Preventing Another Pandemic Requires a Major 'Paradigm Shift'

Globe-spanning governments have invested immense resources and endless legislation in food safety, drinking water quality, and basic sanitation in the pursuit of public health. But all of these leave the most basic need of humans out of the equation. The air you breathe can contain pathogens, especially when contained indoors without ventilation. It's something we might not be able to take for granted anymore.

In a recent policy forum, scientists argued for a comprehensive "paradigm shift" in the way policymakers and engineers consider and execute indoor air quality and health, to lower the risk of respiratory infection, according to a new study published in the journal Science.

The COVID-19 coronavirus isn't the only airborne pathogen

In the forum, Lidia Morawska and her colleagues note how food- and waterborne diseases have, for the most part, become a subject for history in developed countries. Likewise, to achieve clean, pathogen-free air in indoor public spaces and buildings, we're going to need a "paradigm shift" in how scientists, public health officials, and engineers view the risks when performing their roles. To make it happen, the study authors argue for several steps, including the development of recommendations on ways to prevent all kinds of respiratory infection transmission, without sacrificing balance — using state-of-the-art science.

The authors also said a recently published WHO Ventilation Roadmap represents "an important step", but still lacks a necessary recognition of the hazards of airborne respiratory infection transmission, in addition to more advanced means of risk mitigation. "The COVID-19 pandemic has revealed how unprepared the world was to respond to it, despite the knowledge gained from pandemics that have occurred over past centuries," wrote the authors, according to the study. "In the 21st century, we need to establish the foundations to ensure that the air in our buildings is clean with a substantially reduced pathogen count, contributing to the building occupants' health just as we expect for the water coming out of our taps."

In a similar study published Thursday in Science, a group of 39 researchers also argue for a "paradigm shift," calling for radical changes in the way officials, engineers, and policymakers think about indoor ventilation. "Air can contain viruses just as water and surfaces do," said the study's co-author Shelly Miller, who is also a professor of mechanical and environmental engineering at the University of Colorado, Boulder. "We need to understand that it's a problem and that we need to have, in our toolkit, approaches to mitigating risk and reducing the possible exposures that could happen from build-up of viruses in indoor air."

The evolving scientific consensus on airborne pathogens

This comes on the heels of an update on WHO's website that affirms how the coronavirus is transmitted mainly through the air, and another 10 months after the WHO confirmed the potential for aerosol transmission — with 239 scientists (like Jose-Luis Jimenez and Miller of the study) signing an open letter to governing bodies and medical communities regarding the risks of airborne transmission and subsequent infections of a respiratory nature.

Needless to say, an entire paradigm shift is a big request, comparable in scale to the 19th-century implementation of organizing initiatives for clean water supplies and centralized sewage systems in cities. Scientific inquiry on the necessity of enhancing our views on airborne transmission and indoor ventilation goes back to at least 1945, when William Wells published a paper emphasizing the airborne vectors of infectious respiratory pathogens, but he couldn't break through his day's consensus. But now, this might finally be about to change.