Circumventing Covid-19 with better ventilation and air quality

Gathering outdoors has provided people a safer alternative to meeting inside during the Covid-19 pandemic. But for those who spend their days in crowded indoor spaces — workers in office buildings and industrial facilities, students in schools, and the like — how can their indoor environments be made more similar to the outdoors? With better air quality and ventilation.

Yet federal regulations are insufficient for improving indoor ventilation and few states are moving to improve it. We examined the Covid-19 US State Policy database and found that only Michigan, Minnesota, New Jersey, Oregon, and Washington have explicit occupational safety and health standards to promote better air and/or ventilation quality.

The issue goes far beyond preventing Covid-19 transmission. Minimum requirements for indoor air quality could also help reduce the yearly spread of influenza, which causes tens of thousands of deaths each year, and help improve chronic respiratory conditions such as asthma.

Workplace air quality and ventilation standards are long overdue for an update. As the country shapes a new normal in the wake of the pandemic, improving occupational safety and health should be a priority, especially in poorly ventilated indoor spaces.

Mechanical ventilation systems can bring outside air into buildings or recirculate air, increasing the frequency at which the air in a room gets replaced or cleaning the air by passing it through efficient filters. If the outside air is clean, increased ventilation decreases indoor airborne pollutants, including particles of all sizes. Given that infectious agents such as viruses and bacteria are tiny particles and can remain suspended in the air for long times, increased ventilation coupled with filtration systems that trap pathogens and other particles has the potential to reduce airborne transmission of infectious diseases.

Workplaces with high rates of Covid-19 transmission face the greatest need to improve ventilation to support workers’ health. Long-term care facilities have experienced notably bad outbreaks. Data from California and Washington indicate especially high rates of Covid-19 cases among workers in restaurant kitchens and food manufacturing facilities — more than 90,000 workers at meatpacking and food processing plants have tested positive for Covid-19. These industries are relatively low-wage, often with poor workplace quality, and have a disproportionately high number of workers of color. Despite the importance of improving indoor air quality, policymakers are not acting on the urgent need for more protective standards.

States’ initial attempts to address occupational health and safety concerns when reopening schools were inadequate. Guidelines facilitating a return to in-person schooling largely focused on physical barriers and physical distancing. These efforts overlooked the importance of air flow as a means of preventing aerosol disease transmission among teachers and students. If this is not corrected going forward, many people will be unnecessarily infected in indoor workspaces. Yet most states have not mandated that buildings be equipped with better ventilation devices, such as high-efficiency particulate air (HEPA) filters.

Improving indoor air quality is especially important as states roll back remaining Covid-19 restrictions. Without face mask mandates and social distancing requirements in place, cleaner indoor air can help reduce infectious disease transmission and keep people healthy. This can be accomplished: The Occupational Safety and Health Administration (OSHA) has already mandated stronger ventilation guidelines for health care settings. This must be expanded to other work settings as well.

It is in the best interests of both public health and business to implement stronger indoor air quality regulations for workplaces as the U.S. recovers from the effects of the pandemic, even at the cost of higher energy use. When people can breathe better, they perform better. Good ventilation is associated with improved cognitive function, increased productivity, and fewer missed days of work.

Even without a sufficient emergency standard from OSHA to reduce workers’ exposure to SARS-CoV-2, the virus that causes Covid-19, states can pass regulations that adopt recommendations from the American Society of Heating, Refrigerating and Air-Conditioning Engineers to mandate higher air exchange rates and high-quality air filtration in all workplaces. Five states currently have specific occupational air quality and ventilation standards. New York and Oregon recently implemented infectious disease standards for workplaces. Other states should do the same.

The U.S. has missed many opportunities to develop policies to protect essential workers from Covid-19 and other respiratory illnesses. Moving forward, these preventable illnesses and deaths can be stopped. Our elected officials can invest in workplace infrastructure, especially for low-income workers and workers of color, to deliver ventilation that improves health and well-being.

Leslie Boden is an economist and professor at the Boston University School of Public Health. Will Raderman is a research fellow at the Boston University School of Public Health and works on the Covid-19 US State Policy database. Patricia Fabian is an environmental engineer and associate professor at the Boston University School of Public Health.