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      The impact of heating, ventilation, and air conditioning design features on the transmission of viruses, including the 2019 novel coronavirus: A systematic review of ventilation and coronavirus

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          Abstract

          Aerosol transmission has been a pathway for the spread of many viruses. Similarly, emerging evidence has determined aerosol transmission for Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2) and the resulting COVID-19 pandemic to be significant. As such, data regarding the effect of Heating, Ventilation, and Air Conditioning (HVAC) features to control and mitigate virus transmission is essential. A systematic review was conducted to identify and comprehensively synthesize research examining the effectiveness of ventilation for mitigating transmission of coronaviruses. A comprehensive search was conducted in Ovid MEDLINE, Compendex, Web of Science Core to January 2021. Study selection, data extraction, and risk of bias assessments were performed by two authors. Evidence tables were developed and results were described narratively. Results from 32 relevant studies showed that: increased ventilation rate was associated with decreased transmission, transmission probability/risk, infection probability/risk, droplet persistence, virus concentration, and increased virus removal and virus particle removal efficiency; increased ventilation rate decreased risk at longer exposure times; some ventilation was better than no ventilation; airflow patterns affected transmission; ventilation feature (e.g., supply/exhaust, fans) placement influenced particle distribution. Few studies provided specific quantitative ventilation parameters suggesting a significant gap in current research. Adapting HVAC ventilation systems to mitigate virus transmission is not a one-solution-fits-all approach. Changing ventilation rate or using mixing ventilation is not always the only way to mitigate and control viruses. Practitioners need to consider occupancy, ventilation feature (supply/exhaust and fans) placement, and exposure time in conjunction with both ventilation rates and airflow patterns. Some recommendations based on quantitative data were made for specific scenarios (e.g., using air change rate of 9 h -1 for a hospital ward). Other recommendations included using or increasing ventilation, introducing fresh air, using maximum supply rates, avoiding poorly ventilated spaces, assessing fan placement and potentially increasing ventilation locations, and employing ventilation testing and air balancing checks.

          Trial registration: PROSPERO 2020 CRD42020193968.

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          Most cited references55

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          Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement

          David Moher and colleagues introduce PRISMA, an update of the QUOROM guidelines for reporting systematic reviews and meta-analyses
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            COVID-19 Outbreak Associated with Air Conditioning in Restaurant, Guangzhou, China, 2020

            During January 26–February 10, 2020, an outbreak of 2019 novel coronavirus disease in an air-conditioned restaurant in Guangzhou, China, involved 3 family clusters. The airflow direction was consistent with droplet transmission. To prevent the spread of the virus in restaurants, we recommend increasing the distance between tables and improving ventilation.
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              Estimation of airborne viral emission: quanta emission rate of SARS-CoV-2 for infection risk assessment

              Highlights • Airborne transmission is a pathway of contagion of an epidemic. • Simulating the virus airborne transmission requires viral emission data. • A novel approach estimating the quanta emission rate of SARS-CoV-2 infected subject. • The approach estimates the quanta emission rate from the viral load in sputum. • Vocalization during light activity can lead to quanta emission rate >100 quanta h-1.
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                Author and article information

                Contributors
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: InvestigationRole: MethodologyRole: Project administrationRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: SupervisionRole: ValidationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: Data curationRole: Formal analysisRole: InvestigationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: Data curationRole: Formal analysisRole: InvestigationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: Data curationRole: Formal analysisRole: InvestigationRole: VisualizationRole: Writing – original draftRole: Writing – review & editing
                Role: Funding acquisitionRole: Writing – review & editing
                Role: ConceptualizationRole: Data curationRole: Formal analysisRole: Funding acquisitionRole: InvestigationRole: MethodologyRole: Project administrationRole: SupervisionRole: Writing – original draftRole: Writing – review & editing
                Role: Editor
                Journal
                PLOS Glob Public Health
                PLOS Glob Public Health
                plos
                PLOS Global Public Health
                Public Library of Science (San Francisco, CA USA )
                2767-3375
                5 July 2022
                2022
                : 2
                : 7
                : e0000552
                Affiliations
                [1 ] Faculty of Engineering, Department of Mechanical Engineering, University of Alberta, Edmonton, Canada
                [2 ] Faculty of Medicine & Dentistry, Department of Pediatrics, University of Alberta, Edmonton, Canada
                Stellenbosch University, SOUTH AFRICA
                Author notes

                This work is funded by The Canadian Institutes of Health Research and Alberta Innovates. There are no patents, products in development or marketed products to declare. This does not alter our adherence to PLOS policies on sharing data and materials. The authors have declared that no other competing interests exist.

                Author information
                https://orcid.org/0000-0001-8569-300X
                https://orcid.org/0000-0002-8779-2682
                https://orcid.org/0000-0001-5211-8826
                https://orcid.org/0000-0001-8341-3991
                Article
                PGPH-D-21-00860
                10.1371/journal.pgph.0000552
                10021902
                36962357
                e333d0cb-2210-4597-8d5d-6b631cb0efea
                © 2022 Thornton et al

                This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

                History
                : 25 October 2021
                : 9 May 2022
                Page count
                Figures: 1, Tables: 5, Pages: 25
                Funding
                Funded by: funder-id http://dx.doi.org/10.13039/501100000024, Canadian Institutes of Health Research;
                Award Recipient :
                Funded by: Alberta Innovates
                Award Recipient :
                This work is funded by a Canadian Institutes of Health Research (CIHR) Operating Grant: Canadian 2019 Novel Coronavirus (COVID-19) Rapid Research Funding Opportunity [ https://webapps.cihr-irsc.gc.ca/decisions/p/project_details.html?applId=422567&lang=en] and Alberta Innovates. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. Author LH is supported by a Canada Research Chair in Knowledge Synthesis and Translation. Authors BF and LZ are supported by the NSERC Discovery program.
                Categories
                Research Article
                Medicine and Health Sciences
                Epidemiology
                Medical Risk Factors
                Medicine and Health Sciences
                Medical Conditions
                Infectious Diseases
                Respiratory Infections
                Medicine and Health Sciences
                Medical Conditions
                Respiratory Disorders
                Respiratory Infections
                Medicine and Health Sciences
                Pulmonology
                Respiratory Disorders
                Respiratory Infections
                Medicine and Health Sciences
                Medical Conditions
                Infectious Diseases
                Viral Diseases
                Covid 19
                Biology and life sciences
                Organisms
                Viruses
                RNA viruses
                Coronaviruses
                SARS coronavirus
                SARS CoV 2
                Biology and life sciences
                Microbiology
                Medical microbiology
                Microbial pathogens
                Viral pathogens
                Coronaviruses
                SARS coronavirus
                SARS CoV 2
                Medicine and health sciences
                Pathology and laboratory medicine
                Pathogens
                Microbial pathogens
                Viral pathogens
                Coronaviruses
                SARS coronavirus
                SARS CoV 2
                Biology and life sciences
                Organisms
                Viruses
                Viral pathogens
                Coronaviruses
                SARS coronavirus
                SARS CoV 2
                Biology and life sciences
                Organisms
                Viruses
                RNA viruses
                Coronaviruses
                Biology and Life Sciences
                Microbiology
                Medical Microbiology
                Microbial Pathogens
                Viral Pathogens
                Coronaviruses
                Medicine and Health Sciences
                Pathology and Laboratory Medicine
                Pathogens
                Microbial Pathogens
                Viral Pathogens
                Coronaviruses
                Biology and Life Sciences
                Organisms
                Viruses
                Viral Pathogens
                Coronaviruses
                Medicine and Health Sciences
                Medical Conditions
                Infectious Diseases
                Viral Diseases
                SARS
                Medicine and Health Sciences
                Health Care
                Health Care Facilities
                Hospitals
                Research and Analysis Methods
                Research Assessment
                Systematic Reviews
                Custom metadata
                Our paper reports a systematic review of previously published studies. All data appears in evidence tables within the paper.
                COVID-19

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