

The response was very poor. The expected response was assumed to be 3% but it was well below the expected response level. It is unclear why the survey was ignored. The possible reasons are:

  1. COVID-19 fatigue (see Unvaccinated Social Response)
  2. Unsolicited email negative reaction
  3. Survey header did not include links to the broader website for more information
  4. Do not view ventilation as a concern
  5. Are fixated exclusively on the vaccine, masking, and social distancing

The fact that the survey received such a poor response is a key finding and it suggests the following observations:

  1. People are not interested in understanding ventilation and how their facilities are performing even though we have a serious airborne contagion that is not going away in the next few years.
  2. As of December 2021, the typical stakeholders don't care, even though the mainstream healthcare professionals on the mainstream media constantly mention ventilation.

These are other observations:

  1. It is possible that in the future, once people realize the importance of facility ventilation, they might become interested in this ventilation survey.
  2. It is assumed that interest in the survey is related to properly managed and upgraded facility ventilation systems, suggesting that facility ventilation may be a problem because no one is looking.
  3. This research indicated that as early as 2020, the elite facilities (their stakeholders) are aware of the issue and have upgraded their facilities accordingly.

Of special note, on Hawaiian Airlines A330 flights to and from Hawaii and JFK, the passenger entertainment screen clearly shows that the cabin air is exchanged every 3 minutes and that the HEPA filters remove 99.99% of bacteria and viruses. The exchange of every 3 minutes is 20 ACH, this is above the CDC guideline of 12 ACH when there is an airborne contagion in a hospital room [1]. The ventilation is always on at the gate, tarmac, taxi, runway, in flight, and not controlled by the passengers. This is a proper corporate action, but few are taking this lead.

Phase I Findings

It appears that building ventilation is at the same stage of public consciousness as masking, social distancing, and vaccinations were at the start of the COVID-19 disaster in early 2020. There is disbelief and rejection. Eventually most of the people accepted the importance of masking, social distancing, and vaccinations. The same scenario is expected to develop for building ventilation.

It is unclear if building ventilation will reach the public consciousness in 2022 or 2023, but it will happen. The reason is simple, there will be a segment of the population that will never be vaccinated and people will continue to visit public indoor spaces and get sick. A picture is worth a thousand words. The following picture is of Lima Peru, which has the highest death rate per 100,000 people in the world as of September 14, 2021.

Next Steps

The survey is still available and data will continue to be collected.

Please take the COVID-19 Ventilation Survey - Since mid-2020 when it was disclosed that COVID-19 is airborne, the guidance has been to increase ventilation inside public spaces. However, do people know what increasing ventilation means and have they taken steps to properly increase ventilation.

Phase II Findings

These findings will be provided in the future.

The survey introduction has been modified as follows:

*** Survey Start ***

Survey Questions

COVID-19 Ventilation Survey

This survey is for everyone everywhere.

Since mid-2020 when it was disclosed that COVID-19 is airborne, the guidance has been to increase ventilation inside public spaces. However, do people know what increasing ventilation means and have they taken steps to properly increase ventilation. This survey attempts to answer these and other ventilation related questions. We are conducting this COVID-19 ventilation survey as part of our research efforts. The goal of this research is to help facility managers and others to improve their building airborne contagion mitigation plans and learn from others across various industries.

When dealing with airborne contagions like COVID-19 inside indoor spaces, the air must be exchanged at a certain rate per hour. This is called ACH and it is the Air Changes per Hour in a room. Both the CDC and WHO identified the ACH levels needed when there are airborne contagions in a room. For example, on Hawaiian Airlines A330 flights to and from Hawaii and JFK, the passenger entertainment screen clearly shows that the cabin air is exchanged every 3 minutes and that the HEPA filters remove 99.99% of bacteria and viruses. The exchange of every 3 minutes is 20 ACH. The ventilation is always on at the gate, tarmac, taxi, runway, in flight, and not controlled by the passengers.

All entries are optional except for the First Name entry, where you can just enter Anonymous.

You can view the last few survey results [link].

Please visit: COVID-19 Ventilation FAQ [link]

We encourage you to forward this survey to others especially who may benefit or have more information that can support this research.

Once again this survey is for everyone everywhere.

Thank You,
Walt

All entries are optional except for the first name.

You can fill out this survey as many times as you like for any facility you visit no matter how brief, maintain, manage, own, or have facility data to share.

Note: If you are prevented from taking this survey or you do not care about ventilation, jump to the end and please let us know the reason in the Overall Comments at the end of the survey.

Your Contact Information
__________ First Name (Required, it's okay to enter Anonymous)
__________ Last Name
__________ E-mail Address

Note: NA is Not Applicable or No Answer

Some Questions About You

Your Age: __________

Education Level
NA, Still in School, High School, Some College, Associates Degree, BA - Bachelor of Arts Degree, BS - Bachelor of Science Degree, MA - Masters of Arts Degree, MS - Masters of Science Degree, PhD - Doctor of Philosophy

Marital Status
NA, Single, Married, Separated, Divorced, Widowed

Start with your main facility for example school, work, clubhouse. Then fill out a survey for each facility that you visit, manage, own, or have data to share. If you submit surveys for multiple facilities, once you submit the main facility survey just hit the back button and make the changes for each facility. That will speed up the survey entries because the old values may still be available.

Building Name and Location
__________ Website (company, school, restaurant, etc)
__________ Building Name (the Company, the School, the Restaurant, etc)
__________ Address 1
__________ Address 2
__________ City / Town
__________ State / Province
__________ Zip Code
__________ Country

Survey Time Frame the information entered can be old information
Current Month, Jan, Feb, Mar, Apr, May, Jun, Jul, Aug, Sep, Oct, Nov, Dec
Pre 1970, 1971-1980, 1981-1990, 1991-2000, 2001-2010, 2011-2018, 2019, 2020, 2021, 2022, 2023
Season, Spring, Summer, Fall, Winter

Select Your Role
NA, Facility Owner, Facility Manager, Facility Maintenance Staff, ---, School Admin, Teacher, Student, Parent, Grand Parent, ---, Employee Executive, Employee Management, Employee Staff, ---, Customer, Homeowner, Renter, ---, Vendor, Engineer, Journalist, Research, Research Corporate, Research Non Profit, Research University, Other, if Other selected __________

Select Facility Type
NA, School - District, School - Elementary, School - Middle, School - High School, School - College or University, ---, Home Owners Association HOA, Condo Clubhouse, Apartment Complex Clubhouse, ---, Big Box Store, Indoor Mall, Small Retail Shop, Restaurant, Bar, Tavern, Office, Warehouse, ---, Hospital, Urgent Care Facility, Rehab Facility, Assisted Living Facility, Elder Care Facility, Doctors Office, Dentist Office, Eye Care Office, ---, Airplane, Airport, Train, Train Station, Subway, Subway Station, Ground Transportation, Other, if Other selected __________

Questions

1. Are you aware of the term Air Changes Per Hour (ACH)? Yes, No

2. Are you aware that for rooms with airborne contagions the CDC minimum ACH is 12? Yes, No

3. Are you aware that for rooms with airborne contagions the WHO minimum ACH is 24? Yes, No

4. Do you know the ACH for each room in your facility? Yes, No, - if Yes, Highest ACH, Lowest ACH, Average ACH

5. Did an HVAC contractor generate balance reports and provide the ACH for each room? Yes, No, Don't Know

6. Do you know that you can measure the ACH in each room using a tool that costs less than $30 dollars? Yes, No

7. Did an HVAC or other vendor make changes to the HVAC system or install other systems? Yes, No, Don't Know
If Yes above, select all that apply:
Yes, No, Don't Know - Installed HVAC Induct UV lights
Yes, No, Don't Know - Installed HVAC Larger Fans
Yes, No, Don't Know - Modified HVAC Ducts
Yes, No, Don't Know - Installed New HVAC system
Yes, No, Don't Know - Installed Exhaust Fans
Yes, No, Don't Know - Installed In Room Unit Ventilators
Yes, No, Don't Know - Installed Ceiling Level UV-C Systems
Yes, No, Don't Know - Installed FAR UV-222 Systems
Yes, No, Don't Know - Installed Room Sanitizers
Yes, No, Don't Know - Installed Photocatalytic Oxidizer or Ionizer (PCO) Systems
If Yes what else did they do? __________

8. Are you aware that UV lights installed in the HVAC system do not increase the ACH in the actual space, they only keep the ducts clean and help the existing filters? Yes, No

9. Are you aware of the CDC suggestion to use ultraviolet germicidal irradiation (UVGI) to increase room ventilation? Yes, No

10. Does the facility have ceiling level UV-C systems? Yes, No, Don't Know
If possible please provide UV-C vendor contact: __________

11. Does the facility have FAR UV-222 systems? Yes, No, Don't Know
If possible please provide FAR UV-222 vendor contact: __________

12. Have you or the facility manager contacted any vendors that install ceiling level UV-C and or FAR UV-222 systems? Yes, No, Don't Know
If possible please provide UV systems installer contact: __________

13. Do you or the facility manager have plans to upgrade the ventilation in the facility and if so what is the approach (provide comments at the end)? Yes, No, Don't Know

14. Have you or the facility manager been contacted by vendors to upgrade the facility ventilation (UV, Room Sanitizers, PCO, & HVAC systems)? Yes, No, Don't Know
If possible please provide upgrade vendors contact: __________

15. As a facility manager have you posted in plain sight to facility users the ACH level in the facility? Yes, No

16. As a facility user have you seen in plain sight the ACH level in the facility? Yes, No

17. Can you hear the facility ventilation operating? Yes, No

18. Can you feel the facility ventilation air movement in a normal location away from the vents? Yes, No

19. Does the air seem fresh? Yes, No

20. Can you see air streamers on the facility vents and are they moving? Yes, No, No Need Facility Meets CDC Ventilation Guidelines

21. Have you attempted to contact the facility to alert them to possible ventilation issues? Yes, No, No Need to Contact Facility

22. If you contaced the facility about ventilation did they respond? Yes, No, No Need to Contact Facility

Note: NA is Not Applicable or No Answer

Select Criticality
Grave - Loss of Life, Catastrophic - Loss of Health, Critical - Operations Adversely Affected, Marginal - Inconvenience or Annoyance, Other

Select Budget
less than $1 million, $1 million to $4 million, $5 million to $9 million, $10 million to $24 million, $25 million to $49 million, $50 million to $99 million, $100 million +

Select Number of People
1 to 5, 6 to 15, 16 to 49, 50 to 99, 100 to 249, 250 to 499, 500 to 999, 1,000 to 4,999, 5,000 to 9,999, 10,000 to 24,999, 25,000 to 49,999, 50,000 to 99,999, 100,000+

Select Responsible Industry
NA, Government Federal, Government State, Government Local, Government DOD, Government FAA, Government NASA, Government CDC, Government FDA, ---, Education Public, Education Private, ---, Property Management, Facilities Management, Real Estate, Travel, Hospitality, Big Box Store, Small Retail Shop, Wholesale, Entertainment, Restaurant, Bar, ---, Airlines, Airplane Manufacturing, Ground Transportation, Ground Transportation Manufacturing, ---, Health Care, Hospital, Health Services, Medical Supplies, Medical Equipment, Medical Distribution, ---, Consulting, Engineering, Research, Research University, ---, Manufacturing, Manufacturing Industrial, Manufacturing consumer goods, Distribution, Warehouse, ---, Financial, Banking, Insurance Legal, Publishing Broadcast Media, Other

Select Entity Type
Non Profit, For Profit, Government, Other

Overall Comments. Also, if you selected Other above please provide more information. ______________________________

Clear Entries or Submit Survey

*** Survey End ***

References:

[1] Appendix B. Air Guidelines for Environmental Infection Control in Health-Care Facilities (2003), webpage https://www.cdc.gov/infectioncontrol/guidelines/environmental/appendix/air.html, July 2021. Appendix B. Air Guidelines for Environmental Infection Control in Health-Care Facilities (2003)

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.

Constant COVID-19 Virus Exposure

The vaccine is enormously effective. The analysis shows that the vaccine has saved millions of lives and prevented chronic health conditions from developing in tens of millions of people. Those who have access to the vaccine and took the vaccine are protected for now and are hoping that a new deadly variant does not surface that bypasses the current vaccination. They can live their lives with reasonable expectations of not getting hospitalized or dying from COVID-19.

Early research in 2020 suggested that the antibodies in people infected with COVID-19 dropped significantly within 2 to 3 months, causing concern that humoral immunity against the virus may decline rapidly. However, it is a normal part of the immune response that antibody levels fall after an infection has resolved. For example, in seasonal coronavirus infections, antibodies start to decline approximately one week after infection and typically only last for approximately one year. As part of the body response, T and B cells (memory) are formed after infection. These can be reactivated when another infection with the same virus occurs and they are a mechanism for long-lasting immunity [2].

The earliest vaccines against COVID-19 were built on the messenger ribonucleic acid (mRNA) platform. These were given emergency use authorization in December 2020. These vaccines elicit strong humoral (neutralizing antibodies) and cellular (B and T cells) immune responses [3]. Penn Medicine researchers analyzed the T-cell responses in 47 healthy people who received two doses of the Moderna and Pfizer/BioNTech mRNA vaccines. The findings showed that the T-cell response was robust after the first vaccine dose, with no significant increase after the second dose. [4]

The vaccines result in both antibodies and T / B cell responses. The difference between the antibody response and a T / B cell response is associated with time to remove the virus. If antibodies are present, the virus removal is immediate and there may be no symptoms. With a T / B cell response, the body needs to produce antibodies and that takes time. During the time that it takes to produce the antibodies, the virus multiplies and this may result in symptoms but data as of November 2021 suggests there are very few hospitalizations and deaths. In other words the vaccines are very effective at producing both antibodies and long term T / B cell responses. [4]

T cells, also called T lymphocyte, are a type of leukocyte (white blood cell) that is part of the immune system. The T cells are one of two primary types of lymphocytes and B cells are the second type (white blood cell). The B cells determine the specificity of immune response to foreign substances (antigens) in the body. T cells originate in the bone marrow and mature in the thymus. In the thymus, T cells multiply and differentiate into helper, regulatory, or cytotoxic T cells or become memory T cells. They are then sent to tissues or circulate in the blood or lymphatic system. Once stimulated by the appropriate antigen, helper T cells secrete chemical messengers called cytokines, which stimulate the differentiation of B cells into plasma cells (antibody producing cells). Regulatory T cells act to control immune reactions. Cytotoxic T cells, which are activated by various cytokines, bind to and kill infected cells. [5]

Some key questions from a systems perspective are:

  1. What are the implications if there is constant exposure to a contagion after the antibodies start to wane and the T cell response is activated multiple times for the same or a similar contagion?
  2. Is there a risk that the body will begin to ignore the contagion because of some body system element?
  3. Should there be mitigation elements to address any possible negative consequences and what might the mitigation involve?

The following is a direct extract from a compilation of papers on the topic of Immunity to Persistent Recurrent Stimulants [6].

Immunological memory is considered the hallmark of the adaptive immune response, which is essential for long-term protection against infection throughout life. From the perspective of adaptive immunity, clonally expanded antigen-specific lymphocytes accumulate within the immunological memory repertoire to confer protection upon re-encounter with persistent and/or recurrent pathogens. Furthermore, memory cells often respond more rapidly and effectively following antigen encounter than naive precursors do. Recent increasing evidence suggests that immunological memory can also be a feature of innate immune cells. Innate immunological memory has been frequently described as a trained potentiation of anti-pathogen responses upon re-infection and is exquisitely coordinated by transient genetic and transcriptional changes (e.g., epigenetic reprogramming) that alter the functions of innate immune cells, such as macrophages, monocytes, dendritic cells and NK cells.

Under physiological conditions, immunological memory responses are known to undergo alterations throughout our lifespan and can be differentially impacted during the process of aging. However, in conditions such as chronic inflammation (e.g., autoimmune disease and cancer) and in chronic infection due to the presence of persistent pathogen(s), abnormal alterations in immunological memory responses can occur, leading to memory cell exhaustion. This renders vulnerable individuals, such as the elderly, patients suffering from cancer, and transplant recipients at higher risk of infection. Severe infectious conditions, such as sepsis, are also known to affect the metabolic profile and function of immune cells, somehow speeding up the exhaustion of immunological memory.

This deterioration of the immune response is characterized by genetic / epigenetic alterations in immune cells that are driven by chronic or repeated exposure to antigens derived from: (i) persistent or recurrent pathogens (e.g. virus, bacteria and fungi); (ii) self-tissues and (iii) cancer cells. In adaptive immunity, constant stimulation by persistent antigens leads to a disproportionate accumulation of antigen-experienced or memory-phenotype lymphocytes. These phenomena are associated with (i) a decreased diversity of antigen-receptor repertoires and (ii) alterations in signal transduction and cell differentiation processes, subsequently leading to impaired antibody production and/or altered T cell responses, including exhaustion. Similarly, persistent antigens and PAMPs are also known to cause alterations in innate immune cells which can be complex.

Therefore, immune memory responses are affected by cellular exposure to persistent/recurrent antigenic challenges (including PAMPs/DAMPs), ultimately resulting in (i) the development of chronic inflammation, (ii) dampened responses to vaccination and (iii) the development of disease, all of which negatively impact on human longevity.

The study of the above-mentioned processes including the cellular and molecular mechanisms involved may open new avenues for targeted immunotherapeutic strategies and is the subject of this Research Topic. We welcome the submission of Reviews, Mini-Reviews and Original Research articles covering the following sub-topics:

  1. Innate and adaptive memory cell response to persistent antigens during chronic pathogen infections.
  2. Innate and adaptive memory cell responses to persistent self-antigens and/or DAMPs relevant in autoimmunity.
  3. Innate and adaptive memory cell responses to persistent cancer-derived antigens.

The above research suggests that for severe contagions multiple exposures may exhaust the immune system response. The following are key extracts [6]:

  1. Chronic / persistent stimulants can lead to a deterioration of immunity, leaving individuals more vulnerable to disease.
  2. Severe infections, such as sepsis and COVID-19 are associated with immunoparalysis / exhaustion and / or loss of T cells.

.

Vaccinated Constant Virus Exposure

Throughout the COVID-19 disaster the guidance has been to wear masks when indoors with the suggestion that this will lower the overall virus load by preventing the vaccinated from being infected and carriers during the time between T cell activation and antibody production.

However, there is another consideration that has not been clearly stated and that is the possibility of T cell exhaustion or immune system aging. This is December 2021 and the COVID-19 disaster started in late 2019. The virus has been spreading for 2 years with no end in sight. In normal times the population would have done everything possible to avoid sickness and death. These are not normal times and so the virus is still at high concentration levels in the biosphere.

If the virus continues to persist in high concentration levels, only time will tell if the virus will begin to exhaust the immune systems of the vaccinated and lead to eventual death as the immune system is exhausted. This is an extreme scenario but one that must be considered.

.

Unvaccinated Constant Virus Exposure

The unvaccinated are the source of the spread of the virus with no end in sight. They eventually will be infected and initially survive, lose their health, or die. If they survive, they will be in the same category as the vaccinated that are constantly being exposed to the virus. If the virus continues to persist in high concentration levels, only time will tell if the virus will exhaust the immune systems of the previously infected and lead to eventual death.

.

Constant Virus Exposure Mitigation

Eradicating COVID-19 is unlikely in the short term. In the future (5 years) when children have a runny nose and a fever it is likely that it will be a COVID-19 variant. But failure to eradicate the virus does not mean that death, illness or social isolation will continue. The future depends on the type of immunity people acquire through infection or vaccination and how the virus evolves. Influenza and the four human coronaviruses that cause common colds are also endemic, however a combination of annual vaccines and acquired immunity shows that societies tolerate the seasonal deaths and illnesses they bring without requiring lockdowns, masks and social distancing.

The possible mitigation approaches to deal with the constant virus exposure scenario are as follows:

  1. Avoid population centers where there is a high virus load (short term)
  2. Masking & social distancing (short term)
  3. Proper indoor ventilation of a minimum of 12 ACH (air changes per hour) per CDC guidelines (short term & long term)

Many responsible stakeholders have already implemented indoor ventilation rates of 15-20 ACH [7] [8] [9].

In the future the concept of a clean air indoor space will probably be part of the social consciousness much like it was in the previous century.

.

Previous Contagions Death Rates and Mitigations

The following table show previous contagions, death rates, mitigations, outbreak level, and containment success or failure.

Contagion Ref Deaths Outbreak Level Contained Eradicated Mitigation Strategy Year Discovered
Measles [A] 777,000 (in 2000) Pandemic Old Partially No Vaccine 1963 910
Smallpox [A] 330-500 million total Pandemic Old Partially Yes Vaccine 1798 910
Tuberculosis [A] 1.5 million (in 2018) Pandemic Old Partially No Vaccine 1921, Natural Ventilation, Forced Air Heating & Cooling, Ceiling Level UV Lights [H] 1882
Rubella (German Measles) [B] 2-122 per 100,000 congenital deaths Pandemic Old Partially No Vaccine 1969 1740
Mumps [C] 16-38 per 100,000 Pandemic Old Partially No Vaccine 1967, Ceiling Level UV [H] 1934
Chicken Pox [D] 1 per 60,000 cases Vaccine 1995 1658
MERS [E] 34% to 39% of infected Epidemic Modern Yes No Contained quickly 2014
SARS [F] 10% to 11% of infected Epidemic Modern Yes No Contained quickly 2002
COVID-19 [A] [G] 2% to 3% of infected Pandemic Modern No No Masks, Social Distancing, Vaccine 2020 (Partial Population) for the first time in history a large segment of the population refused vacination 2019

[A] https://en.wikipedia.org/wiki/Pandemic, December 2021.
[B] https://en.wikipedia.org/wiki/Rubella, December 2021.
[C] https://en.wikipedia.org/wiki/Mumps, December 2021.
[D] https://en.wikipedia.org/wiki/Chickenpox, December 2021.
[E] https://en.wikipedia.org/wiki/MERS, December 2021.
[F] https://en.wikipedia.org/wiki/SARS, December 2021.
[G] https://en.wikipedia.org/wiki/COVID-19, December 2021.
[H] Air Disinfection in Day Schools, W.F. Wells Associate Professor in Research in Air-borne Infection, Laboratories for the Study of Air-borne Infection, the Department of Preventive Medicine and Public Health, University of Pennsylvania School of Medicine, Philadelphia, Pa. 1943. webpage https://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.33.12.1436, November 2020. Air Disinfection in Day Schools . local

References:

[1] See section Vaccinations Impact.

[2] What is the role of T cells in COVID-19 infection? Why immunity is about more than antibodies, On behalf of the Oxford COVID-19 Evidence Service Team, Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, October 19, 2020. webpage https://www.cebm.net/covid-19/what-is-the-role-of-t-cells-in-covid-19-infection-why-immunity-is-about-more-than-antibodies, December 2021. What is the role of T cells in COVID-19 infection? Why immunity is about more than antibodies . PDF . local

[3] Pfizer COVID-19 vaccine elicits durable specific memory T-cell response, News Medical Life Sciences, November 4 2021. webpage https://www.news-medical.net/news/20211104/Pfizer-COVID-19-vaccine-elicits-durable-specific-memory-T-cell-response.aspx, December 2021. Pfizer COVID-19 vaccine elicits durable specific memory T-cell response.

[4] Penn Study Details Robust T-Cell Response to mRNA COVID-19 Vaccines, Penn Medicine News, August 16, 2021. webpage https://www.pennmedicine.org/news/news-releases/2021/august/penn-study-details-robust-tcell-response-to-mrna-covid19-vaccines, December 2021. Penn Study Details Robust T-Cell Response to mRNA COVID-19 Vaccines.

[5] White blood cell, wikipedia, December 2021. webpage https://en.wikipedia.org/wiki/White_blood_cell, wikipedia, December 2021.

[6] Immune Responses to Persistent or Recurrent Antigens: Implications for Immunological Memory and Immunotherapy, Frontiers in Immunology, 1 April 2021, Immunity to Persistent/Recurrent Stimulants. webpage https://www.frontiersin.org/research-topics/8772/immune-responses-to-persistent-or-recurrent-antigens-implications-for-immunological-memory-and-immun, December 2021. Immune Responses to Persistent or Recurrent Antigens: Implications for Immunological Memory and Immunotherapy . local

[7] Enhanced Ventilation Standards for Indoor Dining and Application Form for Increased Dining Capacity, City of Philadelphia, February 14, 2021. webpage https://www.phila.gov/media/20210216105327/Enhanced-Ventilation-Standards-for-Indoor-Dining_2_16_21.pdf. PDF . local

[8] Food Establishments That Have Met Enhanced Ventilation Standards to Allow for Increased Indoor Dining Capacity, City of Philadelphia, March 09, 2021. webpage https://www.phila.gov/media/20210311122403/50CapacityRestaurants_030921.pdf. PDF . local

[9] See section Ventilation Survey.

[10] The coronavirus is here to stay - here's what that means, Nature, 16 February 2021. webpage https://www.nature.com/articles/d41586-021-00396-2, December 2021. The coronavirus is here to stay - here's what that means.

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Long Haulers and Ventilation

Before the introduction of antibiotics in the 1940s many infectious diseases such as Tuberculosis were treated using a fresh air cure. Tuberculosis spreads from person to person via coughing, sneezing and spitting. Tuberculosis usually affects the lungs. Left untreated, up to two thirds of those infected with Tuberculosis will die. Starting in the 19th century, Tuberculosis patients were forcibly isolated in sanatoriums built in remote locations all around the world, including Australia, where they were provided with the top treatment of the day: fresh air and sunlight [1].

Dr. Auguste Rollier had a substantial cure rate for tuberculosis by exposure to sunlight, or heliotherapy.
His students are pictured here working outside in 1925. [1]

Fresh air treatment was accepted and practiced in all types of settings including special treatment sanatoriums and hospitals [2].

Fresh Air treatment for TB sufferers in London 1936 [2]

A COVID-19 infection may have resulted in damage to one or more body subsystems like the lungs, heart, etc. However, there are those that still have severe symptoms with no visible physical detection using current diagnostic technologies. There may be a category of long haulers that are constantly being reinfected in their own homes because of poor ventilation or no ventilation. In this scenario the virus load is sufficient to prevent the antibodies from clearing the virus from the body or once the virus is cleared it is reintroduced in the home indoor space. This a very difficult systems research area because of the difficulty in collecting sufficient data to prove or disprove the hypothesis of reinfection in a home setting.

Is there anything that can be done to help those suffering from long term effects of COVID-19 infection?

Open-air treatment is the use of fresh air and sunshine in the therapeutic treatment of infections. In a hospital or sanitorium, this is accomplished by ensuring good ventilation in an airy sunny room, placing patients outdoors in tents or other open forms of accommodation. During the 20th century this treatment was used for people with infectious respiratory diseases such as influenza or tuberculosis. Open air schools were established in several countries to provide a healthy environment for sick children, emphasising fresh air, good food and exercise. In England, the first open air school opened at Bostall Wood in 1907 and by the 1930s there were over a hundred across the country. [3] The first fresh-air school in the US for tubercular children opened in Providence in 1908 and by 1910 there were 65 fresh-air schools in the US [4].

The following ventilation suggestions may help the Long Haulers:

  1. Open the window(s) in the occupied room
  2. Go outside and sit in the yard or porch away from others for several hours, if possible exercise
  3. Turn on the HVAC fan and have it run 24/7
    1. Ignore fears that this will spread the virus
    2. The virus is already in the home everywhere
    3. Accept that others in the home probably will be infected, this gives them a fighting chance with a lower virus load
  4. If possible change the HVAC filters once a week not because of filtration needs but because they may clog with dust
  5. When weather permits open all the windows in the house, otherwise do sections of the house for 1-2 hours
  6. Sitting in an enclosed room or basement with no windows to isolate is not the answer
  7. When you are outside, away from others, take off the mask to allow the virus to expel from your lungs, breathe, enjoy the fresh air and sun

Isolated to a single room such as a bedroom with plenty of ventilation is probably the best way to reduce the sick persons virus load and minimize exposure to other members in the house. The problem surfaces when the recovery goes beyond 2 weeks and transitions into months. It is not reasonable to expect someone to isolate in one room for months. This is where key decisions must be made by the members in the house. For example, is there a way to section off the house with periodic visits across the boundary.

The ventilation suggestions are based on the common sense notion that one must remove the virus from their environment to allow the body to heal itself. This also includes allowing the lungs to expel the virus from the body. Call this age old wisdom or age old medicine. The idea of sanatoriums has not yet surfaced as of December 2021. Treatments for COVID-19 are on the horizon but treatments are not available to those currently in need. This is the systems perspective, everything is placed on the table and considered.

References:

[1] How TB was treated before antibiotics and how it might be treated again after the antibiotics apocalypse, nine.com.au. webpage https://coach.nine.com.au/latest/tuberculosis-fresh-air-cure/497fe4ba-cd5d-4419-864d-f0387b474d84#4, December 2021. How TB was treated before antibiotics and how it might be treated again after the antibiotics apocalypse

[2] Life before antibiotics (and maybe life after an antibiotic apocalypse), BBC News, 19 November 2015. webpage https://www.bbc.com/news/newsbeat-34866829, December 2021. Life before antibiotics (and maybe life after an antibiotic apocalypse)

[3] Open-air treatment, wikipedia, December 2021. webpage https://en.wikipedia.org/wiki/Open-air_treatment, December 2021.

[4] Fighting TB with Fresh-Air Schools, RIMS Doctors Launch a Movement, Rhode Island Medical Journal, Mary Korr, September 2016. webpage http://www.rimed.org/rimedicaljournal/2016/09/2016-09-75-heritage.pdf, July 2020. Fighting TB with Fresh-Air Schools, RIMS Doctors Launch a Movement . local

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Airline Ventilation and Masks

The following are extracts of a news article where during a congressional Airline Oversight Hearing it was stated that masks on aircraft are not needed [1]:

On December 15, 2021 the Southwest Airlines CEO Gary Kelly suggested during a congressional Airline Oversight Hearing that face masks provide little value on planes. Citing high-quality filtration systems aboard planes, Southwest Airlines CEO Gary Kelly stated that “masks don’t add much, if anything, in the air cabin environment.” Kelly’s comments came during a Wednesday hearing before the Senate Committee on Commerce, Science, and Transportation. After returning home from the hearing, Kelly tested positive for COVID-19, a Southwest spokesperson confirmed to the AP on Friday.

Kelly made his comment about masks in response to a question from Sen. Roger Wicker, a Republican representing Mississippi, who asked Kelly and another airline CEO if they thought air travel without masks could ever resume. Kelly said that “99.97% of airborne pathogens are captured” by high efficiency particulate air filters, or HEPA filters, on airplanes, before suggesting that masks are unnecessary during air travel. “Yeah, I think the case is very strong that masks don’t add much, if anything, in the air cabin environment,” Kelly said. “It’s very safe, and very high quality compared to any other indoor setting.” American Airlines CEO Doug Parker appeared to agree, saying, “I concur, the aircraft is the safest place you can be.” He noted that all of his company’s aircraft have the same HEPA filters.

While HEPA filtration systems are highly effective at reducing the transmission of viruses, they do not completely eliminate risk aboard flights, according to Linsey Marr, an aerosol scientist at Virginia Tech.

“The issue is that they only work on the air as it passes through the filter,” she said in an email. “If you are sitting near someone who is releasing lots of viruses into the air, you could end up inhaling them before they have had a chance to pass through the filtration system.”

Marr said it takes a few minutes for air to completely pass through the filtration system. She said requiring everyone to wear a mask reduces the amount of virus an infected individual can release into the air, and helps reduce the amount of virus someone wearing a mask might breathe in.

So what are the numbers and what do they mean. In 2020 this systems analysis examined the probability of infection in different settings using different assumptions including masking. From all the analysis it should now be part of the social consciousness of how to predict the probability of infection and use reasonable approximations for comparisons. However, during the hearing no such questions were asked or responses given. Only opinion based on nothing was provided with no follow up questions for the facts.

There are very simple approximations that could have been offered during the hearing as follows:

  1. The air in the cabin is exchanged every 3 minutes. A reasonable approximation is to just divide 3 minutes by 60 minutes and that results in a probability of infection of 3/60 or 5%. Obviously this is an approximation and it drops off with the distance from the infection source as the analysis in 2020 showed.
  2. Consumer masks are approximately 75% effective at reducing the virus load. A reasonable approximation is to just subtract 75% from 100% and that results in a probability of infection of 1 in 4 or 25% for 1 mask, while with 2 masks it is 1 in 16 or 6.25%
  3. Now the key issue is what happens when both ventilation and masking are applied. This is just simple probability calculations as shown in the research in 2020. In this case the probability of infection when ventilation and masking is applied is 0.05 * 0.625 = 0.003 = 0.3 %

So the proper answer to congress should have been:

We have great ventilation on our aircraft and that is key to reducing the probability of infection. As you know the probability of infection with masking alone can be 6.25% but with aircraft ventilation it drops to 0.3%. As far as removing the masking, it is a key element in the system to minimize the probably of infection and although our ventilation systems are better than masking, the probably of infection with just ventilation is still 5%. We picked the system approach where the probablity of infection is 0.3% in what is a worst case scenario. -- Walt

Comment: As I continue to perform this systems analysis it is getting very hard because of the toxic behavior of everyone. No one discloses the numbers, even if they may be generalizations, preliminary, or in question. They only speak in vague qualitative terms or worse opinions that further their agendas. This includes the current CDC as of December 2021 where there is only the vague statement to increase ventilation. All opinions and qualitative statements are irrelevant. This mode of communications must stop or we will be looking at this massive disaster just continuing with no end in sight.

Getting back to the proper questioning and answers during the Airline Oversight Hearing. The next series of questions and response should have been:

Question: Wow isn't 0.3% probability of infection very high?

Response: Yes and no. This is based on a worst case scenario. We know that the probability of infection drops off with the square of the distance from the infection source. So if someone is sitting 10 rows away or approximately 30 feet away from the infection source, then their probably of infection will drop by 900 times to become 0.00035%. Also if we assume that there is an infected passenger on 1 in every 10 flights the number drops to 0.000035%. That means that there is a probably of infection of 1 in every 2,880,000 passengers.

Question: Thank you. That was a very clear and complete answer. The number is also not bad. That number translates into a system availability of 0.999 999 66 or six-9s which is what is expected in a mission critical system where there is the possibility of loss of life. Thank you again.

Question: So what would removing masks do to the system performance?

Response: It would reduce the system performance by 16 times which does not seem like a big number but the probably of infection of 1 in every 2,880,000 passengers goes to 1 in 180,000 and the system availability drops to 0.999 994 or five-9s, which is a borderline expectation for a mission critical system where there is the possibility of loss of life.

Question: So masking is required?

Response: Yes. The above analysis is based on a passenger sitting 30 feet away from an infected passenger. The numbers go up for the passengers that are closer to the infected person and in the worst case go up by 900 times. So even though it is unlikely the passengers as a whole will be infected, there are the passengers that are closest to the infection source. For those passengers, the numbers go to 1 in 3,200 passengers will be infected who sit next to an infected person wearing masks to 1 in 200 passengers sitting next to an infected person where there are no masks. The masks really help in the scenario where a passenger is seated next to an infected passenger.

Question: What can the government do to help the airline industry?

Response: We cleaned up the air on our aircraft, you need to do the same with the airports especially during the TSA process. It would have been nice if you used existing US national labs such as the FAA Technical Center in Atlantic City New Jersey to perform ventilation studies for us so that we could all implement the same ventilation requirements on our aircraft. It still may not be too late to do some studies.

The above dialog never happened. Instead bullshit was read into the Congressional Record [2].

The airline analysis probability of infection analysis results are in the following table.

Scenario

ACH

Pv
(ventilation)

Distance from
infected seat
(feet)

Pvd
(ventilation
& distance)

Pvdi
(ventilation & distance
& 1 in 10 planes
with infected passenger)

passengers
before
1 infection
happens

System
Availability

With masks distant seat

20

0.3125000%

30

0.0003472%

0.0000347%

2,880,000

0.9999996527778

Without masks distant seat

20

5.0000000%

30

0.0055556%

0.0005556%

180,000

0.9999944444444

.

With masks adjacent seat

20

0.3125000%

1

0.3125000%

0.0312500%

3,200

0.9996875000000

Without masks adjacent seat

20

5.0000000%

1

5.0000000%

0.5000000%

200

0.9950000000000

Note: P = Probability of infection, v - based on ventilation, d - based on distance, i - based on infection load in community.

The above analysis uses multiplication, division, addition, subtraction, fractions, decimal math, and probability and statistics. Fractions instruction is taught in grades 3 through 6, in most schools children begin learning the decimal system in the 4th grade, percentages, probability and statistics are taught in grade 7. The above analysis can be performed and demonstrated in any 8th grade math class.

As of December 21, 2021 there are claims in the media that airplanes are the safeist indoor space because they have the best ventilation. These claims are once again toxic management claims and not based on facts. Once again the journalists do not ask questions to backup those claims. For example, many facilities have ventilation equal to or better than airplanes, such as grocery stores. More important is airplanes are a very small space where people are tightly packed and the analysis shows, along with common sense, that there is little volume in the space for a contagion to be diluted before it is removed from the space.

References:

[1] FACT FOCUS: Masks help curb spread of COVID-19 on planes, Associated Press December 17, 2021 Updated December 18, 2021. webpage https://apnews.com/article/coronavirus-pandemic-lifestyle-health-travel-business-38b83b7c4ace8341320ec6d55ac4c485, December 2021. FACT FOCUS: Masks help curb spread of COVID-19 on planes.

[2] On Bullshit Hardcover, Harry G. Frankfurt, Princeton University Press, ISBN: 978-0691122946, January 30, 2005.

back to TOC


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Infection and Body Response

As of December 2021 there appears to be enough information to begin a systems analysis of COVID-19 infection and body response. It is unlikely that the systems analysis will yield new findings, however it will provide a reasonable big picture view, a systems perspective, to other researchers that may result in new insights with their research on COVID-19 infection and body response. The system analysis will include functional and operational analysis with practices that include block diagrams and operational sequence diagrams. These visualizations are different than visualizations provided by specialists in the biological sciences. The biological sciences specialists use animations and free form graphics that are more closely associated with illustrations. The systems engineering specialists use graphics typically associated with a syntax and rules, however, they are usually loosely applied.

Viruses are self-replicating. The infection can start with a small number of viruses (dose). When the dose reaches the respiratory tract, cells are infected and are re-programmed to produce new viruses. The new viruses infect more nearby cells. Early in the infection, the Innate Immune System detects the virus infection and starts an innate immune response. The Innate Immune System is a non-specific anti-viral response with interferon and cytokines, small proteins that have the side effect of causing fever, headaches, and muscle pain. The Innate Immune System response slows down the replication and spread of the virus until the Acquired Immune Response with Antibodies begins. [1]

COVID-19 Body Response Operational Sequence Diagram - Unvaccinated

The Antibodies clear the infection and establish the immune memory to allow for a faster response if infected again in the future. The Antibody response causes the Innate Immune System to stop because the infection is being cleared. If the Antibody response is delayed the virus replicates and spreads and this causes the Innate Immune System response to increase. Without the antibodies to clear the infection the innate immune response will keep increasing as the virus replicates and spreads causing inflammation. Inflammation causes damage of uninfected tissue. This is a cytokine storm and is seen with SARS and avian influenza H5N1. It is difficult to manage, requires intensive care, and has a high risk of death. [1]

.

COVID-19 Body Response

Each COVID-19 SARS-CoV-2 virion (virus particle) has an outer surface of 24 to 40 randomly arranged spike proteins that enable fusing with human cells. The COVID-19 (SARS-CoV-2) spikes are extremely flexible and hinge at three points in the stalk. For other types of virus such as influenza, external fusion proteins are relatively rigid. The flexibility provided by the hinges may explain how multiple spikes act together to engage onto the flat surface of a host cell. [2]

COVID-19 System Block Diagram

COVID-19 System Block Diagram

Spike Protein Subsystems

RBD: The Receptor Binding Domain is what binds to the host cell ACE2 receptor.

Glycan: Sugar molecules that coat the virus and allow it to hide from the immune system.

S1: The S1 subunit has mutations of the spike protein that binds with the cell ACE2 receptor.

S2: The S2 subunit has mutations of material that prompts viral fusion with the host cell’s membrane.

Stalk: Has 3 hinge points that allows the virus to flex increasing the ability to infect a host cell.

S1 S2 Junction: Interface that has five amino acids: proline, arginine, arginine, alanine and arginine.

Notes:

  1. Other coronaviruses have a single arginine amino acid at the S1 S2 Junction.
  2. Furin, a host cell protein, cuts the bond between the S1 and S2 subunits.
  3. These are key elements of COVID-19 infection spread.

Spike Protein Functions

The COVID-19 spike protein key functions are:

  1. Host Cell Virus Preparation: Virus spike binds with the host cell ACE2 receptors using the TMPRSS2 enzyme found in the throat and lung cells.
  2. Host Cell Invasion: Virus merges with the cell and ejects RNA material. Virus is prepared to infect next human host using Furin cleavage site.
  3. Immune System Hiding: Accomplished by Sugar molecules that coat the virus, the Glycan. Immune system cells are also infected.
  4. Cell Structure Changes: Once infected the cell structure is transformed to include spike proteins on the cell membrane and fusion of multiple cells.

COVID-19 System Functional Block Diagram

A key system observation associated with the COVID-19 System Functional Block diagram is the respiratory tract exit. Everyone knows that the interface exists but seeing it on the functional block diagram adds a new level of importance to the system considerations. All of the sudden masking and controlling a sneeze and cough response are critical to minimize the spread of infection. Those with bad manners must be corrected when in public. Seems obvious but it is somehow lost to history because today very few cover their face when they sneeze and cough.

Spike Protein Entry Operations

The primary functions involved with spike protein entry operations are the Host Cell Virus Preparation and Host Cell Invasion functions.

The RBD of the COVID-19 spike proteins attach to a cell ACE2 protein receptor, which is on the outside of human throat and lung cells. This ACE2 receptor is also the docking point for the previous SARS virus. However, compared with SARS, the COVID-19 virus binds to ACE2 an estimated 2 to 4 times more strongly, because of changes in the RBD that stabilize the virus binding hotspots. Variants of COVID-19 tend to have mutations in the S1 subunit of the spike protein. For example, the Alpha variant includes ten changes in the spike protein sequence, which result in RBDs being more likely to attach to the cells ACE2 protein receptor. A second spike subunit, S2, supports viral fusion with the host cell’s membrane. [2]

As of December 20, 2021, we know that COVID-19 is found in multiple areas outside the lungs including: the brain, heart, small intestine, adrenal glands. The virus can spread early during infection and infect cells throughout the entire body including - respiratory tract, cardiovascular tissues, lymphoid tissues, gastrointestinal tissues, renal, endocrine tissues, reproductive tissues, muscle, peripheral nerve, adipose and skin tissues, brain tissues. It can remain in other organs for months. Long COVID can occur even in people who had mild or asymptomatic acute disease and this may explain the cause. The data gathered is from fatal COVID-19 cases, rather than patients with long COVID-19. The mechanism is not clear at this time but it may be infection with defective virus particles, which has also been seen in persistent infections among measles. [9] [10]

Different mutations in the S1 subunit of the spike protein increase the ability for the virus to bind to the host cell making it more more transmissible. Some refer to this as the stickyness of the virus. So it is a probability game. As the stickyness of the virus increases so does the probability of infection increase.

COVID-19 Infection Block Diagram

The TMPRSS2 enzyme is found in high amounts on the outside of respiratory cells in the lungs and throat. The SARS virus uses the host cell TMPRSS2 or cathepsin L enzymes to break into the cell. TMPRSS2 is the faster route, but the SARS virus typically enters through an endosome (a lipid-surrounded bubble) that uses the cathepsin L enzyme. If the virus enters a cell via the cathepsin L enzyme, it can be trapped by antiviral proteins. Unfortunately COVID-19 uses the host cell TMPRSS2 enzyme. [2]

The TMPRSS2 enzyme cuts a site on the COVID-19 spike’s S2 subunit. The cut exposes hydrophobic amino acids that attach to the closest membrane of a host cell. The extended spike eventually causes the virus and cell membranes to fuse. Once fused, the virus ejects its RNA directly into the cell and the cell is infected. Using the TMPRSS2 enzyme, COVID-19 infects faster than SARS and can not be trapped in endosomes by antiviral proteins. [2]

The COVID-19 virus entry mechanism of using the TMPRSS2 enzyme explains why the malaria drug chloroquine does not work for COVID-19. The malaria drug chloroquine works only on cathepsins for endosomal entry as is typically but not always experienced with SARS. To clearly restate the result, when the COVID-19 virus transmits and replicates in the human airway, it does not use endosomes and as a result chloroquine, which is an endosomal disrupting drug, is not effective. As of December 2021, research is being performed for treatments to inhibit the TMPRSS2 enzyme mechanism. [2]

Host Cell Virus Preparation Operational Sequence Diagram

Host Cell Invasion Operational Sequence Diagram

Spike Protein Exit Operations

The primary function involved with spike protein exit operations is the Host Cell Invasion function.

In preparation for when the virus exits the host cell, the host cell Furin cuts at the S1 S2 Junction to loosen virion spike proteins. The Furin clips the string of amino acids and the cut is required for the virus to enter human lung cells efficiently. In a lab setting, if the cuts do not happen, test animals expel fewer viral particles than those infected with the Furin cuts and they do not transmit the infection to nearby animals. The COVID-19 virus with an intact Furin cleavage site enters human airway cells faster than do those without the Furin cleavage site. [2] To infect the next human host there needs to be a Furin cleavage site.

Host Cell Invasion Operational Sequence Diagram

Immune System Hiding Operations

The primary function involved with immune system hiding operations is the Immune System Hiding function.

A key characteristic of COVID-19 is its ability to suppress the immune system response. By the time the immune system does realize there is a virus, there is so much of it that the immune response proteins sometimes flood the bloodstream at a faster rate than normal, which can cause massive inflammation damage in addition to the damage caused by the virus. There are multiple elements that help the virus to suppress the immune system response.

The first immune system suppression element is accomplished via camouflage with a high concentration of sugar coating. The sugar molecules, known as glycans, camouflage the virus from the human immune system. In the large glycan mass there is a small spike, Receptor Binding Domain (RBD) and it is the RBD that binds to a human cell that begins the cell infection process.

The second immune system suppression element is accomplished by disrupting interferon release from an infected cell. After the virus invades the cell and penetrates the nucleus, the virus prevents cellular mRNA from getting out of the nucleus, including instructions for proteins that alert the immune system to infection. Normally the gene transcripts would exit the nucleus and the cells would generate interferons. The interferons are signalling proteins that alert the immune system to the presence of a virus. In this case they are unable to get out of the nucleus and the infected cells don’t release many interferons. COVID-19 infection has significantly lower levels of interferons. [2]

The third immune system suppression element is accomplished by infecting immune system cells, thus hiding as an enemy cell within the immune system cellular defense system.

Immune System Hiding Operational Sequence Diagram

Cell Structure Changes

The primary function involved with cell structure changes is the Cell Structure Changes function.

After the cell is penetrated, the next stage of infection involves structural changes to the cells. Some of viral spike proteins manufactured in the infected cells travel to the surface of the cell and poke out of the host cell membrane. They expels a fatty coating onto the outside of the cell that is the same coating found on cells that naturally fuse together, such as muscle cells. At this point, the infected cell fuses to neighboring cells and develop into a single massive individual respiratory cell filled with up to 20 nuclei. These are called syncytia. Some infected cells even form syncytia with lymphocytes, which is one of the body’s own immune cells. In this case the infected cells avoid immune detection by simply grabbing on to and merging with nearby immune system cells. This is a known mechanism of immune system evasion by tumor cells, but not by viruses. [2]

Cell Structure Changes Operational Sequence Diagram

COVID-19 Infection Operational Sequence

The following is an operational sequence diagram showing how the COVID-19 virus infects the body and the impact on the body cells. The operational sequence diagram shows the COVID-19 infection system operations and the functions. The operations associated with a particular function are on a particular row of the operational sequence. For example the Host Cell Virus Preparation Function has 3 operations associated with that function as shown in the first row of the diagram.

COVID-19 Spike Protein Operational Sequence Diagram

The Spike Protein Operational Sequence Diagram is focused on the infection sequence but a key element is what happens after the infection is established. The answer is obvious but not shown in the diagram, the virus exits from the respiratory tract as shown in the COVID-19 Functional Block Diagram.

COVID-19 System Functional Block Diagram

A key system observation is that it all begins with respiratory tract entry. Preventing respiratory tract entry is not a health care problem, it is an engineering problem. If there is technology available to reasonably stop respiratory tract entry, then that technology must be made part of the infrastructure. Healthcare based solutions such as masks, social distancing, and vaccinations are a reactive approach to the problem not a proactive approach. The healthcare approaches are trying to deal with a situation that can be avoided, if there is the social will to do the right thing. See section Stopping Indoor Respiratory Infection.

.

Delta Body Response

The Delta variant grows more rapidly and at higher levels inside the lungs and throat than did earlier versions of the COVID-19 virus. The mechanism is associated with multiple mutations in the S1 subunit including three mutations in the Receptor Binding Domain (RBD) that improve the RBD’s ability to bind to ACE2 and evade the immune system [2].

COVID-19 Variants Furin Cuts

Two coronavirus variants, Alpha and Delta, have altered furin cleavage sites. Furin is a protease enzyme that in humans and other animals is encoded by the FURIN gene. Some proteins are inactive when they are first synthesized, and must have sections removed in order to become active. Furin cleaves these sections and activates the proteins. In the Alpha variant, the initial proline amino acid is changed to a histidine (P681H). In the Delta variant, it is changed to an arginine (P681R). Both changes make the sequence less acidic, and the more basic the string of amino acids, the more effectively furin recognizes and cuts it. The cuts occur at the S1 S2 boundary. [2] [5]

More furin cuts mean more spike proteins are tuned to enter human cells. In SARS-CoV, less than 10% of spike proteins are primed. In COVID-19 (SARS-CoV-2), the percentage rises to 50%. In the Alpha variant, it’s more than 50%. In the highly transmissible Delta variant, it is greater than 75% of spikes are tuned to infect a human cell. [2]

The empirical data of the virus behavior supports the biological technical findings.

People infected with Delta produce significantly more virus than those infected with the original version of COVID-19 (SARS-CoV-2). Individuals infected with Delta have viral loads up to 1,260 times higher than people infected with the original COVID-19 strain. The Delta variant is detectable in people four days after exposure. This is compared with an average of six days for people with the original COVID-19 strain. Both these observations suggest that Delta replicates much faster. The Delta variant increase in virus load increases the virus spread.

The Delta variant could be more than twice as transmissible as the original strain of COVID-19. The combination of a high number of viruses and a short incubation period supports Delta’s heightened transmissibility. The large amount of virus in the respiratory tract means that more people are likely to be infected, and that the virus begins spreading earlier after infection. [3] [4]

The following Key system observations are associated with virus replication rate:

  1. Does the increase in virus replication for Delta trigger an earlier immune response and lower the probability of serious health complications or death?
  2. Does the increase in virus replication for Delta increase the probability of serious health complications or death regardless of immune system response?
  3. Does the increase in virus replication for Delta have no impact on serious health complications or death regardless of immune system response?

.

Omicron Body Response

As of December 27, 2021 there is still little research on the mechanisms of the Omicron variant. There is a great deal of empirical data on infection levels because Omicron is so infectious. A study using out of body lung and respiratory tract tissue found that over the first 24 hours, Omicron multiplied about 70 times faster inside respiratory tract tissue than the Delta variant. The same study using lung tissue found Omicron was actually worse at infecting those cells than either Delta or the original strain of the COVID-19 virus and multiplied 10 times slower. This finding helps support the variant’s very high level of infectiousness and also why it may not be causing severe sickness as previous variants of COVID-19. Omicron is inherently more transmissible as the virus is released from the respiratory tract tissue in huge numbers. [6] [7]

Contagion Year Upper Respiratory
Reproduction Rate
Lower Respiratory
Reproduction Rate

Death Rates

COVID-19 2019

-

baseline

1% to 3%

Delta variant 2020

baseline

baseline

1% to 2%

Omicron variant 2021

+70 X
(times faster)

-10X
(times slower)

unknown
(December 2021)

The death rates are based on the data captured in this research. The numbers reflect the time frames when a particular strain becomes dominant and not a direct correlation with the infection at the time of death. Unfortunately that data is not publicly available at this time. The correlation is critical to fully verify and validate if the virus is becoming more or less deadly.

COVID-19 starts as a very bad lower respiratory tract infection. Infections of the lungs are traditionally more serious than infections of the upper respiratory tract. We know that the COVID-19 virus can spread early during infection and infect cells throughout the entire body including - respiratory tract, cardiovascular tissues, lymphoid tissues, gastrointestinal tissues, renal, endocrine tissues, reproductive tissues, muscle, peripheral nerve, adipose and skin tissues, brain tissues.

The Omicron variant may be more of an upper respiratory tract  infection and traditionally they are less serious for adults. It is unclear how the immune system will respond in adults. If the immune system responds properly to the upper respiratory tract infection, then the more serious lower respiratory tract infection may not start and the outcomes will be positive for adults. However, babies, toddlers, and young children are significantly impacted by an upper respiratory tract infection because of inflammation effects on their small air passages. Babies, toddlers, and young children may have worse outcomes from the Omicron variant. This is the same age group that as of January 2022 does not have access to the vaccine.

At this time there is only speculation on how the virus might continue to evolve and if Omicron is part of that evolutionary path. [8]

As of December 27, 2021, the following Key system observations associated with Omicron are provided:

References:

[1] COVID-19 A Systems Perspective, Walter Sobkiw, 2021, ISBN 9780983253044, hardback.

[2] How the coronavirus infects cells - and why Delta is so dangerous, Nature, 28 July 2021. webpage https://www.nature.com/articles/d41586-021-02039-y, December 2021. How the coronavirus infects cells - and why Delta is so dangerous

[2.1] Beyond Shielding: The Roles of Glycans in the SARS-CoV-2 Spike Protein, ACS Cent. Sci. 2020, 6, 1722-1734, September 23, 2020. webpage https://pubs.acs.org/doi/pdf/10.1021/acscentsci.0c01056, December 2021. Beyond Shielding: The Roles of Glycans in the SARS-CoV-2 Spike Protein.

[3] How the Delta variant achieves its ultrafast spread, Nature, 21 July 2021. webpage https://www.nature.com/articles/d41586-021-01986-w, December 2021. How the Delta variant achieves its ultrafast spread

[4] Viral infection and transmission in a large, well-traced outbreak caused by the SARS-CoV-2 Delta variant, medRxiv, July 23, 2021. webpage https://www.medrxiv.org/content/10.1101/2021.07.07.21260122v2.full-text, December 2021. Viral infection and transmission in a large, well-traced outbreak caused by the SARS-CoV-2 Delta variant . PDF

[5] Furin, wikipedia, December 2021. webpage https://en.wikipedia.org/wiki/Furin, December 2021.

[6] Preliminary laboratory data hint at what makes Omicron the most superspreading variant yet, Stat, December 17, 2021. webpage https://www.statnews.com/2021/12/17/preliminary-laboratory-data-hint-at-what-makes-omicron-the-most-superspreading-variant-yet, December 2021. Preliminary laboratory data hint at what makes Omicron the most superspreading variant yet.

[7] HKUMed finds Omicron SARS-CoV-2 can infect faster and better than Delta in human bronchus but with less severe infection in lung, Li Ka Shing Faculty of Medicine, The University of Hong Kong, 15 December 2021. webpage https://www.med.hku.hk/en/news/press/20211215-omicron-sars-cov-2-infection, December 2021. HKUMed finds Omicron SARS-CoV-2 can infect faster and better than Delta in human bronchus but with less severe infection in lung.

[8] Beyond Omicron: what’s next for COVID’s viral evolution, Nature, 07 December 2021. webpage https://www.nature.com/articles/d41586-021-03619-8, December 2021. Beyond Omicron: what’s next for COVID’s viral evolution.

[9] Coronavirus Can Spread to Heart, Brain Days After Infection, WebMD, December 28, 2021. webpage https://www.webmd.com/lung/news/20211228/coronavirus-can-spread-heart-brain, December 2021. Coronavirus Can Spread to Heart, Brain Days After Infection.

[10] SARS-CoV-2 infection and persistence throughout the human body and brain, National Institutes of Health - NIH, December 20, 2021. webpage https://assets.researchsquare.com/files/rs-1139035/v1_covered.pdf?c=1640020576, December 2021. SARS-CoV-2 infection and persistence throughout the human body and brain

back to TOC


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Stopping Indoor Respiratory Infection

This analysis bridges the healthcare scientists with the non-healthcare scientists and engineers with their key findings. The analysis then moves forward with a systems perspective that includes all the stakeholders.

It is clear that COVID-19 and its variants will probably become endemic [7]. It will not go away. There has been extenstive science applied to undertand the COVID-19 virus and how it infects the human body. The following is an operational sequence diagram showing how the COVID-19 virus infects the body and the impact on the body cells. The operational sequence diagram shows the COVID-19 infection system operations and the functions. The operations associated with a particular function are on a particular row of the operational sequence. For example the Host Cell Virus Preparation Function has 3 operations associated with that function as shown in the first row of the diagram.

COVID-19 Spike Protein Operational Sequence Diagram

The Spike Protein Operational Sequence Diagram is focused on the infection sequence but a key element is what happens after the infection is established. The answer is obvious but not shown in the diagram, the virus exits from the respiratory tract as shown in the COVID-19 Functional Block Diagram.

COVID-19 System Functional Block Diagram

A key system observation is that it all begins with respiratory tract entry. Preventing respiratory tract entry is not a health care problem, it is an engineering problem [1]. If there is technology available to reasonably stop respiratory tract entry, then that technology must be made part of the infrastructure. Healthcare based solutions such as masks, social distancing, and vaccinations are a reactive approach to the problem not a proactive approach. The healthcare approaches are trying to deal with a situation that can be avoided, if there is the social will to do the right thing.

As of December 2021, everyone in positions of authority has been made aware of dealing with COVID-19 via ventilation and that this is an engineering challenge not a healthcare challenge. There can be no claims of ignorance. The following are some article extracts [1] [2] [3] [4]:

The following is an example of a serious error from the systems perspective:

The above statement is incomplete and misleading. It also suggests that it is best to do nothing, for example not even consider UVGI systems that increase the equivalent ACH (eACH).

The issue is that there will be ventilation no matter what, so the virus will be transported from the infected room to the other rooms even at low ACH levels. It is clear that the ventilation system must be properly designed and maintained. The above claim, while accurate is an example of a serious systems engineering error where the system boundary is drawn too small. The system boundary must be expanded to include what happens with even small levels of ACH in these settings and what happens when a proper ventilation system is provided.

Shrinking the system boundary to shift the focus is usually associated with a hidden stakeholder trying to change the system outcomes in their favor. They are gaming the system. The above claim feeds the stakeholders that do not want to pay for the extra costs associated with increasing ventilation to 12+ ACH. This argument and scenario are unfolding everywhere, preventing proper ventilation upgrades. The arguments are:

  1. Its too expensive to upgrade or install. [3]
  2. Too much ventilation spreads the virus, better to turn off all the ventilation. [5]
  3. UV causes cancer. [5]
  4. It's too expensive to run. [3]
  5. It's too expensive to maintain. [3]
  6. Its not the air, just wash our hands. [3]
  7. The pandemic will end soon anyway, lets just wait.
  8. Sign this COVID release form before you enter the facility.

The system perspective assessment of the situation - it's pathetic.

Once again the following is offered as a definition of Systems Engineering: Discipline that concentrates on the design and application of the whole (system) as distinct from the parts. It involves looking at a problem in its entirety, taking into account all the facets and all the variables and relating the social to the technical aspect.

Human response always must be part of the system solution.

.

A Paradigm Shift to Combat Indoor Respiratory Infection

In May of 2021, 39 scientists published "A Paradigm Shift to Combat Indoor Respiratory Infection" calling for a paradigm shift in how citizens and government officials think about the quality of the air we breathe indoors [3]. This research includes their work because it is a significant generational call to action. At some point in history this document will be referenced for decades. The authors are:

Authors University / Organization Country
Lidia Morawska Queensland University of Technology (QUT) Australia
Joseph Allen Harvard USA
William Bahnfleth Penn State USA
Philomena M. Bluyssen TU Delft Netherlands
Atze Boerstra TU Delft Netherlands
Giorgio Buonanno University of Cassino and Southern Lazio Italy
Junji Cao Desert Research Institute USA
Stephanie J. Dancer Edinburgh Napier University: Edinburgh, Scotland, GB Great Britain
Andres Floto University of Cambridge UK
Francesco Franchimon Franchimon ICM Netherlands
Trisha Greenhalgh University of Oxford UK
Charles Haworth no data no data
Jaap Hogeling EPB Center (standards) Netherlands
Christina Isaxon Lund University Sweden
Jose L. Jimenez University of Colorado Boulder USA
Jarek Kurnitski Tallinn University of Technology Estonia
Yuguo Li University of Hong Kong Hong Kong
Marcel Loomans Eindhoven University of Technology Netherlands
Guy Marks University of New South Wales (UNSW) Australia
Linsey C. Marr Virginia Tech USA
Livio Mazzarella Politecnico di Milano Italy
Arsen Krikor Melikov Technical University of Denmark Denmark
Shelly Miller University of Colorado Boulder USA
Donald K. Milton University of Maryland USA
William Nazaroff UC Berkeley USA
Peter V. Nielsen Aalborg University Denmark
Catherine Noakes University of Leeds UK
Jordan Peccia Yale USA
Kim Prather Scripps Institution of Oceanography USA
Xavier Querol CSIC Spain
Chandra Sekhar National University of Singapore Singapore
Olli Seppänen Aalto University School of Engineering Finland
Shin-ichi Tanabe Waseda University Japan
Julian W. Tang University of Leicester UK
Raymond Tellier McGill University Canada
Kwok Wai Tham National University of Singapore Singapore
Pawel Wargocki Technical University of Denmark Denmark
Aneta Wierzbicka Lund University Sweden
Maosheng Yao Peking University China

A Paradigm Shift to Combat Indoor Respiratory Infection

ABSTRACT

There is great disparity in the way we think about and address different sources of environmental infection. Governments have for decades promulgated a large amount of legislation and invested heavily in food safety, sanitation, and drinking water for public health purposes. By contrast, airborne pathogens and respiratory infections, whether seasonal influenza or COVID-19, are addressed fairly weakly, if at all, in terms of regulations, standards, and building design and operation, pertaining to the air we breathe. We suggest that the rapid growth in our understanding of the mechanisms behind respiratory infection transmission should drive a paradigm shift in how we view and address the transmission of respiratory infections to protect against unnecessary suffering and economic losses. It starts with a recognition that preventing respiratory infection, like reducing waterborne or foodborne disease, is a tractable problem.

The following are key extracts from the paper, A Paradigm Shift to Combat Indoor Respiratory Infection. [3]

There is great disparity in the way we think about and address different sources of environmental infection. Governments have for decades promulgated a large amount of legislation and invested heavily in food safety, sanitation, and drinking water for public health purposes. By contrast, airborne pathogens and respiratory infections, whether seasonal influenza or COVID-19, are addressed fairly weakly, if at all, in terms of regulations, standards, and building design and operation, pertaining to the air we breathe.

Most modern building construction has occurred subsequent to a decline in the belief that airborne pathogens are important. Therefore, the design and construction of modern buildings make few if any modifications for this airborne risk (other than for specialized medical, research, or manufacturing facilities, for example). Respiratory outbreaks have been repeatedly “explained away” by invoking droplet transmission or inadequate hand hygiene.

For decades, the focus of architects and building engineers was on thermal comfort, odor control, perceived air quality, initial investment cost, energy use, and other performance issues, whereas infection control was neglected. This could in part be based on the lack of perceived risk or on the assumption that there are more important ways to control infectious disease, despite ample evidence that healthy indoor environments with a substantially reduced pathogen count are essential for public health.

It is now known that respiratory infections are caused by pathogens emitted through the nose or mouth of an infected person and transported to a susceptible host.

Although the highest exposure for an individual is when they are in close proximity, community outbreaks for COVID-19 infection in particular most frequently occur at larger distances through inhalation of airborne virus laden particles in indoor spaces shared with infected individuals

There are ventilation guidelines, standards, and regulations to which architects and building engineers must adhere.

None of the documents provide recommendations or standards for mitigating bacteria or viruses in indoor air, originating from human respiratory activities. Therefore, it is necessary to reconsider the objective of ventilation to also address air pollutants linked to health effects and airborne pathogens.

There needs to be a shift in the perception that we cannot afford the cost of control, because economic costs of infections can be massive and may exceed initial infrastructure costs to contain them. The global monthly harm from COVID-19 has been conservatively assessed at $1 trillion ([internal ref]), but there are massive costs of common respiratory infections as well. In the United States alone, the yearly cost (direct and indirect) of influenza has been calculated at $11.2 billion; for respiratory infections other than influenza, the yearly cost stood at $40 billion.

We encourage several critical steps. First and foremost, the continuous global hazard of airborne respiratory infection must be recognized so the risk can be controlled. This has not yet been universally accepted, despite strong evidence to support it and no convincing evidence to refute it.

Comprehensive ventilation standards must be developed by professional engineering bodies. Organizations such as the American Society of Heating, Refrigerating and Air-Conditioning Engineers and the Federation of European Heating, Ventilation and Air Conditioning Associations have ventilation standards, and during the COVID-19 pandemic, they have proposed building and system-related control actions and design improvements to mitigate risk of infection. However, standards must be improved to explicitly consider infection control in their statements of purpose and definitions. New approaches must be developed to encourage implementation of standards (e.g., “ventilation certificates” similar to those that exist for food hygiene certification for restaurants).

The COVID-19 pandemic has revealed how unprepared the world was to respond to it, despite the knowledge gained from past pandemics. A paradigm shift is needed on the scale that occurred when Chadwick’s Sanitary Report in 1842 led the British government to encourage cities to organize clean water supplies and centralized sewage systems. In the 21st century, we need to establish the foundations to ensure that the air in our buildings is clean with a substantially reduced pathogen count, contributing to the building occupants’ health, just as we expect for the water coming out of our taps.

.

This Research Attempts to Address Ventilation

In 2020 this research on COVID-19 from a systems perspective quickly moved to the key system issue of airborne contagions and approaches to mitigate airborne contagions. The paradigm shift document [3] is a clear proposal to policy makers to take action and address this critical engineering need. Once again it is not a science or engineering problem, it is a social problem where there must be the social will to do what must be done to stop the COVID-19 disaster from continuing to unfold.

In 2020 this analysis had the following findings: [6]

  1. To mitigate or remove the COVID-19 virus and future deadly viruses the solution must include the Vaccine + UV + HVAC that must be rolled out into the infrastructure.
  2. Using the UV and HVAC technologies that were introduced in the last century will save lives.
  3. The analysis showed that the simple moral ethical choice to save lives is also the most effective and lowest cost choice because of the massive costs associated with loss of life, loss of health, and shut downs.

The following table is an analysis from 2020 of the impact of each of the mitigation subsystems on lives saved.

Naturally
Immune
%

Vaccine
Effectiveness
%

Vaccinated
%

Exposed
Population

Deaths
@ 3.5%

UV-C or
FAR UV-222
Kill / Inactivate

Deaths
@ 3.5%
(With UV)

Ventilation
Effectiveness
4 AUC

Deaths
@ 3.5%
(With UV
+ Ventilation)

10%

70%

70%

150,552,000

5,269,320

90%

526,932

28%

379,391

10%

90%

90%

56,088,000

1,963,080

90%

196,308

28%

141,342

0%

70%

70%

167,280,000

5,854,800

90%

585,480

28%

421,546

0%

90%

90%

62,320,000

2,181,200

90%

218,120

28%

157,046

.

0%

0%

0%

328,000,000

11,480,000

90%

1,148,000

28%

826,560

10%

0%

0%

295,200,000

10,332,000

90%

1,033,200

28%

743,904

Notes: Population = 328,000,000. Ventilation works only when it is turned on. The HVAC fan(s) must run 1 hour before and 1 hour after the facility opens to the public. UV is a form of ventilation.

The above table from the research in 2020 has been expanded to move closer to what an airborne contagion infrastructure upgrade might look like and the impacts on lives saved. The analysis uses the following data:

Total Population = 328,000,000
Naturally Immune = 10%
Vaccine Effectiveness = 90%
Remaining Population = 295,200,000
Exposed Population = Unvaccinated Population + Breakthrough Vaccinations at 10%
Ventilation Effectiveness via AUC = Wells-Riley analysis, 1 hour, No Mask, 10,800 cu-ft scenario.

There are 3 scenarios that are offered. The first scenario is based on using Vaccinations + UV + HVAC subsystems to mitigate COVID-19. The second scenario uses only UV + HVAC subsystems to mitigate COVID-19 to show how its performance might compare with just a vaccination based subsystem. The third scenario is a Vaccine only based scenario where the current ventilation infrastructure is considered.

The following table shows the Vaccinations + UV + HVAC subsystems scenario. [spreadsheet Ventilation]

Vaccine + Upgraded Infrastructure

Vaccinated %

Vaccinated Population

Unvaccinated Population

Exposed Population

Deaths @ 2%

Deaths @ 3%

Deaths @ 3.5%

UV-C or FAR UV-222 Kill / Inactivate

Deaths @ 3.5% (With UV)

AUC

Ventilation Effectiveness via AUC

Deaths @ 3.5% (Ventilation)

Lives Saved

% of infrastructure

Total Deaths

Lives Saved Via Ventilation

70%

206,640,000

88,560,000

109,224,000

2,184,480

3,276,720

3,822,840

0%

3,822,840

1

1%

3,799,141

23,699

3%

113,974

711

70%

206,640,000

88,560,000

109,224,000

2,184,480

3,276,720

3,822,840

0%

3,822,840

4

28%

2,750,160

1,072,680

30%

825,048

321,804

70%

206,640,000

88,560,000

109,224,000

2,184,480

3,276,720

3,822,840

0%

3,822,840

12

65%

1,320,109

2,502,731

35%

462,038

875,956

70%

206,640,000

88,560,000

109,224,000

2,184,480

3,276,720

3,822,840

0%

3,822,840

20

78%

857,989

2,964,851

10%

85,799

296,485

70%

206,640,000

88,560,000

109,224,000

2,184,480

3,276,720

3,822,840

0%

3,822,840

24

81%

729,696

3,093,144

4%

29,188

123,726

70%

206,640,000

88,560,000

109,224,000

2,184,480

3,276,720

3,822,840

90%

382,284

1

1%

379,914

3,442,926

10%

37,991

344,293

70%

206,640,000

88,560,000

109,224,000

2,184,480

3,276,720

3,822,840

90%

382,284

4

28%

275,016

3,547,824

5%

13,751

177,391

70%

206,640,000

88,560,000

109,224,000

2,184,480

3,276,720

3,822,840

90%

382,284

12

65%

132,011

3,690,829

1%

1,320

36,908

70%

206,640,000

88,560,000

109,224,000

2,184,480

3,276,720

3,822,840

90%

382,284

20

78%

85,799

3,737,041

1%

858

37,370

70%

206,640,000

88,560,000

109,224,000

2,184,480

3,276,720

3,822,840

90%

382,284

24

81%

72,970

3,749,870

1%

730

37,499

Total

100%

1,570,697

2,252,143

The above table shows that up to 2,252,143 lives can be saved if the infrastructure is upgraded based on the percentages shown in the column: % of Infrastructure. As the percentages change for the infrastructure upgrades so will the total lives saved. The Deaths at 3.5% was selected as a worst case scenario to build in what most engineers call a pad in the performance numbers. We don't know what the future holds but at one time the death rate was as high as 3.5%.

The above table shows that some infrastructure may never be upgraded. Other infrastructure will use Ceiling Level UV-C or FAR UV-222 systems. Most of the infrastructure will use traditional HVAC upgrades to increase ACH levels. There are still over 1 million lives that can be saved with a better allocation of the infrastructure upgrades.

The following table shows the UV + HVAC subsystems scenario. There is no vaccine. It is offered to show the possible performance level associated with upgraded ventilation in the infrastructure.

No Vaccine Upgraded Infrastructure

Vaccinated %

Vaccinated Population

Unvaccinated Population

Exposed Population

Deaths @ 2%

Deaths @ 3%

Deaths @ 3.5%

UV-C or FAR UV-222 Kill / Inactivate

Deaths @ 3.5% (With UV)

AUC

Ventilation Effectiveness via AUC

Deaths @ 3.5% (Ventilation)

Lives Saved

% of infrastructure

Total Deaths

Lives Saved Via Ventilation

0%

0

295,200,000

295,200,000

5,904,000

8,856,000

10,332,000

0%

10,332,000

1

1%

10,267,950

64,050

3%

308,038

1,922

0%

0

295,200,000

295,200,000

5,904,000

8,856,000

10,332,000

0%

10,332,000

4

28%

7,432,865

2,899,135

30%

2,229,859

869,741

0%

0

295,200,000

295,200,000

5,904,000

8,856,000

10,332,000

0%

10,332,000

12

65%

3,567,862

6,764,138

35%

1,248,752

2,367,448

0%

0

295,200,000

295,200,000

5,904,000

8,856,000

10,332,000

0%

10,332,000

20

78%

2,318,888

8,013,112

10%

231,889

801,311

0%

0

295,200,000

295,200,000

5,904,000

8,856,000

10,332,000

0%

10,332,000

24

81%

1,972,151

8,359,849

4%

78,886

334,394

0%

0

295,200,000

295,200,000

5,904,000

8,856,000

10,332,000

90%

1,033,200

1

1%

1,026,795

9,305,205

10%

102,679

930,521

0%

0

295,200,000

295,200,000

5,904,000

8,856,000

10,332,000

90%

1,033,200

4

28%

743,286

9,588,714

5%

37,164

479,436

0%

0

295,200,000

295,200,000

5,904,000

8,856,000

10,332,000

90%

1,033,200

12

65%

356,786

9,975,214

1%

3,568

99,752

0%

0

295,200,000

295,200,000

5,904,000

8,856,000

10,332,000

90%

1,033,200

20

78%

231,889

10,100,111

1%

2,319

101,001

0%

0

295,200,000

295,200,000

5,904,000

8,856,000

10,332,000

90%

1,033,200

24

81%

197,215

10,134,785

1%

1,972

101,348

Total

100%

4,245,127

6,086,873

The results show that UV + HVAC only would have saved 6,086,873 lives. This is a critical finding because it suggests that the COVID-19 disaster may have never happened if we managed our public facilities to provide clean air in the same way that we provide clean water and protect against gas exposures. Without the vaccination, an upgraded infrastructure could save 6,086,873 lives, however the total loss of life of 10,332,000 lives would mean that 4,245,127 people would die without the vaccine.

The following table shows the ability of the current infrastructure to save lives. The ventilation allocations in the % of infrastructure column are ad hoc and not sourced from any data other than just general observations of the current situation.

Vaccine + Current Ventilation Infrastructure

Vaccinated %

Vaccinated Population

Unvaccinated Population

Exposed Population

Deaths @ 2%

Deaths @ 3%

Deaths @ 3.5%

UV-C or FAR UV-222 Kill / Inactivate

Deaths @ 3.5% (With UV)

AUC

Ventilation Effectiveness via AUC

Deaths @ 3.5% (Ventilation)

Lives Saved

% of infrastructure

Total Deaths

Lives Saved Via Ventilation

70%

206,640,000

88,560,000

109,224,000

2,184,480

3,276,720

3,822,840

0%

3,822,840

1

1%

3,799,141

23,699

80%

3,039,313

18,959

70%

206,640,000

88,560,000

109,224,000

2,184,480

3,276,720

3,822,840

0%

3,822,840

4

28%

2,750,160

1,072,680

15%

412,524

160,902

70%

206,640,000

88,560,000

109,224,000

2,184,480

3,276,720

3,822,840

0%

3,822,840

12

65%

1,320,109

2,502,731

3%

39,603

75,082

70%

206,640,000

88,560,000

109,224,000

2,184,480

3,276,720

3,822,840

0%

3,822,840

20

78%

857,989

2,964,851

1%

8,580

29,649

70%

206,640,000

88,560,000

109,224,000

2,184,480

3,276,720

3,822,840

0%

3,822,840

24

81%

729,696

3,093,144

0.7%

5,108

30,931

70%

206,640,000

88,560,000

109,224,000

2,184,480

3,276,720

3,822,840

90%

382,284

1

1%

379,914

3,442,926

0.1%

380

3,443

70%

206,640,000

88,560,000

109,224,000

2,184,480

3,276,720

3,822,840

90%

382,284

4

28%

275,016

3,547,824

0.1%

275

3,548

70%

206,640,000

88,560,000

109,224,000

2,184,480

3,276,720

3,822,840

90%

382,284

12

65%

132,011

3,690,829

0.1%

132

3,691

70%

206,640,000

88,560,000

109,224,000

2,184,480

3,276,720

3,822,840

90%

382,284

20

78%

85,799

3,737,041

0.0%

0

0

70%

206,640,000

88,560,000

109,224,000

2,184,480

3,276,720

3,822,840

90%

382,284

24

81%

72,970

3,749,870

0.0%

0

0

Total

100%

3,505,915

326,204

The results show that the current infrastructure may save 326,204 lives, however 3,505,915 people will die even with the vaccination subsystem. These findings are significant because it suggests that massive benefit can be gained with targeted infrastructure upgrades.

The following table shows the scenario in 2020 with no vaccine and the current infrastructure. The ventilation allocations in the % of infrastructure column are ad hoc and not sourced from any data other than just general observations of the current situation.

Vaccine + Current Ventilation Infrastructure

Vaccinated %

Vaccinated Population

Unvaccinated Population

Exposed Population

Deaths @ 2%

Deaths @ 3%

Deaths @ 3.5%

UV-C or FAR UV-222 Kill / Inactivate

Deaths @ 3.5% (With UV)

AUC

Ventilation Effectiveness via AUC

Deaths @ 3.5% (Ventilation)

Lives Saved

% of infrastructure

Total Deaths

Lives Saved Via Ventilation

0%

206,640,000

88,560,000

109,224,000

5,904,000

8,856,000

10,332,000

0%

10,332,000

1

1%

3,799,141

64,050

80%

8,214,360

51,240

0%

206,640,000

88,560,000

109,224,000

5,904,000

8,856,000

10,332,000

0%

10,332,000

4

28%

2,750,160

2,899,135

15%

1,114,930

434,870

0%

206,640,000

88,560,000

109,224,000

5,904,000

8,856,000

10,332,000

0%

10,332,000

12

65%

1,320,109

6,764,138

3%

107,036

202,924

0%

206,640,000

88,560,000

109,224,000

5,904,000

8,856,000

10,332,000

0%

10,332,000

20

78%

857,989

8,013,112

1%

23,189

80,131

0%

206,640,000

88,560,000

109,224,000

5,904,000

8,856,000

10,332,000

0%

10,332,000

24

81%

729,696

8,359,849

0.7%

13,805

58,519

0%

206,640,000

88,560,000

109,224,000

5,904,000

8,856,000

10,332,000

90%

1,033,200

1

1%

379,914

9,305,205

0.1%

1,027

9,305

0%

206,640,000

88,560,000

109,224,000

5,904,000

8,856,000

10,332,000

90%

1,033,200

4

28%

275,016

9,588,714

0.1%

743

9,589

0%

206,640,000

88,560,000

109,224,000

5,904,000

8,856,000

10,332,000

90%

1,033,200

12

65%

132,011

9,975,214

0.1%

357

9,975

0%

206,640,000

88,560,000

109,224,000

5,904,000

8,856,000

10,332,000

90%

1,033,200

20

78%

85,799

10,100,111

0.0%

0

0

0%

206,640,000

88,560,000

109,224,000

5,904,000

8,856,000

10,332,000

90%

1,033,200

24

81%

72,970

10,134,785

0.0%

0

0

Total

100%

9,475,446

856,554

The results show that the current infrastructure may save 856,554 lives, however 9,475,446 people will die even with the vaccination subsystem. These findings are significant because it suggests that massive benefit can be gained with targeted infrastructure upgrades.

The results are summarized in the following table. The above scenarios represent various architecture choice that the society can implement with appropriate government action via regulations and oversight as was performed with the vaccine effort.

System Architecture Approaches

Total Deaths

Lives Saved
via Ventilation

Comment
Vaccine + Upgraded Infrastructure

1,570,697

2,252,143

This assumes minimal infrastructure upgrades. More lives can be saved with more infrastructure upgrades.
No Vaccine Upgraded Infrastructure

4,245,127

6,086,873

Possible future scenario with minimal infrastructure upgrades. More lives can be saved with more infrastructure upgrades.
Vaccine + Current Ventilation Infrastructure

3,505,915

326,204

Situation in 2021
No Vaccine + Current Ventilation Infrastructure

9,475,446

856,554

Situation unfolding in 2020

The research in 2020 included a Virus Mutations and Architecture solutions analysis, which included the costs of shutdown: see section Virus Mutations & Architecture Solutions. Between shutdown costs and loss of life costs of $12,252 Trillion dollars, the analysis clearly shows that it is impossible to make a case against ventilation upgrades based on costs. There is also a cost benefit analysis in part 2: see section Cost Benefit Analysis showing the costs associated with annual flu infections and ventilation infrastructure upgrades. There is an analysis of Ventilation Architectures in part 2:  see section School Ventilation Architecture Tradeoffs. Once again it is impossible to make a case against ventilation upgrades based on costs. The costs are summarized in the following table.

[spreadsheet cost benefit]

Cost Items

Costs
($ billions)

Comment
Shutdown Costs

$4,400

Government economic stimulus bills
Lives Lost Costs

$7,852

$7 million per life based on lives lost in October 5, 2020.
Flu Season Hospital Costs

$2 to $14

Min and max costs from 2010 to 2020, does not include COVID-19
Flu Season Loss of Life Costs

$84 to $427

Min and max costs from 2010 to 2020, does not include COVID-19
Flu Season Productivity Costs

$4 to $21

Min and max costs from 2010 to 2020, does not include COVID-19
Flu Season Annual Flu Costs

$175 to $462

Min and max costs from 2010 to 2020, does not include COVID-19
.

Infrastructure Costs

UV Schools

$3

Infrastructure upgrade costs.
UV Commercial Office

$7

Infrastructure upgrade costs.
UV Retail

$16

Infrastructure upgrade costs.
UV Industrial property

$23

Infrastructure upgrade costs.
HVAC Upgrades

$100

Infrastructure upgrade costs, based on schools analysis
Total

$150

Commercial Infrastructure upgrade costs.
HVAC Retrofit All Schools

$107

Worst case schools analysis Proposed Legislation, paid for by legislation in 2021

This research on COVID-19 from a systems perspective spun off the following activities:

  1. Proposed legislation to determine ventilation needs and provide common standards. (2020)
  2. A building ventilation tool for self certification. (2021)
  3. A survey to determine the current level of understanding of ventilation and system changes. (2021)

All three efforts failed. The proposed legislation failed because we are still in the mode of deregulation and privatization of government. The building ventilation tool failed because those that have healthy buildings don't care and those that have unhealthy buildings don't want to know. The survey failed because the general public is unaware of the issue and don't care.

We now have the data that shows that using a government hands off approach to ventilation does not work. Self regulation and relying on industry and the people to do the right thing has failed and follows the same scenarios prior to government actions to ensure clean water. The Building Clean Air government regulations must clearly include:

  1. Minimum ACH requirements
  2. Inspection requirements
  3. Certificate of occupancy based on building clean air requirements

The following areas must be targeted for ventilation upgrades:

  1. Schools, Although some claim that children will be unaffected by COVID-19 it is clear that they get infected and bring the contagion home which will infect and possibly kill people.
  2. Large corporate franchises like restaurants and bars
  3. Large corporate office buildings
  4. Shared living apartments buildings with central HVAC systems
  5. Home Owner Association Club Houses
  6. Shared living healtcare facilities
  7. Large public entertainment venues
  8. Airports
  9. Small restaurants and bars

Some of the facility types above have taken steps to upgrade their ventilation systems but not all. The most suspect facilites are:

  1. Schools
  2. Shared living apartments buildings with central HVAC systems
  3. Home Owner Association Club Houses
  4. Shared living healtcare facilities
  5. Airports
  6. Small restaurants and bars

New and proper regulations associated with ventilation must come from the government and funding mechanisms provided. Although funding has been provided for schools to upgrade the ventilation systems, the funds have not been properly applied because the school districts did not know what to do except listen to a sales person and pick the lowest cost solution, which will not work. Regulations must be produced so that everyone knows exactly what they must do to upgrade and maintain their ventilation systems to ensure a clean and safe air environment.

As time moves on this research is predicting that all of these areas will be revisited by society because there will be no choice as COVID-19 variants continue over the coming years and decades. The above tables will surface in various forms and become part of the social consciousness. There is an old saying, no wine before its time. The numbers in the tables of the analysis show why ventilation upgrades will happen. Unless the virus mutates to a less virulent form, and that may be the case with Omicron, then there will be no choice. The current guess is that sometime in 2022 or 2023 building ventilation systems will start to change for the better, including schools. There is no choice and it will become painfully clear.

See Return To Life P1 2020.

References:

[1] Experts Urge Strict Workplace Air Quality Standards, in Wake of Pandemic, The New York Times, May 13, 2021Updated Oct. 1, 2021. webpage https://www.nytimes.com/2021/05/13/health/aerosols-covid-workplace.html, December 2021. Experts Urge Strict Workplace Air Quality Standards, in Wake of Pandemic.

[2] A Paradigm Shift to Combat Indoor Respiratory Infection, Science Vol 372, Issue 6543 pp. 689-691, 14 May 2021. webpage https://www.science.org/doi/10.1126/science.abg2025, December 2021. A paradigm shift to combat indoor respiratory infection.

[3] A Paradigm Shift to Combat Indoor Respiratory Infection, University of LEEDS, White Rose Research Online, published 14 May 2021, online August 27, 2021. webpage https://eprints.whiterose.ac.uk/177405/3/Paradigm%20Shift%20AAM.pdf, https://eprints.whiterose.ac.uk/177405/, December 2021. A paradigm shift to combat indoor respiratory infection, University of LEEDS . PDF.

[4] Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings, Centers For Disease Control and Prevention - CDC, 2005. webpage https://www.cdc.gov/mmwr/preview/mmwrhtml/rr5417a1.htm, December 2021. Guidelines for Preventing the Transmission of Mycobacterium tuberculosis in Health-Care Settings.

[5] Air Conditioning Systems Can Spread The Coronavirus, Study Suggests, WBUR Boston NPR News TV, May 19, 2020. webpage https://www.wbur.org/hereandnow/2020/05/19/air-conditioning-coronavirus, December 2021. Air Conditioning Systems Can Spread The Coronavirus, Study Suggests

[6] COVID-19 A Systems Perspective, Walter Sobkiw, 2021, ISBN 9780983253044, hardback.

[7] A National Strategy for the New Normal of Life With COVID, National Institutes of Health - NIH, January 6, 2022. webpage https://pubmed.ncbi.nlm.nih.gov/34989789/, https://jamanetwork.com/journals/jama/fullarticle/2787944, January 2022. A National Strategy for the New Normal of Life With COVID.

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Building Clean Air Act Proposed Legislation

We now have the data that shows that using a government hands off approach to building ventilation does not work. Self regulation and relying on industry and the people to do the right thing has failed and follows the same scenarios prior to government actions to ensure clean water. This is the first proposed legislation.

TITLE

Building Clean Air Act

DATE

January 2, 2021

BACKGROUND

New and proper legislation associated with building ventilation must come from the government and funding mechanisms must be provided. Although funding has been provided for schools to upgrade the ventilation systems, the funds have not been properly applied as evidenced by the COVID-19 outbreaks in schools in 2021. This happened because the school districts did not know what to do except to pick the lowest cost solutions, which in most cases did not work. Regulations must be produced so that everyone knows exactly what they must do to properly upgrade and maintain their ventilation systems to ensure a clean and safe air environment.

Research shows that upgraded building ventilation will save millions of lives even when vaccines are available and most of the people are vaccinated. The costs associated with poor building ventilation are enormous and far exceed the costs of implementing and maintaining proper building ventilation. Research shows that although the CDC provides building ventilation guidelines for airborne contagions, few convert those guidelines into requirements.

The Building Clean Air government regulations must clearly include:

  1. Minimum ACH requirements
  2. Inspection requirements
  3. Certificate of occupancy based on building clean air requirements

BUILDING CLEAN AIR

Definitions

  1. ACH - Air changes per hour.

  2. HVAC - Heating Ventilation and Cooling.

  3. UV - Ultra Violet.

  4. Ceiling Level UV-C - Traditional in room UVGI system used to deal with airborne contagions in occupied rooms. Not to be confused with HVAC in-duct UV systems, which do not address room ACH.

  5. FAR UV-222 - New technology in room UVGI system used to deal with airborne contagions in occupied rooms.

  6. CDC - Centers for Disease Control.

  7. WHO - World Health Organization.

Existing Guidelines

The CDC and WHO have existing guidelines for the level of ACH in a room when there is an airborne contagion. The problem with guidelines is that they are not required so few have followed the guidelines. The guidelines must be converted to regulations that can be implemented and enforced. The CDC guideline for airborne infections is provided for hospital rooms and it is 12 ACH. The same guideline must be used with all rooms that have airborne contagions including those outside a hospital setting. The WHO guidance translates into 24 ACH. Some airlines in 2021 have implemented airplane ventilation systems at 20 ACH.

Minimum ACH requirements

  1. Each room in each school shall provide a minimum of 12 ACH at all times when students are present.

  2. Each public space when there are 2 or more occupants shall provide a minimum of 12 ACH at all times when people are present.

  3. Each aircraft shall provide a minimum of 20 ACH at all times when people are present. This includes the gate, tarmac, taxiway, runway, and in all phases of flight. (already implemented by some airlines)

  4. The ventilation system in a public setting must run 1 hour before and 1 after people occupy the space.

  5. The ventilation system in a public setting must run at all times when people are present. On demand only systems must be modified as needed to ensure constant air changes.

  6. ACH requirements can be satisfied with natural ventilation, HVAC systems, In room unit ventilators, Ceiling Level UV-C systems offering an eAUC rating, FAR UV-222 systems offering an eAUC rating, exhaust fans, and other systems that show validated AUC or eAUC ratings.

  7. The ACH levels can be satisfied using multiple systems that work together to provide the required ACH level.

  8. New ventilation approaches and or technologies with no previous history of AUC or eAUC ratings shall be tested and the test data shall be submitted to the government for validation and approval. Any AUC or eAUC claims for such systems and technologies without government review shall be rejected for certificates of occupancy.

Inspection Requirements

  1. All public facilities shall be inspected 90 days after the enactment of this legislation.

  2. All public facilities shall be annually inspected.

Certificate of Occupancy

  1. Facilities able to meet the ACH requirements shall post in public view full compliance with this legislation. This is a certificate that indicates PASS.

  2. Facilities not able to meet the ACH requirements shall post in public view failure to comply with this legislation. This is a certificate that indicates FAIL.

  3. Inspections shall be performed by local authorities that grant building certificates of occupancy.

  4. Any areas in a school unable to comply with the ACH requirements shall be closed off to public access.

  5. Any areas in a public space smaller than 10,000 cubic feet that has 5 or more occupants and is unable to meet the ACH requirements shall be closed off to public access.

  6. Any facilities unable to comply with the the ACH requirements in this legislation shall be able to operate for a maximum of 90 days to allow for ventilation upgrades.

Non Compliance

  1. Failure to comply includes not posting a certificate of occupancy showing PASS or FAIL results.

  2. Failure to comply includes not closing off public spaces as required by this legislation.

  3. Facilities that fail to comply with this law shall be fined a minimum of $100 per day.

  4. After 90 days of non-compliance the minimum fine shall increase to $1,000 per day.

  5. Organizations with revenues in excess of $1 million dollars shall have the fines multiplied by 10X times.

  6. Organizations with revenues in excess of $100 million dollars shall have the fines multiplied by 100X times.

New Ventilation Approaches and or Technologies

  1. A national lab shall be designated to test and evaluate new products and technologies that claim to mitigate airborne contagions.

  2. The test results shall be converted to an AUC or eAUC level so that the product and or technology can be properly designed for a building.

  3. The government shall maintain a database of certified products on a public website showing the product name, date of certification, and final AUC and or eAUC ratings.

FUNDING

  1. Tax credits equal to 50% of the costs of ventilation upgrades shall be provided and able to be used within a 5 year period.

  2. Schools shall be provided a minimum of $110 billion dollars to properly upgrade their ventilation systems. [spreadsheet Schools]

REFERENCES

  1. A Paradigm Shift to Combat Indoor Respiratory Infection, University of LEEDS, White Rose Research Online, published 14 May 2021, online August 27, 2021. webpage https://eprints.whiterose.ac.uk/177405/3/Paradigm%20Shift%20AAM.pdf, https://eprints.whiterose.ac.uk/177405/, December 2021. A paradigm shift to combat indoor respiratory infection, University of LEEDS . PDF

  2. Stopping Indoor Respiratory Infection, Cassbeth, webpage https://www.cassbeth.com/covid-19/return-to-life/index-part-3.html#Stopping-Indoor-Respiratory-Infection, December 2021.

  3. Supporting Research from multiple researchers around the world.

CLOSING REMARKS

This is the worst disaster in modern history. There is something very wrong with our systems and they must be corrected. Our modern enclosed buildings and transportation systems have led to this massive disaster. This legislation will stop the current disaster from continuing and help prevent future outbreaks of airborne disease.. As a result of this legislation we will have healthier facilities and this will lead to reduced healthcare costs in general. Our children and all others to follow will respect us for this choice that we made.

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Virus Infection Testing Approaches

Since 2019 there have been multiple studies performed to understand the nature of the COVID-19 virus that fall into the category of Test and Evaluation that is performed during System Validation when a systems approach is used to develop a system that satisfies a need. Unfortunately, these test events are only the start of a test and evaluation effort because no one has attempted to develop a system that would mitigate and stop the COVID-19 pandemic disaster except for this COVID-19 research from a systems perspective. Regardless of the missing element to solve the fundamental problem of ending the COVID-19 disaster, these studies / tests provide important information on the airborne nature of COVID-19.

It should be noted that toxic people in positions of authority have attempted to use these and other valid studies / test results to further their agendas suggesting that COVID-19 is just a flu outbreak that is not that serious and that the virus is not airborne. Both of these management talking points have proved to be disastrously wrong and the studies are valid and reported the correct data and findings. The virus ignores stupid management and their stupid claims that distort and ignore study findings and empirical data. In the less serious case this is called cherry picking of data and this is usually an innocent condition where the analysts are blindsided by unexpected results. One should never consider mistakes made by scientists and engineers who inadvertently cherry pick data with toxic management that lies and cherry picks data to further their agendas.

Virus Infection Testing Approaches

  1. Goldberg Drums Testing 
  2. University of Bristol Aerosol Testing
  3. Operational Settings Testing
  4. Empirical Data
  5. Virus Infection Testing System Observations

As of January 2022, the COVID-19 virus infection testing approaches are:

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Goldberg Drums Testing

Godberg drums were introduced in 1958 when it was found that stainless steel rotating cylindrical chambers are an effective method of retaining particles suspended in the air for an extended period of time when operated at 2-3 rotations per minute (RPM). The following extract from the paper: Particle Suspension in a Rotating Drum Chamber When the Influence of Gravity and Rotation are Both Significant, is a nice turtorial on Godberg drums. [7]

*** Extract Start ***

Particle Suspension in a Rotating Drum Chamber When the Influence of Gravity and Rotation are Both Significant

Abstract

In recent years, rotating chambers have been found to be an effective method of retaining particles suspended in the air for an extended period of time. Rotating drum chambers have the potential of providing a stable atmosphere of well-characterized inhalable particles for periods lasting from hours to days for use in inhalation toxicology studies. To aid in planning for the use of rotating drum chambers in inhalation studies, we created a model that describes (a) the concentration of particles in the chamber under various conditions and (b) the particle sizes for which gravity and rotation influence particle dynamics. Previous publications describe the suspension / deposition of particles when the rotational effect is dominant, but do not describe particle suspension / deposition when gravitational settling is significant as occurs when such drum chambers are operated at optimal conditions for retaining the highest fraction of particles over time. By using the limiting trajectory of particles, the fraction of particles that remain suspended in a 1-m diameter rotating drum chamber was derived for forces of gravity only, rotation only, and gravity plus rotation. For particles between 0.5 and 1 µm in diameter and for suspension times of < 96 h, there was no loss of the suspended particles for drum rotation rates from 0.1 to 10 rpm. For 2- and 5-µm diameter particles, > 98% and 91%, respectively, remain suspended after 96 h under optimal rotation of the drum chamber. Optimal rotation rates were independent of particle size for particles < 10 µm in diameter (agreeing with Gruel et al. [1987] even though we predicted suspended fractions higher by > 30% for 10-µm particles after 96 h). For 20-µm diameter particles and suspension times < 96 h, the maximum suspended fraction occurred for drum rotation rates between 0.3 and 0.5 rpm. The particles > 2 µm can be selectively removed from an airborne particle size distribution in time periods of < 15 h when the rotational rate is > 5 rpm.

INTRODUCTION

Stainless steel rotating cylindrical chambers have been found to be an effective method of retaining particles suspended in the air for an extended period of time when operated at 2-3 RPM (Goldberg et al., 1958; Dimmick and Wang, 1969; Frostling, 1973). The axis of such cylinders is horizontal with gravity in the vertical direction. Maintaining a high number concentration of generated particles is desirable in long term animal exposure studies where the generated particles are scarce, expensive, or highly toxic. Rotating drum chambers have potential use in providing a stable atmosphere of well characterized respirable particles for periods lasting from hours to days for use in inhalation toxicology studies.

Particle aging by means of rotating chambers was first suggested by Goldberg et al. (1958). In rotating drum chambers, particles remain airborne for a much longer period of time than in simple stirred settling chambers, primarily because of the competition between gravitational and centrifugal forces. Each force attempts to produce a different particle trajectory. When the chamber is not rotating, particles deposit quickly by gravita- tional settling. When the drum chamber is at a high rotation rate (typically above 10 RPM), the particle trajectory due to gravitational settling is depressed and the acting centrifugal forces move the particles in the radial direction away from the center of the drum chamber until the particles are deposited. For rotation rates < 10 rpm, the two competing forces are of the same order of magnitude and the particle deposition is delayed. For each particle size, there must be a rotation rate between 0 and 10 rpm that optimizes the fraction of suspended particles.

A few studies are available on the analysis of rotating drum chambers. Dimmick and Wang (1969), Goldberg (1971), and Frostling (1973) derived an identical expression for the fraction of suspended particles at high drum rotation rates where the centrifugal force is the dominant mechanism of particle deposition. Recently, Gruel et al. (1987) derived a different expression which partly takes into account the effect of gravitational settling. Using this result, they were able to obtain a simple equation predicting the optimum rotation rate of the drum chamber. For chamber rotation rates > 5 RPM, the prediction of the fraction of suspended parti- cles by Gruel et al. (1987) approaches that of the previous findings. However, when the rotation rate is reduced to zero, their solution does not converge to the gravitational settling solution. Their predicted optimum rotation rate can be in error up to 70% for 20-µm diameter particles where gravity is significant.

In the current study, rotating drum chambers are reexamined for potential use in inhalation studies. Using the limiting trajectories of the suspended particles (Pich, 1972), expressions are derived for the fraction of suspended particles in the chamber when the driving mechanisms are gravity, rotation, and gravity plus rotation. The optimum drum rotation rate for the chamber is obtained for different particle sizes and different suspension periods. Utilizing these results, particle size dispersion and the overall fraction of the particles that remained suspended, were obtained for the non-uniform initial size distribution.

Notes:

Dimmick, R. L., and Wang, L. ( 1 9 6 9 ) . In An Introduction to Experimental Aerobiology (R. L. Dimmick and A. B. Ekers, eds.). John Wiley & Sons, New York, pp. 164-1 76.
Frostling, H. (1973). J. Aerosol Sci. 4:411-419.
Goldbberg, L. J., Watkins, H. M. S., Boerke, E. E., and Chatigny, M. A. (1958). Am. J . Hyg. 68:85-93.
Goldberg, L. J. (1971). Appl. Microbiol. 21:244-252.
Gruel, R. L., Reid, C. R., and Allemann, R. T. (1987). J . Aerosol Sci. 18:17-22.
Hinds, W. C. (1982). In Aerosol Technology. John Wiley & Sons, New York, pp. 45.
Hornbeck, W. H. (1975). In Numerical Methods. Quan- tum, New York, pp. 194-196.
Kriebel, A. R. (1961). J. Basic Eng. Trans. ASME 83D:333-340.
Lanczos, C. (1956). In Applied Analysis. Prentice Hall, New York.
Lapple, C. E., and Shepherd, C. B. (1940). Ind. Eng. Chem. 32:605-617.
Pich, J. (1972). J. Aerosol Sci. 33:351-361.
Rudinger, G. (1980). Fundamentals of Gas-Particle Flow (J. C . Williams and T. Allen, eds.). Elsevier, New York, pp. 29-34.

*** Extract Start ***

Even in 2019 there have been studies that attempt to further understand and improve Godberg drums [8].

With the outbreak of the COVID-19 virus, Godberg drums were recommended in 2019 to perform tests on the COVID-19 virus. The following test activaties were performed in 2020 using Godberg drums and described in the following papers:

  1. Aerosol and surface stability of HCoV-19 (SARS-CoV-2) compared to SARS-CoV-1 [2.1] (addressed below)
  2. Experimental aerosol survival of SARS-CoV-2 in artificial saliva and tissue culture media at medium and high humidity [2.2] (addressed below)
  3. Comparative dynamic aerosol efficiencies of three emergent coronaviruses and the unusual persistence of SARS-CoV-2 in aerosol suspensions [2.3]
  4. Airborne SARS-CoV-2 Is Rapidly Inactivated by Simulated Sunlight [2.4]

There are 2 key studies that used Godberg drums to attempt to understand the COVID-19 virus. The first performed tests on various surfaces and the second performed airborne tests.

Study 1: Aerosol and Surface Stability

The study described in Aerosol and surface stability of HCoV-19 (SARS-CoV-2) compared to SARS-CoV-1 is a test associated with surface contamination. It was this test that led some to conclude that the virus is a surface contamination problem. The test did include results for aerosol transmission but the message was lost. The test included results for COVID-19 (SARS-CoV-2) and SARS-CoV-1. The test results are summarized as follows. [2.1]

Surface or Aerosol Time COVID-19 (SARS-CoV-2) SARS-CoV-1 Comments
Aerosol (airborne) 3 hours 10^3.5 to 10^2.7 TCID50/L 10^4.3 to 10^3.5 TCID50/mL resullts are reduction in infectious titer
Plastic 72 hours 10^3.7 to 10^0.6 TCID50/mL similar stable on and viable virus
Stainless Steel 48hours 10^3.7 to 10^0.6 TCID50/mL similar stable on and viable virus
Polypropylene 72 hours 10^3.4 to 10^0.7 TCID50/mL similar stable on and viable virus
Copper 4 hours No viable virus -
Copper 8 hoiurs - No viable virus
Cardboard 24 hours No viable virus -
Cardboard 8 hours - No viable virus

Note: For surfaces, viruses were applied on copper, cardboard, steel and plastic maintained at 21-23°C and 40% RH over seven days.

From the study [2.1]:

Our findings show that the stability of HCoV-19 and SARS-CoV-1 under the experimental circumstances tested is similar. This indicates that differences in the epidemiology of these viruses likely arise from other factors, including high viral loads in the upper respiratory tract and the potential for individuals infected with HCoV-19 to shed and transmit the virus while asymptomatic. Our results indicate that aerosol and fomite transmission of HCoV-19 are plausible, as the virus can remain viable and infectious in aerosols for multiple hours and on surfaces up to days. This echoes the experience with SARS-CoV-1, where these modes of transmission were associated with nosocomial spread and superspreading events, and provides guidance for pandemic mitigation measures.

It appears that the focus was on surface contamination and the bias may have been based on exerience from SARS-CoV-1. That was an unfortunate bias.

The following table shows extracted Aerosol data from Figure 1 in the study [2.1]. There is no table data. It has been augmented to show the Remaining Virus as a percentage.

Remaining Virus = virus level at t = 0 / virus level at t = n. For analysis comparisons Infectivity = Remaining Virus.

[ Drum Tests]

Test

Time
(hours)

COVID-19
(TCID50/L)

Remaining Virus
COVID-19

SARS-CoV-1
(TCID50/L)

Remaining Virus
SARS-CoV-1

Comments

Aerosol

0

10^3.5 = 3162

baseline

10^4.3 = 19953

baseline

Value stated in study, starting virus load [2.1]

Aerosol

0.5

10^3.1 = 1259

40%

10^4.1 = 12589

63%

Visual extraction from graph [2.1]

Aerosol

1

10^2.9 = 794

25%

10^3.8 = 6310

32%

Visual extraction from graph [2.1]

Aerosol

2

10^2.8 = 631

20%

10^3.7 = 5012

25%

Visual extraction from graph [2.1]

Aerosol

3

10^2.7 = 501

16%

10^3.5 = 3162

16%

Value stated in study [2.1]

Note: Virus aerosolized in a rotating drum maintained at 21-23°C and 65% relative humidity (RH) over three hours.

Study 2: Experimental aerosol survival

The study described in Experimental aerosol survival of SARS-CoV-2 in artificial saliva and tissue culture media at medium and high humidity also has data that can be used to understand the airborne nature of COVID-19. [2.2] The following table shows extracted Aerosol data from Figure 1 in the study. There is no table data. It has been augmented to show the Remaining Virus as a percentage.

Remaining Virus = virus level at t = 0 / virus level at t = n. For analysis comparisons Infectivity = Remaining Virus.

[ Drum Tests]

Time (min)

Survival
High RH

Survival
Med RH

Survival
Artificial Saliva
High RH

Survival
Artificial Saliva
Med RH

Comments

0

100%

100%

100%

100%

Starting virus load. [2.2]

30

50%

78%

90%

62%

[2.2]

60

25%

59%

80%

39%

[2.2]

90

12%

45%

70%

23%

[2.2]

120

8%

15%

62%

15%

[2.2]

Note: RH = Relative Humidty. All data is a visual extraction from the graph in the study. [2.2]

Godberg Drums Studies Observations

These Godberg drums studies translate to tests that show that the virus is present in aerosols at significant levels after 60 minutes. This suggests that a room is filled with aerosol virus at high levels even 1 hour after an infected person leaves a room. The time of 60 minutes, or 1 hour, is a key number because most of the current infrastructure changes the air at 1 air change per hour or 1 ACH.

The key question is how much virus is shed by an infected person, what is the room dilution level, what is the ACH level, and what is the actual infection load needed to infect a person. This was addressed in this system study. Recommended ACH levels were offered. [6]

Back to Virus Infection Testing Approaches

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University of Bristol Aerosol Testing

A team at the University of Bristol [3] developed a new test system that generates virus containing particles and levitates them between two electric rings. The levitation ranges from 5 seconds to 20 minutes. The temperature, humidity, and UV light intensity are controlled to determine the impacts on the levitated viruses [1]. The following are extractions from a general media article. [1]

Previously assumptions about how long the virus survives in tiny airborne droplets were based on studies that involved spraying virus loads into sealed vessels called Goldberg drums. The drums rotate to keep the droplets airborne. Researchers that use Goldberg drums suggest that infectious virus can be detected after 3 hours. However, Goldberg drums may not accurately replicate what happens when people cough or breathe. The levitated aerosol approach may be a closer simulation of what happens to human generated virus aerosols [1].

In the University of Bristol study, the viral particles leave the relatively moist and carbon dioxide-rich conditions of the lungs, they quickly lose water and dry out, and the transition to lower levels of carbon dioxide is associated with a rapid increase in pH. Both of these factors disrupt the ability for the virus to infect human cells. The speed at which the virus particles dry out varies according to the relative humidity of the surrounding air. The findings are summarized as follows: [1] [2]

Relative
Humidity

Infectivity
(Average)

Time
(Minutes & Seconds)

References

Equivalent
ACH *

40%

54%

5 seconds

[2]

-

40%

19%

5 minutes

[2]

-

40%

10%

20 minutes

[2]

3

90%

100%

5 seconds

[2] Figure A

-

90%

48%

5 minutes

[2]

-

90%

10%

20 minutes

[1]

3

Notes:

  1. Humidity level is less than 50% is relatively dry air found in many offices.
  2. Humidity level of 90% is equivalent to a steam or shower room.
  3. * not part of reference [2] study. Added by this analysis.

A graph (Figure A) is provided in the study and the points have been visually extracted to populate the following table. The average values for the Infectivity at 40% and 90% relative humidity are shown. [2]

Time
(Sec)

Infectivity
(at 40% RH)

Infectivity
(at 90% RH)

0

48-56%

100%

50

42%

95%

100

40%

88%

300

22%

55%

600

20%

30%

1200

15%

19%

According to a visual examination of the graph (Figure A) of the results, the virus infectivity is higher than stated and is 15% at 40% humidity and 19% at 90% humidity.

As of January 2021, the system has not been used to gather data on well known airborne contagions like Measles, which could be used to further confirm that it does perform as expected.

When the new test approach findings were disclosed by the University of Bristol, the following statements were offered from multiple sources [1]:

The above statements are misleading after 2 years into the COVID-19 disaster, especially the statement: Ventilation, though still worthwhile, is likely to have a lesser impact. While the test system is a new and important tool that can be used for the study of airborne viruses, it all comes down to the virus load being released by an infected person and the virus load needed to infect a person. If the load is sufficient to infect someone across a room, then that is what matters. We know through massive empirical data that this is happening. That is why the world is still suffering from this massive disaster.

Further we know that ventilation is key because people do not easily get infected in outdoor settings. We also know that ventilation moving the virus through the air aids in the evaporation rate. The virus is suspended in a water bubble with 100% humidity and it exists in a room at some humidity level. Moving that virus water bubble through the lower humidity air will more quickly evaporate the water bubble and deactivate the virus.

It would be interesting to determine if this test system can be used to perform real world testing where actual room sizes are used with actual environmental conditions, such as a classroom. For example, if this test system can be modified to support such a real world live test scenario, it could be very useful for those wanting to determine the effectiveness of PCO Room Sanitizers and new approaches to sanitizing the air in a room. The challenge is to somehow allow the barrier generated by the levitating field to allow the external room air to penetrate in a normal unperturbed condition.

Back to Virus Infection Testing Approaches

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Operational Settings Testing

A literature search was performed in 2020 that reviewed possible COVID-19 air contamination in hospital settings and the factors associated with contamination, including viral load and particle size. [4]

From the study [4]:

The MEDLINE, Embase, and Web of Science databases were systematically queried for original English-language articles detailing SARS-CoV-2 air contamination in hospital settings between January 1 and October 27, 2020. This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. The positivity rate of SARS-CoV-2 viral RNA and culture were described and compared according to the setting, clinical context, air ventilation system, and distance from patients. The SARS-CoV-2 RNA concentrations in copies per meter cubed of air were pooled, and their distribution was described by hospital areas. Particle sizes and SARS-CoV-2 RNA concentrations in copies or median tissue culture infectious dose (TCID50) per meter cubed were analyzed after categorization as less than 1 µm, from 1 to 4 µm, and greater than 4 µm.

The study findings are [4]:

The study includes detailed data for various settings including the ventilation. The Ventilation fell into tthe following categories [4]:

The study conclusions are [4]:

In this systematic review, the air close to and distant from patients with coronavirus disease 2019 was frequently contaminated with SARS-CoV-2 RNA; however, few of these samples contained viable viruses. High viral loads found in toilets and bathrooms, staff areas, and public hallways suggest that these areas should be carefully considered.

The study includes a table that includes various data including ventilation and infectivity findings. [4] The following table summarizes this data:

[ Ops Tests]

Ref

Ops Test Num

Setting

Areas

Clinical Context

Location

Air Ventilation

Ventilation Mitigation Result

Positivity

Total

Positivity
%

9 Wuhan

1

ICU

ICU patient environments

Severe

IR

Negative pressure

FAIL

2

3

67%

8 Iran

2

ICU

ICU patient environments

Severe

Multiple-bed room

Mechanical or Natural

PASS

0

9

0%

11 Wuhan

3

ICU

ICU patient environments

Severe

IRs, bay room

12 Air supplies; 16 air discharges/h

FAIL, possible surface contamination

13

32

41%

22

4

ICU

ICU patient environments

Critical

Multiple-bed room

ND

Unknown

0

1

0%

10

5

ICU

ICU patient environments

Severe

Multiple-bed room; 3 beds

12 Air supplies; 16 air discharges/h

PASS

0

9

0%

19

6

ICU

ICU patient environments

ND

ND

Natural ventilation

PASS

0

5

0%

23 Milan, Italy

7

ICU

ICU patient environments

2 Patients intubated, 1 patient not intubated

Multiple-bed room

Negative pressure

FAIL

12

12

100%

18

8

ICU

ICU patient environments

Mild

IRs

Negative pressure

PASS

0

26

0%

27

9

ICU

ICU patient environments

3 Patients intubated

IRs

Negative pressure and 12 air changes/h

PASS

0

3

0%

28

10

ICU

ICU patient environments

6 Critical

Multiple beds;10 patients

Natural

PASS

0

6

0%

29

11

ICU

ICU patient environments

1 Critical

IR

Negative pressure

FAIL

1

1

100%

25 Wuhan

12

ICU

ICU patient environments

9 Severe or critical

Single room

Natural ventilation

PASS, possible surface contamination

1

10

10%

9 Wuhan

13

GW

Non-ICU patient environments

Severe

4 Single and 1 multiple-bed room; 2 beds

Negative pressure

PASS

0

2

0%

8 Iran

14

GW

Non-ICU patient environments

Severe

Multiple-bed room; 2-9 beds

Mechanical or Natural

PASS

0

1

0%

3

15

GW

Non-ICU patient environments

Moderate or mild

IRs

12 Air exchanges/h

PASS

0

18

0%

12

16

IW

Non-ICU patient environments

Mild

IRs

Negative pressure

PASS

0

18

0%

11 Wuhan

17

GW

Non-ICU patient environments

Mild

Single bay room

8 Air supplies and 12 air discharges/h

PASS, possible surface contamination

2

16

13%

16

18

GW

Non-ICU patient environments

Mild or asymptomatic

IRs

12 Air changes/h

FAIL

4

10

40%

22

19

IW

Non-ICU patient environments

Critical

ND

ND

Unknown

1

1

100%

14

20

IW

Non-ICU patient environments

Severe, mild, asymptomatic

IRs 12 Air changes/h,

shelter

Unknown

0

6

0%

21 Hong Kong

21

IW

Non-ICU patient environments

ND

IRs

Negative pressure

PASS

0

8

0%

17 London

22

IW and GW

Non-ICU patient environments

ND

ND

ND

Unknown

6

12

50%

10

23

IW

Non-ICU patient environments

Severe

Multiple-bed room; 3 beds

8 Air supplies; 12 air discharges/h

PASS

0

18

0%

15

24

IW

Non-ICU patient environments

Mild or asymptomatic

IRs

12 Air exchanges/h

PASS

0

6

0%

19

25

GW

Non-ICU patient environments

ND

IRs

Natural

PASS

0

16

0%

13

26

ND

Non-ICU patient environments

ND

IRs

ND

Unknown

18

18

100%

24 Korean

27

IW and GW

Non-ICU patient environments

7 Mild and 1 asymptomatic

IRs; 5-bed room

IR with 15 air changes/h; IR without negative pressure; room without negative air pressure

PASS

0

32

0%

25 Wuhan

28

IW

Non-ICU patient environments

15 Mild

3 Patients per room

Natural ventilation

FAIL

1

2

50%

26

29

IW

Non-ICU patient environments

4 Asymptomatic; 16 mild

Single rooms

14 Air exchange/h

PASS, possible surface contamination

3

160

2%

28

30

Laboratory, radiology, internal medicine, emergency

Non-ICU patient environments

5 Mild and 1 suspected case

Multiple rooms, 18-30 patients

Natural

PASS

0

6

0%

30

31

IW

Non-ICU patient environments

2 Patients with mild disease

IRs

6 Air changes/h

FAIL

4

4

100%

9 Wuhan

32

Non-ICU

Toilet or bathroom

NA

Patient mobile toilet room

No ventilation

FAIL

1

1

100%

3

33

GW

Toilet or bathroom

NA

IRs

ND

Unknown

0

6

0%

22

34

IW

Toilet or bathroom

NA

Patient bathroom

ND

Unknown

2

2

100%

17 London

35

Cohort ward

Toilet or bathroom

NA

Outside patient bay, in the ward

ND

Unknown

1

2

50%

19

36

Fever clinic

Toilet or bathroom

NA

In the ward

Natural

PASS

0

3

0%

18

37

4 ICU

Toilet or bathroom

NA

Patient bathroom

4 With negative pressure

FAIL

1

7

14%

9 Wuhan

38

Non-ICU

Clinical areas

ND

Workstation

Natural

FAIL

4

5

80%

3

39

ICU and non-ICU

Clinical areas

ND

Corridor, anteroom

NA

Unknown

0

12

0%

12

40

ND

Clinical areas

Mild

Floor adjacent to rooms

NA

Unknown

2

3

67%

11 Wuhan

41

ICU, GW

Clinical areas

1Severe, ND

Near office, pharmacy, nurse station, corridor, and buffer room

ND

Unknown

1

34

3%

20

42

1 ICU

Clinical areas

Ward and various clinical rooms

ND

ND

Unknown

0

69

0%

17 London

43

ICU and non-ICU

Clinical areas

ND

Nurse station, ward, ambulatory waiting room, Resus bay, CPAP unit

ND

Unknown

4

10

40%

10

44

ICU and non-ICU

Clinical areas

Severe

Corridor, clinic, buffer room

1 With negative pressure

PASS

0

45

0%

19

45

ND

Clinical areas

ND

Corridor and preroom

Natural

PASS

0

18

0%

23

46

ND

Clinical areas

ND

Corridor

ND

Unknown

8

8

100%

18

47

IW

Clinical areas

3Mild, ND for others

Ward, corridor, nurse station, and storage room

3 Negative pressure, ND for others

PASS, possible surface contamination

1

12

8%

24 Korean

48

IW and GW

Clinical areas

7 Mild and 1 asymptomatic

5 Anterooms, regardless of room type

ND

Unknown

0

20

0%

28

49

ICU entrance

Clinical areas

NA

NA

Natural

PASS

0

1

0%

9 Wuhan

50

ICU

Staff areas

NA

Changing, meeting, and dining rooms, warehouse

Natural and/or mechanical; small air purifier

FAIL

10

13

77%

12

51

IW

Staff areas

NA

Personal air sample

NA

Unknown

4

4

100%

11 Wuhan

52

ICU and GW

Staff areas

NA

Dressing rooms

NA

Unknown

0

36

0%

13

53

ND

Staff areas

NA

Staff and changing rooms

NA

Unknown

1

4

25%

10

54

ICU and IW

Staff areas

NA

Conference room and clean zone

2/3 With negative pressure

PASS

0

45

0%

19

55

ND

Staff areas

NA

Waste storage

Natural

PASS

0

2

0%

23 Milan, Italy

56

ND

Staff areas

NA

Changing and locker rooms

NA

Unknown

0

17

0%

29

57

ICU

Staff areas

NA

Changing room

Negative pressure

PASS

0

1

0%

9 Wuhan

58

NA

Public areas

NA

Pharmacy, hall, office, store, and supermarket

Mechanical, Natural, outdoor

FAIL

4

11

36%

12

59

NA

Public areas

NA

Hallway

ND

Unknown

8

12

67%

20

60

NA

Public areas

NA

Public area

ND

Unknown

0

6

0%

17 London

61

NA

Public areas

NA

Main entrance, toilet entrance, and lift area

ND

Unknown

2

3

67%

10

62

NA

Public areas

NA

Public area

ND

Unknown

0

9

0%

28

63

Hospital entrance

Public areas

NA

NA

Natural

PASS

0

1

0%

Notes:

Abbreviations

CPAP, continuous positive airway pressure; Ct, cycle threshold; ddPCR, droplet-digital polymerase chain reaction; GW, general ward; ICU, intensive care unit; IR, isolation room; IW, isolation ward; NA, not applicable; ND not detailed; NP, not performed; RT-PCR, reverse transcription–polymerase chain reaction; RT-qPCR, quantitative reverse transcription–polymerase chain reaction; SARS-CoV-2, severe acute respiratory syndrome coronavirus 2.

Ref

3. Ong SWX, Tan YK, Chia PY, et al. Air, surface environmental, and personal protective equipment contamination by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from a symptomatic patient. JAMA. 2020;323 (16):1610-1612. doi:10.1001/jama.2020.3227

8. Faridi S, Niazi S, Sadeghi K, et al. A field indoor air measurement of SARS-CoV-2 in the patient rooms of the largest hospital in Iran. Sci Total Environ. 2020;725:138401. doi:10.1016/j.scitotenv.2020.138401

9. Liu Y, Ning Z, Chen Y, et al. Aerodynamic analysis of SARS-CoV-2 in two Wuhan hospitals. Nature. 2020;582 (7813):557-560. doi:10.1038/s41586-020-2271-3

10. Li YH, Fan YZ, Jiang L,Wang HB. Aerosol and environmental surface monitoring for SARS-CoV-2 RNA in a designated hospital for severe COVID-19 patients. Epidemiol Infect. 2020;148:e154. doi:10.1017/ S0950268820001570

11. Guo Z-D,Wang Z-Y, Zhang S-F, et al. Aerosol and surface distribution of severe acute respiratory syndrome coronavirus 2 in hospital wards,Wuhan, China, 2020. Emerg Infect Dis. 2020;26(7):1583-1591. doi:10.3201/ eid2607.200885

12. Santarpia JL, Rivera DN, Herrera V, et al. Aerosol and surface transmission potential of SARS-CoV-2. medRxiv. Preprint published online June 3, 2020. doi:10.1101/2020.03.23.20039446

13. Santarpia JL, Herrera VL, Rivera DN, et al. The infectious nature of patient-generated SARS-CoV-2 aerosol. medRxiv. Preprint published online July 21, 2020. doi:10.1101/2020.07.13.20041632

14. Cheng VC-C,Wong S-C, Chan VW-M, et al. Air and environmental sampling for SARS-CoV-2 around hospitalized patients with coronavirus disease 2019 (COVID-19). Infect Control Hosp Epidemiol. 2020;41(11):1258-1265. doi:10. 1017/ice.2020.282

15. Wei L, Lin J, Duan X, et al. Asymptomatic COVID-19 patients can contaminate their surroundings: an environment sampling study. mSphere. 2020;5(3):e00442-20. doi:10.1128/mSphere.00442-20

16. Chia PY, Coleman KK, Tan YK, et al. Detection of air and surface contamination by SARS-CoV-2 in hospital rooms of infected patients. Nature Communications. 2020;11:2800. doi:10.1038/s41467-020-16670-2

17. Zhou J, Otter JA, Price JR, et al. Investigating SARS-CoV-2 surface and air contamination in an acute healthcare setting during the peak of the COVID-19 pandemic in London. Clin Infect Dis. 2020;ciaa905. doi:10.1093/cid/ ciaa905

18. Ding Z, Qian H, Xu B, et al. Toilets dominate environmental detection of SARS-CoV-2 virus in a hospital. medRxiv. Preprint published online April 7, 2020. doi:10.1101/2020.04.03.20052175

19. Zhou L, YaoM, Zhang X, et al. Detection of SARS-CoV-2 in exhaled breath from COVID-19 patients ready for hospital discharge. medRxiv. Preprint published online June 2, 2020. doi:10.1101/2020.05.31.20115196

20. Wu S,Wang Y, Jin X, Tian J, Liu J, Mao Y. Environmental contamination by SARS-CoV-2 in a designated hospital for coronavirus disease 2019. Am J Infect Control. 2020;48(8):910-914. doi:10.1016/j.ajic.2020.05.003

21. Cheng VCC,Wong S-C, Chen JHK, et al. Escalating infection control response to the rapidly evolving epidemiology of the coronavirus disease 2019 (COVID-19) due to SARS-CoV-2 in Hong Kong. Infect Control Hosp Epidemiol. 2020;41(5):493-498. doi:10.1017/ice.2020.58

22. Lei H, Ye F, Liu X, et al. SARS-CoV-2 environmental contamination associated with persistently infected COVID-19 patients. Influenza Other Respir Viruses. 2020;14(6):688-699. doi:10.1111/irv.12783

23. Razzini K, Castrica M, Menchetti L, et al. SARS-CoV-2 RNA detection in the air and on surfaces in the COVID-19 ward of a hospital in Milan, Italy. Sci Total Environ. 2020;742:140540. doi:10.1016/j.scitotenv.2020.140540

24. Kim UJ, Lee SY, Lee JY, et al. Air and environmental contamination caused by COVID-19 patients: a multi-center study. J Korean Med Sci. 2020;35(37):e332. doi:10.3346/jkms.2020.35.e332

25. Tan L, Ma B, Lai X, et al. Air and surface contamination by SARS-CoV-2 virus in a tertiary hospital in Wuhan, China. Int J Infect Dis. 2020;99:3-7. doi:10.1016/j.ijid.2020.07.027

26. Binder RA, Alarja NA, Robie ER, et al. Environmental and aerosolized severe acute respiratory syndrome coronavirus 2 among hospitalized coronavirus disease 2019 patients. J Infect Dis. 2020;222(11):1798-1806. doi:10. 1093/infdis/jiaa575

27. Ahn JY, An S, Sohn Y, et al. Environmental contamination in the isolation rooms of COVID-19 patients with severe pneumonia requiring mechanical ventilation or high-flow oxygen therapy. J Hosp Infect. 2020;106(3): 570-576. doi:10.1016/j.jhin.2020.08.014

28. Kenarkoohi A, Noorimotlagh Z, Falahi S, et al. Hospital indoor air quality monitoring for the detection of SARSCoV- 2 (COVID-19) virus. Sci Total Environ. 2020;748:141324. doi:10.1016/j.scitotenv.2020.141324

29. Jin T, Li J, Yang J, et al. SARS-CoV-2 presented in the air of an intensive care unit (ICU). Sustain Cities Soc. 2020;102446. doi:10.1016/j.scs.2020.102446

30. Lednicky JA, Lauzardo M, Fan ZH, et al. Viable SARS-CoV-2 in the air of a hospital room with COVID-19 patients. Int J Infect Dis. 2020;100:476-482. doi:10.1016/j.ijid.2020.09.025

The data is summarized as follows.

Test Results Number of Tests
PASS

24

FAIL

11

Unknown

23

FAIL, possible surface contamination

1

PASS, possible surface contamination

4

Total

63

The ventilation approaches that show a PASS or a FAIL indication are in the following table.

 PASS Ventilation Test Cases

FAILVentilation Test Cases

Ventilation Approach Result

1. Mechanical or Natural Mechanical, Natural, outdoor

FAIL

2. 12 Air supplies; 16 air discharges/h NA

PASS

3. Natural ventilation Natural ventilation

FAIL

4. Negative pressure Negative pressure

FAIL

5. Negative pressure and 12 air changes/h NA

PASS

6. 12 Air exchanges/h 12 Air changes/h

FAIL

6. 8 Air supplies; 12 air discharges/h NA

PASS

8. IR with 15 air changes/h; IR without negative pressure; room without negative air pressure NA

PASS

NA 9. 6 Air changes/h

FAIL

NA 10. No ventilation

FAIL

NA 11. Natural and/or mechanical; small air purifier

FAIL

Note: If a ventilation test case appeared in a failed test, even if it passed one or more test cases, it is marked as a failed ventilation approach result. It only takes 1 event for the failure condition.

This analysis represents 63 different operational tests of the ability of the COVID-19 virus to infect others within a physical space in a hospital settings. Many spaces have been characterized in terms of ventilation, but many spaces have no ventilation data. The data is inconsistent suggesting that there are multiple external elements affecting the results. A common test methodology applied across all the operational tests is needed to gain further insight into the affects of ventilation in an operational setting. Even with the inconsistencies it appears that the most effective ventilation approaches are:

Back to Virus Infection Testing Approaches

.

Empirical Data

In 2020 this systems research accessed various empirical data suggesting that the COVID-19 virus is airborne and that the airborne threat is significant such that it is the cause of this massive disaster. The research included various models of airborne contagions including the Well-Riley probability of infection for various living scenarios including small indoor spaces, large indoor spaces, and outside spaces. The analysis suggested that it is very unlikely to be infected outside but very likely to be infected in small indoor spaces with poor ventilation. The analysis matched the empirical data.

Once the numbers were disclosed, the public media started reporting on the need for ventilation. It is this research that used the term VENTILATION when contacting the press and other researchers. This was a difficult decision because there was a desired to ensure that the research was not rejected. Unfortunately, no one in positions of authority has publicly stated the needed ventilation rates (12+ ACH) or the proper mitigation approaches. This systems research in 2021 focused on showing the needed air changes per hour (ACH) or effective ACH (eACH) and the potential mitigation systems that will work.

The following is a summary of the empirical data that suggests COVID-19 is a serious airborne threat. [6]

Operational Settings

Year

Contact Tracing

Empirical Data

Comment
1. Airplanes & Airports

2020

Yes

R0 = 13.4, massive spikes after holiday travel There were 4 airplane studies.
2. Restaurant

2020

Yes

10 infected out of 83
3. Workplace

2020

Yes

94 infected out of 216 (43.5%)
4. Choir

2020

Yes

45 sick out of the 60, 2 died
5. Funeral

2020

Yes

4 cases Possible physical contact. This began a chain of events: Birthday Party, Personal Care, Church.
6. Birthday Party

2020

Yes

7 cases Possible physical contact. Started with a Funeral.
7. Personal Care

2020

Yes

3 cases Possible physical contact. Started with a Funeral.
8. Church

2020

Yes

4 cases Possible physical contact. Started with a Funeral.
9. Meat Packing Plants

2020

Yes

Facility shutdowns due to sick staff
10. Nursing Homes

2020

Yes

Extremely large loss of life
11. Ground Public Transportation (trains and subways)

2020

Yes

No cases This was used to correlate ventilation to infection. It is possible that as of 2021 there may be a small number of cases. Ground Public Transportation (trains and subways) systems have very large ventilation rates and people do not spend long periods of time in transport.
12. School Case History

2021

Yes

10 cases, 1 ACH This is key empirical data because it shows that 1 ACH leads to infection.
13. School Student and Staff Absence

2021

No

Massive levels of student and staff absence Omicron has become dominant. Even though statements are made that there is little infection happening in school settings, empirical data of the large number of student and teacher infections does not support the claims from school management / administration.

The above data is based on contact tracing that was performed in 2020 and 2021, except for operational setting13, School Student and Staff Absence. Because of the massive levels of absence, it is obvious that there is infection happening in the schools.

Back to Virus Infection Testing Approaches

.

Virus Infection Testing System Observations

Although there have been various assessments of air contamination in hospital settings by analyzing data [4], there does not appear to be any attempts to measure the COVID-19 virus under controlled conditions in real world room settings. For example, setup a virus gathering station in various parts of a hospital room while measuring temperature, humidity, and Air Changes Per hour (ACH) as part of a nation wide controlled study of hundreds of hospitals. There are only individual studies each with their own possible issues.

There have been no attempts to place infected people who have no need for hospitalization in test rooms while in quaranteen to understand the virus behavior in real world room sizes with various temperature, humidity, ACH, eACH, and mitigation technologies. If there is sufficient virus to infect people then there should be sufficient virus for instrumentation to measure the virus load. Such testing may answer key questions associated with clean air mitigation systems. This systems analysis was able to access a study from 1943 by the University of Pennsylvania when there was an attempt to determine the effects of ceiling level UV ventilation in classroom settings. [5]

The table following is a summary of the various testing approaches and Empirical data.

Test Approach and Emprical Data Date Key Observations Testing Type

Systems
Approach

Systems
Program

Goldberg Drums Testing

2020

Remaining virus is 40% and 50% - 90% after 30 minutes. Fundemental Research

No

No

University of Bristol Aerosol Testing

2022

Infectivity is 14% - 19% after 20 minutes. Fundemental Research

No

No

Operational Settings Testing

2020

The virus is airborne. An ACH 12+ appears to mitigate infection as long as the air is clean. Fundemental Research

No

No

Empirical Data

2020

The virus is airborne. Infection happens in schools with snall children with 1 ACH. Fundemental Research

No

No

Note: Remaining virus = Infectivity.

This whole area is being treated as a fundamental research project at the University levels that is more of a sandbox rather than a mission critical need. Unfortunately, this all needed to be a critical applied research and development program performed by a viable industrial base that should have been funded by the US Government in early 2020 as suggested by this systems research when legislation text was offered to begin such an effort. We properly funded and managed a systems based program that engaged the industrial base to go to the Moon but we did not fund and properly manage a systems based program to test and understand the COVID-19 virus or determine proper mitigation approaches that could be followed by a lost people. This is a direct result of stripping research and development labs from major corporations beginning in the 1980's and relegating all research activities as fundamental research to be performed at the University levels.

We do more rigorous testing of our:

  1. DOD Missile Defense Systems
  2. FAA Air Traffic Control Systems
  3. DOD Communications Systems

Each of the organizations engaged in the above testing activities could have easily established and managed an effective COVID-19 test and evaluation program that also could have addressed and provided proper mitigation requirements. The bottom line is that the approach should not have been a research project but a project that would solve the problem. In this case, develop a working system that would fully mitigate the virus and end the pandemic as quickly as possible.

Big Picture System Observation

Performing this analysis of Virus Infection Testing Approaches yields a big picture system observation.

It is clear that the market and extreme self-interest approach has hit a catastrophic brick wall much like it hits a brick wall in times of War or Revolution. So much for the realities of a deregulated and privatized government. The system instability introduced by this toxic behavior is yet to be felt across the world. The massive impacts of the COVID-19 disaster are coming and will last a generation or more. Only responsible engaged and accountable governments will be able to solve the problem.

The system perspective assessment of the situation - it's pathetic.

Back to Virus Infection Testing Approaches

References:

[1] Covid loses 90% of ability to infect within 20 minutes in air - study, The Guardian, 11 and 12 January 2022. Note: This article was amended on 11 and 12 January 2022. In an earlier version, we said Covid loses 90% of ability to infect within five minutes. It is actually within the first 20 minutes – with most of the loss occurring within the first 5 minutes. The article and headline have been corrected for clarity. The webpage link still contains five-minutes. webpage https://www.theguardian.com/world/2022/jan/11/covid-loses-90-of-ability-to-infect-within-five-minutes-in-air-study, January 2022. Covid loses 90% of ability to infect within 20 minutes in air - study.

[2] The Dynamics of SARS-CoV-2 Infectivity with Changes in Aerosol Microenvironment, MedRxiv Yale University, January 08, 2022. webpage https://www.medrxiv.org/content/10.1101/2022.01.08.22268944v1.full.pdf, January 2022. The Dynamics of SARS-CoV-2 Infectivity with Changes in Aerosol Microenvironment.

[2.1] N. van Doremalen, et al., Aerosol and surface stability of HCoV-19 (SARS-CoV-2) compared to SARS-CoV-1. medRxiv Prepr. Serv. Heal. Sci. (2020) https:/doi.org/10.1101/2020.03.09.20033217. webpage https://www.medrxiv.org/content/10.1101/2020.03.09.20033217v2.full-text, https://www.medrxiv.org/content/10.1101/2020.03.09.20033217v2.full.pdf, January 2022. Aerosol and surface stability of HCoV-19 (SARS-CoV-2) compared to SARS-CoV-1 . PDF.

[2.2] S. J. Smither, L. S. Eastaugh, J. S. Findlay, M. S. Lever, Experimental aerosol survival of SARS-CoV-2 in artificial saliva and tissue culture media at medium and high humidity. Emerg. Microbes Infect. 9, 1415–1417 (2020). webpage https://pubmed.ncbi.nlm.nih.gov/32496967, https://www.tandfonline.com/doi/full/10.1080/22221751.2020.1777906, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7473326/pdf/TEMI_9_1777906.pdf, January 2022. Experimental aerosol survival of SARS-CoV-2 in artificial saliva and tissue culture media at medium and high humidity . PDF.

[2.3] A. C. Fears, et al., Comparative dynamic aerosol efficiencies of three emergent coronaviruses and the unusual persistence of SARS-CoV-2 in aerosol suspensions. medRxiv 2 (2020). webpage https://www.medrxiv.org/content/10.1101/2020.04.13.20063784v1.full-text, https://www.medrxiv.org/content/10.1101/2020.04.13.20063784v1.full.pdf, January 2022. Comparative dynamic aerosol efficiencies of three emergent coronaviruses and the unusual persistence of SARS-CoV-2 in aerosol suspensions . PDF.

[2.4] M. Schuit, et al., Airborne SARS-CoV-2 is rapidly inactivated by simulated sunlight. J. Infect. Dis. 222, 564–571 (2020). webpage https://academic.oup.com/jid/article/222/4/564/5856149, January 2022. Airborne SARS-CoV-2 is rapidly inactivated by simulated sunlight.

[3] Bristol Aerosol Research Centre, webpage http://www.bristol.ac.uk/chemistry/research/barc, Jaurary 2022.

[4] Assessment of Air Contamination by SARS-CoV-2 in Hospital Settings, JAMA Network, December 23, 2020. webpage https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2774463, January 2022. Assessment of Air Contamination by SARS-CoV-2 in Hospital Settings . PDF.

[5] Air Disinfection in Day Schools, W.F. Wells Associate Professor in Research in Air-borne Infection, Laboratories for the Study of Air-borne Infection, the Department of Preventive Medicine and Public Health, University of Pennsylvania School of Medicine, Philadelphia, Pa. 1943. webpage https://ajph.aphapublications.org/doi/pdf/10.2105/AJPH.33.12.1436, November 2020. Air Disinfection in Day Schools . local

[6] COVID-19 A Systems Perspective, Walter Sobkiw, 2021, ISBN 9780983253044, hardback.

[7] Particle Suspension in a Rotating Drum Chamber When the Influence of Gravity and Rotation are Both Significant, Acrosol Science and Technology 17:263-277 (1992), Elsevier Science Puhlshing Co., Inc. webpage https://www.tandfonline.com/doi/pdf/10.1080/02786829208959575, https://doi.org/10.1080/02786829208959575, January 2021. Particle Suspension in a Rotating Drum Chamber When the Influence of Gravity and Rotation are Both Significant.

[8] Experimental Characterization of Aerosol Suspension in a Rotating Drum, Aerosol and Air Quality Research, 19: 688–697, 2019, Taiwan Association for Aerosol Research, ISSN: 1680-8584 print / 2071-1409 online doi: 10.4209/aaqr.2018.05.0174, 2019. webpage https://aaqr.org/articles/aaqr-18-05-oa-0174.pdf, January 2021. Experimental Characterization of Aerosol Suspension in a Rotating Drum.

back to TOC


.

Proposed Ventilation Test and Evaluation Program

This proposal is offered in the same spirit as the key document after World War II, Science the Endless Frontier from 1945 [1]. This set the US policy and tone for most of the last half of the previous century.

This proposed ventilation test and evaluation program is a direct result of the analysis performed in sections: A Paradigm Shift to Combat Indoor Respiratory Infection [2] and Virus Infection Testing Approaches. At the conclusion of the analysis, with the systems perspective of always trying to solve the problem, this systems approach surfaced.

Why is this Ventilation Test and Evaluation Program so critically needed?

All across the country facility managers have been asked to address their ventilation needs. However, all they are able to do is to comply with local codes typically driven by existing standards. Facility managers have found that old buildings from the 1920's, 30s, 40s, and 50s that were retrofitted in the past have great ventilation far surpassing modern buildings and existing standards. Recently sustainability requirements rolling out across the country are further restricting ventilation levels in buildings. [A] [B] Evidence suggests that it is possible that the recent rise in respiratory diseases may be a direct result of these massive engineering trends. Regardless, we now have COVID-19 and it appears that it will be endemic [5] and we must determine new ventilation rates that must be placed into new standards moving forward. There is no choice if we want to avoid sickness and death.

A PROGRAM FOR ACTION

In 2020 this research proposed a Ventilation Test and Evaluation effort and offered Legislation Text that would establish a program for Virus Mitigation Solution Based Programs to enable a reasonable return to life scenario. It did not happen, although the legislation text for allocating a minimum of $110 billion dollars to fund the upgrade of all public schools was included in legislation in 2021 with a slight increase in funding. Unfortunately the funds are being misspent on the wrong products and technologies and the facility managers are still restricted by the old standards that do not effectively mitigate airborne contagions. This year (2022) additional legislation was proposed, Building Clean Air Act Proposed Legislation, that is also being ignored.

The following is a proposed test and evaluation program that would perform testing of airborne contagions using operational room settings that physically represent the real world as closely as possible. The purpose of the testing is to examine various virus mitigation approaches and quantify the results in the same way that the results are quantified for Goldberg Drum and other test approaches except, once again, the testing would use real world operational rooms and settings.

The intent is for the US Federal Government to step up and perform these and similar tests and then make the data publicly available so that the industrial base can properly respond to the reality that COVD-19 will become endemic [5] and that airborne contagions in general are becoming more of a problem in this new century. This is a massive program and must be respected in the same way as other massive government programs after World War II. Most people can relate to the Moon Shot, but there were many other similar programs that only the US Government could establish, run, and then allow for the critical needs to be satisfied in the last half of the last century.

Although the focus is the USA, all other countries must step up to the challenge and establish similar programs.

.

Technical Roadmap

.

Test Approach

The test and evaluation approach is to continuously release virus or simulated virus into a test room with sufficient levels so that test instrumentation is able to gather data and develop results. This is contrary to most other testing where a space is subjected to virus for a short period of time (step function) and then decay rates and aerosol cloud paths are observed. The continuous release of virus represents a real world operational setting. For background, especially test equipment, see sections: Virus Infection Testing Approaches and Other Test Activities on how this can be accomplished.

A key element in the testing platform is the mechanism used to detect COVID-19 virus levels.

The current approaches to detect virus are PCR (from 1988), ddPCR (from 1999) [3], and a relatively new approach targeted to future consumers is the Fresh Air Clip (2021) from Yale University [4]. All these approaches are not real time and still require lab processing but they work.

Most of the testing can be performed using simulated virus aerosols and particle detectors, see section Other Test Activities. Using simulated virus allows for real time test data reporting and they are safe making the test and evaluation activity easier to implement. However, this approach can only be used with mechanical and natural ventilation systems.

The intent is to establish a set of standard tests that can be consistently performed across all operational settings. Each test will measure the virus load as a function of time in various locations in a room and report the minimum, maximum, and average virus load readings in a summary table. The details are reported within the body of the test report.

The new ventilation standard will use ACH or eACH rather than cfm/person, L/s per person, cfm/sq-ft, or L/s per sq-m because the cfm/person approach (1) requires occupancy levels and room size assumptions and (2) it is impossible to visualize and compare the performance of the ventilation systems across room sizes and operational scenarios with various occupancy levels. The following is an example from ASHRAE [6]:

Classrooms (ages 5-8), 25 persons, 1000 sq-ft, 15 CFM, there is no ceiling level but lets assume 10 feet
ACH = (15 CFM * 25 people * 60 minutes) / 1000 sq-ft * 10 ft = 2.25

The ACH value (ACH = 2.25) is a common performance number that applies to all rooms regardless of occupancy level or room sizes. It is also the performance number needed to understand how quickly a contagion is evacuated from a room. For example, the CDC recommendation for hospital room contagions is 12+ ACH. The 15 CFM per person number has no meaning, it is an irrelevant system performance number. It does come into consideration when avoiding CO2 poisoning but by the time the ventilation level drops to just avoiding CO2 poisoning, the system performance from a clean air perspective is unacceptable. It should be noted that this analysis identified that the respiration rate for an adult male is 12+ CFM, but the ASHRAE standard [6] has some rooms at 5 CFM per person.

There are test parameters that must be consistently applied across all the testing activities so that the data can be easily compared across all the standard tests. These parameters are time, virus load at source rate, virus load at measured location, and ACH levels. The standard tests using the common set of parameters are used to calculate the Virus Level (percentage) which is the ratio between the virus load at a measure location and the virus load at the source and it is calculated as follows:

Virus Level (ACH) = virus load at measured location (ta) / virus load at source (tb)

Virus Level is reported in a table as a function of ACH and time
ACH = measured level 0, 1, 4, 6, 12, 20, 24
ta = data gathering time 10, 30, 60, 120, 240 min
tb = ta (condition 1)
tb = 1 min (condition 2)
virus load = virus count = particle count
virus load at measured location = multiple sensors should be distributed throughout the space and reported as min, max, and avg
virus load at source = continuous during the entire test time (e.g. 4 hours) using an assumed infection load of 1200 particles / min or 12,000, 120,000, 1,200,000

This will provide a performance level for the ventilation system by capturing the ability for the ventilation system to keep up with the continuous virus entry into the space. At some point the ventilation system will be unable to keep up with the virus load source and the virus load at any measured location will start to approach the virus load at the source and exceed the virus load at source (1 min) leading to an unstable system with a positive feedback loop. For example, this will happen very quickly in a small space when the ACH = 0 but in a large space it may not happen even after 4 hours. This testing can be performed using particles that simulate the virus or contagion.

For technologies that use other approaches to mitigate the virus or contagions, such as ceiling level UV-C, FAR UV-222, PCO systems, etc., the testing must use live virus or contagions. The same performance level measurement and units must be used to allow for comparison with mechanical ventilation approaches.

Virus Level (eACH) = virus load at measured location (ta) / virus load at source (tb)

Virus Level is reported in a table as a function of ACH and time
ACH = measured level 0, 1, 4, 6, 12, 20, 24
ta = data gathering time 10, 30, 60, 120, 240 min
tb = ta (condition 1)
tb = 1 min (condition 2)
virus load = virus count = particle count
virus load at measured location = multiple sensors should be distributed throughout the space and reported as min, max, and avg
virus load at source = continuous during the entire test time (e.g. 4 hours) using an assumed infection load of 1200 particles / min or 12,000, 120,000, 1,200,000

Many ventilation systems are on demand systems and the ACH level is available only when the system is on to maintain either heat or cooling temperatures. Most of these systems have a fan option but few people will turn on the fan option especially in public spaces like community club houses. The testing must be performed for both of these system conditions. For example, an on demand system with 6 ACH when it is running will cycle on for 10 minutes then off for 20 minutes. As a result the average ACH drops to 3 ACH but during a 20 minute window the ACH = 0. This can be reported using AVGpk, AVGavg, and AVG0. In other instances ACHavg = ACHpk because the system is always on (e.g. large grocery store).

The source virus load needed to infect is assumed to be 1200 particles / min. This number is in not fully understood and varies significantly in the body of knowledge. [7] However, when trying to determine the performance of the ventilation system using the Virus Level calculation, this number is somewhat irrelevant. We are not trying to determine at what point someone will become infected, instead we are trying to determine the virus load remaining as the ventilation system is performing its function of cleaning the air. Testing can include changing this number as part of a sensitivity analysis to determine if there is a large shift in the performance of ventilation systems as the virus load at the source changes. The current mental model suggests that the changes should be minimal, but we will not know until the testing is performed. The reason 1200 particles / min is offered as the starting point is because all the modeling performed in this systems analysis in 2020 used that number to determine the probability of infection across different physical spaces and living scenarios. [8] It should be noted that 1200 particles / min may not exceed the particle noise floor in a space so it is suggested that the number be increase by 10, 100, or 1000 times to allow for quick comparisons with previous analysis in 2020.

This test is different from other tests not only because operational settings are being used but also because the virus source load is releasing particles for the entire length of the test (e.g. 4 hours). This is in contrast to other tests were the virus source load is on for a brief period of time (e.g. 2 minutes) and then a time is offered for when the virus is reduced to 99.x%. This number is irrelevant as a system performance level. It is only meant to suggest that something good is happening, however in the real world the virus source load does not go away in 2 minutes, it is present in the space for 10, 30, 60, 120, 240 min, etc.

The starting point for the analysis can be the findings for when tb = ta. This is a reasonable assessment for the conditions of high ventilation rates. For very low ventilation rates tb is set to 1 minute because that is the virus load at the source in 1 minute and it is a sufficient infection load. Once the data is collected, then an assessment of relative infection risk can be performed. The lower the Virus Level percentage the lower the Infection Risk. If the Virus Level is 1%, this suggests that the ventilation system has removed 99% of the contagion, but it is derived from a continuous virus source in a real operational setting. The challenge will then be to put a stake in the ground for what is an acceptable Infection Risk (1%, 0.1% etc) and that will indicate the new ACH standard.

Infection Risk = Virus Level (reported as a percentage)

The following is an example mental model of test results for a sensor next to the virus load source. Sensors further away from the virus load are expected to be smaller. However, we really will not know the actual numbers until the testing is performed. We may find that 6 ACH is fine for a classroom and 4 ACH is fine for a big box store while a doctors waiting room needs to be 12 ACH. Each of these scenarios have different room sizes and the virus will have different dilution characteristics.

[spreadsheet VentAlt]
Mental Model of Possible Test Results
Operational Test

Ventilation

Virus Level
(10 min) c.

Virus Level
(30 min) c.

Virus Level
(60 min) b.

Virus Level
(2 hrs) b.

Virus Level
(4 hrs) b.

Standard Test x A0 0 ACH d.

100%

100%

100%

100%

100%

Standard Test x A1 1 ACH a.

17%

50%

100%

100%

100%

Standard Test x A4 4 ACH

4%

13%

25%

25%

25%

Standard Test x A6 6 ACH

3%

8%

17%

17%

17%

Standard Test x A12 12 ACH

1.4%

4%

8%

8%

8%

Standard Test x A20 20 ACH

0.8%

2.5%

5%

5%

5%

Standard Test x A24 24 ACH

0.7%

2%

4%

4%

4%

Notes:
a. Case history shows infection happens at this level, see section School Case History.
b. virus level = 100% virus/ACH = 1/ACH for time >= 60 min.
c. virus level = virus level at 60 min * time / 60 for virus < 60 min.
d. This is all on demand systems when the system is OFF.  Many systems are on demand, the fans must be turned ON or infection will happen when the system is OFF. This becomes operational test case ACH = 0 regardless of the ACH level when the system is ON. For example a 12 ACH on demand system is treated like a 0 ACH system unless there are locks to prevent the fans from being disabled and alarms that are activated if the locks are penetrated. See section Building Contagion Mitigation Certification (BCMC) Tool. The worst case scenario must be used.

This is all part of future analysis and will be performed to determine new ventilation standards. Enforcing the new standards is a social problem, but with the establishment of new standards the documented evidence of what must be done will significantly remove barriers to acceptance and eventual enforcement of the standards. However, without the new standards derived from standard tests there is no coherent consistent documented evidence to justify action on the part of policy makers. Random tests from academia and others are irrelevant.

.

Test Templates

The proposed tests are as follows. Some of the tests will be used to establish new standards and some of the test will be used to understand facilities, products, and technologies. [spreadsheet Test Templates]

At the end of the proposed tests section is a section proposing the organization, staffing levels, and costs.

The following is a set of proposed standard tests with a nomenclature to quickly identify the standard operational test type and key test conditions.

Classroom Testing

Room Size: 30 X 30 X 12 feet = 10,800 cu-ft

Test Location(s): Any school district, College or University, CDC
Responsible Organization: Any school district, College or University, CDC
Conversion to the new standards: NIST
Key reference documents that must be included in test procedures and reports: A Paradigm Shift to Combat Indoor Respiratory Infection [2]
Pre-Test Notes: Small children classroom case history suggests infection happens at 1 ACH. Hospital conditions with PPE suggests 12+ ACH prevents infection.

Operational Test Ventilation

Virus Level
(10 min)

Virus Level
(30 min)

Virus Level
(60 min)

Virus Level
(2 hrs)

Virus Level
(4 hrs)

Standard Test CR A0 0 ACH min, max, avg
Standard Test CR A1 1 ACH
Standard Test CR A4 4 ACH
Standard Test CR A6 6 ACH
Standard Test CR A12 12 ACH
Standard Test CR A20 20 ACH
Standard Test CR A24 24 ACH
Standard Test CR NV Natural Ventilation
.
Standard Test CR A0-e10 0 ACH & Ceiling Level UV-C eAUC = 10
Standard Test CR A0-e20 0 ACH & Ceiling Level UV-C eAUC = 20
Standard Test CR A1-e10 1 ACH & Ceiling Level UV-C eAUC = 10
Standard Test CR A1-e20 1 ACH & Ceiling Level UV-C eAUC = 20
Standard Test CR A4-e10 4 ACH & Ceiling Level UV-C eAUC = 10
Standard Test CR A4-e20 4 ACH & Ceiling Level UV-C eAUC = 20
.
Standard Test CR A0-1RS300 0 ACH & 1 room sanitizer 300 CFM
Standard Test CR A0-1RS500 0 ACH & 1 room sanitizer 500 CFM
Standard Test CR A1-1RS300 1 ACH & 1 room sanitizer 300 CFM
Standard Test CR A1-1RS500 1 ACH & 1 room sanitizer 500 CFM
.
Standard Test CR A0-P1 Proposed products 1
Standard Test CR A0-P2 Proposed products n

Public Building Testing - Small Space

Room Size: 30 X 30 X 12 feet = 10,800 cu-ft

Test Location(s): CDC
Responsible Organization: CDC
Conversion to the new standards: NIST
Key reference documents that must be included in test procedures and reports: A Paradigm Shift to Combat Indoor Respiratory Infection [2]
Pre-Test Notes: Small children classroom case history suggests infection happens at 1 ACH. Hospital conditions with PPE suggests 12+ ACH prevents infection.

Operational Test Ventilation

Virus Level
(10 min)

Virus Level
(30 min)

Virus Level
(60 min)

Virus Level
(2 hrs)

Virus Level
(4 hrs)

Standard Test BSS A0 0 ACH min, max, avg
Standard Test BSS A1 1 ACH
Standard Test BSS A4 4 ACH
Standard Test BSS A6 6 ACH
Standard Test BSS A12 12 ACH
Standard Test BSS A20 20 ACH
Standard Test BSS A24 24 ACH
Standard Test BSS NV Natural Ventilation
.
Standard Test BSS A0-e10 0 ACH & Ceiling Level UV-C eAUC = 10
Standard Test BSS A0-e20 0 ACH & Ceiling Level UV-C eAUC = 20
Standard Test BSS A1-e10 1 ACH & Ceiling Level UV-C eAUC = 10
Standard Test BSS A1-e20 1 ACH & Ceiling Level UV-C eAUC = 20
Standard Test BSS A4-e10 4 ACH & Ceiling Level UV-C eAUC = 10
Standard Test BSS A4-e20 4 ACH & Ceiling Level UV-C eAUC = 20
.
Standard Test BSS A0-1RS300 0 ACH & 1 room sanitizer 300 CFM
Standard Test BSS A0-1RS500 0 ACH & 1 room sanitizer 500 CFM
Standard Test BSS A1-1RS300 1 ACH & 1 room sanitizer 300 CFM
Standard Test BSS A1-1RS500 1 ACH & 1 room sanitizer 500 CFM
.
Standard Test BSS A0-P1 Proposed products 1
Standard Test BSS A0-P2 Proposed products n

Public Building Testing - Large Space

Room Size: 100 X 100 X 40 = 400,000

Test Location(s): CDC, private companies, individual government entities with similar facilities
Responsible Organization: CDC, private companies, individual government entities with similar facilities
Conversion to the new standards: NIST
Key reference documents that must be included in test procedures and reports: A Paradigm Shift to Combat Indoor Respiratory Infection [2]
Pre-Test Notes: Small children classroom case history suggests infection happens at 1 ACH. Hospital conditions with PPE suggests 12+ ACH prevents infection.

Operational Test Ventilation

Virus Level
(10 min)

Virus Level
(30 min)

Virus Level
(60 min)

Virus Level
(2 hrs)

Virus Level
(4 hrs)

Standard Test BLS A0 0 ACH min, max, avg
Standard Test BLS A1 1 ACH
Standard Test BLS A4 4 ACH
Standard Test BLS A6 6 ACH
Standard Test BLS A12 12 ACH
Standard Test BLS A20 20 ACH
Standard Test BLS A24 24 ACH
Standard Test BLS NV Natural Ventilation
.
Standard Test BLS A0-e10 0 ACH & Ceiling Level UV-C eAUC = 10
Standard Test BLS A0-e20 0 ACH & Ceiling Level UV-C eAUC = 20
Standard Test BLS A1-e10 1 ACH & Ceiling Level UV-C eAUC = 10
Standard Test BLS A1-e20 1 ACH & Ceiling Level UV-C eAUC = 20
Standard Test BLS A4-e10 4 ACH & Ceiling Level UV-C eAUC = 10
Standard Test BLS A4-e20 4 ACH & Ceiling Level UV-C eAUC = 20
.
Standard Test BLS A0-1RS300 0 ACH & 1 room sanitizer 300 CFM
Standard Test BLS A0-1RS500 0 ACH & 1 room sanitizer 500 CFM
Standard Test BLS A1-1RS300 1 ACH & 1 room sanitizer 300 CFM
Standard Test BLS A1-1RS500 1 ACH & 1 room sanitizer 500 CFM
.
Standard Test BLS A0-P1 Proposed products 1
Standard Test BLS A0-P2 Proposed products n

Custom Test - Home Owners Association Clubhouse

This test is performed for the pre and post mitigation upgrades. To avoid confusion two separate test logs must be produced. One test log is for the situation before any contagion mitigations and one is for the post mitigations virus levels. This is a pattern that can be used for all other public buildings such as elder care facilities.

Test Location(s): Actual home owners association clubhouse
Responsible Organization: Home Owners Association Organization entity
Key reference documents that must be included in test procedures and reports: A Paradigm Shift to Combat Indoor Respiratory Infection [2]
Pre-Test Notes: Small children classroom case history suggests infection happens at 1 ACH. Hospital conditions with PPE suggests 12+ ACH prevents infection.

Approach: Let CDC teams go out and oversee or perform the needed tests for free based on requests from the Home Owners Association Organization.

Test Log 1: Pre Mitigation

Pre Mitigation
Operational Test

Room Size
(cu-ft)

Pre Mitigation
Measured Ventilation
(ACH and or eACH)

Virus Level
(10 min)

Virus Level
(30 min)

Virus Level
(60 min)

Virus Level
(2 hrs)

Virus Level
(4 hrs)

Room 1 min, max, avg
Room 2
Room n

Test Log 2: Post Mitigation

Post Mitigation
Operational Test

Room Size
(cu-ft)

Post Mitigation
Measured Ventilation
(ACH and or eACH)

Virus Level
(10 min)

Virus Level
(30 min)

Virus Level
(60 min)

Virus Level
(2 hrs)

Virus Level
(4 hrs)

Room 1 min, max, avg
Room 2
Room n

Airport TSA, Ticket, and Gate Areas Testing, and FAA Facilities

This test is performed for the pre and post mitigation upgrades. To avoid confusion two separate test logs must be produced. One test log is for the situation before any contagion mitigations and one is for the post mitigations virus levels. The FAA has a challenge because many airports operate 24/7/365, however there are airports that shutdown after midnight like ACY and there are airports whose terminals have little activity during the midnight shift that can be closed off to perform the tests in a 4 to 6 hour window. The FAA can expand their test and evaluation program to include testing all their facilities including: TRACONS, Towers, EnRoute Centers, Lab Facilities, Administrative Facilities. This will provide a wealth of information to the rest of the world because of the diversity of the FAA facilities.

Test Location(s): All US Airports
Responsible Organization: FAA
Conversion to the new standards: NIST
Key reference documents that must be included in test procedures and reports: A Paradigm Shift to Combat Indoor Respiratory Infection [2]
Pre-Test Notes: Small children classroom case history suggests infection happens at 1 ACH. Hospital conditions with PPE suggests 12+ ACH prevents infection.

Test Log 1: Pre Mitigation

Pre Mitigation
Operational Test

Area Size
(cu-ft)

Pre Mitigation
Measured Ventilation
(ACH and or eACH)

Virus Level
(10 min)

Virus Level
(30 min)

Virus Level
(60 min)

Virus Level
(2 hrs)

Virus Level
(4 hrs)

Airport 1 Ticket Area 1 min, max, avg
Airport 1 TSA Area 1
Airport 1 Gate Area 1
Airport 1 Ticket Area n
Airport 1 TSA Area n
Airport 1 Gate Area n
Airport n

Test Log 2: Post Mitigation

Post Mitigation
Operational Test

Area Size
(cu-ft)

Post Mitigation
Measured Ventilation
(ACH and or eACH)

Virus Level
(10 min)

Virus Level
(30 min)

Virus Level
(60 min)

Virus Level
(2 hrs)

Virus Level
(4 hrs)

Airport 1 Ticket Area 1 min, max, avg
Airport 1 TSA Area 1
Airport 1 Gate Area 1
Airport 1 Ticket Area n
Airport 1 TSA Area n
Airport 1 Gate Area n
Airport n

Airplane Cabin Testing

This test is performed for the pre and post mitigation upgrades. To avoid confusion two separate test logs must be produced. One test log is for the situation before any contagion mitigations and one is for the post mitigations virus levels.

Test Location(s): William J. Hughes Technical Center
Responsible Organization: FAA
Conversion to the new standards: NIST
Key reference documents that must be included in test procedures and reports: A Paradigm Shift to Combat Indoor Respiratory Infection [2]
Pre-Test Notes: Small children classroom case history suggests infection happens at 1 ACH. Hospital conditions with PPE suggests 12+ ACH prevents infection.

Test Log 1: Pre Mitigation

Pre Mitigation
Operational Test

Cabin Size
(cu-ft)

Pre Mitigation
Measured Ventilation
(ACH and or eACH)

Virus Level
(10 min)

Virus Level
(30 min)

Virus Level
(60 min)

Virus Level
(2 hrs)

Virus Level
(4 hrs)

Air Frame 1 min, max, avg
Air Frame 2
Air Frame n

Test Log 2: Post Mitigation

Post Mitigation
Operational Test

Cabin Size
(cu-ft)

Post Mitigation
Measured Ventilation
(ACH and or eACH)

Virus Level
(10 min)

Virus Level
(30 min)

Virus Level
(60 min)

Virus Level
(2 hrs)

Virus Level
(4 hrs)

Air Frame 1 min, max, avg
Air Frame 2
Air Frame n

The above test templates are the minimum set of data that must be captured and reported. The format should be the same so that easy comparisons can be made across all facility settings and scenarios. The body of the test reports should contain all the supporting data. They also may contain additional data and other tables as needed. The key is to report the data in a way that anyones grand parents can understand the results.

.

Possible Test Results and New Standards

The following is an example mental model of test results for a sensor next to the virus load source. Sensors further away from the virus load are expected to be smaller. However, we really will not know the actual numbers until the testing is performed. We may find that 6 ACH is fine for a classroom and 4 ACH is fine for a big box store while a doctors waiting room needs to be 12 ACH. Each of these scenarios have different room sizes and the virus will have different dilution characteristics.

[spreadsheet VentAlt]
Mental Model of Possible Test Results
Operational Test

Ventilation

Virus Level
(10 min) c.

Virus Level
(30 min) c.

Virus Level
(60 min) b.

Virus Level
(2 hrs) b.

Virus Level
(4 hrs) b.

Standard Test x A0 0 ACH d.

100%

100%

100%

100%

100%

Standard Test x A1 1 ACH a.

17%

50%

100%

100%

100%

Standard Test x A4 4 ACH

4%

13%

25%

25%

25%

Standard Test x A6 6 ACH

3%

8%

17%

17%

17%

Standard Test x A12 12 ACH

1.4%

4%

8%

8%

8%

Standard Test x A20 20 ACH

0.8%

2.5%

5%

5%

5%

Standard Test x A24 24 ACH

0.7%

2%

4%

4%

4%

Notes:
a. Case history shows infection happens at this level, see section School Case History.
b. virus level = 100% virus/ACH = 1/ACH for time >= 60 min.
c. virus level = virus level at 60 min * time / 60 for virus < 60 min.
d. This is all on demand systems when the system is OFF.  Many systems are on demand, the fans must be turned ON or infection will happen when the system is OFF. This becomes operational test case ACH = 0 regardless of the ACH level when the system is ON. For example a 12 ACH on demand system is treated like a 0 ACH system unless there are locks to prevent the fans from being disabled and alarms that are activated if the locks are penetrated. See section Building Contagion Mitigation Certification (BCMC) Tool. The worst case scenario must be used.

The above mental model the Virus Level as a percentage is equal to 1/ACH and then modifies the number based on when we know infection happens and what may happen for times less than 60 minutes.

The following is a mental model of the possible room dilution effects when the ACH is equal to zero and the room size is irrelevant because the aerosol travels as a cloud. As the aerosol cloud naturally disperses the density decreases. The cloud density is largest closest to the virus source and smallest when furthest away from the virus source. We know that classroom infection happens in 60 minutes, a typical classroom session. This suggests that the Virus Count of 80 is when infection wll happen. The Virus Level is calculated using this key number and the following equation described in the Test Approach section:

Virus Level (ACH or eACH) = virus load at measured location (ta) / virus load at source (tb)

Virus Level is reported in a table as a function of ACH and time
ACH = measured level 0, 1, 4, 6, 12, 20, 24
ta = data gathering time 10, 30, 60, 120, 240 min
tb = ta (condition 1)
tb = 1 min (condition 2)
virus load = virus count = particle count
virus load at measured location = multiple sensors should be distributed throughout the space and reported as min, max, and avg
virus load at source = continuous during the entire test time (e.g. 4 hours) using an assumed infection load of 1200 particles / min or 12,000, 120,000, 1,200,000

[spreadsheet VentAlt]
Aerosol Mental model #1 traveling cloud ACH = 0

Operational Test

Space
cu-ft b.

Sensor
distance
(sd) (ft)

Aerosol
cloud cu-ft d.

Particles / min

Particle Count
(1 min)
c.

Particle Count
(10 min)
c.

Particle Count
(30 min)
c.

Particle Count
(60 min)
c.

Particle Count
(2 hrs)
c.

Particle Count
(4 hrs)
c.

virus load at source

na



1,200

1,200

12,000

36,000

72,000

144,000

288,000

virus load at measured location (sd)

na

30

900

na

1

13

40

80 a.

160

320

virus load at measured location (sd)

na

10

100

na

12

120

360

720

1,440

2,880

virus load at measured location (sd)

na

6

36

na

33

333

1,000

2,000

4,000

8,000

virus load at measured location (sd)

na

2

4

na

300

3,000

9,000

18,000

36,000

72,000

virus load at measured location (sd)

na

1

1

na

1,200

12,000

36,000

72,000

144,000

288,000

Notes:
a. Classroom infection happens in 60 minutes with ACH = 1, based on emperical data
b. space size is not a factor in cloud dilution for this model of a traveling cloud
c. The virus load = virus count = particle count
d. The aerosol cloud density is calculated as (sd*sd/4)*4 ft

The Particle Count (or virus count) when infection happens can be found from emperical data and that number is 80. This Count can then be used to calculate the Virus Level (0):

Virus Level (0) = 80/1200 = 0.0667 = 6.67%

The ventilation system must maintain less than 6.67% as a performance level of remaining contagions at all times. This is a key number because it can be located in the table of the Mental Model of Possible Test Results above to find the resulting ACH Level and in this case the ACH = 12+. It can be directly calculated as follows:

ACH = 1/Virus Level (0) = 1/0.0667 = 15 ACH

The following table is a mental model of an aerosol being fully dispersed in a space after 10+ minutes and 2+ feet away from the source.

[spreadsheet VentAlt]
Aeosol Mental model #2 uniform distribution in space ACH = 0

Operational Test

Space
cu-ft

Sensor
distance
(sd) (ft)

Aerosol
cloud cu-ft d.

Particles / min

Particle Count
(1 min)
c.

Particle Count
(10 min)
c.

Particle Count
(30 min)
c.

Particle Count
(60 min)
c.

Particle Count
(2 hrs)
c.

Particle Count
(4 hrs)
c.

virus load at source

na



1,200

1,200

12,000

36,000

72,000

144,000

288,000

virus load at measured location (sd)

10,800 e.

30

900

na

0

1 e.

3 e.

7 e.

13 e.

27 e.

virus load at measured location (sd)

10,800 e.

10

100

na

12

1 e.

3 e.

7 e.

13 e.

27 e.

virus load at measured location (sd)

10,800 e.

6

36

na

33

1 e.

3 e.

7 e.

13 e.

27 e.

virus load at measured location (sd)

na

2

4

na

300

3,000

9,000

18,000

36,000

300

virus load at measured location (sd)

na

1

1

na

1,200

12,000

36,000

72,000

144,000

1,200

Notes:
a. Classroom infection happens in 60 minutes with ACH = 1, based on emperical data
b. space size is not a factor in cloud dilution for this model of a traveling cloud
c. The virus load = virus count = particle count
d. The aerosol cloud density is calculated as (sd*sd/4)*4 ft
e. cloud is fully dispersed in space at 10+ min and 2+ ft

The Particle Count (or virus count) when infection happens can be found from emperical data and that number is 7. This Count can then be used to calculate the Virus Level (0):

Virus Level (0) = 7/1200 = 0.0056 = 0.56%

The ventilation system must maintain less than 0.56% as a performance level of remaining contagions at all times. This is a key number because it can be located in the table of the Mental Model of Possible Test Results above to find the resulting ACH Level and in this case the ACH = 24++. It can be directly calculated as follows:

ACH = 1/Virus Level (0) = 1/0.0056 = 179 ACH

This does not match emperical data of when infection happens and when infection tends to be mitigated. This suggests that aerosols do not fully dilute in the physical space.

MIL-STD-1472 does address ventilation. For a small space of 150 cu-ft the required ventilation is 30 CFM. As the space size increases the CFM level drops such that the resulting ACH level drops. The possible reason for these numbers may have to do with the need to protect against non-aerosol airborne contagions. As the space increases the non-aerosol airborne contagion is less of a threat. This is based on the past history that there were few aerosol based contagions. The threat was measles and tuberculosis not COVID-19.

ACH = 30 CFM * 60 minutes / 150 cu-ft = 12 ACH

The number keeps circling around the 12 ACH level. If that is the case, then the standards should be updated so that the infrastructure can be updated and certified at each location as quickly as possible. The test program may not be as large and complex as we may think, but we won/'t know until the testing to develop new ventilation standards is started.

There are multiple technologies that can reach this ACH level with reasonable costs that are identified and discussed in this analysis.

The city of Philadelphia Restaurant program used the following standards. [9] [10]

Enhanced Ventilation Standards for Indoor Dining and Application Form for Increased Dining Capacity

Standards

.

Organization Staffing Levels and Costs

The US Government organizations that must be involved are the CDC, NIST, and the FAA. If a test and evaluation program is not established to deal with the COVID-19 disaster the human and financial costs will be enormous as described in various parts of this analysis. Other governments from around the world have an equal responsibility to establish their own ventilation test and evaluation programs.

The Federal Government must establish a lab where new ventilation products can be tested and quantified from a virus mitigation level so that proper engineering can be performed. In the past this has been the identification of the ACH and or eACH. This may be the approach moving forward. The products may include the following technologies: Mechanical, Various UV while people are present in the space, Ionizers, Electrostatic, Destructive Heat, other. As time moves forward some of the technologies may show to be just as effective as mechanical ventilation but will use significantly less energy satisfying sustainability needs while minimizing costs, see section Ventilation Products Testing and Cost Tradeoffs. We won't know unless we do the tests. Alternatively, we could wait 50 years for the market to possibly make the choices.

So what should the organization look like? There always needs to be starting point and this is it.

MITRE

FAA

CDC

NIST

This is an engineering and scientific intensive activity.

It is anticipated the it will take 2-3 years to fully complete all the needed test and evaluation efforts and convert the findings to new standards. It is expected that results will start to roll out for the highest risk settings like schools within 6 months of the start of the program. Once the initial task of updating all the standards is complete the next phase is anticipated to be a sustainment effort to monitor the standards and to continuously test and evaluate new products and systems. The program could be expected to roll down to a 25% level once fully in sustainment mode.

The total estimate is approximately 960 staff + ~10% overhead for management and administration = 1,100 for 3 years with an expected personnel cost of ~$250 million per year. Facilities, equipment, travel, and contract support costs are unknown but $250 million is a possible starting point. The total program cost is estimated as follows:

Year

Costs
(millions)

1 - 2022

$500

2 - 2023

$500

3 - 2024

$250

Total

$1,250

.
Sustainment Years (per year)

$125

These costs are similar to the costs proposed in the Legislation Text in 2020 to stand up such a capability. It should be noted that organizations are currently engaged in these activities with massive costs being applied but the efforts are unfocused and not drilling down to working system solutions. The proposed organized system solution would redirect these costs and add additional funds as needed to:

  1. Determine virus levels as a function of ACH / eACH and time in various operational settings
  2. Put a stake in the ground and provide ACH / eACH levels to be moved into existing and or new standards
  3. Subject various ventilation approaches to tests and determine the power levels so that reasonable tradeoffs can be made
  4. Provide all the findings to the industrial base including assessing facilities based on requests

Once again, although the focus is the USA, all other countries must step up to the challenge and establish similar programs.

In systems engineering this is called a strawman approach. It is expected that engineers, scientists, and policy makers will convert this into an ironman approach and then a stoneman approach. The implication is that nothing can take down the stoneman approach. It is as close to perfect as our technologies and capabilities will permit. In systems based approaches a strawman is never ignored or burned down unless a better alternative is offered but ignoring the problem is not a viable alternative.

References:

[1] Science The Endless Frontier, US Government Office of Scientific Research and Development, United States Government Printing Office, Washington: 1945. webpage https://www.nsf.gov/od/lpa/nsf50/vbush1945.htm, November 2020. Science The Endless Frontier . local

[2] A Paradigm Shift to Combat Indoor Respiratory Infection, University of LEEDS, White Rose Research Online, published 14 May 2021, online August 27, 2021. webpage https://eprints.whiterose.ac.uk/177405/3/Paradigm%20Shift%20AAM.pdf, https://eprints.whiterose.ac.uk/177405/, December 2021. A paradigm shift to combat indoor respiratory infection, University of LEEDS . PDF.

[3] Digital polymerase chain reaction, wikipedia, https://en.wikipedia.org/wiki/Digital_polymerase_chain_reaction, January 2022.

[4] Development and Application of Polydimethylsiloxane (PDMS)-based Passive Air Sampler to Assess Personal Exposure to SARS-CoV-2, Yale University, New Haven, CT, 06520, USA, January 11, 2022. webpage https://pubs.acs.org/doi/10.1021/acs.estlett.1c00877?goto=supporting-info, https://pubs.acs.org/doi/suppl/10.1021/acs.estlett.1c00877/suppl_file/ez1c00877_si_001.pdf, January 2022. Development and Application of Polydimethylsiloxane (PDMS)-based Passive Air Sampler to Assess Personal Exposure to SARS-CoV-2 . PDF.

[5] A National Strategy for the New Normal of Life With COVID, National Institutes of Health - NIH, January 6, 2022. webpage https://pubmed.ncbi.nlm.nih.gov/34989789/, https://jamanetwork.com/journals/jama/fullarticle/2787944, January 2022. A National Strategy for the New Normal of Life With COVID.

[6] Ventilation for Acceptable Indoor Air Quality, ANSI/ASHRAE Addendum n to ANSI/ASHRAE Standard 62-2001. webpage https://www.ashrae.org/File%20Library/Technical%20Resources/Standards%20and%20Guidelines/Standards%20Addenda/62-2001/62-2001_Addendum-n.pdf, February 2022.

[7] TRANSCOM/AMC Commercial Aircraft Cabin Aerosol Dispersion Tests, United States Transportation Command (USTRANSCOM) & Air Mobility Command (AMC), United States Air Force, November 09, 2020. webpage https://www.ustranscom.mil/cmd/docs/TRANSCOM%20Report%20Final.pdf, February 2022. PDF . local

[8] COVID-19 A Systems Perspective, Walter Sobkiw, 2021, ISBN 9780983253044, hardback.

[9] Enhanced Ventilation Standards for Indoor Dining and Application Form for Increased Dining Capacity, City of Philadelphia, February 14, 2021. webpage https://www.phila.gov/media/20210216105327/Enhanced-Ventilation-Standards-for-Indoor-Dining_2_16_21.pdf. PDF . local

[10] Food Establishments That Have Met Enhanced Ventilation Standards to Allow for Increased Indoor Dining Capacity, City of Philadelphia, March 09, 2021. webpage https://www.phila.gov/media/20210311122403/50CapacityRestaurants_030921.pdf. PDF . local

[A] Informal discussions with building ventilation engineering professionals, 2019, 2021,

[B] Informal discussions with facility managers, January 2022.

back to TOC


.

Ventilation Products Testing and Cost Tradeoffs

With the establishment of effective standard test and evaluation programs various existing and new products and technologies can be properly tested and operational costs can be determined for each approach, see section Proposed Ventilation Test and Evaluation Program. Because of the diversity of facilities and their needs the lowest operational costs alternative may be inappropriate and should not be the sole driver in a final architecture solution. This analysis is as much a road map for future analysis in this area as it is a standalone analysis.

Mechanical ventilation and Ceiling level UV-C systems have been in operation for decades. While mechanical ventilation is found starting at the consumer market level all the way up to the specialty industrial market level, Ceiling level UV-C systems are only found at the specialty industrial market level. The following table suggests that some products and technologies are targeted to only limited markets. This must change now that COVID-19 is endemic. [1]

Market Level

Mechanical

Ceiling level UV-C

FAR UV-222 Other
Consumer Low End

X

Consumer Middle End

X

Consumer High End

X

X

High End Realestate

X

X

Industrial

X

X

Industrial Specialty (hospitals, etc)

X

X

The following is an operational cost analysis of mechanical ventilation versus ceiling level UV-C ventilation. A product was selected in each category to identify the key performance data. The product is then used as a baseline to determine what the performance data might be with a different ventilation level. This is called the Baseline Approach and it is a derived design using the selected product data. The ventilation level that is selected is 12 ACH or eACH. To determine the operational cost differences the electrical power in terms of Watts is calculated for each baseline approach at the selected ACH level.

The following table shows the Ventilation Alternatives Cost Analysis. [spreadsheet VentAlt]

Mechanical

Units

CFM

sq-ft

ceiling

cu-ft

ACH

Amps

Watts

Watts / CFM

Watts / ACH

Initial Cost

Comments

Dayton Furnace Blower possible

1

1600

900

12

10800

8.89

6.9

828

0.52

93.15

$350

https://www.electricmotorwarehouse.com/content/PDF/1XJX7_spec.pdf

Dayton Furnace Blower Selected

1

2700

900

12

10800

15.00

15.3

1836

0.68

122.40

$700

https://www.grainger.com/product/DAYTON-1-hpHP-115V-Double-Inlet-Forward-1XJY3

Derived / check

1

2700

900

12

10800

15.00

15.3

1836

0.68

122.40

na

used to check derived design from the selected approach

Baseline Approach

0.8

2160

900

12

10800

12.00

12.24

1469

0.68

122.40

na

Derived design

.

Ceiling Level UV-C

Units

eCFM

sq-ft

ceiling

cu-ft

eACH

Amps

Watts

Watts/eCFM

Watts / eACH

Initial Cost

GC-295 (2x95W bulbs)

1

2200

550

12

6600

20

1.58

190

0.09

9.50

na

https://www.lumalier.com/upper-air-disinfection/ceiling-mounted/gc-cieling-mount

GC-295 (2x95W bulbs) Selected

1.64

3608

902

12

10824

20

2.60

312

0.09

15.58

na

https://www.lumalier.com/upper-air-disinfection/ceiling-mounted/gc-cieling-mount

Derived / Check

1.64

3608

902

12

10824

20

2.60

312

0.09

15.58

na

used to check derived design from the selected approach

Baseline Approach

0.984

2164.8

902

12

10824

12

1.56

187

0.09

15.58

na

Derived design

.
Cost Difference

8

8

8

8

Mechanical ventilation costs 8 times more than ceiling level UV-C ventilation

Notes: ACH = CFM*60/cu-ft, CFM = ACH*cu-ft/60, Cost Difference = Mechanical Baseline Approach / Ceiling Level UV-C Baseline Approach

A key finding is that the costs associated with mechanical ventilation are not linear. As more air needs to be pushed there is greater air resistance. This is shown by the 2 different mechanical fan models (possible & selected). For this analysis a fan was selected that is close to satisfying the need for a classroom (30 X 30 X 12 ft) and the desired 12 ACH level.

Mechanical ventilation costs 8 times more than ceiling level UV-C ventilation. However when making a final architecture solution it may be better to stay with mechanical ventilation because of other unique conditions including an existing system that is operating at the 12 ACH level.

The following table shows a list of possible products and technologies that can be subjected to a test and evaluation effort and the possible operational costs with each approach.

Product / Technology to be Tested

Products

ACH or eACH

Watts

Watts/ACH or eACH

Comments

Mechanical (old fan design)

Existing

12

1469

122

Data is from analysis.

Mechanical (Inverter 360 Cassette)

Existing

12

240

20

New technology. Displaces in room unit ventilators

Ceiling Level UV-C

Existing

12

187

16

Data is from analysis.

FAR UV-22

New

12

New technology.

Room Sanitizers

Existing

12

multiple units are needed to reach 12 ACH

Photocatalytic Oxidizer/Ionizer

Existing

12

multiple units are needed to reach 12 ACH + eACH

Localized Negative Pressure

Proposed

12

see note A

Electrostatic Floor or Wall or Ceiling

Proposed

TBD

see note B

25 inch 1970's Tube Color TV

Obsolete

TBD

see note C

25 inch 1970's solid state Color TV

Obsolete

TBD

see note C

Radio 1940's Tube Radio

Obsolete

TBD

see note C

Electric Element Space Heater

Existing

TBD

see note D

Notes: For A-D see the following discussions.

Mechanical

There are also new mechanical technologies such as the Samsung Inverter 360 Cassette AC140KN4DKH/EU. The specifications for the 4.5 HP unit are: Motor 97 W Air Flow Rate (High / Mid / Low) 32.4/27.1/22.8 CMM (cubic meters per minute) or 874/729/621. The required CFM is 2160. This can be met with 2.47 units for a total of 240 Watts.

Localized Negative Pressure

Localized negative pressure using PVC tubes, flexible tubes, and standalone new products was suggested in 2020 for student desks, workstations, walkways, standing pads, crowd control poles and barriers for areas like TSA checks, restaurant tables, etc. See 2020 research sections Ventilation Test and Evaluation and Proposed Legislation. This test would determine if this approach has an effect on airborne contagions.

Electrostatic Floor or Wall or Ceiling

In low humidity settings there is electrostatic buildup. For example, someone walks across a carpet in their home, they touch a surface, and there is a spark. Today there is an emphasis to remove electrostatic buildup because of semiconductor based electronics. What would be the effect on airborne contagions if this electrostatic condition were artificially induced to have contagions travel to the floor, or ceiling, or walls? This test would determine if this approach has an effect on airborne contagions.

Tube Based Radios and TVs

A key nagging question is why did COVID-19 turn into a world wide pandemic. Was something removed from the environment that in the past mitigated airborne contagions like COVID-19. After the 1918 pandemic tube based radios were found everywhere and in constant use. These devices used tubes that operated at 150V, 300V, and 600V. The tubes had a surface temperature of 350+ degrees. They attracted massive amounts of dust as everyone knew because they would replace the dusty / dirty tubes as part of normal maintenance. The air is moved by convection. When TV came along the number of tubes increased significantly and the picture tube increased the voltage to 25KV. Did these devices attract and destroy airborne contagions because of the high heat and high voltage space? This test would determine if these appliances had an effect on airborne contagions.

Electric Element Space Heater

Electric heaters using heating elements are not as ubiquitous as tube based radios and TVs from the past, however they have a very high temperature external electrical heating element (300+ degrees) that may destroy airborne contagions as the fan pushes air across the heating element. This test would determine if a low cost space heater could significantly reduce airborne contagions in the winter months.

.

FAR UV Performance

UV Systems

The following are key extracts from an article making the case for UV systems [2].

EXTRACT START

As the Omicron variant spreads rapidly across vaccinated and unvaccinated America, and a shocking number of Americans are still dying, many are wondering what the coming months will bring, how will they continue to protect themselves from COVID-19, and when, if ever, life will really return to something resembling the pre-pandemic normal. The good news is that this pandemic will eventually end due to effective vaccines, infection-induced herd immunity, and the further evolution of the virus. The bad news is that like seasonal influenza, COVID-variants may be with us for years to come, and this will certainly not be the last respiratory virus pandemic. We have long suffered from annual contagious respiratory infections, but exceptionally low rates of influenza and common colds during COVID-precautions have demonstrated that not all of this suffering need happen. So, we need to think clearly and scientifically about how better we can reduce the spread of viruses indoors especially when and where masks will no longer be in common use.

Are there effective engineering controls that can help make indoor environments truly safer? Yes,

It’s All About the Air We Share

From the beginning of this pandemic, buildings managers, airport operators, restaurateurs, and the public have been inundated with product promotions claiming to have the latest and greatest technology to protect workers, travelers, and customers from infection with SARS-CoV-2. Products are varied, including surface sanitizers, air filtration machines, ion generators, and a host of germicidal ultraviolet (GUV) devices, ranging from hand-held wands to whole-room irradiators and walk-through portals. An imaginative architectural firm in the Netherlands even planned to flood entire city squares and outdoor sports areas with safe, germicidal 222 nanometer ultraviolet light - their “Urban Sun” project. A Sharper Image gift catalogue listed no fewer than 14 air or surface disinfection gadgets, including a tiny ion generator meant to be worn around the neck.

Not all of these devices are likely to do what they’re marketing claims. Others are almost certainly not effective at all. The challenge is to discern those from the products that could, in fact, play a significant role in our ongoing effort to limit the spread of airborne pathogens.

Marketers are quick to present in ads the results of industry-sponsored testing, typically claiming ‘99.9%” or greater reductions in particles or test bacteria or viruses. Often these reductions compare test organism concentrations in air before and after passing through a device but not what happens in a room where the device would be used, which is all that matters in the long run. The details of these company-sponsored tests are usually lacking - one common issue is the failure to mention the rate at which decontamination occurs in rooms, which is often far too slow to be of practical use. For example, a device may claim 99.9% air contamination, but only in the fine print indicate that the test was conducted over 24 hrs. That’s not useful if you’re sitting in a room with an infected person. What does matter to prevent person-to-person spread of infection is clearance in minutes. Testing is rarely controlled, unbiased, properly compared to other technologies, or conducted under real-world conditions. In fairness, it is extremely difficult and expensive to prove the efficacy of interventions to reduce infections, especially one like COVID-19 that is often asymptomatic and might go unnoticed (especially in a country, like the U.S., where testing capability has been sorely lacking), and where transmission can occur by several potential routes, or occur in any number of settings besides the site of the intervention (like on a school bus versus the classroom).

Early in the pandemic, aerosol spread of COVID-19 was considered less important than other transmission pathways. But it is now clear that vast majority of its spread is the result of inhaled aerosol, with a lesser amount attributable to direct contact with droplets.

Outdoors, dilution of any aerosols is infinite although the time it takes to dilute clouds of aerosol, depends on air movement. Think, for example, of how a cloud of cigarette smoke outdoors lingers or dissipates depending on whether there’s a breeze or not. Indoors, however, aerosols almost always linger longer than outdoors, often long enough to be inhaled by someone sharing the same space. Put another way, if you breath in an indoor setting where other people are also breathing, you will almost surely breath in some amount of air that has been recently exhaled by someone else.

Previously tuberculosis control focused on engineering and non-engineering strategies, such as prompt, effective TB treatment, but there was little commercial interest in TB-related products because the market was primarily in poor countries. COVID-19 has changed that. Suddenly there is great commercial interest in airborne infection control, for schools, hospitals, and restaurants, and a greater need to apply scientific principles and testing rigor to evaluating efficacy claims, and in making sound recommendations.

Think About Ventilation

Ventilation, natural or mechanical, is the main way that the risk of airborne infection indoors is reduced. For hospital airborne infection isolation and procedure rooms, the U.S. Centers for Disease Control and Prevention (CDC) recommends 6 to 12 room air changes per hour (ACH) with infection free outdoor air, or air that has been filtered or otherwise decontaminated. For rooms with airborne contagions the CDC recommendation is 12 ACH. One ACH occurs when a volume of air equal to that of the room enters and leaves over a period of one hour. As fresh air enters and mixes with contaminated room air, not all the contaminated air is removed by one air change. Under well mixed conditions, one air change removes approximately 63% of room air contaminants, and a second air change removes about 63% of what remains, and so on. But under real world conditions, the protection achieved by ventilation also depends on the amount of contaminant (virus in this case) being added over time, by an infected person, and on the contagiousness of the infection. The greater the infectiousness of the virus, greater the infection-free ventilation needed to keep concentrations low. For Omicron, for example, 6-12 ACH ventilation, or equivalent air disinfection, may not be enough to prevent transmission. Unfortunately, not all transmission is preventable by air disinfection, for example, transmission at very close range where there is no time to remove or inactivate viruses generated by one person before they are inhaled by someone else.

Many residential and older buildings without mechanical ventilation may have about one ACH or less due to air leakage around doors and windows but when windows are open, depending on building design, orientation, and outside weather conditions, may enjoy significantly higher ACHs. For economical heating and cooling, however, windows are normally closed, especially in larger mechanically ventilated buildings, by design, or closed by occupants in response to outside temperatures. Automated mechanical ventilation systems often bring in a minimum amount of outside air under very cold or hot outside conditions, resulting in most air being recirculated within the building, thereby recirculating air contaminants rather than removing them, [however properly maintained filters minimize the recirculated contaminates].

The relationship of room ventilation to risk of infection isn’t linear. Doubling of ventilation rate reduces the concentration of air contaminants by only about half. This means that doubling poor ventilation from 1 ACH to 2 ACH provides relatively greater improvement in protection for room occupants than, for example, the increased protection from doubling ventilation from 6-12 ACH. This is because when air contaminants are low, much more air movement is required to dilute and remove them. Moreover, increases in ventilation rates are costly, often requiring larger fans, blowers, ventilation ducts, and more electricity, as well as greater heating, cooling, and dehumidification capacity. At the same time, as noted, for the much more infectious Omicon variant, very high ventilation rates are needed to keep up with high viral concentrations and infectiousness . Therefore, because mechanical ventilation may not be sufficient to reduce the risk of infection, mechanical ventilation in public buildings should be supplemented by other methods of air disinfection. For current and future viral pathogens like SARS-CoV-19, relatively high levels of “equivalent” ventilation by supplemental air disinfection will be needed.

Image: Installation of two different types of upper-room UVC luminaires at St Augustine of Canterbury Episcopal Church, Oklahoma City, OK.

Presented with particulate air contamination, a standard engineering response is to filter the air. High-efficiency air filters can be used in building ventilation systems to assure that fewer than 99.9% of respirable-size particles are recirculated back into rooms, essentially converting recirculated air into the equivalent of infection-free outdoor air. While some filter manufacturers boast of inactivating virus with UV, bipolar ions, cold plasma, or other technologies as advantageous over simple retention, there is no practical difference for risk in rooms. Importantly, while environmentally adapted TB bacteria and fungal spores readily spread through ventilation ducts, and this is theoretically possible for SARS-CoV-2 virus, there are few if any convincing reports of COVID-19 spread from room-to-room or floor-to-floor exclusively through ventilation systems; A relevant exception being a single report of spread of waste-water contaminated air not through ventilation ducts, but through faulty plumbing stacks in a high-rise apartment building in China.

While it is often difficult to discern among several airborne infection transmission pathways, the apparent paucity of reports of transmission through ventilation ducts likely reflects the well known fragility of envelope viruses, such as SARS-CoV-2, although dilution in rooms and ventilation ducts to concentrations below infectious dose could also be playing a role. Importantly, if air recirculation in ventilation ducts is not contributing importantly to COVID-19 transmission in buildings, the value of high-efficiency filters or germicidal UV in recirculating ventilation ducts for preventing spread is speculative and limited at best. Moreover, to a person sharing air in a room with someone with infectious COVID-19, there is little comfort in knowing that the air will be decontaminated only after it leaves the room. A more effective air disinfection strategy is to rapidly decontaminate the air within the room where person-to-person transmission occurs.

In the room where it happened is a guide to the application of air-disinfection technology. The evidence-based options for enhanced in-room air decontamination include increased ventilation, portable room-air cleaners, upper-room germicidal UV, and newer whole-room Far UV. Ion generators can also be used in rooms, but the evidence for efficacy is far less than for other approaches.

Natural ventilation

Natural ventilation is by far the most common form of room decontamination worldwide that can be highly effective with proper building design and favorable outdoor conditions. However, windows are often closed in inclement weather, and wind currents are not always conducive to good air exchange within buildings. With global warming, moreover, increasing use of efficient ductless air conditioners is resulting in windows being closed, reducing natural ventilation, and greatly increasing the risk of airborne infections. Extreme air pollution is another factor limiting the use of outdoor air for air disinfection in some parts of the world. Many mechanically ventilated commercial buildings don’t have operable windows, and deep interior spaces often make natural ventilation ineffective.

Portable room-air cleaners

These comprise a wide range of devices in price and performance. They usually consist of a box with a fan or blower and air filters, with or without UV or more sophisticated technologies for trapping particles or inactivating pathogens. The major determinants of room-air cleaner efficacy are: 1) the flow rate of air processed (clean-air delivery rate) relative to room volume, 2) the flow patterns produced in the room, which determines the ability of the device to process most of the air in the room rather than reprocess the same air near the device over and over again. In many applications, room air cleaners are undersized for the room volume, producing very few equivalent ACH. But, when properly sized they can be intrusively large, and when run at an effective fan speed, many room air cleaners are noisy and produce drafts. They may be acceptable in a gym, but generate too much noise for a classroom or house of worship. Nevertheless, when they are sized to produce at least 6 equivalent ACH, room air cleaners can be an effective intervention to reduce in-room transmission of airborne infections.

Germicidal UV lamps and fixtures

Upper-room germicidal UV (GUV) fixtures are a more than 80 years old technology, well-proven, safe, and underused technology for airborne infection control. Upper room GUV works by flooding the upper room (above the heads of occupants) with sufficient germ-killing ultraviolet light to rapidly inactivate airborne pathogens. All known pathogenic microbes contain either DNA or RNA and are susceptible to GUV. Air mixing between the upper and lower room results in high rates of air disinfection in the lower, occupied room. In the 1930s upper room GUV fixtures were installed in school classrooms in two Philadelphia suburbs and were convincingly shown, compared to classrooms without fixtures, to markedly reduce the spread of measles, the most infectious of airborne respiratory viruses. It was widely used in U.S. health care settings before the discovery of antibiotics for tuberculosis, and vaccines for the childhood viral infections, measles, mumps, and rubella. Renewed interest in GUV in health care settings, homeless shelters, prisons, jails and other congregate settings followed the 1985-92 resurgence of TB in the U.S. and Europe. Since then, GUV has found its greatest application in countries endemic for TB, but it has remained an extremely useful but underdeveloped technology for any airborne infection. COVID-19 has again renewed interest in GUV, upper room as well as a newly developed shorter wavelength, called Far UV. As for visible lighting, more efficient LED sources for GUV are rapidly being developed and may be the predominant technology for upper room use in the near future.

Far UV refers to 222 nm UV that has the remarkable properties of being equally or more effective against airborne viruses and bacteria, but unable to penetrate even the thin liquid layer covering the surface of the eye, or the outermost layers of skin. While conventional upper room UV has long been safely used to disinfect air in occupied rooms, Far UV appears safer yet with little potential for even mild eye or skin irritation when used within established exposure guidelines. It does not reach the deeper layer of skin cells where solar UV can cause skin cancer. Far UV sources require effective filters to prevent exposure to unwanted longer wavelength UV that can be damaging. Applications of current Far UV fixtures might include treating air and counters between workers and clients, such as bars, salons, restaurant tables, elevators, other high contact settings. Far UV is currently being used, for example, in a Boston homeless shelter, a Boston nightclub and piano bar, and for some critical U.S. military applications.

Image: Shows the application of an upper room UV fixture in a classroom. The fixture is the black box on the upper, left side of the front wall, with blue light visible. Another fixture on the rear wall would contribute to an effective upper room air disinfection zone.

Compared to mechanical ventilation and room-air cleaners, GUV is cheaper and much more effective. Upper-room GUV decontaminates a large volume of air at once, typically the upper two feet (20%) of a room with a 9 ft ceiling, for example. Air mixing between the lower and upper room, assisted by rising warm air produced by occupants, ventilation outlets, or fans, results in high rates of air disinfection in the lower, occupied room. In a controlled study in a hospital in South Africa, we showed that GUV inactivation of airborne TB bacteria was equivalent to 24 ACH, well beyond the capacity of most mechanical ventilation systems and room-air cleaners. Independent investigators aerosolized test bacteria into an unoccupied hospital room in Russia and compared mechanical ventilation, upper room GUV, and three commercial room air cleaners. They found that upper-room GUV was about 9.4 times more cost effective than mechanical ventilation for the same amount of air disinfection. Based on the potential energy savings over ventilation, the U.S. Dept. of Energy is supporting the commercial development and deployment of LED UV technology for air and surface disinfection.

There have been several barriers to the broader acceptance and application of GUV including unfamiliarity with the technology, and especially safety concerns. GUV raises safety concerns primarily because of a public perception that it is the same as the UV in sunlight. But not all UV is the same. It is skin exposure to the more tissue-penetrating longer wavelength UV in sunlight (UV-A and UV-B radiation) that is associated with skin cancer, and eye exposure to sunlight with cataracts, whereas shorter wavelength GUV penetrates eyes and skin surfaces far less, not reaching the lens of the eye to cause cataracts, or the deep layers of skin where it could induce cancer within well-established exposure limits. As mentioned, Far UV is far less penetrating and safe for direct exposure of room occupants. Acceptance and wider deployment of safe and highly effective UV systems will require education—of professional engineers, architects, and safety personnel, as well as the general public.

But not all GUV devices on the market pass the test in terms of plausible benefit, and these detract from the credibility of the proven applications. There are numerous examples of GUV devices targeting both commercial and home applications that are not evidence-based and are unlikely to be effective in reducing COVID-19 transmission. For instance, a small GUV air disinfecting device designed to be worn around the neck cannot possibly move enough air to reduce aerosol transmission. Or, another example, small boxes with UV sources designed to decontaminate cell phones are likely no better than an occasional wipe down with alcohol. Equally irrational are GUV wands because delivering an effective germicidal dose is unpredictable when waving a wand over a surface, and they must be low power to avoid accidental direct over-exposure of eyes or skin. At an even larger scale, GUV portals have been marketed and used in building entrances or exits to “disinfect” people walking through them. This makes no sense not only because no significant decontamination of skin or clothing is possible, but respiratory virus resides in the human respiratory tract, and cannot be eliminated from the outside. Finally, the Urban Sun project for disinfecting large outdoor spaces likewise makes no sense since dilution and upward convection air currents already render the outside far safer than indoors. Under crowded indoor or indoor conditions, very close-range person to person aerosol transmission may be difficult to interrupt by air disinfection of any kind, requiring other proven interventions like vaccines, distancing, and masks.

Ionization

A variety of ionizers (bipolar, unipolar, and cold plasma) are marketed to generate positive and negative ions, deployed directly into occupied rooms or within filtration systems, to cause infectious particles to be attracted to filters or stick to each other and then settle out of the air and onto surfaces where they can no longer be inhaled. The mechanisms of action of ion generators is not fully understood and might include direct chemical inactivation of viruses and bacteria. Ion generators have been incorporated into a variety of products, with marketing claims based on industry funded performance testing, there are very few published independent studies. In an older study conducted in Lima, Peru, a crude ionization system was directly compared to upper room UV and shown to be about 50% effective in decontaminating infectious hospital air of TB organisms. UV was 73% effective. But, in that study room air ionization had a serious practical limitation: the walls of the rooms in the study were blackened with black soot that became ionized and settled out onto surfaces. Other studies have shown that ionization can produce ozone from oxygen, as well as other dangerous ions and gases. These can lead to unanticipated, potentially toxic chemical reactions with other room air contaminants. Both the safety and effectiveness of ion generators require greater study to be compared to the established interventions of ventilation, room air cleaners, and GUV.

Nearly two years into the COVID-19 pandemic, the post-pandemic world is becoming clearer. While vaccines remain the mainstay of controlling person to person aerosol transmission, the efficacy of social distancing and mask wearing has been proven scientifically, albeit not fully accepted or implemented. Since the vast majority of COVID-19 likely spreads indoors, air disinfection is an underutilized role making indoor living safer. Building ventilation, natural and mechanical, is vitally important for the health and comfort of occupants. At its best, natural ventilation can be highly effective in reducing the risk of aerosol born infection, but it is not feasible or reliable in many climates and buildings. Mechanical ventilation is designed for comfort, not infection control, and generally in most buildings cannot achieve the air change rates needed to protect against a highly infectious viral aerosol like the current COVID-19 variants.

It’s clear that for indoor spaces air disinfection is a safe and efficient way to reduce transmission. Although they are not equivalent, the three established and proven air disinfection technologies are mechanical ventilation, upper room GUV, and portable room air cleaners. Of these, upper room UV is the most cost-effective and is demonstrably safe and readily available to deploy today to reduce COVID-19 and other respiratory virus transmission. Far UV is available, even safer, and may be a more effective air disinfection technology because it works around room occupants and does not depend on room air mixing. Although limited by the ability to quietly move sufficient air in many rooms, room air cleaners also have a role for in-room air disinfection, especially in small rooms where at least 6 equivalent air changes per hour can be achieved. Implementation of effective air disinfection, while driven by the COVID-19 pandemic, should find its way into building codes and practices so that we are not as unprepared for seasonal respiratory viruses, ongoing epidemics like TB, and the next pandemic.

EXTRACT END

Most of the technical content was preserved. There was a statement associated with CO2 monitors possibly being used to detect virus levels in a room. That statement was removed because it is not relevant and could be a distraction as some may suggest there is no relationship between CO2 levels and virus concentration.

As of February 2022, it appears that FAR UV systems are moving quickly into the market and infrastructure. There is now reasonable performance data available on these systems. The following is an example of available performance data. The 99% COVID-19 disinfection time as a function of distance is: [3]

With this data it is possible to determine some eACH performance numbers. The following table shows some of the possible eACH performance numbers for a FAR UV system.

Ceiling Height = 9 feet
% of Room Height = Feet / 9 foot ceiling
eACH = 1/Time min
eACH slice = eACH * % of Room Height

Meters Feet % of
Room Height
Time
sec
Time
min
eACH eACH slice Comments
0.50 1.64 0.18 30 0.50 120.00 21.87
1.50 4.92 0.55 4.50 13.33 7.29 The eACH avg 3 foot from floor level can be calculated
2.50 8.20 0.91 12.40 4.84 4.41 The eACH avg floor level can be calculated
Average 11.19
. eACH . . . . . .
eACH avg 3 foot from floor level 14.58
eACH avg floor level 11.19

References:

[1] A National Strategy for the New Normal of Life With COVID, National Institutes of Health - NIH, January 6, 2022. webpage https://pubmed.ncbi.nlm.nih.gov/34989789/, https://jamanetwork.com/journals/jama/fullarticle/2787944, January 2022. A National Strategy for the New Normal of Life With COVID.

[2] If We're Going to Live With COVID-19, It's Time to Clean Our Indoor Air Properly, TIME, February 1, 2022. website https://time.com/6143799/covid-19-indoor-air-cleaning.

[3] R Zero, Vive Revolutionary air & surface disinfection for occupied spaces. website https://rzero.com/vive, February 2022. Vive Product Data.

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Other Test Activities

The following are other testing activities that fall into the category of operational test and evaluation. They are the starting point for understanding and developing a National Test and Evaluation Test Center that can perform operational test and evaluation.

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MITRE Testing

MITRE is a Federally Funded Research and Development Center (FFRDC) supporting various government organizations including the DOD, FAA, DHS, etc. It also supports the COVID-19 Healthcare Coalition. As of February 2022, MITRE has performed COVID-19 related testing and analysis as follows:

Systems Assessment of This Testing

The information captured in these papers are an excellent source for developing the tests needed to perform Ventilation Test and Evaluation efforts. It is suggested that the Ventilation Test and Evaluation Program begin with tests that follow this pattern developed by MITRE. As time moves forward then other more complex tests using live virus can be performed to understand new technologies that do not use mechanical ventilation, such as ceiling level UV-C systems, FAR UV -222 systems, PCO systems, etc.

Test Description and Results

The approach has been to attempt to understand how aerosols behave using a physics approach to the problem rather than an infection approach. This is important because the test environments are easy to establish and there are no safety concerns such as when dealing with an actual airborne contagion. The key findings from these tests are:

A Practical Approach to Indoor Air Quality for Municipal Public Health and Safety [2]

This paper provides a summary of the test tools and methods used to perform the MITRE testing of masks and a school bus. More importantly a test approach with recommended tools was developed that anyone can perform to understand indoor ventilation needs. The following are key extracts from the analysis:

The methods can be adapted for locally administered indoor air quality programs, including high-risk environments such as nursing homes, schools, office areas, and public transportation. The approach follows an Occupational Health and Safety Administration (OSHA) hazards-control process and includes surveys, analysis and decisions based on science and mitigation selection, as well as a detailed description of implementing reduced-cost field testing.

We have presented a practical approach for municipalities, counties, and other administrative organizations to implement an indoor air quality program for public health and safety. The simplified operational model for conducting the indoor air quality surveys, analysis, and testing can be reliably executed by non-specialist government employees, community volunteers (similar to many smoke detector programs) or by local contractors (e.g., home inspectors) who are informed on the steps of this IAQ method. The outcome of this simplified method based on the OSHA hazard control process can help stewards of indoor environments reduce the risks to population health and well-being caused by pollutants or airborne pathogens. Affordable and effective IAQ management techniques such as the one we have described are essential today as the current pandemic evolves, and will be increasingly valuable as new and consequential airborne threats emerge.

The following are key extracts on Particle Counters:

Particle monitoring sensors (PMS) and particle counters are essential test devices. They allow a baseline particle count measurement and give a quantification of existing air pollutants at locations inside a facility or vehicle. They also allow for a PM2.5 or PM10 standard air quality measurement (U.S. EPA, 2016a) and a raw particle count for capturing the dispersion of a test aerosol cloud. Improvements to IAQ are compared with baseline measurements by using differential methods such as comparing the differences between particle count areas under curve or using other statistical methods.

Many commercially available options exist for PMS devices; however, an industrial grade sensor is recommended. Industrial grade model utilizes a photometer-based sensor which offers high sensitivity and minimal false positives at a cost ranging from $1500 to $4500 USD each unit. There are several manufacturers of these devices (Lighthouse Worldwide Solutions, n.d.; Particles Plus, Inc., n.d.; TSI Incorporated, n.d.). Another important feature is that industrial grade sensors can be NIST calibrated annually to maintain their accuracy, and also offer internal data storage and networked or USB connections to capture and analyze the time-series data (necessary for testing aerosol cloud dispersion and mitigations).

An alternative is the ultra-low-cost non-industrial PMS device, which uses a laser light scattering detector. This reduces reliability and is more subject to false positives (Pariseau, 2019), however, the cost of light scattering sensors is typically less than $100 USD per unit and still offers a rough estimation of the air quality. In addition, the low-cost sensor typically requires additional embedded electronics development to enable time-series data collection. The best example from extensive low-cost academic use is the Plantower PMS5003 which is usually packaged with a display screen and basic user mode button. These ultra-low-cost PMS can be useful for surveillance monitoring by local staff.

The following are key extracts on Aerosol Test Agents:

Aerosol test agents are used to check the propagation and dispersion within an air space as well as the effectiveness of any IAQ improvements using ventilation, filtration, and other mitigations. When selecting test aerosols, it is important to consider human safety, aerosol particle sizes, and the chemical attributes previously described. The test agent must also generate sufficient particles for the sensors to detect small concentrations within the total air volume and will require a mechanism of delivery to initiate the aerosol dispersion.

The ideal safe test agents are aerosolized Potassium Chloride (KCl) or Sodium Chloride (NaCl) solution with distilled water. Both of these salt products are safe for human consumption or aerosolization in moderate concentrations. When either solution is nebulized, the water evaporates when dispersed into air and allow the salts to recrystallize with a variety of particle sizes making them an ideal agent representing a variety of pollutants. Other test agents such as smoke detector test aerosols are not appropriate to use for IAQ testing because they typically use a mixture of isobutane, butane and propane which are flammable agents that disperse quickly into the air.

The American Society of Heating, Refrigeration and Air-conditioning Engineers (ASHRAE) recommends KCL as the standard HVAC test agent because it has a more stable generation of particles as it is not as affected by relative humidity (RH) including the temperature component of RH. In contrast, the National Institute for Occupational Safety and Health (NIOSH) selected NaCl as its standard test agent for respiratory protective equipment such as the N95 masks. One of the considerations is that NaCl particle generation will be affected by temperature and relative humidity inside the test environment. Either KCl or NaCl solutions will provide valuable dispersion data and are safe in air spaces frequented by people.

Our experiments used 10% NaCl by weight to 90% distilled water to generate particle counts sufficient for the air volume of transit buses when measured by a Particles Plus 8306 sensor. KCl will have its own unique concentration needed for generating sufficient particles. For smaller indoor air volumes, a lower concentration may be indicated and, separately, purging of the air after a test is required. Both NaCl and KCl water-based solutions can be aerosolized with a simple cosmetic atomizer, small hobby air brush (venturi effect pickup tube), or the use of an over-the-counter medical nebulizer. Once aerosolized, the solution can be delivered into the indoor test environment with a mechanical air volume from a medical bag resuscitator or a manual high-volume camping air pump, which is commonly available at retail outdoor stores, both of which emulate an adult’s exhalation.

The following are key extracts on Carbon Dioxide and Other Gas Sensors:

Carbon dioxide (CO2) and other gas sensors have some usefulness for IAQ, however, they have some limitations compared to particulate matter sensors. CO2 in low concentrations is a safe representation of the physical gas state of some pollutants which can be noxious odors, corrosive agents, or asphyxiants. However, CO2 and other gas tend to be lighter than air and diffuse or equalized more quickly through normal air environments compared to that of particulate matter or aerosols. This means that the use of CO2 and sensors for testing a ventilation system’s effectiveness will not fully represent the system’s ability to exchange air as some gas will dissipate elsewhere. While CO2 sensors have typically been used for specialty work areas that have hazardous asphyxiants such as fire suppression systems, cryogenics, or other areas where CO2 biproducts may exist, they have also been used in research as a measurement of human respiration gas exchange in public environments and then as a basis for estimating respiratory transmission risk.

The following are key extracts on Airflow Sensors:

Characterizing and understanding the airflow in an indoor environment is extremely important. Airflow and differential pressures have a direct impact on the movement or evacuation of airborne contaminants. These details of airflow allow decision makers to best position auxiliary risk mitigation equipment.

Anemometers are the typical sensors used to characterize airflow in an indoor environment. The two most common types are hot wire anemometers and vane anemometers. Hot wire anemometers operate based on a very thin wire being cooled as a result of airflow and are extremely accurate. Hotwire devices are also the preferred choice for low air speeds and in open environments where the directionality of the airflow is typically unknown, both of which are typical of indoor environments. In contrast, vane anemometers are a mechanical device which convert the rotating motion of a propeller into a linear air speed and more suited for capturing mean airflow in a system where directionality effects are minimal. An example would be a long, straight section in HVAC ducting.

Manometers are typically used to characterize pressure drop or differential pressure in a system. One critical application for manometers is the measurement of and calibration of a negative pressure room used for the medical treatment of respiratory disease patients. Another application is during testing of a retrofit air filter application; some air filters with improved filtration are more restrictive to airflow and may require measurement if they will strain the HVAC system. These devices are typically used by HVAC technicians but are recommended mainly for the special applications or environments that require an understanding of differential pressures.

Reducing COVID-19 airborne transmission risks on public transportation buses: an empirical study on aerosol dispersion and control [3]

The following are extracts from the test and evaluation effort.

Abstract

This study is one of the first COVID-19 related bus studies to fully characterize cough aerosol dispersion and control in the highly turbulent real-world environment of driving regular bus routes on both a school bus and a transit bus. While several other bus studies have been conducted, they were limited to clinical contact tracing, simulation, or partial characterization of aerosol transmission in the passenger areas with constraint conditions. When considering the risk of transmission of SARS-CoV-2 (COVID-19) and other highly infectious airborne diseases, ground based public transportation systems are high-risk environments for airborne transmission particularly since social distancing of six feet is not practical on most buses. This study demonstrates that wearing of masks reduced the overall particle count released into the bus by an average of 50% or more depending on mask quality and reduced the dispersion distance by several feet. The study also demonstrates an 84.36% reduction in aerosol particles and an 80.28% reduction in the mean aerosol residence time for some test cases. We conducted 84 experimental runs using nebulized 10% sodium chloride and a mechanical exhalation simulator that resulted in 78.3 million data points and 124 miles of on-the-road testing. Our study not only captures the dispersion patterns using 28 networked particle counters, it also quantifies the effectiveness of using on-board fans, opening of various windows, use of face coverings or masks, and the use of the transit bus HVAC system. This work additionally provides empirical observations of aerosol dispersion in a real-world turbulent air environment, which are remarkably different than many existing fluid dynamics simulations, and also offers substantial discussion on the implications for inclement weather conditions, driver safety, retrofit applications to improve bus air quality, and operational considerations for public transportation organizations.

Conclusion

This study presents conclusive results showing the efficacy of masks, open windows, and HVAC systems to reduce risks of aerosol transmission on public transportation buses. The study thoroughly discusses key observations of airflow and aerosol dynamics inside buses and implications or practicalities of applying the results to transportation systems for passenger and driver safety. For example, when masks were not worn and windows are closed, the aerosol particles spread rapidly throughout the whole bus which emphasizes the importance of wearing face coverings and maintaining some airflow to evacuate the particles. In addition, this study also highlights the challenge of an imperfect risk problem where the selected mitigations may not be the optimal solution for all desirable effects such as a ventilation scheme that reduces the overall particle counts but speeds up the dispersion of the aerosol (it can reach more people faster). Considering the tradeoffs between both metrics, the results of this study clearly indicate that ventilation has a greater effect at reducing a passenger’s overall exposure time and concentration to potentially infectious aerosols on the bus. While there are some limitations of this study, it increases scientific understanding of aerosol dispersion and control on buses while bringing clarity on the best options to reduce risks of airborne particle transmission while riding on school and transit buses. While the results and recommendations may seem intuitive, the study provides the scientific data to help inform regional decisions on applying risk mitigation options for COVID-19 variants and other high infectious airborne diseases.

The key finding from this test and evaluation effort is that an operational test and evaluation effort is not only possible but it will yield significant useful data. This is a test design pattern that can be used as part of the Ventilation Test and Evaluation Program.

References:

[1] Quantifying Respiratory Airborne Particle Dispersion Control Through Improvised Reusable Masks: The Physics of Non-Pharmaceutical Interventions for Reducing SARS-CoV-2 (COVID-19) Airborne Transmission, The MITRE Corporation, August 26, 2020. webpage https://www.scientificarchives.com/article/quantifying-respiratory-airborne-particle-dispersion-control-through-improvised-reusable-masks-the-physics-of-non-pharmaceutical-interventions-for-reducing-sars-cov-2-covid-19-airborne-transmission, https://www.medrxiv.org/content/10.1101/2020.07.12.20152157v2, https://www.medrxiv.org/content/10.1101/2020.07.12.20152157v2.full.pdf, February 2022. PDF

[2] A Practical Approach to Indoor Air Quality for Municipal Public Health and Safety, The MITRE Corporation, December 13, 2020. webpage https://www.scirp.org/journal/paperinformation.aspx?paperid=106897, Februaru 2022. A Practical Approach to Indoor Air Quality for Municipal Public Health and Safety.

[3] Reducing COVID-19 airborne transmission risks on public transportation buses: an empirical study on aerosol dispersion and control, The MITRE Corporation, 19 Feb 2021. webpage https://www.tandfonline.com/doi/full/10.1080/02786826.2021.1966376, February 2022. Reducing COVID-19 airborne transmission risks on public transportation buses: an empirical study on aerosol dispersion and control.

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US Air Force Commercial Aircraft Testing

In November 2020, the US Air Force performed testing on commercial aircraft to determine if these aircraft could be used to safely transport troops. Fortunately, the US Air Force realizing the need to protect its personnel performed these tests.

Systems Assessment of This Testing

The focus of this test was to determine if existing aircraft have a reasonable level of facility contagion mitigation risk reduction. It was not to determine a new standard that should be applied to aircraft or parts of an airport facility. The testing approach and equipment is reasonable and should be considered in any proposed Ventilation Test and Evaluation Efforts. This is a good effort and it should be used to gage the depth, breadth, and quality of other efforts.

The problem with the test is that the the DNA-tagged beads were generated for five minutes and the fluorescent tagged microspheres were generated for one minute in a breathing pattern of 2 seconds on and 2 seconds off. This is a step function test and it does not fully represent an operational scenario of continuous system stimulus, in other words continuous release of the virus as would be found in a real world setting. The fluorescent tagged microspheres need to be continuously generated for the entire length of the test and the data needs to be gathered and reported at various time intervals such as 3, 10, 30 minutes and 1, 2, 3, 4, 5, 6, 7, 8 hours. It is understood that a steady state condition will be reached, however there might be an unexpected unknown that may surface during an 8 hour test. It happens all the time in real operational settings and operational test and evaluations always have these types of long running test events. The aircraft cabin ventilation then needs to be lowered from the current normal state of operations to a degraded state of operations in increments until a lower limit is reached. Only then can the ventilation contagion mitigation effectiveness be fully understood.

Test Description and Results

United States Transportation Command (USTRANSCOM), The Defense Advanced Research Project Agency (DARPA) and Air Mobility Command sponsored testing to better understand aerosol particle distribution from potentially infected passengers within the passenger compartment on commercial aircraft. Information gained from such testing will be used to inform USTRANSCOM in its COVID-19 risk reduction planning for Patriot Express flights. In August 2020, the team brought together instrumentation to implement testing of a large series of aerosol tracer releases simulating a passenger who may be COVID-positive on 767-300 and 777-200 airframes. The tests were designed to measure the relative aerosol penetration within passenger breathing zones in neighboring seats and rows from the simulated infected passenger. The tests were also designed to measure passenger breathing zone aerosol concentration distributions at different sections of the airframes and with the simulated infected passenger seated at various locations. [1]

The testing used fluorescent aerosol tracers between 1-3 ìm and real time optical sensors, coupled with DNA-tagged tracers to measure aerosol deposition. They completed the largest aircraft aerosol experimental validation testing as of November 2020, with 8 days of testing involving both inflight and ground tests on Boeing 777-200 and 767-300 airframes. Tracer aerosols were released from a simulated infected passenger, in multiple rows and seats, to determine their risk of exposure and penetration into breathing zones of nearby seats. In particular, penetration into the breathing zones of passengers seated in the same row and in numerous rows in front and back of the source were measured. [1]

Over 300 aerosol release tests were performed repeatedly releasing 180,000,000 fluorescent tracer particles from the aerosol source (simulated virus aerosol), with 40+ Instantaneous Biological Analyzer and Collector (IBAC) sensors placed in passenger breathing zones for real-time measurement of simulated virus particle penetration. In total, more than 11,500 breathing zone seat measurements were taken with releases in 46 seats of the airframes. [1]

The process provided a real-time method for mapping tracer particle concentration for passenger breathing zones in four sections of the 777-200 and three sections for the smaller 767-300. Over 300 aerosol releases were performed in eight days. Testing for each airframe included terminal loading and unloading simulations, simulated inflight conditions in a hangar (with more seats and replicates then are possible during inflight testing), and then two days of inflight testing at altitude (~35000 ft). DNA-tagged aerosol tests were also performed along with surface sample collections to evaluate aerosol deposition and potential fomite risk. [1]

The main objectives of these tests were to collect aerosol data sets for COVID-19 risk analysis for USTRANSCOM planning especially with respect to determining the optimal capacity of flights, determining relative risk under different seating configurations, optimizing strategies for boarding and deboarding, and to determine what contact tracing requirements might be necessary in the event that a passenger tests positive soon after landing. Additionally, there was an added benefit to assembling a data package that was shareable with the scientific community at large, to encourage analysis by other parties including validation of computational fluid dynamics and other transmission models. [1]

Results from the Boeing 777-200 and 767-300 airframes showed a minimum reduction of 99.7% of 1 micro-m simulated virus aerosol from the index source to passengers seated directly next to the source. An average 99.99% reduction was measured for the 40+ breathing zones tested in each section of both airframes. Rapid dilution, mixing and purging of aerosol from the index source was observed due to both airframes’ high air exchange rates, downward ventilation design, and HEPA-filtered recirculation. Contamination of surfaces from aerosol sources was minimal, and DNA-tagged 3 micro-m tracers agreed well with real-time fluorescent results. [1]

The testing used Instantaneous Biological Analyzer and Collector (IBAC, FLIR Systems) discrete particle detectors that simultaneously measures an airborne particle’s elastic scatter and intrinsic autofluorescence at an excitation wavelength of 405nm. The sensor has been deployed since 2006 for 24/7 facility protection applications as an early warning component to biodefense monitoring architectures. The IBAC is capable of utilizing two fluorescence channels, one for biological aerosols and the other for fluorescent tracer aerosol detection. The IBAC sensors have been used to characterize exposure risk and real-time spatiotemporal aerosol dispersion mapping of indoor environments such as subway systems, airports, skyscrapers, large building complexes, critical infrastructure facilities, commercial aircraft and numerous other types of buildings. IBAC sensors have been used for fluorescent tracer particle dispersion tests in numerous government, research, and clinical settings. [1]

The report is filled with data that captures the full operational scenario of someone using an air transportation system. This is a summary of only a small part of the data and it is provided to show key data associated with ventilation rates and infection risk. A picture is worth a thousand words. This is the testing effort and findings in pictures.

This is an operational test an evaluation - test setup.

IBAC sensors with extended inlets and tripod mounted mannequin with integrated aerosol generation [1]

This is an operational test an evaluation - test setup.

Example coupon locations highlighted in red. Left: Economy seat. Right: First class seat. [1]

This is an operational test an evaluation - test setup.

Chamber testing using a mannequin, three APS particle sizers, and four IBACs. [1]

This is an operational test an evaluation - 777-200 Terminal/Jetway MID-AFT scenarios.

777-200 Terminal/Jetway MID-AFT tests [1]

This is an operational test an evaluation - 777-200 Inflight Tests.

777-200 Inflight Tests [1]

This is an operational test an evaluation - 767-300 Terminal/Jetway Tests, including three rows of 40W heaters.

767-300 Terminal/Jetway Tests, including three rows of 40W heaters [1]

This is an operational test an evaluation - 767-300 Inflight Tests

767-300 Inflight Tests [1]

This following are Operational test results - 777-200 Inflight Data – AFT Section.

777-200 Inflight Data – AFT Section [1]

It is unclear at what time during the test these numbers were achieved.

The following are Operational test results - 777-200 Hangar “Inflight” Data – AFT Section.

777-200 Hangar “Inflight” Data – AFT Section [1]

It is unclear at what time during the test these numbers were achieved.

The following are Operational test results - 767-300 Terminal Data – Cooling Configuration Comparison.

767-300 Terminal Data – Cooling Configuration Comparison [1]

It is unclear at what time during the test these numbers were achieved.

The following table shows a Comparison of Air Exchange Rates and the Boeing 767 and 777 Airframes Tested. [1]

Building Type

Air Changes
per Hour (ACH) (a)

Time (mins.)
Required for Removal
99.9% efficiency

Typical Single Family Home (Low Estimate)

2

207

Typical Single Family Home

4

104

Typical Single Family Home (High Estimate)

6

69

Standard for Hospital Operating Rooms and Isolation Units (b)

12

35

.
Boeing 767-200 As Tested (c)

32

6

Boeing 777-300 As Tested (c)

35

6

Notes:
(a) Adapted from CDC: https://www.cdc.gov/infectioncontrol/guidelines/environmental/appendix/air.html#tableb1
(b) Recommended in ASHRAE / ASHE STANDARD Ventilation of Health Care Facilities (Vol. 4723)
(c) Experimentally determined during this report

The recommendations from the report are as follows: [1]

Given the data captured during this most recent round of testing, and coupled with existing literature and a growing consensus on COVID-19 risks, the following recommendations regarding troop transport on commercial airlines can be conveyed.

Additionally, during boarding and deboarding, the following recommendations should be considered:

References:

[1] TRANSCOM/AMC Commercial Aircraft Cabin Aerosol Dispersion Tests, United States Transportation Command (USTRANSCOM) & Air Mobility Command (AMC), United States Air Force, November 09, 2020. webpage https://www.ustranscom.mil/cmd/docs/TRANSCOM%20Report%20Final.pdf, February 2022. PDF . local

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FAA Testing

The FAA performs test and evaluation on the air traffic control systems. These are massive computer and communications systems with 365/24/7 operations involving thousands of operational staff that support Tower, TRACON, En Route, Oceanic, and joint military operations. In the past they tested aircraft cabin safety issues associated with seats, cabin fires, and emergency evacuation. They also tested airport surfaces for emergency aircraft landing to prevent end of runway accidents. They even had a jet engine test lab. These tests led to lives being saved with the introduction of floor strip lighting for use in cabin fires, quick evacuation saving lives after a crash, minimizing fireballs with different jet fuel mixtures, saving lives when aircraft in distress run out of runway surface, and more. However all test and evaluation efforts have been minimized except for the air traffic control systems.

As of February 2022 the FAA has performed no testing associated with the COVID-19 virus. The testing performed by the United States Transportation Command (USTRANSCOM) & Air Mobility Command (AMC) should have been done by the FAA. The FAA should circle back, review this testing, and establish a full test and evaluation program for the entire air transportation infrastructure as part of their charter to ensure safe air transportation operations. The Federal Aviation Act of 1958 created the Federal Aviation Agency (later the Federal Aviation Administration or the FAA). The act empowered the FAA to oversee and regulate safety in the airline industry and the use of American airspace by both military aircraft and civilian aircraft. This is an excerpt from the Federal Aviation Act of 1958: [1] [2]

"The Administrator shall develop, modify, test, and evaluate systems, procedures, facilities, and devices, as well as define the performance characteristics thereof, to meet the needs for safe and efficient navigation and traffic control of all civil and military aviation except for those needs of military agencies which are peculiar to air warfare and primarily of military concern, and select such systems, procedures, facilities, and devices as will best serve such need and will promote maximum coordination of air traffic control and air defense systems. The Administrator shall undertake or supervise research to develop a better understanding of the relationship between human factors and aviation accidents and between human factors and air safety, to enhance air traffic controller and mechanic and flight crew performance, to develop a human-factor analysis of the hazards associated with new technologies to be used by air traffic controllers, mechanics, and flight crews, and to identify innovative and effective corrective measures for human errors which adversely affect air safety. The Administrator shall undertake or supervise a research program to develop dynamic simulation models of the air traffic control system and airport design and operating procedures which will provide analytical technology for predicting airport and air traffic control safety and capacity problems, for evaluating planned research projects, and for testing proposed revisions in airport and air traffic control operations programs. The Administrator shall undertake or supervise research programs concerning airspace and airport planning and design, airport capacity enhancement techniques, human performance in the air transportation environment, aviation safety and security, the supply of trained air transportation personnel including pilots and mechanics, and other aviation issues pertinent to developing and maintaining a safe and efficient air transportation system."

At the time of when the act was developed no one envisioned a society that would place its people at risk of being exposed to a potentially deadly virus. The safety emphasis was on the operation of the system. However, the last phrase maintaining a safe and efficient air transportation system clearly allows the FAA to establish a ventilation test and evaluation program that would address the entire air transportation system.

The FAA has obviously reduced its role over the years and this mind set allowed them to justify ignoring the COVID-19 facilities safety issues associated with their staff, the transportation system, and the public. The FAA in the past 40 years has become heavily privatized with massive numbers of support contractors, each with their narrow tasking and difficulties associated with changing contract scope. [2] Privatization of working lab staff is one of the reasons why the FAA failed to step up to what was needed and expected by the taxpayers.

Systems Assessment of This Testing

The FAA does perform serious test and evaluation efforts but for unknown reasons has not performed any COVID-19 facility ventilation test and evaluation or tests that could be used as a pattern for other facility ventilation test and evaluation efforts. This suggests that a congressional review is needed to explain why the FAA has not performed any testing in to address this massive national disaster.

References:

[1] Systems Practices systems Practices As Common Sense, Walter Sobkiw, ISBN: 978-0983253082, first edition 2011, ISBN: 978-0983253051, second edition 2020.  Systems Practices systems Practices As Common Sense.

[2] Privatization A Systems Perspective, Walter Sobkiw, 2019, ISBN 9780983253068. Privatization A Systems Perspective.

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MIT Testing

References:

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ASHRAE

ASHRAE was formed as the American Society of Heating, Refrigerating and Air-Conditioning Engineers by the merger in 1959 of American Society of Heating and Air-Conditioning Engineers (ASHAE) founded in 1894 and The American Society of Refrigerating Engineers (ASRE) founded in 1904. With more than 50,000 members from over 132 nations, ASHRAE is a diverse organization dedicated to advancing the arts and sciences of heating, ventilation, air conditioning and refrigeration to serve humanity and promote a sustainable world.

Like all technical societies since the rise of the internet, all its publications from members have become unavailable to the general public. Physical libraries no longer house physical publications from technical societies. Unfortunately most building codes follow ASHRAE standards and the public that enters and uses both private and public buildings do not have access to this critical information. So no one really knows the ventilation levels of any of the buildings that they enter. [1]

This is the ASHRAE guidance offered as of October 19, 2021:

ASHRAE EPIDEMIC TASK FORCE [2]

Core Recommendations for Reducing Airborne Infectious

Aerosol Exposure

The following recommendations are the basis for the detailed guidance issued by ASHRAE Epidemic Task Force. They are based on the concept that within limits ventilation, filtration, and air cleaners can be deployed flexibly to achieve exposure reduction goals subject to constraints that may include comfort, energy use, and costs. This is done by setting targets for equivalent clean air supply rate and expressing the performance of filters, air cleaners, and other removal mechanisms in these terms.

1. Public Health Guidance – Follow all current regulatory and statutory requirements and recommendations, including vaccination, wearing of masks and other personal protective equipment, social distancing, administrative measures, circulation of occupants, hygiene, and sanitation.

2. Ventilation, Filtration, Air Cleaning
2.1 Provide and maintain at least required minimum outdoor airflow rates for ventilation as specified by applicable codes and standards.
2.2 Use combinations of filters and air cleaners that achieve MERV 13 or better levels of performance for air recirculated by HVAC systems.
2.3 Only use air cleaners for which evidence of effectiveness and safety is clear.
2.4 Select control options, including standalone filters and air cleaners, that provide desired exposure reduction while minimizing associated energy penalties.

3. Air Distribution - Where directional airflow is not specifically required, or not recommended as the result of a risk assessment, promote mixing of space air without causing strong air currents that increase direct transmission from person-to-person.

4. HVAC System Operation
4.1 Maintain temperature and humidity design set points.
4.2 Maintain equivalent clean air supply required for design occupancy whenever anyone is present in the space served by a system.
4.3 When necessary to flush spaces between occupied periods, operate systems for a time required to achieve three air changes of equivalent clean air supply.
4.4 Limit re-entry of contaminated air that may re-enter the building from energy recovery devices, outdoor air, and other sources to acceptable levels.

5. System Commissioning – Verify that HVAC systems are functioning as designed.

ASHRAE as a technical society allows professionals to share information and form groups and committees to address various topics. It produces standards that are the result of the industry professionals collective professional options based on the engineering and science found in their papers and work. Most of the recommended ventilation rates are based on the needs of industry to reduce costs while not compromising comfort levels [3]. With new sustainability needs the ventilation rates further favor reducing costs over comfort levels. However, applying science and engineering to reduce or eliminate airborne contagions in all public buildings, not just hospitals, is a new need. Since ASHRAE members come primarily from industry, there is a conflict of interest that may compromise recommendations. Building owners do not want to pay for new ventilation systems or the increased operational costs to address airborne contagions.

No one should expect ASHRAE to standup and perform a massive Ventilation Test and Evaluation effort to address the development of new building contagion mitigation standards. That is a clear function of the US Government in collaboration with industry where the US Government is in clear control and industry respects and does not attempt to compromise the US Government findings.

References:

[1] Ventilation for Acceptable Indoor Air Quality, ANSI/ASHRAE Standard 62.1-2019. webpage https://www.ashrae.org/technical-resources/bookstore/standards-62-1-62-2. For purchase or through organization access.

[2] Core Recommendations for Reducing Airborne Infectious Aerosol Exposure, ASHRAE EPIDEMIC TASK FORCE, October 19, 2021. webpage https://www.ashrae.org/file%20library/technical%20resources/covid-19/core-recommendations-for-reducing-airborne-infectious-aerosol-exposure.pdf, February 2022.

[3] Ventilation for Acceptable Indoor Air Quality, ANSI/ASHRAE Addendum n to ANSI/ASHRAE Standard 62-2001. webpage https://www.ashrae.org/File%20Library/Technical%20Resources/Standards%20and%20Guidelines/Standards%20Addenda/62-2001/62-2001_Addendum-n.pdf, February 2022.

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Military Standards

There was a time in the US when the various government organizations produced and maintained standards that were based on testing and evaluation in various government labs. On of them is MIL-STD-1472. [1] The FAA established and used the National Aviation Facilities Experimental Center (NAFEC). The name captured the full intent of the facility. As the years rolled by NAFEC changed and it is now primarily supporting system upgrades. Its name changed to the FAA Technical Center and then William J. Hughes Technical Center. This is important to know and understand because it is why the US Government response to the COVID-19 disaster has been so poor. However, from a ventilation standards perspective there is data still available from the old standards that may provide some insight into what the ventilation system performance should be moving forward.

MIL-STD-1472 provides ventilation requirements. This is from MIL-STD-1472:

5.8.1.2 Ventilating. Adequate ventilation shall be assured by introducing fresh air into any personnel enclosure. If the enclosure volume is 4.25 m3 (150 ft3) or less per person, a minimum of 0.85 m3 (30 ft3) of ventilation air per minute shall be introduced into the enclosure; approximately two-thirds should be outdoor air. For larger enclosures, the air supply per person may be inaccordance with the curves in Figure 35. Air shall be moved past personnel at a velocity not more than 60 m (200 ft) per minute. Where manuals or loose papers are used, airspeed past these items shall be not more than 30 m (l00 ft) per minute- 20 m (65 ft) per minute if possible - to preclude pages in manuals from being turned by the air or papers from being blown off work surfaces.

Under NBC conditions, ventilation requirements shall be modified as required. Ventilation or other protective measures shall be provided to keep gases, vapors, dust, and fumes within the Permissible Exposure Limits specified by 29 CFR 1910 and the limits specified in the American Conference of Governmental Industrial Hygienists Threshold Limit Values. Intakes for ventilation systems shall be located to minimize the introduction of contaminated air from such sources as exhaust pipes. (See 5.12.6.2 for vehicle ventilation provisions.)

Note that 29 CFR 1910 is a reference to the OSHA standards. [2] Using the above numbers, the ACH can be calculated:

ACH = 30 CFM * 60 minutes / 150 cu-ft = 12 ACH

This is an interesting number because it matches the CDC guideline for hospital room airborne contagions.

However, as the enclosure volume increases in figure 35, the required CFM level decreases significantly and this reduces the ACH level.

MIL-STD-1472 Figure 35

The possible reason for this may have to do with the need to protect against non-aerosol airborne contagions. As the space increases the non-aerosol airborne contagion is less of a threat. This is based on the past history that there were few aerosol based contagions. The threat was measles and tuberculosis not COVID-19.

This is the text for vehicle ventilation provisions:

5.12.6.2 Ventilation. Outside fresh air shall be supplied at minimum rate of 0.57 m3 (20 ft3)/min/person. Air flow rates for hot-climate operation (temperatures above 32°C (90°F)) shallbe maintained between 4.2 and 5.7 m3 (150 and 200 ft3)/min./person, unless air conditioning orindividual (microclimate) cooling is provided. Air velocity at each person's head location shall beadjustable either continuously or with not less than three settings (OFF, LOW and HIGH) from near zero to at least 120 m (400 ft)/minute.

MIL-STD-1472F dated 23 August 1999, was maintained by the U.S. Army Aviation and Missile Command, ATTN: AMSAM-RD-SE-TD-ST, Redstone Arsenal, AL 35898. The same content is found in MIL-STD-1472D dated 14 March 1989. It is assumed that the same content is found in MIL-STD-1472C dated 02, May 1981. This is important because we are looking at a body of work that is 40 to 50 years old. We don't know how these requirements were derived but we do know that labs like NAFEC and the U.S. Army Aviation and Missile Command engaged in understanding human factors and providing requirements that the industrial base used to develop and maintain systems. We also know that these were trusted sources.

References:

[1] Human Engineering, MIL-STD-1472F, Department of Defense, 23 August 1999, MIL-STD-1472D, 14 March 1989. MIL-STD-1472F . MIL-STD-1472D . local.

[2] Occupational Safety and Health Administration, Regulations (Standards - 29 CFR), webpage https://www.osha.gov/laws-regs/regulations/standardnumber/1910, February 2022.

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Clean Air Certificates For Buildings

In May of 2021, 39 scientists published "A Paradigm Shift to Combat Indoor Respiratory Infection" calling for a paradigm shift in how citizens and government officials think about the quality of the air we breathe indoors. [1] This Clean Air Certificates For Buildings effort is in direct response to that call for action.

The Clean Air Certificates For Buildings is modeled after the Philadelphia Restaurant program that was used by the city of Philadelphia to help restaurants open by showing them how to understand, manage, and document their ventilation systems performance levels. [2] [3] The owner operators were shown how to measure their ACH levels and self certify the findings. The city might then in the future examine the results. This program had a massive impact on establishing consumer confidence that the restaurants were reasonably safe for dining.

The following instructions are based on the city of Philadelphia Restaurant program. They include forms and Clean Air Certificate templates that can be filled out and posted in each room for a building and an overall certificate for the entire building. If in the future one or more government entities establish programs to issue certificates of building occupancy based on clean air requirements, it is anticipated that these self certification certificates will guide and streamline the process.

What's in it for the building owner operators? Simple, it's the right thing to do and it will instill massive public confidence that someone is thinking about the air that they breathe.

The city of Philadelphia Restaurant program used the following standards. [2] [3]

The clean air certificate provides flexibility in meeting the standards. The key element in the clean air certificate is to report the current state of the occupied space and then ensure that it is managed effectively. If needed, the owner operators can decide if they want to improve the performance levels of their ventilation systems in the future.

Unlike the Philadelphia program, this Clean Air Room Certificate program provides a certificate that can be posted in the rooms and buildings that are assessed. The emphasis is on assessment and the findings rather than meeting a strict standard. It is assumed that all buildings with certificates of occupancy follow the standard codes. Until the codes are updated to include clean air standards, this program will significantly help the public to eliminate their fears when they enter a building.

The certificates and procedure for determining the ACH levels are located at:  

Videos prepared by the city of Philadelphia shows how to measure a space and calculate the air changes per hour (ACH) and certify the spaces:

Ideally these certificates will start to be posted in schools, public club houses, restaurants, bars, retail stores, office buildings, waiting rooms, lobbies, airports, airplanes, busses, trains, anywhere where the space is used by the public. The reality is that this data exists for most public buildings, it just needs to be posted.

Clean Air Room Certificate

Clean Air Building Certificate

References:

[1] A Paradigm Shift to Combat Indoor Respiratory Infection, University of LEEDS, White Rose Research Online, published 14 May 2021, online August 27, 2021. webpage https://eprints.whiterose.ac.uk/177405/3/Paradigm%20Shift%20AAM.pdf, https://eprints.whiterose.ac.uk/177405/, December 2021. A paradigm shift to combat indoor respiratory infection, University of LEEDS . PDF.

[2] Enhanced Ventilation Standards for Indoor Dining and Application Form for Increased Dining Capacity, City of Philadelphia, February 14, 2021. webpage https://www.phila.gov/media/20210216105327/Enhanced-Ventilation-Standards-for-Indoor-Dining_2_16_21.pdf. PDF . local

[3] Food Establishments That Have Met Enhanced Ventilation Standards to Allow for Increased Indoor Dining Capacity, City of Philadelphia, March 09, 2021. webpage https://www.phila.gov/media/20210311122403/50CapacityRestaurants_030921.pdf. PDF . local

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Building Ventilation In The Age Of Contagions

As of 2022 this research has focused on how to educate people on ventilation and development of tools to help facility staff and people to understand a facilities ventilation performance levels. There is a presentation that attempts to address the education challenge. The presentation is called: Building Ventilation In The Age Of Contagions.

Today everyone uses the qualitative phrase of increase ventilation. However, that has no meaning. We must change the dialog to precise measurable performance levels using a common metric. The common performance level must be stated as Air Changes Per Hour (ACH). Instead of saying a building or room has poor ventilation we must start saying that the room or building ACH is 0 or the ACH is 1.

This serious problem of imprecise communications on a building’s ventilation performance level is partly traceable to this research. When this research was disclosed, it was stated using the term ventilation rather than suggested ACH levels. The thought at the time was that people in positions of authority would do the right thing and come to a consensus on acceptable risk and ACH levels. That did not happen. Instead the information is being hidden and confused.

To deal with the education challenge and correct the dialog, a presentation is provided to frame the problem and what must be done. The research content is too long and difficult for most people to read.

What the research has shown is that the biggest problem with building ventilation is maintenance and operations. People close off vents, complain about temperature and staff close vent dampers in the ducts, zones fail and are abandoned, thermostats, sensors, and actuators are broken, etc.

From an operational perspective, public buildings that use on demand systems like clubhouses are not managed properly. People do not turn on the system fan mode because they don’t know to do that or they don’t want to turn them on because there are improper vent diffusers and the ventilation is uncomfortable. In the home situation people do not know to turn on the fan mode when people visit. Most do not even know they have a fan mode.

As of 2022 this research developed 3 tools to help address the building ventilation challenges.

The first tool is the Building Contagion Mitigation Certification (BCMC) tool. This is an all encompassing tool that captures the ACH levels of all rooms and applies them to a risk scale. Other data is also collected. Certificates can be printed and posted in rooms and for the entire building. This is a tool that contains private data but allows the certificates to be posted for public viewing as part of the concept of - The Right To Know.

The second tool, Clean Air Buildings (CAB) was developed to allow anyone to capture the ACH of rooms in a building and post it in a public database. The public database also allows users to search for buildings and examine the ACH performance levels. Unlike the BCMC, it does not subject the ACH to a risk scale. The goal is to just assess buildings for their current conditions but not make any judgments of risk. Like the BCMC, the CAB also allows users to print room and building level certificates. It is also less difficult to use than the BCMC.

The third tool, ACH Calculations, is closely integrated with the CAB and it allows users to easily capture the data to calculate ACH levels using room size and anemometer measurements or balance reports from an HVAC company. This seems like a trivial exercise until one attempts to capture this data. This is a third generation attempt to create a user friendly mechanism to capture the ACH performance level. The first generation was via spreadsheet, the second generation was in the BCMC and it was too complicated for the average user. Once the ACH Calculations tool is used the data is stored and linked to the CAB so that users can switch between the two views and databases.

This is the ventilation education presentation link: Building Ventilation In The Age Of Contagions

This is the CAB link: Clean Air Buildings

This is the ACH Calculations links: ACH Calculations

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Living with COVID-19 - Outdoor Indoor ACH Benefits

Abstract

An ACH Benefit scale is suggested that shows the relative benefit with each increment of Air Change Per Hour (ACH). It has been embedded in the CAB and ACT tools used to capture and store facility ACH levels in an open database accessible by anyone on the Internet. The ACH Benefit scale can be used to manage existing facilities and develop new building standards to deal with COVID-19 and its variants becoming endemic. The ACH Benefit scale surfaced during this analysis of living with COVID-19 while considering outdoor settings, indoor settings, leading causes of death, and ACH. The analysis includes:

Introduction

In 2022 some are still wearing masks outside with no people present suggesting that they do not understand or are aware of the probability of infection in the 3 scenarios of small indoor spaces, large indoor spaces and outside. They do not realize the vast differences between outdoor and indoor living. Outdoor living with a gentle wind and or walking translates into massive Air Changes with the massive Benefit results in terms of contagion mitigation.

For indoor spaces there is no pressure on facility managers to properly maintain, properly operate, and if needed upgrade or install building ventilation systems. It is obvious that those focused on their building ventilation performance levels are in the minority. When the public and or employee unions attempt to address these questions in work settings, clubhouses, and schools there is massive push back and data is not provided and it is being prevented from being captured by others such as employees, residents that use clubhouses, and union members.

This analysis is focused on educating people so that they know how to live going forward. It is based on systems safety risk analysis techniques. Probabilities of infection are determined for various scenarios and the relative risk is determined between the different scenarios. This was previously performed and disclosed by this research in 2020. What is new in this systems research increment in 2022 is that the probabilities and risks are tied to various causes of death and the odds of dying in the USA. At the end of this analysis a comparison between different analysis approaches is performed and a Benefit scale is offered that shows relative benefit with each increment of Air Change Per Hour (ACH). At the end of this analysis is a table quantifying a Benefit level for various ACH levels using different analysis approaches.

There are many trying to build a case that ventilation is not important and that nothing needs to be done, even if rooms and buildings have 0 ACH or 1 ACH. We know that infection happens at 0 ACH and 1 ACH. The CDC guideline is 12+ ACH for airborne contagions. So the answer is someplace between 1 and 12 ACH and the risk of infection drops as the ACH level increases and that risk drops significantly based on empirical data and most analysis perspectives. However, there are analysis perspectives that can suggest that increasing ACH levels offers minimal benefits. There is an old saying, figures never lie but liers figure. This is the current situation with those trying to maintain the status quo of facilities with ACH levels of 0 or 1 ACH. They are cherry picking the analysis approaches and findings to justify doing nothing. Unfortunately the cherry picked analysis and findings are gravely wrong leading to sickness and death.

This analysis has offered a Proposed Ventilation Test and Evaluation Program to answer once and for all the ACH levels needed going forward in this new reality of living with COVID-19. Until we have that program up and running we have this analysis.

.

Leading Causes of Death

The following table shows the various causes of death and the odds of dying from those causes [1].

[spreadsheet Probability 2022]

Cause of Death (USA)

Odds of Dying

1. Heart disease

1 in 6

2. Cancer

1 in 7

3. All preventable causes of death

1 in 24

4. Chronic lower respiratory disease

1 in 27

5. Suicide

1 in 88

6. Opioid overdose

1 in 92

7. Fall

1 in 106

8. Motor vehicle crash

1 in 107

9. Gun assault

1 in 289

10. Pedestrian incident

1 in 543

11. Motorcyclist

1 in 899

12. Drowning

1 in 1,128

13. Fire or smoke

1 in 1,547

14. Choking on food

1 in 2,535

15. Bicyclist

1 in 3,825

16. Sunstroke

1 in 8,248

17. Accidental gun discharge

1 in 8,571

18. Electrocution, radiation, extreme temperatures, and pressure

1 in 13,394

19. Sharp objects

1 in 29,334

20. Cataclysmic storm

1 in 58,669

21. Hornet, wasp, and bee stings

1 in 59,507

22. Hot surfaces and substances

1 in 63,113

23. Dog attack

1 in 86,781

24. Lightning

1 in 138,849

This data can be mapped to different analysis approaches to determine the cause of death or odds of dying with each increment of ACH in a room and building. The following analysis approaches map this data to various ACH levels:

The analysis approaches are then compared:

This is then used to provide the benefit of each increment of ACH:

A procedure is offered to gather ACH data for any facility:

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COVID-19 Cause of Death Ranking - Wells Riley Details

Since the start of the COVID-19 disaster there are stakeholders trying to determine if the ACH levels for non hospital settings need to be updated. One approach is to use the Well-Riley probability of infection equation. But there are also other analysis perspectives that exist that can be used to suggest what the new ACH levels must be in public buildings.

This analysis uses the Wells–Riley probability of infection equation. [2]

P = D/S = 1 - exp ( - (Ipqt/Q) )

where:
D = number of disease cases
D = number of disease cases
S = number of susceptibles
I = number of infectors
P = probability of infection for susceptibles
p = breathing rate per person (m3/s)
p = breathing rate per person (m3/s)
q = quantum generation rate by an infected person (quanta/s)
t = total exposure time (s)
Q = outdoor air supply rate (m3/s)

The following tables show the various living scenarios using the Wells-Riley equation, the odds of dying, and how COVID-19 death in those scenarios compares with other causes of death. For example if the odds of dying from COVID-19 are similar to being struck by lightening, go live your life and be happy. If the odds of dying are equivalent to or worse than a heart attack, you must proceed with extreme caution. The 3 scenarios are a small indoor space like a school classroom (30x30x12 ft), a large indoor space like a shopping center or big box store (100x100x40), and then outside.

The probability of infection (Pi) from the Wells-Riley equation is used to determine the probability of death and eventually the odds of dying and cause of death.

Pi = Remaining Virus
Odds = Pi * Calibration Factor (15% or 2%)
Cause of Death  = Odds lookup table

Empirical data from the past 2 years shows that the odds of dying from COVID-19 are closer to Heart Attack and Cancer. This empirical data is used to calibrate the analysis to the worst case cause of death when ACH = 0. See section COVID-19 Death Rate Ranking.

[spreadsheet Probability 2022 15%]

Scenario

Odds of
Dying 1:x

Cause of Death
Calibrated to ACH=0

Masks

ACH

time
hour

# of
Infected

Space
cu-ft

Ventilation

Small Indoor Space 107 7. Fall Yes 1 1 2 10,800 Poor
Small Indoor Space 107 8. Motor vehicle crash Yes 1 1 1 10,800 Poor
Small Indoor Space 148 8. Motor vehicle crash Yes 4 1 1 10,800 Expected
Small Indoor Space 7 1. Heart disease No 1 1 1 10,800 Expected
Small Indoor Space 9 2. Cancer No 4 1 1 10,800 Expected
Small Indoor Space 19 2. Cancer No 12 1 1 10,800 upgraded to CDC guideline
Small Indoor Space 30 4. Chronic lower respiratory disease No 20 1 1 10,800 upgraded to WHO guideline
Small Indoor Space 35 4. Chronic lower respiratory disease No 24 1 1 10,800 upgraded to WHO guideline
Small Indoor Space 268 8. Motor vehicle crash Yes 10 1 1 10,800 Rare
Small Indoor Space 894 10. Pedestrian incident Yes 40 1 1 10,800 Massive Natural
Large Indoor Space 444 9. Gun assault Yes 1 1 2 400,000 Poor
Large Indoor Space 832 10. Pedestrian incident Yes 1 1 1 400,000 Poor
Large Indoor Space 3,162 14. Choking on food Yes 4 1 1 400,000 Expected
Large Indoor Space 7,825 15. Bicyclist Yes 10 1 1 400,000 Rare
Large Indoor Space 31,140 19. Sharp objects Yes 40 1 1 400,000 Massive Natural
Small Indoor Space 107 8. Motor vehicle crash Yes 1 1 1 10,800 Poor
Small Indoor Space 148 8. Motor vehicle crash Yes 4 1 1 10,800 Expected
Small Indoor Space 107 7. Fall Yes 4 8 1 10,800 Expected
Large Indoor Space 832 10. Pedestrian incident Yes 1 1 1 400,000 Poor
Large Indoor Space 3,162 14. Choking on food Yes 4 1 1 400,000 Expected
Large Indoor Space 444 9. Gun assault Yes 4 8 1 400,000 Expected
Small Indoor Space 7 1. Heart disease Yes but 1 hour mask off 1 1 1 10,800 Poor
Small Indoor Space 9 2. Cancer Yes but 1 hour mask off 4 1 1 10,800 Expected
Small Indoor Space 56 4. Chronic lower respiratory disease Yes but 1 hour mask off 40 1 1 10,800 Massive Natural
Small Indoor Space 7 1. Heart disease No 4 8 1 10,800 Expected
Small Indoor Space 10 2. Cancer No 40 8 1 10,800 Massive Natural
Large Indoor Space 52 4. Chronic lower respiratory disease No 1 1 1 400,000 Poor
Large Indoor Space 198 8. Motor vehicle crash No 4 1 1 400,000 Expected
Large Indoor Space 1,946 13. Fire or smoke No 40 1 1 400,000 Massive Natural
Large Indoor Space 28 4. Chronic lower respiratory disease No 4 8 1 400,000 Expected
Large Indoor Space 246 8. Motor vehicle crash No 40 8 1 400,000 Massive Natural
Outside courtyard 1,184 12. Drowning No 3600 4 1 10,800 wind 1 mile / hr
Outside courtyard 5,905 15. Bicyclist No 18000 4 1 10,800 wind 5 mile / hr
Outside large pool area 43,719 19. Sharp objects No 3600 4 1 400,000 wind 1 mile / hr
Outside large pool area 218,583 24. Lightning No 18000 4 1 400,000 wind 5 mile / hr
Outside wide open 437,162 24. Lightning No 3600 4 1 4,000,000 wind 1 mile / hr
Outside wide open 2,185,796 24. Lightning No 18000 4 1 4,000,000 wind 5 mile / hr

The odds of dying from a lightening strike are 1 in 138,849. When people are walking they tend to exceed 1 mile / hr. So living outside is radically different than living inside when there is the threat of an airborne contagion.

If the analysis is calibrated to a 2% death rate the odds of dying shift and spread more across the ACH range.

[spreadsheet Probability 2022 2%]

Scenario

Odds of
Dying 1:x

Cause of Death
at 2% Death Rate

Masks

ACH

time
hour

# of
Infected

Space
cu-ft

Ventilation

Small Indoor Space 800 10. Pedestrian incident Yes 1 1 2 10,800 Poor
Small Indoor Space 805 10. Pedestrian incident Yes 1 1 1 10,800 Poor
Small Indoor Space 1,112 11. Motorcyclist Yes 4 1 1 10,800 Expected
Small Indoor Space 50 4. Chronic lower respiratory disease No 1 1 1 10,800 Expected
Small Indoor Space 70 4. Chronic lower respiratory disease No 4 1 1 10,800 Expected
Small Indoor Space 145 8. Motor vehicle crash No 12 1 1 10,800 upgraded to CDC guideline
Small Indoor Space 223 8. Motor vehicle crash No 20 1 1 10,800 upgraded to WHO guideline
Small Indoor Space 262 8. Motor vehicle crash No 24 1 1 10,800 upgraded to WHO guideline
Small Indoor Space 2,008 13. Fire or smoke Yes 10 1 1 10,800 Rare
Small Indoor Space 6,704 15. Bicyclist Yes 40 1 1 10,800 Massive Natural
Large Indoor Space 3,333 14. Choking on food Yes 1 1 2 400,000 Poor
Large Indoor Space 6,238 15. Bicyclist Yes 1 1 1 400,000 Poor
Large Indoor Space 23,717 18. Electrocution, radiation, extreme temperatures, and pressure Yes 4 1 1 400,000 Expected
Large Indoor Space 58,689 20. Cataclysmic storm Yes 10 1 1 400,000 Rare
Large Indoor Space 233,551 24. Lightning Yes 40 1 1 400,000 Massive Natural
Small Indoor Space 805 10. Pedestrian incident Yes 1 1 1 10,800 Poor
Small Indoor Space 1,112 11. Motorcyclist Yes 4 1 1 10,800 Expected
Small Indoor Space 800 10. Pedestrian incident Yes 4 8 1 10,800 Expected
Large Indoor Space 6,238 15. Bicyclist Yes 1 1 1 400,000 Poor
Large Indoor Space 23,717 18. Electrocution, radiation, extreme temperatures, and pressure Yes 4 1 1 400,000 Expected
Large Indoor Space 3,333 14. Choking on food Yes 4 8 1 400,000 Expected
Small Indoor Space 50 4. Chronic lower respiratory disease Yes but 1 hour mask off 1 1 1 10,800 Poor
Small Indoor Space 70 4. Chronic lower respiratory disease Yes but 1 hour mask off 4 1 1 10,800 Expected
Small Indoor Space 419 9. Gun assault Yes but 1 hour mask off 40 1 1 10,800 Massive Natural
Small Indoor Space 50 4. Chronic lower respiratory disease No 4 8 1 10,800 Expected
Small Indoor Space 78 4. Chronic lower respiratory disease No 40 8 1 10,800 Massive Natural
Large Indoor Space 390 9. Gun assault No 1 1 1 400,000 Poor
Large Indoor Space 1,482 12. Drowning No 4 1 1 400,000 Expected
Large Indoor Space 14,597 18. Electrocution, radiation, extreme temperatures, and pressure No 40 1 1 400,000 Massive Natural
Large Indoor Space 208 8. Motor vehicle crash No 4 8 1 400,000 Expected
Large Indoor Space 1,847 13. Fire or smoke No 40 8 1 400,000 Massive Natural
Outside courtyard 8,877 17. Accidental gun discharge No 3600 4 1 10,800 wind 1 mile / hr
Outside courtyard 44,287 19. Sharp objects No 18000 4 1 10,800 wind 5 mile / hr
Outside large pool area 327,894 24. Lightning No 3600 4 1 400,000 wind 1 mile / hr
Outside large pool area 1,639,369 24. Lightning No 18000 4 1 400,000 wind 5 mile / hr
Outside wide open 3,278,714 24. Lightning No 3600 4 1 4,000,000 wind 1 mile / hr
Outside wide open 16,393,468 24. Lightning No 18000 4 1 4,000,000 wind 5 mile / hr

This detailed analysis is used as an approach for other analysis alternatives. It is a model that can be followed and used consistently across different analysis approaches. It is revisited with less data so that a comparison can be made between various analysis approaches. The outside case is not carried forward because there is not point. The massive problem is indoors not outdoors.

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.

COVID-19 Cause of Death Ranking - Remaining Virus Perspective

The following tables show the odds of dying and cause of death ranking from a remaining virus level perspective for various ACH Levels. This is based on 63% of the virus being eliminated with 1 ACH and then 63% of the remaining virus being eliminated with each successive 1 ACH increment. [3] [4] [2] The remaining virus is then equaled to probability of infection (Pi = Remaining Virus). The probability of infection (Pi) is used to determine the probability of death and eventually the odds of dying and cause of death.

Pi = Remaining Virus
Odds = Pi * Calibration Factor (15% or 2%)
Cause of Death  = Odds lookup table

Empirical data from the past 2 years shows that the odds of dying from COVID-19 are closer to Heart Attack and Cancer. This empirical data is used to calibrate the analysis to the worst case cause of death when ACH = 0. See section COVID-19 Death Rate Ranking.

[spreadsheet Odds 15%]

Scenario
Remaining Virus Perspective

Odds of
Dying 1:x

Cause of Death
Calibrated to ACH=0

ACH

Remaining
Virus
63% / AC

Chance of
Infection

Indoor Space 7 1. Heart disease 0 100% 100%
Indoor Space 11 2. Cancer 1 63% 63%
Indoor Space 17 2. Cancer 2 40% 40%
Indoor Space 42 4. Chronic lower respiratory disease 4 16% 16%
Indoor Space 111 8. Motor vehicle crash 6 6% 6%
Indoor Space 333 9. Gun assault 8 2% 2%
Indoor Space 667 10. Pedestrian incident 10 1% 1%
Indoor Space 1,709 13. Fire or smoke 12 0.39% 0%
Indoor Space 6,667 15. Bicyclist 15 0.10% 0%
Indoor Space 66,667 22. Hot surfaces and substances 20 0.01% 0%
Indoor Space 50

If the analysis is calibrated to a 2% death rate the odds of dying shift and spread more across the ACH range.

[spreadsheet Odds 2%]

Scenario
Remaining Virus Perspective

Odds of
Dying 1:x

Cause of Death
at 2% death rate

ACH

Remaining
Virus
63% / AC

Chance of
Infection

Indoor Space 50 4. Chronic lower respiratory disease 0 100% 100%
Indoor Space 79 4. Chronic lower respiratory disease 1 63% 63%
Indoor Space 125 8. Motor vehicle crash 2 40% 40%
Indoor Space 313 9. Gun assault 4 16% 16%
Indoor Space 833 10. Pedestrian incident 6 6% 6%
Indoor Space 2,500 13. Fire or smoke 8 2% 2%
Indoor Space 5,000 15. Bicyclist 10 1% 1%
Indoor Space 12,821 17. Accidental gun discharge 12 0.39% 0%
Indoor Space 50,000 19. Sharp objects 15 0.10% 0%
Indoor Space 500,000 24. Lightning 20 0.01% 0%
Indoor Space 50

The Remaining Virus Perspective analysis suggests that there is benefit for each increment of ACH.

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.

COVID-19 Cause of Death Ranking - Systems Safety Perspective

The following tables show the odds of dying and cause of death ranking from a systems safety perspective for various ACH Levels. This analysis is based on assuming that the probability of infection is 100% at ACH=0. We know from empirical data that infection happens at ACH=1. [5] [6] [7]. From a risk safety perspective if the ACH rate is doubled from 1 to 2 then the Risk is cut in half to 50%, from 1 to 4 the Risk is cut in 4 to 25% and so on. The risk is then equaled to probability of infection (Pi = Risk). The probability of infection (Pi) is used to determine the probability of death and eventually the odds of dying and cause of death.

Pi = Risk
Odds = Pi * Calibration Factor (15% or 2%)
Cause of Death  = Odds lookup table

Empirical data from the past 2 years shows that the odds of dying from COVID-19 are closer to Heart Attack and Cancer. This empirical data is used to calibrate the analysis to the worst case cause of death when ACH = 0. See section COVID-19 Death Rate Ranking.

[spreadsheet Odds 15%]

Scenario
Systems Safety Perspective

Odds of
Dying 1:x

Cause of Death
Calibrated to ACH=0

ACH

Infection Risk
(1/ACH)
Safety world

Chance of
Infection

Indoor Space 7 1. Heart disease 0 100% 100%
Indoor Space 7 1. Heart disease 1 100% 100%
Indoor Space 13 2. Cancer 2 50% 50%
Indoor Space 27 3. All preventable causes of death 4 25% 25%
Indoor Space 39 4. Chronic lower respiratory disease 6 17% 17%
Indoor Space 51 4. Chronic lower respiratory disease 8 13% 13%
Indoor Space 67 4. Chronic lower respiratory disease 10 10% 10%
Indoor Space 83 4. Chronic lower respiratory disease 12 8% 8%
Indoor Space 95 6. Opioid overdose 15 7% 7%
Indoor Space 133 8. Motor vehicle crash 20 5% 5%
Indoor Space 333 9. Gun assault 50 2% 2%

If the analysis is calibrated to a 2% death rate the odds of dying shift and spread more across the ACH range.

[spreadsheet Odds 2%]

Scenario
Systems Safety Perspective

Odds of
Dying 1:x

Cause of Death
at 2% death rate

ACH

Infection Risk
(1/ACH)
Safety world

Chance of
Infection

Indoor Space 50 4. Chronic lower respiratory disease 0 100% 100%
Indoor Space 50 4. Chronic lower respiratory disease 1 100% 100%
Indoor Space 100 6. Opioid overdose 2 50% 50%
Indoor Space 200 8. Motor vehicle crash 4 25% 25%
Indoor Space 294 9. Gun assault 6 17% 17%
Indoor Space 385 9. Gun assault 8 13% 13%
Indoor Space 500 9. Gun assault 10 10% 10%
Indoor Space 625 10. Pedestrian incident 12 8% 8%
Indoor Space 714 10. Pedestrian incident 15 7% 7%
Indoor Space 1,000 11. Motorcyclist 20 5% 5%
Indoor Space 2,500 13. Fire or smoke 50 2% 2%

The Systems Safety Perspective analysis suggests that there still is benefit for each increment of ACH.

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.

COVID-19 Cause of Death Ranking - Wells-Riley Perspective

The following tables show the odds of dying and cause of death ranking when using the Wells-Riley equation for various ACH Levels. The probability of infection (Pi) is used to determine the probability of death and eventually the odds of dying and cause of death.

Pi = Remaining Virus
Odds = Pi * Calibration Factor (15% or 2%)
Cause of Death  = Odds lookup table

Empirical data from the past 2 years shows that the odds of dying from COVID-19 are closer to Heart Attack and Cancer. This empirical data is used to calibrate the analysis to the worst case cause of death when ACH = 0. See section COVID-19 Death Rate Ranking.

[spreadsheet Odds 15%]

Scenario
Well-Riley Perspective

Odds of
Dying 1:x

Cause of Death
Calibrated to ACH=0

ACH

Probability
of Infection

Chance of
Infection

Small Indoor Space 7 1. Heart disease 0 1.0000000 100%
Small Indoor Space 7 1. Heart disease 1 0.9938008 99%
Small Indoor Space 7 2. Cancer 2 0.9212649 92%
Small Indoor Space 9 2. Cancer 4 0.7194023 72%
Small Indoor Space 12 2. Cancer 6 0.5713962 57%
Small Indoor Space 14 2. Cancer 8 0.4702853 47%
Small Indoor Space 17 2. Cancer 10 0.3985028 40%
Small Indoor Space 19 2. Cancer 12 0.3453216 35%
Small Indoor Space 23 2. Cancer 15 0.2874384 29%
Small Indoor Space 30 2. Cancer 20 0.2244375 22%
Small Indoor Space 69 4. Chronic lower respiratory disease 50 0.0966694 10%
Large Indoor Space 50 1. Heart disease 0 1.0000000 100%
Large Indoor Space 390 4. Chronic lower respiratory disease 1 0.1282477 13%
Large Indoor Space 754 6. Opioid overdose 2 0.0663233 7%
Large Indoor Space 1,482 8. Motor vehicle crash 4 0.0337305 3%
Large Indoor Space 2,211 9. Gun assault 6 0.0226154 2%
Large Indoor Space 2,939 9. Gun assault 8 0.0170099 2%
Large Indoor Space 3,668 9. Gun assault 10 0.0136312 1%
Large Indoor Space 4,397 10. Pedestrian incident 12 0.0113723 1%
Large Indoor Space 5,490 10. Pedestrian incident 15 0.0091083 1%
Large Indoor Space 7,311 11. Motorcyclist 20 0.0068390 1%
Large Indoor Space 18,240 13. Fire or smoke 50 0.0027412 0%

If the analysis is calibrated to a 2% death rate the odds of dying shift and spread more across the ACH range.

[spreadsheet Odds 2%]

Scenario
Well-Riley Perspective

Odds of
Dying 1:x

Cause of Death
at 2% death rate

ACH

Probability
of Infection

Chance of
Infection

Small Indoor Space 50 4. Chronic lower respiratory disease 0 1.0000000 100%
Small Indoor Space 50 4. Chronic lower respiratory disease 1 0.9938008 99%
Small Indoor Space 54 4. Chronic lower respiratory disease 2 0.9212649 92%
Small Indoor Space 70 4. Chronic lower respiratory disease 4 0.7194023 72%
Small Indoor Space 88 4. Chronic lower respiratory disease 6 0.5713962 57%
Small Indoor Space 106 7. Fall 8 0.4702853 47%
Small Indoor Space 125 8. Motor vehicle crash 10 0.3985028 40%
Small Indoor Space 145 8. Motor vehicle crash 12 0.3453216 35%
Small Indoor Space 174 8. Motor vehicle crash 15 0.2874384 29%
Small Indoor Space 223 8. Motor vehicle crash 20 0.2244375 22%
Small Indoor Space 517 9. Gun assault 50 0.0966694 10%
Large Indoor Space 50 4. Chronic lower respiratory disease 0 1.0000000 100%
Large Indoor Space 390 9. Gun assault 1 0.1282477 13%
Large Indoor Space 754 10. Pedestrian incident 2 0.0663233 7%
Large Indoor Space 1,482 12. Drowning 4 0.0337305 3%
Large Indoor Space 2,211 13. Fire or smoke 6 0.0226154 2%
Large Indoor Space 2,939 14. Choking on food 8 0.0170099 2%
Large Indoor Space 3,668 14. Choking on food 10 0.0136312 1%
Large Indoor Space 4,397 15. Bicyclist 12 0.0113723 1%
Large Indoor Space 5,490 15. Bicyclist 15 0.0091083 1%
Large Indoor Space 7,311 15. Bicyclist 20 0.0068390 1%
Large Indoor Space 18,240 18. Electrocution, radiation, extreme temperatures, and pressure 50 0.0027412 0%

The Wells-Riley Perspective analysis suggests that there still is benefit for each increment of ACH but it is the least benefit between the 3 analysis approaches..

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.

COVID-19 Cause of Death Ranking - All Perspectives Comparisons

The following table compares the various analysis perspectives at various ACH levels. Probability of Infection, Safety Risk, and Remaining Virus are all treated the same way in the comparison. There is no change in the numbers to account for any possible differences. They are all Probability of Infection that lead to a cause of death.

ACH

Remaining Virus
Perspective
Percent

Systems Safety
Perspective
Risk

Well-Riley Perspective
Small Indoor Space
Prob of Infection

Well-Riley Perspective
Large Indoor Space
Prob of Infection

Well-Riley Perspective
Large Indoor Space
Ignore 0 ACH

0

100%

100%

100%

100%

-

1

63%

100%

99%

13%

100%

2

40%

50%

92%

7%

52%

4

16%

25%

72%

3%

26%

6

6%

17%

57%

2%

18%

8

2%

13%

47%

2%

13%

10

1%

10%

40%

1%

11%

12

0%

8%

35%

1%

9%

15

0%

7%

29%

1%

7%

20

0%

5%

22%

1%

5%

50

0%

2%

10%

0%

2%

This data is used to calculate the Benefit of each increment of ACH.

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.

ACH Benefit Analysis

A Benefit scale is offered that shows the relative benefit with each increment of ACH. A table quantifying a Benefit level for various ACH levels using different analysis approaches can be developed. This can be used to manage existing facilities and develop new building standards to deal with COVID-19 becoming endemic. The following analysis takes the above values in the COVID-19 Cause of Death Ranking - All Perspectives Comparisons table and quantifies the benefit. The ACH Benefit or just Benefit in this context is calculated by taking each cell value and dividing it into 100. The Benefit equation is:

ACH Benefit = Benefit = 100 / Value from each cell
where:
Value from each cell = Remaining Virus Perspective or
Value from each cell = Remaining Virus Systems Safety Perspective Risk or
Value from each cell = Well-Riley Perspective Small Indoor Space Prob of Infection or
Value from each cell = Well-Riley Perspective Large Indoor Space Prob of Infection

The ACH Benefit level provides a reading of how much better the increased ACH level is from the baseline, which is 100% Probability of Infection or 100% Risk of infection when the ACH level is 0.

The following table shows the ACH Benefit or Benefit level for each increment of ACH for the different analysis perspectives.

ACH

Benefit
Remaining Virus
Perspective

Benefit
Systems Safety
Perspective

Benefit
Well-Riley
Small Indoor Space
Perspective

Benefit
Well-Riley
Large Indoor Space
Perspective

Facility Types

0

1.0

1

1.0

1.0

Very Low End

1

1.6

1

1.0

7.8

Very Low End

2

2.5

2

1.1

15.1

Low End

4

6.3

4

1.4

29.6

Low End

6

16.7

6

1.8

44.2

Medium

8

50.0

8

2.1

58.8

Medium

10

100.0

10

2.5

73.4

Medium

12

256.4

12

2.9

87.9

Elite

15

1000.0

15

3.5

109.8

Elite

20

10000.0

20

4.5

146.2

Elite

50

-

50

10.3

364.8

Elite

For example when the ACH level is 6 the situation is 16.7 times better when using the analysis from the Remaining Virus Perspective. The analysis from the Systems Safety Perspective is less optimistic and the benefit is 6 times better. This suggests that the Systems Safety Perspective would lean towards a larger ACH level that should be part of possible future ACH standard updates to deal with the new reality of COVID-19 being endemic. For example when selecting an ACH level for a possible future standard, if the desired Benefit is approximately 12 and the Systems Safety Perspective drives the future standard, then ACH = 12 would be used rather than ACH = 5 to 6 from the Remaining Virus Perspective.

A key element to consider is that the CDC guideline is 12+ ACH for a room with airborne contagions and the WHO suggests 24+ ACH. Both the CDC and the WHO tend to favor the Remaining Virus Perspective because they specifically address it in their documentation. Both those ACH levels translate to very large benefits (256 and 10,000+) from the Remaining Virus Perspective. The issue is that the stakeholders that suggest the ACH levels can drop to lower levels such as 4 or 6 ACH because of the Benefit from Remaining Virus Perspective must be corrected and shown the lower Benefit from the Systems Safety Perspective.

If one were to build a case for not increasing the ACH levels in a room then the Well-Riley Small Indoor Space Perspective would be offered because the benefit for increasing the ACH level is minimal. If one were to build a case for increasing the ACH level the Remaining Virus Perspective would be offered. An interesting assessment is coming from the Systems Safety Perspective. This is based on just taking the inverse of the level, which then just becomes the actual ACH level.

Home Case Histories: When many went into telework mode because of the COVID-19 disaster and spending a great deal of time indoors, some bought CO2 monitors. In some cases homeowners previously closed off the fresh air intake in their home HVAC systems to save on costs. In many cases, after introducing the monitor, the HVAC fresh air intake was opened and there was an improvement with no real impact on cost. The readings went from an average CO2 level 1100-1200 to 700-800. What alerted one homeowner was their dog was sleeping and behaving oddly after telework started. The source is the Internet message boards and product review boards for the CO2 monitors. The same message boards were also trying to correlate CO2 levels with possible COVID-19 levels in a room.

Some analysts have formally tried to connect CO2 levels to virus concentration but that is inappropriate because we know that maintaining CO2 levels translates to less than 1 ACH in real room settings and that leads to infection. The ideal situation would be to place a device in a room to determine if there is a contagion. However, the virus concentration levels are too small in a room setting and even for a personal air sniffing device. The approaches for understanding the system challenges for COVID-19 appear to be:

  1. Particle Simulations: Simulate the virus with particles that can be detected with particle detectors using lots of particles (MITRE, Air Force) [8]
  2. PCR Placements: PCR test strips and long exposure times (Others). [9] [10]
  3. Petri Dish Placements: Using Petri Dishes and counting growth of similar contagions over long exposure times (Infectious disease staff that maintain clean rooms).

These are all more or less batch approaches to the problem rather than realtime sensors. However, they all feed into the solution of ventilation and what the ventilation rates do to risk levels.

Some have suggested that sensors be developed to detect COVID-19 in a room or on a person as a personal detector. [11] The problem is that once a sensor has detected the contagion, the infection has already been spread into the space. That is why testing people before they enter a space is one strategy to prevent infection from entering into a safe clean space. The systems challenge is that people are always the weakest link in any system and the testing results are untrusted. Establishing trusted testing results is problematic in a free society. This also assumes that testing will provide a reasonable level of accuracy.

The bottom line is that ventilation clearly stated in terms of ACH must be determined for all rooms and all buildings. Further the ACH levels are directly tied to risk of infection and the CDC guidance clearly states that the minimum ACH level must be 12+ ACH. That is why facilities types are noted in the above table and Elite Facilities begin at 12+ ACH. We also know that infection happens with 0 and 1 ACH [5] [6] [7] and so those facilities are considered to be Very Low End facilities.

As of July 2022, there is no effort to change building codes to include new items such as periodic inspections of HVAC systems to ensure that they are properly maintained and operated. Many buildings have poor ventilation performance levels in terms of ACH and operate at 0 or 1 ACH. The challenges are closed off vents, blocked vents, broken fans, and for on demand systems people are not turning on the fan mode when the public is present. This is why it is critical to capture, document, and understand all facilities ventilation performance levels. In the absence of government regulation and oversight several attempts at building self certification systems have been attempted like the Philadelphia Restaurant program [12], but they are too small and do not address the need of full coverage of all buildings everywhere.

This research has offered a public database where building and transportation system ventilation performance levels are captured and offered for public review and self certification.

The following ACH Benefit Scale is offered and is embedded in the CAB and ACT. It allows for a quick visualization of ventilation performance levels in terms of ACH.

ACH Risk / Benefit Scale

Risk / Benefit Scale
with ACH Levels
worst

very low
0

very low
1

low
2

low
3

low
4

low
5

med
6

med
7

med
8

med
9

med
10

med
11

elite
12

elite
13

elite
14

elite
15+

best

It is obvious that those focused on their building ventilation performance levels are in the minority. When the public and or employee unions attempt to address these questions in work settings, clubhouses, and schools there is massive push back and data is not provided. If data is provided, it is only incomplete engineering data and there are no measurements of the actual ventilation performance levels. For example, what should be happening is what the Philadelphia School district did to understand their schools ventilation performance levels. [12] [13]

Unfortunately because of a lack of knowledge in this area, a massive education effort is needed. However, none has come to pass as of July 2022. This research has provided some education content:

embedded video

***

.

ACH Benefit Observations

Some are suggesting that the new variants like BA.5 are more contagious where outdoor living is now compromised and so there is no point in dealing with the buildings. That is incorrect. The science and engineering is based on physics and how particles behave. It is also based on the biology of the ability of a contagion to take root in a body. [14] [15] There are either more particles or the ability of the contagion to take root increases. However, the physics is about cleaning the air. The more clean the air, the lower the probability of infection and the greater the Benefit. Once again this incorrect messaging is an attempt on the part of some stakeholders to do nothing with our buildings. The reality is people are engaging in life. They go to poorly ventilated restaurants, clubhouses, schools, and other public spaces. Many are still unvaccinated spreading the virus and keeping the virus level high in the population. This is all happening with random use of masks.

COVID-19 Body Response Operational Sequence Diagram - Starts with Poor Ventilation

What this systems analysis has shown over the years is that airborne contagions do not behave like a toxic gas. Toxic gas spreads and evenly distributes into a space while airborne contagions travel like a cloud. [8] Further the concentration levels coming from an infected human are significantly less than from manufactured gas tank(s). Many have the incorrect mental model of gas poisoning rather than a contagion mental model of small traveling airborne clouds. The entire atmosphere is not deadly like it might be with a gas release. Unfortunately, some people have the mental model of gas poisoning and they are wearing masks outside with no other people present, for example walking alone by the side of the road, in the distance in a park, or in the distance at the beach.

The mental model of small traveling airborne clouds is critical because this is what allows people to move forward and live by being intelligently outside and properly managing the indoor air in buildings. Unlike a gas which may not breakdown, contagions do become infective once the water maintaining the virus structure evaporates. [16] Moving viruses through the air increases the evaporation rates suggesting that the effective filtration rate is not just based on the filters used in an HVAC system but also movement through the air. If a virus becomes inactivated it is irrelevant if a downstream filter captures the remaining physical structure. The ACH with the resulting air mixing to evaporate water from a contagion in a room and an entire building are also a key element to the resulting Benefit. The benefits due to evaporation have not yet been quantified in this analysis as of July 2022. A quick look at the University of Bristol test results suggests that moving the virus through the air may be equivalent to 1-3 ACH but a more detailed examination and formal analysis is needed. Once again there must be extreme caution to ensure that evaporation is not used to reduce ACH levels and maintain the status quo of doing nothing.

We are 3 years into the COVID-19 disaster and it is clear that we are in big trouble. There needs to be a massive shift in thinking to immediately start building ventilation education, building ventilation performance measurements, and building ventilation disclosures. This must become a top priority or people will continue to get sick and die. People also need to be told that they do not need to wear a mask while outside with few people nearby. They need to enjoy their lives.

.

Vaccine Coverage Versus Proper Ventilation Coverage

Everyone has been alerted to the need for vaccination. Because of early disinformation the population was slow to get vaccinated and some have refused to get the vaccines. We know that having 20% to 30% of the population vaccinated is not appropriate. The same holds true for proper ventilation in the buildings. Having just 5%, or 10% or even 25% of the buildings operating at effective ventilation performance levels in terms of ACH is not appropriate.

The following Risk Benefit results are for the Philadelphia School district. They decided to upgrade their infrastructure with an eACH systems approach. Prior to the upgrade 2.8 + 2.4 + 1.2 + 6.9 = 13% of the school district was at the elite Benefit level. After the initial upgrade 2.4 + 0.8 + 0.4 + 30.8 = 34% of the district was at the elite level. An additional upgrade moved most of the infrastructure into the elite Benefit level (data was not updated to reflect additional buys). A key element is that only 13% of existing infrastructure was at the elite Benefit level. It is not unreasonable to assume that this data may represent the entire USA infrastructure. This is similar to the early vaccination levels.

ACH Risk / Benefit Levels

Risk / Benefit Scale
with ACH Levels
worst 0 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15+ best
Count (min or avg ACH) 243 34 12 8 22 21 21 23 18 20 17 9 5 7 6 3 17
Percent (min or avg ACH) 100% 13.9 4.9 3.2 9 8.6 8.6 9.4 7.4 8.2 6.9 3.7 2 2.8 2.4 1.2 6.9
Count (with eACH) 243 34 8 5 14 13 15 18 14 15 11 9 3 6 2 1 75
Percent (with eACH) 100% 13.9 3.2 2 5.7 5.3 6.1 7.4 5.7 6.1 4.5 3.7 1.2 2.4 0.8 0.4 30.8
Benefit Level (ACH avg)

X

Benefit Level (with eACH avg)

X

See [CAB Database Link]

Just like with vaccinations 80% or more of the infrastructure must be operating with effective ventilation ACH levels. The only way to get there is with proper new standards and proper enforcement possible only through effective government regulation. It should begin with all government buildings to set an example moving forward. The elite buildings can form the template for what the government should do with government buildings. On the commercial side there are models that the Philadelphia Restaurant Program and the Philadelphia School district developed that everyone can easily follow and adopt. [12] [13] This research has a proposed a National Level Test and Evaluation program [17]. There is only action that is needed.

Ask not what your country can do for you - ask what you can do for your country. --- President John F. Kennedy.

Ask not what others can do for you - ask what you can do for others. --- USA Culture before the rise of extreme self interest circa 1980 with the rejection of the New Deal. [18]

President Kennedy was not asking people to change, President Kennedy was reflecting on how the people were actually behaving at the time. That behavior of putting extreme self-interest aside is what gave us the modern world that we enjoy. [18] The new extreme self-interest world gave us COVID-19 and is keeping us in this COVID-19 disaster.

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.

Ventilation Test Procedure Performed By Volunteers

There is great resistance on the part of facility managers to perform ventilation measurements and disclose the ventilation rates in terms of ACH. [19] Others still appear to be trying to determine how to proceed. [20] The following procedure is offered to volunteers to gather ventilation data. This can be performed by parents, teachers, unions, residents, employees, owners, and others for schools, clubhouses, libraries, workplaces, buildings of all types, transportation vehicles of all types, and other spaces.

Staff - 3 people

  1. 1 scribe to write the data down and take notes
  2. 1 person taking the measurements
  3. 1 person as a second set of eyes and taking measurements when the other person gets tired

Tools

  1. 1 anemometer - https://www.amazon.com/Anemometer-Handheld-Detector-Temperature-Windsurfing/dp/B07ZJ38ZMX ($17)
  2. 2 metal broom sticks from the dollar store and 2 lawn light stakes to join sticks ($4)
  3. 1 selfie stick to hold anemometer ($1)
  4. 1 Computer to record the data and produce the test results
  5. ACH Calculations Tool (ACT) tools to perform the calculations
  6. Clean Air Buildings (CAB) places the data in the public database for comparison with other facilities

Calculations

You can use the ACH Calculations Tool (ACT) or perform the calculations yourself as follows:

  1. Room Cubic Feet (cu-ft) = Length X Width X Height
  2. Vent Size in Square Inches (sq-in) = Length X Width
  3. Vent Size in Square Feet (sq-ft) = (Length/12) X (Width/12)
  4. Anemometer Feet Per Minute (FPM) = Measured from Anemometer
  5. Cubic Feet Per Minute  (CFM) = Anemometer Feet Per Minute X Vent Size In Square Feet
  6. Cubic Feet Per Hour (CFH) = Cubic Feet Per Minute X 60
  7. ACH = Cubic Feet Per Hour / Room Cubic Feet
  8. or ACH = CFH / Room cu-ft
  9. or ACH = Anemometer Feet Per Minute X 60 X (Vent Size in Square Inches / 144) / Room Cubic Feet

Test Procedure

Cubical Area

  1. Measure office cubical space (L W H)
  2. Walk each isle and look for vents per the facility drawing if it exists, if no drawing just look for vents
  3. Measure each vent linear feet per minute (FPM) using MAX setting
  4. Measure the size of each vent (should be all the same)
  5. Record the data

Rooms

  1. Find all rooms with doors
  2. Name each room
  3. Measure each room space (L W H)
  4. Open the door
  5. Measure each vent linear feet per minute (FPM) using MAX setting
  6. Measure the size of each vent
  7. Record the data

Hall

  1. Measure space (L W H)
  2. Measure each vent linear feet per minute (FPM) using MAX setting
  3. Measure the size of each vent
  4. Record the data

Bathrooms and Snack Room

  1. Measure space (L W H)
  2. Measure each vent linear feet per minute (FPM) using MAX setting
  3. Measure the size of each vent
  4. Record the data

General Guidelines

  1. Look for vents with no ventilation
  2. Look for vents with drastically lower ventilation rates than nearby vents
  3. Look for spaces that appear to have missing vents
  4. Look for inconsistencies
  5. If exhaust vents are found measure them, they will be used to check for consistency with outlet vents

https://www.youtube.com/watch?v=HlneLDi9r54 (video on how to calculate air changes per hour)

The procedure and process is very simple. Do not be side tracked with irrelevant details that some may claim to stop the measurements. Just roll up your sleeves and do the work and then present it to the community.

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References

[1] Leading Causes of Death, Centers for Disease Control and Prevention, March 1, 2021. webpage https://www.cdc.gov/nchs/fastats/leading-causes-of-death.htm, April 2021. Leading Causes of Death . local

[2] WHO Publication/Guidelines Natural Ventilation for Infection Control in Health-Care Settings, World Health Organization (WHO), 2009. webpage https://www.ncbi.nlm.nih.gov/books/NBK143284/pdf/Bookshelf_NBK143284.pdf, May 2020.  Natural Ventilation for Infection Control in Health-Care Settings, WHO, 2009 . local

[3] If We're Going to Live With COVID-19, It's Time to Clean Our Indoor Air Properly, TIME, February 1, 2022. website https://time.com/6143799/covid-19-indoor-air-cleaning.

[4] SARS-CoV-2: Dynamics of Airborne Transmission and Air Disinfection, Edward Nardell, MD, Professor of Medicine, Harvard Medical School. Presentation. Gilbert W. Beebe Webinar Series September 16, 2020. webpage https://www.nationalacademies.org/event/09-16-2020/docs/DE63EBA42A7C0AB93A2F3CCFC455B80ECA47F0B03790, July 2022. PDF . local

[5] See section School Case History.

[6] 8 Classmates, 2 Fully Vaccinated Family Members, Test Positive for COVID in Lower Merion, NBC 10 Philadelphia, April 25, 2021. webpage https://www.nbcphiladelphia.com/news/coronavirus/8-classmates-2-fully-vaccinated-family-members-test-positive-for-covid-in-lower-merion/2791754, May 2021. 8 Classmates, 2 Fully Vaccinated Family Members, Test Positive for COVID in Lower Merion.

[7] Lower Merion School District says a ventilation flaw could have fueled a COVID-19 outbreak in second-grade classroom, The Philadelphia Inquirer, April 26, 2021. webpage https://www.inquirer.com/education/lower-merion-school-district-penn-valley-covid-outbreak-hvac-20210426.html, May 2021. Lower Merion School District says a ventilation flaw could have fueled a COVID-19 outbreak in second-grade classroom.

[8] See section Other Test Activities.

[9] See section Virus Infection Testing Approaches.

[10] See section Test Approach.

[11] Development and Application of Polydimethylsiloxane (PDMS)-based Passive Air Sampler to Assess Personal Exposure to SARS-CoV-2, Yale University, New Haven, CT, 06520, USA, January 11, 2022. webpage https://pubs.acs.org/doi/10.1021/acs.estlett.1c00877?goto=supporting-info, https://pubs.acs.org/doi/suppl/10.1021/acs.estlett.1c00877/suppl_file/ez1c00877_si_001.pdf, January 2022. Development and Application of Polydimethylsiloxane (PDMS)-based Passive Air Sampler to Assess Personal Exposure to SARS-CoV-2 . PDF.

[12] See section Healthy Infrastructure for the Philadelphia Restaurant Program.

[13] See section Philadelphia School District.

[14] See section Infection and Body Response.

[15] See section Stopping Indoor Respiratory Infection.

[16] See section University of Bristol Aerosol Testing.

[17] See section Proposed Ventilation Test and Evaluation Program.

[18] Privatization A Systems Perspective, Walter Sobkiw, 2019, ISBN 9780983253068. Privatization A Systems Perspective.

[19] This Research activity contacted various school districts, the Federal Aviation Administration (FAA), and employee unions.

[20] HSTA: 'Ventilation is absolutely important', HAWAII TRIBUNE-HERALD, July 31, 2022. webpage https://printreplica.westhawaiitoday.com/?publink=35a28426c_134855f, 07/31/22. https://printreplica.westhawaiitoday.com/?publink=35a28426c_134855f.

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Airborne Contagion Detection Architecture Alternatives

In systems engineering when attempting to address a need with a new system various conceptual architectures are proposed and clearly communicated. These are strawmen architectures. Then the team proceeds to invalidate each architecture using common sense and accepted known knowledge. The surviving architectures are then subjected to rigorous analysis to invalidate each conceptual arhictecture. The surviving architectures are called ironmen architectures. A stoneman architecture is a surviving architecture that cannot be invalidated regardless of the resources and analysis applied. The process may yield multiple stonemen conceptual architectures. The process then restarts with physical architectures that use chosen technologies and products. It is at this point that many stonemen conceptual architectures fall because they cannot be implemented with known technologies and products.

A fundamental question is can airborne contagions be detected especially in the indoor air spaces. The need is to detect airborne contagions before people are infected. To attempt to answer this question various architecture alternatives with the associated technologies need to be examined. The following are various architecture alternatives to detect airborne contagions.

A. Air Quality Sensors

Some have suggested that Air Quality Sensors (AQS) can be correlated to a virus concentration in a space. Unfortunately all the AQS based architecture can do is measure a level of gas where a gas is emitted into a space that is equivalent to a virus load. The problem with this approach is that a gas will disperse evenly in a space while a virus is embedded in a cloud that travels around a room so it does not mimic a virus load.  [2] It can measure the ventilation rate in a room, however what is the point of trying to determine the ventilation rate in a room indirectly. Finally, the traveling cloud risk of infection is a function of random probability. This architecture approach does not even make the strawman level. [4]

B. CO2 Sensors

Some have suggested that CO2 sensors used to determine the minimum ventilation rate in a room before occupants begin to suffer from CO2 poisoning can be used to determine the virus load in a space. The problem with this approach is that there is always a baseline CO2 level and that baseline CO2 level exists in settings where the ACH is less than 1. We know infection happens in settings where the ACH is equal to 1 ACH [1]. The other problem with this approach is that the CO2 gas will disperse evenly in a space while a virus is embedded in a cloud that travels around a room so it does not mimic a virus load [2]. It cannot even measure the ventilation rate in a room because of the baseline CO2 level that is the atmosphere. Finally, the traveling cloud risk of infection is a function of random probability. This architecture approach does not even make the strawman level. [4]

C. Unique Virus Sensors

There are various sensors that are used to detect a virus. [2] The problems with this approach are associated with sensitivity and the cloud characteristics of airborne contagions. For example a sensor may not be located where the airborne cloud and an occupant is concentrated. If there are a sufficient number of sensors, such as a sensor on each occupant in a room the next issue is one of concentration needed for detection. Assuming a sensor is able to detect 1/10 of what it takes for an infection load over assuming 10 minutes, it only buys the occupants 100 minutes before they are infected. The issue is simple, once the sensor detects an infection load it is too late for the occupants. This architecture approach does not even make the strawman level. [4]

D. Proper Room Ventilation

This approach relies on proper ventilation using natural, mechanical, or equivalent ventilation measured as ACH or eACH (air changes per hour). Experiments can and have been performed to determine the impact of virus load, probability of infection, and ventilation rates. [3] The CDC recommends 12 ACH for airborne contagions in a hospital room. This analysis has shown various risks associated with various ventilation rates. The issue is to ensure that a space is just properly ventilated with a level sufficient to deal with airborne contagions and just not prevent CO2 poisoning while saving on energy costs. This architecture approach is the only one that works short of moving everyone outside. The challenge is that this architecture is in direct conflict with the status quo of minimal ventilation rates to save on energy costs and now address global warming needs. This architecture requires that the spaces now be monitored for proper ventilation rates. This architecture makes it to the strawman, ironman, and stoneman level. [4]

As of 2022 the only viable architecture approach is: D. Proper Room Ventilation.

References

[1] See section School Case History.

[2] See section MITRE Testing.

[3] See section A Paradigm Shift to Combat Indoor Respiratory Infection .

[4] Note: The references to this area are the entire COVID-19 Return to Life study starting in 2020.

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Mask ACH Equivalence

In the last century engineers and scientists studied UV systems to understand their effectiveness in dealing with airborne contagions. Eventually a new performance measurement surfaced for the UV systems that equated their performance levels to mechanical ventilation. This new performance measurement is known as Equivalent Air Changes Per Hour or eACH. A mechanical ACH level was now equated to a UV eACH level. The following analysis provides some insight into the effects of mask use and equates mask use to mechanical ACH and proposes a new performance measurement associated with mask use called Mask Equivalent Air Changes Per Hour or meACH.

The previous analysis identified various approaches for determining risk of infection based on ACH. There were 5 approaches that were used as follows [1]:

Remaining Virus Perspective Percent

This is based on 63% of the virus being eliminated with 1 ACH (well mixed) and then 63% of the remaining virus being eliminated with each successive 1 ACH increment. [3] [4] [2] The remaining virus is then equaled to probability of infection (Pi = Remaining Virus Percent). This approach comes from the medical analysts. Pi = Remaining Virus Percent.

Systems Safety Perspective Risk

This analysis comes from a systems safety perspective for various ACH Levels. This analysis is based on assuming that the probability of infection is 100% at ACH=0. We know from empirical data that infection happens at ACH=1. [5] [6] [7]. From a risk safety perspective if the ACH rate is doubled from 1 to 2 then the Risk is cut in half to 50%, from 1 to 4 the Risk is cut in 4 to 25% and so on. The risk is then equaled to probability of infection (Pi = Risk). Pi = Risk

Well-Riley Perspective Small Indoor Space Prob of Infection

This analysis comes from the Wells-Riley equation for various ACH Levels. It is based on a small indoor space and a constant virus load. The space is 30 X 30 X 12 feet for 10,800 cubic feet. Pi = Remaining Virus

Well-Riley Perspective Large Indoor Space Prob of Infection

This analysis comes from the Wells-Riley equation for various ACH Levels. It is based on a large indoor space and a constant virus load. The space is 100 X 100 X 40 feet for 400,000 cubic feet. Pi = Remaining Virus

Well-Riley Perspective Large Indoor Space Ignore 0 ACH

This analysis comes from the Wells-Riley equation for various ACH Levels. It is based on a large indoor space and a constant virus load. The space is 100 X 100 X 40 feet for 400,000 cubic feet. Since we know that the risk of infection approaches 100% at an ACH = 1, the scale is shifted. It is interesting to see that the values are similar to the Systems Safety Perspective. Pi = Remaining Virus

ACH

Remaining Virus
Perspective
Percent

Systems Safety
Perspective
Risk

Well-Riley Perspective
Small Indoor Space
Prob of Infection

Well-Riley Perspective
Large Indoor Space
Prob of Infection

Well-Riley Perspective
Large Indoor Space
Ignore 0 ACH

0

100%

100%

100%

100%

-

1

63%

100%

99%

13%

100%

2

40%

50%

92%

7%

52%

4

16%

25%

72%

3%

26%

6

6%

17%

57%

2%

18%

8

2%

13%

47%

2%

13%

10

1%

10%

40%

1%

11%

12

0.39%

8%

35%

1%

9%

15

0.10%

7%

29%

1%

7%

20

0.01%

5%

22%

1%

5%

50

-

2%

10%

0%

2%

The next step is to determine the effectiveness of various masks. There have been many studies to try and understand the filtration level of various masks. We know that there are mask failures where they leak around the mask face interface. We also know that people remove masks in normal daily activities. This suggests that trying to find an absolute number for mask filtration level is not realistic. However in the ideal situation we can assume the following levels of filtration: Mask A = 75%, Mask B = 90%, Mask C= 99%, Mask D= 99.9%. The filtration level can now be used to determine the risk of infection (Risk = 1 - filtration level) and the risk of infection is equated to probability of infection (Pi = Risk). This results in the following Pi level for the 3 different masks:

For the worst case analysis, the Remaining Virus Perspective Percent scale is selected. Using the remaining virus mechanical ventilation rates, the masks fall into the following mechanical ACH levels. From this the Mask Equivalent ACH is determined (meACH).

ACH

Remaining Virus
Perspective
Percent

Mask A
(75%)

Mask B
(90%)

Mask C
(99%)

Mask D
(99.9%)

Comments

0

100%

1

63%

2

40%

3

25%

X

meACH = 3

4

16%

5

10%

X

meACH = 5

6

6%

8

2%

10

1%

X

meACH = 10

12

0.39%

15

0.10%

X

meACH = 15

20

0.01%

50

-

From the above analysis the masks have the following meACH levels:

Wearing a mask for a typical scenario can add an additional 3 ACH (meACH) to a room for the mask user. In a hospital setting it can add an additional 10 to 15 ACH (meACH). When the mask leaks around the mask / face interface, the meACH level is less. When the mask is removed, obviously the meACH level is zereo.

The key systems driver is how masks are used in an operational setting. This is called mask failures. In a hospital setting people are on shift and then off shift. When going off shift they remove their protective gear in a clean safe space. In a school or work setting people will remove masks to engage in life like eating, perhaps going to the bathroom, and the masks may drop without the users knowing but there is no clean safe space. When this happens in an enclosed space, with poor ventilation, where there is an infected person, the analysis and empirical data shows people are very quickly infected. Analysis suggests it is in less than 1 hour for the original strain. Closer to 15 minutes. So proper ventilation is critical to prevent the spread of airborne infection.

This is a complex systems problem and simple point solutions do not work. We have been engaged in simple point solutions that on the surface suggest will work but once analysis attempts to tie numbers to the point solutions we start to see the solution limitations. For example we fixate on masks, then we fixate on vaccines neglecting the fact the people will reject both masks and vaccines. We fail to acknowledge that people are always the weakest link in any system. The system must be structured to address people and that they behave in unexpected ways. The system solution must include the reality that people will fail in the system and the system must protect the people from themselves. This analysis showed that vaccines, masks, and proper ventilation is key to stopping the spread of airborne contagions.

References

[1] See section Living with COVID-19.

[2] WHO Publication/Guidelines Natural Ventilation for Infection Control in Health-Care Settings, World Health Organization (WHO), 2009. webpage https://www.ncbi.nlm.nih.gov/books/NBK143284/pdf/Bookshelf_NBK143284.pdf, May 2020.  Natural Ventilation for Infection Control in Health-Care Settings, WHO, 2009 . local

[3] If We're Going to Live With COVID-19, It's Time to Clean Our Indoor Air Properly, TIME, February 1, 2022. website https://time.com/6143799/covid-19-indoor-air-cleaning.

[4] SARS-CoV-2: Dynamics of Airborne Transmission and Air Disinfection, Edward Nardell, MD, Professor of Medicine, Harvard Medical School. Presentation. Gilbert W. Beebe Webinar Series September 16, 2020. webpage https://www.nationalacademies.org/event/09-16-2020/docs/DE63EBA42A7C0AB93A2F3CCFC455B80ECA47F0B03790, July 2022. PDF . local

[5] See section School Case History.

[6] 8 Classmates, 2 Fully Vaccinated Family Members, Test Positive for COVID in Lower Merion, NBC 10 Philadelphia, April 25, 2021. webpage https://www.nbcphiladelphia.com/news/coronavirus/8-classmates-2-fully-vaccinated-family-members-test-positive-for-covid-in-lower-merion/2791754, May 2021. 8 Classmates, 2 Fully Vaccinated Family Members, Test Positive for COVID in Lower Merion.

[7] Lower Merion School District says a ventilation flaw could have fueled a COVID-19 outbreak in second-grade classroom, The Philadelphia Inquirer, April 26, 2021. webpage https://www.inquirer.com/education/lower-merion-school-district-penn-valley-covid-outbreak-hvac-20210426.html, May 2021. Lower Merion School District says a ventilation flaw could have fueled a COVID-19 outbreak in second-grade classroom.

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What Should Be The ACH Levels

So what should be the ACH (Air Change Per Hour) levels?

We know that if there is no air exchanges in the room in other words if the ACH level is 0 this is going to lead to infection. We also know from empirical data that an ACH level of one will lead to infection. A key piece of data that surfaced came from a school district in the Philadelphia suburbs where in one of the classrooms the damper was partially shut down. This is probably because someone was complaining about it being too cold or too hot. The ACH level in that classroom was 1 and there were 8 second grade students that were infected. The CDC recommends 12 ACH for a hospital room with airborne contagions. So the ACH number must be greater than 1 and as the ACH increases the risk of infection drops.

When we think in terms of ACH there are different mental models that have been developed and then converted to real models. These models provide some insight into potential ACH levels.

Many address ACH levels as a percentage of remaining contagions after 1 ACH. For example, one air change removes approximately 63% of the room air contaminates and the second air change removes about 63% percent of what remains and so on. This mental model starts with a known amount of contagion and there's nothing adding more contagion, it's just measured and dropped off with time. But that's not a real scenario because we know that when a person is infected they're constantly releasing a contagion. It's not a one-time event and now you start to measure things. It's also difficult to understand what these numbers mean and how one should behave. This is the remaining virus mental model and comes from the medical world.

In Systems Engineering there is Safety Engineering and Reliability Engineering. This type of analysis is about probabilities, relative probabilities, and time before failure. Those numbers can give an indication of how you can live and what one can do. Applying systems engineering safety and reliability concepts to ACH provides a quick view on the effectiveness of the ACH levels. This is the systems engineering mental model.

Reducing these mental models to numbers allows for some comparisons.

ACH

Remaining
Virus *
63% / AC

Time (mins.)
removal
99% efficiency *

Time (mins.)
removal
99.9% efficiency *

Infection Risk
(1/ACH)
Safety world

Time to Infection
(hours)
Reliability world

0

100%

-

-

100%

1 or .5 or .25

1

63%

-

-

100% or 50%

1 or 4 or 6

2

40%

138

207

50%

2

4

16%

69

104

25%

4

6

6%

46

69

17%

6

8

2%

35

52

13%

8

10

1%

28

41

10%

10

12

0.39%

23

35

8%

12

15

0.10%

18

28

7%

15

20

0.01%

14

21

5%

20

50

-

6

8

2%

50

* CDC Appendix B. Air Guidelines for Environmental Infection Control in Health Care Facilities (2003), Medical world

The first three columns are basically coming from the medical world. In this mental model the ACH is viewed in terms of removal of a contagion at 99% efficiency or 99.9% efficiency or remaining virus. Those are all interesting numbers, but it really doesn't tell people how to live and it really doesn't give an indication of what they should be doing with ACH levels because again we really don't know how this translates into how we should be living in a real world scenario.

The columns on the right come from systems engineering and again there is the safety world and there is the reliability world. So let me just walk through the scenarios here a bit so we have some feeling for what's going on with these numbers.

We know that if there is 0 ACH the probability of infection is a 100%. We also know that if the ACH is at 1 the probability of infection is a 100% because of that classroom data point of 8 students being infected in a second grade class. What we don't know is the size of that class; Was it a class of 8 students where therefore it really would be 100% or was it a class of for example 16 students and only half the students were infected so maybe that probability then is 50% probability of infection.

Let's start with just a 100% probability of infection. If the ACH level increases from 1 to 2 where 1 is 100% risk of infection then a possible perspective is the risk drops off and divides by 2 to 50%, divide by 4 we get 25% divide by 6 we get 17% on down the line. All of the sudden what we have is something that we can relate to and it is risk of infection as the ACH level increases. We see that when we start to approach 12 ACH we have an 8% risk of infection that would have happened in that classroom as opposed to what really happened which was a 100% . If we are talking about 16 students versus 8 students out of the total class size then instead of being 8% that would be 4%. This type of systems analysis is coming from the from the safety world and this is what we do when we design everything that exists around us. This is what we do to ensure for example that when driving down the freeway the tires don't fly off a car driving 65 miles an hour. Analysis is performed, risks and probabilities are determined, and this comes from the safety world.

There is the reliability world where they try to figure out when something fails the cause of failure and in how many hours it will fail. If we examine 0 ACH in these different infection scenarios, does the infection happen in 1 hour does it happen in 30 minutes or does it happen in 15 minutes. Other analysis suggests that COVID-19 infection happens in about 10 to 15 minutes, but let's just leave these numbers here for now with 1 ACH. Going to that data point of the school district in the Philadelphia suburb, where the second grade children were infected, 8 of them out of some class size, maybe that happened within an hour or maybe it happened during a morning session a four-hour session or maybe it took the entire day for that class to be infected but let's start with one hour - let's just assume those children were infected in one hour. What happens if we have 2 ACH? Perhaps we can stay in that classroom for 2 hours before being infected or we can stay in that classroom for 4 hours if the ACH is 4, 6 for 6 ACH, 8 hours for 8 ACH, and once the ACH level goes up to 12 we can stay in that classroom for 12 hours before being infected. Now once we leave that classroom our bodies have an the innate immune system that's working while away from the contagion source. One could potentially keep re-entering that classroom and still not be infected.

These are two different analysis perspectives coming with two different mental models. There is the medical world and then there is the engineering world specifically the systems engineering world where risks, relative risks, probabilities, and relative probabilities are determined from baseline assumptions.

MIL-STD-1472 does address ventilation. For a small space of 150 cu-ft the required ventilation is 30 CFM. As the space size increases the CFM level drops such that the resulting ACH level drops. The possible reason for these numbers may have to do with the need to protect against non-aerosol airborne contagions. As the space increases the non-aerosol airborne contagion is less of a threat. This is based on the past history that there were few aerosol based contagions. The threat was measles and tuberculosis not COVID-19.

ACH = 30 CFM * 60 minutes / 150 cu-ft = 12 ACH

The number keeps circling around the 12 ACH level. If that is the case, then the standards should be updated so that the infrastructure can be updated and certified at each location as quickly as possible.

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ACH Measurement Protocols

Measuring the ventilation rates in a room is not a complex process. However, there should be a protocol available so that the measurements are fully captured and the ACH level calculated. The following are examples that can be used to develop an internal protocol to consistently measure ACH levels in a facility.

Philadelphia Restaurant Program

The city of Philadelphia Restaurant program used the following standards. [1] [2]

Anyone can execute this protocol and it uses inexpensive equipment that is perfectly suitable to gather the data.

Philadelphia School District

The Philadelphia School District performed a site survey of their schools and published the findings on the school district website. [3] This is an excellent system site survey and the data is captured in a spreadsheet. Each school is captured in a separate tab in the spreadsheet. There are 220 tabs suggesting that there are 220 schools that were surveyed. Each row represents a space in the school with an appropriate name that conveys the space use. The spreadsheet was converted to a single tab spreadsheet so that all the spaces in all the schools could be easily analyzed for AUC (or eACH). [4]

Boston School District

The Boston School District performed a site survey of their schools and published the findings on the school district website. [5] They used the 5-Step Guide To Checking Ventilation Rates In Classrooms from the Harvard T.H. Chan School of Public Health. [6] The steps are:

  1. Measure the Classroom Dimensions
  2. Perform Preliminary Audio and Visual Checks
  3. Measure or Estimate Outdoor Air Ventilation Rate (using one of four methods)
  4. Compare Results to Targets
  5. If Needed, Consider Supplemental Air cleaning Strategies to Meet Targets

The guide provides information to complete the protocol. The guide also includes a scale to rate the ventilation levels however, the scale is based on the limitations of the existing infrastructure rather than what is needed moving forward with airborne contagions. For airborne contagions the CDC recommends a minimum of 12 ACH. Another limitation is the testing is based on a company performing the testing using expensive equipment. This is unlike what the Philadelphia Restaurant program protocol offered where anyone can perform the testing using low cost equipment.

Cassbeth FVSE Protocol

The FVSE protocol captures the knowledge from existing protocols and Cassbeth research. It can be executed by anyone or by external companies. It further subjects the ACH levels to 3 different scales to determine ACH level risks. Cassbeth FVSE Protocol

Cassbeth FVSE

The Cassbeth FVSE allows anyone to capture ACH levels from multiple data sources. The data sources are:

  1. User Observations
  2. Site Surveys (using protocols)
  3. Certified Data from Government Sources
  4. Real Time Data from Vents, Grills, existing HVAC systems, and UV ventilation Systems

Visit FVSE for more information.

References:

[1] Enhanced Ventilation Standards for Indoor Dining and Application Form for Increased Dining Capacity, City of Philadelphia, February 14, 2021. webpage https://www.phila.gov/media/20210216105327/Enhanced-Ventilation-Standards-for-Indoor-Dining_2_16_21.pdf. PDF . local

[2] Food Establishments That Have Met Enhanced Ventilation Standards to Allow for Increased Indoor Dining Capacity, City of Philadelphia, March 09, 2021. webpage https://www.phila.gov/media/20210311122403/50CapacityRestaurants_030921.pdf. PDF . local

[3] Philadelphia School District Air Balance Reports by school. webpage https://www.philasd.org/coronavirus/schoolstart2020/#1613757068528-a10a5ddf-592d, https://drive.google.com/drive/folders/1XULamBiR3v1sB_u15rcyXOxQlq1ygsGT, May 2021. local excel cert analysis

[4] Philadelphia-Schools-Walkthroughs-Total-Summary_Public_final-merged.xls, May 2021. webpage http://www.cassbeth.com/covid-19/lib/Certification/Philadelphia/Certification-Analysis/Philadelphia-Schools-Walkthroughs-Total-Summary_Public_final-merged.xlsx, May 2021. local

[5] Boston School District March 18, 2021, https://www.bostonpublicschools.org/Page/8463, https://drive.google.com/file/d/1bzam7XeMQDjjv7Og_86PS41K78hBEOfT/view . PDF

[6] 5-Step Guide To Checking Ventilation Rates In Classrooms, Harvard T.H. Chan School of Public Health, 2020. 46 pages. https://schools.forhealth.org/ventilation-guide/, https://schools.forhealth.org/wp-content/uploads/sites/19/2020/10/Harvard-Healthy-Buildings-program-How-to-assess-classroom-ventilation-10-30-2020.pdf-EN.pdf . PDF . PDF

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STEM Ventilation Activities

Unfortunately the COVID-19 research from a systems perspective suggests that building ventilation is a challenge that this generation must face and properly address in this century. To do this they need ventilation related education content where the students become aware of all aspects of building ventilation and airborne contagions. The following are suggestions for course content and or STEM activities associated with ventilation.

No. Ventilation Topics / Activities Grades
1 Fresh Air

We breathe air, windows, doors, outside, rooms and ventilation.

1-5

2 Anemometers

What are they, how they work, where to buy them, how to use them.

4-5

6-12

3 Fresh Air Schools

Background, pictures, old school architectures, new school architectures, ventilation limitations of new school architectures.

4-5

6-12

4 Natural Ventilation

WHO report, building designs, ACH levels.

6-12

5 Measuring Ventilation Rates

Tools, gathering data, calculating ACH, capturing ACH levels at home and at school, discussing ACH levels.

4-5

6-12

6 Capturing School Classroom ventilation data

This is for all or part of the school. A report is generated and provided to the school. Discussion of findings.

9-12

7 Ventilation Approaches and Sustainability: Natural, mechanical, UV-C, FAR UV, other.

9-12

The research suggests that no one today is aware of what was common ventilation knowledge and respect in the previous century. Introducing ventilation course content will help this generation regain some of that lost knowledge and allow them to navigate through the challenges they will face such as the tradeoffs between sustainability, ventilation, airborne infection risks, and available technologies.

Please feel free to reach out to further discuss possibilities. There is a protocol package that is available to startup the above STEM activities. See Ventilation Measurement Protocol - School Applications. back to TOC


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Ventilation Cost Benefit Analysis

It has been over a year since this systems analysis has been updated. One of the remaining analsyis that was left on the table is an ACH Cost Benefit analysis. These are the results.

Assumptions:

Model Scenarios:

Calculations:

ACH

Remaining
Virus
63%

Watts
(1000 sq ft)

kWh
(work yr)

Ventilation
($/yr
)

Total
Costs A

Total
Costs B

Total
Costs C

Total
Costs D

Total
Savings A

Total
Savings B

Total
Savings C

Total
Savings D

0

1.00

0

0

$0

$6,720.00

$3,360.00

$2,016.00

$672.00

$0.00

$0.00

$0.00

$0.00

1

0.63

104

216.32

$30

$4,263.30

$2,146.50

$1,299.78

$453.06

$2,456.70

$1,213.50

$716.22

$218.94

2

0.40

208

432.64

$59

$2,726.57

$1,392.99

$859.55

$326.12

$3,993.43

$1,967.01

$1,156.45

$345.88

3

0.25

312

648.96

$89

$1,769.42

$929.26

$593.20

$257.13

$4,950.58

$2,430.74

$1,422.80

$414.87

4

0.16

416

865.28

$119

$1,177.40

$648.10

$436.38

$224.66

$5,542.60

$2,711.90

$1,579.62

$447.34

5

0.10

520

1081.6

$149

$815.42

$481.96

$348.58

$215.20

$5,904.58

$2,878.04

$1,667.42

$456.80

6

0.06

624

1297.92

$178

$598.36

$388.28

$304.25

$220.22

$6,121.64

$2,971.72

$1,711.75

$451.78

7

0.04

728

1514.24

$208

$472.60

$340.25

$287.32

$234.38

$6,247.40

$3,019.75

$1,728.68

$437.62

8

0.02

832

1730.56

$238

$404.37

$320.99

$287.63

$254.28

$6,315.63

$3,039.01

$1,728.37

$417.72

9

0.02

936

1946.88

$267

$372.37

$319.84

$298.82

$277.81

$6,347.63

$3,040.16

$1,717.18

$394.19

10

0.01

1040

2163.2

$297

$363.19

$330.10

$316.86

$303.63

$6,356.81

$3,029.90

$1,699.14

$368.37

11

0.01

1144

2379.52

$327

$368.41

$347.56

$339.22

$330.88

$6,351.59

$3,012.44

$1,676.78

$341.12

12

0.00

1248

2595.84

$356

$382.68

$369.54

$364.29

$359.04

$6,337.32

$2,990.46

$1,651.71

$312.96

It is interesting to see that if the occupant density per 1000 sq-ft exceeds 3 occupants, there is a cost savings with large levels of ventilation. These are direct savings for an employer.

This is an unexpected result primarily because everyone has been pre-conditioned to think that the lowest cost approach to ventilation is to just turn it off.

This analysis strongly shows that the lowest cost approach is not only to turn on the ventilation, but actually have relatively high levels of ventilation.

This analysis is based only on sick days and does not include the more severe cases that may lead to death or loss of health.

It also does not include the indirect society costs of healthcare such as drugs, doctor visits, and hospital visits.

[Ventilation-Cost-Benefit.xlsx]

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Ukraine Events

This topic moved to a new standalone area: Ukraine

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Full Research Links

COVID-19 Return to Life (2020 to 2021 March research)

COVID-19 Return to Life Part 2 (Started March 2021)

COVID-19 Return to Life Part 3 (Started September 2021)


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