Can technology speed the return to office post-COVID? Is contaminated office air conditioning a COVID culprit?

Most offices in the US are still not open or only ‘essential personnel’. As this Editor noted on 19 May, a number of companies, including startups, are focusing on working with employers on return-to-work strategies. There are a raft of approaches including on-site clinics, temperature screening checkpoints, and check-in/reporting apps from Verily (Alphabet) and Fitbit’s Ready to Work. These screeners generally monitor for self-reported symptoms, but some will advise and track you to testing if you demonstrate risk, such as UnitedHealth Group and Microsoft’s ‘ProtectWell’ with a closed loop of testing recommendations that are reported to the employer. Collective Go from Collective Health goes a bit further in emphasizing up-front (molecular [PCR]) testing and continuous employee monitoring into their protocols for, apparently, every worker. OneMedical, which works with 7,000 employers, adds to their on-site management and testing additional contact tracing. FierceHealthcare

Maybe it’s in the air-conditioned air you breathe? Office building air circulation may be a culprit in the spike in Florida, Arizona, and Texas cases. The uptick in cases in Southern states where the contagion rates were initially fairly light may be due to the mostly recirculated air in office air conditioning systems. Most modern buildings don’t have windows which open. Older buildings have their own problems like mold from leaky systems and ‘soot’ (from air pollution and when people used to smoke in offices, remember when?). Newer LEED buildings are so ‘tight’ and energy efficient that air tends to be stagnant. Few buildings have good ratios of air exchange with the outside plus use HEPA filtration throughout the HVAC system. The total picture is that any virus can make its way through offices–six feet of distancing, masks, sanitization, no cafeterias, and acrylic panel separators be d****d.  (Contrast your average office building with modern commercial aircraft where about 50 percent of air is recirculated at any one time, there’s a total change about every three minutes, and HEPA filters are used! AskThePilot, a great site for all things airline)

A return-to-work readiness strategy suggested here by a Harvard Medical epidemiologist whose main area is TB spread are germicidal UV lights high in the room to catch the viruses that go up, then down. UV light for sanitization and disinfection is a technology used for several years to disinfect patient care areas (PurpleSun is one). Far-UVC, versus near-UVC, and potential uses are outlined in this Nature article from February 2018Harvard Gazette

Weekend reading: the life and spread of microbes in the average hospital room

We in healthcare and health tech know how deadly nosocomial or hospital-acquired infections are. Current CDC estimates are that in US hospitals, there are 1.7 million infections and 99,000 associated deaths each year (up from a previous estimate of 75,000) PatientCareLink. Most of us know that visiting a patient in a hospital room means also making sure hands are washed, clothes and shoes are clean, and that we bring a container of industrial strength bleach wipes for cleaning surfaces versus flowers.

However, it was news to this Editor that few studies have been done on the actual hospital room environment–the microbiome–and how the microbes in the room interact with the patient and the staff.  Sue Barnes, an RN who spent 30 years as the National Leader for Infection Prevention for Kaiser Permanente, reviews a newly published study in Science Translational Medicine (24 May, abstract available only). The study collected bacterial cultures from the ‘patient zone’ around the bed, every surface in the hospital room, and swabbed the hands and noses of patients and staff, along with the shoes, shirts, and cell phones of staff members. The problem is much more complex than simple cleaning.

  • Patient skin and the microbial makeup of room surfaces became more similar over time. Non-ambulatory patients were less so, as they had less contact with external surfaces.
  • The longer patients were in the room, the more genetic resistance to antibiotics the organisms acquired. This is despite the lack of association with antibiotics save topicals. The author suggests that regular cleaning may be the reason–only the strongest survive.
  • The hospital room is most threating to the most vulnerable, such as babies in a neonatal ICU
  • “In the Lax study, several bacterial samples taken more than 71 days apart were identical,  (more…)