Singing, Covid-19, and the Future of Live Entertainment – Part 2

Read part 1 of this blog post here.

Since the early days of the covid-19 pandemic, singing has been a super-spreading culprit leading to an effect on the future of live entertainment.

What about Singing?

Until Covid-19 emerged, just one study, conducted in 1968 and prompted by choir-related TB outbreaks, had analyzed particles generated by singing. The study involved just three singers, none of them professionals.

Forty years later, the explosion of choir-related coronavirus outbreaks prompted larger, more robust, and more sophisticated studies. These trials, in combination with prior flu-focused research, provide insight on the safest way to reopen live entertainment and dining venues.

Scientists at Sweden’s Lund University, for example, compared respiratory emissions from 12 vocalists, including seven opera singers, under three conditions: singing, reading a book out loud, and breathing silently.

With metal funnels fitted around their faces, the volunteers performed for 2 minutes at a time while a vacuum pump continually introduced fresh air into the funnel. A high-speed camera imaged the emissions produced by five of the singers.

Overall, the results were unsurprising: “Normal singing generated significantly more aerosol particles than normal talking. Loud singing produced more particles than normal singing.” Also, the professional singers generated about twice as many particles as the amateurs.

One finding, though, was intriguing. While loud singing and loud talking both generated vastly more particles than normal talking and breathing, the difference between both types of loud vocalization was relatively small. In other words, infection might spread as readily at a noisy pub as at musical performance.

University of Bristol scientists obtained similar, but even more dramatic, results when they studied emissions from 25 professional singers from a broad range of genres — gospel, opera, jazz, and pop, among them.

Performing in a highly filtered operating theatre, volunteers sang single notes at different pitches. They also sang and spoke the “Happy Birthday” song at multiple volumes.

Like the Swedish scientists, the UK team found singing generates more aerosol than talking — about 1.5 to 3 times more. These differences, however, were “eclipsed by the effect of volume on aerosol production.”

Both loud singing and loud talking produced an astonishing 20 to 30 times more aerosolized particles than vocalizing at a typical volume.

Why Pubs and Future Live Entertainment Music Venues Must Clean the Air

Loud singing and loud talking — those are the hallmarks, along with exuberant merrymaking. TradFest, Dublin’s annual 5-day celebration of Irish music and culture. Since 2005, the festival has drawn top bands and massive crowds to historic churches, castles, and pubs. It’s an aerosol eruption of the highest order. Yet when the pandemic struck, organiser Martin Harte was determined not to cancel. With the right precautions, he felt, live performances could happen, even if live audiences could not.

At the time, plastic dividers and relentless surface cleaning protocols were all the rage in entertainment and hospitality. “Everyone was obsessed with handwashing and hygiene, as opposed to cleaning air,” Harte recalls. Even today, more than a year into the pandemic, “disinfectant mania” persists while ventilation, filtration, and air dis-infection are undervalued.

“Some people still don’t get it,” asserts microbiologist Emanuel Goldman, Ph.D., of Rutgers New Jersey Medical School. “They’re distracting the public from the measures that can really protect them.”

Among the most protective measures is air dis-infection, particularly NanoStrike technology, used in Novaerus portable devices.

Inside Novaerus’ sleek, compact units, coil tubes produce an electrical discharge that obliterates pathogens at the molecular level. Instantly, the DNA of a virus or bacteria becomes inert, harmless debris, and clean air is released back into the room.

Noaverus technology has been used in over 60 countries to fight Covid-19, particularly in hospital operating rooms, Covid wards, emergency departmentes, waiting rooms, and surgical theatres.

That’s largely why Harte chose Novaerus as his solution for TradFest 2021. For five days, musicians performed at Dublin Castle, with portable Novaerus units parked in the castle’s historic rooms but out of camera range.

“Novaerus isn’t a hygiene product,” says Harte. “This is something you’ll find in an ICU, in a neonatal unit. That was the level of protection we wanted.” The devices featured prominently in TradFest’s safety proposal to the Office of Public Works, the government agency that operates Dublin Castle.

“Novaerus helped us hugely in securing approval to use the castle and made all the difference in getting musicians to agree to perform,” Harte says.

TradFest deployed Novaerus’ most powerful unit, the Defend 1050, which has been cleared by the U.S. Food and Drug Administration as a 510(k) Class II medical device.

In independent laboratory testing, the Defend 1050 has demonstrated a 99.99% reduction of live SARS-CoV-2 virus, within 30 minutes. Like other Novaerus units, the Defend 1050 shown similar efficacy with other airborne pathogens, including influenza, Clostridium difficile, Aspergillus, and surrogates for Measles virus, tuberculosis, and Methicillin-Resistant Staphylococcus Aureus (MRSA).

NanoStrike technology also destroys surrogates for tuberculosis and measles — two deadly pathogens that, while tamed, were never eradicated and continue to plague the globe, infecting millions each year. That may be the destiny of SARS-CoV-2, a virus expected to circulate well beyond the end of the pandemic.

For this reason, Harte says, and because he knows that noisy conversation itself can generate highly infectious aerosol plumes, he has encouraged bars and restaurants throughout Temple Bar, Dublin’s primary tourist district, to deploy Novaerus devices.

“I don’t think you can safely open any establishment, anywhere, without cleaning the air.”

If you are interested in learning more about the Novaerus products, additional information can be found here, or please contact Novaerus.

Singing, Covid-19, and the Future of Live Entertainment – Part 1

“Particles shoot out like a geyser”: Singing, Covid-19, and the Future of Live Entertainment

Since the early days of the covid-19 pandemic, singing has been a super-spreading culprit leading to an effect on the future of live entertainment.

Around the world, choristers have become infected at remarkably high rates. At a rehearsal in the United States, 53 of 61 singers contracted Covid-19, and a practice in France infected 19 of 27. A choir seminar in Austria left 43 of 44 singers infected, and after the Amsterdam Mixed Choir performed Bach’s St John Passion, 102 of 130 members fell ill.

Karaoke, too, has sparked numerous outbreaks, including an explosion of cases traced to a popular Quebec City bar. In the coronavirus era, noted Quebec City’s health director, “All singing poses a problem.”

Science shows that’s true. Singing emits high volumes of aerosol, and infectious particles generated by one singer can sail across a choir hall, as far as 13 meters, only to be inhaled by another. But is singing more hazardous than, say, loud conversation at a pub? Not substantially.

As British scientists have found, aerosol transmission of disease is “equally possible” whether the particles are produced by singing or loud speaking — a finding of importance to anyone who operates an establishment noisier than a library.

With vaccinations underway, we can plan for a time when choirs reconvene, karaoke bars reopen, restaurants operate at full capacity, and musicians get back on the road. But post-pandemic, the landscape for entertainment and hospitality will look different than it did before.

Moving forward, building operators will need a working knowledge of SARS-CoV-2 transmission and of the precautions, such as air dis-infection, proven to mitigate the risks of singing and socializing indoors.

“Covid is here to stay, in some shape or form, and we need to adapt,” says Martin Harte, CEO of The Temple Bar Company, the not-for-profit organiser of TradFest, Ireland’s largest festival of traditional music. Harte adapted by installing medical-grade air dis-infection devices at Dublin Castle, the historic fortress where TradFest musicians performed indoors, with government permission, amidst the pandemic. The sessions, livestreamed to a global audience, did not lead to a single infection.

“Music travels through the air, and so does the coronavirus,” says Harte. “I wasn’t going to put our performers or crew at risk.”

From TB to Covid: The Super-Spreading Power of Singing

In 1962, at an American boarding school, two boys, feverish and coughing, were diagnosed with tuberculosis and admitted to the hospital. Testing at the school turned up 25 more cases. A medical team was dispatched to study the outbreak. At the time, conventional wisdom held that TB was transmitted via large respiratory droplets and close contact. But intriguing rodent studies suggested otherwise. If guinea pigs could become infected from afar, perhaps humans could, too.

But how? What behaviors might spread the disease?

At first, the medical team was stumped. Though all 153 students slept in a single, poorly ventilated dormitory, the TB cases were randomly distributed. Classroom and chore groupings revealed no patterns, either.

But further analysis yielded a clue: Among members of the school choir, 60% contracted TB, compared to just 20% of the student body as a whole. Reporting in the Journal of the American Medical Association, the doctors noted that three other mid-century TB outbreaks had been associated with choir singing.

“It seems quite possible,” the doctors wrote, “that vigorous singing could be an effective generator of fine particles in large quantity.”

Today, we know that’s not just “possible” — it’s a fact.

“When you sing, microscopic particles burst forth from your mouth in a fountain of mist . . . shooting out like a geyser,” explains James Hamblin, M.D., an American public health physician. “The rush of exhaled air creates an aerosolized mixture of everything that’s lingering in the mucus membrane of your pharynx.”

This location, he notes, is “exactly where the coronavirus attaches and replicates.” Until Covid-19 began rampaging through choirs, the connection between singing and disease transmission had largely been forgotten.

Instead, aerosol scientists focused on more ordinary sources of respiratory emissions — coughing, sneezing, talking, and breathing. Studies were conducted for the purpose of helping reduce spread of the flu.

As one prescient research team, from the U.S. National Institute for Occupational Safety and Health, noted: “To prepare for a possible influenza pandemic, a better understanding of the potential for the airborne transmission of influenza from person to person is needed.”

What that study found: while coughing generated more viable influenza particles than mere breathing, the difference was not large and “both respiratory activities could be important in airborne influenza transmission.”

Another flu-focused study compared emissions while speaking at various volumes. “We showed that as you talk louder, no matter what you say, you will release more particles,” reported chemical engineer Sima Asadi, Ph.D., the study’s lead author.

The key take-away, Asadi said: “Talking is potentially as important as sneezing and coughing for influenza transmission.

Read part 2 of this blog post here.

TradFest Temple Bar 2021

As Covid-19 spread around the world, live music events everywhere were canceled or postponed. TradFest Temple Bar, an annual live music festival celebrating Irish music and culture, reimagined their iconic event with the help of Novaerus air dis-infection technology from WellAir.

A live music festival reimagined for the COVID-19 era.

Every January, Dublin’s famed Temple Bar district erupts with music and joy, as TradFest Temple Bar — a five-day celebration of Irish music and culture — draws top bands and massive crowds to historic churches, castles, pubs, and other iconic venues.

TradFest Temple Bar 2020 beat the Covid-19 pandemic by mere weeks, wrapping up just before live music everywhere came to a screeching halt. When it came time to plan TradFest Temple Bar 2021, the virus was on its second rampage, and prospects for live performances had worsened. Science had established that SARS-CoV-2 was airborne and that singing was especially risky.

Novaerus Protect 800 at Tradfest Temple Bar 2021 — Novaerus Protect 800

Worldwide, music festivals were cancelled. But Martin Harte, CEO of The Temple Bar Company, the not-for-profit organiser of TradFest, wasn’t having it. After all, Tradfest, Ireland’s largest festival of traditional music, had run annually since 2005.

“I said, ‘No, the show must go on,’” recalls Harte. And it did. In the throes of the pandemic, TradFest delighted fans with a scarce commodity: music performed live and indoors.

Novaerus Medical-Grade Air Dis-Infection Technology

The audiences weren’t live, of course; the concerts were streamed. But the artists performed within the storied, stone walls of Dublin Castle, a fortress that dates back to 1230 and, just for TradFest 2021, was outfitted with Novaerus medical-grade air dis-infection technology from WellAir. Over five days, some 50 musicians and crew members gathered to rehearse, pose for photos, and perform amidst rococo ceilings and portraits of Irish viceroys — all the while breathing air cleaned by sleek, white Novaerus devices out of camera range.

Novaerus Defend 1050 at TradFest Temple Bar 2021 — Novaerus Defend 1050

The devices featured prominently in TradFest’s safety proposal to the Office of Public Works, the government agency that operates Dublin Castle. “The Novaerus devices helped us hugely in securing approval to use the castle,” says Harte.

Of course, it wasn’t just government authorities that needed convincing; the performers and crew — ages 18 to 80, emerging artists and folk legends alike — had to feel protected. “Novaerus devices made the difference in getting people to agree to perform,” Harte says. During the event, artists, and staff noted the quiet presence of Novaerus devices, says Harte. “I pointed out that right on the back of the machine, it says ‘infection control device.’ People felt reassured and relaxed.”

A Covid-Free Event

The technology helped foster a sense of normalcy in decidedly abnormal times. “It was a lovely and very hopeful atmosphere,” says Deirdre Devitt of The McGreals Group, a TradFest sponsor and Novaerus distributor. “You could feel the sheer joy the performers and crew were feeling.”

The festival proved to be entirely Covid-free — “We had no illness, nothing,” reports Harte — while the same could not be said for the rest of Ireland. “During that week, Covid got out of control,” says Harte. “Three days after we finished shooting, Ireland closed down. Dublin Castle was possibly the safest space you could be in the whole country.”

When the pandemic struck, Harte knew nothing of Novaerus devices. He just knew he wanted TradFest 2021 to happen — somehow. “People need culture, and artists need work, and there was the commercial opportunity for us to sell tickets worldwide,” Harte says.

Following the Science

Harte delved into research on Covid-19 transmission and became convinced, early on, that the disease was largely spread via aerosol. He even read up on tuberculosis, another disease that was initially considered transmissible only via large droplets but was ultimately proven to be spread by microscopic viral particles. Harte noticed, too, that businesses were scrambling to install plastic dividers and disinfect surfaces, disregarding the real threat: infectious aerosols. “I could see we were making the same mistakes with Covid that they made with TB,” Harte recalls.

Harte’s global search for a solution led him back home to Ireland, where WellAir’s Novaerus technology was being developed and manufactured for use in medical settings.

“Novaerus isn’t a hygiene product — it’s something you’ll find in an ICU, in a neonatal unit,” says Harte. “That was the level of care we wanted. Our brand is too strong and our audience and performers are too important to put them at risk.”

Reopening in the COVID-19 Era

Novaerus Protect 200 at TradFest Temple Bar 2021 — Novaerus Protect 200

Not only did Harte deploy Novaerus devices for TradFest but he also has encouraged bars and restaurants throughout Temple Bar, Dublin’s primary tourist district, to do the same. In fact, Harte won’t hold meetings in a room that is not continually cleaned by WellAir’s patented NanoStrike technology, which powers all Novaerus devices.

“I don’t feel comfortable breathing someone’s contaminated air,” he says. The public, he believes, is starting to feel the same way.

“When the world re-opens, people will make choices as to what bars and restaurants they’ll go into. And once people want it, you have to have it. Novaerus technology is like a fire extinguisher: You cannot safely run your business without it.”

Covid is here to stay in some shape or form, says Harte, “and we need to adapt. We’re not returning to normal any time soon.”

In the video below, Martin Harte, CEO of The Temple Bar Company, explains how TradFest Temple Bar reimagined their iconic event with the help of Novaerus air dis-infection technology from WellAir.

Download the full case study here.

Hear from customers in Ireland who have chosen WellAir’s Novaerus devices to protect the air for their staff and customers.

The Fallacy of the 2-Metre Rule – Part 2

Read part one of this blog post here.

Aerosol Transmission of Covid: More Prevalent than Presumed

For months into the pandemic, the World Health Organization (WHO) and U.S. Centers for Disease Control and Prevention (CDC) insisted close-range, large-droplet spread was driving the pandemic. Aerosol transmission, WHO stated, was limited to “specific circumstances and settings,” primarily aerosol-generating medical procedures such as intubation and CPR.

Prodded by scientists worldwide, both organizations eventually agreed aerosol transmission of SARS-CoV-2 was possible in community settings and perhaps not rare. But even today, top scientists warn the impact of long-range spread has been vastly underestimated.

“Aerosol transmission plays a significant role in indoor environments and cannot be neglected,” argues Maosheng Yao, PhD a professor of engineering at Peking University.

Covid transmission via aerosols “matters much more than has been officially acknowledged to date,” agrees Linsey Marr.

In reality, transmission via large-droplet spray, like transmission via aerosol, requires its own “special circumstances and settings” — for example, standing before a Covid-infected person who just sneezed.

There’s no evidence that close-range, droplet transmission is the primary driver of Covid spread and much to suggest that it’s not.

For one thing, asymptomatic and pre-symptomatic people account for at least 50% of all transmission, according to the U.S. CDC. In other words, they’re not sneezing or coughing up phlegmy, infectious gobs — the kind those plexiglass dividers are designed to contain.

What’s more, careful studies of super-spreading events have found long-range aerosol spread responsible for large numbers of infections.

For example, an analysis of the Diamond Princess cruise ship — where 712 of 3,711 passengers became infected — estimated that short-range transmission accounted for just 35% of cases. Another 35% were attributed to long-range transmission and 30% to spread via contaminated surfaces.

Then there’s the infamous American choir-practice case, in which a single infected singer transmitted Covid-19 to 53 of the choir’s 61 members. Scientists interviewed the entire choir and analysed their seating arrangements and movements throughout the 2.5-hour practice.

While it’s possible some members became infected at close range, inhalation of aerosols from shared air was “almost certainly the leading mode of transmission,” the study concluded.

No choir member sat within 3 metres in front of the infected singer, and four singers who contracted Covid sat behind the singer. For them to have become infected via large droplets, those infectious gobs would have had to travel backwards, a physics-defying scenario in a room with poor ventilation.

American chemist Jose Jimenez, who interviewed the choir, says one member contracted Covid despite remaining 44 feet (13.5 metres) from the contagious singer.

All the evidence taken together, says Jimenez, “convinced us that only airborne transmission could explain this case.”

Restaurants and shops worldwide have reduced occupancy, on the theory that spreading out patrons would control Covid spread. But without other precautions in place, such as air dis-infection, reducing capacity won’t suffice. Occupancy in sections of the choir hall ranged from 44% to 55%.

Those ubiquitous plexiglass dividers won’t help much, either.

As part of his research on Covid spread, California scientist William Ristenpart investigated transmission at a karaoke bar. After an initial outbreak, the owners installed plastic partitions in front of the singers.

“But it didn’t solve anything,” Ristenpart reported at the international Covid-transmission workshop. “Another 18 people got infected. It’s more indirect evidence for this idea of long-range aerosol transmission.”

Covid Will Fade, But Aerosol Spread Won’t

Ultimately, it doesn’t matter what percent of Covid cases are spread via large droplets or tiny aerosols. We know aerosol spread happens — often.

And those responsible for the safety of indoor spaces must take heed.

As the Diamond Princess analysis noted, the cruise outbreak underscores “the importance of implementing public health measures that target the control of inhalation of aerosols . . . not only aboard cruise ships but in other indoor environments as well.”

Which measures target aerosol spread best?

Certainly, mask mandates help. “But even with the masks, you have leakages of particles,” Lydia Bourouiba of MIT said at the Covid workshop. “The aerosol spread will be slower, but aerosols will still accumulate.”

Even universal masking wouldn’t halt transmission. “In Hong Kong, we’re very good at wearing masks, but we’ve had two community epidemics in spite of more than 99% of adults reporting wearing face masks in public,” says Ben Cowling, PhD, a University of Hong Kong epidemiologist.

At any rate, masks are not a long-term solution to aerosol spread of disease.

When the Covid pandemic fades and masks are tossed, infectious microbes will still be swirling around. These pathogens include influenza, which, like Covid-19, can be transmitted by both aerosols and large droplets.

What’s needed indoors are increased ventilation and air filtration, as well as continual, medical-grade air disinfection, such as NanoStrike technology, developed by Novaerus.

As independent laboratory tests confirm, plasma generated within Novaerus units obliterates airborne pathogens of all types: viruses, bacteria, and fungi. Instantly, virulent particles are reduced to inert debris.

Novaerus units accomplish this without emitting harmful byproducts and have proven safe for 24/7 use around even the most vulnerable patients.

Throughout the pandemic, the compact, unobtrusive devices have been running in hospital Covid wards, emergency rooms, and operating theatres, protecting staff, patients, and visitors alike.

Now that the pandemic’s end appears within sight, the same technology is being installed by pubs, restaurants, pharmacies, retail shops, offices, and schools. The goal: to fight Covid, influenza, norovirus, and other pathogens, current and emerging, that can and will spread infection.

We can’t remain 2 metres apart forever. And as science now demonstrates, standing 2 meters apart won’t stop aerosol spread, anyway.

Novaerus Closes the Infection Control Loop with Defend 1050, All-in-One Air Disinfection and Purification Device

The Defend 1050 is a medical-grade, portable device that uses a combination of plasma and filter technology to safely disinfect and purify indoor air, supplementing surface and hand hygiene for comprehensive infection control.

Dublin, Ireland, June 28, 2018 – Novaerus, an Irish company specialising in non-chemical air disinfection using patented ultra-low energy plasma, today announced the launch of the Defend 1050. The Defend 1050 is a portable, easy to use device ideal for rapid disinfection and purification of the air in large spaces and high-risk situations such as operating theatres, ICUs, IVF labs, emergency and waiting rooms, and construction zones.

The Defend 1050 uses ultra-low energy plasma technology – a highly effective method of rapid pathogen destruction – and a multi-stage high performance filter system from Camfil® to reduce infection, adsorb odours, neutralise volatile organic compounds (VOCs), and trap particulate as small as 0.3µm.

Independent tests completed to date show that the Defend 1050 at max. speed reduces:

Mycobacterium smegmatis (surrogate for Mycobacterium tuberculosis) by 97% in 30 minutes (30m³ space)
Influenza A by 99.9% in 10-20 minutes (28.5m³ space)
Staphylococcus epidermidis by 99.9% in 15 minutes (30m³ space)
Aspergillus niger by 99.99% in 30 minutes (15.9m³ space)
Nitrogen Dioxide (NO2) by 100% in 6 minutes (16m³ space)
VOCs at a clean air delivery rate (CADR) of 596 m³/hr
PM1.0 at a CADR of 860 m3/hr (19.7m³ space)
PM2.5 at a CADR of 870 m3/hr (19.7m³ space)

The Defend 1050 combines six coils of Novaerus’ patented, NASA-tested, ultra-low energy plasma technology with a M5 pre-filter, a genuine H13 HEPA filter certified in accordance with EN-1822, and carbon/molecular filter from Camfil, a world leader in high quality air filtration.

“We created the Defend 1050 in response to a growing demand from our customers for a mobile, rapid remediation solution for airborne pathogens and VOCs in high-risk situations,” said Dr. Kevin Devlin, EVP of product at Novaerus. “As a problem solver, the Defend 1050 is the perfect complement to our filter-free units, the Protect 800 and Protect 200, which are designed to be operated continuously to maintain optimal indoor air quality.”

Since 2009, Novaerus has been researching and developing plasma technology that is unmatched in its ability to safely destroy airborne pathogens that lead to infection in populated indoor spaces. The patented technology uses short-exposure, ultra-low energy plasma that has been tested and shown by several respected laboratories – including Airmid, Aerosol, Microbac, and Ames – to deactivate pathogens on contact.

“We now know conclusively that infection can be transmitted on air currents over large distances, by direct and indirect contact or a combination of all three routes.” said Dr. Felipe Soberon, chief technology officer at Novaerus. “The Defend 1050 is ideal for mitigating the risk of airborne dissemination of infection and contamination of surfaces and hands by reducing the bioburden in the air.”

Many air cleaning methods in use by healthcare facilities today rely on filters to capture pathogens. But without deactivating those pathogens first, the filter can become a safe haven for viable pathogens to colonise. The Novaerus plasma technology solves that problem by killing airborne pathogens before they become trapped in the filter.

“Novaerus has done an incredible job of bringing together the benefits of their patented plasma technology and our high-performance filters”, said Paul Flanagan, general manager of Camfil Ireland, “As an emerging global leader in portable non-chemical air disinfection, Novaerus is a natural partner for us. By being embedded in Novaerus units, Camfil’s filters can be deployed at the point of care, when and where they are needed most.”

The Defend 1050 can be moved easily by staff and plugged into any power outlet. It has five fan speeds to accommodate different room sizes and noise level requirements.

The Defend 1050 is now available for ordering in Europe and for pre-order in the USA.

About Novaerus

Novaerus is on a mission to reduce indoor airborne pollutants that lead to infection, allergies, asthma, and irritation. We envision a world where indoor spaces foster rather than detract from human health, productivity, and wellbeing. The patented plasma technology used in Novaerus portable devices was invented in Ireland in 2006. Clinical trials began in Europe in 2008 and a radical upgrade of the technology was completed in 2011. In 2016, Novaerus purchased Plasma Air and sister company, Aerisa, adding HVAC bipolar ionization technology to our portfolio and expanding into industrial and commercial applications.

For more information about Novaerus, visit www.novaerus.com.

About Camfil

For more than half a century, Camfil has been helping people breathe cleaner air. As a leading manufacturer of premium clean air solutions, we provide commercial and industrial systems for air filtration and air pollution control that improve worker and equipment productivity, minimize energy use, and benefit human health and the environment. We firmly believe that the best solutions for our customers are the best solutions for our planet, too. That’s why every step of the way – from design to delivery and across the product life cycle – we consider the impact of what we do on people and on the world around us. Through a fresh approach to problem-solving, innovative design, precise process control and a strong customer focus we aim to conserve more, use less and find better ways – so we can all breathe easier.

The Camfil Group is headquartered in Stockholm, Sweden, and has 28 manufacturing sites, six R&D centres, local sales offices in 26 countries, and 4,180 employees and growing. We proudly serve and support customers in a wide variety of industries and in communities across the world. To discover how Camfil can help you to protect people, processes and the environment, visit us at www.camfil.com.

Fighting Superbugs: We Have the Power

Health officials around the world agree: the superbug crisis has reached the “red alert” stage.

Since the 1940s, antibiotics have dramatically reduced illness and death from infectious diseases; penicillin alone has saved about 200 million lives. But thanks to overuse in humans and animals, antibiotics are losing their power to fight bacteria.

Infections once easily treated with penicillin now require rounds and rounds of multiple antibiotics. Eventually, some bacterial strains will become untreatable, rendering C-sections, hip replacements, and chemotherapy too risky for patients.

“[Antibiotic resistance] is very serious indeed – it’s killing people around the world at the rate of hundreds of thousands of year,” cautioned one infectious disease epidemiologist. “And we all expect it to get worse if something isn’t done now.”

But what can be done?

Health officials’ top priority is the development of new antibiotics, and in 2016, 193 countries signed a United Nation declaration to encourage drug research. “We need governments, the pharmaceutical industry, health professionals and the agricultural sector to follow through on their commitments to save modern medicine,” said England’s chief medical officer.

But developing new antibiotics is a long, slow, and very expensive process. It can take 10 years to bring a new drug to market and 23 years for the investment to start paying off.

The world can’t afford to sit and wait.

In the meantime, we all — governments, employers, individuals — can take immediate action to combat the superbug crisis. The strategy must be two-pronged: 1.) halting antibiotic overuse, in both humans and farm animals, and 2.) preventing infections.

Stopping Antibiotic Overuse — in Humans and Livestock

Antibiotics are useless against viral infections, such as colds, coughs, bronchitis, the flu, and many ear and sinus infections. And yet, out of habit or in response to patient demand, doctors routinely prescribe antibiotics for these conditions. In the United States, more than 30 per cent of oral antibiotic prescriptions — about 47 million per year — are unwarranted, according to a study published in the Journal of the American Medical Association.

Worldwide, medical authorities are working to halt this practice. In 2015, the U.S. government set a goal of reducing inappropriate outpatient antibiotic use by at least half by 2020, and The National Health Service of England reduced antibiotic prescriptions by 5 per cent in one year and is striving for further reductions.

At the same time, behavioural scientists are studying ways of spurring doctors to stop prescribing unnecessary antibiotics, and medical organizations are educating patients to stop requesting them. As one doctor noted, it’s an uphill battle: “For some reason, faith in the body’s natural ability to heal itself has waned, and everyone believes that an antibiotic is the only possible cure that could help.”

Another critical strategy in the fight against superbugs: curbing antibiotic overuse in cattle, chicken, turkeys, and pigs. Two-thirds of antibiotics consumed in the European Union and 70 per cent consumed in the United States are given to healthy farm animals, either to promote growth or prevent diseases common in overcrowded conditions.

This is no small problem, as antibiotic-resistant bacteria jump easily from the animals to humans, via farmworkers, anyone handling raw and contaminated meat, and anyone swimming in or drinking water contaminated with animal faeces.

The U.S. government, a decade behind the European Union, has finally enacted rules to limit antibiotic use in livestock. But the rules have loopholes and don’t ban all antibiotic use, and some countries have no such laws.

Retailers and consumers need to pick up the slack: Restaurants must stop selling antibiotic-laden meat, and consumers must stop buying it.

Progress is happening, albeit slowly. Chains such as Subway, McDonald’s, and In-N-Out Burger are shifting away from meat raised with antibiotics. But Olive Garden, Starbucks, and Burger King are among those receiving an “F” grade for taking no such action.

Preventing Infections That Require Antibiotics

Halting antibiotic overuse is imperative, but it’s only part of the superbug solution. We must also work to prevent the bacterial infections that have become harder to treat, as well as the viral infections that are treated inappropriately with antibiotics. After all, if fewer people show up at the doctor with a sore throat, whatever its cause, fewer antibiotics will be prescribed.

Preventing infection can be accomplished with simple measures:

Increasing vaccination rates. Anyone with the flu is more susceptible to a superbug infection, yet flu vaccination rates in the United States hover below 45 per cent for adults and are dismal in Europe as well.
Better handwashing practices. Seventy per cent of adults admit they’ve bypassed the soap in public bathrooms, and most of us don’t wash for the recommended 20 seconds. It’s important to wash with soap and warm water after coughing, sneezing, blowing your nose, feeding your pet, gardening, or visiting a sick person.
Cleaning the air. Even universal handwashing can’t contain influenza, because the virus can spread via airborne particles, which contain 8.8 times more virus than surface particles. Countless other viral and bacterial particles waft through our buildings, day and night, spreading all manner of infections. Yet today’s technology makes it easy and cost-effective for employers, schools, and medical facilities to rid the indoor air of these pathogens.

Superbugs won’t be vanquished any time soon, but the good news is, we’re well equipped to control the conditions that unleashed them.

The Superbug Crisis is Here – And it is Dire

Back in 1999, infectious disease specialists were worried. Antibiotics, the most important medical development of the 20^th century, were losing their power to combat dangerous bacteria, and few new drugs were in development.

As a British medical report noted at the time: “In the closing years of the century, there is an uneasy sense that micro-organisms are ‘getting ahead’ and that therapeutic options are narrowing.”

Today, infectious disease specialists are no longer uneasy. They’re panicked.

Overuse of antibiotics has unleashed “superbugs,” harmful bacterial strains resistant to the drugs that revolutionized medicine in the 1940s.

In the United States, more than 2 million people are infected by drug-resistant bugs each year, and 23,000 die of their infections, according to the U.S. Centers for Disease Control and Prevention (CDC). Globally, drug-resistant bacteria cause an estimated 700,000 deaths annually and are on pace to kill 10 million people a year by 2050 — more than currently die from cancer.

“If we are not careful,” a CDC official cautioned, “the medicine chest will be empty when we go there to look for a lifesaving antibiotic for somebody who has a deadly infection.”

The situation is so dire that the World Health Organization (WHO) has issued its first list of “priority pathogens”— bacteria with such severe antibiotic resistance they’re considered urgent threats to human health. WHO is imploring governments and pharmaceutical companies to accelerate the development of new antibiotics.

“The pipeline is practically dry,” said a WHO official upon release of the report. Companies have little incentive to invest in drugs that can take a decade to develop and are usually used as short-term treatment.

Meanwhile, as drug companies dawdle, superbugs proliferate.

A study of 48 children’s hospitals, for example, tracked infections of Enterobacteriaceae, a family of bacteria that includes Salmonella and E. coli, and found the percentage of cases resistant to multiple antibiotics increased 7-fold from 2007 to 2015, a finding the lead author called “ominous.”

In the study, children with resistant strains of the bacteria remained hospitalized, on average, for four more days than the children with more easily treated infections. Enterobacteriaceae, on the WHO’s list of priority pathogens, are responsible for many serious, sometimes fatal, infections that arise in hospitals and nursing homes.

Worldwide, infections once easily treated with penicillin, like tuberculosis, now require rounds and rounds of multiple antibiotics. Treating a drug-resistant strain of TB can now require 14,000 pills, take up to two years to treat, and cost nearly 30 times more than TB that responds to conventional antibiotics.

It is estimated that 70 per cent of bacteria around the world have already developed resistance to antibiotics.

What happens when the first-line and second-line antibiotics fail? Minor infections can become deadly, and doctors resort to using drugs previously shelved because they were considered too toxic.

At some point, for some infections, we may be left without any drugs at all.

In 2015, Canadian researchers found, the only remaining oral drug used for gonorrhoea treatment failed in 6.7 per cent of the patients at a Toronto clinic. Doctors now have just one effective treatment left: an injectable antibiotic called ceftriaxone.

And in 2016, for the first time, an American patient was infected with a strain of E. coli resistant to one of the “last resort” antibiotics, colistin, a drug that lost favour in the 1970s because of its harsh side effects, including respiratory distress and kidney damage.

The patient recovered after being treated by a different drug, but health officials fear this incident is a bad omen. “It is the end of the road for antibiotics unless we act urgently,” a CDC official said at the time.

The Dawn of the Superbug Era

Historically speaking, the rise and fall of antibiotics has happened in a blip. Penicillin, the first antibiotic, began production on a large scale in the 1940s. Discovery of new antibiotics peaked in the 1950s and 60s, but no new class has been developed since 1984.

“If antibiotics were telephones, we would still be calling each other using clunky rotary dials and copper lines,” quipped one microbiologist.

These old-school drugs worked well — until they didn’t. The dawn of the superbug era can be traced largely to overuse of antibiotics.

Antibiotics are worthless against viral infections like the common cold, flu, bronchitis, many sinus infections, and most sore throats, yet patients routinely exit the doctor’s office with an antibiotic prescription in hand.

Each year, more than 30% of U.S. oral antibiotic prescriptions — including half of all prescriptions for acute respiratory conditions — are unwarranted, according to a study published in the Journal of the American Medical Association.

Consider the sore throat: Only about 18 per cent of adults who show up at the doctor with a sore throat test positive for strep and actually need antibiotics. Yet, the JAMA study found, 72 per cent of sore-throat patients are prescribed these drugs.

What’s the harm beyond wasted money?

Well, the unwarranted antibiotic, while doing zilch to fight the virus, will destroy some of the “good,” infection-fighting bacteria in the body. At the same time, other bacteria will outwit the drug and multiply. Over time, these drug-resistant bacteria will spread to others. That’s just one of the many ways bacteria can become resistant to antibiotics.

Also fueling the superbug crisis: the common practice of giving antibiotics to livestock to make them grow faster and stay healthy in their overcrowded facilities. This practice accounts for 80 percent of antibiotic use in the U.S.

It is imperative that these trends be reversed. Otherwise, as the director general of WHO cautioned, “a common disease like gonorrhea may become untreatable. Doctors facing patients will have to say, ‘I’m sorry – there’s nothing I can do for you.’”

Legionnaires’ Disease: No Longer a Mystery, Still a Threat

In the summer of 1976, reports of a mysterious and terrifying infection outbreak dominated American news: 34 people died suddenly and 220 were hospitalized after visiting Philadelphia.

Patients developed headaches, chest pain, chills, and fevers up to 107 degrees. Autopsies of the deceased revealed lungs that resembled Brillo pads. Was it swine flu? Food poisoning? “Super” gonorrhoea? A terrorist attack? Theories abounded.

Months later, concluding the most extensive medical investigation in history, a microbiologist peered into a microscope and identified the cause: a previously unknown bacteria. Officials named it Legionella after the victims, military veterans who’d attended a convention of the American Legion.

Today, Legionnaires’ disease is no mystery. We know where it lurks and how it’s spread. We know between 8,000 and 18,000 people in the United States are hospitalized yearly with Legionnaires’ disease, along with tens of thousands more around the globe. We know the bacteria kills 10 per cent of those who contract the disease — and 25 per cent of those stricken in a healthcare facility.

And yet, Legionella continues to wreak havoc, because little is done to contain it.

“Legionnaires’ disease in hospitals is widespread, deadly, and preventable,” said a CDC official, Anne Schuchat, M.D.

The disease garners headlines after mass outbreaks — on cruise ships, at conventions, at healthcare facilities — but these outbreaks account for just 4 per cent of total cases in the United States.

Incidence of Legionnaires’ disease more than tripled in the United States between 2000 and 2011. Worldwide, cases are vastly underreported. In England and Wales, a national surveillance program detects clusters of the disease and investigates the sources of infection. Today, as researchers have noted, Legionnaires’ is considered “an increasingly important disease from a public health standpoint.”

How Legionella Spreads

The Legionella bacteria actually cause two conditions: Legionnaires’ disease, a virulent form of pneumonia that must be treated with antibiotics, and Pontiac fever, a mild, flu-like condition that resolves within a week. Since Pontiac fever resembles other conditions and doesn’t require medical attention, many cases of Legionella infection go unreported — and the source remains unidentified.

Legionnaires’ disease and Pontiac fever aren’t contagious. Patients become infected by inhaling the airborne droplets of contaminated water, typically at facilities with large water systems, such as convention centres, prisons, schools, and healthcare facilities. (Legionella is found naturally in lakes and streams, but in amounts too low to cause disease.)

Investigators eventually traced the 1976 Philadelphia outbreak to contaminated vapour that rose from air conditioning cooling units atop a hotel. The droplets fell to the street below, where they were inhaled by pedestrians and sucked into the hotel lobby by fans on the side of the building.

In the decades since, air conditioning cooling towers have been ground zero for numerous Legionnaires’ cases, including the largest recorded outbreak, at a hospital in Spain, where some 800 patients were thought to have been infected.

Other Legionella breeding grounds have been identified, too: hot tubs, fountains, showerheads, whirlpool baths, hotel ice machines, and supermarket mist sprayers. At a flower show in the Netherlands and a fair in Belgium, attendees contracted Legionnaires’ disease from whirlpool spas in the exhibition halls. At a South Dakota restaurant and a hospital in Wisconsin, dozens were infected by mist sprayed from decorative fountains.

Legionella also thrives in respiratory devices such as humidifiers, vaporizers, nebulizers, and can grow in parts of building water systems that are continually wet, such as pipes, valves, and fittings.

Who’s Susceptible to Legionella Infection

Those at greatest risk of falling ill from Legionella are the medically vulnerable: people over age 50, current or former smokers, diabetes or lung disease patients, and anyone with a weakened immune system. That’s why hospital outbreaks are particularly deadly.

Still, relatively healthy people can become infected, especially if they work near contaminated water sources. For example, employees at wastewater treatment plants may be at elevated risk for infection, as sewage and aeration ponds can contain very high concentrations of Legionella.

Patients typically come down with symptoms within 2 to 10 days after exposure. Infection rates are highest in the summer when air conditioners kick into heavy use and water chemistry changes due to warmer outdoor temperatures. But Legionnaires’ disease can strike at any time of the year.

Preventing the Growth and Spread of Legionella

For facility maintenance managers, preventing Legionella infection has become a serious responsibility. After a deadly outbreak at a UK art centre, caused by a contaminated air conditioning system, the centre’s governing council and architect were charged with corporate manslaughter. Though they were acquitted after a trial, they were fined for safety breaches.

Protecting patients and patrons from Legionella infection requires vigilance on two fronts: keeping water systems clean and cleaning the surrounding air.

For years, prevention efforts at hotels, hospitals and other large venues have focused solely on the water half of the equation. Legionella bacteria are wily and hardy, easily adapting to their environment, surviving for long periods — even in chlorinated drinking water systems — and then pouncing when conditions are just right.

Water temperature plays a big role in Legionella growth. Because Legionella thrives in warm water, experts recommend hot water temperature be kept at 55 degrees Celsius (131 °F) or above. But this can be a challenge; in some countries, regulations that keep residents and hotel patrons from being scalded by showers also keep maximum temperatures too low to halt Legionella growth.

Stagnating water also allows Legionella to flourish. Facilities must take precautions during hotel renovations or off-peak seasons; hospitals must know which showers are rarely used.

Countless other water-related scenarios can promote Legionella growth. An inadequate disinfectant is introduced. Vibrations from construction cause a change in water pressure. Heating or filtering processes degrade water quality, using up extra disinfectant.

Legionella water management programs are both critical and complex, typically requiring expertise from microbiologists, industrial hygienists, or environmental health specialists.

Also critical — but much simpler — are strategies to clean the air.

In order for Legionella-contaminated vapour to be inhaled and attack the lungs, the bacteria must remain airborne. So, prevention efforts must focus on making the air less hospitable for the bacteria to survive and proliferate.

At this point, much remains unknown about how precisely Legionella is transmitted from water to air. It’s unclear, for example, what air temperature and humidity are best for the bacteria to thrive and how long Legionella can survive in the air.

What we do know: Legionella can travel long distances. In a Danish study of a Pontiac fever outbreak, bacteria were recovered 200 meters downwind of an aeration pond at a water treatment plant. And epidemiological studies have suggested Legionella can be dispersed greater than 10 kilometres from wastewater treatment plants.

What’s more, certain strains of airborne Legionella can survive for several hours, under the right conditions.

It’s therefore essential for facilities to deploy continuous and strategically placed air purification technology. Novaerus air disinfection technology has been shown in laboratory testing to reduce infectious, gram-negative bacteria like Legionella.

The year following the Philadelphia Legionella outbreak, investigators used blood samples to identify the bacteria as the culprit in other unsolved infection outbreaks, dating back to 1957. But as a documentary of the discovery noted, it is likely that Legionnaires’ disease “has been killing us for thousands of years.”

Now that we know so much more about Legionella — where it thrives, how it’s transmitted, and how to prevent its spread in the water and air — we are well equipped to stop the bacteria in its tracks.

Sick Building Syndrome – It’s Up In The [Hospital] Air

It’s a terrible irony: around the globe, countless buildings that were designed for healing are actually making their occupants sick.

Studies show that sick building syndrome (SBS), considered a “a major occupational hazard,” may be especially prevalent among employees in healthcare facilities.

Among the symptoms experienced by nurses and other healthcare workers: headaches, nausea, itchy skin, throat irritation, watery eyes, and impaired concentration.

“SBS manifests as weakness and fatigue, reduced productivity and increased absence from work,” according to a study of sick building syndrome among nurses, published in the Global Journal of Health Science. “Considering the nurse’s important role in saving the lives of patients and hospital infection control, this is notable.”

To say the least! Certainly anyone responsible for the wellbeing of a healthcare facility’s employees should be aware of SBS symptoms and the potential for hospitals and nursing homes to trigger them.

Air pollution in office buildings has drawn much attention and is easier to research than in the hospital environment; the presence of infected patients, the common use of latex, as well as a highly mobile workforce make it more challenging for scientists to design high-quality studies on SBS in hospitals.

Nonetheless, a number of careful studies have assessed sick building syndrome in the healthcare arena and concluded it’s a problem.

For example, a study examining three Iranian hospitals found that 86% of nurses experienced sick building syndrome, with headache and fatigue among the most common symptoms reported. In addition, among those nurses reporting SBS symptoms, 90.7% sensed a foul odor coming from toilets, medicines, hospital kitchens, and chlorine.

SBS in healthcare facilities appears to be global concern. A hospital study in Spain found
“unpleasant odor, irritation and watery eyes, sore throat, redness and inflammation of the skin” as the most common symptoms. One Swedish study noted, “the high complaint rate . . . shows a need to improve the indoor environment in hospitals.” Another Swedish study concluded that “more focus is needed on the indoor environment in schools and day care centres, hospitals and nursing homes for elderly.”

Sick building syndrome is well known to be caused by a combination of biological pollutants (such as bacteria, viruses, and molds) and chemical contaminants (mainly volatile organic compounds, aka VOCs, emitted by furniture, carpeting, adhesives, cleaning solutions, and personal-care products).

Given the ubiquity of drugs, detergents, disinfectants, and solvents in hospitals and nursing homes — not to mention the virus and bacteria particles floating about — it is hardly surprising that SBS is common in the healthcare environment.

In the United States, most hospitals are older buildings, not designed to minimize the effects of high-VOC building materials, gases from anesthesia, lab chemicals, dust from renovations, and the like. Hospital floors are typically made of vinyl tile, requiring continuous waxing and stripping.

As sick building syndrome and the hazards of indoor air pollution gain more attention, green building will become the norm. Newly built hospitals are using low-VOC construction materials and installing roof gardens, windows that open, and natural flooring that can be cleaned with just soap and water. At some point in the distant future, sick building syndrome may become a thing of the past.

But for now, hospitals, nursing homes, and other healthcare facilities must work with they have.

Among the various remedies for SBS — improving ventilation, banning perfumes and VOC-emitting products, replacing carpeting and furniture, and so on — the most effective and practical may be to clean the air.

In the past, air purification was either inadequate or too expensive, but technology has advanced to the point where cost-effective purification systems can remove the tiniest and most damaging toxic airborne particles, whether biological or chemical in origin.

At this point, most of us can’t escape exposure to indoor pollutants. However, those in charge of healthcare facilities can take steps to control the toxins that make its highly valuable employees ill.

Sick Building Syndrome: The Triggers

For any given case of sick building syndrome (SBS), the trigger can be hard to pinpoint.

In fact, the mystery is part of the very definition of the syndrome. The U.S. Environmental Protection agency defines SBS as “situations in which building occupants experience acute health and comfort effects that appear to be linked to time spent in a building, but no specific illness or cause can be identified.”

But this much is certain: SBS symptoms — headaches, nausea, fatigue, itchy skin, throat irritation, watery eyes, and impaired concentration — are linked with exposure to both chemical and biological contaminants.

Science has not yet identified specific measurements of indoor contaminants that put workers at risk, according to the U.S. Centers for Disease Control and Prevention (CDC), and it’s likely that different varieties and amounts of pollutants affect individuals in different ways.

For one building occupant, the gases emanating from cleaning products or new hallway carpeting may be the source of nausea; for another, it may be cooking odors emanating from the hospital kitchen. And what is annoying to one person may be debilitating to another.

Nonetheless, research has identified the most common SBS sources, and anyone responsible for the wellbeing of a facility’s occupants should be aware of them.

First, let’s talk chemicals. Thanks to workplace smoking bans and lower smoking rates, tobacco toxins have become less of a hazard to indoor air quality. However, volatile organic compounds (VOCs) remain a huge threat in the workplace and school environments.

VOCs are toxic gases emitted by the products we walk on, sit on, wear, and use to do our jobs every single day. In other words, carpets, desks, shelving, upholstery, adhesives, copy machines, and personal products such as shampoos, perfumes, lotions, and hand sanitizers. Products needn’t even be scented, or emit obvious odors, to trigger symptoms. Deodorants, cosmetics, and cleaning supplies designated as “unscented” may actually contain chemicals used cover up odors emitted by other ingredients.

What these products have in common: they all contain compounds refined from petroleum, and they’re everywhere.

In fact, indoor concentrations of VOCs are often 10 times higher indoors than outdoors. In urban areas, new research shows, the compounds contribute just as much to air pollution as vehicles.

But VOCs are not the only source of toxins wafting around “sick” buildings. Bacteria, viruses, mold, dust mites, insect droppings, and pollen are among the biological contaminants that can trigger the syndrome.

What’s more, not all the triggers of SBS originate from within the building. About 11 percent of the contaminants — such as vehicle exhaust, construction materials, and tobacco smoke — waft in from the outdoors via vents and windows.

Just as some people are more susceptible to SBS due to their genetic makeup and health status, some buildings are more susceptible due to their construction.

Sick building syndrome dates back to changes in building construction that followed the 1973 oil embargo against the United States. To save on fuel for heating and air conditioning, buildings lowered ventilation standards by two-thirds, requiring a paltry 5 cubic feet per minute (cfm) of outside air per occupant. In other words, buildings became practically air tight.

These days, U.S. building codes have improved considerably, typically requiring a ventilation rate of 20 cfm per person. However, many older buildings have not been upgraded, and standards vary greatly around the globe. In dense urban areas with limited land for high-rise construction, buildings often lack adequate ventilation.

Besides, workers can experience sick building symptoms even at 20 cfm. According to the Environmental Advisory Council, ventilation rates would have to exceed 53 cfm per person to make SBS vanish.

But ventilation alone can’t clear up the problem — not when a building is cleaned with chemicals that emit VOCs, lined with toxic carpeting, contaminated by mold within the HVAC system, or occupied by staff who wear VOC-emitting perfumes.

A building’s interior design can also contribute to SBS. For example, the arrangement of cubicles and offices can compromise indoor air flow and exacerbate the itchy eyes, respiratory problems, nausea and other symptoms triggered by biological and chemical pollutants.

In short, indoor environments are highly complex, and occupants are exposed to a mix of chemical and biological contaminants from a vast array of sources.

However, just because the cause of SBS is complex does not mean the solution is equally complex. In fact, technology has progressed to the point where a single remedy — air purification — can, quite effectively, rid a room of pollutants as different as nausea-inducing gases and allergy-inducing pollen.