The EPA has for years provided evidence-based guidance designed specifically for schools—their Tools for Schools—yet as of the start of the pandemic, more than half of all schools in the US had not adopted a framework for effective air quality management, called an Indoor Air Quality (IAQ) Management plan.
These are not opaque jargony strategies that exist only in the bottom drawers of facilities managers’ desks, they are evidence-based, practical toolboxes written to help families and schools partner to ensure their schools are as healthy as possible within existing budgets. In fact, that partnership is an essential aspect of an effective framework, as parents’, teachers’ and students’ reports of allergies and symptoms related to indoor air quality problems in school spaces are essential to implementing the plan (not to be dismissed, buried, or handled effectively in their absence).
As of the last time I looked, only one state out of 50 had strong laws promising that schools would have healthy air quality and ensuring parents could pursue remedies if they did not. This California PTA Resolution from 2007 may as well have been written yesterday, for all the progress that hasn’t been made in the state in the years since (and the generation of children who could have benefited): link.
As a parent who fought (and lost) to help our local schools adopt an air quality management plan—that would have reduced absenteeism related to asthma, improved overall student performance, and helped our locals schools reopen faster and more safely now—I dearly hope this moment will turn into an opportunity to not only mitigate the spread of Covid-19 in schools, but also to give students and teachers the benefits of good indoor air quality management long into the future. From what I have seen, that isn’t happening despite many good intentions. It’s not too late to change that.
Has your district purchased new filters? How are they being used and monitored for safety and efficacy? Has your district adopted an effective indoor air quality management plan? (If they say they have a plan that doesn’t involve working with and communicating with students, teachers, and families on an ongoing basis to ensure the spaces are healthy, the answer is no.)
“Many countries have prioritized schools in their COVID-19 pandemic recovery plans, including providing funding to support costs associated with reopening safely. These resources represent a once-in-a-generation opportunity for health-based improvements to school buildings, such as improving indoor air quality (IAQ), which can reduce the risk of airborne infectious disease transmission as well as benefit health and academic performance. Unfortunately, there are reports of schools spending millions of dollars on unproven or largely ineffective air cleaning technologies…” [my emphasis]
Melanie Robbins, mom of a kindergartner and a child in pre-K in Montclair, New Jersey, joined a campaign of concerned parents who tried to raise concerns with the Montclair Board of Education over the use of Global Plasma Solutions ionizing devices in their children’s public school classrooms. (Jackie Molloy / for KHN)
As Schools Spend Millions on Air Purifiers, Experts Warn of Overblown Claims and Harm to Children
“We’re going to live in a world where the air quality in schools is worse after the pandemic, after all of this money,” Zaatari said. “It’s really sickening.”
Last summer, Global Plasma Solutions wanted to test whether the company’s air-purifying devices could kill covid-19 virus particles but could find only a lab using a chamber the size of a shoebox for its trials. In the company-funded study, the virus was blasted with 27,000 ions per cubic centimeter.
In September, the company’s founder incidentally mentioned that the devices being offered for sale actually deliver a lot less ion power — 13 times less — into a full-sized room.
The company nonetheless used the shoebox results — over 99% viral reduction — in marketing its device heavily to schools as something that could combat covid in classrooms far, far larger than a shoebox.
School officials desperate to calm worried parents bought these devices and others with a flood of federal funds, installing them in more than 2,000 schools across 44 states, a KHN investigation found. They use the same technology — ionization, plasma and dry hydrogen peroxide — that the Lancet COVID-19 Commission recently deemed “often unproven” and potential sources of pollution themselves.
In the frenzy, schools are buying technology that academic air-quality experts warn can lull them into a false sense of security or even potentially harm kids. And schools often overlook the fact that their trusted contractors — typically engineering, HVAC or consulting firms — stand to earn big money from the deals, KHN found.
Academic experts are encouraging schools to pump in more fresh air and use tried-and-true filters, like HEPA, to capture the virus. Yet every ion- or hydroxyl-blasting air purifier sale strengthens a firm’s next pitch: The device is doing a great job in the neighboring town.
“It’s a self-fulfilling prophecy. The more people buy these technologies, the more they get legitimacy,” said Jeffrey Siegel, a civil engineering professor at the University of Toronto. “It’s really the complete wild west out there.”
Marwa Zaatari, a member of the American Society of Heating, Refrigerating and Air-Conditioning Engineers’ (ASHRAE) Epidemic Task Force, first compiled a list of schools and districts using such devices.
Schools have been “bombarded with persistent salespersons peddling the latest air and cleaning technologies, including those with minimal evidence to-date supporting safety and efficacy” according to a report released Thursday by the Center for Green Schools and ASHRAE.
Zaatari said she was particularly concerned that officials in New Jersey are buying thousands of devices made by another company that says they emit ozone, which can exacerbate asthma and harm developing lungs, according to decades of research.
“We’re going to live in a world where the air quality in schools is worse after the pandemic, after all of this money,” Zaatari said. “It’s really sickening.”
The sales race is fueled by roughly $193 billion in federal funds allocated to schools for teacher pay and safety upgrades — a giant fund that can be used to buy air cleaners. And Democrats are pushing for $100 billion more that could also be spent on air cleaners.
In April, Global Plasma Solutions said further tests show its devices inactivate covid in the air and on surfaces in larger chambers. The company studies still use about twice the level of ions than its leaders have publicly said the devices can deliver, KHN found.
There is virtually no federal oversight or enforcement of safe air-cleaning technology. Only California bans air cleaners that emit a certain amount of ozone.
U.S. Rep. Robert “Bobby” Scott (D-Va.), chair of the education and labor committee, said the federal government typically is not involved in local decisions of what products to buy, although he hopes for more federal guidance.
In the meantime, “these school systems are dealing with contractors providing all kinds of services,” he said, “so you just have to trust them to get the best expert advice on what to do.”
These go-between contractors — and the air cleaner companies themselves — have a stake in the sales. While their names might appear in school board records, their role in selling the device or commission from the deal is seldom made public, KHN found.
A LinkedIn job ad with the logo for one air purifier company, ActivePure Technology, which employs former Trump adviser Dr. Deborah Birx as its chief medical and science adviser, recruited salespeople this way: “Make Tons of Money with this COVID-killing Technology!!” The commission, the post said, is up to $900 per device.
“We have reps [who] made over 6-figures in 1 month selling to 1 school district,” the ad says. “This could be the biggest opportunity you have seen!”
‘A Tiny Bit of Ozone’
Schools in New Jersey have a particularly easy time buying air cleaners called Odorox: A state education agency lists them on their group-purchasing commodity list, with a large unit selling for more than $5,100. Originally used in home restoration and mold remediation, the devices have become popular in New Jersey schools as the company says its products can inactivate covid.
In Newark, administrators welcomed students back to class last month with more than 3,200 Odorox units, purchased with $7.5 million in federal funds, said Steven Morlino, executive director of Facilities Management for Newark Public Schools.
“I think parents feel pretty comfortable that their children are going to a safe environment,” he said. “And so did the staff.”
Environmental health and air-quality experts, though, are alarmed by the district’s plan.
The Pyure company’s Odorox devices are on California air-quality regulators’ list of “potentially hazardous ozone generators sold as air purifiers” and cannot be sold in the state.
A company distributor’s research shows that its Boss XL3 device pumps out as much as 77 parts per billion of ozone, a level that exceeds limits set by California lawmakers for the sale of indoor air cleaners and the EPA standard for ground-level ozone — a limit set to protect children from the well-documented harm of ozone to developing lungs.
That level exceeds the industry’s self-imposed limit by more than 10 times and is “unacceptable,” according to William Bahnfleth, an architectural engineering professor at Penn State who studies indoor air quality and leads the ASHRAE Epidemic Task Force.
Jean-Francois “JF” Huc, CEO of the Pyure company, pointed out that the study was done in a space smaller than they would recommend for such a powerful Odorox device. He cautioned that it was done that way to prove that home-restoration workers could be in the room with the device without violating work-safety rules.
“We provide very stringent operating guidelines around the size of room that our different devices should be put in,” he said.
You can’t see or smell ozone, but lungs treat it like a “foreign invader,” said Michael Jerrett, who has studied its health effects as director of the UCLA Center for Occupational and Environmental Health.
Lung cells mount an immune-like response, which can trigger asthma complications and divert energy from normal lung function, he said. Chronic exposure has been linked to more emergency room visits and can even cause premature death. Once harmed, Jerrett said, children’s lungs may not regain full function.
“Ozone is a very serious public health problem,” Jerrett said.
Adding ozone into the classroom is “just nightmarish,” Siegel, of the University of Toronto, said.
Morlino said the district plans to monitor ozone levels in each classroom, based on the federal Occupational Safety and Health Administration level for working adults, which is 100 parts per billion.
“In our research of the product,” he said, “we’ve determined it’s within the guidelines the federal government produces.”
While legal for healthy working adults, the work-safety standard should not apply to developing children, said Michael Kleinman, an air-quality researcher at the UC Irvine School of Medicine. “It’s not a good device to be using in the presence of children,” he said.
But the devices are going into schools throughout the state that will not be monitoring ozone levels, acknowledged Dave Matisoff, owner of Bio-Shine, a New Jersey-based distributor of Odorox. He said the main safeguard is informing schools about the appropriate-size room each device should be deployed to, a factor in ozone concentration.
Huc, the CEO, said his team has measured levels of ozone that are higher outdoors in Newark than inside — with his company’s units running.
“There is a tiny bit of ozone that is introduced, but it’s very, very low,” he said. “And you get the benefit of the antimicrobial effect, you get the benefit of reduction of pathogens, which we’ve demonstrated in a number of studies, and you get the reduction of VOC [volatile organic compounds].”
Meanwhile, despite expert concerns, the devices continue to pop up in classrooms and school nurses’ offices across the state, said Allen Barkkume, an industrial hygienist for the New Jersey teachers union.
He doesn’t blame schools for buying them, as they’re a lot less expensive than overhauling ventilation systems. Teachers often push for the devices in their classrooms, he said, as they see them in the nurses’ offices and think it’ll keep them safe. And superintendents are not well-versed in air quality’s complex scientific concepts.
“Nothing sounds better than something that’s cheap, quiet, small and easy to find, and we can stick them in every classroom,” Barkkume said.
Tested in Shoebox, Sold for Classrooms
While New York officials are “not permitting” the installation of ionization devices due to “potential negative health effects,” schools across the state of New Jersey are installing ionizing devices.
Ten miles away from Newark in Montclair, New Jersey, parents have been raising hell over the new Global Plasma Solutions’ ionizing devices in their children’s classrooms. The company website promises a product that emits ions like those “created with energy from rushing water, crashing waves and even sunlight.”
The devices emit positive and negative ions that are meant to help particles clump together, making them easier to filter out. The company says the ions can also reduce the viral particles that cause covid-19.
But Justin Klabin, a building developer with a background in indoor air quality and two sons in the district, was not convinced.
He spent hours compiling scientific evidence. He created painstaking YouTubevideos picking apart the ionizers’ viability and helped organize a petition signed by dozens of parents warning the school board against the installation.
Even so, the district spent $635,900 on installing ionizers, which would go in classrooms serving more than 6,000 kids. The devices are often installed in ducts, an important consideration, the company founder Charles Waddell said, because the ions that are emitted lose their power after 60 seconds.
But the company’s shoebox study and inflated ion blast numbers that helped sell the product last year leave a potential customer with little sense of how the device would perform in a classroom, Zaatari said.
“It’s a high cost for nothing,” Zaatari said. The company has sued her and another air-quality consultant for criticizing their devices. Of the pending case, Zaatari said it is a David-versus-Goliath situation, but she will not be deterred from speaking on behalf of children.
“Size of the [test] chamber has proved not to play a role in efficacy results but rather ion density,” GPS spokesperson Kevin Boyle said in an email. The company notes by its covid-inactivating test results that they “may include … higher-than-average ion concentrations.”
He also said the company is proud to meet the ASHRAE “zero ozone” certification.
Glenn Morrison, a professor of environmental science and engineering at the University of North Carolina, reviewed a March GPS study on a device combating the covid virus in the air. The device appears to reduce virus concentrations, he said in an email, but noted it would not be very effective under normal building conditions, outside a test chamber. “A cheap portable HEPA filter would work many times better and have fewer side effects (possibly ozone or other unwanted chemistry),” he wrote.
Other parents joined Klabin’s campaign, including Melanie Robbins, the mom of a kindergartner and a child in pre-K. Armed with her background in nonprofit advocacy, she reached out to experts. She and other parents spoke at local government meetings about their concerns.
In April, the superintendent told parents the school would turn off the devices, but parents say they haven’t turned them all off.
“As far as I understand, the district has relied only on information from GPS, the manufacturer,” Robbins said during a Montclair Board of Education meeting via Zoom on April 19. “This is like only listening to advice from Philip Morris as to whether smoking is safe or not.”
Dan Daniello, of D&B Building Solutions, an HVAC contracting company, defended GPS products during the meeting. He said they are even in the White House, a selling point the company has made repeatedly.
The catch: A GPS contractor installed its ionization technology in the East Wing of the White House after it was purchased in 2018 — before covid emerged, according to GPS’ Boyle. But the company was still using the White House logo as a marketing image on its website when KHN asked the White House about the advertising in April. It was taken down shortly thereafter.
Boyle said GPS was “recently informed that the White House logo may not be used for marketing purposes, and promptly complied.”
The Montclair school district did not respond to requests for comment.
“I want to bang my head against the wall, it’s so black-and-white,” Robbins said. “Admit this is a poor purchase, the district got played.”
Selling ‘the Big Kahuna’
Academic air-quality experts agree on what’s best for schools: More outside air pumped into classes, MERV 13 filters in heating systems and portable HEPA filters. The solution is time-tested and effective, they say. Yet as common commodities, like a pair of khaki pants, these items are not widely flogged by a sales force chasing big commissions.
After covid hit, Tony Barron said the companies pitched air purifying technology nonstop to the Kansas district where he worked as a facility manager last fall.
Pressure came from inside the school as well. Teachers sent links for air cleaners they saw on the news. His superintendent had him meet with a friend who sold ionization products. He got constant calls, mail and email from mechanical engineering companies.
The hundreds of phone calls from air cleaner pitches were overwhelming, said Chris Crockett, director of facilities for Turner USD 202 in Kansas City, Kansas. While he wanted to trust the contractors he had worked with, he tested four products before deciding to spend several hundred thousands of dollars.
“Custodial supply companies see the writing on the wall, that there’s a lot of money out there,” he said. “And then a lot of money is going to be spent on HVAC systems.”
ActivePure says on its website that its air purifiers are in hundreds of schools. In a press release, the company said they were “sold through a nationwide network of several hundred franchises, 5,000 general contractors/HVAC specialists and thousands of individual distributors.”
Enviro Technology Pros, founded in January, is one company pitching ActivePure to HVAC contractors. In a YouTube video, the founders said contractors can make $950 for each air-cleaning device sold, and some dealers can make up to $30,000 a month. Citing the bounty of the billions in federal relief, another video touted ready-made campaigns to target school principals directly.
After KHN asked ActivePure for comment, the Enviro Technology Pros YouTube videos about ActivePure were no longer accessible publicly.
ActivePure did not respond to requests for comment but has said its devices are effective and one is validated by the Food and Drug Administration.
An Enviro Technology Pros founder, Rod Norman, told KHN the company was asked to take the posts down by Vollara, a company related to ActivePure. He called sales to schools “the big kahuna.”
Shortly after he spoke with KHN, the website for his own company was taken down.
This story was produced by KHN (Kaiser Health News), a national newsroom that produces in-depth journalism about health issues. Together with Policy Analysis and Polling, KHN is one of the three major operating programs at KFF (Kaiser Family Foundation). KFF is an endowed nonprofit organization providing information on health issues to the nation.
The article points out that occupied rooms can easily have CO2 levels of 1,000ppm or higher: “Decision-making decreased moderately at 1,000 ppm as measured on seven of the nine scales, with decreases ranging from 11 to 23 percent, and significantly on those same scales at 2,500 ppm, with decreases of 44 to 94 percent. The most dramatic effects were found in the participants’ ability to engage in strategic thinking and take initiative.”
Note the most dramatic impact is on executive function!
Even a single person in a small room can raise CO2 levels into this range. I already knew all this, but for those stuck at home working and studying in small rooms, it can be hard to know how much anything we do, like opening windows, or keeping a door open during the day, or the house heating system, improves ventilation and CO2 levels. Students may need to keep their doors closed in order to maintain peace and quiet, but that has to be balanced against pragmatic steps to keep CO2 levels to a healthy level.
As I wrote in a previous post, a surprising number of schools don’t measure up when it comes to proper ventilation. Nevertheless, many schools and workplaces do pay attention to proper ventilation, something we take for granted at home. With people at home for long stretches of time, and college students having to work from the dorm rooms, it’s up to us to pay attention to the issue.
So I bit the bullet and bought a well-reviewed CO2 monitor Now we can make adjustments based on data to keep those levels closer to what’s outside, which is around 380ppm according to the article. In practice, we found that closing the door to the room allowed levels to quickly exceed 1,600ppm, which according to research would mean a decline in cognitive function. Leaving a window open kept the levels to 500-600ppm, but wasn’t practical with classes. So we again bit the bullet and got a pair of noise cancelling headphones that also receive audio from the computer, to allow for leaving the door open with less distraction. (One had already been recommended by a professional for other reasons.)
Especially if there are other reasons a child has difficulties, maintaining indoor air quality is so important to their health and school performance. I have done a lot of personal research on the issue of indoor air quality in indoor spaces and health, and CO2 levels aren’t anywhere near the top of the list of concerns, yet they should be, based on research. I hope this information about CO2 helps people to more easily make decisions about improved ventilation and air quality related to Covid control, too.
The Aliso Canyon gas leak in Southern California was big news a few years ago. As a result, a dozen and a half elementary schools in the area were provided high quality air filtration in every classroom. Measurements were made to assess levels of outdoor pollutants entering the classrooms, and children’s math and reading test scores were also analyzed and put through various comparisons.
Very little outdoor pollution made it into the classrooms, as it turns out, but the filters cleaned up typical indoor pollution. As air quality improved in the schools that received the filters, so did the students’ test scores. A lot. Test scores improved so much, the benefit was “equal to the learning benefits from reducing class sizes or providing intensive tutoring.” While the researchers noted a drop in illnesses and absenteeism among occupants of these classrooms, the improvements could not be attributed to those benefits alone.
Test scores improved so much, the benefit was “equal to the learning benefits from reducing class sizes or providing intensive tutoring.”
While the article and the original paper both bear reading, the benefits of better air quality in schools is not news. Prior research already linked air quality in schools with student test scores and achievement, and poor air quality with student and teacher illnesses and absenteeism (which are further connected to a litany of other ills).
Healthy schools = healthy kids
The EPA even developed a whole body of helpful, evidence-based resources for schools to use, their Tools for Schools, upon which many other well-researched indoor air quality management plans have been based. Indoor air quality management plans are just well-researched strategies that help make schools healthier and keep them that way. If you want to really delve into the issue, the EPA has an indoor air quality master class webinar series which is free and definitely worth the time: IAQ Master Class Professional Training Webinar Series
Although this research shows just how dramatically better indoor air quality can improve student performance and reduce illnesses and absenteeism in the classroom, an even greater takeaway should be that:
a) evidence already exists that schools can get such dramatic benefits from adopting indoor air quality management plans, without filtration, and often at very little cost, and
b) using filtration in addition to adopting indoor air quality management plans could be powerful tools to both reducing illnesses spread in schools and improving student achievement.
The well-researched tools to accomplish this have been available to schools, for free, for many years, yet less than half of schools have an indoor air quality management plan, despite the EPA reporting that half of schools have problems related to air quality, and despite the aging school infrastructure—the majority of schools in this country built over 50 years ago.
Although such problems can affect children in poorer districts disproportionately by compounding other factors, rich districts are not immune. Recent research in California schools found inadequate ventilation and poor air circulation (with the attendant harm to learning and student health) in the vast majority of classrooms, around 85% of classrooms they looked at, a finding that confirms previous research. They found new school sites were just as prone to having poor ventilation as older ones.
It has always been something of an ongoing tragedy that this major body of environmental health research hasn’t been recognized and adopted uniformly across the nation, because very small investments can reap such major rewards for our nation’s children.
This may be in part because adopting such plans can seem complicated and is completely voluntary, and next to no legal obligations exist in virtually any states to ensure good air quality in schools or to allow parents recourse to fix things when their children’s schools have air quality problems. I’ve had discussions with school administrators who told me frankly that they follow many regulations and they believed if adopting such plans were important, there would be a law they had to follow. I’ve had discussions with experienced environmental scientists who told me frankly (going back many years, irrespective of partisan turnover in Washington) that they are under considerable political pressure and the best way to get schools the benefits of this research is for the EPA to share what they can and make it voluntary.
And thus the fundamental problem here, a gap in understanding between environmental health scientists and school health stakeholders, including teachers, parents, students, and the doctors who care for them all, leads to an unnecessary and easily-removed health burden on our nation’s children and teachers.
How this school filter research could help students return to schools and colleges
Looking ahead to the fall of 2020, with so many uncertainties and the likelihood of both the flu and Covid-19 surging at the same time, schools and colleges are trying to cope with the staggering adjustments that will have to be made in order to safely return students to campuses.
Unfortunately, the impact on colleges is especially severe with the economic strain of many students, especially international students, staying home, deferring, or simply not going to college at all next fall. Any livelihoods that depend on gatherings, such as live music and restaurants, travel and tourism, all stand to be hit even worse if there is another surge of infections in the fall, thus compounding the problem for colleges with the greater demand for financial aid as a large percentage of families lose jobs and income. Certainly, a coronavirus vaccine will help, but there is almost no scenario under which there will be a proven effective vaccine in place before fall, and if one is rushed and doesn’t work, or worse, has unexpected, serious consequences, it could undermine faith in other vaccines.
Attention to research like this should be part of the planning picture, because improving indoor air quality doesn’t just demonstrably improve student performance, per considerable research, it also reduces the number of infections the occupants of buildings get and pass around.
Improve indoor air quality, and you reduce the rate of infections and absenteeism, not just in those with asthma, but in everyone. Fewer children and teachers get asthma, and those who have asthma get fewer attacks. This is well-established by decades of environmental science, including specifically in schools.
Adopting an effective framework for indoor air quality management can improve air quality by more than just the simple filtration reported in this paper, and adding filters can mean even greater benefits. Especially since few people seem to be minding proper two-step disinfection, and are using detergent wipes like they’re going out of style. Such products leave residues that build up as dust and cause asthma.
According to the CDC’s Healthy Cleaning and Asthma-Safer Schools: “AVOID DISINFECTANT WIPES Disinfectant wipes are used regularly, but they usually contain asthmagens. “ (Substances that are known to cause asthma.) It is possible to achieve the same or better cleaning and disinfection results without causing asthma at the same time.
We all know that asthma is a risk factor when it comes to Covid-19, and people can also develop inflammation in the lungs that makes them susceptible from these same environmental influences short of having diagnosable asthma. The CDC cleaning recommendations, the two-step process I blogged about earlier, can be done—in fact, are better done—without increasing asthmagenic chemicals in the environment which can increase susceptibility to infection.
Another serious problem that schools face this fall, is that environmental scientists have also long known that when a closed up space, like a school, has been shuttered and unoccupied for a period of time, when it is reopened, the new occupants stir up all kinds of stuff that worsens air quality and causes spikes in infectious diseases and other known consequences of poor air quality. If this is not understood and addressed before schools, workplaces, colleges, and other communal spaces reopen globally in the fall, the predictable, attendant spikes in upper respiratory symptoms AND infections could cause a preventable wave of more deaths and lengthier shutdowns.
When a school has been closed up for a period of time, when it is reopened, the new occupants stir up stuff that worsens air quality and causes spikes in upper respiratory infections and other known consequences of poor air quality.
Seriously adopting indoor air quality management plans in all schools now, even without filtration, could help reduce this phenomenon, which could cause panic in the fall as schools and colleges around the world reopen for the majority of students after being closed up for so long. Filtration could reduce problems further, and it could be an important tool for allowing more normal life again as one of many tools.
From what I learned about the topic, filtration is actually a poor second cousin to implementing an indoor air quality management plan. It’s better to avoid building up unhealthy chemicals and particles in the first place than to try to filter them out, but in practice, I have observed that the easy, cheap indoor air quality management steps seem to be the hardest for people to believe work.
The EPA has done previous research with filters in classrooms, when a known environmental problem could not otherwise be remediated (mold), with good results, but they did not use commercial filters which tend to be too small and too loud. They used cabinet-sized filters that resulted in more robust filtration without adding noise to the class room environment. (Don’t quote me on this, but I vaguely remember the company involved in that work was also involved in providing the plug-in filters for this research.)
One of the reasons I brought up the question in my last post—why are people still getting sick?—and wondered if it’s possible to keep detailed data on new infections, is the possibility that a more refined understanding of exactly how people get sick in groups (or not), and how they don’t, in as much detail as possible, could help mitigate the extreme response, even mitigate the indiscriminate use of disinfectants.
Such an understanding would especially help schools and colleges understand the parameters for safe return of students. In the meantime, measures to improve indoor air quality need to become a priority, as they can be adopted while students are home, and are already proven to significantly improve student performance and reduce the spread of infectious illnesses in schools.
*I should note that while mechanical filtration can filter out viruses, it’s not necessary to do that in order to get the benefits above, such as reducing illnesses going around in schools. Simply removing the harmful chemicals (like those that come from mold growing in the environment) and particles that cause damaging health effects like airway inflammation, including “remodeling” of the upper respiratory system from chronic inflammation, is enough to improve student performance and reduce the incidences of colds and flus going around at school. Further research would be necessary to know the best kind of filtration to get the absolute best reduction of novel coronavirus spread.
After weeks of sheltering in place, as the nation reopens, I would like to know what has been done in the interim to sharpen the understanding of hygiene to contain the virus and allow normal life without fear of making things worse again? Hygiene is not cleaning or killing every germ, it’s what you do to prevent the spread of infection.
The sheltering in place was clearly necessary and saved many lived. But after all these weeks, I am left to wonder why there aren’t more nuanced hygiene instructions? This is not intended as criticism—scientists and doctors working on this problem have been working hard, heroically, really.
But I don’t want to lose sight of the problem solving opportunity here. As public health efforts increase testing, they should also consider taking methodical data on when and how everyone got infected, or likely was infected, down to the nitty gritty details and the spectrum of possibilities, the way the health inspector investigates after food poisoning complaints at restaurants.
Knowing more about exactly why people do get sick from interactions and the kinds of interactions they don’t get sick from—and teasing apart why some people get sick from seemingly similar interactions and others don’t—will make all the difference in whether students can go to school or college in the fall, safely, or people can travel again, or restaurants get customers next month instead of next year. If I were Disneyland or Johns Hopkins University, I would be throwing money at knowing that information.
After all these weeks of lockdown, people are still getting sick. Is it because 6 feet apart isn’t enough? Is it that people aren’t maintaining known recommendations? Are some of those recommendations unnecessary for a lot of circumstances and people? What if we could be resuming, like, 80% of the things we used to do because we understand in better detail how and why people are still getting sick and how to avoid it?
Who is systematically trying to understand human interactions in more detail right now so we understand why infection continues to spread, or when it doesn’t? Contact tracing is necessary, but it’s not the same thing.
The lockdown is like a national allergy elimination diet — you can eliminate everything you eat to stop reacting, but you can’t live like that forever. But you go through the sacrifice because it allows you to track down what causes a reaction so that you can eat almost everything else again and remain healthy.
If you go through the trouble of eliminating everything just to stop reacting, then reintroduce foods simply because you want to get your digestion going again but without truly trying to track down what causes problems at every step, then you lose most of the value of the original sacrifice.
Continuing the lockdown without using it to get a more nuanced understanding of hygiene is like reducing your diet to just toast forever. Reopening the country without understanding the nature of interactions that are still spreading disease and why, is like going to all that trouble to stop eating everything to stop the allergy, only to just start up eating everything willy nilly and losing the advantage of the temporary sacrifice.
Many people and parts of the country are probably safe to resume life. But we don’t know the nuances of the conditions under which those behaviors go from safe to dangerous and vice versa. Just expanding testing isn’t going to tell us that. We need a systematic attempt to understand how this virus is transmitted and how to prevent it, and our current situation where almost everyone is still sheltering in place but the disease continues to be transmitted is the ideal time to do that.
Having that knowledge could allow us to better move forward confidently and safely, and resume more normal life. We need this prevalence testing and contact tracing, but I hope researchers will also start taking detailed data that allows a more nuanced look at when and how infection is being spread, and when and how it is not being spread. Is it really necessary to shut down the beaches, for example? Knowing more detail about the conditions of how the infection is spreading in the world now, and not spread, hand-in-hand with testing, could help make such decisions with confidence.
Some years ago, I posted a page on my blog with homegrown steps for preventing colds and flus by heading them off before they get going. I am reposting them below, updated, for family and my doctor.
In the close to 20 years that I have employed these strategies, I have never had the incipient symptoms of an upper respiratory infections—like sore throat, congestion, cough from post-nasal drip—turn into anything. I’ve experienced the beginnings of runny noses or bad sore throats plenty of times—and I don’t mean minor ones, I mean the kind of sore throats that are so inflamed and painful, it’s hard to talk or swallow your own spit, including fever—and other symptoms that at one time would have always turned into a major illness.*
These strategies have reliably helped me (and my family members and friends who have used them) to cut those symptoms short and get better quickly without ever developing a systemic illness.
As with SolveEczema.org (environmental strategies for eczema and astham), the strategies involve taking simple measures that anyone can do, generally regarded as safe, and that are based on a combination of my own research and methodical, empirical observation. And just as with SolveEczema strategies, it can be easy to make wrong assumptions and miss getting the results unless one reads and understands that these strategies are something new and different despite familiar elements.
And just as with SolveEczema.org, I tend to keep things low-key until there is research to back it up—even more than SolveEczema, these flu-prevention strategies could be easily validated with appropriate clinical trials. Which are difficult to get done as an outsider. (As SolveEczema.org users know, I am not a medical professional.)
But as the Covid-19 pandemic has progressed, I feel I should speak up. Testing the above strategies would be easy and fairly low risk, with the potential benefit of reducing the number of people who get sick with Covid-19 after exposure, allowing for a faster recovery, faster resolution of the epidemiological “curve” and faster and more confident transition to normal life. Especially for healthcare workers and people in essential jobs like first responders, grocery and delivery employees, construction and transportation workers, having a way to regularly mitigate the likelihood of infection even after exposure or development of new symptoms would be very powerful. If these steps prove broadly effective, it could significantly reduce the risk of illness because of exposures in their work. The strategies could conceivably reduce transmissibility and thus cut short the epidemic.
There would be relatively few downsides to a clinical trial. The strategies could be employed by half of those with a known exposure but who have not gotten sick and comparisons made with the other half for how many came down with the full-blown disease. Another group could be health care workers or public health professionals who get constant exposure, with half getting the strategies (modified specifically for their circumstances), half not.
The best trial would be to test the strategies with people who get incipient symptoms like GI problems, sore throat, or congestion, because these strategies work best in my experience when used at the beginnings of an illness or right after a known exposure, rather than as regular well-care prophylaxis, but from what I understand, the typical symptoms of an incipient flu are not necessarily present very often at the start Covid-19.
The other kind of trial that might be helpful is to give the strategies to a portion of those who develop incipient flu symptoms and give only partial strategies that are already in common use to others, and see if it changes the number of people who get sick with flus. Even if the strategies don’t work with Covid-19 as well, if they are generally as effective as I have observed with flu, they could reduce the number of people who need medical services for flu, and thus help free up the healthcare system at this time of crisis. (And would also help reduce the number of flu deaths every year!)
These are not just typical strategies such as to reduce the pain of a sore throat by gargling with salt water, they are a combined set of strategies to eliminate the sore throat altogether within a short period of time and keep something worse from developing. I speculate from what I have observed that the strategies may allow the immune system to catch up, essentially.
I have updated the strategies and posted them below for convenience. My next post will include selected updated research support for this from medical literature, and why I believe these strategies could help with Covid-19 control WITH APPROPRIATE CLINICAL TRIALS FOR VALIDATION. Please note again that if you have symptoms, CONTACT YOUR DOCTOR. If you want to try these strategies, run them by your doctor and understand when you should call. Do not use something anyone provides you from the Internet, even me, in lieu of professional medical attention.
Wishing everyone Good Health as we all do our parts to end this pandemic as soon as possible.
*Only one time, I had something that seemed to go straight into my lungs without any sore throat or other symptoms first, but even then, the strategies allowed my to keep the coughing from starting up so I could sleep.
Better than chicken soup* – Our family’s best home remedy for heading off colds, sore throats, and cough from post-nasal drip
This is what we do during cold and flu season — it really seems preventive and to head off sore throats, colds and coughs. I couldn’t say if it beats my Grandma’s onion poultices because — sorry Grandma! — making onion poultices is not my idea of a soothing solution when I am sick! These steps seem to work fast — without onions — and help head off the congestion that tickles the back of the throat and becomes a cough, especially at night.
As you might expect if you follow SolveEczema.org, I developed this because of research I read over the years, and copious experimentation and observation. Since following these steps, I’ve never had a sore throat turn into anything, and the few times I’ve had problems that seemed to bypass the sore throat stage, it was still helpful at heading off the coughing and letting me sleep at night — without a lot of medication.
DISCLAIMER: As always, I feel like I need to make a disclaimer, because even if this is effective for you — especially if it is effective for you — DO NOT do this instead of consulting your doctor. Only do with your doctor’s blessing, and after making sure nothing more serious needs to be addressed! That H1N1 flu, for example, moves FAST into the lungs and gets scary serious even faster — this is NOT a substitute for getting urgent care for something like that, and is NOT a home remedy once something has moved into the lungs, among other problems. See your doctor immediately if there is any question of there being pneumonia or infection in the lungs. (My readers know how cautious I am about medical treatment — even I recommend everyone getting flu shots.)
So, with that in mind ….
Not all of these steps are always necessary — the essential ones are starred *** — but the order of all the steps is important, regardless. With very young children, check with doctor before doing any of these steps:
Whenever a sore throat, congestion, or cough starts (a cough that isn’t yet in the lungs but comes from higher up):
1. Brush teeth — use a new brush or disinfect toothbrush first with peroxide if possible, use toothpaste from a new tube, don’t contact the bristles to the tube.
Brushing can be skipped in a pinch, but it’s a good idea to start by brushing. The microorganisms don’t just inhabit the back of the throat, and brushing reduces the bacterial soup swimming around the mouth.
2. Drink a large glass of warm water — it’s so important for the immune system and also because you don’t want to drink right after the next steps. Many people come from cultural traditions that view warm water (room temperature or slightly warmer rather than cold water) as important for health — there is research support for this notion now, and from my own empirical observation, I am in agreement with this view.
Simply Saline Allergy and Sinus ****
***3. Rinse sinuses with Simply Saline sterile nasal spray from each side per instructions (regular or Allergy and Sinus formula, they are both non-detergent and JUST saline) and blow nose.
Simply Saline is my favorite product for this purpose, it works well and the mist delivers the product into the sinuses in a very gentle way, especially for children, though you may still have to talk them through it. You can also use other products, or a Neti Pot but not if you are EVER tempted to use it without sterile water!!! (I can’t stress that enough, never put unsterilized tap water in your sinuses!!!!!)
Step #3 is important EVEN IF YOU ONLY HAVE A SORE THROAT AND DON’T YET HAVE CONGESTION.
For very bad congestion, after rinsing well with regular Simply Saline, rinse again with the Allergy and Sinus Simply Saline. That works the vast majority of the time, but if things come back and repeating the steps using those isn’t enough, you can rinse with Simply Saline then follow with Nutribiotic Nasal Spray, per instructions, probably one or two sprays per nostril. (I am concerned about how well the valve works so I always spray it into a clean tissue once or twice after every use, keep the nozzle wiped clean, and throw it away when I no longer need it for that illness.)
***4. Gargle several times with a glass of warm salt water (just use ordinary table salt, maybe a spoon in a glass, it doesn’t have to be ocean-salty). Swish some of the salt water around in your mouth, between the teeth, and spit out. (If you have high blood pressure and need to watch salt intake, discuss with doctor beforehand.)
Step #4 is important EVEN IF YOU DON’T HAVE A SORE THROAT BUT ONLY HAVE CONGESTION AND/OR COUGHING FROM POST-NASAL DRIP.
***5. Dissolve a dose of probiotic in a small amount of warm water, like only just a teaspoon or two of water, then swallow so it coats the back of the throat and tongue.
My favorite probiotics for this (including for myself) are Jarrow Baby’s Jarro-dophilus. (The link is for information only, this product has to be refrigerated and is available in most health food stores, although it can be ordered here with a cold pack if necessary.) It comes in powder form and can be measured out by the teaspoon or fractions of. It tends to clump, so make sure it is well dissolved. Primadophilus Intensive is also good. It comes in a powder, in separate packets. (I can no longer find this product in stores, perhaps they don’t make it.)
I find in a pinch, just taking the concentrated probiotic can help combat a sore throat. LINK
If you don’t have those brands, you can use what you have, split open a capsule and dissolve it in the glass. Be sure it’s a refrigerated acidophilus with live bacteria. Dead shelf-stable ones are better than nothing, but you may not get the same results. Use a probiotic with as many strains as possible. If you only have one, that’s better than nothing, but 6-12 strains is best in my experience. (There is at least evidence that 2 strains is better than one when it comes to cold and flue prevention.)
You may have to try more than one probiotic product to hit the right one to beat back whatever is causing the problem sometimes — it’s always more effective to do this at the very start of the sore throat than after it gets entrenched. How do you know if it’s a good probiotic? It should begin working right away. If it makes no discernible difference, you need a different probiotic. The difference is usually pretty obvious.
Repeat whenever the pain returns. But try to do after eating rather than before.
This seems to work really well to ward off sore throats and congestion when they happen and keep them from turning into something else, and also, it has been very useful to stop the coughing at night when lying down, whether there is a sore throat or not. Even if you don’t seem to be congested, the stuff that comes down postnasal can be very irritating and be the reason for the cough. This really seems effective at getting all that stuff out of the way, if you do it right before going to bed, so you can sleep and the immune system can do its job better.
If you want to be really hard core — it does seem to help — eat healthy and don’t eat sugary and starchy foods while sick, the bad microbes seem to love those foods as much as we do. If taking an antibiotic, take probiotics during treatment (not just after) per medical advice — take oral enteric coated probiotics in addition to the dissolved per #5 above.
Lastly, if you spend time at school or the doctor’s office during cold and flu season, when you get home, wash hands (of course) and change into clean clothes (bag the dirty ones and put them by the laundry, don’t leave them in your room even in the hamper). I don’t know if the question of how much doctors’ coats and ties are spreading disease has been settled LINK , but taking this step has definitely worked for me from personal experience.
So the steps are again:
1. Brush teeth with a clean brush and paste. 2. Drink a large glass of warm water. 3. Rinse sinuses with sterile saline nasal rinse (whether you are congested or not), immediately followed by: 4. Gargle with warm salt water (whether you have a sore throat or not). 5. Dissolve a dose of probiotic in a small amount of water, just a teaspoon or two, and drink. 6. Repeat the whole process as soon as symptoms return. Use Allergy & Sinus Simply Saline in all subsequent repeats if the regular wasn’t enough to make things go away completely the first time.
Remember to rinse and sterilize the sink when you are done, as necessary.
Do not get “lazy” and let things go just because the steps make things feel instantly better when you do them. They work best if you go do them right when the symptoms start and repeat them right away if symptoms come back. Doing this, I have been able to reliably get rid of even aggressive sore throats and congestion and keep them from turning into a something worse for around 20 years now. If symptoms get entrenched, it’s not too late—following the steps seems to help reduce the severity and duration of any illness that gets a foothold.
Be Well! I hope this helps!
*My opinion! Believe it or not, I think chicken soup can actually claim published support for its healing properties!
**As everyone who reads my site knows, I am a mom, not a doctor. I have given this advice to my own doctor!
****I have mostly suspended affiliate marketing, because it’s a lot of work, and people get the wrong impression. I do earn a very small percentage if people buy using the links, but with personal care products, it earns very little, it’s just a convenience. Sadly, my favorite site for personal care products was bought up and closed down. As of this writing, Simply Saline products are available at Costco, Amazon, and many drugstores.
I have decided to expand the scope of my posts during the pandemic, to include a backlog of SolveEczema-related updates, but also education—my son is now going off to college—environmental health, and other problems that need attention since national news is so focused, necessarily, on the pandemic. Some things need to be said, that aren’t being said.
It may seem as if my blog hasn’t been active, and but I have had to focus on behind-the-scenes stuff like moving my website to a new host and all the nail-biting and nested-tech-tasks-of-indeterminate-time-sinks that entailed. I’m very thankful the new host seems to be so much better.
My son ended up homeschooling for high school, to start in large part because our local school didn’t handle either the environmental health issues or his education very well. I have a lot to share about how families can hopefully be more successful than we were at improving their schools’ environmental health.
It’s become more imperative because environmental health research shows that when schools are closed up for any period of time, as schools all over the world are now because of the Covid-19 pandemic, the sudden worsening of indoor air quality from everything being stirred up when schools are reopened makes for a spike in colds, flus, and upper respiratory infections among students and staff. After everything everyone is doing to end this pandemic, the environmental health evidence-base points to the need to head off that surge by understanding effective indoor air quality management to avoid another round of lockdowns and a surge in the Covid-19 cases when schools and colleges start up again.
So, for the next few months, my posts won’t necessarily be on topic. I will try to make posts that are helpful my site users, since I want everyone to be able to safely employ preventive environmental strategies for eczema and asthma while also following CDC and other official guidelines and recommendations to stay safe.