Why Should We Care About Indoor Air Quality?

Ashish Jha: 00:00:05

Hey everybody. Sheesh Jha, here on yet another cold and rainy Providence afternoon, it happens in the fall. Welcome to the next episode of a moment in health, the podcast where we talk about a data point, discuss a study and answer a question. Let's jump right into it. The data point is 13.1% that's the proportion of respondents in a national survey of 12 to 21 year olds who said they use AI based tools for mental health advice. About one in eight. That's pretty big number. I have to say, I was surprised by that. That number represents about 5.4 million people, young people, kids, young adults, 12 to 21 year olds who are using AI for mental health advice. The interesting part of that, to me also is that 93% of them said they actually found the advice useful. So most people did. I guess that's why they continue to use it. At some point, we'll come back to another future episode and talk about the quality of the studies about how well these things work. But that number is striking to me and suggests that a lot of people, a lot of young people, are using AI based tools for mental health. All right, so that's your data point.

Ashish Jha: 00:01:22

Let let's talk about a study. And the study I want to discuss today comes to us from Italy. It was published a couple of years ago, actually, almost three years ago, in December 2022 and it was increasing ventilation, reduces SARS, covid two, airborne transmission in schools, a retrospective cohort study in Italy's Marche region. I think that's how you pronounce it. All right. What's the study about? The study looked at what happened when you improved ventilation in schools to improve the indoor air quality in those schools. And what they found was they looked at more than 10,000 classrooms which were equipped with better mechanical ventilation, they found that when the ventilation rate in those schools was improved, you saw dramatic reductions in infection rates, and overall infection rates decreased by almost 80% in these schools. Here's the big picture point about this indoor air quality. Just improving ventilation and filtration is something that a lot of us have been talking about for a long time, and the data that it makes a difference in reducing infections is enormous, because we know respiratory infections largely spread through the air, and if you can clean the air indoors by improving ventilation and filtration, something that doesn't actually cost a lot of money to do, it can make an enormous difference. And the study from December of 22 in Italy is one of the landmark studies here that really shows that if you improve ventilation in schools, you can dramatically reduce the number of infections that that kids get, reducing absenteeism for kids, teachers and everybody else

Ashish Jha: 00:03:06

okay, now for the question of the week and for the question of the week, I have a very special guest, Georgia. Laguna was a colleague of mine at the White House, is now a senior fellow at the pandemic center, working on indoor air quality.

Georgia Lagoudas: 00:03:22

Georgia, welcome. Thank you. Ashish, great to be here. So

Ashish Jha: 00:03:25

Georgia, you might have heard a little skepticism, and I voice about indoor air quality, and we actually worked on this together when we were at the White House. So I'm obviously a believer. But like, what is this about? Because, like, why should we care about indoor air quality? My sense is indoor air in most places is fine, but you you think is an important issue to be working on from a public health perspective. Explain, why should we care about indoor air quality?

Georgia Lagoudas: 00:03:46

Yes. Why? Why am I working on this topic? Why do I think about it day and night? Yeah. And why am I still working on it post being together at the White House? Yeah, we spend 90% of our time indoors, yeah. And yet, there are no health based standards for indoor air quality

Ashish Jha: 00:04:01

health based. Like, do we need health based standards? Like, what don't we have standards for indoor air

Georgia Lagoudas: 00:04:05

quality, right? We have building ventilation codes, something that says, ventilate your building at a certain amount of air changes per hour, so that's clean. But those ventilation codes were set decades ago, and they were set based off of odor. So they were set at a level of which 80% of people don't complain about how smelly a building is. And we used to have higher ventilation standards, actually, but in the 1970s we lowered them because of the energy crisis, we sealed up buildings. We said, Let's make them really energy efficient. Buildings consume 70% of the electricity in the United States. How do we make them as efficient as possible? And then that led to the decade of the 1980s with the sick building syndrome, people having headaches and feeling bad and cough, and we set those ventilation rates based off of odor, nothing related to do we feel good and are we healthy indoors? And we spend most of the time indoors, and actually most. Pollutants, they're often two to five times higher indoors. So it feels like this is such an important problem to tackle, and yet we're not really addressing

Ashish Jha: 00:05:07

it. Got it okay? So let's just keep going on this for a couple more seconds. So I get the idea that we set the standards wrong, or we set it at a different time for a different set of needs. But is this a public health problem like is would improving indoor air quality actually have a meaningful public health impact? And if yes, in which context, how would it help?

Georgia Lagoudas: 00:05:26

Yes, yes. And all the ways, one, we just lived through a respiratory disease pandemic. It was painful, and there was very clear evidence, right? It is. It was primarily transmitted through the air. Covid is primarily transmitted through the air. We have evidence from a large study of schools in Italy that showed you can reduce covid transmission by 80% with better ventilation. Wow, huge gains from cleaning the air. This means, like running air through filters that capture virus particles, most of our buildings in the United States use a lower quality filter, something called a MERV eight, it's a type of rating that captures less than 10% of those virus particles. If you go up to the recommendations from CDC and other places, you go to a MERV 13 filter that captures almost 80% of the virus particles. So this each filter, maybe the increase in cost is five bucks per filter, small changes, huge impact in respiratory disease transmission. And then you go to the other things in there. We also have mold in the air. We have allergens, asthma exposure. And you know that how kids suffer from asthma, those are captured by air filters and particles. And then you have other things, like gasses. This is a funny one. We don't have to think about it. One of the major gasses that influences how our brains work is carbon dioxide. Yeah. So when you and I sit in a room, if we close the door and we're in a small we're in a small room, the CO two is going to tick up. So I have my little CO two monitor with us today. It's 800 looks pretty good. It's pretty good. I'm an Air nerd, that's correct. But when that number gets above 900 you and I are now dumber, so we score 15% lower scores on a test when it gets above 900 when it gets above 1500 that can even go up to 50% reduction in test scores and brain function. So that isn't just a health problem, it's how we learn and how we work, not only, you know, for students, but also everyone working in offices. So

Georgia Lagoudas: 00:07:22

there's so many places where air quality impacts.

Ashish Jha: 00:07:25

So there are lots of health benefits of improving indoor air quality, correct? Awesome. You making progress?

Georgia Lagoudas: 00:07:30

Am I making progress? Are

Ashish Jha: 00:07:32

we as a country? Are we as a country? And by the way, way off my one question thing I have, like, somehow I try to stick to one question. And here we are on question number three. This is a disaster. I'm gonna rename the pod, but just for today, just give me that. And then we'll come back and we'll kind of have you come back and talk, like in more detail, about the kinds of things we should be doing. But like, are we

Georgia Lagoudas: 00:07:48

making any progress? Are we making progress? We made some early strides during the covid pandemic. It was a wake up call. They'll say indoor air quality matters, and so together, we're at the White House, right? Some of the early progress was the CDC published the first ever guidelines for the United States. Health based guidelines. Five air changes per hour is what you can aim for. And the government buildings, they launched an effort with the General Services Administration to say, let's check the ventilation in government buildings. Often you build a building, and that's the one and only time when you built that building, if you check ventilation, there are not requirements to check it later. So the government went around. It's like, let's just see what the ventilation is. It's a good starting point. There is not been much federal progress recently, given the chaotic nature of our times, but there has been a lot of good state progress. So in the past five years, about a quarter of states have have passed and enacted air quality legislation, which is great. They look like different things. Virginia has a bill. Connecticut had a bill. Maine had a bill that was passed into law. And some of them are about coordination. Some of them are about launch new pilots in schools. Some of them are about stat put out some guidelines what numbers came for. So I think that's progress. And then the other progress is the more nerdy component, which is, how do we develop ventilation standards in buildings that are more health based? And that's a long road, but the main organizing body that does this, this is ASHRAE, a ventilation engineering society. They published the first ever health based standards. There's an open question of how many people are using it. One nation, the United Arab Emirates was the first to come out and say, we're going to require this for all new buildings. Wow. So that's like a tremendous step forward, but there's a lot

Georgia Lagoudas: 00:09:28

more tracking that could still

Ashish Jha: 00:09:30

be done. Awesome. This was great. So important. We can do stuff about it. There is a little bit of progress Georgia. Thanks so much for coming by. Thanks, Ashish. You.

Ashish Jha: 00:09:44

All right, and there you have it, another episode of a moment in health where we talked about a data point 13.1% about one in eight kids, young people, 12 to 21 year olds who reported using AI for mental health advice in a new cross national study. 30 and 92% of these kids, or people, I shouldn't call them kids, because some of them are young adults, found the advice actually quite useful. Then we talked about one study, which was a study from Italy a couple of years old, now, improving ventilation reduced SARS, covid, two infections in schools by about 80% very dramatic drop in infection rates by improving ventilation. And then we talked to an expert about indoor air quality, Georgia Lagunas, who is a senior fellow at the pandemic Center here at Brown I first met Georgia when I was at the White House, and she was working at the White House on these issues, and I think she taught us a bunch of really interesting things that I didn't even know, that most building standards for indoor air quality are really based on trying to avoid odors so that most people don't complain of odors. Second point is that most of those standards were actually relaxed in the 1970s as a way to conserve energy, and really have not been updated, and now there are real efforts to say we have got to make indoor air quality such that you can actually prevent the spread of respiratory infections, covid, flu, RSV, a whole bunch of other things that spread around, particularly in wintertime. And the truth is that, given that we spend about 90% of our time indoors, improving ventilation can have dramatic improvements on health outcomes. And then the last point that she raised, which I thought was very important and has actually been pretty well documented, is better air quality doesn't just lead to fewer infections, it improves cognitive function. Improves test scores for kids, better brain function. And so while we have made some progress on improving indoor air quality in the last few

Ashish Jha: 00:11:44

years, partly because of covid, we really have to redouble our efforts here, because it's good for health, it's good for mental activity, it's good for economic productivity, and it's pretty cheap and easy thing to do with a lot of very good science behind it all right, so that's your episode of a moment in health. Thanks so much for joining us. I'll be back next week with another episode where we'll talk about a data point, discuss the study, answer a question. Have a great week, folks. You.