Carbon Dioxide Monitoring Demonstrates Variations in the Quality of Ventilation on Public Transportation Buses and University Student Shuttle Vans and Identifies Effective Interventions
Main Article Content
Abstract
Background: There is a risk for transmission of severe acute respiratory syndrome 2 (SARS-CoV-2) and other respiratory viruses in motor vehicles, particularly if ventilation is inadequate.
Methods: We used carbon dioxide monitoring to examine the quality of ventilation in several public transportation buses and in university student shuttle vans in the Cleveland metro area during peak and non-peak travel times. Carbon dioxide levels above 800 parts per million (ppm) were considered an indicator of suboptimal ventilation for the number of people present. In the shuttle vans, we evaluated the impact of an intervention to improve ventilation.
Results: In large articulated buses with 2 ventilation systems, carbon dioxide concentrations never exceeded 800 ppm, whereas in standard buses with 1 ventilation system concentrations rose above 800 ppm during peak travel times and on some trips during non-peak travel times. In shuttle vans, the ventilation system was not turned on during routine operation, and carbon dioxide levels rose above 800 ppm on all trips during peak and non-peak travel times. In the shuttle vans, an intervention involving operation of the existing ventilation system resulted in a significant reduction in carbon dioxide levels (mean concentration, 1,042 no intervention versus 785 with intervention; P<0.001).
Conclusion: Our findings demonstrate substantial variability in the quality of ventilation in public transportation buses and university shuttle vans. There is a need for efforts to assess and optimize ventilation in motor vehicles used for public transportation to reduce the risk for aerosol-mediated transmission of respiratory viruses. Carbon dioxide monitoring may provide a useful tool to assess and improve ventilation.
Downloads
Article Details
This work is licensed under a Creative Commons Attribution 4.0 International License.
Pathogens and Immunity abides by Creative Commons BY 4.0:
http://creativecommons.org/licenses/by/4.0/
This license lets others distribute, remix, tweak, and build upon your work for any lawful purpose, even commercially, as long as they credit you for the original creation. This is the most accommodating of licenses offered. Recommended for maximum dissemination and use of licensed materials. The authors maintain copyright of their materal.
*Due to a template error on our pdfs, articles published from May 20, 2016 to June 24, 2022 incorrectly state the copyright is held by Pathogens and Immunity. Copyright of all articles is held by the authors of each article as noted in the above copyright policy.
References
1. Cadnum JL, Donskey CJ. If you can’t measure it, you can’t improve it: Practical tools to assess ventilation and airflow patterns to reduce the risk for transmission of severe acute respiratory syndrome coronavirus 2 and other airborne pathogens. Infect Control Hosp Epidemiol. 2022;43(7):915-7. doi: 10.1017/ice.2022.103. PubMed PMID: 35379373; PMCID: PMC9021581.
2. Wang CC, Prather KA, Sznitman J, Jimenez JL, Lakdawala SS, Tufekci Z, Marr LC. Airborne transmission of respiratory viruses. Science. 2021;373(6558). doi: 10.1126/science.abd9149. PubMed PMID: 34446582; PMCID: PMC8721651.
3. Ventilation in buildings Centers for Disease Control and Prevention [updated May 12, 2023]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/community/ventilation.html.
4. Improving ventilation in buildings Centers for Disease Control and Prevention [updated May 11, 2023]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/improving-ventilation-in-buildings.html.
5. Gettings J, Czarnik M, Morris E, Haller E, Thompson-Paul AM, Rasberry C, Lanzieri TM, Smith-Grant J, Aholou TM, Thomas E, Drenzek C, MacKellar D. Mask Use and Ventilation Improvements to Reduce COVID-19 Incidence in Elementary Schools - Georgia, November 16-December 11, 2020. MMWR Morb Mortal Wkly Rep. 2021;70(21):779-84. doi: 10.15585/mmwr.mm7021e1. PubMed PMID: 34043610; PMCID: PMC8158891.
6. Buonanno G, Ricolfi L, Morawska L, Stabile L. Increasing ventilation reduces SARS-CoV-2 airborne transmission in schools: A retrospective cohort study in Italy’s Marche region. Front Public Health. 2022;10:1087087. doi: 10.3389/fpubh.2022.1087087. PubMed PMID: 36568748; PMCID: PMC9787545.
7. Haq MF, Cadnum JL, Carlisle M, Hecker MT, Donskey CJ. SARS in Cars: Carbon Dioxide Levels Provide a Simple Means to Assess Ventilation in Motor Vehicles. Pathog Immun. 2022;7(1):19-30. doi: 10.20411/pai.v7i1.493. PubMed PMID: 35178491; PMCID: PMC8843085.
8. Cadnum JL, Jones LD, Memic S, Donskey CJ. Use of Carbon Dioxide Monitoring to Assess Ventilation at a National Infectious Diseases Conference. Clin Infect Dis. 2023;76(10):1870-2. doi: 10.1093/cid/ciac986. PubMed PMID: 36594166.
9. Cadnum JL, Alhmidi H, Donskey CJ. Planes, Trains, and Automobiles: Use of Carbon Dioxide Monitoring to Assess Ventilation During Travel. Pathog Immun. 2022;7(1):31-40. doi: 10.20411/pai.v7i1.495. PubMed PMID: 35316971; PMCID: PMC8932639.
10. Heinzerling A VX, Gebreegziabher E, Beckman J, Wong J, Nguyen A, Khan S, Frederick M, Bui D, Chan E, Gibb K, Rodriguez A, Jain S, Cummings KJ. COVID-19 Outbreaks and Mortality Among Public Transportation Workers – California, January 2020–May 2022 MMWR Morb Mortal Wkly Rep2022 [updated August 18, 2022]. Available from: https://www.cdc.gov/mmwr/volumes/71/wr/mm7133a4.htm?s_cid=mm7133a4_w#suggestedcitation.
11. Toren K, Albin M, Bergstrom T, Murgia N, Alderling M, Schioler L, Aberg M. Occupational risks associated with severe COVID-19 disease and SARS-CoV-2 infection - a Swedish national case-control study conducted from October 2020 to December 2021. Scand J Work Environ Health. 2023;49(6):386-94. doi: 10.5271/sjweh.4103. PubMed PMID: 37417898.
12. De Matteis S, Cencedda V, Pilia I, Cocco P. COVID-19 incidence in a cohort of public transport workers. Med Lav. 2022;113(4):e2022039. doi: 10.23749/mdl.v113i4.13478. PubMed PMID: 36006092; PMCID: PMC9484285.
13. Jones LD, Chan ER, Zabarsky TF, Cadnum JL, Navas ME, Redmond SN, Kovach JD, Linger M, Rutala WA, Zimmerman PA, Donskey CJ. Transmission of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in a Patient Transport Van. Clin Infect Dis. 2022;74(2):339-42. doi: 10.1093/cid/ciab347. PubMed PMID: 33893474; PMCID: PMC8135457.
14. Shen Y, Li C, Dong H, Wang Z, Martinez L, Sun Z, Handel A, Chen Z, Chen E, Ebell MH, Wang F, Yi B, Wang H, Wang X, Wang A, Chen B, Qi Y, Liang L, Li Y, Ling F, Chen J, Xu G. Community Outbreak Investigation of SARS-CoV-2 Transmission Among Bus Riders in Eastern China. JAMA Intern Med. 2020;180(12):1665-71. doi: 10.1001/jamainternmed.2020.5225. PubMed PMID: 32870239; PMCID: PMC7489377.
15. Luo K, Lei Z, Hai Z, Xiao S, Rui J, Yang H, Jing X, Wang H, Xie Z, Luo P, Li W, Li Q, Tan H, Xu Z, Yang Y, Hu S, Chen T. Transmission of SARS-CoV-2 in Public Transportation Vehicles: A Case Study in Hunan Province, China. Open Forum Infect Dis. 2020;7(10):ofaa430. doi: 10.1093/ofid/ofaa430. PubMed PMID: 33123609; PMCID: PMC7543623.
16. ASHRAE Position Document on Indoor Carbon Dioxide The American Society of Heating, Refrigerating and Air-Conditioning Engineers. Available from: https://www.ashrae.org/file%20library/about/position%20documents/pd_indoorcarbondioxide_2022.pdf.
17. Huang Q, Marzouk T, Cirligeanu R, Malmstrom H, Eliav E, Ren YF. Ventilation Assessment by Carbon Dioxide Levels in Dental Treatment Rooms. J Dent Res. 2021;100(8):810-6. doi: 10.1177/00220345211014441. PubMed PMID: 33973494; PMCID: PMC8120146.
18. McNeill VF, Corsi R, Huffman JA, King C, Klein R, Lamore M, Maeng DY, Miller SL, Lee Ng N, Olsiewski P, Godri Pollitt KJ, Segalman R, Sessions A, Squires T, Westgate S. Room-level ventilation in schools and universities. Atmos Environ X. 2022;13:100152. doi: 10.1016/j.aeaoa.2022.100152. PubMed PMID: 35098105; PMCID: PMC8789458.
19. Ha W, Stiefel MA, Gries JR, Cadnum JL, Torres-Teran MM, Wilson BM, Donskey CJ. Evaluation of Interventions to Improve Ventilation in Households to Reduce Risk for Transmission of Severe Acute Respiratory Syndrome Coronavirus 2. Pathog Immun. 2022;7(2):120-30. doi: 10.20411/pai.v7i2.553. PubMed PMID: 36655199; PMCID: PMC9836208.
20. Du CR, Wang SC, Yu MC, Chiu TF, Wang JY, Chuang PC, Jou R, Chan PC, Fang CT. Effect of ventilation improvement during a tuberculosis outbreak in underventilated university buildings. Indoor Air. 2020;30(3):422-32. doi: 10.1111/ina.12639. PubMed PMID: 31883403; PMCID: PMC7217216.
21. Querol X, Alastuey A, Moreno N, Minguillon MC, Moreno T, Karanasiou A, Jimenez JL, Li Y, Morgui JA, Felisi JM. How can ventilation be improved on public transportation buses? Insights from CO(2) measurements. Environ Res. 2022;205:112451. doi: 10.1016/j.envres.2021.112451. PubMed PMID: 34848209.
22. Nathavitharana RR, Mishra H, Sullivan A, Hurwitz S, Lederer P, Meintjes J, Nardell E, Theron G. Predicting Airborne Infection Risk: Association Between Personal Ambient Carbon Dioxide Level Monitoring and Incidence of Tuberculosis Infection in South African Health Workers. Clin Infect Dis. 2022;75(8):1297-306. doi: 10.1093/cid/ciac183. PubMed PMID: 35348657; PMCID: PMC9383651.
23. Cadnum JL, Jencson AL, Alhmidi H, Zabarsky TF, Donskey CJ. Airflow Patterns in Double-Occupancy Patient Rooms May Contribute to Roommate-to-Roommate Transmission of Severe Acute Respiratory Syndrome Coronavirus 2. Clin Infect Dis. 2022;75(12):2128-34. doi: 10.1093/cid/ciac334. PubMed PMID: 35476020; PMCID: PMC9129113.
24. Lu J, Gu J, Li K, Xu C, Su W, Lai Z, Zhou D, Yu C, Xu B, Yang Z. COVID-19 Outbreak Associated with Air Conditioning in Restaurant, Guangzhou, China, 2020. Emerg Infect Dis. 2020;26(7):1628-31. doi: 10.3201/eid2607.200764. PubMed PMID: 32240078; PMCID: PMC7323555.