Rethinking Society
The coronavirus (COVID-19) pandemic is a devastating, once-in-a-century event that is adversely impacting countries across the globe. In the past, humans have learned to adapt to challenging and deadly environments. Best practices should include rapid research, communication, contact tracing, testing, and development of a vaccine. In the absence of leadership on implementing best practices, we need to identify a path to a new normal. Even assuming the worst, we do have a path forward. In our current state, buildings are designed to prolong the life and spread of pathogenic (disease or infection-causing) microorganisms, e.g., viruses, bacteria, and fungi, etc.. Cleaning and remediation can be undergone but not all edifices are designed with that intent, e.g., mold remediation, toxic spill clean-up, etc. The path forward requires using biosafety principles to rethink how we design, construct, and maintain homes, buildings, and public spaces.
The pandemic also presents economic challenges as social distancing has resulted in 33.5 million U.S. total unemployment claims in the last 7 weeks , supply chain disruptions, closed restaurants, and idle factories. There are some calling for a swift return to an antiquated normal (currently unattainable without scaled testing or a vaccine) — consequences and unnecessary deaths be damned. Will we leverage existing biosafety principles or sacrifice human lives for a thumbs up from the invisible hand of the market?
Throughout our existence, humans have survived by learning to adapt to harsh and unforgiving environments. Cave(wo)men learned to clothe themselves, build shelter, and use fire for protection from the cold. California buildings near fault lines are built to withstand earthquakes. Similarly, South Florida structures are built to withstand hurricanes and Midwest buildings are often equipped with shelters to protect inhabitants from tornadoes. There are existing practices and procedures from biosafety and biomedical research that can be leveraged to rethink and redesign existing building codes. Yet, consideration needs to be given to implementation of pandemic best practices before we move forward to discussing adaptation.
Best Practices or Stuff We Should Be Doing, But Won’t, For…Reasons…
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Best practices in response to a global pandemic should include rapid research, communication, emergency declarations, contact tracing, testing, and working on a vaccine [*]. Unfortunately, we can forget pandemic best practices — we’re not doing that now and there are no plans for the U.S. to implement them any time in the near or distant future. However, some state governors have announced staged plans to return to some form of normal life. Crises require wise, informed, and empathetic central leadership. That’s about all that I’ll say about that. We need to resolve key uncertainties about the virus, testing, treatments, and finding a vaccine to seriously transition to a new normal. Will the virus mutate to become benign or more lethal? Will the seasonal flu + COVID-19 in the fall be more lethal? Can you be re-infected after developing antibodies to the virus? What are the life-long implications of COVID-19 infections? When will an effective treatment be available? When will we scale up viral and/or antibody testing? When will a vaccine be widely available?[*]
In a world with so many unknowns and uncertainties, we should assume the worst and hope for the best. Like the Spanish Flu Pandemic of 1918, a second wave of COVID-19 this fall could be more lethal. The virus may evolve to be more contagious and/or lethal. Second infections could be possible. Hence, people would need to continue to simultaneously protect themselves from spreading AND catching subsequent COVID-19 infections. Rapid availability of the vaccine may take 2–3 years or no viable vaccine may be found (HIV). Geopolitics and conspiracy theory (anti-vaxxers) could impact global distribution, availability, and/or adoption of a vaccine if a country like China were first to market. Furthermore, the time from vaccine availability to eradication of COVID-19 may take years or more (smallpox)[*]. How do we transition to a new normal in spite of an abundance of unknowns and uncertainties?
Building Design
Parents and school teachers have something in common — they expect to get sick from their young children. Transmission of colds is expected to occur at day care facilities and elementary schools. Heating Ventilation and Air-Conditioning (HVAC) systems with recirculated air in rooms that may or may not have exhaust systems and are not cleaned (disinfected, to be discussed later) frequently are excellent for harboring and spreading pathogenic microorganisms or “germs”. Let’s think about how HVAC systems are configured in most buildings. Take a look at the room you are in— you may see supply air vents; and, possibly (but not likely) exhaust air vents. Many home and apartment bathrooms have an exhaust fan that can be turned on at the flip of a switch to reduce relative humidity in the room during a shower. Many HVAC systems (like car air conditions) use recirculated air. The physics of small particles is different from larger particles — the shape, relative humidity, temperature, light and/or wind can cause a virus to almost hover in the air. A useful thought experiment is to think of a skydiver jumping out of a plane, launching her parachute, and attaining terminal velocity when the force of acceleration (gravity) equals the drag force (parachute) — she ceases to accelerate while continuing her descent. Many other variables other than gravity and drag will impact the path of descent of the virus. A virus can achieve “terminal velocity” and almost float in the air while remaining viable (alive and able to be transmitted). A recent National Institutes of Health study found that coronavirus can be viable for up to 3 hours in the air and anywhere from 24 hours to several days on various surfaces. Thus, an individual that has COVID-19 but no symptoms can wipe a sweaty brow and touch a metal door knob or a symptomatic person could sneeze and current HVAC systems and cleaning regimens may not eliminate both infectious hazards.
Biosafety Principles
I worked at the U.S. National Institutes of Health (NIH) for over 9 years, 6 years of which were spent leading a team that designed and validated biomedical research laboratories. As a part of my job, I designed and validated biosafety labs and vivariums, provided training on biosafety and biocontainment, trained emerging biosafety professionals, and helped update the NIH’s office building and biosafety lab design requirements(NIH Design Requirements Manual). I implemented U.S. Center for Disease Control (CDC) Federal requirements for biosafety labs and select agents detailed in the Biosafety in Microbiology and Biomedical Laboratories manual, 5th edition (BMBL). The critical insights from my experience are the vast differences in the goals and requirements for biosafety facilities versus generally acceptable building codes (GABC).
Decontamination
According to the CDC, decontamination “removes pathogenic microorganisms from objects so they are safe to handle, use, or discard.” There are varying levels of decontamination. Cleaning is removal of the visible organic and inorganic materials from an object or surface. Example: hand-washing. Disinfection is a process that eliminates most or all pathogenic micro-organisms with a few exceptions bacterials spores, inanimate objects, etc. Example: cleaning a surface with a disinfectant like alcohol or bleach. Sterilization is special. Sterilization eliminates ALL forms of microbial life by physical and/or chemical means. Example: Medical equipment like syringes and needles are sterile to transmission of pathogenic microorganisms when fluids are drawn from and/or delivered to patients.
Personal Protective Equipment (PPE)
PPE stands for personal protective equipment. The U.S. Occupational Safety and Health Administration (OSHA) defines PPE as “equipment worn to minimize exposure to hazards that cause serious workplace injuries and illnesses.” Within the context of this pandemic, PPE is the material and equipment used to prevent the transmission or spreading of COVID-19. Day-to-day PPE may be as simple as a cloth mask and gloves in public or N95 masks, medical face shields and a head-to-toe gowns for use by physicians and nurses in COVID-19 intensive care unit wards. PPE , donned (put on), worn, and doffed (removed) properly, should protect the wearer from infection/transmission of COVID-19. PPE should be able to be decontaminated if it is intended to be reused. In the case of cloth masks, the CDC issued guidance to use them to slow the symptomatic and potential asymptomatic spread of the coronavirus.
Building Design
We need to transition from GABC (generally accepted building codes) to leveraging best practices from biosafety principles. Building HVAC systems should be re-designed to have single pass air with supply and exhaust vents in each room. The NIH Office of Research Facilities design guidelines (Design Requirements Manual) specifies that vivariums or Animal Biosafety Labs Level 3 (ABSL-3) should have a minimum air change rate of 6–12 air changes per hour — this means that all the air would be exhausted from the room every 5–10 minutes. COVID-19 can remain viable in the air for up to 3 hours so increasing the current theoretical GABC air change rate from 0 (zero) would make facilities a lot safer than status quo.
REHVA, the Federation of European Heating, Ventilation, and Air Conditioning Associations, released guidance on COVID-19 highlighting the need to eliminate re-circulating air. ASHRAE is the American Society of Heating, Refrigerating and Air-Conditioning Engineers — it provides guidelines that form the backbone of the US (GABC for HVAC systems). In the wake of the COVID pandemic, ASHRAE has issued COVID-19 re-opening guidance that recommends flushing building HVAC systems. Flushing and cleaning a system requires purging it of potential contaminants. It just so happens that animal biosafety labs are designed to continuously purge and exhaust harmful materials through multiple HEPA filters (filters designed to capture particles as small as bacteria and viruses) and at a high velocity beyond the building envelope.
Redesigned spaces should also have the capability to be decontaminated. Animal biosafety labs (ABSL-3) are mostly air-tight with drains and utilization of specific caulking, paint, and laboratory furniture and equipment that can be disinfected. Decontamination methods depend on the targeted microorganisms but can range from using heated and vaporized gas or spraying liquid disinfectants.
It’s time for HVAC systems with recirculating air to become history like outhouses and chamber pots. If it ain’t broke don’t fix it. It is a tall order to ask society to rip up what we believe works and then go rethink, redesign, and rebuild everything (perhaps in a prioritized manner). Yet, the New Deal and the post-financial crisis Stimulus Act were herculean tasks enacted to respond to enormous economic challenges. We can get millions in the U.S. and billions around the world back to work envisioning, designing, and building a safer future.
A (Bio)Clean New Deal
On Friday May 8, the U.S. Bureau of Labor Statistics announced that over 20.5 million jobs were lost in April and unemployment shot up to 14.7%. There are hopes and wishes for a quick “V” shaped recovery but that’s just not realistic. The unemployment rate may peak between 20–25%. The nonpartisan Congressional Budget Office estimates that U.S. unemployment will finally get down to 9% by the end of 2021. Yet, the approach to returning to normal is being portrayed as a binary decision. The Economy or Life. Health or Income. Liberty or Safety. The choice is certainly not black and white. We should not be lulled into such a myopic and unimaginitative decision-making framework.
The New Deal helped lift America out of the Great Depression and propelled her into a period of amazing prosperity. The Stimulus Plan following the financial crisis led to the longest expansion in U.S. economic history. We need a (Bio)Clean New Deal, where we get to work rethinking, redesigning, and rebuilding society for the great challenge of the 21st Century. We should get people to work defining building codes that minimize transmission of pathogens and rethinking public spaces and activities with biosafety in mind including mass transit, dining, sporting events, theater, concerts, parks, and wayfinding. Then, we could get millions employed in construction, project management, logistics, janitorial services, accounting, software development, communications, human resources and more building a 21st Century Society. Stay safe, continue to practice social distancing, wash your hands, wear a mask, and let’s get to work.
*Note: Pfizer and Moderna have started distributing SARS-COVID2 vaccinations in the UK and the US with effectiveness greater than 90% in trials. Innovations in biomedical research with genomics and mRNA have enabled rapid development of the vaccine. I was incorrect in stating that a vaccine may take years to develop and complete trials. The incorrect assumption was based on outdated vaccine development methods.
