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Indoor Air Changes and Potential Implications for SARS-CoV-2 Transmission

Educational Objective
To identify the key insights or developments described in this article
1 Credit CME

Buildings have been associated with spread of infectious diseases, such as outbreaks of measles, influenza, and Legionella. With SARS-CoV-2, the majority of outbreaks involving 3 or more people have been linked with time spent indoors, and evidence confirms that far-field airborne transmission (defined as within-room but beyond 6 feet) of SARS-CoV-2 is occurring.1

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Article Information

Corresponding Author: Joseph G. Allen, DSc, MPH, Harvard T.H. Chan School of Public Health, 677 Huntington Ave, Boston, MA 02115 (jgallen@hsph.harvard.edu).

Published Online: April 16, 2021. doi:10.1001/jama.2021.5053

Conflict of Interest Disclosures: Dr Ibrahim reports receiving payments from HOK Architects in his role as a senior principal and chief medical officer. Dr Allen owns 9 Foundations Inc, which has provided consulting regarding COVID-19 risk reduction strategies across many sectors, including education, real estate, government, private entities, and faith-based organizations. Dr Allen has also received consulting fees from for-profit organizations, including serving as a scientific advisor for Carrier Corporation.

References
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National Academies of Sciences, Engineering, and Medicine. Airborne Transmission of SARS-CoV-2: Proceedings of a Workshop—in Brief. National Academy of Sciences; October 2020.
2.
Lerner  AM , Folkers  GK , Fauci  AS .  Preventing the spread of SARS-CoV-2 with masks and other “low-tech” interventions.   JAMA. 2020;324(19):1935-1936. doi:10.1001/jama.2020.21946PubMedGoogle ScholarCrossref
3.
The Lancet COVID-19 Commission Task Force on Safe Work, Safe School, and Safe Travel. Six priority areas. The Lancet COVID-19 Commission; 2021.
4.
Li  Y , Leung  GM , Tang  JW ,  et al.  Role of ventilation in airborne transmission of infectious agents in the built environment: a multidisciplinary systematic review.   Indoor Air. 2007;17(1):2-18. doi:10.1111/j.1600-0668.2006.00445.xPubMedGoogle ScholarCrossref
5.
Sundell  J , Levin  H , Nazaroff  WW ,  et al.  Ventilation rates and health: multidisciplinary review of the scientific literature.   Indoor Air. 2011;21(3):191-204. doi:10.1111/j.1600-0668.2010.00703.xPubMedGoogle ScholarCrossref
6.
Luongo  JC , Fennelly  KP , Keen  JA ,  et al.  Role of mechanical ventilation in the airborne transmission of infectious agents in buildings.   Indoor Air. 2016;26(5):666-678. doi:10.1111/ina.12267PubMedGoogle ScholarCrossref
7.
American Society of Heating, Refrigerating and Air-Conditioning Engineers. ANSI/ASHRAE standards and guidelines to address COVID-19. Accessed April 9, 2021. https://www.ashrae.org/technical-resources/ashrae-standards-and-guidelines
8.
Persily  A .  Challenges in developing ventilation and indoor air quality standards: the story of ASHRAE Standard 62.   Build Environ. 2015;91:61-69. doi:10.1016/j.buildenv.2015.02.026PubMedGoogle ScholarCrossref
9.
Fisk  WJ .  The ventilation problem in schools: literature review.   Indoor Air. 2017;27(6):1039-1051. doi:10.1111/ina.12403PubMedGoogle ScholarCrossref
10.
Allen  J , Macomber  J.   Healthy Buildings: How Indoor Spaces Drive Performance and Productivity. Harvard University Press; 2020.
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