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By Jasmine Laws
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A study has found that the close contact between children in classrooms alongside issues with indoor air quality may contribute to the spread of respiratory viruses such as influenza in the coming months.
While it is known that close contact with others can increase the transmission of certain viruses, the study highlights in greater detail how improving classroom ventilation could have notable impacts in reducing transmission.
"Air quality has a big impact on the transmission of respiratory viruses, not only the flu," Lukas Fenner, a scientist at the University of Bern, Switzerland, and one of the authors of the study, told Newsweek.
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Why It Matters
Influenza is a respiratory illness that can cause mild to severe illness, and in serious cases, even death. It is one of many common viruses that circulate in the winter months, such as norovirus, the 'winter vomiting virus,' and more recently COVID.
Respiratory syncytial virus (RSV) is another common respiratory virus, and can be difficult to distinguish from the common cold, flu or COVID, given the overlapping symptoms.
For all these respiratory illnesses—flu, RSV and COVID—higher risk groups like infants and older adults can become very sick and require hospitalization so better understanding of virus transmission could improve methods of protecting those more vulnerable to these viruses.
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What To Know
The study, published in the journal Nature Communications on November 25 by scientists at the University of Bern, Switzerland, was conducted over six weeks reviewing 67 students aged 14-15 in a Swiss secondary school.
The children were within 1.5 meters of each other for 21.2 minutes per day and spent 5.3 hours in shared classrooms. The study authors noted the air quality was "suboptimal" for 1.9 hours.
The researchers found that under these conditions, virus transmission was more likely within than between classes.
They also noted that they thought "prolonged exposure in shared, poorly ventilated spaces, which potentially includes several infectious sources, drives respiratory virus transmission more than close contact."
Fenner said that "opening windows regularly during breaks will help, but the trade-off with energy saving in cold winters needs to be taken into account."
In the longer term, he said "investments in ventilation and cleaning systems for buildings, as well as investments in innovative designs for building engineering and building air flow systems need to be considered."
"Shared classroom air is a major driver of influenza transmission," Aubree Gordon, a professor and director of the Michigan Center for Infectious Disease Threats and Pandemic Preparedness at the University of Michigan, who was not part of the study, told Newsweek.
She added that this means "improving ventilation needs to be a priority." This could be opening windows for even a few minutes at a time, she said, and agreed that upgrading heating ventilation and air conditioning (HVAC) systems could be an "important longer-term solution."
"Improving indoor air quality is one of the most effective and practical steps we can take to protect children from respiratory viruses," she added. "The benefits extend beyond infection control: better-ventilated classrooms support improved learning, better concentration, and healthier school environments overall."
What People Are Saying
Lukas Fenner, a scientist at the University of Bern, Switzerland, and one of the authors of the study, told Newsweek: "Crowded closed spaces substantially contribute to transmission of flu and other respiratory viral diseases in winter. These conditions frequently converge in educational settings, where students experience prolonged interactions in indoor spaces, but also includes workplaces, transportation, and health care facilities. Refocusing on air quality in closed spaces is certainly warranted. In a broader sense, our findings also contribute to pandemic preparedness, including aspects such as air ventilation, air quality, exposure time in enclosed spaces, and contact tracing in closed indoor spaces."
Aubree Gordon, a professor and director of the Michigan Center for Infectious Disease Threats and Pandemic Preparedness at the University of Michigan, told Newsweek: "Children play a key role in influenza transmission because they spend long stretches together in shared indoor spaces and tend to have lower immunity compared to adults, but that doesn’t mean they are the only drivers every winter. Schools can amplify spread, but influenza moves through households and communities as a whole. The study highlights that it’s the environment, especially poorly ventilated rooms, that really accelerates transmission."
Professor Seema Lakdawala, co-director of the Emory Center for Transmission of Airborne Pathogens, told Newsweek: "Multiple interventions will help reduce transmission in classrooms—increasing air circulation and dilution of expelled plumes from opening windows, ceiling fans, air purifiers, or other cross-ventilation strategies are all ways to achieve this as well as changes to HVAC. However, increased ventilation alone is unlikely to have a profound impact on close-range transmission, as we suggested from our prior work. Stopping flu transmission needs a multilayer approach."
She added: "The seasonal vaccine acts like our armor and prevents us from getting badly beaten up but not from getting infected, masking acts like a shield, and increased ventilation acts like a sword. All these combined are going to let us win the war. Put another way, in our desire to move on from the COVID-19 pandemic we should not forget all the interventions that are in our tool box. Wearing masks at school and on planes was normalized, staying home when someone has respiratory symptoms was acceptable, and having gatherings in well ventilated spaces was always considered. Finally, having and using over-the-counter rapid diagnostic tests can quickly help people make informed decisions about their own risk and actions to protect their neighbors."
Dr Donald Milton, a professor of environmental health at the University of Maryland, told Newsweek: "Ventilation and filtration are very standard approaches to improving air quality in classrooms and have multiple benefits beyond infection control. Opening windows is unlikely to help consistently, especially if only open transiently. In the absence of mechanical ventilation at adequate levels, portable air cleaners (filters) can help. Another option is to use germicidal ultraviolet. The older upper-room technology has been around since the 1930s and was effective at suppressing even measles transmission in classrooms. Newer technology using whole room far-UVC may be an alternative as costs come down."
He added: "Children are much more susceptible to seasonal influenza than working age adults and younger children seem to shed more virus for longer. That makes schools a much bigger problem for influenza, relative to other environments. This is very different from COVID-19 where children were no more likely to be infected and less likely to be contagious. We've known this about influenza for a long time and that's why we expected schools to be more important for COVID than they turned out to be."
Andrew Pekosz, professor and vice chair of the Department of Molecular Microbiology and Immunology at Johns Hopkins University told Newsweek: "There are other studies that come to similar conclusions. The fact that children spend so much time together in an environment that facilitates transmission—as shown in this paper as well—is one of the primary drivers [of flu in winter months]. It may also be that younger children don’t have a history of exposure to some of these viruses which makes them more susceptible to getting infected as opposed to adults who might have more preexisting immunity to a broader range of pathogens."
He added: "Adjusting things like the airflow rates into and out of rooms to make sure that the total air within a room is changed at a high rate is a more practical approach [than opening windows]. The conclusion that spread within a room is an important driver means you have to focus more on the in-room environment if you want to make a dent in transmission."
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