1. Airborne Pandemic nH1N1 Swine Flu in Buildings Proactive Strategies for Property Managers Steven Welty CAFS, CIE, LEED AP Green Clean Air Reston, VA 703.927.7532 GreenCleanAir@aol.com International Facility Managers Association Atlanta Chapter September 10, 2009

2. Protect Your Occupants’ Health by Preventing Airborne Virus Transmission. This will: 1. Keep The Building Open 2. Assure Business Continuity 3. Keep tenants happy During the Swine Flu Pandemic Keep your Building’s Air Safe

3. The “n” before H1N1 denotes that it is a Novel virus. Novel viruses cause pandemics because no one has immunity antibodies to the novel virus. INFECTED PERSONS can transmit virions before they become physically sick. Infected persons who don’t have physical symptoms can still be infectious and are called asymptomatics. Infected persons can eject airborne virions into the air by coughing, sneezing, talking or singing. In addition, the flushing action of a toilet can eject virions into the air. The 2009 Swine Flu Pandemic is being caused by a Novel Influenza Virus called nH1N1

4. Indoor Air Can Recirculate Airborne Viruses Which Make People Sick 1.Return air sucks in viruses and redistributes those viruses back into occupied spaces, 2.In wintertime, dry outdoor air + heat = dry indoor air = the perfect environment for airborne virus transmission (contagion), 3.Dry indoor air dries out occupant’s mucus lining which compromises their natural filtration system making it easier to get sick. 4©2009 Steven Welty

5. 5 CDC’s Top Influenza Scientist states that flu is Airborne Nancy J. Cox PhD Director of CDC Influenza Division “It is generally accepted that influenza viruses are spread primarily by aerosols* of virus-laden respiratory secretions that are expelled into the air during coughing, sneezing, or talking by an infected person.” From : Virology 2005 (Medical School Textbook and Doctor Reference book) *Droplet Nuclei which can stay airborne indefinitely- Aerosols are Not Large Droplets which can infect at @ 3-6 feet away and quickly fall to the ground. ©2009 Steven Welty

6. ASHRAE says that the Swine Flu Virus is Airborne “While the long-standing public health view is that influenza transmission occurs through direct contact or large droplets, newer data suggests it also occurs through the airborne route, meaning HVAC&R systems may contribute far more to transmission of the disease and, potentially, to reduction of that same transmission risk.” Gordon Holness, President of ASHRAE ( American Society of Heating, Refrigerating and Air-Conditioning Engineers Atlanta, GA)

7. Scientists from the Prestigious RAND Center for Domestic and International Health Security state that the Swine Flu Virus is Airborne “Experience from seasonal influenza also provides evidence of contact, droplet and aerosol transmission of influenza that lend support for N95 respirators, which are designed to stop up to 95% of small airborne particles.” Non-pharmaceutical public health interventions for pandemic influenza Published in: BMC Public Health Journal 2007

8. Infectious Disease Professor Dr. John J Treanor describes Airborne Influenza Virus “Influenza virus infection is acquired by a mechanism involving the transfer of virus-containing respiratory secretions from an infected to a susceptible person. A number of lines of evidence indicate that small particle aerosols are the predominant factor in such person-to-person transmission. The explosive nature and simultaneous onset in many persons suggest that a single infected person can transmit virus to a large number of susceptible persons.” 8©2009 Steven Welty

9. British Scientists state that Influenza infection is by Airborne Transmission “Influenza viruses are highly infectious, being readily transmitted in both large and small droplets. It is the small-droplet spread which accounts for the explosive nature of influenza outbreaks in closed environments, where one infected person can potentially infect a large number of susceptible hosts.” Donald Jeffries & Celia Aitken Department of Virology-Royal London Hospital Published in: Clinical Microbiology Reviews July 2001 Page 532) 9©2009 Steven Welty

10. More Leading Influenza Scientists who state that Influenza is Airborne Professor Peter Wright- Vanderbilt- School of Medicine Professor Gabrielle Neumann- University of Wisconsin Professor Yoshihiro Kawaoka- University of Tokyo “ The incubation period is about 3 days for influenza A viruses (H1N1). The most effective means of spread among humans are (airborne) aerosols. Most aerosol droplets formed during sneezing or coughing are less than 2µm (microns) in diameter and are preferentially deposited in the lower airways of the lung.” 10©2009 Steven Welty

11. The New Swine Flu Virus will Kill Many People September 2009 1,700 total deaths linked to nH1N1 Many victims are healthy people under 30 nH1N1 causes more vomiting & diarrhea We are not yet into flu Season: Oct-March 11©2009 Steven Welty

12. The Flu Virus is the perfect airborne smart bomb 12 1. Flu Virions are so microscopic they can float for days in building’s indoor air. 2. Flu Virions invade their hosts and use them to make billions of clones of themselves. 3. Flu Virions can hide in people’s bodies (not making them sick) but the person can still infect others with the flu. (Asymptomatics) ©2009 Steven Welty

13. nH1N1 “Swine Flu” has Swine, Bird, Human Flu RNA 13©2009 Steven Welty

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18. What’s Influenza A Virus & How does it infect people? Influenza A causes disease primarily in the lungs as it loves to infect the lower respiratory system. It is not a rhinovirus which primarily causes infection in the nose and upper respiratory system. Washing your hands will do little to prevent flu viruses from entering deep into your lungs unless you put your finger into your nose. Touching your mouth or eye has not been shown to transmit Influenza Infection. NO matter how sterile your hands are, you’ll still be fully exposed to airborne Influenza viruses entering and depositing into your lungs to cause disease. 18©2009 Steven Welty

19. How does Influenza A Virus kill people? Influenza A likes to multiply at 98.6° which is the temperature of the lower respiratory system. (The upper respiratory system- nasal cavity & pharynx- are approx. 93° which rhinoviruses favor for multiplication). Influenza A infects and destroys its victim’s lung surface tissue (the epithelium). The damaged lung tissue has compromised its protective layers which can lead to pneumonia or massive bacterial infection. Victims may die from aggressive Staph infections like Methicillin Resistant Staphylococcus Aureus (MRSA) or Strep. 19©2009 Steven Welty

20. NIOSH scientists captured thousands of airborne viruses in a Hospital’s air As recent as 2004, Harvard’s Don Milton said: “infectious aerosols are usually extremely dilute, and it is hard to collect and culture fine particles.” NEJM 4.22.04 Air testing equipment has finally improved enough to meet the challenge of finding airborne virions. In 2008, NIOSH found 15,000 airborne flu viruses in just one area of a hospital waiting room. Remember: it can take just 1 (one) airborne flu virus to infect and sicken you with the flu. 20©2009 Steven Welty

21. 1. How long will it take me to infect everyone in this room? (1-2 hours depending on humidity, air flow patterns and air exchange rates) 2. How long will it take for me to infect everyone in this building? (varies depending on humidity, the HVAC system configuration, air sterilization & purification systems) If I’m now infected with the H1N1 Swine Flu Virus…… 21©2009 Steven Welty

22. Public Health Officials advice on preventing the Swine Flu Pandemic: 1. Wash your hands. 2. Cover your cough. 3. If you’re sick, stay home. This advice ignores studies showing that 30-50% of infected influenza carriers have NO symptoms. (Asymptomatics) It also ignores both human airway and toilet water viral aerosolization. These both are critical modes of airborne contagion within a building’s indoor spaces. 22©2009 Steven Welty

23. 1. How can people eject Flu Viruses into the Air? 2. What different forms can airborne viruses take? 3. How far can those viruses travel & how can they circulate within buildings and inside their HVAC units? 4. What conditions increase Airborne Flu Viruses Survival? 5. What Systems are Available to Sterilize, Capture and/or Kill Airborne Flu Viruses? Here’s a short list of Human Indoor Airborne Virus Transmission Issues:

24. Airborne Transmission depends on people to launch viruses into the air. People can shed this many Flu Viruses into the air: 1. Coughing 300+ 2. Sneezing 300+ 3. Breathing Nose-Few Mouth-10+ 4. Talking/Singing 100+ 5. Vomiting 100+ 6. Diarrhea* 2,000+ *As a Result of Toilet Water Aerosolization 24©2009 Steven Welty

25. How far can Airborne Viruses Travel? *As a Result of Toilet Water Aerosolization and Mechanical Fan Dispersion into outdoor air (2003 Hong Kong SARS Virus Epidemic) 1. Coughing 1-6 feet 160+ feet 2. Sneezing 8-15 feet 160+ feet 3. Singing, Talking 1-3 feet 160+ feet 4. Mouth Breathing 1-3 feet 160+ feet 5. Diarrhea* 6 feet+ 160+ feet Large/Small DropletsDroplet Nuclei

26. Infectious Droplets & Droplet Nuclei 26©2009 Steven Welty

27. Infectious Droplets & Droplet Nuclei travel lengths 27©2009 Steven Welty

28. 1 Person Coughing out 900 virions can infect 300 People 28©2009 Steven Welty

29. Droplet Nuclei Travel Within Buildings 29©2009 Steven Welty

30. Microscopic Particles are measured in Micrometers or Microns The scientific symbol for a micron is: µm. A micron or 1/1,000,000 of a meter. The smallest particle size you can see is 30µm and that is a tiny, tiny speck. You’ll never ever see an airborne virion. 30©2009 Steven Welty

31. Airborne Influenza Virions (.3-2µ) penetrate deep into the lungs producing fill blown flu illness. 31©2009 Steven Welty

32. Large Droplet Influenza (10µ) does NOT Penetrate into the lungs and therefore DOESN’T produce fill blown flu illness. 32©2009 Steven Welty

33. Toilet Aerosolization Droplet Nuclei Recirculation in buildings 33©2009 Steven Welty

34. Proactive Toilet Aerosolization Droplet Nuclei Infection Prevention 34©2009 Steven Welty

35. Air Filters, UV Lights and Photo-catalytic Oxidation Can Kill, Sterilize & can Capture Viral Droplet Nuclei 35©2009 Steven Welty

36. Buildings are Ideal Swine Flu Transmission Locations Dry environments! In winter Many buildings have 20-30% relative humidity levels indoors! This is the PERFECT environment for airborne Viral transmission and contagion. Low MERV Filter Ratings! Many building have low MERV rated filters like MERV 10. You need a MERV 13 or higher to have any real effect on airborne viral capture. No Ultraviolet Lights! Few non-Federal buildings use ultraviolet lights. Buildings with UV lights have enjoyed lower airborne viral transmission rates and higher indoor air quality. Bathrooms with ceiling exhaust fans! Airborne aerosolized viruses will infect bathroom users in addition to returning into the Building through the fresh air ventilation ducts. Air Recirculation! HVAC systems are constantly recirculating viruses to infect more victims. 36©2009 Steven Welty

37. Indoor Air Doesn’t Have to Infect People with Swine Flu! All you have to do is fix these three things: 1.Air Filtration & UV Sterilization systems 2.Increase Winter Humidity 3.Direct Bathroom Air down & away from the Breathing Zone. Sterilize air before exhausting outdoors. 37©2009 Steven Welty

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39. Combined UV Light & Filtration can Kill or Sterilize Flu this % of Viruses: MERV & UVR Combined %Viruses Killed/Sterilized 6 10% 7 12% 8 19% 10 35% 13 84% 15 97% 16 98.8% 17 99.9+ 39©2009 Steven Welty

40. Recommendations…. 1. Seal your filter rack & HVAC system 2. Keep wintertime humidity @ 40% or more. 3. Get the Highest MERV rated filter that your filter rack and air handling fan can tolerate. 4. Put as much UV light within your coil plenum to achieve a 99% single pass kill rate. 5. Increase air exchange rates. 6. Configure air supply vents to direct air down to prevent droplet nuclei from staying airborne. 7. Install Photocatalytic Oxidation and Bi-Polar Ionization for additional viral sterilization. 8. Install bathroom exhausts 1-12” above the floor. 9. Coughing or sneezing occupants must stay at home or wear a mask. 40©2009 Steven Welty

41. Airborne Pandemic nH1N1 Swine Flu in Buildings Proactive Strategies for Property Managers Steven Welty CAFS, CIE, LEED AP Green Clean Air Reston, VA 703.927.7532 GreenCleanAir@aol.com International Facility Managers Association Atlanta Chapter September 10, 2009