Healthy Buildings: Optimize Health and COVID 19 Ventilation (Best Air purifiers, HEPA Filters)

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Professor Joseph Allen, DSc, MPH: We're an indoor 
species. 90 percent of our time indoors. The   indoor environment is just having this massive, 
massive impact on our health. We've done past work   showing that ventilation not only helps in terms 
of infectious disease, this virus and others,   but also it has many benefits, and one is better 
cognitive function performance. But fewer people,   even to this day, are thinking about ventilation 
and filtration in their homes, offices, schools,   wherever. We know how to keep kids and adults 
safe in school. It should absolutely shock you,   because there's an assumption that the 
products we buy are safe. But what happens is,   they often replace the toxic chemical with 
a chemical cousin that's just as toxic,   and we call this "chemical whack-a-mole."
Kyle Allred, MedCram Co-Founder & Producer:   Welcome.

I'm here with Professor Joe Allen 
from the Harvard School of Public Health,   and if you're interested in practical ways 
that you can improve your home, your workplace   and our schools, not only from a 
COVID-19 transmission standpoint,   but as places that can improve your 
overall health and mental performance,   there may be no better person to talk with than 
Professor Allen. He's co-author of a book called   "Healthy Buildings," and he's published over 70 
different articles in peer-reviewed journals,   including some excellent research on COVID-19. 
And, Professor, since I started following your   work a few months ago, I made a variety 
of changes to my home, to my workplace,   even some of the products I buy, so I'm really 
excited for our viewers to meet you and learn from   you, and thanks so much for making time for this.
Professor Allen: Yeah, it's great to be here.

And   that's quite a compliment. I mean, we really 
work hard to take the science and translate   it into actionable tips for people, so 
that's really rewarding to hear you've   actually taken it and made some changes.
Kyle: Definitely. And we'll start with some   COVID-19 questions, and then we can hopefully 
get into just healthy buildings in general   at the end. But I want to start with 
something that everyone's familiar with now,   and that's plexiglass or barriers similar to 
plexiglass. We see them in stores, we see them   in workplaces. How effective are these? Can they 
give a false sense of security? And are there even   times when they may do more harm than good?
Professor Allen: Yeah, I mean, the short   answer is plexiglass is not the answer. And 
really, to understand why, let's just think about   how this virus is transmitted. So, coming 
from respiratory aerosols, right? And these   are smaller particles that float through the 
air. So if you have a plexiglass divider,   that might capture ballistic droplets, 
you know, like droplets you can even see.   But most of what you emit when you're 
just breathing or talking are finer   aerosols that travel right around plexiglass. 
So plexiglass isn't doing much, and actually,   it can interfere with good airflow in a room. 
So, counterintuitively, it actually could be   doing more harm than good.

That said, I want a 
caveat, there are some places I think plexiglass   is a good idea. If you think about a checkout 
line with a cashier. Many people are coming   across that person. I think that's OK to put 
that there. Kind of static locations where you're   trying to protect the worker just a bit more.
Kyle: If I'm in an office building and I have,   let's say, plexiglass up six feet high, and I'm 
spaced at least six feet away from my coworkers,   still a good idea to wear a mask indoors?
Professor Allen: Yeah, absolutely. Because,   for the same reasons, if you're in a room 
and you're with coworkers and you're spaced,   that's good.

The amount, or how much, the 
aerosol's built up indoors would be a function of   how much is emitted from an infectious person and 
how well the ventilation system is working. And so   masks are the single-most important intervention, 
because you're limiting the emissions or how much   is coming out. Even a simple mask could get you 
60, 70 percent removal efficiency. So this is the   most important intervention we can do, and I don't 
see masks going away any time soon, certainly not   until we get through this next surge, whatever 
this new variant brings us, and until many, many,   a large percentage of people, are vaccinated.
Kyle: We've all heard so much about washing hands,   masks, distancing.

Why do you think there's been 
so little discussion about ventilation, especially   up until recently when the CDC finally revised 
their guidelines to include ventilation strategies   as part of their recommendations. Do you think 
ventilation is as important as those other three   pillars, if you will?
Professor Allen: Yeah,   there's no question, and it has been such a 
disappointment, and quite honestly it's been so   utterly confusing to me why the CDC, World Health 
Organization, many others, have not acknowledged   airborne transmission, which then sets up 
buildings and ventilation as a control measure,   so it doesn't make sense to talk about ventilation 
and filtration unless you acknowledge airborne   transmission is happening. We're coming up on a 
year since I wrote my first piece and published   it, talking about healthy buildings as the first 
line of defense against this novel coronavirus,   and in that piece, I said, there's things we don't 
know and we don't know for sure, but certainly we   know enough to know that we need to act and that 
airborne transmission was likely.

And that means,   we need more outdoor air and better filters. 
And so this is, I think I have 25 or 26 op-eds   since last February, and in every one, even though 
I'm talking about different topics — airplanes,   schools — I'm always talking about 
ventilation. Fundamentally, it's the same thing.   So it's been really frustrating, I think 
for everyone in my field who studies this,   that CDC would not acknowledge that airborne 
transmission was happening. The evidence is   just airtight. We could talk about the basics of 
aerosol physics; we could talk about air sampling   data; we could talk about the epidemiology and 
high-profile case studies. Everything points to   airborne transmission. We knew this in 
February last year, and every piece of   evidence has further supported it. And that's 
a problem for the exact reason you said, that   many people have gotten a handle on the 
control measures.

OK, I have to wash my hands,   distance is good, hopefully people are wearing 
their masks. But fewer people, even to this day,   are thinking about ventilation and filtration 
in their homes, offices, schools, wherever.  Kyle: What are some practical things people 
could do today or tomorrow in their home or   their office or their school to make it safer 
from a ventilation and filtration standpoint?  Professor Allen: Yeah, it's actually quite 
easy, and I'm not oversimplifying it. But the   way we talk about it are really three steps. Think 
about it this way: first, you want to increase the   amount of outdoor air coming in.

So if you're in a 
home, like I am, that means opening up the windows   even an inch or two. It's cold outside where I 
am, but an inch or two really helps. If you're in   a place with a mechanical ventilation system, you 
want to open up the outdoor dampers, bring in more   outdoor air, because typically a building doesn't 
bring in enough. It's a bare minimum. You want to   go above those bare minimums. So that's number 
one. Same applies to the car, for example. Roll   down your windows, bring in more outdoor air. 
Number one. Two: any air that's recirculated,   you want to run through a higher efficiency 
filter. So maybe not everybody recognizes   that in, say, a commercial office 
building with a mechanical system,   some fraction of the air's from outside, but a lot 
of the air is recirculated.

And we don't just want   to be recirculating virus-polluted air, of course, 
so you want to use what's called a MERV 13 filter,   M-E-R-V 13, or higher. That's a filter that 
captures about 80 percent of the particle   sizes that we're interested in for this virus. 
Number three: if you can't achieve what you need,   in terms of protection, with those two, you want 
to use portable air cleaners with a HEPA filter.   This is a simple device. You can get it at your 
local hardware store even. Plug and play. We built   a tool at my Harvard Healthy Buildings Program 
website with Shelly Miller at UC-Boulder, that   lets you calculate what size device you would need 
in your room based on the room size. So really,   three things: more outdoor air. better filter; 
on recirculated air; if you can't achieve it,   use a portable air cleaner with a 
HEPA filter. It's really that simple.  Kyle: I was looking at a chart earlier today that 
showed the average air changes per hour that a   home or office building or school should try to 
achieve, and I think it was over six air changers   per hour is optimal.

I heard an interview with you 
recently where you mentioned that the average home   in the United States has about 1/2 of an air 
change per hour, dramatically less than what's   optimal. Why do you think homes and office 
buildings are so terrible with ventilation?  Professor Allen: The answer is, we don't design 
buildings for people, and that's shocking. Said   better, we don't design it for people's health, 
right? We design for these bare minimums, largely   driven by energy efficiency, which is critically 
important, but often at the expense of health.   And, you know, it was about the time in the 70s 
we started tightening up our building envelopes   to save energy in response to the energy crisis, 
and it ushered in the era of sick buildings   and the term "sick building syndrome" 
first appeared shortly after that.

Now,   we've all spent time in these under-ventilated 
spaces. You might describe it as "stuffy" or   "stale," or you're in a conference room and 
you can't concentrate, and the door opens and   it literally breathes life back into the room. 
And so, in all of the spaces we spend our time,   people will be surprised, we get very low 
ventilation rates. So half an air change per hour   means about half the volume in the air of your 
house is being changed out. And new condominiums   that are super airtight can be 0.1 air changes per 
hour, so really little exchange happening. Schools   should be, if they're meeting code, three air 
changes per hour, but most of them only get 1.5.   So, we have many places that aren't even meeting 
the minimum standards, let alone a healthy   standard, and it's a real problem.
Kyle: I want to ask you a little bit more about   portable air purifiers.

I have two in my home, and 
I think they might be good examples that people   can learn from and learn from my mistakes. One of 
them, I bought years ago. It's not a HEPA filter,   but it has some kind of fancy features; 
it's got a UV option that you can turn on;   it's got an ionization option. Are these 
effective at stopping transmission of viruses   like the SARS-CoV-2 virus, and are they necessary?
Professor Allen: Yeah, so first thing I'll say,   then I'll answer your question is if 
you're looking for a portable air cleaner,   look for a HEPA filter and nothing else. You 
don't want any of these bells and whistles.   But I'll answer your question directly, because 
it was different.

Can UV inactivate a virus?   Sure, absolutely. Do you need it in a portable 
air cleaner that's in your house or your office?   Absolutely not. You're probably paying more for 
it, and the reason you don't need it is because   all you need is a good fan in your portable 
air cleaner, blowing air against a HEPA filter,   which captures nearly all airborne 
particles. So you don't need any of those   bells and whistles, and you have to be careful if 
you use something like ionization, in particular,   because they can generate ozone, which is a 
respiratory hazard and you'd be putting that   right into your breathing zone. They can generate 
formaldehyde, which is another respiratory hazard,   and they can also generate ultra-fine particles, 
which is another respiratory hazard. So you want   to be careful that we're not solving one problem 
and creating others, and importantly, there's   something else that's actually less expensive 
that will do the job the same or even better.   So, for those reasons, you need to avoid 
ionization and UV in a portable air cleaner.   Just look for a good HEPA filter with what's 
called a good clean air delivery rate.

And I   can talk about that more if you're interested. d
Kyle: Yeah, I am, because I got a HEPA filter   this summer, because of the forest 
fires here in Oregon were so bad,   and I heard you mention that clean air delivery 
rate, and mine is well below that. I think mine   is 150. So, yeah, could you explain what 
that is and what number you should look for?  Professor Allen: Yeah, and that's interesting you 
bought it for the wildfires. That's a great idea,   because the mechanics are the same. 
And I'll talk about clean air delivery   in a second. All you're doing is removing 
particles from the air, be it from smoke,   wildfires or cigarette smoke or respiratory 
aerosols. You're just capturing these particles,   so that's the basics. The clean air delivery rate 
is something you can find on most air cleaners,   where they actually measure this. And it's a 
combination of how much air moves across a filter   and how good that filter is.

So you can imagine, 
you have the world's best filter and a poor fan,   and it should have a low clean air delivery rate; 
it's not that good, even if it has a good filter.   The opposite could be true. You could have a fan 
that's super powerful, moving a lot of air but a   terrible filter. That's not gonna do much good. 
So the clean air delivery rate is something that   combines both factors. The clean air delivery rate 
is in units of CFM, cubic feet per minute. So if   you took the CADR, clear air delivery rate, on 
a box from one of these manufacturers, you could   estimate how many air changes per hour you'd get 
from your room. And the formula is super simple.   Clean air delivery rates, let's take that 300. 
300 CFM times 60, so now it's 300 feet per hour,   divided by the volume of the room, length times 
width times height.

So if you had a 300 CADR   in a 500 square-foot room with 8-foot ceilings, 
you're gonna get over four air changes per hour;   it's gonna be 4.5 air changes per hour. So the 
calculation's pretty simple, and our team has   recommended for small volume spaces trying to 
get 4-6 air changes per hour. And remember, the   typical home is half an air change per 
hour, so it's 10 times higher than that.   So it becomes really easy to then find a portable 
air cleaner that's the right size for your room,   and if that all sounded too much or you didn't 
follow it, we have a tool on our website that   you just put in the size of your room and it lets 
you know what to look for in terms of the clean   air delivery rate for a portable air cleaner.
Kyle: Thanks a lot. Yeah, we'll definitely link   to that. And some of these HEPA filters, 
I mean, they're not that expensive,   right? You can get some around $200 or less?
Professor Allen: Yeah, that's right.

I mean,   you could find one for a lot more than 
that that has all the bells and whistles,   sensors and all these things, but if you want 
a basic one, and that's all you need really.   You turn it on, it's got a good CADR, look 
for a clean air delivery rate over 300, um,   yeah it'll be about two or three hundred dollars, 
and that'll be great for a room of that size.  Kyle: You and your team have done a lot 
of research and had commentary on masks,   and I was in the situation about a month ago of 
wanting to buy some new masks, because ones I had   early on in the pandemic were two-layered 
masks and they didn't fit all that well.   So can you walk through some tips? I know 
everyone has heard a lot about masks, but   it still can be a daunting process to figure out 
exactly what mask to actually purchase.

Can you   go through some tips on really optimizing masks?
Professor Allen: Yeah, and I feel for people. It   is confusing out there, and at this point in the 
pandemic, it shouldn't be confusing and we should   be well beyond the "anything goes" period of the 
mask. That said, I'll talk about masks in terms   of low risk activities — going for a walk and 
maybe you're going to pass by someone and stay   distanced. Any old mask, I think that's good. 
You have a cloth mask, simple cloth mask, fine.   Going to the grocery store, you're gonna 
want something a bit better, and certainly   if you're in an occupation where you're around 
a lot of people, you're going to want something   that's even more efficient. But here's the basics, 
right? It's a function of the filter efficiency   and the fit, and that makes sense, right? You 
want something that's going to capture a lot   of the particles coming out, but it also has to 
fit on your face pretty well, or else, instead   of going through the filter, it's just going to 
come out through the sides or through the top.   And so, we recommend two or three layer 
masks, because they have high efficiency,   or pretty good efficiency, like a good 
surgical mask, a blue surgical mask.   If you want something that's more 
efficient, you could go to the N95,   which are hard to get and there are some shortages 
still in healthcare, unbelievably at this point.   Something that's called a KN95, but 
I can mention to be careful there,   because there have been counterfeit KN95s on the 

And the N95 stands for 95% efficient.   But there is a way to get close to N95 with 
just materials that you probably have access   to right now. And so a colleague of mine, Linsey 
Marr, put out a paper with a colleague of hers,   where they showed that a simple surgical mask with 
a cloth mask over it gave you over 91% efficiency.   And really what that cloth mask is doing is 
helping with that fit. So you've maybe seen   blue surgical masks and some gaps on the side. 
Well, if you put a mask on top of that, now you're   really forcing that air through those filters. 
But here's the most important thing about masks.   It's less about the individual removal 
efficiency and more about the combined   benefit.

So when everybody wears a mask, particles 
have to go through two filters. So even if I have   a 70% percent efficient mask and you have a 70% 
efficient mask, the combined efficacy is 91%.   Add in spacing between us, put 
in ventilation and filtration,   and you can quickly get to exposure reductions 
of 99% or more. So this is where the power of   universal masking comes in, even if people have 
imperfect masks or they're not fit exactly right.   It's the combined benefit that's what's 
providing the big benefit for everybody.  Kyle: And in a high risk environment, that's 
really interesting about wearing a cloth   mask over top of a surgical mask. I've also heard 
come discussion about inexpensive mask fitters,   so like a piece of rubber that can go around 
the mask to help achieve a better fit.   Do you have any familiarity with those?
Professor Allen: So I've seen them.

I   haven't tested them or actually haven't looked 
at the data, but the logic of it makes a lot   of sense. I've seen people do all sorts of simple 
tips like that in trying to improve the fit, even   with the loops in the back, tying them tighter 
or cross-stitching them. And the idea, right,   is that's all you're trying to do: make sure 
it goes over the bridge of the nose, it's flush   against the face, and comes around your chin. And 
so if you have a loose mask, that's not going to   help that much, so any kind of face mask fitting, 
or even something that can tie and tighten it   is gonna provide a big benefit. And the way to 
think about that, if you think about an N95 mask,   which is technically a half-face respirator, 
if you were given one of those if you worked   in a hospital, and you were given one of those, 
you would have to go through what's called "fit   testing." And the idea of fit testing is to be 
sure that the fit is good. So we know fit matters;   in fact, there's all sorts of regulations 
around fit testing, but to the average person,   you just want to make sure you can get by with 
a regular mask that's sealed pretty well, or do   some of these other tricks to improve the fit.
Kyle: So we've talked about masks, we've talked   about ventilation a bit, what about humidity? 
Does humidity play a big role in transmission   and should we consider humidifying our homes?
Professor Allen: Yeah, humidity,   it's interesting.

I wrote about this in the 
first couple pieces I wrote last winter,   and then I stopped writing about it through the 
spring and summer, I think for obvious reasons.   And then colleagues and I wrote about it 
again in November. Humidity's important,   but I put it as a "nice to have," not a 
"must have." Maybe I'll talk about the   "what's happening" and why, and why I 
think it's challenging for buildings.   So it's probably helping in two different ways 
at least, maybe three. First is, our respiratory   system. So, in our lungs, we have what's called 
a mucociliary escalator or mucociliary clearance,   and that's the cells of our lungs are lined with 
cilia and they're all beating, right. Anything we   breath in, many of the particles are captured in 
the mucus and the cilia bring it up and we swallow   it harmlessly. Great defense mechanism, cleans 
out our lungs. Low humidity, and here I'm talking   about 20 percent humidity, actually the beating 
of the cilia, a colleague of ours just showed this   beautifully animated, that it's less efficient. 
You have less clearance.

So your immune system,   or your, should say, respiratory system's, 
defenses function better at humidity in the 40-60%   relative humidity range. Not a problem in the 
summer, but in the winter when the humidity   gets down to 20%, 30%, it's not ideal. Second 
in other ways, it's influencing transmission, so   when it's less humid, the virus survives better, 
which is maybe counterintuitive to some people. So   the virus survivability is less at 40-60% relative 
humidity. And last, it also may influence how   quickly droplets evaporate and how long they can 
stay aloft. So for a few reasons, it can influence   disease transmission and also host susceptibility. 
The problem, and why I think it's a "nice to have"   not a "must have" is that most buildings can't 
do anything about it. If you have a mechanical   system, it's really hard to retrofit or any time 
you're adding water into a building it gets very   tricky.

But your question at the beginning, right, 
if you're home, sure. If you have a portable   humidifier, my team, we've had papers maybe 10 
years ago modeling the humidity inside homes and   influenza transmission. And yeah, you can bring 
up the humidity into that 40-60% relative humidity   sweet spot through a portable humidifier.
Kyle: You mentioned car travel early and   how just cracking a window in a car can make 
it significantly safer from a transmission   standpoint.

How about air travel? How safe 
do you think air travel is and what are some   of the most high-risk parts of air travel?
Professor Allen: Yeah, so I'll do a little   credentialing, unfortunately, just to establish 
that I've done work not just on buildings but on   airplanes for over 10 years. In 2013, I was one of 
the lead authors of a National Academies report on   infectious disease transmission in airports and on 
airplanes. So I've studied this for a long time,   and I wrote an op-ed in the Washington Post, maybe 
it was in May, that seemed to surprise people,   because I said, you don't get sick 
when you're on an airplane, really.   And that's because, if you think about 
what's happening , these fundamental   factors we're talking about — ventilation 
and filtration — when you're on an airplane,   the ventilation's actually quite good.

So you get 
10 or 20 air changes per hour. Recall the home   is about half an air change, and our target was 
4-6. Hospitals will target 6 air changes, except   for the most extreme and then they'll target 12 
air changes. So an airplane, you're getting a   lot of air. Second, all of that recirculated air, 
remember I said in buildings we'd like a MERV 13;   that gets about 80%. Well an airplane, everything 
that's recirculated goes through a HEPA filter.   That's 99.97%. So it turns out, when you're 
on an airplane and the systems are running,   it's probably one of the lowest risk times 
during the whole travel experience. Now,   add on masks on top of that, which is an excellent 
idea, and the risk gets even lower. Now, that's   not to say it can't happen. Can transmission 
happen? Yeah, transmission can happen anywhere.   It's just lower risk than most people think, and 
we have millions and millions of passengers, even   to date, and we have a handful of cases that are 
suspected — and I'm not even sure all of them are   accurate — a handful of cases or instances 
of transmission on an airplane.

That said,   there are areas during travel that I think 
are important. We know restaurants are higher   risk. Well, when you're in an airport, lots of 
opportunities to sit at a restaurant, at a bar,   masks come off. So I think those are higher 
risk. Also, during boarding on an airplane,   we warned in our 2013 report that airplanes do not 
always have the ventilation systems running while   people are boarding. That's a mistake. And I hope 
— I called this out in the op-ed in May and we've   been talking about it ever since — airlines 
have to have ventilation on when the plane's   at the gate. Otherwise, you are cramming a lot of 
people into a small volume space. When the systems   are running, the ventilation and filtration 
are great, but they're not always running.  Kyle: Speaking of that, you mentioned in a 
previous discussion how a portable CO2 monitor   can be a way to measure, kind of a surrogate to 
measure air quality, and it made me think of it   with airplanes, if the engine's not running and 
you have one of those, could the CO2 levels raise   to unacceptable levels? And is this something 
that people should consider for their workplace   if they're concerned about ventilation issues?
Professor Allen: Yeah, I mean the reason we   know that airplane ventilation can be poor 
during boarding is because we've measured it.   I published a paper a couple years ago looking 
at CO2 concentrations during the whole flight,   including boarding, and we see CO2 concentrations 
sometimes over 2500 parts per million at boarding.   Now for reference, if you're meeting a 
minimum standard, it's gonna be under 1000.   And so I'm with you, I've got one right here 
on my desk, too, right? So I'm over 1000 parts   per million.

I should open up my door, get some 
cross ventilation going in here. That's too high.   But, you know, the other side of this, 
I'm in my own home with my family,   I would never have somebody over here right now 
with these conditions. If had somebody in here,   which I wouldn't, I 'd have a mask on, 
windows open, I'd have my air purifier going.   So, I think these things are gaining traction 
because the other controls we have, people can   assess. I can tell if you're wearing a mask, you 
see hand washing, you see distancing. But you   can't tell if the air is clean, so this is a way 
to kind of get a sense of a space, right. You have   no idea what's happening in my office, unless I 
did this. I wouldn't know. The challenge with CO2   monitoring… So first, CO2, if you're not 
familiar with it, is a proxy for ventilation,   where the main source of CO2 indoors, if 
you're well ventilated, CO2 would be low,   and vice versa.

The problem, though, is 
that there are two really main mechanisms   for controlling this virus indoors in the air. 
It's ventilation or filtration. So ventilation   will change the CO2 concentrations, but filtration 
won't. So said better, I could be in this office   with my air purifier going with my HEPA filter, 
have a thousand parts per million of CO2,   which isn't good from a ventilation standpoint, 
but be totally fine because the filter is working.   So you have to be careful with CO2; it's only 
covering half of the control measures indoors.  Kyle: Interesting.

And I've heard you also 
speak about how when ventilation drops and   potentially CO2 levels rise indoors, cognitive 
performance can suffer as well. Tell us more about   that. I thought that was very interesting.
Professor Allen: Yeah, I mean, right now,   we're thinking about half of health, which 
is disease avoidance, and rightly so,   but here's a whole other aspect of health, 
right? It's flourishing, it's wellbeing,   it's the positive aspects of health and 
feeling well. And so we've done past work   showing that ventilation not only helps in terms 
of infectious disease, this virus and others,   but also it has many benefits and one is better 
cognitive function performance. So we've done   studies, we use people in a really controlled 
office environment, where we have them do   their normal work routine, we administered 
these complex cognitive function tests,   and while they're in the room, we change the 
air they're breathing.

We change the CO2 levels,   we change ventilation without them knowing. It's a 
guinea pig type of scenario. It's a double-blinded   study, and what we find is that when people are 
in these environments with better air quality,   low CO2, they perform significantly better on 
these tasks of higher-order cognitive function   in domains like strategic decision making, 
information usage, crisis response,   things that are really relevant to everyday 
functioning but also the types of work we all   do every day. And I think that's surprising to 
people, that study surprised people because we   didn't test anything exotic.

We just changed 
the levels slightly indoors to levels that most   buildings could attain. And we went above the bare 
minimums that are required. And when you do that,   our study and many others now. There's decades 
of research showing the benefits of going beyond   these kind of code minimum standards that we set 
in buildings, beyond infectious disease benefits.  Kyle: Beyond ventilation, are there any other 
design changes that you think can contribute to   a healthy building and better performance, better 
work performance or school performance for kids?  Professor Allen: Yeah, I mean, so we released 
— so there's a lot of things.

And right now,   the world, rightly so, is thinking about 
ventilation, air quality, filtration, humidity.   But we released a couple years ago called 
"The Nine Foundations of a Healthy Building,"   and it was in response to questions just like 
you asked, where people say, "well, what else   matters?" We realize that, despite all this great 
research, not a lot had been hitting the mark   in terms of the people who were designing and 
operating buildings.

So we released this report,   "The Nine Foundations of a Healthy Building," 
where we talk about air quality, water quality,   lighting and views, or biophilic design, acoustic 
performance, thermal conditions, dust and pests,   safety and security. You know, all of these 
factors that really have a deep scientific   body of literature behind them, supporting them 
and showing how each one is associated with   sometimes better cognitive function, reduced "sick 
building" symptoms, some of these are associated   with reduction in asthma. So, there is a really 
rich body of scientific knowledge out there on all   the ways that a building influences our health.
Kyle: And speaking of buildings influencing our   health and ways to make them safer, you've been 
a big advocate for getting kids back to school   for in-person learning, and that it 
can be done safely for both teachers   and students.

What is the landscape right now 
in the United States for in-person learning,   and what are some of the consequences of kids 
not being in school for in-person learning?  Professor Allen: Yeah, I've been saying this is a 
national emergency. It's been a national emergency   since we first closed schools, and I don't think 
it's been treated as such. And it's something that   I'm working 24/7, 7 days a week. I can't stop 
thinking about this topic, trying to think,   "what else can we do?" What other tools can 
we put out there to help schools get back,   because it is so concerning what's happening. 
The costs are enormous with kids out of school.   This included virtual dropouts.

We knew it from 
the spring, right, in Boston where I was, 10,000   — 10,000 — high school students unaccounted 
for in May. We've seen impacts –actually, the   virtual dropout issue has persisted. A report from 
60 Minutes just a week ago. Hundreds of thousands   of kids missing in the system. Totally missing. 
And talking about how schools are really our first   effort to detect issues with kids or find out why 
are they out? Are they having problems at home?   UNICEF reports kids are out of school, 
greater risk of exploitation, abuse, neglect,   violence. There's food security issues. I wrote an 
op-ed with a colleague of mine, Dr. Sara Bleich,   talking about a billion missed school meals in 
the spring alone from schools closed — a billion   missed meals. And this has continued now, and 
we're coming up on a year of schools closed.   We've seen decrements, or losses, in learning 
and we have reports — it's not one area   of the country — we've had reports out of 
Virginia, Los Angeles, in Texas, in Minnesota.   We see losses and gains in literacy.

is just the beginning of these impacts.   We're just starting to uncover these. We will 
see these kinds of reports for months and years,   and this is why I call it a national emergency 
and here's the flip side of that. We know how to   keep kids and adults safe in school.We know that 
schools are not driving transmission. We had this   data in June from studying what was 
going on in Europe. We had many YMCAs   and childcare centers opened in New 
York through the peak of the spring   spike. We had camps open through the summer. We 
now have data through the fall that schools are   not driving this. Transmission through the school 
looks just like transmission in the community.   And when we put in these control measures, like 
universal masking, ventilation and filtration.   We've been harping on these since June 
when my team released this full report.   We can keep kids and adults safe.

these are not just about keeping kids safe.   It's about keeping everyone in the 
building safe. We do get some advantages   with kids. The virus has spared us in 
now ways except this one, miraculously.   The risk of a kid dying from COVID is one in 
a million. That's the most recent study in   JAMA. They're about half as likely to get it as 
adults. So we are getting some benefit; they can   transmit it, they can definitely get it, and kids 
can definitely die, but it is very rare. So we   get another benefit when it comes to schools. 
So weighing those factors to me is absolutely   imperative that we get kids back in school safely 
and that schools put in these mitigation measures   we've been talking about.

And the costs are just 
so massive, and just so deeply, deeply concerning.   It's why I call it a national 
emergency, the national emergency.  Kyle: And you and your team have put out a PDF 
with some simple steps that schools can follow   to make their environments safer, correct?
Professor Allen: Yeah, so many resources.   So my Harvard Healthy Buildings program is a, and we have a page dedicated   to schools, We have a 
60-page report and PDF, and also on the website   on holistic risk reduction strategies that also 
talk about the specific of these healthy building   measures, the target air changes per hour, 
ventilation, filtration, tips and tricks   for what you can do.

We've also released a 5-step 
guide for assessing ventilation. So if you're not   sure what to do in your school or what it looks 
like, we went out in schools over the summer, on   the weekends, were measuring ventilation rates and 
turned it into a guide that any school can use.   We built a tool to help you calculate 
portable air cleaners, written 7 or 8 op-eds   talking about how portable air cleaners can 
help with a HEPA filter and other strategies.   So we put out many of these guidance documents, a 
white paper on the science around risk reduction   and air filtration. So we tried to put out these 
guides to help schools get back, and we've worked   with schools. I know there's an entire state 
that's using that report as their strategy.   I get calls from really all over the country 
from different districts that have used that as   a template. So there are other guides out there, 
too, and I just think the important thing is that   you do something. I think some schools haven't 
put in any control measures, and I think that's   a mistake too. And if they haven't had cases, I 
think they're getting lucky and maybe with the new   variant that's more transmissable, their luck may 
run out.

So it's absolutely imperative to put in   these simple, relatively simple, 
control measures we're talking about.  Kyle: I want to ask you about some of the products 
that we all have in our homes or use every day.   And I have a water bottle here that says BPA free 
on it, and when I read some of your book, when you   talk about how some of these chemicals — I think 
"chemical whack-a-mole" was the term you used.   So could you talk a little bit about 
that? Why something like "BPA free"   may not give the security that we hope it would?
Professor Allen: Yeah, so moving to the topic of   chemicals, this is a massive topic that doesn't 
get enough attention.

It's something I've been   studying for a long time, and you'll really get me 
going, because there's a chapter in the middle of   our book — I'm not trying to sell a book here — 
but it talks about our global chemical experiment,   and I promise if you read it, it should shock you. 
It should absolutely shock you, because there's   an assumption that the products we buy are safe 
and if there was a chemical that's toxic, well of   course it shouldn't be in your water bottle or 
my couch or my kids' car seat. But, here's how   it works, and here's the problem: there are over 
80,000 chemicals in commerce, very few have been   tested for health and safety. And so, what happens 
is we don't follow the precautionary principle. We   allow companies to put these chemicals in commerce 
and if we as scientists find out it's harmful,   they take it out.

But what happens is they often 
replace the toxic chemical with a chemical cousin   that's just as toxic. And we call this "chemical 
whack-a-mole." And it's this never-ending game   that's been played for decades. And BPA is a 
great example. So if you're a customer, you're   well-meaning, you look at your bottle and one 
says "BPA free." Well, I'll get the BPA free one.   BPA must be bad. Even if you know nothing about 
BPA, and BPA stands for bisphenol A. It's a   hormone interrupting chemical that's used in 
some plastics. The reality is, though, BPA got a   bad rap, and so manufacturer's seized on this and 
said, "well, I'm gonna sell BPA-free everything."   They didn't just take out BPA. They took out BPA, 
but they replaced it with its chemical cousin BPS,   for bisphenol S.

Sure enough, the toxicological 
profile looks exactly the same, darn near similar   to BPA. So that way, they played a game with you. 
As a consumer, BPA free is great. That label might   as well say, "contains BPS." BPS is starting to 
get a bad rap. You know what the replacement is?   BPF. This goes on and on. We've seen this with 
pesticides decades ago. We see this "chemical   whack-a-mole" in nail polish. We see swapping of 
chemicals in e-cigarettes. We see this in flame   retardants that are in your couch, in my couch. 
We see this with these "forever chemicals,"   these stain repellent chemicals that can cause 
testicular cancer that you find in nonstick pans   that are used on carpets, and there was one 
that was labeled "bad," so that was removed   and were just subbed in for another one. 
So this game of chemical whack-a-mole   happens all the time and we sometimes 
call it "regrettable substitution"   is the less playful name for it, but it's another 
name I don't like, because it implies, "oh,   whoops, we made a mistake.

It's a regrettable 
substitution. Whoops." This has been happening   for decades. There's nothing regrettable about 
it. It's a knowing failure of the system and a   loophole in our chemical policy. And here's where 
it's interesting for all of us and everybody.   These chemicals, they migrate out of their 
products. And if you take something like   these forever chemicals, the ones that are in your 
nonstick pans and in your carpets and are in our   clothes — it makes things water and soil, just 
wash off these days. We love them as consumers.   Well, these things are really pernicious. They 
last in the environment forever. I wrote an   op-ed calling them forever chemicals and named 
them that two or three years ago at this point   when that piece came out. But they're associated 
with these harmful effects, carcinogenic effects.   They're called "obesigens." They interfere 
with lipid metabolism. So we have all of these,   you know, known adverse effects. We keep using 
them, and we have this chemical whack-a-mole,   and the problem with these forever chemicals 
is that at this point 6,000 variants.   So what do we even study next, right? So 
as a consumer we really have no chance to   be like a thoughtful consumer and avoid these 
things, because it's a totally broken system.  Kyle: Any specific recommendations for people to 
help navigate this system of chemical whack-a-mole   and finding products that are safe to use?
Professor Allen: Yeah, so I think the first   thing is all getting informed about this, because 
I think few people know this is going on.

Again,   I'm not trying to sell a book here, but you could 
look up "forever chemicals." Look up this op-ed   on chemical whack-a-mole. If you're interested, 
read that chapter. And you'd be really surprised,   and then you can start asking for it. I'll say 
from a system standpoint, we're trying to address   this through my Healthy Buildings Program at 
Harvard, with Harvard's Office for Sustainability.   We created the Harvard Healthy Building Materials 
Academy. And what we're doing is starting to   change buying practices. So instead of a company 
saying, here's something that doesn't have BPA,   we're starting to ask and say, "well, what 
else is in it? And by the way, we don't want   anything in that whole class of chemicals." Right, 
we're not gonna play this whack-a-mole game.   Forever chemicals, we don't want any of them. I 
don't care what your next "safe" replacement is   that you tell us is safe that we'll find out is 
toxic. And we're having a lot of success. We have   over 40 pilot projects on our campus where 
we're showing that you can design these spaces   with great products that don't impact cost 
or time of your projects, they look great,   perform the same, and you don't have the 
toxic chemicals in them.

So, there's a way   to do it and we're trying to move that with the 
market. We partnered with Google two years ago   on this initiative. Many other manufacturers, big 
companies are starting to put their buying power   behind this movement to kind of rid the market 
of these toxic chemicals that are in everything.   They're in our deodorants and shampoos, and I 
don't use shampoo; that's a bad example for me,   but in our couches chairs, they're all 
around us. So the way to do it is to   move upstream and change the whole system.
Kyle: Well, professor, thanks so much for   all of your research and advocacy for this. 
Before I let you go, any last things that   you want to mention before we chat next time?
Professor Allen: Yeah, I just want to say thanks,   and I really appreciate the interview, because 
it's rare to touch on COVID, but also talk about   all other aspects of healthy building, and then 
even end on that topic of chemicals, right.

So   we think about healthy buildings and it's all 
of these spaces. And the last thing I'll say is   something I usually start my presentations with, 
but I think it emphasizes why healthy buildings   matter so much. We're an indoor species. We 
spend 90 percent of our time indoors, and so   it's obvious, I think, when we think of it that 
way that the indoor environment is just having   this massive impact on our health. But there 
are ways to do it better. We've been in the sick   building era, but it doesn't mean we don't know 
how or can't do it better going forward. Any my   hope with a silver lining coming from COVID is now 
with everybody recognizing just how much the built   environment and building influence our health 
that it leads to a fundamental shift and change   in terms of how we prioritize these places where 
we live, work, play, pray, heal, that we start   designing them with a health-first perspective.
Kyle: Well, we'll be sure to put links to   some of the resources that you mentioned, and 
thanks again. Really appreciate it, professor.  Professor Allen: Yeah, thanks 
for having me on.

I enjoyed it..

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