Abstract
Physical contact and respiratory droplet transmission have been widely regarded as the main routes of COVID-19 infection. However, mounting evidence has unveiled the risk of aerosol transmission of the virus. Whereas caution has been taken to avoid this risk in association with clinical facilities, facilities such as spa pools and Jacuzzis, which are characterized by bubble-aerosol generation, high bather loads, and limited turnover rates, may promote aerosol transmission. Focusing on these non-clinical facilities in the built environment, a review study was undertaken. First, the typical water disinfection and ventilation-aided operations for the facilities were illustrated. Second, cross comparisons were made between the applicable standards and guidelines of the World Health Organization and countries including Australia, Canada, China, the United Kingdom, and the United States. The similarities and differences in their water quality specifications, ventilation requirements, and air quality enhancement measures were identified; there were no specific regulations for preventing aerosol transmission at those aerosol-generating facilities. Third, a qualitative review of research publications revealed the emergence of studies on potential air-borne transmission of COVID-19, but research on built facilities posing high risks of aerosol transmission remains scant. This study’s results inform key directions for future research on abating aerosol transmission of COVID-19: the development of bespoke personal protective equipment and engineering and management controls on water quality, ventilation, and air quality.
Highlights
Coronavirus disease 2019 (COVID-19) has triggered a world-wide pandemic, causing over 2.3 million deaths [1]
In a hospital in Wuhan, China, researchers found that the concentration of severe acute respiratory syndrome (SARS)-CoV-2-ribonucleic acid (RNA)-laden aerosol was exceptionally high in crowded gathering places and poorly ventilated areas used by infected persons, negligible concentrations were found in most patient areas that are designed with negative pressurization and high air exchange rates [9]
Another study in Singapore found a much higher concentration of SARS-CoV-2 RNA in the airborne infection isolation rooms (AIIRs), which ranged from 1.84 × 103 to 3.38 × 103 copies/m3 air sampled with particle sizes larger than 1 μm [10]
Summary
Coronavirus disease 2019 (COVID-19) has triggered a world-wide pandemic, causing over 2.3 million deaths [1]. The risk of COVID-19 transmission associated with aerosols generated from clinical facilities has been well-recognized. In non-clinical areas of the built environment, facilities such as spa pools and Jacuzzis, which are characterized by bubble-aerosol generation, high bather loads, and limited turnover rates, may promote aerosol-borne COVID-19 transmission. To contribute to the understanding of information or research outcomes that are conducive to mitigating the risk of COVID-19 transmission via non-clinical aerosol-generating facilities, this present study conducted a literature review of relevant national/international standards, leading professional guidelines, and top-notch research publications. Based upon the review findings, directions for future research were identified
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