In particular for this post I will remind the reader that I am not a public health official, an epidemiologist, or an infectious disease specialist. Nor do I speak on behalf of my institution. I am a medical librarian and, with many of my peers and colleagues, I’ve been immersed for two months now in a wealth of information generated at top speed as we attempt to understand this new reality.
My university, like many others, is trying to sort out what re-opening will look like. This includes relying on OSHA, the CDC, our Department of Environmental and Occupational Health Sciences, NIOSH, and various other resources, including the newest scientific literature. Something that has come up in conversation a couple of times are questions about aerosol transmission and community spread. The short version is that we don’t know enough yet and I don’t anticipate we will know for a while. But there are the preprints/first versions of papers that I’ve shared recently and I think they can help us consider some of the risks libraries in particular may face as public spaces where large groups of people gather and congregate for extended periods of time. Please keep in mind the below articles are not final peer-reviewed versions and may change.
Coronavirus Disease Outbreak in Call Center, South Korea ; https://wwwnc.cdc.gov/eid/article/26/8/20-1274_article
This early version/pre-final-review synopsis looks at the results of a call center where over 1000 employees were tested following identification of a patient who tested positive and who was believed to be tied to a cluster of cases. Probably most interesting is Figure 2 — which shows the seating plan of the eleventh floor where the attack rate was 43.5%. No other floor showed a similar cluster, despite use of the same lobby and elevator. What struck me here was how much this looked like the floor plans I see of academic libraries, where we’ve removed stacks, re-architected for open floor plans, and created spaces where students can be densely together although within their own small desk area or cubby space to study.
COVID-19 Outbreak Associated with Air Conditioning in Restaurant, Guangzhou, China, 2020; https://wwwnc.cdc.gov/eid/article/26/7/20-0764_article
This early version/pre-final-review research letter is tied again to contract tracing and examines how the air conditioning in a restaurant appears to have specifically affect seated diners and facilitated exposure. While the specific flow of transmission cannot be fully documented — as the authors note in detail — there appears to be correlation between the airflow and infections. Again, I think of the larger tables in our spaces where students work in groups and how every librarian I know talks about how their AC is on full blast in June and we’re all hauling sweaters into the office because we’re cold–oh and there’s that one room that’s unbearably hot/cold and the corner over there that is *just* under a vent.
Aerodynamic analysis of SARS-CoV-2 in two Wuhan hospitals https://www.nature.com/articles/s41586-020-2271-3
This third early review/pre-print just came out in the past couple of days and doesn’t look specifically at infection but at the presence in aerosols of viral RNA. Of particular note was an elevation in “patients’ toilet areas.” And herein is a particular concern — even as we continue to limit the number of people in any of our buildings, individuals will always have only a few options for bathrooms. Even with face masks and extensive handwashing– people will be in these very small spaces one after another. I find it very unlikely that we’re prepared to have hospital-disinfection levels for our bathrooms.
The perspective I’m reading these from is in an academic medical library: where normally my students pack into the building for hours to study and collaborate with each other and meet with us; where they regularly rearrange the furniture so that they can be closer together or nearer a preferred outlet; where we cannot open any of the windows and are wholly reliant on internal air handling. In creating welcoming open light-filled spaces (well– okay except the AC freezer temps in July) — I worry about how the physical space might introduce risk.
This is emerging research that I have shared with my leadership and these are also concerns my administration and management are taking very seriously. We are still operating under the stay-at-home from our governor and everyone is being very cautious because we do not wish to put individuals or groups at risk or give a false impression that it is “safe” to congregate in our library buildings.
I encourage you to read these papers and to pursue your own further investigation using LitCOVID, where the NIH is aggregating biomedical literature. And also to keep advocating for Open Access, which has proven absolutely critical during this time.
I really like this article and it’s Figure 3. It’s a helpful guide for navigating people density, activity, wearing a mask, and ventilation: https://doi.org/10.1136/bmj.m3223 . We need to start talking about ventilation more.