A recent study by researchers at the UCLA Fielding School of Public Health concluded that a filtration system designed especially for use in school buses can diminish on-board pollutants by up to 88 percent.
“School buses are by far the safest way to transport children between school and home,” said Yifang Chu, senior author of the study and associate professor at UCLA’s department of Environmental Health Sciences. “Our goal is to make it also the cleanest way.”
Researchers designed a prototype high-efficiency cabin air (HECA) filtration system and installed two units in the rear of six school buses used for testing. The units drew in air through diffusers located on its sides of the bus and passed the air through the HECA filters. Researchers tested the air inside and outside the buses for emissions such as black carbon and fine as well as ultrafine particles.
The study, funded by the California Air Resources Board, tested buses without passengers both while they were parked and while they were running on major arteries and highways in the Los Angeles area.
Interestingly, researchers found that the decrease in pollutants was greater in freeway driving conditions. This was surprising due to the higher concentration of pollutants that come from the highly congested Los Angeles freeways. The study stated that the quality of the filtered air inside the bus was comparable to that of the beach in Santa Monica, California.
According to Zhu, exposure to pollutants can take a toll on children’s health.
“During school bus commuting, children can be exposed to significantly greater levels of air pollutants than a typical resident in the South Coast air basin,” she said. “Studies have shown that exposure to high levels of vehicle pollution is associated with pulmonary and cardiovascular health risks, including oxidative stress, mitochondrial damage and acute pulmonary inflammation.”
UCLA said in a statement that another study funded by CARB over a decade ago found “air quality problems” inside diesel-powered school buses.
“That study led to efforts to retrofit school buses with exterior pollution-reducing devices. While that method is promising for minimizing emissions from buses’ tailpipes, it doesn’t always provide cleaner air inside the buses,” the statement read.
A prior study also conducted by Zhu and her team found that air purifiers designed for home use can decrease levels of pollution inside the school bus by approximately 50 percent. However, these filters are not designed for use inside moving vehicles.
A long-term follow-up study will test the HECA systems on a greater number of school buses with children on board.
The scene could be straight from a science-fiction film: a vision of everyday life, but with one jarring difference that makes you realise you’re on another planet, or in a distant future era.
A sports class is in full swing on the outskirts of Beijing. Herds of children charge after a football on an artificial pitch, criss-crossed with colourful markings and illuminated in high definition by the glare of bright white floodlights. It all seems normal enough – except for the fact that this familiar playground scene is taking place beneath a gigantic inflatable dome.
“It’s a bit of a change having to go through an airlock on the way to class,” says Travis Washko, director of sports at the British School of Beijing. “But the kids love it, and parents can now rest assured their children are playing in a safe environment.”
The reason for the dome becomes apparent when you step outside. A grey blanket hangs in the sky, swamping the surroundings in a de-saturated haze and almost obscuring the buildings across the street. A red flag hangs above the school’s main entrance to warn it’s a no-go day: stay indoors at all costs. The airpocalypse has arrived.
A sports class inside the inflatable clean-air dome at the British School of Beijing.
Beijing’s air quality has long been a cause of concern, but the effects of its extreme levels of pollution on daily life can now be seen in physical changes to the architecture of the city. Buildings and spaces are being reconfigured and daily routines modified to allow normal life to go on beneath the toxic shroud.
Paper face masks have been common here for a long time, but now the heavy-duty kind with purifying canister filters – of the sort you might wear for a day of asbestos removal – are frequently seen on the streets. On bad days, bike lanes are completely deserted, as people stay at home or retreat to the conditioned environments of hermetically-sealed malls. It’s as if the 21-million-strong population of the Chinese capital is engaged in a mass city-wide rehearsal for life on an inhospitable planet. Only it’s not a rehearsal: the poisonous atmosphere is already here.
The British School is the latest of Beijing’s international colleges to go to the drastic lengths of building an artificial bubble in which to simulate a normal environment beneath the cloak of smog. Earlier this year, the nearby International School of Beijing lavished £3m on a pair of domes covering an area of six tennis courts, with hospital-grade air-filtration systems, following the lead of the Beijing satellite of exclusive British private school Dulwich College, which opened its own clean-air dome last year.
Air Quality Index graphics by the Shanghai Environmental Monitoring Centte
“Pollution is what all the parents are talking about,” says Nicole Washko, Travis’s wife, who also works at the school where their two daughters go, too. “More and more ex-pat families are leaving this country for the sake of their kids’ health. So if all the other schools have a dome, then we’ve got to have a dome.” A non-toxic learning environment is perhaps the least parents might expect, when they’re paying £20,000-a-year fees.
The British School has recently undergone a complete filtration overhaul, as if preparing for atmospheric armageddon, with new air curtains installed above the doors and almost 200 ceiling-mounted air purifiers put in to complement the floor-standing kind in each classroom. Windows must remain closed, and pupils must adhere to the strict air safety code. Reception classes stay indoors when the air quality index (AQI) hits 180 – measured on an official scale of 500 by various sensors across the city. For primary kids the limit is 200, while the eldest students are allowed to brave the elements up to 250. Anything above 300 and school trips are called off. The World Health Organisation, meanwhile, recommends a safe exposure level of 25.
“We were finding our sports fixtures were being cancelled so often, and kids were getting cabin fever from being kept in doors so much of the time,” says Travis Washko. “But now we have the dome, it’s perfect weather all year round.”
The day I arrive in Beijing, the AQI hits 460, just 40 points away from maximum doom. It’s the kind of air that seems to have a thickness to it, like the dense fug in an airport smokers’ cubicle. It sticks in the back of your throat, and if you blow your nose at the end of the day, it comes out black. Peddling around the city (I am one of the only cyclists mad enough to be on the road) is an eerie experience – not just for the desolation, but for the strange neon glow coming from signs at the top of invisible buildings, like a supernatural, carcinogenic version of the northern lights. The midday sun hangs in the sky looking more like the moon, its glare filtered out by the haze.
Heavy-duty face masks are now frequently seen on Beijing’s streets. Photograph: Imaginechina/Corbis
Daily talk of the AQI has become a national pastime amongst ex-pats and Chinese locals alike. Air-quality apps are the staple of every smartphone. Chinese microblogs and parenting forums are monopolised by discussions about the best air filters (sales of the top brands have tripled over the last year alone) and chatter about holidays to “clean-air destinations” like Fujian, Hainan and Tibet.
This year’s Beijing marathon, held on a day that exceeded 400 on the scale, saw many drop out when their face-mask filters turned a shade of grey after just a few kilometres. Some said it felt like running through bonfire smoke. With such hazardous conditions increasingly common, it’s not surprising that foreign companies are now expected to pay a “hardship bonus” of up to 20 or 30% to those willing to work in the Chinese capital.
And yet denial still persists. Many Beijingers tend to use the word “wumai” (meaning fog), rather than “wuran” (pollution), to describe the poor air quality – and not just because it’s the official Newspeak of weather reports. It’s partly because, one local tells me, “if we had to face up to how much we’re destroying the environment and our bodies every day, it would just be too much.” A recent report by researchers in Shanghai described Beijing’s atmosphere as almost “uninhabitable for human beings” – not really something you want to be reminded of every day.
October’s Beijing marathon saw many competitors drop out; some said it felt like running through bonfire smoke. Photograph: Imaginechina/Corbis
When I first came to Beijing in 2003, as a volunteer English teacher, my students told me that the city’s air wasn’t nearly as bad as London’s. “We know about your ‘pea-soupers’,” they would say, conjuring images of ye olde England shrouded in Dickensian gloom, happily ignoring the murky haze outside their own classroom window (then more often caused by sand storms than coal-burning power plants). Ten years later, the same former students are all too aware of the problem.
“We never used to have days as bad as this,” says Li Yutong, who has recently returned to Beijing after several years studying in Australia and working in Hong Kong. “I used to play football outside and go running, but you just can’t do that any more. School kids seem to get sick more often now – and they’re much fatter because they don’t play outside.”
Our school was sited across the street from the national Centre for Disease Control and Prevention, which proved to be an alarming neighbour when SARS broke out and we watched the constant train of ambulances. Now its attentions have turned to an airborne threat of a different kind. In June, the centre released data which suggested that the average 18-year-old Beijinger will spend as much as 40% of their remaining years in ill-health – potentially suffering from cancer, cardiovascular or respiratory disease. Breaking the usual government silence on the issue, China’s former health minister, Chen Zhu, spoke out in January to reveal that between 350,000 and 500,000 people die prematurely each year here as a result of air pollution.
In response to mounting pressure, the government has introduced a host of new laws and regulations, increasing fines for environmental violations, and attempting to shut down high carbon-emission factories. But there is little to suggest any of their measures are having an effect.
“To be able to monitor these factories, local officials are supposed to visit them in person,” says Zhang Kai, lead campaigner on air pollution at Greenpeace East Asia. “But there is just no capacity to do that, and no policy in place to punish the polluting factories effectively.”
British artist Matt Hope has designed a ‘breathing bicycle’ which filters air as you pedal, then feeds it into your mask. Photograph: Petar Kujundzic/Reuters
The national “airmageddon” has spawned a host of other attempts to solve the problem, ranging from the miraculous to the madcap. In the western city of Lanzhou, officially deemed by the World Health Organisation to have the worst air in China, officials have proposed digging great gullies into the surrounding mountains in the hope of trapping polluted air in a gigantic landscape gutter, like an atmospheric ha-ha. But Lanzhou’s poor air quality is caused less by burning coal and car fumes than by the local penchant for blowing up mountains with dynamite. More than 700 peaks are being levelled to provide swathes of flat land for development, and blowing out a huge gulley would only add to the problem.
Other solutions proposed in Beijing have a more futuristic air. Environmental scientist Yu Shaocai has proposed fitting water sprinklers to the tops of tall buildings, to try and “wash” the smog out of the sky. “Water should be sprayed into the atmosphere like watering a garden,” Yu wrote in the journal Environmental Chemistry Letters, noting that most urban pollution hangs below 100m, so it could be caught by an artificial shower from the city’s taller towers. An expert in “wet deposition” (how rain can clean particles from the air), he thinks he’s got the science sorted, and the main challenge is just to “design the specific spray system that can spray a good raindrop size and [ensure] the most scavenging efficiencies for the air pollution.” But his hastily Photoshopped visuals of garden sprinklers stuck on top of skyscrapers don’t do much to inspire confidence.
In fact, wet deposition has long been hailed as a possible solution by higher powers, with their lofty pretensions to control the elements. China’s Meteorological Administration issued a paper last year which ambitiously declared all local officials would be able to use artificial rain to clear away smog by 2015. And as the Washington Post reported, the idea might not be so far from reality: because of chronic water shortages, China has invested heavily in artificial rain since the late 1950s. The country now boats a battery of 7,000 cloud-seeding artillery guns, the same number of launchers for chemical-bearing rockets, and more than 50 planes – all manned by an army of 50,000 employees, ready to launch full-scale warfare on the weather.
Daan Roosegaarde’s plan for a smog-free park uses buried coils of copper to create an electrostatic field that attracts smog particles. Illustration: studioroosegaarde.net
At the other end of the scale are the initiatives that aim to affect people’s attitudes on the ground. Driven by an effort to raise awareness of the smog problem and spur the government into action, a host of critical art projects have been spawned. British artist Matt Hope has designed a “breathing bicycle”, a home-made Heath Robinson-style contraption that filters air as you pedal along and feeds it through a tube into a fighter-pilot breathing mask. Cycling around the hutong alleys, looking like Darth Vader being attacked by a hoover, he’s certainly attracted some funny looks.
“It’s a provocational prototype,” Hope says. “It’s pretty archaic, but then burning coal is pretty archaic too. It’s an intentionally ridiculous solution to a ridiculous problem.”
Another plucky Dutch designer thinks he can turn the pollution into a lucrative commodity. Over the past few months, Daan Rossegaarde has been meeting with the mayor of Beijing to talk through his plan for “electronic vacuum cleaners” to be installed in parks across the city, to suck smog from the skies. It might sound far-fetched, but he says his working prototype should be ready by next summer.
“I want to move away from statistics and the usual factsheet discussion,” says Roosegaarde, talking at excitable break-neck speed, a man on a mission. “If you create a place that’s 75% cleaner than the rest of the city, you create a powerful incentive for people to clean the whole city.”
Roosegaarde’s ‘smog ring’ houses a cubic kilometre of smog in a 1mm-cube carbon crystal
His proposal, developed in partnership with scientists at the Technological University of Delft in the Netherlands, uses buried coils of copper to create an electrostatic field that attracts smog particles, creating a kind of halo of clean air above it. “It’s similar to how static electricity attracts your hair,” Roosegaarde says. “We charge the smog particles and suck them to the ground.”
He has also developed a mobile version which uses the same technology, but housed in a vertical totem-pole structure that sits atop a small temple-like pavilion, akin to those found in Beijing’s parks. It’s here where the real alchemy will happen. “We’re going to turn dust into diamonds,” Roosegaarde says. “We will condense a cubic kilometre of smog down into a millimetre-cube carbon crystal – which we will set like a diamond on a ring.” When you buy a smog ring, he says, you’re effectively donating 1,000 cubic metres of clean air to the city.
“I like the idea that you can take a problem and turn it into something desirable,” Roosegaarde adds. “Of course it’s not a practical solution, but I’m hoping that smog jewellery will get people talking about the problem – and when they see these clear circles of blue sky above the parks, they’ll demand clean air for the whole city.”
The volume of discontent has been rising since Beijingers got a chance to see exactly what clear blue skies looked like last month, when miraculous weather was laid on for visiting world leaders, in town for the high-profile Apec summit. With the kind of draconian measures unseen since the 2008 Olympics, the entire region was locked down to guarantee clear skies for the precious week. Production in all factories within a 125-mile radius of the city was suspended, half the cars were banned from the roads, schools were closed, and public-sector workers were given compulsory holidays. No weddings were registered, no passports issued, no taxes paid, no fresh products delivered, and no banks open. Bodies went uncremated and burials were partly suspended.
A Chinese soldier enjoys the ‘Apec blue’ sky after Beijing imposed drastic measures to reduce pollution levels for the recent summit. Photograph: Narendra Shrestha/EPA
The result? A climatic Potemkin facade of perfect blue skies – which soon became an internet meme, coining the term “Apec blue”.
“It’s not sky blue or ocean blue. It’s not Prussian blue or Tiffany blue,” wrote one user of the microblogging site, Weibo. “A few years ago it was Olympic blue, and now it’s Apec blue.” It quickly came to mean something of fleeting, artificial beauty, probably too good to be true. “He’s not really into you,” went one recurring online saying. “It’s just an Apec blue.”
Returning to Beijing during the Apec week was like arriving in a completely different city. What had been a ghostly world of streets that disappeared if more than a block away, became a wide-open place of grand avenues terminating at distant mountains, visible for the first time.
And back at the British School, the smog dome was empty. Pupils were enjoying a rare outdoor lesson beneath a different kind of artificial roof – the crystal clear canopy of Apec blue.
When a new, highly infectious disease lands on U.S. shores, four unique treatment centers stand ready to contain and treat it. Sprinkled across the east coast, Midwest and Rocky Mountain west, these “biocontainment units” inside larger facilities have been funded and tapped by the federal government to take patients who could otherwise fuel a devastating epidemic.
These centers made the news in August as Ebola patients began to arrive in the U.S. Of these, three patients have been treated at Emory University Hospital (Kent Brantly, Nancy Writebol and a doctor who remains unidentified) and two at Nebraska Medical Center (Rick Sacra and Ashoka Mukpo)—and all have survived. But these units weren’t designed with Ebola in mind.
Containing Ebola, a hemorrhagic fever virus that is spread via contact with bodily fluids, should be a relatively simple undertaking for these specialized units. The centers were made to contain and treat highly infectious as well as contagious deadly diseases, such as those that can easily spread through the air. (Ebola is highly infectious in that patients displaying symptoms shed many virus particles but it is not considered highly contagious, given that it can only be spread through bodily fluids of symptomatic patients.) Among the scary diseases these highly specialized facilities can handle are bird flu (avian influenza), drug-resistant tuberculosis, monkeypox, plague, SARS, smallpox and tularemia. “Right now they’re the best we have,” says Michael Osterholm, director of the Center for Infectious Disease Research and Policy at the University of Minnesota. “They serve as the very foundation in the U.S.” for fighting highly infectious diseases. They have, he notes, the best equipment, the right protocols and the properly trained personnel to confront diseases for which most other hospitals would be unprepared.
“Highly infectious patients are really their forte,” says Amy Ray, an assistant professor focusing on infectious disease at the Case Western Reserve University School of Medicine and chair of the University Hospitals System Infection Control Committee. “This is really what these centers were built for.”
So how do these centers deal with patients who show signs of rare, highly virulent or unknown pathogens? Here are the vitals on each facility.
National Institutes of Health Embedded in the sprawling campus of the National Institutes of Health (NIH) in Bethesda, Md., is a small but mighty high-level containment facility known as the Special Clinical Studies Unit. The unit aims to mesh treatment with front-line research. Its ward is “specifically designed to provide high-level isolation capabilities and is staffed by infectious disease and critical care specialists,” a spokesperson said in a prepared statement. “The unit staff is trained in strict infection-control practices optimized to prevent spread of potentially transmissible agents.”
The unit has just four rooms and seven beds; three of the rooms are built for two patients and one is single-occupancy. Each room is equipped with negative airflow, which sends cleaned, filtered air at all times into the patient room while preventing air—along with potentially infectious particles—from escaping out into the rest of the hospital. Closed-circuit video cameras monitor safety throughout the patient areas. A glass window—and intercom connection—links the patient care area to the room where unprotected health care providers are stationed, to let workers observe and communicate with the patient without having to don specialized garb.
The facility, in keeping with the NIH’s research-focused mission, is also designed for implementing best practices for research into infectious diseases. The unit “allows for the study of patients harboring potentially infectious pathogens,” explains Molly Hooven, a spokesperson for the NIH’s Clinical Center—as well as for trials that use potentially infectious vectors, such as vaccine studies that include attenuated live viruses. Many of the individuals who end up staying here are otherwise healthy participants in vaccine trials.
Emory University Hospital Located outside of Atlanta and near the U.S. Centers for Disease Control and Prevention (CDC), Emory University Hospital’s Isolation Unit was built in cooperation with that agency.
It houses just two patient rooms—designed to be identical to intensive care unit (ICU) rooms, and each with contained bathrooms with toilets and showers. Each room also has a window and intercom connecting it to an area where health care workers can be without putting on protective equipment. The design dedicates a substantial amount of space to staff work areas. Between the two rooms is an anteroom with hands-free sink as well as a staff prep room with lockers and a shower for emergency decontamination. The work space includes its own biosafety hood, where staff can prepare samples in a contained space and an adjacent dedicated lab that can be used to test for pathogens, do blood tests and other essential procedures.
Negative air pressure—continuously tracked by multiple digital pressure monitors—keeps clean air flowing in from the hallways into the anteroom, from the anteroom into the patient rooms and then out through high-efficiency particulate air (HEPA) filters. That gives “two levels of protection to make sure that no airborne particles in the patient room go into the general hallway,” Bruce Ribner, a professor of infectious diseases at Emory University School of Medicine, explains in a video demonstration of the unit. Even in the patient rooms the airflow has been specially designed, coming from vents in the ceiling and exiting through a vent near the floor to avoid any turbulence and redirected flow. Each room has full air exchange on average every three minutes.
The hospital has taken a serious approach to ensuring waste is safe. Items that are disposable, such as protective suits and food trays, are first sanitized with pressurized steam and then incinerated. Any liquid waste—such as the patient’s bodily fluids coming from the bathroom or receptacles—is treated with bleach or detergent for more than five minutes, preventing live pathogens from entering the local wastewater system.
University of Nebraska Medical Center Also commissioned in partnership with the CDC, the University of Nebraska Medical Center’s Biocontainment Patient Care Unit opened in 2005 and is “designed to provide the first line of treatment for people affected by bioterrorism or extremely infectious naturally occurring diseases,” according to a statement from the university. The 10 beds make this unit the largest of the four U.S. biocontainment facilities.
To get patients safely from outside into the isolation ward, the hospital has “biopods” or “isopods”—mobile, contained, person-length bubbles that can strap over hospital gurneys. They stay inflated with negative-pressure air that is then HEPA filtered before being pushed out. A series of rubberized gloves dot each clear side so that health care workers can care for the patient inside with a clear view without having to open the pod (watch this detailed video on its features).
The unit is on its own ventilation system, separate from the rest of the hospital. In addition to negative-pressure air in patient rooms (which cycles through 15 complete air exchanges per hour) and HEPA filtration systems, it also has a double-door air lock to the unit’s main entrance. The unit uses ultraviolet light to disinfect contaminated items—as well as a disinfecting “dunk tank” where workers can place containers of samples (such as blood) into the solution before taking them out of the unit. It also has a “pass-through” autoclave that can sterilize equipment leaving the unit with high-pressure steam. A different sterilizer processes laundry from patient rooms as well.
Staff at the unit go through special training as well as multiple drills each year. A public running leaderboard ranks nursing staff as they complete levels of training. The unit is located close to Nebraska Public Health Laboratory’s Biosafety Level 3 Laboratory, which can expedite diagnosis and analysis of a pathogen from an infected patient.
Saint Patrick Hospital The containment facility farthest west is in Missoula, Mont. The Care and Isolation Unit at St. Patrick Hospital was born from a 2005 NIH request for a local patient isolation facility—specifically to serve staff and visitors who might accidentally become infected at the nearby Rocky Mountain Laboratories, an NIH research facility that works with dangerous pathogens in biosafety level 2, 3 and 4 labs.
Grant money to bring the facility up to speed for the NIH labs allowed the hospital to prepare for infectious patients coming from the broader community and country. The unit has three rooms designed to hold a single patient but they can each serve two patients if necessary. All of the rooms are equipped with standard ICU fittings and each also has a separate bathroom. Security cameras installed on the ceiling monitor safety. A large, dedicated nurses station and lab service the small unit, which also has portable radiology machines as well as its own autoclave for sanitizing equipment. An anteroom for each patient room has areas for health care workers to suit up, along with a touchless sink.
Negative air pressure keeps airborne pathogens from escaping patient rooms, which have separate air-handling systems to avoid cross-contamination. Each room has full air exchange roughly every five minutes, with the air flowing diagonally from ceiling vents, past the patient, into two large ducts along the headboard wall. Exhaust air is processed through HEPA filters before being released—2.5 meters above the hospital’s roofline.
Lessons from the best Beyond all of the air filters and autoclaves these highly specialized units have one key, intangible asset. And that, Osterholm says, is: “training, training and training.” To be more specific, he adds, employees at these biocontainment centers “have worked through very specific protocols and they have practiced those—and practiced those and practiced those.”
Which is an important lesson for community hospitals throughout the U.S. and the globe. Training, protocols and drills are an important part of readiness for a hospital at any level. Larger hospitals might also begin replicating other features of these biocontainment units, Osterholm says. “In the end I think we may very well see more of these treatment centers showing up around the country—particularly on a regional basis.”
Having local and regional hospitals prepared for handling infectious disease patients is important for long-term epidemic preparedness because these few, specialized containment units are not exactly sprawling wards. If general hospital ICUs are the battalions in a large-scale war against an infection, these units are the special forces. With an extremely limited number of beds—25 max at current capacity—these units are not going to be the nation’s answer to a larger, widespread outbreak.
