Planes, Trains, and Automobiles: Use of Carbon Dioxide Monitoring to Assess Ventilation During Travel

Main Article Content

Jennifer Cadnum
Heba Alhmidi
Curtis Donskey

Abstract

Background: Travel poses a risk for transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and other respiratory viruses. Poorly ventilated indoor settings pose a particularly high risk for transmission.  


Methods:  We used carbon dioxide measurements to assess adequacy of ventilation during 5 trips that included air travel. During selected parts of each trip that involved indoor settings, we monitored carbon dioxide levels every 1 minute and recorded peak levels and the number of people present. Carbon dioxide readings above 800 parts per million (ppm) were considered an indicator of suboptimal ventilation.     


Results: Carbon dioxide levels remained below 800 ppm during train rides to and from the airport and inside airports except in a crowded boarding area with ~300 people present. Carbon dioxide levels exceeded 800 ppm inside the airplanes, but the air was filtered with high efficiency particulate air filters. Carbon dioxide levels remained below 800 ppm in common areas of a hotel but exceeded 800 ppm in a hotel room with 2 to 3 occupants and in a fitness center with 3 people exercising. In restaurants, carbon dioxide levels increased above 800 ppm during crowded conditions with 24 or more people present and 75% or more seat occupancy.


Conclusion: Our results suggest that ventilation may be sufficient to minimize the risk for airborne transmission in many situations during travel. However, ventilation may be suboptimal in some areas or under certain conditions such as in hotel rooms or when restaurants, fitness centers, or airplane boarding areas are crowded. There is a need for larger scale studies to assess the quality of ventilation in a wide range of community settings.  

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References

Centers for Disease Control and Prevention. Ventilation in buildings 2021 [cited 2021 November 21]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/community/ventilation.html.

Wang CC, Prather KA, Sznitman J, Jimenez JL, Lakdawala SS, Tufekci Z, Marr LC. Airborne transmission of respiratory viruses. Science. 2021;373(6558). doi: 10.1126/science.abd9149. PubMed PMID: 34446582; PMCID: PMC8721651.

Jones LD, Chan ER, Zabarsky TF, Cadnum JL, Navas ME, Redmond SN, Kovach JD, Linger M, Rutala WA, Zimmerman PA, Donskey CJ. Transmission of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in a Patient Transport Van. Clin Infect Dis. 2022;74(2):339-42. doi: 10.1093/cid/ciab347. PubMed PMID: 33893474; PMCID: PMC8135457.

Ha W, Zabarsky TF, Eckstein EC, Alhmidi H, Jencson AL, Cadnum JL, Donskey CJ. Use of carbon dioxide measurements to assess ventilation in an acute care hospital. Am J Infect Control. 2022;50(2):229-32. doi: 10.1016/j.ajic.2021.11.017. PubMed PMID: 34848292; PMCID: PMC8627286.

Khatib AN, Carvalho AM, Primavesi R, To K, Poirier V. Navigating the risks of flying during COVID-19: a review for safe air travel. J Travel Med. 2020;27(8). doi: 10.1093/jtm/taaa212. PubMed PMID: 33184655; PMCID: PMC7717328.

Swadi T, Geoghegan JL, Devine T, McElnay C, Sherwood J, Shoemack P, Ren X, Storey M, Jefferies S, Smit E, Hadfield J, Kenny A, Jelley L, Sporle A, McNeill A, Reynolds GE, Mouldey K, Lowe L, Sonder G, Drummond AJ, Huang S, Welch D, Holmes EC, French N, Simpson CR, de Ligt J. Genomic Evidence of In-Flight Transmission of SARS-CoV-2 Despite Predeparture Testing. Emerg Infect Dis. 2021;27(3):687-93. doi: 10.3201/eid2703.204714. PubMed PMID: 33400642; PMCID: PMC7920679.

Bielecki M, Patel D, Hinkelbein J, Komorowski M, Kester J, Ebrahim S, Rodriguez-Morales AJ, Memish ZA, Schlagenhauf P. Air travel and COVID-19 prevention in the pandemic and peri-pandemic period: A narrative review. Travel Med Infect Dis. 2021;39:101915. doi: 10.1016/j.tmaid.2020.101915. PubMed PMID: 33186687; PMCID: PMC7655026.

Pombal R, Hosegood I, Powell D. Risk of COVID-19 During Air Travel. Jama. 2020;324(17):1798. doi: 10.1001/jama.2020.19108. PubMed PMID: 33022035.

Huang Q, Marzouk T, Cirligeanu R, Malmstrom H, Eliav E, Ren YF. Ventilation Assessment by Carbon Dioxide Levels in Dental Treatment Rooms. J Dent Res. 2021;100(8):810-6. doi: 10.1177/00220345211014441. PubMed PMID: 33973494; PMCID: PMC8120146.

Wargocki P, Da Silva NA. Use of visual CO2 feedback as a retrofit solution for improving classroom air quality. Indoor Air. 2015;25(1):105-14. doi: 10.1111/ina.12119. PubMed PMID: 24735406.

Centers for Disease Control and Prevention. Guidelines for environmental infection control in health-care facilities: recommendations of CDC and the Healthcare Infection Control Practices Advisory Committee (HICPAC) Appendix B: Air 2003 [cited 2021 September, 6]1-48]. Available from: https://www.cdc.gov/infectioncontrol/guidelines/environmental/appendix/air.html.

Centers for Disease Control and Prevention. Protect Yourself When Using Transportation; 2021 2021 [cited 2021 September, 15]. Available from: https://www.cdc.gov/coronavirus/2019-ncov/daily-life-coping/using-transportation.html. .

He J, Yin Y, Yang X, Pei J, Sun Y, Cui X, Chen Q. Carbon dioxide in passenger cabins: Spatial temporal characteristics and 30-year trends. Indoor Air. 2021;31(6):2200-12. doi: 10.1111/ina.12874. PubMed PMID: 34164852.

Kwon KS, Park JI, Park YJ, Jung DM, Ryu KW, Lee JH. Evidence of Long-Distance Droplet Transmission of SARS-CoV-2 by Direct Air Flow in a Restaurant in Korea. J Korean Med Sci. 2020;35(46):e415. doi: 10.3346/jkms.2020.35.e415. PubMed PMID: 33258335; PMCID: PMC7707926.

Li Y, Qian H, Hang J, Chen X, Cheng P, Ling H, Wang S, Liang P, Li J, Xiao S, Wei J, Liu L, Cowling BJ, Kang M. Probable airborne transmission of SARS-CoV-2 in a poorly ventilated restaurant. Build Environ. 2021;196:107788. doi: 10.1016/j.buildenv.2021.107788. PubMed PMID: 33746341; PMCID: PMC7954773.

Fisher KA, Tenforde MW, Feldstein LR, Lindsell CJ, Shapiro NI, Files DC, Gibbs KW, Erickson HL, Prekker ME, Steingrub JS, Exline MC, Henning DJ, Wilson JG, Brown SM, Peltan ID, Rice TW, Hager DN, Ginde AA, Talbot HK, Casey JD, Grijalva CG, Flannery B, Patel MM, Self WH, Investigators IVYN, Team CC-R. Community and Close Contact Exposures Associated with COVID-19 Among Symptomatic Adults >/=18 Years in 11 Outpatient Health Care Facilities - United States, July 2020. MMWR Morb Mortal Wkly Rep. 2020;69(36):1258-64. doi: 10.15585/mmwr.mm6936a5. PubMed PMID: 32915165; PMCID: PMC7499837

Lentz RJ, Colt H, Chen H, Cordovilla R, Popevic S, Tahura S, Candoli P, Tomassetti S, Meachery GJ, Cohen BP, Harris BD, Talbot TR, Maldonado F. Assessing coronavirus disease 2019 (COVID-19) transmission to healthcare personnel: The global ACT-HCP case-control study. Infect Control Hosp Epidemiol. 2021;42(4):381-7. doi: 10.1017/ice.2020.455. PubMed PMID: 32900402; PMCID: PMC7542323.

Zabarsky TF, Bhullar D, Silva SY, Mana TSC, Ertle MT, Navas ME, Donskey CJ. What are the sources of exposure in healthcare personnel with coronavirus disease 2019 infection? Am J Infect Control. 2021;49(3):392-5. doi: 10.1016/j.ajic.2020.08.004. PubMed PMID: 32795495; PMCID: PMC7419261.

Wong SC, Chen H, Lung DC, Ho PL, Yuen KY, Cheng VC. To prevent SARS-CoV-2 transmission in designated quarantine hotel for travelers: Is the ventilation system a concern? Indoor Air. 2021;31(5):1295-7. doi: 10.1111/ina.12870. PubMed PMID: 34259364; PMCID: PMC8447387.

Leong LEX, Soubrier J, Turra M, Denehy E, Walters L, Kassahn K, Higgins G, Dodd T, Hall R, D'Onise K, Spurrier N, Bastian I, Lim CK. Whole-Genome Sequencing of SARS-CoV-2 from Quarantine Hotel Outbreak. Emerg Infect Dis. 2021;27(8):2219-21. doi: 10.3201/eid2708.204875. PubMed PMID: 34287141; PMCID: PMC8314830.

Hoefer A, Pampaka D, Rivas Wagner E, Aleman Herrera A, Garcia-Ramos Alonso E, Lopez-Perea N, Cano Portero R, Herrera-Leon L, Herrera-Leon S, Nunez Gallo D. Management of a COVID-19 outbreak in a hotel in Tenerife, Spain. Int J Infect Dis. 2020;96:384-6. doi: 10.1016/j.ijid.2020.05.047. PubMed PMID: 32425635; PMCID: PMC7231486.

Jang S, Han SH, Rhee JY. Cluster of Coronavirus Disease Associated with Fitness Dance Classes, South Korea. Emerg Infect Dis. 2020;26(8):1917-20. doi: 10.3201/eid2608.200633. PubMed PMID: 32412896; PMCID: PMC7392463.

Blocken B, van Druenen T, Ricci A, Kang L, van Hooff T, Qin P, Xia L, Ruiz CA, Arts JH, Diepens JFL, Maas GA, Gillmeier SG, Vos SB, Brombacher AC. Ventilation and air cleaning to limit aerosol particle concentrations in a gym during the COVID-19 pandemic. Build Environ. 2021;193:107659. doi: 10.1016/j.buildenv.2021.107659. PubMed PMID: 33568882; PMCID: PMC7860965.

Suhs T, Gerlach D, Garfin J, Lorentz A, Firestone M, Sherden M, Hackman K, Gray T, Siebman S, Wienkes H, Vilen K, Wang X, Como-Sabetti K, Danila R, Smith K, Medus C. COVID-19 Outbreak Associated with a Fitness Center - Minnesota, September-November 2020. Clin Infect Dis. 2021. doi: 10.1093/cid/ciab653. PubMed PMID: 34297064; PMCID: PMC8344575.

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