Making Confidence Our Travel Companion - Part Two

Claire Bird  00:03

 

Welcome, everyone. As you join us to discuss experiences and gain knowledge on how we can keep ourselves and others safer when we travel, we will delve into public and individual responses to travel, especially in these times when workplaces are continually changing. Many face pressures, whether it’s to work from home or to commute. I’m Claire Bird, the executive secretary of IBEC, which stands for the Integrated Bioscience and Built Environment Consortium. Our consortium, a global team of specialist advisers on pathogens and their interactions with buildings and people, was conceptualized by Ted Cowan. Today, however, we have Ken Martinez in his stead. Together with Ted’s brother, Tony Cowan, and Dr. Jayne Morrow, they formed the core executive committee of IBEC.

In these times of rapidly changing indoor air quality conditions and disease spread dynamics, especially with COVID, IBEC has taken proactive steps. We aim to promote safer indoor spaces by providing credible information about safer indoor air. IBEC remains committed to elevating public awareness about the science of pathogen transmission prevention. We’ve made significant strides by gathering global experts from various fields. IBEC collaborates extensively with several organizations globally. Together, our collective aim is to enhance the public’s understanding of pathogen spread in built structures.

In our early days, we worked in partnership with the American Industrial Hygiene Association to create the CDC-funded Commit to C.A.R.E. package. This initiative encourages individuals and organizations to pledge to reduce COVID-19 spread in their workplaces. It has gained immense support globally from diverse professional bodies. Two of our latest collaborators are the Indoor Air Quality Association and the Australian Institute of Occupational Hygienists, who are represented today. We are delighted to have Dr. Laurie Glossop, Luke Von Oldenburg, and Mitesh Kumar with us. Unfortunately, Dr. Melissa Marot couldn’t join us today due to unforeseen personal circumstances.

Back in 2020, at the onset of the COVID-19 pandemic, IBEC launched its first of two C.L.E.A.N. summits, reaching over 1200 participants from 16 countries. Our second summit in 2022 focused on vulnerable workers and their challenges. Today’s session is a continuation of that program, aimed at empowering individuals with knowledge and insights. In past sessions, we’ve discussed the economic and psychological impacts of the pandemic and today, our focus shifts to public transport. With that said, I’d like to hand over to Kenneth Martinez, our moderator for today.

 

Kenneth Martinez  04:40

 

Good evening to our US audience and a warm good morning to friends from other parts of the world, including Australia and India. I appreciate this global collaboration and eagerly anticipate our discussions. As Claire pointed out, I serve as the Chief Science Officer for IBEC and have been associated with it since its inception. With a background in industrial hygiene and environmental engineering, I’ve spent over 30 years with the National Institute for Occupational Safety and Health, working on indoor air quality and exposure to biological agents, which, of course, includes infectious diseases. Given the current challenges posed by SARS-COV-2, COVID-19, and now even monkeypox, my association with IBEC feels all the more relevant.

This session, the second in a two-part series on public transportation, will delve into understanding personal risks associated with traveling. We will explore the struggles faced by transportation networks in countries like Australia and the USA, contrasting it with the unique situation in Singapore. Our goal is to equip everyone with the knowledge they need for safer travel on buses, trains, and aircraft. We will ensure both sessions are available for a few days for those who missed them. As we proceed, feel free to drop questions in the chat box. After the introductions, we’ll engage in a Q&A with the panelists and address questions from our audience. Sadly, Dr. Melissa Marot couldn’t join us, but our thoughts are with her as she deals with a family emergency. Now, I’d like to introduce Luke Von Oldenburg. Luke, could you share a bit about yourself and your work?

 

Luke Von Oldenburg  07:51

I am Luke Von Oldenburg. Like Ken, I’m a certified industrial hygienist and an environmental chemist. Additionally, I serve on the National Board for the Indoor Air Quality Association as the Secretary and am part of the education committee. I’m also a certified safety professional. I’ve been working hands-on in the corporate world, addressing the challenges posed by the pandemic and interacting directly with our staff and clients. I’m here to share my experience and knowledge. Thank you.

 

Kenneth Martinez  08:48

Malala, can you bring Luke onto the screen? Thank you. Laurie Glossop, could you introduce yourself and share a bit about your background?

 

Laurie Glossop  08:58

Hello, everyone. I’m speaking from Perth in Western Australia, the world’s most isolated capital city. Due to our isolation, we went almost two years without any COVID cases. However, we’re now grappling with the virus like many other places, and more than 50% of our population has been affected. I’m a certified occupational hygienist with the Australian Institute. In the context of COVID, I’ve conducted numerous assessments related to ventilation risks. I’ll delve into this more later and hope it provides some insights. Thanks to the other panel members. Back to you.

 

Kenneth Martinez  09:55

Thank you, Laurie. Lastly, from the Indoor Air Quality Association, we have Mitesh Kumar from Singapore. Mitesh, following the example set by our previous panelists, could you tell us about yourself?

 

Mitesh Kumar  10:16

Certainly. Hello, everyone. My name is Mitesh Kumar. I currently serve as the chapter director for the Indoor Air Quality Association based in Singapore. Professionally, I’m an environmental health and safety consultant and have worked on various projects across Singapore and Southeast Asia. Thank you.

 

Kenneth Martinez  10:41

Thank you, Mitesh. Now, as we transition, each of our panelists has prepared a presentation to contextualize our forthcoming discussion. I believe we’re starting with Luke. Is that right?

 

Luke Von Oldenburg  11:19

Actually, I didn’t prepare a presentation for this specific discussion. However, I can share some experiences from the southeast of Atlanta. One of the challenges we faced was the diverse cultures and family orientations of our workforce. While we could control the spread in the workplace, once employees went home, we had little control, leading to more cases from family gatherings. Another challenge was the inherent rebellious nature of the US. In some ways, trying to enforce guidelines here is like instructing teenagers without parental guidance. This became evident when pushing for masks or vaccinations. The CDC, located in Atlanta, also had inconsistencies in their data and approach. Recently, they admitted shortcomings in their response to the pandemic. Sometimes, it felt that larger organizations like the CDC or WHO were influenced politically, causing delays in accurate information dissemination.

 

Kenneth Martinez  14:56

Thank you, Luke, for sharing that perspective regarding the US. Mitesh, could you give us a broader context of your experiences in Singapore?

 

Mitesh Kumar  15:13

Of course. Much like what Luke described, Singapore transitioned from focusing on surface-bound to airborne transmission of COVID-19. At first, the public’s response was chaotic. We observed varied adherence to mask mandates, especially among the youth. However, Singapore’s size and strict governmental regulations helped control the spread efficiently. Families faced a significant adjustment, especially with mandates to wear masks outside and in public areas. Despite initial challenges, the spread has been controlled, and there are currently no more spreading cases in Singapore.

 

Kenneth Martinez  17:14

Thank you, Mitesh. Laurie, I understand you have a short presentation you’d like to offer?

 

Laurie Glossop  17:22

I wanted to see if I could share a photo that shows the inside of a train during a football event. It clearly indicates a lack of social distancing and absence of masks or respirators. Just a brief introduction about myself: I’m a certified occupational hygienist and have conducted numerous COVID ventilation risk assessments in Western Australia. Our health department mandated assessments for all our quarantine hotels in Perth. Out of the 10 quarantine hotels, some were suitable while others were not. The only instances of community spread of COVID were within these hotels. Additionally, I’ve evaluated our tertiary hospitals, four in total, to determine measures to reduce the risk. Another challenging environment was our prisons. Western Australia has a vast landscape, and our prisons are spread over 2000 kilometers. I’ve assessed these facilities, ranging from high to medium and low security. Interestingly, the highest risk wasn’t posed to the prisoners but the prison officers working there. I’ve also collaborated with major companies like Rio Tinto, especially with their remote operation centers. I’ll touch on that shortly.

Regarding a recent graph, it compared public transport use to private transport before and during the pandemic. Before COVID, public transport was significantly more popular than private cars. However, recent data shows a decline in public transport use and a surge in private car usage, marking a 400% shift in transportation preference. Our goal is to revert to pre-pandemic transport choices.

Speaking of Rio Tinto’s operation center, workers here operate mines located 1500 kilometers away. The room houses over 100 people and is equipped with air supply grills on the floor, designed not for COVID but due to heat from the numerous monitors. These grills offer excellent ventilation as they create individual air streams for everyone, with vertical airflow from the floor to the ceiling.

Another project I was involved in concerned our ambulances in Western Australia. They have two air conditioning units: one in the driver’s cab and another in the patient compartment. Using smoke tests, I’ve observed that the air flows from the top-back to the front-bottom, extracting right beside the patient’s head. Remarkably, the half-life of the smoke is only 15 seconds in these ambulances. Initially, this design was to protect paramedics from the effects of anesthetic gasses. These ambulances offer outstanding ventilation. With that, I’ll pass the discussion back to you, Kenneth.

 

Kenneth Martinez  25:47

Thank you, Laurie. Now, I’m curious about the travel experiences across Singapore, Australia, and the US. We’ve prepared some questions but welcome the audience to submit theirs. Mitesh, can you share how public awareness about infection risks has changed pre and post-pandemic?

 

Mitesh Kumar  26:26

Thank you for the question. Before COVID, the situation was what we refer to as “pre-COVID normal.” This means everyone moved about as they usually did, often in groups of four, five, or six. They weren’t practicing social distancing, which requires keeping at least one meter apart from one another. This was the case whether they were family, friends, or at social gatherings. When traveling on public transport, like buses, MRTS (which stands for mass rapid transport system), taxis, or cabs, the same lack of distancing was evident.

However, during COVID, things changed drastically based on government regulations. We were mandated to wear masks and maintain social distance. For instance, on buses with several seats, we could only occupy every alternate seat, ensuring we weren’t sitting close to each other. There were a few exceptions. A mother with her small children or an elderly couple could sit together. But, in general, everyone was expected to adhere to social distancing protocols. Furthermore, commuters weren’t allowed to speak during their journeys, even if it lasted 15-20 minutes and even if they were wearing masks. This was to prevent the potential spread of droplets or infectious particles in public transport, be it buses, taxis, or MRTS. That covers it from my end.

 

Kenneth Martinez  28:33

Thank you, Mitesh. Alright, Luke, let’s turn to you with the same question. How aware do you think the traveling public was of infection risk both before and after the pandemic, especially in the US?

 

Luke Von Oldenburg  28:44

Certainly, and thank you. Prior to the pandemic, most individuals perceived such risks as mere annoyances. For instance, travelers might have been concerned about contracting a cold or perhaps the flu. Such illnesses would inconvenience them for a week or two, but there wasn’t widespread panic or fear. Instead, any frustration was generally directed at the person believed to have transmitted the cold or flu. The sentiment was more about irritation rather than genuine fear for one’s life.

However, post-pandemic, the mood shifted dramatically. People became panicky and were often on edge if someone stood too close or seemed to be intruding on their personal airspace. A significant part of this reaction can be attributed to the initial lack of clear information about the virus—how it spread, the exact dangers it posed, and so on. In situations where individuals weren’t sure about the risks, many tended to assume the worst and act out of heightened fear. As a response, transport systems, like the ones Mitesh mentioned, implemented controls. For instance, buses adopted alternate seating arrangements, airplanes didn’t use the middle rows, and company vehicles limited occupancy to one person at a time. Previously, it was common to have two or three individuals in the same vehicle. With services like Uber or Lyft, drivers installed makeshift plastic or Plexiglass barriers. Passengers were no longer allowed to sit in the front next to the driver, and windows were often kept slightly open to ensure fresh air circulation. Yet, even with these measures, not everyone felt safe using such modes of transportation. Many transport services saw a decline in use, both because people felt unsafe and because many workers opted not to report to work, making it challenging to operate the vehicles. I’ll stop there and hand it over. Thanks again.

 

Luke Von Oldenburg  30:41

Thank you, Luke. Laurie, how about the Australian experience with the rest with a regard to risk awareness.

 

Laurie Glossop  30:49

I just said, putting in background again, as I said, Where I come from, for two years, we didn’t have COVID. So at the beginning, yes, there was a lot of people wearing masks or respirators, that seems to be a distinction here, people say mask, and that’s a surgical mask, which in terms of protecting other people, that probably helps but not for the person who’s wearing the surgical mask. And so we battle all the time to get people to wear, what we call the P two or an n 95. respirator. But certainly in high risk places like aged care, or hospitals, etc. People are wearing an N 95 masks. So in terms of public transport, for that two years where we didn’t have anything, I suppose people were getting used to the idea of wearing a mask and traveling. And what we’ve seen is that a lot of people were then asked to work from home. So the number of people on public transport was really low. So if you weren’t traveling on public transport, the risk was low, because we didn’t have the density of people, there was usually rows between people. But one thing that we did know and as with as the as the pandemic went ahead, people who were young, have decided in their mind that there’s no serious risk from COVID, that they’ll get it. It’s nothing more than a cold, and we’ll get over it. But people will like me, in that old age bracket, they are essentially some of them very paranoid about getting infected. And they’re the ones who are wearing respirators. And so now in Western Australia, it’s mandatory still to wear a respirator in public transport. So if you’re still traveling on a bus or a train here, you still have to wear a respirator. But as I said, at the moment, the only people that seem to be fearful, the people who are elderly, anybody less than, say 50 years of age, they’re treating this as being no worse than a cold. Historically, people maybe were concerned if somebody was coughing they would move away from somebody. But now if you’re coughing, everybody will look at you and say, Why are you here? So things are certainly changed. But at the moment, it’s really only required to wear respirators in public transport, aged care. And in high schools and high schools, you still need to wear a respirator. 

 

Kenneth Martinez  33:24

Let’s delve deeper into that topic. As a certified occupational health professional, do you think this has implications for preventing the occupational transmission of the disease, especially concerning those actually in the transportation service industry, like bus drivers and flight attendants? How did this situation impact them?

 

Laurie Glossop  33:48

Certainly, many of these individuals were directly in the line of fire. When we discuss population density, several of these environments, especially in the airline industry, are highly congested. Planes, in particular, pack people closely together, posing a significant risk to those working in the sector. We observed that a considerable number of these workers contracted COVID early in the outbreak. However, when it came to bus services, the impact on drivers was noticeably less severe. One possible reason might be that drivers are often separated from passengers by some barrier and have independent ventilation systems.

Presently, in certain areas, wearing a respirator is still mandatory. Yet, when I visit shopping centers, it seems the only individuals wearing respirators are those around my age or older. Many no longer view COVID as a personal threat. In the employment sphere, I’ve noticed that numerous employers continue to encourage remote work. This indirectly implies that commuting to work and being at the workplace carry inherent risks. So, currently, a significant number of individuals opt to work from home if their jobs permit. This reluctance to return to physical workplaces underscores the hesitation many feel about using public transport. I hope that provides some clarity.

 

Kenneth Martinez  35:24

Thank you, Laurie. Luke, as an industrial hygienist, How has your profession been engaged? Have you been approached by those in the transportation industry to provide guidance counseling on control issues? 

 

Luke Von Oldenburg  35:39

Certainly. Initially, representatives from various offices who were keen on ensuring the operational safety of planes, buses, and trains reached out. Their primary concern was guaranteeing the safety of their personnel. Subsequently, their focus shifted to the systems in place. Specifically, airlines were altering their air filtration systems. Their objective wasn’t just to enhance safety but also to assure passengers that flying was safe. They emphasized that while a plane is in operation and its air is being filtered, there are minimal risks. However, one aspect they didn’t highlight enough was the air quality during boarding. When passengers stow their luggage in overhead compartments, the plane’s filtration system isn’t fully operational. This necessitated the implementation of mandatory mask-wearing, a directive that met resistance from a section of passengers who eagerly anticipated a return to mask-optional scenarios.

This predicament wasn’t exclusive to airlines. Be it any mode of transportation or even public places like restaurants, the challenges remained consistent. In many areas, displaying a vaccination card became a requisite, not as an absolute safeguard but as a risk reduction measure. Drawing an analogy, a medical professional recently told me to view COVID vaccinations like seat belts. While seat belts can mitigate the severity of injuries during car crashes, they don’t prevent accidents from occurring in the first place. Hence, expectations need to be tempered.

 

Kenneth Martinez  38:09

Mitesh, the same question to you from the Singapore perspective. How did you and your colleagues address the occupational workforce within the transportation industry? Did they reach out to you?

 

Mitesh Kumar  38:24

Yes, Kenneth. So for us, our approach was rooted in the hierarchy of controls, which I believe is familiar to many as an inverted pyramid model. We initiated with PPE. In this context, PPE primarily referred to masks. Initially, we utilized surgical masks, but we also transitioned to respirators like the N95 masks Laurie mentioned. However, we’re currently reverting to the surgical mask protocols. That’s one aspect rooted in PPE.

In terms of administrative controls, we emphasized cleaning and disinfecting high-touch points in public transport. This encompasses areas like the buttons passengers press to signal bus stops, surfaces in the MRTS, escalator handles, and elevator buttons. These high-touch areas underwent daily cleaning. Transport operators, be it bus drivers or MRT operators, were equipped with daily test kits. Each day, before starting their shifts, they needed to conduct a test and present the results. If they displayed any symptoms or felt unwell, they weren’t permitted to operate their respective vehicles or systems.

Then, we explored engineering controls. Our emphasis here was on air quality. We ensured the air filtration systems were rigorously maintained. In administrative transport offices, air purifiers were installed. Regular comprehensive cleaning was conducted for buses and the MRTS. So, drawing from the hierarchy of controls, we implemented a myriad of measures to ensure as much safety as possible.

 

Luke Von Oldenburg  40:27

Ken, interestingly, one challenge we encountered was an overflow of controls. People perceived this as a business opportunity and started pitching to the transportation companies we were consulting with. They’d say, “Here’s our miraculous air cleaner. This will help.” Given the panic, many were desperate for solutions, and we often had to advise them against certain investments. While these products might work in theory or in a controlled lab environment, they wouldn’t in real-world settings. Thus, we sometimes found ourselves in the unpopular position of advising against what they wanted to hear.

 

Laurie Glossop  41:23

As the pandemic commenced, there was substantial focus on hand sanitizing and similar preventive measures. But as our understanding of COVID developed, especially in the UK, we recognized its primarily aerosol transmission. Based on my observations, I’m confident that large air handling units, like those in quarantine hotels or hospitals, don’t facilitate virus spread from one floor to another. This insight is valuable as people return to work. However, when it comes to public transport, it’s a different story. Their air conditioning systems aren’t designed with this in mind. Consequently, for those in our profession, we must continue advocating for the use of respirators and masks. Making modifications to public transport systems to cater to these needs might be so extensive that it would be akin to rebuilding them entirely.

 

Kenneth Martinez  42:37

Okay, pardon me for a moment. Let’s shift our focus to the present. In the US, there’s a perception that COVID-19 is largely behind us, and that we’re seeing a light at the end of the tunnel due to vaccinations. However, currently, only about 65% of the US population is fully vaccinated, and even fewer have received their first booster shot. While vaccination is of paramount importance, it doesn’t guarantee 100% protection. We’re witnessing breakthrough infections in vaccinated individuals, partly because of Omicron’s capability to bypass our antibody defenses. Given this backdrop, my question to you is: based on your local experiences and observations, do you believe the general public comprehends the transmission risks associated with COVID-19 and how to mitigate them, especially on public transportation? Luke, could you start us off?

 

Luke Von Oldenburg  43:45

To be frank, the public in my area seems to have a limited grasp on this issue. Currently, wearing masks on public transport, be it surgical or N95, is more of a recommendation than a requirement. When my wife and I use public transport, for instance, to attend our local soccer (or football, for some) matches, our observations suggest that maybe only 25% of passengers wear masks. The majority appear to operate under the assumption that the threat has diminished or that COVID-19 is now just a mild illness, akin to a common cold. This is far from the truth. My wife, who had contracted COVID in 2020, recently got infected again despite being boostered [sic]. This underlines the fact that the virus is still prevalent and poses significant risks. Part of the problem might be the inconsistent or ambiguous information available on platforms like the CDC website, or the reduced media coverage which might lead people to believe the pandemic is over.

 

Kenneth Martinez  45:15

All right, Laurie, I’d like to direct the same question to you concerning the awareness of risks in today’s context based on your experience.

 

Laurie Glossop  45:26

Indeed, as I mentioned earlier, the elderly population seems to have a keen understanding. When it comes to aged care, there were protocols like requiring rapid testing before entry, mandatory use of respirators, and limitations on visitors, allowing only two per day. Therefore, especially among the elderly, I perceive a heightened risk awareness. I also believe they recognize the primary mode of COVID-19 transmission is airborne or aerosol. While COVID might persist for a while and eventually become akin to a common cold, it’s essential to note that people are still dying. In Australia, we’re currently seeing approximately 100 COVID-related deaths per day. A significant portion, about 95%, are individuals aged 70 and above. Another vital point is the potential for reinfection. Emerging studies suggest that with each subsequent COVID infection, the risk of developing long-term symptoms, or “long COVID,” increases. Thus, even if someone previously had a mild case, the next infection might have more severe implications. Long COVID, experienced by an estimated 5-10% of COVID patients, will likely be a pressing concern moving forward, and it’s crucial to prevent reinfections.

 

Kenneth Martinez  47:10

Understood. Laurie, I find it remarkable that your state didn’t encounter COVID until two years into the pandemic. With that context, do you believe this delay enhanced your ability to communicate risks when borders opened, cases surged, hospitalizations increased, and daily deaths reached around 100, as you mentioned? Or are you grappling with similar messaging challenges that we’re facing in the US?

 

Laurie Glossop  47:44

I suspect the messaging challenges are universally shared. As I highlighted, there’s a demographic, notably the elderly, who are more engaged and recognize their heightened risk of severe outcomes, possibly even higher transmission likelihood. However, it’s interesting to note that in Australia, when examining infection rates, the elderly have the lowest percentages. The age group with the highest infection rates is the 30-39 bracket. This suggests that risk communication effectively reached the older population, but perhaps not the younger ones. Would that answer suffice?

 

Kenneth Martinez  48:36

Yes, thank you for that, Mitesh. I’d like to direct the same question to you. Considering the current environment, do you observe that people have a sense of an end to COVID? Are we past the worst of it? Or are individuals still recognizing and acting on the risks at hand?

 

Mitesh Kumar  48:54

I appreciate the question, Ken. When considering awareness among different age groups, young adults and teenagers seem to be quite informed about the ramifications of COVID-19. They are well-versed in the usage of masks and other PPE measures. The elderly, too, have been educated, especially through the government’s initiatives designed for those who might not be literate, which include templates and other informational resources. However, I’ve noticed a distinct gap between awareness and actual behavior. While there’s widespread awareness, largely owing to the ubiquitous information on social media, television, and other platforms, the behavior does not always align. For instance, wearing a mask is essential in public transport, but the adherence to proper mask etiquette is inconsistent. I’ve observed elderly individuals whose masks might slip below the nose or those who might altogether forget to wear them. So, while there is extensive awareness in places like Singapore, given the two-year barrage of information across all media outlets, there’s a behavioral gap that presents a challenge.

 

Kenneth Martinez  50:37

Mitesh, I’m grateful for your insights, especially regarding the divergence between risk awareness and behavior. This is a crucial distinction. To pivot slightly, given that a small percentage of individuals tested positive for Omicron (56% in one report) were unaware of their infection, what are the primary precautions individuals should adopt while traveling to either prevent contracting COVID-19 or transmitting it if they’re carriers? Laurie, let’s begin with your perspective.

 

Laurie Glossop  51:20

Indeed, the conventional guidelines about maintaining distance remain vital. But, understandably, distancing can be challenging on public transport given its design. In such cases, wearing protective gear becomes paramount. While surgical masks have their merits, as an occupational hygienist, I’d assert that their primary design was for surgical settings—to prevent surgeons from infecting patients. For individual protection, the best option would be an N95 respirator, known as P2s in Australia. As Mitesh mentioned earlier, we advise individuals on public transport to minimize speaking because conversing could compromise the mask’s efficacy. Therefore, practices like remaining silent and avoiding direct face-to-face interactions can serve as critical controls in such settings.

 

Kenneth Martinez  52:28

Luke, let’s shift to you with the same question. Oh, Luke, you’re on mute. Ah, the joys of pandemic video conferencing.

 

Laurie Glossop  52:42

It happens to all of us. I completely concur with Laurie that a properly worn N95 mask is highly effective. Granted, cloth masks and surgical masks might not be as protective, but they still offer some protection, mainly for those around the wearer. Another aspect people often overlook is protecting their eyes, given how vulnerable and sensitive our eye tissues are. While the skin isn’t a significant concern, and hand sanitizers might not seem essential for COVID-19, they have effectively reduced instances of colds and flus. I always emphasize the importance of good hygiene. If one’s immune system is compromised by a cold or flu, they might be more susceptible to COVID-19. Therefore, I continuously promote hand washing and using sanitizers.

 

Kenneth Martinez  53:44

Luke, that’s a valuable observation. The broader scientific consensus is that while airborne transmission is the primary mode for COVID-19 spread, other means of transmission, like from surfaces to hands and then to eyes, still exist. They might not be the predominant ways, but they’re still plausible. Potensial, let’s pivot to you with the same question.

 

Mitesh Kumar  54:16

Thank you, Ken. I find myself in agreement with both Luke and Laurie. When it comes to awareness and behavior, there’s a clear divergence. While there’s ample knowledge about the various modes of transmission – be it airborne or surface contact – the challenge lies in individuals’ actions. In today’s digital age, most people are connected to social media, which can be both a boon and a bane. While there’s a plethora of valuable information available, there’s also misinformation, like claims denying the existence of COVID-19 or promoting the idea that some are naturally immune. However, even with accurate knowledge, many tend to forget or neglect best practices in social settings. This behavior gap has contributed to spikes in COVID-19 cases, as we’ve observed in Singapore and across Southeast Asia. That’s my perspective on the matter.

 

Kenneth Martinez  55:22

Thank you for sharing. In the US, as businesses begin to reopen, there’s an ongoing debate about returning to the office. Some are concerned about potential exposure to COVID-19, while others believe they’re just as productive working from home. My question is: How have employers responded to requests to work from home due to apprehensions about returning to public transportation? Laurie, I’d like to start with you since you touched on this topic in your presentation, highlighting the shift from public to private transportation during the early pandemic days.

 

Laurie Glossop  56:10

Thank you, Ken. Addressing this issue is challenging. There’s a prevailing mindset suggesting inherent risks associated with public transport and office spaces. Many employers are still advocating for remote work, reinforcing the notion of these perceived dangers. While some individuals prefer the remote setup, others miss the interpersonal interactions of an office environment. It remains uncertain when employers will universally encourage a return to office spaces. For instance, my two sons have been requested to work on-site, yet a significant portion of the workforce remains remote. This dynamic further amplifies the ongoing risk perception.

 

Kenneth Martinez  57:18

Thank you, Laurie. Mitesh, turning to you, can you shed light on the situation in Singapore? How are employers there handling the return-to-office transition?

 

Mitesh Kumar  57:30

Certainly, and thank you for posing this question. In Singapore, our experience differed. Initially, due to government regulations at the onset of COVID-19, everyone was mandated to work from home. However, as the situation improved and case numbers dwindled, the government allowed a phased return to the workplace, increasing from 25% to 50%, and now at approximately 80% of the workforce. There’s also a flexible work scheme in place, where employers offer options for employees to work two or three days from home and the remaining days in the office. This flexibility extends to allowing some administrative roles to operate entirely remotely. Conversely, positions like sales or business-critical roles might require more office time. Overall, there’s a harmonious understanding between the government and both the public and private sectors, ensuring no one feels compelled to return to the office against their will.

 

Kenneth Martinez  58:50

Thank you, Mitesh. Luke, considering our interactions with many federal agencies, I’ve noticed they’re adopting what Mitesh described as a hybrid work model, balancing days at home and the office, and showing greater leniency towards remote work. As the Indoor Air Quality Association, I presume corporate America has approached you with questions about navigating this shift. Can you share your perspective?

 

Luke Von Oldenburg  59:20

Certainly. We’ve received inquiries about protecting employees, determining if they should work from home, ensuring their safety in office environments, and then addressing the challenges of having them return. One intriguing observation was employees’ concerns about COVID cases in their offices. Many heard about colleagues contracting the virus and began demanding the option to work remotely. Here in the United States, we have the Occupational Safety and Health Administration (OSHA). Their general duty clause stipulates that the work environment should be free from recognized hazards causing or potentially causing death or severe physical harm. COVID-19, being a proven lethal threat, meant many office environments couldn’t ensure safety. Some employees referenced this clause, requesting remote work until a safe office environment was guaranteed. Employers sought frequent testing, but testing only indicates one’s COVID status at that specific moment. Despite advancements in HVAC systems, we can’t guarantee continuous safety. This places industrial hygienists like us in a challenging position. Although the frequency of COVID cases has decreased and employers wish to monitor their staff in-person, the Omicron variant surge reminded everyone of the persistent threat. Thus, while employers would ideally have everyone back, their insistence has weakened.

 

Kenneth Martinez  1:01:36

Thank you for that insight. Laurie, I have a specific question for you concerning occupational groups like school bus drivers and ambulance drivers. Have you observed any significant trends or monitoring efforts targeting these professions?

 

Laurie Glossop  1:02:03

Yes, several organizations are meticulously tracking COVID cases among these groups. Another concern is the protective measures in place when they return to work. In some workplaces, wearing a respirator is mandatory, leading to resistance, especially from those working long shifts. I often wear a P2 mask during my visits to certain facilities, like hospitals, where fit testing is required. While I’ve passed these tests multiple times, many individuals, especially in aged care facilities with a significant number of small-statured migrant workers, struggle to find a suitable fit. Could you please reiterate your question?

 

Kenneth Martinez  1:03:13

Yes, I’m specifically inquiring about certain occupational workforces. Are there monitoring efforts in place for bus drivers and ambulance drivers? Have there been any notable increases in cases among these groups, or is that data not readily available?

 

Laurie Glossop  1:03:28

That data is indeed available. What’s been observed, especially with ambulance drivers, nurses, and those working in aged care, is that those contracting COVID are not primarily being infected at their workplaces. Instead, they’re contracting the virus within their communities. This suggests that the protective measures in workplaces are relatively effective, given that a significant percentage of infections aren’t happening on the job but in community and familial settings.

 

Kenneth Martinez  1:04:00

Thank you for sharing that. Mitesh and Luke, I have a similar question for both of you. Mitesh, let’s begin with you. Is your nation concentrating on specific occupational groups, particularly now that public transportation is becoming more active again?

 

Mitesh Kumar  1:04:17

Yes, initially, for instance, every public transport operator was mandated to use an ARP test kit, which I believe most are familiar with. Additionally, they were required to undergo a PCR test monthly to verify their COVID-free status. There were also administrative protocols in place, like if an individual exhibited symptoms such as a high fever or flu-like symptoms, they were advised not to report to work but to self-quarantine. Once their symptoms subsided, they could return to their duties. Currently, in Singapore, these protocols are still enforced. We did observe a surge in cases among public transport workers, especially bus operators, but those outbreaks were managed, and currently, the situation seems stable.

 

Kenneth Martinez  1:05:30

And Luke?

 

Luke Von Oldenburg  1:05:31

To be succinct, no. What’s transpired is a decline in the strict measures that were once in place. Like Mitesh mentioned, we too had a procedure where public transportation workers were screened daily for symptoms and had to complete a health questionnaire. They also had their temperatures checked at the start of each shift. If any concerns arose, testing kits were available on-site. However, these rigorous measures have waned. While the kits are still available, the enforcement isn’t as stringent. I’ve noticed some bypassing the temperature checkpoints. If someone feels unwell, they might or might not disclose a COVID diagnosis when taking time off. If they do inform us, we attempt to gather more details for contact tracing, considering who they’ve interacted with, despite some limitations imposed by HIPAA regulations. Regrettably, there’s been a general relaxation in attitudes, which I fear might have repercussions.

 

Kenneth Martinez  1:07:04

Thank you. I’d like to pivot to questions from the audience, as we want them to know that we’re being responsive to their concerns. Given the global outbreaks of multiple emerging and re-emerging communicable diseases, such as the monkeypox, which is currently a public health emergency of concern, and the detection of poliovirus in the wastewater systems of some municipalities, where do you think the transportation sector requires more support or improvements for better preparedness and response? I invite any of you to answer this question.

 

Luke Von Oldenburg  1:07:48

In my opinion, we need to offer better training. We should clearly guide our staff on the necessary personal protective equipment (PPE) to wear. Considering they work with the public, they will inevitably come into contact with more people. They should be exemplars. If passengers see them wearing masks, they might be more inclined to wear one themselves, even though we currently only recommend it to our passengers. We must also continually remind them of the symptoms and risks. There’s been a decline in adherence to safety protocols. Some argue that these measures slow them down. But despite the lack of media coverage, we need to keep our staff informed.

 

Kenneth Martinez  1:09:00

Laurie, drawing from the lessons learned from COVID-19, we know its primary route of transmission is airborne. However, with monkeypox, it’s mainly through close contact, skin-to-skin, and sometimes via fomites. Aerosol transmission has been documented but is less prevalent. So, has the emergence of monkeypox altered your state’s approach to control and preparedness?

 

Laurie Glossop  1:09:38

To begin with, we have a robust system for tracking influenza in Australia. For two years, influenza cases were minimal, with around 30 cases a month, compared to our historical peak of around 200,000 during winter months. The reasons behind this dramatic decrease, whether it’s due to social distancing, the use of respirators, or restrictions on international travelers, remain unclear. However, recent data shows a significant spike in influenza cases. Last month, we recorded the highest rate of influenza ever. This underscores the continued importance of safety measures like wearing respirators and maintaining distance. But the surge in cases also suggests a decline in individual responsibility.

 

Kenneth Martinez  1:11:06

Thank you, Laurie. Mitesh, the same question to you. From your presentations, we’ve observed that Singapore was quite proactive early on in implementing controls and mandates. Has the emergence of monkeypox altered Singapore’s level of awareness and concern regarding emerging infectious diseases? And how do you see the government’s role evolving in this context?

 

Mitesh Kumar  1:11:46

Absolutely. Discussing Singapore and Southeast Asia more broadly, the approach taken by many governments here was initially passive. They were reacting to the evolution of COVID-19. And as you’ve pointed out, with the emergence of new communicable diseases like monkeypox, polio, and influenza, as Laurie mentioned, the response remains largely reactive. There’s still a prevalent lack of proactive strategy. Even some government offices don’t have a designated department or team focused on these specific concerns. Thus, they often react rather than taking a forward-thinking stance. If there were more proactive measures in place, with dedicated teams assessing transportation systems, identifying gaps, and implementing necessary protocols, I believe our long-term safety would be significantly enhanced and the risks minimized.

 

Kenneth Martinez  1:13:08

Thank you, Mitesh. Claire, I see you’re back with us. With about 15 minutes remaining, I believe you have some questions for our panel?

 

Claire Bird  1:13:17

Yes, thank you, Ken. Hi everyone. This has been a fantastic session, and I truly appreciate all your insightful contributions. I have a query from Laurie at the Canadian Aerosol Transmission Coalition. They’re wondering if ambulance ventilation systems, which were originally designed for anesthetic gasses, have been effective in keeping worker exposure below the defined limits. Do we have data on COVID-19 infection rates for healthcare workers in ambulances? Does this design effectively control the spread?

 

Laurie Glossop  1:14:00

Indeed, there is data. In Western Australia, our ambulance service is operated by St. John, and they’ve maintained detailed records regarding their staff contracting COVID-19. The results indicate that none contracted the virus at work. Most were infected in the community or at home, suggesting that the implemented controls were effective. These workers, like Natasha highlighted, underwent rapid testing and were required to wear respirators. Moreover, the ambulances here boast what I deem an exemplary ventilation system. It features a downdraft system with airflow transitioning from the back to the front, exclusively using fresh air. This evidence indicates that the controls in the ambulances are indeed effective. As for publishing this data, it hasn’t been done yet. While there are valuable findings worth sharing, obtaining the necessary permissions for publication is a separate challenge.

 

Claire Bird  1:15:28

Right there Luke, do you have any experience in that area?

 

Luke Von Oldenburg  1:15:36

In operating rooms here, I’ve observed the airflow dynamics. They utilized a three-system ventilation setup specifically designed for the operating rooms, which functioned effectively. However, it wasn’t just about air filtration; the design played a crucial role. Fresh, clean air would descend over the operating table, circulate around the building, and then they’d deploy an air curtain to maintain sterility. Currently, some companies are promoting sensors placed at intervals of about three feet to detect temperature variations, assisting in optimizing conditions. This strategy, differing from the ventilation systems in other hospital areas, has been effective in preserving a healthy environment.

 

Kenneth Martinez  1:16:37

Shifting gears slightly, has anyone on this panel observed the application of germicidal ultraviolet light in public transportation? And is there evidence supporting its effectiveness?

 

Luke Von Oldenburg  1:16:55

From my perspective, while the theory is solid that UVC can be effective, its practical implementation often falls short. I’ve noticed its use in public buildings, but my main concern is that we might not expose the air or surfaces to the light for a sufficient duration for it to work effectively.

 

Kenneth Martinez  1:17:21

Thank you for that insight.

 

Laurie Glossop  1:17:27

Regarding UVC, consider it akin to having a HEPA filter. If you combine a HEPA with UVC, you’re essentially filtering out virulence. However, UVC can produce ozone, which is toxic and can trigger asthma. So, post-UV light exposure, a carbon filter might be essential. Additionally, UV lights aren’t long-lasting. Some might last just six months, so they are high maintenance and costly. And as Luke mentioned, the time the virus spends in proximity to the UV light determines its effectiveness. In very confined spaces, like a transport vehicle designed for prisoner transfer, UVC might prove effective. But in a typical office setting, its efficacy is questionable.

 

Claire Bird  1:18:59

May I interject briefly? Last week, I attended the Australian Refrigeration Services meeting. There was significant discussion about far UV light, which ranges around two to two nanometers, as opposed to the traditional germicidal UV wavelength of 253-256 nanometers. Preliminary research indicates that far UV is utilized in specific applications, like eye surgeries, because it causes less damage to the skin and eyes than its traditional counterpart. This suggests it might be suitable for continuous use in occupied spaces without necessitating brief virus exposure times in HVAC systems. Do any of you have insights on the potential of this two to two nanometer UV light for in-room or in-vehicle applications?

 

Luke Von Oldenburg  1:20:03

From my readings, I agree that it seems safer for humans when present in the same room. However, regarding its increased effectiveness, it still appears to need sufficient exposure time. Interestingly, Laurie, one of my clients, was sold a UVA system. I had to point out to them that it’s essentially sunlight.

 

Laurie Glossop  1:20:44

Yes, there are different types of UV light: UVA, UVB, and UVC.

 

Luke Von Oldenburg  1:20:55

It felt like just another snake oil salesman approach.

 

Laurie Glossop  1:21:00

Another effective thing is sunlight. Sunlight rapidly neutralizes SARS. When you’re outdoors, it’s an excellent control measure, especially since it isn’t effective at nighttime.

 

Kenneth Martinez  1:21:15

Indeed, that’s a good observation. Early in the pandemic, we had a presentation from researchers at the Department of Homeland Security. They worked with the SARS-CoV-2 virus and demonstrated that just two to four minutes in simulated sunlight would neutralize the virus swiftly. Being outdoors offers more protection, not only because UV light kills the virus, but also due to the enhanced dilution of the virus in the open air. Mitesh, about Singaporeans being advised against talking on transportation, can you comment on the difference in infection spread between talking, shouting, and coughing?

 

Mitesh Kumar  1:22:04

Thank you for the question. Studies have shown that aerosol particles travel a greater distance when a person speaks, especially compared to when they are speaking softly or not at all. This data is the basis for such guidelines. In public transport, it’s impractical to monitor everyone’s speech, but passengers were advised through repeated radio announcements every five to ten minutes to refrain from talking unless necessary. Obviously, in emergencies, speaking is essential, like if someone needs help after a fall. That was the rationale behind the advice.

 

Kenneth Martinez  1:23:08

Thank you, Mitesh. As our session is drawing to a close, I’d like to pose two concluding questions for the panel. Considering that ventilation may not be enough to shield people from highly infectious airborne pathogens, how can we enhance public comprehension and share these global insights to make travelers feel more confident? I invite any panel member to respond

 

Laurie Glossop  1:23:49

Examining various transport modes is essential. Even before this pandemic, many believed that traveling by plane, especially on long flights, almost guaranteed catching some illness. In Australia, where long flights are common and international flights can last up to 20 hours, it’s vital to ensure protection. Making it mandatory to wear respirators in these situations seems effective because it ensures everyone is protected, reducing the potential spread of diseases like COVID. Similarly, in public transport here, wearing a mask or respirator is still required, and I believe it effectively mitigates disease transmission.

 

Luke Von Oldenburg  1:25:00

I agree. For a significant push towards better air filtration or protection in our transportation system, it comes down to the business aspect. If customers don’t feel safe, they won’t use the service, which from our perspective makes promoting better air quality easier. For larger vehicles like boats or planes, personal protection and mandatory vaccination is crucial. However, it’s more challenging for ground transportation, like buses or subway systems, to check everyone’s vaccination status. Nonetheless, we can enforce proper mask-wearing. Some don’t wear masks correctly, either positioning them below their noses or on their chins. The best environmental controls involve air filtration and consistently introducing fresh air. Lastly, personal protective equipment is essential.

 

Laurie Glossop  1:25:03

Furthermore, when considering upgrading filters, many air handling units aren’t designed to accommodate HEPA filters. From my experience examining quarantine hotels, we couldn’t detect any viable virus within the air conditioning system. The virus seems to become non-viable after traveling through long transmission paths in the ducting. Public transport systems don’t have long enough distances for this natural process. Retrofitting better air conditioning systems to vehicles like buses or trains is unlikely, but there have been units with HEPA filters installed in buses in places like Norway. However, these upgrades require more power, and not all vehicles can support that. To introduce more fresh air, the air conditioning system would have to be revamped, which few are willing to undertake.

 

Kenneth Martinez  1:28:12

I’d like to ask one more question. Mitesh, where can individuals find information when deciding between traveling in a car versus a bus?

 

Mitesh Kumar  1:28:27

In Singapore, the government websites provide comprehensive information in various formats. The government also utilizes social media channels for wider reach since most people access information through their smartphones. The key is to utilize this available information and change behavior accordingly.

 

Kenneth Martinez  1:29:14

Yeah, thank you Mitesh. Luke, how about the US perspective? 

 

Luke Von Oldenburg  1:29:19

Certainly. I’d recommend checking IBEC, perhaps IAQA. Individuals can also consult their local public health departments, even though they might be overburdened and understaffed, they offer valuable information

 

Kenneth Martinez  1:29:39

Thank you, Luke. Laurie, what’s the situation in Australia?

 

Laurie Glossop  1:29:43

Australia’s situation is somewhat unique due to our state and territory system. Each state and territory controls its COVID information, leading to variations across regions. In Western Australia, for instance, the government health department provides extensive information, which they also disseminate through newspapers and TV advertisements. However, the continuous changes in recommendations are confusing, making it hard for even professionals to keep up.

Claire Bird

Thank you, IBEC, Ken, and all our panelists for today’s enlightening discussion. It’s evident from our conversation that different continents have adopted varying approaches to cope with the challenges presented by the pandemic, adding layers of complexity to the situation. This diversity in strategies can sometimes make global coordination harder. However, we are profoundly grateful to organizations and individuals who are tirelessly working to streamline information, making sense of the myriad of data, and ensuring that the public remains informed and safe. Your efforts are deeply appreciated.