One of the best ways to battle the current onslaught of respiratory viruses that is battering older adults and other vulnerable populations is focusing more on improving indoor air quality. 

Current regulations, however, are “simply out of date” and don’t consider airborne pathogens, experts say.

Almost all COVID-19 infections occurred indoors, usually in poorly ventilated spaces, explained Natalie Kopp, an adviser on the White House COVID-19 Response Team, during a LeadingAge member conference call last week.

Improving and increasing ventilation and filtration in the air, Kopp said, can dramatically reduce the burden of COVID-19 and decrease the transmission of flu and respiratory syncytial virus (RSV). The trio of bugs has presented a unique challenge for long-term care and other providers this season. Together, they have been coined a “tripledemic” by some.

To elevate the topic in people’s minds, the White House hosted a Summit on Indoor Air Quality in October, bringing together experts in public health, education and the private sector to discuss the future of indoor air quality investment.

“We have to bring the burden of respiratory pathogens down,” Ashish Jha, MD, the White House COVID-19 response coordinator, said during the event. “And the single biggest structural change that we can make as a society is to do for indoor air quality what we’ve done for water quality. We need healthy buildings because we need healthy communities.”

Many Americans don’t know that much about indoor air quality or its effects on society, Kopp said.

“We really want to elevate this as a key mitigation strategy,” she said. “But we also recognize that it can mean energy efficiency and other positive health effects to people in our building stock in the US.”

To generate buy-in, she said, the White House launched the Clean Air in Buildings Challenge  in March, calling on building owners and operators to improve ventilation and filtration systems that can improve indoor air quality. Senior living communities and other long-term care facilities, as well as other businesses and schools, can sign a pledge and receive a digital “badge” to display on their websites and social media. 

“Signing the pledge makes you look at your building, what your organization is doing on this topic,” Kopp said. “The goal is to lift up and reward institutions making changes. We want to show the nation there is leadership in this area.” 

Where to start

Many experts in the field of indoor air quality can provide guidance on improving ventilation and filtration, Kopp said. Providers don’t normally look at HVAC systems from the perspective of airborne pathogens, she said, so an outside expert can perform an initial inspection and provide a checklist of steps to take to focus on the health benefits of the system.

“The most impactful thing you can do is ensure your HVAC system is running as intended,” Kopp said, adding that doing so means scheduling a deep inspection and regular maintenance.

She encouraged operators on a budget to look for simple things, such as portable air cleaners, with a good track record and evidence of effectiveness and being cost-effective. The main factor to look for when choosing an air cleaner is HEPA, or high efficiency particulate air unit. She also discouraged buying units that use bipolar ionization, citing little research on its safety and effectiveness and the fact that such units generate ozone, a known lung irritant.

Senior living communities and other long-term care facilities also are eligible for grants to improve HVAC systems, as well as other ventilation and filtration improvements. The Biden administration provided $350 billion for state and local governments through the American Rescue Plan to address those and other pandemic-related infection control efforts. 

Push to adopt indoor air quality regulations

The end goal for the federal government, Kopp said, is to adopt regulations similar to those that govern safe drinking water. She pointed to a recent study from the Lancet COVID-19 Commission’s Task Force on Safe Work, Safe School, and Safe Travel. The group of experts examined air ventilation, filtration and disinfection to reduce the transmission risk of airborne infectious diseases inside buildings. 

Their findings led to recommendations to adopt new noninfectious air delivery rates, or NADRs, for reducing exposure to airborne respiratory infectious diseases — including COVID-19, influenza and RSV — and to improve health.

“Current standards for ventilation are based on bare minimums targets, do not reflect the latest scientific evidence on the multiple benefits of enhanced ventilation and filtration, and are not designed for health or infection control,” the authors concluded. 

Other than in healthcare settings, commercial building guidelines for indoor air quality are not designed to control the transmission of infectious diseases, they noted.

The task force examined a variety of indoor air quality targets and metrics — including air changes per hour, volumetric flow rate per floor and volumetric flow rate per person. It also looked at various methods of mitigating infectious disease risks, including ventilation with outdoor air, air filtration and air disinfection using germicidal ultraviolet energy.

The group proposed a set of “good, better and best” NADR targets for reducing exposure to airborne respiratory diseases, ranging from four to more than six equivalent air changes per hour. They also noted that the targets are not intended to replace existing ones for healthcare or residential settings. 

In addition to reducing respiratory infection risks, the task force noted that other benefits of its NADR targets would include better cognitive function; improvements in cardiopulmonary health and the prevalence of sick building syndrome symptoms; and asthma control and quality-of-life scores