In addition to being a lung and ICU doctor, I am the mother of three young kids who have only just received their COVID19 vaccine, and we also have immunocompromised adults in our family. As the holidays approach and outdoor gatherings become more challenging, I have been giving a great deal of thought to indoor air safety. I am not alone in this, and many individuals, churches, school districts and companies are also wondering how to decrease both COVID19 and particulate matter in the air.
There are so many devices marketed to us as air cleaners, but they do a variety of things to the air. I recall standing in a classroom watching someone squirt a bottle of Febreeze into the air and claim that a device attached to a mini-split in the room would ionize the room and generate hydrogen peroxide that would clean the coronavirus from the air my children were breathing. It was interesting. The supplied marketing materials seemed to show graphs from chamber studies, but no data on human occupied spaces.
I saw this sign on a restaurant door recently in Oregon, and wondered whether a similar pitch about ions had been made to the owner. I wonder if there was more data available on using this technology in a place filled with families and workers. We briefly covered some of this technology in the podcast episode “The Air Kids Share,” and since that time, parents have reached out to me about their own schools purchasing devices claiming to clean the air through hydrogen peroxide and ionizing technology. It can be really challenging to know what to do with these claims, so I wanted to talk to an expert.
Fortunately, I was able to discuss indoor air safety with Kenneth Martinez, who is a certified Industrial Hygienist and Environmental Engineer with experience in leading and conducting large-scale research and managing programs in occupational safety and health and emergency response. After studying engineering at Colorado State University and University of North Carolina Chapel Hill, he went on to spend 33 years at the CDC with expertise in hazardous agent exposure characterization and mitigation practices in the manufacturing and healthcare industry, particularly in biological agents including infectious and bioterrorism threats. He also spent nine years at the CDC in emergency response field leadership roles including the World Trade Center collapse, anthrax, SARS, multi-drug resistant TB, and hurricanes. In particular relevance to our current situation, he also served on a CDC team tasked to provide responses and a strategic plan to the Pandemic and All-Hazards Preparedness Act (PAHPA). He has published his research in bioaerosols extensively in books, peer-reviewed literature and NIOSH technical reports. From 2013 to 2020, he supported the Department of Homeland Security as a contractor for a national airborne biodetection system. He currently serves as a Senior Critical Infrastructure analyst for Idaho National Laboratory and also as an executive officer for the Integrated Bioscience and the Built Environment Consortium or IBEC, a non-profit created to provide support of COVID-19 pandemic response efforts nationally.
On the podcast episode, we talk about everything from what we can learn from previous public health and bioterrorism crises as well as what technology currently has enough safety data to trust in the air we breathe. He is skeptical of ionizing technology and introducing additional chemical foggers. Listen to the episode to learn more.
As the winter holidays near and we all wonder whether or how the next COVID19 variant is going to affect us, there are many things we can do to help keep our families and communities safe. I sincerely appreciated Ken’s approach discussing the “Four Ds,” decreasing the density of people, decreasing the duration of time indoors, ensuring sufficient distance among us, and diluting the air with ventilation and mechanical filtration, such as with HEPA and MERV technology. IBEC is working with the American Industrial Hygiene Association to help empower local businesses, schools and individuals to make their indoor spaces safer, by committing to “CARE,” which stands for Community, Awareness, Responsibility and Equity. We can all commit to CARE. We can ensure all who are eligible are vaccinated and make sure our holiday gatherings observe those 4Ds. See the bottom of this post for more material from the Commit to Care Campaign.
One thing that really struck me was when Ken said that it would be “unethical” to study these technologies that are already in use in human trials without more data. We essentially have human trials going on in schools and homes across the US. I sincerely hope this technology is studied now that it is out there. Two studies in China using ionizing technology in occupied spaces showed preliminary findings that may be concerning for the heart health of our kids.
Many of these technologies were installed in our schools without studying what is generated by them in whole building environments. One independent study of a commercially available bipolar ionization device showed that it might not do much to drop the particles of concern but did increase volatile organic compounds like acetone, ethanol and toluene, which worries me. You can see the post for this episode for those references.
I am not against new technology at all- maybe there is a role for this technology in buildings when they are not occupied to clean air overnight or over the weekend, or maybe there is a way to target this technology at levels that are safe for humans, or maybe the risks truly are worth the benefit. Though to be honest, I struggle to understand why we would want to risk it, when there is proven technology with mechanical fibrous filters, such as HEPA filters, MERV filtration, etc. If you are aware of any good independent studies of this technology in occupied spaces, please send them my way.
As a lung doctor, I am very skeptical of any attempt to introduce new chemicals into the air that I, my patients, and my children breathe. Air cleaning technology that removes particles in a mechanical way from the air makes sense to me, and more importantly, there are studies of HEPA filters in wildfire zones that show health benefits for vulnerable patients. I also have little interest in my children breathing air into which hydrogen peroxide or ions are continuously introduced. Kids breathe more than adults, and if there are adverse consequences, those will affect my kiddos more.
TLDR= Don't Light Things on Fire (Oxidize them) and Breathe them into your Lungs
To Do-
1- Remember the “Four Ds”- Density, Duration, Distance, and Dilution in your upcoming holiday gatherings. Encourage anyone who is not vaccinated who is eligible to be vaccinated. Learn more about COVID19 vaccine technology and how to have these conversations.
2- Commit to Care to reduce COVID spread by learning how to optimize both HVAC and portable air filters for indoor safety.
3- Do you already have a portable air cleaner? If so, check to see whether it is a filter that is removing particles from the air, like a certified HEPA filter, vs something that is adding something to the air, such as ionizing technology, ozone, hydrogen peroxide or hydroxyl radical generation, etc. Until we know more, focus on removing particles from the air and ventilating well rather than introducing new things into your air. Learn more about selecting and sizing an air filter for your space- this post is geared for wildfire concerns, but has information about air filters in references. You would want to add ventilation to the air cleaning, not seal the home as you would for a wildfire.
4- Find out what air “cleaners” are being used in your school, church and home. If they are using additive technology by adding ions, hydrogen peroxide, etc, ask whether the device has been studied in occupied spaces. If it has, send me the data! You can also reach out to me, and I can try to put you in touch with scientists who are interested in studying the effectiveness of this technology in the real world.
5- Learn more about school and home air safety with COVID19 by listening to the episode “The Air Kids Share” with Dr. Olsiewski of Johns Hopkins Center for Health Security.
6- Consider a donation to IBEC to help them in their work to make the air in our schools, churches and workplaces safer. See the bottom of this post for more of their Commit to Care campaign materials to optimize your HVAC system and Portable Air Cleaner.
Twitchy Airways Club Members-
Be careful of adding anything to the air you breathe. To learn more about cleaning agents causing long term airway disease, see this post.
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Lay Press:
