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Hand sanitiser. After several Australian water polo players tested positive for COVID in Paris last week, Olympics officials were pressed for details on how they would be mitigating viral transmission at the summer games.
Athletes who have respiratory symptoms should wear a mask around other people, a Paris 2024 spokesperson said, and wash their hands regularly with soap and water or hand sanitiser. "Hand sanitiser stations can be found at all the residential areas and also the restaurant of the Olympic Village."
More than four years since the pandemic hit it was another sign that old habits — and bad science — dies hard.
For much of 2020 health authorities urged the public to prevent SARS-CoV-2 infection by washing hands, wiping surfaces and coughing into elbows. It soon became clear that it was a major misdirection or, as one headline put it bluntly, a scientific screw-up that helped COVID kill. Why? Because the virus is airborne. It wafts through the air in tiny particles called aerosols that can linger indoors for hours, like smoke, and infect anyone who inhales them.
The solution, then, is not hand sanitiser — though hand hygiene is still important — but strategies to filter or clean the air. We don't worry about whether the tap water we drink is going to make us sick, because it's tested and sanitised to meet strict standards. So why aren't we thinking similarly about indoor air quality, especially given most Australians spend 90 per of our time inside?
The Pathway to Clean Indoor Air
That crucial insight sits at the heart of an ambitious new project aiming to figure out how to clean the air in public spaces in Victoria, reducing the impacts of respiratory viruses and other airborne hazards on our health and the economy. A collaboration between the Burnet Institute, the Victorian Government and several other research partners, the Pathway to Clean Indoor Air in Victoria will also lay the groundwork for indoor air quality standards — recommended limits on pollutants that don't just make us sick, but stop us thinking clearly and working productively.
The $9.9 million project is significant not just because it could speed up the end of the current pandemic and help us prepare for the next one. It is also a major deal because of the hurdles the push for clean indoor air is facing globally: in the form of stubborn misinformation and confusion about how viruses like COVID spread, and resistance — including from within the scientific community — to the idea that improving the quality of the air we breathe can bring substantial health and economic benefits.
"Had we had clean air solutions when COVID first came along, had we been able to walk into a room with the same confidence that we turn on a tap to drink water, we probably wouldn't have had a pandemic, and we definitely would have been able to manage it much easier," said Professor Brendan Crabb, director and chief executive of the Burnet Institute.
"So the Pathway to Clean Indoor Air is a big part, if not the biggest part of our way out of the pandemic … and in my view this is the most powerful thing we can do for readiness for the next pandemic."
The benefits are broader than COVID
Cleaning the air is not just about trying to prevent the spread of respiratory viruses like COVID, though it remains an important mission: 227 people died as a result of COVID in the most recent 28-day reporting period in Victoria alone. Poor indoor air quality can cause a disturbing range of health problems including cancer, stroke, heart disease and chronic conditions like asthma, with an estimated 3.2 million people dying prematurely each year from illnesses caused by indoor air pollution in homes.
Mounting research has also shown poor indoor air quality impairs adults' ability to think clearly and creatively and children's performance in maths, reading and comprehension tests — a threat not just to individual productivity but businesses and governments concerned about the economy.
Some scientists estimate improving ventilation in workplaces can add 10 per cent to a business's bottom line by reducing employee absenteeism and lifting productivity.
Public health economist Richard Bruns last year estimated the cost-benefit ratio of investing in ventilation and filtration in American buildings was 1:10 — just from reducing the risks of COVID infection alone. Dr Bruns calculated it would cost US$4 billion to improve indoor air quality in all buildings for 16 weeks over winter each year, when respiratory virus transmission is high, delivering a benefit of about $40 billion.
But the Pathway to Clean Indoor Air isn't about the science of whether we need clean indoor air, Professor Crabb said, or even what tools will help achieve it. Those tools, of course, are well-known and widely used already because they work: devices like C0₂ monitors, ventilation and filtration technologies like air conditioning systems and portable air purifiers, and germicidal ultraviolet light.
Instead, it will build evidence for what kinds of strategies work in different settings — what Professor Crabb calls "the science of implementation". Does every school classroom need an air purifier, even if the building has a modern ventilation system? Are people not using purifiers because they're noisy, or because they're forgetting to switch them on? What's the most cost-effective way to improve the air quality in an office-based workplace compared to, say, a healthcare service? How does improving indoor air quality affect rates of sickness, absenteeism and productivity?
Who's responsible for indoor air quality?
For Minister for Medical Research Ben Carroll, the most compelling part of the two-year project is the goal to develop a "policy framework" for indoor air quality regulations and legislation. "I think potentially changing the standards in the building codes will be the real game-changer," Mr Carroll said.
"If that's where the recommendations go, this will change the way we establish buildings and how we treat indoor air quality. And it will essentially stop people getting ill in the first place. It's about prevention."
Distinguished Professor Lidia Morawksa, a renowned atmospheric physicist at Queensland University of Technology and one of the Pathway to Clean Indoor Air's research partners, said improving indoor air quality needn't be an expensive exercise. Newer buildings in Australia are often equipped with modern ventilation systems that "take care of most of the risk", she said, and older buildings can generally be retrofitted with cost-effective solutions.
But a critical first step, she said, is installing monitoring devices. These little metres measure problematic particles and gases like fine particulate matter (PM2.5) from smoke and vehicle exhaust, and carbon dioxide, which is exhaled when we breathe and is also a proxy for COVID infection risk. "So just like we have smoke alarms in every room we need to have air [quality] monitoring in every room as well," Professor Morawska said.
In a paper published in the journal Science in March, Professor Morawska and her co-authors argued that indoor air quality standards should be mandatory in public spaces, while homes should be designed so they can meet those standards. Though people in urban locations spend 90 per cent of their time inside, she said, most countries don't have legislated indoor air quality standards, and most building codes don't address airborne disease transmission.
"The biggest obstacle in most countries is where this [issue] sits in the regulatory system," Professor Morawksa told ABC News — who is responsible for clean indoor air. "When we're talking about outdoor air quality, it's very clear, there's usually one organisation. In Australia, it's the Environment Protection Authority (EPA) in different states. But who is responsible for buildings? Well, it depends on what buildings."
For that reason, she said, the Victorian Government's leadership here is "an extremely important step forward, setting a model for the rest of the country and for the world".
Climate change will up the ante
Another obstacle may be the reluctance of some scientists to recognise the consequences of poor indoor air quality, and the nature of aerosol transmission of viruses — perhaps because doing so would require substantive action, not hectolitres of hand sanitiser.
In a lecture at the Australian National University in 2022, for instance, infectious diseases physician Professor Peter Collignon said he thought COVID spread not through aerosols but "close contacts with larger particles" — droplets. "The reason I guess I want to believe that is because we can do something about that; it means face shields work, it means eye protection works, it means surgical masks give you reasonable protection," he said. "While if it's aerosols, you think, well, how can you ever let people on public transport again? How can you ever have a building reopen with people all there? How can you even go to a supermarket?"
The importance of clean indoor air will only become more urgent, scientists have warned, as the effects of climate change bite harder. In Australia, spending time outside and opening windows to improve ventilation won't be possible during periods of extreme heat, say, or catastrophic bushfire seasons that leave cities blanketed in thick smoke for weeks on end.
"So as climate and environmental change … take hold, you're not going to be outdoors with those asthma thunderstorms, with bushfire smoke … with the wild weather that is going to happen more and more frequently," Professor Crabb said. "You're going to be indoors, and the dream is to have indoor spaces be a true safe haven from those direct threats, and the indirect threat of having lots of people gathering inside."
When it comes to the Pathway to Clean Indoor Air, though, perhaps what excites him most is the idea that other governments in Australia and around the world will take notice and follow Victoria's lead. "In the end, in my view, the biggest impact of this investment is going to be dragging others along," Professor Crabb said. "That's why I say it's trailblazing, it's leading-edge. In a few years time, clean indoor air will be the norm. Everyone will be doing it, as they should."