Managing IAQ for occupant health is essential for our personal wellbeing, productivity, and national economy. Despite the importance of good IAQ, standards have often been influenced by shortsighted, profit-driven industries that deny or attack the validity of medical data. In many ways, conflicts in managing IAQ represent a microcosm for a much broader question: Will people respect scientific studies that guide the containment of harmful airborne compounds, both infectious and noninfectious, if the measures challenge industry profits? The answer to this question is not yet clear.

Airborne Infectious Disease

Documented controversies around airborne transmission of infectious disease date back to the 1500’s, when physicians wrote about new evidence of “effluvia that polluted the air around patients.” Soon, medical treatises added the category of “volatile contagions” for diseases that spread without direct contact. This idea of volatile contagions not only destabilized preexisting epidemiological theories but was accompanied by fear that had a near-paralyzing effect on the general public. Consequently, health officials and medical experts became reluctant to endorse the idea. Physicians, with little to offer against the danger of volatile contagions, also underplayed the role of airborne transmission. Acrimonious disputes about the spread of influenza, tuberculosis, and smallpox continued throughout the 19th century with the debates eventually becoming political. The faction believing in airborne transmission, called liberals, demanded environmental containment. Conversely, the faction considered conservative argued that broad restrictions were evidence of bureaucratic oppression and insisted that behavioral interventions, such as quarantines, would solve the problem while protecting individual freedom.

Clearly, the political and scientific divisions regarding the dominant transmission routes of SARS-CoV-2 and appropriate interventions continue today with profound implications for public health and non-pharmacologic interventions.

Noninfectious Disease and Indoor Air

Controversies about the role of noninfectious indoor pollutants in disease outcomes have also obscured knowledge about IAQ standards that are optimal for human occupants. History is rife with examples of profit-driven industries denying harm from certain indoor pollutants and intentionally obscuring regulations for safe indoor air management.

Notably, starting in the 1950s, U.S. tobacco companies denied the association between smoking and lung cancer and other respiratory diseases. When the Arab Oil Embargo in the 1970s triggered an energy crisis, ASHRAE reexamined ventilation rates in commercial buildings in order to reduce excess energy consumption. Toward this end, Standard 62 was revised in 1981. This revision clearly stated that smoke-free buildings required less ventilation and, therefore, saved energy. Additional reasons to prohibit indoor smoking soon emerged as the health hazards of secondhand smoke exposure became public. The tobacco industry — caught off guard and fearful that a ban on indoor smoking would drastically diminish their profits — fought back.

In their fight, tobacco companies infiltrated ASHRAE with company employees and consultants, creating time-consuming controversies and stalemates in committees considering issues relating to indoor smoking. Unfortunately, Standard 62 was revised — this time to assuage tobacco companies. Acceptable IAQ and ventilation in areas where smoking was permitted was now written to emphasize comfort rather than health. Eventually, smoking was banned from most public buildings; however, the battle with tobacco companies was lengthy and expensive.

Moving Forward

How can infectious and noninfectious diseases that spread through the air, are not fully controlled by individual behaviors, and affect “innocent bystanders” be contained to protect the health of the general public? ASHRAE and other consultants and regulators of IAQ best practices and standards must adhere to scientific and medical data rather than repeating suboptimal practices that are familiar or easy. Furthermore, it’s absolutely essential that building professionals resist arm-twisting by powerful industries that fear diminished profits if their “solutions” are not installed. Now that the role of IAQ in supporting occupant health in all buildings has been highlighted by COVID-19, engineers must endorse air management steps that have measurable benefits and provide these solutions in the most cost and energy-efficient way.

Unlike a stereotypical politician who may hide being wrong because of fear of looking weak to opponents, building professionals — now protectors of public health — must openly embrace substantiated data, even if this means changing preexisting views and practices. I hope you are up to this challenge.