The Kids Are Not OK: A Reading List on Clean Air

For parents, teachers, principals, and politicians.

Photo by Kelly Sikkema on Unsplash

Children’s hospitals are bursting. Kids with pneumonia are being sent home without medicine. There’s not enough beds. There’s not enough antibiotics. You might get lucky where you live, but it’s hit or miss.

Winter has barely begun.

In mid-November, the chief executives of the Children’s Hospital Association and the American Academy of Pediatrics sent a letter to President Biden urging him to declare an emergency. They describe an “alarming surge of pediatric hospitalizations” due to a range of respiratory viruses, including Covid. The American College of Emergency Physicians and the American Medical Association also wrote to Biden urging the administration to help overwhelmed ERs.

So far, the White House has said nothing. Even the mainstream media has started to call the administration out for sidestepping.

Some of us know what a huge difference clean air would make, but we can’t get anyone to listen. There’s a mountain of new studies on the importance of air quality in public settings, including schools. Still, most schools aren’t doing anything. Some of them are even rejecting HEPA air purifiers when parents try to donate them. It’s madness, and it’s hurting our kids.

We’re in the same situation experts were in London in the 1850s. They knew dirty water spread disease, but they couldn’t convince the public to take them seriously, even with regular outbreaks of cholera and other deadly diseases. It wasn’t until after an especially bad summer called “The Great Stink” that the city finally invested in upgrading their sewer system.

The outbreaks stopped.

As a parent, it’s unsettling to watch the world make the same mistakes with air that prior generations made with sanitation.

Scientists know these things:

1. The air can make you sick.

2. It needs to be cleaned.

3. We have ways.

It’s simple. If we don’t start cleaning the air, we’re going to keep getting sicker and sicker. With Covid in the mix, it’s going to keep getting worse. This problem won’t go away on its own. Vaccines alone can’t do the job. Without a plan, every winter is going to feel like its own pandemic. We’re going to ruin our hospitals. We’re going to ruin ourselves. We’re going to ruin our children.

Everyone needs to read these articles.

Here they are:

“The 60-Year-Old Scientific Screwup That Helped Covid Kill,” Wired, 2021.

An aerosol scientist at Virginia Tech named Linsey Marr led a revolution in how doctors think about viruses. When the World Health Organization insisted that Covid wasn’t airborne, she joined dozens of other specialists to warn them they were making “a big mistake.” They scheduled a Zoom call, where WHO scientists rudely interrupted and talked over them. As it turns out, the aerosol scientists were right. Covid spreads through the air. In fact, a lot of viruses do that. Marr and her team went digging back through decades of research and found out that doctors have actually been misinterpreting original data on what kinds of viruses can hang in the air. We’ve had it all wrong for 60 years.

Key takeaway: You can get sick from the air.

Don’t assume you can’t.

“The Plan to Stop Every Respiratory Virus at Once,” The Atlantic, 2021

Sarah Zhang asks a simple question: “We don’t drink contaminated water. Why do we tolerate breathing contaminated air?” She interviews a range of scientists at labs and universities all over the world who agree. It’s time to start cleaning our air. It’s not just about Covid. We don’t have to accept the constant onslaught of cold and flu bugs. We don’t have to suffer through pandemics, either. Like the Wired piece, Zhang talks about the growing awareness that lots of diseases we thought were spread through close contact actually spread through the air we breathe.

We have to start acting on that.

Key takeaway: We don’t have to get sick every winter.

“A paradigm shift to combat indoor respiratory infection,” Science, 2021.

More than 30 scientists from around the world collaborated on a declaration about the need to address indoor air quality. As they point out, governments already invest millions and millions of dollars in food safety and public sanitation. We should be doing the same thing with air. We should be developing standards for building design, overhauling HVAC systems, and installing air filtration and purification systems to lower the risk of infection. If you think that’s too expensive, consider some facts: the flu alone does $11.2 billion in economic damage every year. Other respiratory infections cost a combined $40 billion a year. So, not upgrading ventilation and filtration is already killing us, literally and financially.

Key takeaway: Not cleaning the air is expensive.

“The ventilation problem in schools: literature review,” Indoor Air, 2017.

Even before the pandemic, researchers were stressing the importance of air quality in schools. This literature review cites a number of studies, showing that even modest investments in air filtration and ventilation can make students healthier. It improves their performance. We should be investing in it.

Key takeaway: Clean air makes you smarter.

“How Enhanced Ventilation And Air Filtration Can Fight Covid-19,” Forbes, 2022.

A retired Harvard Medical School professor named William A. Haseltine lays out the importance of air ventilation and filtration. He cites a handful of key studies, and he explains some of the basic equipment you need.

Key takeaway: Clean air is doable.

“Testing mobile air purifiers in a school classroom: Reducing the airborne transmission risk for SARS-CoV-2,” Aerosol Science and Technology, 2021.

Researchers at a university in Germany ran an experiment in a high school classroom. They installed four HEPA air purifiers and measured the concentration of aerosolized particles in the room. It removed more than 90 percent of small aerosols in less than 30 minutes. The air purifiers had an air exchange rate of 5.5. According to their numbers, it substantially lowered the amount of viral load you could inhale from being around “a highly infected person” for two hours. They concluded that air purifiers can help protect students.

Key takeaway: HEPA purifiers work.

“Your Kid's School Needs Better Ventilation to Help Keep COVID-19 in Check,” Time Magazine, 2022.

Betsy Ladyzhets explains why public schools haven’t invested in cleaner air, despite having millions of dollars in funding reserved specifically for that purpose. She refers to a CDC study that found only 39 percent of schools upgraded their HVAC system, and only 28 percent even use portable air filters. A lot of administrators don’t really understand the importance of air quality. Some of them don’t want to go through the trouble of hiring HVAC experts. Some of them run into red tape. In some states, stubborn politicians control the purse strings, and they just don’t want to spend the money. That doesn’t mean parents have to accept it.

Insistent parents get things done.

Key takeaway: Demand clean air for your kids.

“Long distance airborne transmission of SARS-CoV-2: rapid systematic review,” British Medical Journal, 2022.

Scientists in Britain went through 18 major studies on Covid transmission. They found that Covid does spread indoors through the air at places like restaurants, offices, concert halls, and gyms. Poor ventilation and filtration made the problem worse. They conclude that we need better ventilation and air filters. That lines up with virtually every other scientist.

Key takeaway: Everyone deserves clean air.

“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,” PLOS Global Public Health, 2022.

Engineers and data scientists at a Canadian university reviewed 32 major studies on Covid transmission. They found that Covid is definitely airborne, and that ventilation definitely reduces your risk of infection. Any ventilation is better than none, and the pattern of airflow matters.

Key takeaway: See above.

“Patterns of SARS-CoV-2 aerosol spread in typical classrooms,” Building and Environment, 2021.

A group of engineers at MIT did a study on airflow and Covid in classroom settings. They found poorly-ventilated classrooms greatly increase your risk of catching Covid. They made 14 different models to simulate airflow. Basically, you want fresh air to enter a classroom at the ground level and then flow up and out through ceiling vents. They call these types of models “displacement.” The idea is to keep air moving upward, not sideways. We usually exhale warm air from our bodies, and it naturally rises. So that helps. Believe it or not, opening a window can actually disrupt that airflow and create sideways spread. If you’re going to open windows, install a baffle (basically a vent) to direct outside air downward.

There’s a good summary of the study here.

Key takeaway: Airflow matters.

“Modeling turbulent transport of aerosols inside rooms using eddy diffusivity,” Indoor Air, 2021.

A mechanical engineering professor at UC-Riverside teamed up with an atmospheric scientist to study airflow in public spaces. Their conclusions validate what the MIT group learned. Upward air ventilation works best. There’s a good summary of the study here, where the main author explains the reasoning: “Fresh air should be emitted from floor vents, while the outgoing air should be removed with ceiling vents. Such systems would allow for a continuous upward movement of air that would most expediently carry away virus-containing microdroplets exhaled by infected people.” Ventilation that pushes air sideways can make things worse.

Key takeaway: Upward airflow.

“The best and worst engineering methods to stop COVID,” It’s Airborne, 2022.

HVAC Engineer Joey Fox lists out the things everyone should and shouldn’t be doing to clean the air and reduce the transmission of viruses including Covid. For example, fogging the air is actually one of the worst things you can do. Sadly, a lot of schools (including my university) still think that helps. It doesn’t. In fact, it exposes you to all kinds of harsh chemicals. Some of the best things you can do: stand-alone HEPA filters and Corsi-Rosenthal boxes. Open windows. Upgraded ventilation. Humidifiers. Upper room UVGI systems. Joey lays it all out very clearly.

Key takeaway: You have options.

It’s time to make a stink.

This reading list scratches the surface, but it shows what scientists know. Viruses like Covid spread through the air. We should be cleaning the air just like we clean our drinking water. We already have the tools.

It would make our lives a lot easier.

We should be insisting on clean air in our offices and schools. We should be demanding it at bars and restaurants, and everywhere else. Our principals and school boards should be hiring HVAC specialists and clean air experts to figure out the best, most efficient ways to make it happen.

Politicians and pundits use the health and safety of our children as props. When we need real leadership, they’re nowhere to be found.

Our kids are not okay right now.

They deserve better.