WHAT’S NEXT FOR CORONA?
How to Survive in a World of COVID-19 and the Likes
Madhavan Pisharodi, M.D.
Total Air Replacement , 2.Total Fresh Air Conditioning, 3.Total Air Purification
COVID-19 has shocked this world. We have learned to give up a lot of our daily routines. Unfortunately, there is no end in sight for this disaster. The purpose of this article is to explore ways to stay away from and/or destroy the virus, so that we can get back to our normal life style in a gradual but safe pattern. It’ll be nice to start traveling, eating out, attending religious functions, sending children to schools, taking cruise ship vacations and watching sports in their own arenas with some assurance that this will not bring another wave of COVID-19 infections and deaths.
As of the 1st of August 2020, COVID-19 has infected almost 18 million people worldwide and has killed about 700,000 people according to the statistics available through WHO. Among the various countries, USA has been leading in the number of infections and deaths for the last several months and it has reported nearly 5 million infected cases with almost 160,000 deaths. With just 4.2% of the world’s population, USA has 26.5% of world’s total infections and 23% of world’s total deaths. In the early stages, more than 30% of deaths in the United States were among nursing home population. The simplistic explanation, that the high rate of infection and death are due to poor preventive measures, seems to be unacceptable considering that USA has one of the world’s most expensive and organized medical care. COVID-19 has so far evaded any kind of meaningful predictions, reliable treatment options, and the usual preventive measures. The infection is spreading all over the world even after seven months, as if it is in absolute control, humbling and humiliating anyone trying to analyze the situation. Figure 1 shows that the worldwide infection rate is showing a steady upward trend.
Fig. 1
Since the time the COVID-19 showed up in the affluent populations in northern Italy and the northern states in USA, we have been considering the possibility that COVID-19 is not only infecting individuals, but also it is “infecting” the buildings. We also considered the possibility, from that time onwards, that the “vector” for the COVID-19 infection is our inadequate air conditioning.
Even in the early stages of the pandemic, preventive measures from Thailand suggested 7 items which the virus apparently disliked (Fig. 2). The WHO immediately spoke out against much of these 7 items and cautioned people not to try many of those measures for different reasons. Since WHO did not accept COVID-19 spread through the air until almost the middle of July, it did not even discuss the topic of ventilation. In reality, the severity of the pandemic could probably have been reduced if WHO had not taken this position and had given more importance to the ventilation in preventing COVID-19 spread.
Fig. 2
It is true that the COVID-19 is spreading through droplets (about 10 microns) and contamination of structures and objects where the droplets are deposited. According to the WHO this droplet spread is limited to about 3 to 6 feet radius around the infected person. Linsey Marr, a professor of civil and environmental engineering at Virginia Tech discounted this by stating that there is no virtual wall at 6 feet. Lydia Bourbouiba, a professor at MIT, who specializes in “disease transmission” published an article in JAMA stating that the virus cloud can travel to about 27 feet from a sneeze (Fig 3) Dr. Anthony Fauci from CDC immediately came to the defense of the WHO stating that this will happen only if the sneeze is violent and that the message is misleading. He further added that the 6 feet distancing is adequate. It is interesting that the proposal for the 6 feet distancing is without any consideration for the time taken for the droplets to fall from the 5 feet height to the ground.
Figure.3
We find it difficult to accept that the droplets fall to the ground and give up by auto-destruction. A study posted by UKRI showed that coronavirus can stay active on copper surfaces for 4 hours, cardboard for 24 hours, and at least 72 hours on plastics and steel. We don’t have any reliable data about its survival on carpets,wood, linoleum, tiles and other flooring materials. Lydia Bourouiba suggested that the arbitrary division of droplets (more than 5 microns) and aerosols (less than 5 microns) is probably not true and that the droplets vary from large size to small in a smooth gradation. The larger droplets settle faster and evaporate slower than the smaller droplets which settle slower and evaporate faster. Another study published by Paul Baron from CDC shows that even larger droplets take about 8 minutes to fall from 5 feet in still air (Fig. 4) and 8 minutes to fall from 8 feet in turbulent air (Fig. 5). Smaller and aerosolized droplets can take upwards of 12 hours in similar conditions. So far, there has not been any study regarding what happens to the particles in the air beyond 27 feet. We postulate that the really small droplets evaporate almost instantly in the dry, cool stagnant air-conditioned surroundings into a mist of virions beyond the 27 feet (Fig. 6). We also postulate that the droplets that settled on the floor do not self-destruct. They lose their water content by evaporation and turn into a mist of fine particles ready to move around (Fig. 7). When people walk around over this virus mist on the floor, they are driven upwards into the room, helped by the small suction force from the AC exhaust in the ceiling. We postulate that this can result in a room full of this virion mist of different densities, based on the number of patients in the area and whether there are any super spreaders (Fig. 8). These virions are then taken up by the air conditioning system and circulated over the entire building. Our hypothesis is that the COVID-19 infects the buildings in this way. Anytime the infected person plants the virus in a building, the building gets infected. People walking into these infected buildings do not stand a chance to avoid exposure. The COVID-19 hot-spots in the air-conditioned nursing homes and crowded hospitals have no other reasonable explanation.
Figure. 4
Figure. 5
Figure. 6
Figure. 7
Figure. 8
PREVENTIVE MEASURES FOR CONTROL OF COVID-19
It is a sad fact that this little bug is laughing at the human race. The PPE and other measures presently advocated can have temporary benefits only. The uncontrolled spread of the virus even after 7 months of the pandemic is telling us that these measures are not really working.
SIX FEET DISTANCING
Even assuming that there is a virtual wall at 6 feet and that people don’t sneeze hard enough to push the virus close to 27 feet, the fact that these droplets take upwards of 8 minutes to settle from a height of 5 feet makes this measure of questionable value. It is not difficult to visualize a halo of viruses around an infected person standing on a spot (Fig. 9).
Figure. 9
When this person moves forward, the person behind who was keeping the 6 feet distancing is walking into this halo that has not settled yet. Six feet distancing will work only if these individuals are stationary like people sitting down in a conference hall. In the outdoor set up, the halo will most probably float away and so the six feet distancing will provide partial protection. This partial protection outdoors is not valid if people are crowding and shouting in which case the individual virus halos will coalesce to form a virus cloud over the crowd (Fig. 10). The importance of this much advertised preventive measure needs to be scientifically evaluated.
Figure. 10
MASKS
Wearing masks will protect against droplet spread both indoors and outdoors. However, masks will not protect if the room is filled with virion mist. This will be like wearing a mask in a smoke-filled room to avoid smoke inhalation. The risk of infection in such a building/room is real as long as the individual has to breathe the enclosed air and the virion mist has enough density. Good quality masks do have a role in reducing infection in an outdoor setting. It is also important to consider the multiple side effects from wearing a mask, especially for people with COPD and other respiratory illnesses. People who have got cured of COVD-19 and carried the antibodies cannot infect others and most probably cannot get infected for a second time. To force them to wear mask is unjustified. The wide spread acceptance of this measure maybe a reflection of our sense of helplessness than any proven benefits.
LOCKDOWN
Very tight lockdowns have helped to prevent the spread of COVID-19 in many countries. However, this lockdown is like giving aspirin for pneumonia. Lockdown is only good if we know that after a certain period this virus cannot and will not infect us. Alternately, we should have developed reliable treatment or vaccine to control the spread. Otherwise, the virus will be waiting outside when the lockdown is lifted. This was proven is the U.S. and many other countries. There was an excellent lockdown plan in India and when this was partially lifted, the infection began spreading again. It is not worthwhile hurting the businesses and the families with the lockdown requirement, unless we have an end point in sight. The financial, psychological, educational, recreational, and other setbacks from the lockdown are too extreme to ignore. The demand for indefinite lockdowns without weighing in the risk benefit ratio is only a political weapon at best.
COVID-19 TESTING
It is well established that COVID-19 can spread through asymptomatic carriers. If we know all the asymptomatic carriers, it will be possible to isolate them and prevent the virus spread. There has been a powerful public demand to “increase the testing” to achieve this. This is bordering on insanity. For instance, a person tested negative on Monday can become positive on Tuesday or any time afterwards. To be certain that one individual is safe and not an asymptomatic carrier, he/she will have to get tested at least once a week. In order to satisfy the demand for “increase the testing to control the infection” in the U.S., we will have to test 331 million Americans and a large number of non-Americans living in this country, once a week indefinitely. This is absurd. The reasonable compromise will be to test people with symptoms so that they can be treated properly. Anything more than this is unreasonable and just a political argument.
VACCINE
The whole world is now competing to make COVID-19 vaccines. Not all of them are doing this for the jackpot of financial gain. A vaccine that is produced over such a short period cannot be tested for long term effects. Also, there has been some isolated reports that people can get infected for the second time. Hopefully, these are due to false negative tests between the infections. Otherwise, the value of a vaccine (miniature infection) is questionable when full-fledged infection cannot give adequate protection. The task of persuading people to take the vaccine will be another challenge. While keeping great hopes on the value of a COVID-19 vaccine, it is also important to be cautioned against unreasonable expectations.
PROPOSED ADDITIONAL MEASURES TO CONTROL COVID-19
If some modifications to the air flow in the buildings can reduce the pain and discomfort demanded of the individuals in this pandemic, such measures are desirable. These measures are meant to compliment the presently available methods and not in any way replace them. These measures need deliberate planning, engineering expertise and focus on long term benefits rather than quick fix measures.
Modification of Air Conditioners
With very few exceptions, several homes and most business offices have air conditioner inlet and outlet both on the ceiling. This will make the air current stronger near the ceiling and weaker at the ground level. In cold climate, when the inlet brings down hot air, this air has no reason to go to the ground level and bounce back to the outlet. Since the hot air stays on the upper layers of the room it crawls along the ceiling and gets out through the outlet (Fig. 11).
Figure. 11
The air is cooler and slower as the distance from the ceiling to the floor increases. In the area of the room, where people move around or rest, especially in wheelchairs and hospital beds, the air is cool, stagnant, and dry. This is the best condition for the COVID-19 droplets to settle down, evaporate and fill the room with the virion mist. Another important fact is that in efforts to heat the lower portion of the room, the consumers use more energy and pay more for their air conditioning.
By bringing the air inlet to the ground level, we can bring the heat where it is needed, increase the air circulation in the lower portion of the room, and hopefully make the air current to sweep up the virion mist from the ground level to the outlet in the ceiling (Fig. 12 ). This will be a form of “Total Air Replacement” This will also reduce the cost of heating.
Figure. 12
The used air getting out of the room can be completely discarded to the exterior of the building to accomplish “Total Fresh Air Conditioning”. This will be equivalent to leaving the doors and windows wide open. Alternately, we can recirculate the air after destroying the viruses using ultraviolet treatment away from human circulation.
Ultraviolet to Destroy COVID-19
WHO has advised that we do not use ultraviolet devices because of the potential harm to the skin, eye, etc. and even causing cancer. This is on the understanding that the UV light is applied directly on the individuals. UV devices are already in use to sterilize tabletops and surgical instruments, water purification, etc. where the individuals do not have to be near the devices. The disadvantage of these devices is that light travels only in straight line and cannot go around furniture or equipment. One of the methods we are proposing is to hire the readily available air to do the job. Air can go around and under the furniture and equipment. By weaponizing the air conditioners to purify the air, the air circulation can be converted into a self-cleaning system. Combining this with the modification of the air conditioners that was already described, the air purification can be accomplished (Fig. 13). These UV light units can be incorporated into the main air conditioners or the individual rooms, to accomplish “Total Air Purification”.
Reopening of Business, Restaurants, Hotels, Schools, Bars, etc. with Measures to Tame the Virus
It is possible that these air purifying measures can make reopening of these facilities safer than just relying on PPE and social distancing. A gradual adaptation of these measures will also help to reduce the severity of similar pandemics in the future. Hopefully, these measures can also avoid another wave of COVID-19 resurgence after the next effort to lift the lockdown.
Making Air Travel Safer
It is possible to incorporate UV light into the air conditioning into the air planes to make air travel safer. Alternately, there can be a method of preventing recirculation of contaminated cabin air. This will be in the form of “Total fresh air conditioning”. Any combination of these two measures will also be possible.
Bringing Back Cruise Ship Vacations
By modifying the air conditioning in the cruise ships this very important business can be revived. Open air programs on the ship will have to follow the social distancing and PPE requirements.
Prepare for the Coming Winter
As explained in the section relating to our existing air conditioners, the winter heating can cause another increase in the infections due to the cold, stagnant, dry air in the lower portions of the rooms. It will be proper to anticipate this and prevent this.
Prepare for Future Pandemics with Similar Viruses
COIVD-19 has exposed some of our weaknesses against these evolving pathogens. It will be a good idea to slowly develop an air purification system to be prepared.
Reduce the Incidence and Seriousness of “Winter Flu Season”
The flu season is a curse for the cold countries. Tropical climate does not favor such a flu season. If the flu viruses have some of the same behavior pattern of COVID-19, we can expect some improvement in the flu season in cold countries by adopting the improvements in the air conditioning and the air purification method discussed above.
Reduce the Cost of Air Conditioning
By bringing the cold, and especially the hot air to the lower part of the room, where people move around, the air conditioning cost can be hopefully reduced.
Figure. 13
SUMMARY
COVID-19 is undefeated and is continuing its rampage despite our efforts to control it. Vaccines will give us a fighting chance. Other agents like COVID-19 are likely to come up in the future. We must tame the COVID-19 and be prepared for the ones coming up in the future. The two measures described here can most probably have significant impact on the spread of COVID-19 which is not showing any sign of settling after 7 months of this pandemic. The measures described here require a lot of future studies and verifications. You can reach the author through [email protected]