Masks appear to be a thing of the past for most Americans. Even though a lot of people are catching and spreading COVID these days, masking has mostly faded away as a precautionary measure against catching or spreading the virus. Where does that leave us? Public health authorities once suggested we should improve indoor air quality, but most organizations and individuals have ignored that advice. What a shame! It might be the best way to prevent future COVID outbreaks and/or new pandemics.
Do you remember who Florence Nightingale was? She has almost been forgotten by modern medicine. Ms. Nightingale was, however, a brilliant nurse who changed the world of medicine a long time ago. Her observations and recommendations during the 19th century could be useful today in our fight against COVID-19.
Florence was born in Florence, Italy in 1820 to a well-to-do British family. She was raised in a classic English mansion in Derbyshire, England. Although her parents expected her to marry into another wealthy family, Florence knew from an early age that she wanted to become a nurse. She excelled in mathematics, science and languages.
Unlike other well-to-do young women of that period, our heroine refused a marriage proposal at age 17. At age 24 she traveled to Germany to start nursing studies at the Lutheran Hospital of Pastor Fliedner.
A decade later she was asked by the British Secretary of War to lead a team of nurses. British soldiers were fighting alongside their allies from Turkey in Crimea against Russia. Conditions for care of the wounded soldiers were abysmal. She described what she saw as “the Kingdom of Hell.” It was at the British base hospital in Crimea that Florence Nightingale changed the future of medicine.
Her observations and recommendations during the 19th century to improve air quality are useful today in our fight against COVID-19. Nightingale established standards of cleanliness and nutrition that made a huge difference for the soldiers’ recovery. They called her “the Angel of Crimea.” Her 830-page report reformed military hospitals.
Upon her return to England, she set up a nursing school that applied scientific principles to the care of the sick. In particular, she emphasized the importance of fresh air as well as good lighting, sanitation and nutrition. The “Nightingale wards” she designed had ample cross-ventilation as well as plenty of natural light. Both were critical to a healthful environment for hospitals.
This was not a by-the-way issue for Florence. In her renowned textbook, Notes on Nursing (1859), the first chapter emphasizes that hospitals should keep the air inside wards:
In other words, good ventilation was crucial for recovery and good health!
Virologists and epidemiologists are now emphasizing the importance of Nightingale’s ideas. In the late 20th century, builders were looking for ways to save money on energy bills. As a result, they sealed buildings and cut down on fresh air circulation. Florence would be shocked to see hospitals in which windows do not open.
Our modern-day Florence Nightingale is Dr. Linsey Marr. She is a professor of civil and environmental engineering at Virginia Tech, where she leads the Applied Interdisciplinary Research in Air (AIR2) laboratory. Dr. Marr is one of the world’s foremost authorities on airborne viruses.
She has provided valuable information on the aerosol transmission of SARS-Cov-2 in the spread of COVID-19. She advises people to imagine someone smoking in a closed room. If you can smell smoke, you are also exposing yourself to the possibility of inhaling the coronavirus.
Many Americans have stopped wearing masks and are gathering in restaurants, movie theaters and sporting arenas. Just look around the next time you go shopping or get a haircut. As a result, the virus has been spreading again at a fairly rapid rate.
Chances are good that we won’t be able to get most people to wear high-quality masks again. Judging from the comments on this website, many individuals are done with masks regardless of the outcome.
Some have dismissed “face diapers” as “virtue signaling.” They refused to wear anything from day one and they won’t change no matter what happens in the future.
If we want to control COVID and other viral infections, we will need to take ventilation, filtration and disinfection far more seriously. A recent article in JAMA (June 7, 2022) titled “Reducing SARS-CoV-23 in Shared Indoor Air” notes that:
“SARS-CoV-2 replicates in the respiratory tract and spreads through exhalation of infectious respiratory particles. The chances of transmission increase the longer an uninfected person stays in an enclosed space with an infected person. Infection can occur not only through short-range transmission of exhaled respiratory particles from an infectious person resulting in mucous membrane deposition or inhalation of exhaled respiratory particles by an uninfected person. Infection also can occur through long-range transmission from inhalation of infectious respiratory particles that remain suspended in air for longer periods (potentially after the infectious person is no longer present) and across longer distances (greater than a few meters).”
Remember Dr. Marr’s analogy? If you can smell the lingering odor of smoke after someone was puffing on a cigarette or a cigar, you are breathing particles floating in the air. You may not see them, but they are getting into your nose.
Someone with COVID-19 who was walking in the grocery store half an hour before you entered could leave behind aerosol particles of COVID-19. Now imagine that you also travel to the bank, the post office and a restaurant. If you develop symptoms three to five days later you will have no idea where you acquired the virus. It could have been at any one of those places.
It’s time for public health authorities to focus on making it safe to breathe indoors. That will involve radical changes in air handling. To improve air quality builders will need to rethink ventilation practices.
The people who manage offices, supermarkets, pharmacies, hospitals, schools and all other public buildings will need to retrofit their HVAC systems. What difference could better air quality make?
A study of schools in Georgia found that rates of COVID-19 were 39 percent lower in schools that upgraded their ventilation than in schools that did not (MMWR, May 28, 2021).
The Article in JAMA (June 7, 2022) adds this about how to improve indoor air quality:
“A growing list of options exists for structural interventions to prevent COVID-19 through dilution, filtration, and disinfection of shared indoor air. Air handling system upgrades, improvements, or setting changes can reduce viral particle concentrations by bringing in outdoor air to dilute potential contaminants. Using air filters with higher minimum efficiency reporting value (MERV) ratings in HVAC systems can more effectively filter respiratory particles from recirculated air. Portable and commercially available HEPA air cleaners can do the same for a single room without modifying the building’s existing air handling system.”
There are also systems that use ultraviolet (UV) germicidal irradiation. They can be put into duct work or air handling systems.
Improving air quality through better ventilation, filtration and disinfection reduces the risk of COVID-19 for everyone who uses the building. Utilizing high-efficiency particulate air (HEPA) filters can cut exposure to viruses (MMWR, July 9, 2021).
It’s not just SARS-CoV-2 at stake. Transmission of viruses that cause influenza, colds and other respiratory infections would also be hampered by ventilation that would make Florence Nightingale proud. Isn’t it time to invest in our health?
Have we whet your appetite for more information? Would you like to learn more about MERV (minimum efficiency reporting value) air filters? We were honored to interview Dr. Linsey Marr and Dr. Richard Corsi on our public radio show. They provide far greater detail about how to improve indoor air quality at this link. You can stream the audio by clicking on the arrow inside the green circle under Dr. Marr’s photo at the top of the page or you can scroll to the bottom and click on the link that says “Download the free mp3.”
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