The Fallacy of the 2-Metre Rule – Part 1

“People think they are protected indoors and they’re really not”

Six months into the Covid-19 pandemic, an American governor recounted a visit she’d made to a local business. Upon entering, she didn’t wear a mask, she told her TV audience, “because I was socially distant.”

Only when she ventured near employees did she slip on her mask. Her message: Stay 6 feet (2 metres) apart from others. “But if you can’t, have a mask ready, and put it on.”

For nearly a year, the 6-foot/2-metre rule has been invoked by officials worldwide and gained traction with the public.

And yet, scientists say, the rule is misleading — based on an erroneous understanding of aerosol science and insufficient to curb Covid transmission.

“It has been biggest disservice that public health groups have given,” Robert Schooley, M.D., an American infectious-disease specialist told a panel at an international workshop on Covid-19 transmission. “It never should have come out of anybody’s mouth.”

Early on, experts assumed SARS-CoV-2, like the first SARS coronavirus, was spread almost entirely via close contact. They assumed virus-laden droplets, launched by a sneeze or a cough, were too heavy to travel beyond 2 metres, so physical distancing would largely control transmission.

A mountain of research has debunked these notions.

We now know large droplets can journey beyond 2 metres and, at any rate, play just a partial role in the spread of Covid-19. Often, the disease is transmitted via far smaller particles, known as aerosols, that can sail across a large room and hover for hours, only to be inhaled by vulnerable people.

“Indoors, those distance rules don’t matter,” says Robyn Schofield, PhD, an atmospheric chemist at Melbourne University in Australia. “People think they are protected indoors and they’re really not.”

The evidence documenting long-range aerosol spread of Covid-19 has major implications for hospitals, restaurants, pharmacies, retail spaces, offices — any enclosed, high-traffic space.

In the short term, the science makes a strong case for face coverings. However, it’s impossible to eat, drink, or have your teeth cleaned while wearing a mask, and at some point, following the Covid-19 vaccine rollout, mask guidelines may disappear.

SARS-CoV-2, however, will remain in our midst, along with influenza and other airborne pathogens that continually endanger lives. In addition, new airborne viruses and strains of antibiotic-resistant bacteria are certain to emerge.

“Distance alone will never solve the aerosol problem,” says Jose-Luis Jimenez, Ph.D., a University of Colorado chemist. “If you are in the same room, you can get infected.”

That’s why building operators must augment their current infection-control precautions, upgrading ventilation, filtration, and air dis-infection technology.

The Dubious Origin of the 2-Metre Rule

Back when commercial flights were divided into smoking and non-smoking sections, it didn’t much matter where you sat; before long, the smell of smoke would permeate the plane.

In the same way, particles carrying SARS-CoV-2, which are similar in size to smoke particles, can permeate a room.

“High concentrations of smoke do not usually build up outdoors because the smoke is quickly diluted by the large volume of air. This is also true for respiratory droplets,” explains at team of mechanical engineers at Clarkson University in New York.

But indoors — where the odds of Covid transmission are 18.7 times greater than outdoors — the picture is quite different: Lack of ventilation “allows the concentration of small airborne respiratory droplets to build up over time, reaching all corners of a room.”

Would a 2-metre separation, even if bolstered by a plexiglass shield, block cigarette smoke?

“The answer is no,” William Ristenpart, PhD, a University of California chemical engineer, told the international Covid workshop panel. “[SARS-CoV-2] aerosol particles behave the same way.”

Yet restaurants and shops often operate as if coronavirus particles either vanish within 2 metres or can be stopped by plastic dividers. Restaurants place tables 2 metres apart, and offices do the same with desks. See-through barriers have been installed in karaoke bars and countless retail establishments.

Surprisingly, these precautions rely on a model of disease transmission that dates back nearly a century.

It was 1934 when William Wells, an American scientist, published a paper dividing infectious respiratory particles into two categories: large and small. Wells believed small droplets (less than about 10 microns) evaporate rapidly while large ones quickly succumb to gravity.

“He found that the farthest any droplets travelled before either settling or evaporating was about 6 feet,” the Clarkson team recounted.

But Wells didn’t have the high-speed video to deconstruct the explosive aftermath of a sneeze or a sigh.

Turns out, respiratory droplets come in a wide range of sizes, not just “small” and “large,” and they can drift far and wide.

Once expired, droplets travel in clusters, and the warm, moist cloud enveloping the droplets allows the tiniest among them to “evade evaporation” for long periods, explains Lydia Bourouiba, PhD, an expert in fluid dynamics at the Massachusetts Institute of Technology.

“The cloud is in fact moving forward, trapping its payload over wide ranges of distances,” says Bououiba, who films exhalations with cameras running at thousands of frames per second. “There is really no barrier of 1 to 2 meters.”

Even large droplets can travel beyond 2 metres. “You have to get up to a size of 30 microns for something that won’t travel more than 2 metres,” reports Linsey Marr, PhD, an environmental engineer at Virginia Tech university.

And that’s in stagnant air. Under high air velocity, Marr says, “a 30-micron droplet can travel 7 to 8 metres.”

A 5-micron aerosol takes about half an hour to drop to the floor and, under certain conditions, can travel over 100 metres, according to Marr. Air currents in a room play a big role in how far aerosols can journey.

Yet the 2-metre theory continues to influence, even dictate, public-health guidance.

“The idea of 6 feet is to keep you out of each other’s large droplets, but that doesn’t do anything for the background aerosols that might be in the room,” says Marr.

Part two coming soon.

Novaerus Defend 1050 cleared by FDA as 510(k) Class II Medical Device

Novaerus Defend 1050 cleared by FDA as 510(k) Class II Medical Device to inactivate and filter out airborne virus and bacteria for medical purposes

Defend 1050 uses patented NanoStrike® technology to damage and inactivate airborne micro-organisms.

Dublin, Ireland and Stamford, CT – Novaerus, a WellAir company that delivers clean air solutions to help prevent the spread of infectious outbreaks, announced today that the U.S. Food and Drug Administration (FDA) cleared the Novaerus Defend 1050 (NV 1050) as a 510(k) Class II Medical Device to inactivate and filter out micro-organisms, including virus and bacteria, for medical purposes. The Novaerus Defend 1050 is the first system that uses NanoStrike®, a patented plasma generating technology, to receive FDA 510(k) clearance.

The Novaerus Defend 1050 is a free-standing, portable recirculating air cleaning system designed for additional frontline protection in healthcare settings such as operating rooms, intensive care units, in vitro fertilization labs, emergency rooms, waiting and treatment areas, neonatal units, and other critical environments including those performing aerosol-generating medical procedures (AGMP).

The Defend 1050’s NanoStrike technology uses a plasma field that rapidly inactivates micro-organisms at the molecular level. Within 15 minutes, the Defend 1050 has demonstrated a 4-log (99.99%) reduction of the MS2 bacteriophage RNA virus, an accepted surrogate for SARS-CoV-2. The Defend 1050 also showed a 4-log (99.99%) reduction in Bacillus Globigii endospores (bacterial spores) within 15 minutes, which was maintained over the prolonged operation (24 hours).

The Defend 1050 is currently used in hospitals and healthcare settings worldwide. Given the rapid spread of COVID-19, WellAir moved quickly to understand how this device could potentially combat the virus while moving it through a thorough FDA medical device clearance process. Additionally, the Defend 1050 meets relevant performance criteria in the FDA Guidance, which provides non-binding recommendations that may reduce the risk of viral exposure for patients and healthcare providers during the current public health emergency.

“Our team of outstanding engineers and scientists have been focused on delivering innovative and powerful airborne infection control devices. The FDA clearance on the Defend 1050 is a critical milestone for our company, validating our work to deliver a safe and effective medical device,” said Dr Kevin Devlin, WellAir CEO. “The Defend 1050 has demonstrated tremendous efficacy in third party testing against viruses, bacteria, VOCs, and particulate matter, which makes it an ideal solution for hospitals and healthcare settings. As we continue to see an alarming rise in the number of COVID-19 cases, we have moved quickly to make the device readily available.”

Defend 1050 utilizes multiple stages to reduce airborne micro-organisms. The first stage is a general air pre-filter that captures particles between 4 and 10 microns from the input airflow. This filtered air passes through a series of NanoStrike coils (plasma generators) that damage and inactivate micro-organisms on contact, including viruses and bacteria. The resulting inactive particulates are trapped by a HEPA (High-efficiency Particulate Air) filter. In a final cleaning stage, an activated carbon filter traps VOCs in the airstream before the air is released into the environment.

The Defend 1050 system is delivered complete with all components necessary for immediate use. It can be wheeled easily by a single person to the desired point of use and plugs into standard outlets. Five airflow speed settings enable optimization to each healthcare environment. The only routine maintenance required is a calendar-based filter change schedule.

If you are a medical or healthcare facility interested in learning more about the Novaerus Defend 1050 or other Novaerus products, additional information can be found here, or please contact Novaerus.

The “Pig Pen” Effect: When Motion, Not Breathing, Spreads Infection

Back in the 1950s, cartoonist Charles Schulz introduced a new character into his world-famous Peanuts strip: Pig-Pen, an amiable boy known for the cloud of dirt and dust that follows him everywhere.

“I’m a dust magnet!” Pig-Pen declared.

In truth, we’re all dust magnets, and this fact may play a role in the airborne spread of disease.

Research shows airborne pathogens, having landed on surfaces, can be kicked back up into the air by human activity — walking a hallway, opening a door, removing a lab coat. These dangerous microbes, riding on dust particles, can then be inhaled or swallowed.

Influenza, norovirus, and Clostridium difficile are likely transmissible in this manner, and SARS-CoV-2 may be as well. Pig-Pen himself has been invoked in scientific discussion on transmission of the flu and Covid-19.

“Aerosols can settle to the ground, where they are resuspended into air just by us walking around,” Linsey Marr, Ph.D., an American environmental engineer, explained at an international workshop on Covid transmission. “[This causes] a secondary opportunity for transmission by aerosols. We call this the Pig-Pen effect.”

We know that sneezing, coughing, singing, talking, and mere breathing can transmit Covid-19. It’s assumed that SARS-CoV-2 also can be transmitted via contaminated surfaces, known as fomites. Now, evidence suggests another possible route: “aerosolized fomites” — in other words, the Pig-Pen effect.

“We showed that just rubbing a [flu-]contaminated paper tissue aerosolizes several thousand micron-scale particles,” William Ristenpart, PhD, a chemical engineer at the University of California, reported at the international workshop. “What this points to is, there are other ways a virus can get into the air.”

Ristenpart’s studies on flu spread among guinea pigs points in the same direction, as does coronavirus research conducted at Wuhan hospitals.

Ristenpart calls aerosolized fomite transmission “underappreciated” and notes that his team’s findings, published in Nature, have important implications for public health, including the spread of Covid-19.

This is especially true for hospitals, nursing homes, businesses — any high-traffic where air is shared. Certainly, masks can reduce the number of particles exhaled by infected people, and enhanced surface cleaning can help contain spread via fomite. However, controlling disease transmission via the Pig-Pen effect requires additional precautions, including continual air dis-infection.

Walking Kicks up Millions of Particles Per Minute        

In a slide shown at the international Covid-19 workshop, three women, one of them infectious, stand in a room filled with virus-laden dust particles. The particles, some of them resuspended by footsteps, are represented as red dots, to help us imagine what we can’t see.

But those scattered red dots don’t adequately represent the swarm of aerosols typically kicked up by human activity.

“An adult walking across the floor can resuspend 10 to 100 million particles per minute, while tossing and turning on a mattress can stir-up similar levels of microbial-laden dust,” explains Brandon Boor, PhD, an aerosol scientist at Purdue University in the United States.

In a study conducted with Finnish microbiologists, Boor found that in 1 minute of crawling across a carpet, 1,000 to 10,000 resuspended particles will deposit in the infant respiratory system.

Boor is another scientist who references Charles Schulz in his work, noting the cartoonist’s portrayal of Pig-Pen as being perpetually enveloped by a dust cloud is “quite accurate.” Boor calls resuspension of particles via human movement a “major indoor source of biological particulate matter,” including bacteria, fungi, and allergens.

Well before the emergence of SARS-CoV-2, research suggested infectious aerosols could be bandied about by human activity.

In a British hospital study, for example, researchers sampled the air near patients infected with Clostridium difficile. The bacteria, known to cause nausea and severe diarrhoea, has become a deadly threat in hospitals due to the emergence of virulent, antibiotic-resistant strains.

What the study found: Over a 10-hour period, airborne C. difficile was most commonly detected during periods of activity, such as food delivery, ward rounds, or bedding changes.

“Activities known to liberate particles into the air, such as bed making and curtain drawing” may contribute to the spread and aerosolization of C. difficile, the scientists concluded.

Unlike SARS-CoV-2 or influenza, C. difficile is not a respiratory pathogen; people become infected by swallowing airborne particles or touching contaminated surfaces and then touching their mouths. Given that patients’ clothing, bedding, and skin are often teeming with C. difficile spores, aerosolization of surface particles could be quite dangerous.

Norovirus, another virulent and highly contagious stomach bug, can be resuspended off the floor, as well.

A Brazilian research team, reporting in the Journal of Hospital Infection, evaluated protocols for cleaning floors contaminated with norovirus. The scientists detected Norovirus particles in 27 of 36 post-cleaning air samples, concluding the virus “can be aerosolized during floor cleaning, and its particles may be inhaled and then swallowed or can settle on surfaces.”

Can SARS-CoV-2 Spread via the Pig-Pen Effect?

It’s clear that pathogens can be dislodged from surfaces and resuspended into the air. But can these “liberated” aerosols actually cause infection?

Apparently so, according to a clever University of California study on the spread of influenza among guinea pigs.

The study involved 12 pairs of guinea pigs, housed in separate but adjoining cages. One rodent was immune to influenza, having previously been infected; its partner remained vulnerable to the disease. Using a paintbrush, researchers applied liquified influenza to each immune rodent’s fur, ears, and paws.

The cage design prevented contact between the rodents while directing air to flow from the immune rodent’s cage to its partner’s cage. This left just one plausible infection source for the vulnerable rodents: viral particles launched airborne by the activity, rather than exhalation, of their immune partners.

The results surprised even the scientists: After one week, 3 of the 12 vulnerable guinea pigs had contracted influenza.

Based on the study, co-author William Ristenpart disputes the assumption that infectious airborne flu particles must come from breathing, coughing, or sneezing or from aerosol-generating medical procedures.

“We now provide direct experimental evidence that . . . aerosolized fomites from a virus-contaminated environment can spread influenza viruses through the air,” his team wrote.

In the same paper, Ristenpart reported that viable influenza particles can be aerosolized from paper tissue. His team found that crumpling, folding, and rubbing dried, contaminated tissue released up to 900 particles per second and that the particles were “in the respirable range.”

If influenza can be spread via the Pig-Pen effect, can SARS-CoV-2?

Ristenpart’s team suspects so. Their guinea-pig study references research conducted at two Wuhan hospitals dedicated to Covid-19 care.

In one study, researchers captured air samples in several locations throughout the hospitals. They found the highest concentration of coronavirus RNA not in Covid wards or patient isolation rooms but rather in rooms where medical staff changed out of their gowns, masks, and other gear.

The suspected source: “resuspension of virus-laden aerosols from the surface of the protective apparel worn by medical staff while they are removing the equipment.”

The virus-containing aerosols were small enough to remain suspended in the air for long periods and to be inhaled.

Continual Air Dis-infection: Critical for Limiting Infection Spread

As Brandon Boor notes, the resuspension of dust is “an inherently transient process,” changing minute by minute based on human occupancy and movement patterns.

What this means for hospitals, nursing homes, retail, or office spaces: air dis-infection units must be running 24/7.

Surface cleaning is important, but pathogens rebound quickly. One study found hospital bed rails would have to be professionally cleaned every 2 hours to keep harmful bacteria to a safe level.

And while masks effectively limit emissions of dangerous particles, public mask-wearing regulations are often flouted, and the rules will disappear, at any rate, when a Covid-19 vaccine becomes widely available. SARS-CoV-2, however, will continue to float about, along with influenza, norovirus, and countless other pathogens that contaminate our shared air.

In the indoor environment, controlling infection will always require multiple strategies. Critical among these is 24/7 air dis-infection, particularly NanoStrike technology from Novaerus.

Novaerus units generate an electrical discharge, known as ultra-low energy plasma, that destroys viral, bacterial, and fungal particles. Within nanoseconds, the devices obliterate pathogens into inert, harmless debris, expelling clean air back into the room.

Unique among air-disinfection devices, NanoStrike technology leaves behind no by-products and is safe to operate continually even in ICUs and operating theatres.

Independent lab tests have confirmed the technology destroys MS2 Bacteriophage, a surrogate for SARS-CoV-2, as well as influenza, Clostridium difficile, and numerous other airborne pathogens. The same technology also wipes out the pollutants, such as volatile organic compounds (VOCs), that cling to dust particles.

In an early Peanuts strip, Pig-Pen is described as the only person who could manage to get dirty while walking in a snowstorm. He simply can’t shake off the dust.

In reality, none of us can, which makes Novaerus technology essential for hospitals, schools, pharmacies, and pubs alike.

Air Dis-infection: A Potent Weapon for Averting a Covid-Influenza “Twindemic” – Part 2

Read part one of this blog post here.

Flu Virus Hovers in the Air

For decades, scientists assumed influenza was spread only by large droplets and by touch. For example, an infected person coughs or sneezes, spraying gobs of virus that land in the mouths or noses of those nearby. Or, those hefty, virus-laden particles settle on a surface touched by people who then touch their own mouth, nose, or eyes.

But in recent years, we’ve learned that influenza can be transmitted via aerosols, much smaller particles that linger in the air and can travel longer distances. (We’ve learned the same, in far less time, about like SARS-CoV-2.)

“Aerosols play an important part in the transmission of flu viruses,” observes Australian virologist Ian Mackay. “Virus can be recovered from asymptomatic folks, and breathing and talking are the likely ways transmission occur before anyone around us knows we are sick.”

Not only can influenza aerosols travel farther than larger droplets, but they may also be more infectious.

In an intriguing American study, scientists collected breath samples from 37 confirmed influenza patients who were asked to cough periodically into a cone. Some 43% of the volunteers emitted large particles (greater than 5 µm) of detectible viral RNA, and 92% exhaled aerosols. The interesting part: the aerosols contained more flu virus than did the larger droplets.

The authors concluded: “The abundance of viral copies in fine particle aerosols and evidence for their infectiousness suggests an important role in seasonal influenza transmission.”

Just how important a role? A University of Hong Kong team, studying influenza transmission in households, concluded that aerosol transmission accounts for “approximately half of all transmission events.”

Compared to a flu case transmitted via droplets, a case transmitted via aerosol appears “more likely to manifest in fever plus cough,” the Hong Kong scientists wrote.

Can masks mitigate the spread of influenza, as they do SARS-CoV-2? Absolutely, but aerosols still slip through masks, and despite the surging threat of Covid-19, mask-wearing among the general public is low.

When the Americans coughed into the cone while wearing surgical masks, they emitted three times less viral aerosol than when they coughed maskless, but 78% of the volunteers nonetheless emitted virus-laden aerosols.

Another American study, simulating influenza spread in exam-room conditions, found that surgical masks blocked the entry of 56.6% of infectious virus.

Flu particles generated during coughing, sneezing and breathing, the authors concluded, “is a concern in healthcare facilities because these particles may remain airborne for prolonged periods. Anyone present in a room with a patient who has influenza might be at risk of exposure.”

NanoStrike Technology: A Hedge Against Fatigue and Apathy

Mass flu vaccination, mask-wearing, and social distancing — this trifecta would go a long way toward averting the feared twindemic. But resistance to these measures is on the rise.

Sacrificing our normal routines “has exhausted us all,” observes Dr Hans Kluge, the WHO’s regional director for Europe.

In the eurozone, about half the population feels “pandemic fatigue,” says Cornelia Betsch, PhD, a German professor of health communication. In the United States, resistance is even stronger and more widespread. Citizens are flocking to bars and gathering with family as if Covid-19 did not exist.

What this means: medical facilities, schools, and workplaces must adopt virus-control strategies that are not compromised by human indifference, fatigue, or defiance.

Among the most important of these strategies is air dis-infection, particularly the ultra-low energy plasma technology, known as NanoStrike, used in Novaerus devices.

These compact devices generate an electrical discharge that destroys viral and bacterial particles. Within nanoseconds, the particles explode into inert, harmless debris, and clean air is expelled back into the room.

Independent lab tests have confirmed the technology destroys influenza as well as MS2 Bacteriophage, a virus used as a surrogate for SARS-CoV-2.

Unique among air-disinfection devices, NanoStrike technology leaves behind no harmful by-products. Novaerus units are so safe that they are commonly installed in hospital ICUs, Covid wards, operating theatres, and emergency rooms.

Schools, pharmacies, pubs, and numerous workplaces find that installing medical-grade technology instils confidence in staff, students, and patrons.

We know most transmission of Covid-19 and influenza happens indoors, and significant spread is due to respirable aerosols that can travel beyond 6 feet and linger for long periods.

We know, too, that people are just plain tired of taking precautions.

“In the spring, it was fear and a sense of, ‘We are all in it together,’” says Vaile Wright, a psychologist at the American Psychological Association. “Things are different now. Fear has really been replaced with fatigue.”

Given this fatigue, along with the absence of a Covid vaccine and the obstacles to widespread flu vaccination, workplaces of all types must continually dis-infect the indoor air we all share.

Air Dis-infection: A Potent Weapon for Averting a Covid-Influenza “Twindemic” – Part 1

For months, global health experts have feared the collision of Covid-19 and the seasonal flu. But now, with flu season nearing and Covid-19 surging, averting a “twindemic” appears more challenging than initially predicted.

The coronavirus has rebounded across Europe and continues to rage throughout the United States, overwhelming hospitals in many regions. Pandemic fatigue has set in on both continents, escalating resistance to social distancing and masks. At the same time, nations are plagued by shortages and distrust of the flu vaccine.

“There’s a considerable concern, as we enter the fall and winter months and into the flu season, that we’ll have that dreaded overlap of two respiratory-borne diseases,” warns Anthony Fauci, M.D., director of the U.S. National Institute of Allergy and Infectious Diseases.

Covid-19 and influenza share many symptoms: fever, cough, muscle aches, fatigue, sore throat, and headache. As a result, symptom onset may send a flood of people to emergency rooms, unsure which disease they may have.

Some may even have both, a particularly worrying scenario. Hospitalized adults who contract both diseases face 2.3 times the risk of death compared to those with Covid-19 alone, according to Public Health England. What’s more, influenza infection appears to leave patients vulnerable to a more serious bout of Covid-19.

Both influenza and SARS-CoV-2 can spread via aerosol and before symptoms appear. These two facts point to a single imperative for hospitals and nursing homes: continual air dis-infection.

Air-management strategies are “important protections against spread of infection within healthcare settings,” asserts Australian virologist Ian Mackay, PhD, an expert in influenza transmission.

The same strategies, including air dis-infection with low-energy plasma technology, can be deployed in schools, pharmacies, offices, and restaurants — any indoor space where infectious pathogens are sure to be hovering.

When operated 24/7, air dis-infection units can reduce the transmission odds of both SARS-CoV-2 and influenza. Whether installed on a wall or a shelf, these devices operate safely, unobtrusively, and — of particular importance — without reliance on human effort.

As the population’s energy and patience wanes, low-energy plasma technology has become a critical line of defence against two viruses certain to wreak havoc this winter.

“Frightening” Indifference to the Flu Vaccine

While the world awaits a coronavirus vaccine, we already possess an effective flu shot, —considered a powerful weapon against the feared twindemic. Widespread influenza vaccination, Dr Fauci emphasizes, can “help eliminate at least eliminate at least one” of the two diseases, and the vaccine significantly reduces the severity of symptoms of those who become infected.

Yet vaccination rates are dismal.

Even in the United States, where the flu vaccine is available to everyone and heavily promoted at supermarkets, distrust and disinterest are pervasive. In the flu season that ended just as Covid exploded, just 45% of U.S. adults were vaccinated.

Scepticism abounds: 34% of American adults don’t think flu vaccines work well, and 29% fear side effects. This winter, 17% plan to forego the vaccine for fear of contracting Covid-19 by venturing out.

Vaccination rates are far lower in Europe, where the flu shot is recommended only for high-risk groups, such as the elderly, healthcare workers, and those with chronic health conditions.

Among Europeans ages 65 and older, just 44% are vaccinated, a far cry from the World Health Organization’s target of 75% and far lower than the 60% of American seniors who get vaccinated. Half the countries in the European WHO region vaccinate fewer than 1 in 3 older people, even though flu vaccination reduces the risk of flu-related hospitalization among seniors by 61%.

Just 30% of European healthcare workers get vaccinated annually; in Italy, the rate is just 15%. These paltry figures include healthcare workers at nursing homes, locations highly vulnerable to both influenza and Covid-19 outbreaks.

“Vaccination coverage among high-risk groups has unfortunately been declining in a number of countries in the Region in recent years,” reports the WHO.

Even this year, only half of eligible Germans plan to get vaccinated, a scenario the country’s pharmacists consider “frightening.”

To be sure, the Covid explosion has been a wake-up call for some; globally, the twindemic threat has spiked demand for the flu vaccine. However, distribution and supply problems abound.

Though the United States is well stocked with vaccine, many of the offices, schools, and manufacturing plants that offered free shots on site are closed because of the pandemic.

Europe has bigger problems. Having placed vaccine orders prior to the explosion of Covid-19, most EU countries don’t have enough vaccine to meet demand.

In Belgium, which faces a “tsunami” of Covid cases, offering flu vaccinations to those who fall outside the highest-risk groups is “out of the question,” according to the country’s pharmacists. In Britain, pharmacies have stopped offering flu shots; only 25% of general practitioners expect to have enough flu vaccine to last the winter.

Hospital Flu Outbreaks: “Underdetected and Underreported”

Of course, even if flu shots were universally available and welcomed, the vaccine is not a panacea. Influenza mutates frequently, and some flu strains are especially apt to replicate in the body. The vaccine’s effectiveness in a given year ranges from 40% to 60% and is lower for seniors.

As well, immunity wanes over time; those vaccinated early in the season are less protected at the end.

For plenty of reasons, then, influenza takes a large toll each winter and into early spring. In the United States, about 8% of the population develops a symptomatic infection. In Europe, annual infection rates range between 5% and 15%.

In the coronavirus era, the severity of influenza gets downplayed. Certainly, the flu is far less lethal than Covid-19, but many of the vulnerable suffer severe complications: pneumonia, heart attacks, myocarditis, and strokes.

In the United States, some 740,000 people were hospitalized with the flu during 2019/2020, a mild flu season, and up to 62,000 Americans died from the disease. In the WHO European Region each year, about 44,000 deaths are associated with seasonal flu.

Even without the added threat of Covid-19, a high caseload of even mild to moderate influenza overtaxes medical services and compromises productivity in the workforce. In some years, hospital units are forced to close temporarily because so many healthcare workers become infected.

“Any patient, healthcare worker or visitor is capable of transmitting [influenza] to susceptible persons within hospitals,” French scientists wrote in a review paper of hospital-acquired flu outbreaks. The French team noted that such outbreaks are “probably under detected and underreported.”

Nursing homes, too, are hot spots for influenza outbreaks. The close living quarters and fragile health of residents make these facilities “conducive to the rapid spread of influenza virus.”

Flu outbreaks not only have “devastating consequences for individuals,” the authors wrote, but also place substantial strain on health services. During the flu outbreaks studied, 33% of residents become infected, and 6.5% died. Though staff were considerably younger and healthier, 23% contracted the flu.

Read part two here.

The Massive Responsibility to Safeguard Students: Why Schools Must Disinfect the Air – Part 2

Read part one of this blog here.

Ventilation and Filtration: School Buildings Must Do More

Some school websites do discuss ventilation and air filtration, critical strategies for controlling airborne spread. But here again, actions fall short.

Open windows are a simple way to reduce airborne concentration of coronavirus particles, but many classrooms have no windows. In others, the windows are bolted shut. Even when windows are operational, they’re often kept closed to keep out allergy-inducing pollen or blasts of cold air.

Schools are notorious for ventilation deficiencies. A  recent analysis documented ventilation problems in 60% of New York City schools with ventilation reports. Well before the emergence of Covid, the U.S. Environmental Protection Agency (EPA) reported poor indoor air quality in U.S. schools may pose a “serious health threat” to students and staff.

The EPA was referring to airborne contaminants emitted by a wide range of biological and chemical sources, from mouldy ceiling tiles to cockroach dander to idling school buses and vaping devices.  But the ventilation deficiencies that expose students and staff to pollutants also leave them vulnerable to SARS-CoV-2.

So do shortcomings in air filtration. At many schools, the HVAC systems just aren’t equipped to handle high-level systems. As one American college concedes, adopting a more powerful filtration system “could very well cause system failure.” Even stand-alone HEPA filters won’t capture 100% of coronavirus particles, some of which are 900 times smaller than the width of a human hair.

One toxicologist, a member of the American Industrial Hygiene Association, described school filtration systems as “designed to control body odour, to be honest.” SARS-CoV-2, he noted, is a highly contagious aerosol. “We’re being asked to suspend disbelief and believe that buildings were designed to protect us against infections. You’re going to have to do more.”

What more can be done?

Ultraviolet (UV) light technologies, designed to kill viral particles that slip through filters, are often touted as alternatives. But UV rays pose their own health risks, which is why they’re used to disinfect subway trains after hours and elevators not in use. UV light is not a practical or safe way to destroy coronavirus particles hovering in classrooms.

A far better solution is an ultra-low energy plasma-based nanotechnology from Novaerus, called NanoStrike®.

Powered by NanoStrike, Novaerus air dis-infection devices are unobtrusive, available in three different sizes, and can be easily placed or mounted in classrooms, dorm rooms, restrooms, school nurse’s offices, campus health centres, and other high-risk spaces.

The devices house a series of coil tubes that generate an electrical discharge, not unlike the plasma emitted by lightning. A high-quality fan draws contaminated air into the chamber where, in nanoseconds, the DNA of pathogens becomes stretched by the plasma and explodes into inert, harmless debris. Clean air is then expelled back into the room.

Unique among air-disinfection devices, NanoStrike technology leaves behind no harmful by-products.

Novaerus devices are so safe, even for the most vulnerable populations, that they are commonly deployed in hospital ICUs, operating theatres, and emergency rooms. Designed to protect both patients and medical staff from infection, the devices run 24/7. With a highly infectious virus such as SARS- CoV-2, continual air disinfection is critical.

The same sleek, white metal boxes can now be found in universities and schools alike.

NanoStrike technology, proven highly effective by independent lab testing, has long been used to fight influenza, norovirus, measles, MRSA — any number of viral and bacterial diseases. Tests also have confirmed the devices destroy airborne toxins such as VOCs and fine particulate matter.

Now, lab tests confirm NanoStrike technology can reduce airborne load of MS2 Bacteriophage, a virus used as a surrogate for SARS-CoV-2, by 99.99% in just 15 minutes.* Hospitals worldwide, from Wuhan to Budapest, have installed the units in their Covid wards.

Novaerus portable devices, powered by NanoStrike Technology can help to remove airborne viruses which travel in tiny aggregated droplets that can linger for hours before they settle on surfaces.

Schools Must Prioritize Air Disinfection

The stakes for schools have never been higher. At least 6 American school teachers died from Covid-19 in the weeks after schools re-opened. Mississippi reported over 600 cases among teachers and staff.

In Italy, concerns were raised as the country with the oldest teaching workforce in the EU returned to school. More than half of primary and secondary school teachers in Italy are over the age of 50, with 17% over 60.

Schools are working hard to keep staff and students safe. At the same time, administrators and building operators are inundated with conflicting guidance — from government authorities and public-health experts — on how best to minimize coronavirus spread. Recently, the CDC has updated its guidance on how COVID-19 spreads, acknowledging that the coronavirus can spread via airborne transmission.

“People have prevention fatigue,” says Dr Emanuel Goldman, the Columbia microbiologist. “They’re exhausted by all the information we’re throwing at them. We have to communicate priorities clearly.”

In schools, Dr Goldman asserts, the top priority must be air disinfection. An investment made during the pandemic will pay dividends in the aftermath.

“Covid-19 is not the first — and will not be the last — infectious disease to threaten our society,” says Harvard’s Joseph Allen, co-author of Healthy Buildings. “School building systems, in general, have historically been underfunded, under-ventilated, and under-prepared.”

By deploying Novaerus NanoStrike technology, schools will find themselves prepared for future waves of Covid-19 and the inevitable outbreaks of other highly infectious diseases.

*The Novaerus Defend 1050 air dis-infection unit was shown to reduce the virus by 99.99% in 15 minutes.

The Massive Responsibility to Safeguard Students: Why Schools Must Disinfect the Air – Part 1

Scan the website of any school that has reopened in the Covid-19 era, and you’ll find a litany of “enhanced disinfection protocols.”

Cleaning schedules for whiteboards, light switches, and cafeteria microwaves. Lists of government-approved carpet disinfectants. An accounting of “hypochlorous acid disinfectant wipes” in staff restrooms.

Keep clicking and you’ll find the school’s “physical distancing framework” — protocols for university shuttles and chemistry labs, guidelines for classroom desk dividers and elevator occupancy.

As schools welcome students and teachers back to class, they are seeking to inspire confidence in their Covid-19 precautions. But just how effective are all these measures?

It’s a high-stakes question. Already, more than 50,000 coronavirus cases have been reported by U.S. colleges, U.S. pediatric cases have hit half a million, and outbreaks have forced schools worldwide — from Wales to Israel to the United States — to close just days after re-opening.

In Berlin, Germany, coronavirus cases were reported by at least 41 schools a fortnight after the capital’s 825 schools reopened.

As for the answer: Scientists say schools are largely missing the boat.

“Surfaces are not really the problem,” asserts microbiologist Emanuel Goldman, Ph.D., of Rutgers New Jersey Medical School. “What [schools] really should be doing is focusing on the main routes of transmission of this disease, which is breathing.”

That’s why physical distancing measures indoors are of limited value, too.

“Distance alone will never solve the aerosol problem,” says Jose-Luis Jimenez, Ph.D., a University of Colorado chemist. “If you are in the same room, you can get infected.”

It’s well documented that coronavirus particles can linger in the air and travel across a room. To protect students and staff from inhaling these particles, schools must focus less on disinfecting desks and more on disinfecting the air.

Of course, SARS-CoV-2, the virus that causes Covid-19, isn’t the only pathogen swirling about campuses. School buildings are reservoirs for a range of airborne viruses and bacteria, as well as asthma-inducing mould spores and pollutants such as volatile organic compounds (VOCs). The coronavirus pandemic has only underscored the need for schools to deploy air-disinfection technologies year-round.

“They’re not only going to be helpful for Covid-19 but for next year’s flu season,” says David Brenner, Ph.D., a Columbia University physicist.

And not just to minimize influenza spread but also to quell the inevitable outbreaks of norovirus, common cold, and even high infectious diseases such as measles, now making a comeback around the world. As one American epidemiologist noted, once the Covid pandemic fades, schools will continue to have “the massive responsibility to safeguard the health and well-being of their students.”

Why Surface Cleaning and the 2-Metre Rule Fall Short

Scientists agree surface cleaning plays a minor role, at best, in controlling transmission of SARS-CoV-2. In fact, elaborate disinfection measures have been dubbed “hygiene theatre,” a feel-good display of concern that provides little actual protection.

School surface protocols emerged after early research suggested SARS-CoV-2 can survive for days on metal and cardboard. But recent analyses found those studies used exaggerated conditions. As Columbia’s Dr Goldman notes, up to 100 people would need to sneeze in precisely the same spot to match some of the experimental conditions.

The early studies, Goldman argues, “stacked the  deck to get a result that bears no resemblance to the real world.”

What is happening in the real world: aerosol transmission, often by young people with no symptoms. A student who feels top-notch can,  merely by asking a question, emit infectious particles light enough to sail across a classroom, even a lecture hall. A single minute of loud talking could launch over 1,000 virus-containing droplets.

Depending on the conditions, SARS-CoV-2 can travel well beyond 2 metres, the default distancing guidance for schools. In one hospital study, scientists captured viable airborne coronavirus particles nearly 4.8 metres away from a hospitalized Covid patient.

The guidance dates from 19th-century research suggesting 6 feet (approximately 2 metres) was as far as microbe-laden droplets could travel. Today’s more sophisticated studies, using laser-light technology, demonstrate that droplets exist in a range of sizes, cluster in invisible clouds, and can travel much farther indoors.

Six feet is a fine number, but we need to convey that this is a starting point,” says Linsey Marr, Ph.D., a Virginia Tech environmental engineer.

Case reports bolster the evidence. For example, in a well-known Washington choir practice, one singer spread SARS-CoV-2 as far as 13.5 metres; 53 of 61 choir members became infected, and two died.

No doubt infectious particles can waft about classrooms, hallways, staff lounges — anywhere on campus, including restrooms.

“When you flush a toilet, the churning and bubbling of water aerosolizes faecal matter,” explains Joseph Allen, Ph.D., director of the Healthy Buildings program at Harvard’s school of public health. “You’re breathing in toilet water and whatever is in that toilet water — including viruses and bacteria.”

SARS-CoV-2 may well be among those viruses.

In hospital studies, traces of coronavirus RNA have been detected in air samples collected near toilets of Covid-19 patients. Bioaerosols may linger for more than 30 minutes after a flush, other research has found. What’s more, compared to toilets with lids, lidless toilets — standard in elementary and secondary schools — increase the risk infectious particles will escape.

Enforcing the 2-metre rule won’t lower the odds that a student or staff member might inhale those particles. Neither will scrupulous disinfection of door handles and microwaves.

All in all, experts concur, school Covid precautions are falling short. Indeed, one American epidemiologist called the priorities at her own child’s school — one-way hallways, frequent sanitizing, temperature checks — “dangerously misdirected.” Airborne coronavirus spread, she lamented, was “absent from the conversation.”

Read part two here.

Clean Hospitals Day – 10/10/20

Novaerus is delighted to be supporting Clean Hospitals Day, a global awareness campaign created to highlight the importance of healthcare environmental hygiene.

On the 10th of October 2020, Clean Hospitals Day will celebrate and empower key environmental hygiene healthcare workers. This day also represents a call to hospital management, decision-makers and stakeholders to champion environmental hygiene and to take action to make hospitals cleaner and safer.

Clean Hospitals Day aims to ensure recognition of the importance of healthcare environmental hygiene, to provide stronger focus and guidance and to define and share a global understanding for hygiene standards. The global campaign will address all the components of healthcare environmental hygiene such as surfaces, air, medical waste, fabrics and fittings, water, IT, digitalization and much more.

To learn more about Clean Hospitals Day, visit the website.

Please join us on 10/10/20 and let’s celebrate Clean Hospitals Day together – #CleanHospitalsDay.

As part of the campaign, Clean Hospitals are holding a  free teleclass – Clean Hospitals: The Next Frontier in Infection Prevention on the 20th of October at 7.30 PM CEST.  The teleclass will be taught by Prof Didier Pittet, Chair of Clean Hospitals, and Dr Pierre Parneix, Education Director of Clean Hospitals, who will address pressing questions in healthcare environmental hygiene, explaining why it is key for preventing healthcare-associated infections and protecting staff and our environment. 

Register for the free teleclass here. 

In preparation for the teleclass, from the 10th – 20th of October, Clean Hospitals will release 10 mini videos with questions about healthcare environmental hygiene. These questions will be answered during the teleclass. 

Follow Clean Hospitals on social media to make sure you don’t miss out!

Clean Hospitals is a coalition of international stakeholders who work explicitly to promote Healthcare Hygiene. Clean Hospital’s vision is to be the guardians protecting healthcare workers, patients and the environment, believing that by making care facilities a cleaner place, the healthcare system will be better equipped to protect its inhabitants.

Novaerus and Major Appliance Maker Galanz Create Commercial Partnership to Bring Air Disinfection to the Chinese Consumer Market

Novaerus Technology Powers New Galanz Air Disinfection Devices – Providing the First Line of Protection Against Airborne Viruses and Bacteria

Dublin, Ireland, September 1, 2020 – Novaerus, an Irish company that manufactures and sells medical-grade, clean air solutions, has announced that it has entered into a strategic partnership with Chinese powerhouse manufacturer, Galanz. By partnering with Novaerus, Galanz can provide a cutting-edge, air disinfection solution to China’s consumer market to protect people from airborne viruses and bacteria.

The license agreement will allow Galanz to manufacture the Novaerus designed air disinfection devices. Novaerus’s patented plasma-based nanotechnology, NanoStrikeâ will power the devices. Developed by the Novaerus team of scientists and engineers, this is the only air disinfection technology that kills and deactivates harmful airborne microorganisms on contact — in a sub-second time frame.

Specializing in manufacturing, Galanz provides a fundamental focus on quality and innovation. Starting with the microwave trade and becoming the largest microwave manufacturer globally, its business now covers award-winning technologies, including air conditioners, refrigerators, washing machines, dryers, dishwashers, and other small home appliances. In the past 20 years, Galanz has established strategic partnerships with many famous brands in Europe.

This is truly an ideal union of exceptional air disinfection technology combined with renowned manufacturing capabilities. Partnering with the Dublin based Novaerus helps Galanz develop a stronghold in the Chinese air disinfection market during a critical time. “Although our partnership with Galanz began in 2019, before the COVID-19 pandemic, the timing of the launch of their newest air disinfection solution could not come at a better time,” states Dr Kevin Devlin, CEO of WellAir. “There is mounting research to suggest that clean, disinfected air plays a vital role in preventing the spread of SARS-CoV-2, the virus causing COVID-19.

Novaerus’s NanoStrike air disinfection technology has been shown effective at reducing MS2 Bacteriophage, a surrogate for SARS-CoV-2 (COVID-19), by 99.99%.”

“We looked to partner with a company with a tested and proven air disinfection technology, a technology that was not available in China — until now. Novaerus has a strong reputation in the medical market, with solutions deployed in over 400 hospitals worldwide,” states Benjamin Leung, Vice Chairman of Galanz. “Their solutions are also registered on China’s National Online Record Information Service Platform for Disinfection Products, and the efficacy of their devices have been tested and qualified by the Guangzhou Institute of Microbiology.” The partnership will start with the launch of Galanz’s new GZ20 air disinfection unit, powered by Novaerus’s NanoStrike technology.

About Novaerus

Novaerus is part of WellAir, an Irish company on a mission to reduce indoor airborne pollutants to create living, working, and healing spaces that foster rather than detract from human health, productivity, and wellbeing. WellAir and its brands, Novaerus and Plasma Air, can be found installed in hundreds of hospitals, senior living facilities, schools, casinos, railway stations, residences, and industrial facilities in more than 60 countries around the world.

About Galanz

Galanz is a leading global home appliances manufacturer of a range of products, including microwave ovens, refrigerators, dishwashers, laundry, air conditioners, toaster ovens, and more. For decades, Galanz has been at the forefront of appliance invention, with more than 1,600 patents and product partnerships with some of the world’s most recognized and trusted brands. Galanz designs appliances with thoughtful engineering for the home and will continue to innovate to create efficient, dependable, and great products that consumers love.

Infection Spread in the NICU: “The Tip of the Iceberg” – Part 2

COVID-19 aside, respiratory viral infections (RVIs) strike newborns particularly hard and, according to Austrian researchers, are “more prevalent in the NICU than previously considered.” RVIs are likely underdiagnosed, the authors assert, as many NICUs don’t routinely test for viral pathogens in symptomatic patients. Respiratory viral infections are a leading cause of mortality among newborns and often are detected only late in the course of illness.

Read part one of this blog post here.

Viral Outbreaks in the NICU

Though the majority of NICU infections are bacterial, nosocomial viral infections have been widely reported, including outbreaks of syncytial virus (RSV), influenza H1N1, rotavirus, adenovirus, enterovirus, and norovirus.

COVID-19 aside, respiratory viral infections (RVIs) strike newborns particularly hard and, according to Austrian researchers, are “more prevalent in the NICU than previously considered.”

RVIs are likely underdiagnosed, the authors assert, as many NICUs don’t routinely test for viral pathogens in symptomatic patients. Respiratory viral infections are a leading cause of mortality among newborns and often are detected only late in the course of illness.

The hospital costs of RVIs are particularly high. A 6-year study of a NICU in Nottingham, UK, found that compared to uninfected newborns, infected NICU patients spent far longer in the hospital — 76 days compared to 41 days — and in-hospital care costs were significantly higher, £49,664 compared to £22,155.

Infected NICU staff are often the source of viral outbreaks, especially influenza infection.

Newborns, of course, cannot be vaccinated, and annual vaccination rates among the healthcare workers who care for these patients are alarmingly low.

An H1N1 influenza outbreak in a Greek NICU, for example, was traced to the nursing staff, just 15% of whom were vaccinated.

“Nosocomial influenza can cause considerable morbidity, especially in high-risk neonates,” the authors wrote, “and is readily transmissible in the NICU setting by unvaccinated staff members.”

Viral infection spreads quickly in the NICU. A norovirus outbreak at Texas Children’s Hospital, traced to one newborn, began spreading within 24 hours and within two weeks had afflicted 28 babies, along with 12 staff members, who had to be furloughed.

Disinfecting the NICU Air, Safely and Quietly

Hand hygiene has long been the cornerstone of hospital infection prevention, in the NICU and elsewhere, and healthcare workers are striving to be even more meticulous in the COVID era. Yet hundreds of studies demonstrate that over the decades, compliance has been, in the words of the World Health Organization, “abysmally low.”

Surface cleaning, too, has been augmented since the emergence of SARS-CoV-2 but inevitably falls short, as airborne pathogens continually settle on medical equipment, floors, clothing, and healthcare workers’ hands.

It is impossible to operate [NICU] environments in complete sterility,” a University of California team reported. The infants themselves, the adults who care for them, the equipment required for their care — all represent “fertile vectors for microbial transmission.”

Though stringent cleaning protocols for NICU surfaces have been in place for years, infections rates remain stubbornly high.

“It is tempting to speculate that more potent cleaning techniques or agents will lead to further decreases in nosocomial infections,” the researchers concluded, but reality may be otherwise. “Future improvement may require innovative approaches.”

Among the most effective innovations is ultra-low-energy plasma technology by Novaerus, now deployed in NICUs and COVID wards worldwide. Easily installed on the wall, a shelf, or a rolling stand, Novaerus devices quickly destroy airborne viral, bacterial, and fungal particles.

For example, lab tests found the company’s most powerful unit can reduce the airborne load of MS2 Bacteriophage, a virus used as a surrogate for SARS-CoV-2, by 99.99% in just 15 minutes. The technology decimates MRSA load just as thoroughly and quickly.

Dis-infecting air in the NICU, as well as other wards and common areas, is imperative, as study after study points to hospital infection spread via aerosolization. A Japanese team, for example, reported on an outbreak of Bacillus cereus in its NICU, concluding the bacteria spread via the airflow of the ventilation system. Numerous studies have detected MRSA and Clostridicum difficile in hospital air.

As for SARS-CoV-2, air-sampling studies have detected viral RNA in hospital hallways and in rooms where healthcare workers changed their clothing, prompting the World Health Organization to finally agree with scientists worldwide that aerosol transmission of COVID-19 cannot be ruled out.

In a year-long study of an American NICU, a team of environmental engineers noted in PLOS One: “Hospital hygiene protocols may undervalue the potential importance of the airborne transmission route.”

Throughout hospitals, but especially in the NICU, ultra-low-energy plasma technology is an important addition to ventilation and filtration. Whereas conventional filters capture only large particles, Novaerus units destroy the smaller and deadlier ones.

Novaerus units run continuously and quietly, a benefit given the adverse effect of noise on the heart rates and respiratory systems of preterm or very low birth weight infants.

The technology is safe to operate around even the smallest, most medically fragile NICU patients, unlike other air-sanitation methods that can produce harmful byproducts.

Novaerus technology not only helps prevent infection but also mitigates newborns’ exposure to chemicals such as volatile organic compounds (VOCs) and particulate matter. Lacking the protective buffer of the womb, research suggests, newborns in the NICU are exposed to chemicals that may permanently alter neurobehavioral outcomes.

Air quality in the NICU may have a “significant impact on their long-term development,” note researchers at the Icahn School of Medicine at Mount Sinai in New York City, who are conducting the first study of air quality in neonatal intensive care.

Infants admitted to the NICU often stay for long periods, putting them at elevated risk for contracting an infection. The average length of stay for a term or near-term infant with surgical or respiratory issues is about 15 days; the length of stay for preterm infants born at 26 weeks’ gestation is more than 2 months.

Throughout their stay, it is imperative that their infection risk is reduced by stringent hand hygiene, effective surface cleaning, and 24/7 air dis-infection.

Microbes accumulate 24 hours a day, as visitors, staff, and medical devices come and go. Healthcare workers’ hands and NICU equipment cannot be cleaned continually, but with the installation of Novaerus technology, the air in the NICU can.