COVID-19 part 1

Mitigating solutions to help fight the COVID-19 crisis from an engineering perspective

“Our health starts with the health of the homes or buildings we spent 80 to 90% of our time in. Unhealthy, sick homes & buildings result in sick inhabitants.”
–Erney Errol Pinas (EEP)

POINT OF DEPARTURE:

• Hospitals or nursing homes were not designed to handle the loads of bacteria and viruses as is the case now with the COVID-19 virus
• We cannot afford it to lose doctors and nursing personnel to COVID-19.
• Buildings are highly efficient at spreading disease. (Dr. J. Allen, director of the Healthy Buildings program at Harvard T.H. Chan School of Public Health)

Most of our homes and (commercial) buildings today still operate with tradtional HVAC (Heating, Ventilation & Air-Conditioning) systems that were primarily developed from a standpoint of aestatics, comfort and cost…..not human health, planet health or energy efficiency. Homes and buildings are relatively air-tight constructions and modern homes are becoming even more air-tight to increase energy efficiency. The HVAC systems, however, that run in these homes & buildings, were designed and build as re-circulation HVAC systems that re-circulate the air in the home or building, only using a small portion of outside air. Most of these climatization systems have no or poor filtering and bacteria/virus treatment systems, resulting in pumping around harmful dust particles, bacteria, viruses and other pollutants. This often results in a high level of poor indoor air quality, leading to building related triggers for a multitude of illnesses like allergies and asthma. The totality of all indoor air pollution causing health issues is commonly referred to as “sick building syndrome.” The COVID-19 pandemic has literally tipped the scale in the wrong direction with high level of contamination of this virus present in buildings such as hospitals, elderly & nursing homes, cruise-ships, prisons, etc.

Based on the current data that the COVID-19 virus is also being spread to some degree through the air (breathing, speaking), our buildings are another crucial element that need to be taken into consideration as part of the battle to mitgate/overcome the coronavirus pandemic. A holistic approach to mitigating this crisis is imperative.

As a holistic engineer & inventor of machines, equipment and installations, specialized in HVAC, indoor climate (making buildings healthier) and renewable energy for more than 30 years in Europe, Caribbean and South America, I am proposing two ways in which to help mitigate the COVID-19 crisis from an engineering perspective:

1. Bringing down the COVID-19 virus & bacterial load in hospitals & nursing homes through adaptations & expansions to the HVAC system in an effort to help reduce the risk of contamination for front line healthcare workers and patients. (INTERVENTION 1: short term – immediate execution)
   
   
2. Helping to support patients who have not yet escalated to the ICU with breathing, through controlled supply of clean fresh air and oxygen by means of designing & installing a simple central respiratory system with individual connections to each patient. (INTERVENTION 2: short term – further analysis needed)

I have carefully put this document together as a means of voluntarily contributing to helping to alleviate the COVID-19 crisis from an engineering perspective. In my more than 30 years of experience designing and helping to build technical installations for elderly homes, hospitals, hotels, airports, etc. my focus has been to maximize both the health of the buildings and thereby its inhabitants as well as the energy efficiency and thereby the health of the planet. I am hereby offering my assistance virtually, to support engineering teams of hospitals and nursing homes in the US and other countries, in order to help them design and implement the above mentioned mitigating solutions to help fight COVID-19 from an engineering perspective.

OUR BUILDINGS AND COVID-19
All areas and rooms in our hospitals and commercial buildings are designed according to certain standards. Each room in a building needs to have a certain number of air-changes an hour depending on the purpose of that room. Surgery rooms have the highest standards of air changes and air quality, with an additional recommendation of 100 % fresh air supply. In some cases, 100% fresh air is even mandatory. Although hospitals have stricter rules for air quality, none of these buildings were designed to meet the excessive virus and bacterial load of this COVID-19 crisis at hand. We must, therefore, urgently revisit the existing situation in order to enhance the indoor air quality in hospitals and nursing homes in order to help protect the healthcare workers on the front-line as well as the patients.

PRINCIPLES OF HVAC SYSTEM IN HOSPITALS AND NURSING HOME:
Central heating, ventilation and air-conditioning (HVAC) systems are normally designed as a re-circulating system with a fresh air component of only 10 to 20%. Critical areas like intensive care units and surgery rooms, however, are normally equipped with 100% fresh air systems. Traditional HVAC systems in hospitals and nursing rooms are equipped with air-handling units, long supply & return ducts and supply & return diffuses in the ceiling. The latter creates an upward flow towards the ceiling, which increases the risk of infections of medical personnel when bacteria and viruses are getting airborne, what is the case with the COVID-19 virus. To better protect doctors and nursing personnel it is of extreme importance to revisit existing HVAC systems and adapt these systems to help mitigate the risks of the coronavirus crisis.

Following is an overview of the two interventions from an engineering perspective to help combat the COVID-19 crisis. Whereas both interventions are relatively simple, fast and cost effective, intervention 2 will require more collaboration between different cross-functional specialists beyond engineering.

INTERVENTION 1: (short term – immediate execution)

Potential measures to help bring down the level of contamination of the COVID-19 virus & bacteria in hospitals (and makeshift hospitals) & nursing homes through adaptations to the HVAC system

1	Adapting HVAC system air-flow Adapt the existing air-flow of the HVAC system by installing the (air) return grills of spaces with COVID-19 patients low in the wall, so that the return air with potential load does not have an upward flow, thereby lowering the infection risk for healthcare workers as they breathe in.
2	Check for COVID-19 spores in the supply, return ducts and the drain pan of HVAC systems COVID-19 virus can get airborne and ends up in crucial parts of the HVAC system, such as in the air-handler and the supply & the return ducts. As the air-handler is circulating air on a continuous basis there is a reasonable chance of spreading bacteria and viruses throughout the systems and infecting unprotected or poorly protected inhabitants in the building.
3	If COVID-19 spores are found in the HVAC systems, fumigate all ducts and disinfect air-handler and HVAC units It is of vital importance to measure and check for bacteria and COVID-19 spores in each air-handlers system of the building, as well as in mini split units. In case bacteria and COVID-19 spores are detected, the complete system should be disinfected by a specialized company.
4	Service all air-handler and HVAC systems and disinfect coils and drain pans thoroughly Accumulation of bacteria is normal in air-handlerand HVAC units and these bacteria can be spread to the duct system, reason why it is extremely important to service and disinfect air-handler and HVAC systems periodically. In times of high risk for infections as is the case with COVID-19 now and the overcrowded hospital conditions, it is imperative to clean air-handler coils and drain pans more often. Normally air-handler and HVAC units are serviced and disinfected twice to 4 times a year depending on the use, but in this case with the COVID-19 crisis it is worth considering a monthly or even a bi-weekly service and disinfecting sequence.
5	Install UV lamps in ducts to kill of bacteria and viruses It is well known that Ultraviolet (UV) lamps (ultraviolet germicidal irradiation-UVGI) are used in the industry to kill of bacteria and viruses, however, in most hospitals and nursing homes HVAC installations, these UV lamps are not installed. With the COVID-19 pandemic, installing UV lamps in the supply ducts from the air-handlers or HVAC systems can help to mitigate the risk of infection in the building. These lamps have a high irradiation rate and are more effective than other type of UV systems. Another option is using high mounted or mobile UV lamps in the room with COVID-19 patients.
6	Install HEPA filters at supply and return diffusers Even if you have the best filters on your air-handlers, there will always be very small particles that will float with the air through the duct system. These participles can jeopardize the respiratory system, especially for people with compromised airway systems and COVID-19 patients. High quality HEPA (U17) filters, however, can filter most small particles out of the air up to .1 micron and thus help mitigate this COVID-19 crisis. HEPA filters at the supply grills will keep small particles, bacteria and viruses from entering the living space in the building, while HEPA filters on the return grills will prevent small particles, bacteria and viruses from the contaminated spaces in the building to enter the air-handler systems. These high grade HEPA filters thus greatly mitigate the further spread of small particles, bacteria and viruses such as the COVID-19 in the building.
7	Install additional 100% fresh-air air-handling systems in all areas where COVID-19 patients are located The most important rule for enhancing air quality in buildings, especially hospitals and nursing homes is filtration and diluting of the contaminated indoor air by introducing fresh outside air. The latter is of vital importance now with the crowded hospitals and the heavily contaminated inside air. Hospitals should consider installing additional fresh air units in all areas where COVID-19 patients are located. The system should lay a blanket of fresh air from the ceiling, with return options 4 to 10 inches lower than the bed of a patient, creating a downwards air flow. The system needs to have a proper air-handler with the filter system, the proper cooling coil, UV lamps and an anti-bacterial duct system.
8	Put areas of COVID 19 patients under negative pressure It is important to contain airborne viruses and bacteria in one area and prevent them from spreading throughout the building. This is the reason why there should be a proper pressure regime in the building, whereby the area with COVID-19 patients is placed under negative pressure.

INTERVENTION 2: short term – further analysis needed

Design and install an efficient 100% fresh-air and oxygen supply system, with controllers at each patient’s bed to help less severe COVID patients with breathing. This in an effort to help mitigate escalations to the ICU.

The short history of the COVID-19 crisis has taught us thus far that most cases are relatively mild, yet, creating lots of discomfort and breathing problems for patients. At the same time some cases are quite severe, and patients need to be hooked up to a ventilator. Our systems and equipment in the hospitals are almost at capacity due to COVID-19 and it is difficult and often impossible to handle new patient. This situation will get worse throughout the country and the world, especially with the huge shortage of ventilators. The hospitals and nursing homes were not designed to handle the level of contamination we see right now with the COVID-19 pandemic, and so our buildings are now also part of the problem. To ease the pressure on the medical staff and the limited resources such as ventilators, high air quality air-handler system and oxygen systems can be installed in hospitals to take care of the mild and less severe COVID-19 cases. These temporary central systems, working with 100% filtered clean fresh air, will deliver air with a pre-determined temperature, pressure and relative humidity through a central supply and return duct system. Each bed is connected to the central system via flexible tubes, filters and valves. At each bed a controller (small computer) is installed that processes information from pressures sensors, temperature sensors, etc. and controls the valves for the air and oxygen supply to and from the patient. Therefore, a mixture of fresh air and oxygen can be provided depending on the need of each patient.

The functionality and applicability of this initiative, however, needs to be further analyzed within a larger group of expertise, including medical specialists. If proven applicable from a medical standpoint, this initiative can be executed in a relatively short period of time and may serve as a preventative approach to help mitigate the corona crisis by helping the less severe patients from further escalating to ICU status.

For more a visual overview on INTERVENTION 2,
see illustration below:

Conditions and requirements for success for INTERVENTION 2:

• Gathering a holistic team consisting of:
  • One medical specialist/engineer (respiratory systems)
  • One holistic engineer with specialized in HVAC and indoor climate (EEP)
  • One HVAC engineer
  • One system programmer with experience in HVAC controllers and internet of things (coding)
  • One procurements engineer
  • One HVAC contractor
• Available budget to execute the intervention

Finally, I note that besides hospitals and elderly homes, HVAC installations of prisons, law enforcement buildings, fire brigade departments, cruise ships, military ships & bases and churches are most often functioning as re-circulation systems and should therefore be re-visited, especially during this COVID-19 pandemic.

CALL TO ACTION:

As part of having worked & done business in various parts of the world, including the USA, Europe, Caribbean, South America, Asia and parts of the middle East, I’ve had the opportunity to study many buildings and technical installations in these areas of the world. From my experience, I can confidently state that the indoor air quality issues in buildings are not just a problem in the USA, but world-wide…..as is the Corona-virus pandemic. In this article, I propose two short-term initiatives and I am reaching out to fellow experts in the US and the world to come together to holistically look at how we can help to mitigate the COVID-19 crisis from an engineering perspective.

I am volunteering my services to support engineering teams of hospitals, nursing & elderly homes, prisons in the US and other countries, in order to help them design and implement the above mentioned mitigating solutions to help fight COVID-19 from an engineering perspective. I am looking for others willing to participate in this initiative.

Finally, I appreciate your help in spreading this message to relevant stakeholders such as governors, mayors, hospital & nursing home directors, etc. to help with mitigating the corona-virus crisis from an engineering perspective. as we’re running out of time.

DISCLAIMER: Although the guidelines in this document are crafted with great care, I nor my company take any responsibility or liability, whatsoever for the way this document or any part of it is used by third parties. This document is aimed at decision makers in government positions, at hospitals and in nursing homes who are responsible for handling the COVID-19 crisis and other respiratory problems.