Recommitting to Ventilation Standards for Healthy Indoor Air Quality

1(p34) Not long after, in 1893, and motivated by tuberculosis, a physician–scientist named John Shaw Billings proposed the first health-focused ventilation rate: 30 cubic feet per minute per person (30 cfm/p).2 In 1895, this healthfocused 30 cfm/p was adopted by a standards organization, American Society of Heating and Ventilation Engineers (ASHVE). [...]health-focused ventilation became the basis for building design in the early part of the 20th century, until a monumental and costly pivot away from health in the 1970s. Research studies documented higher ventilation rates associated with better math and reading scores in students,4 fewer missed school days for kids,5 fewer worker absences,6 lower risk of respiratory disease infection,7 higher cognitive function test scores,8 and better workplace performance.9 Lawrence Berkeley National Laboratory estimated that there were more than $20 billion in benefits to the US economy with improvements to ventilation.10 The commentary by LaFay and Sampson in the August 2024 issue of AJPH argues that this focus on economic impacts of ventilation was a historicand current-problem, holding back the advancement of higher ventilation standards.11 But recent efforts by researchers to quantify the health benefits of ventilation in terms of economic benefits is in addition to-not at the expense of-the health argument. Focusing on health, and adding in an economic dimension, is good public health practice with a long history, dating back to the 1800s.12 Despite the accumulating research on health and economic benefits of higher ventilation rates, not much changed, and the standard for "acceptable" ventilation rates remained the basis for many building codes and industry practice. Control of Infectious Aerosols, wherein they recommended a total "clean air" target (outdoor air 1 filtered/cleaned air) more in-line with historical, healthfocused ventilation rates.15 Inexplicably, the standard was tempered by the inclusion of an "on/off switch" in the guidelines (what they call "risk management mode"), which suggested that enhanced ventilation could be discretionary and that baseline levels of influenza, COVID-19, and other respiratory diseases-which, for influenza alone, the Centers for Disease Control and Prevention estimates resulted in up to 41 million illnesses, 710 000 hospitalizations, and 51 000 deaths annually since 201016-were somehow not worthy of being declared a full-time risk.