Proposal
A section is added to the Communicable Diseases Act:
Section 56a. Prevention of Airborne Communicable Diseases
In order to prevent the spread of airborne communicable diseases that are of general danger, notifiable, or other communicable diseases as referred to in the Basic Education Act (628/1998), the organizer of basic education referred to in the Early Childhood Education Act (540/2018), the university referred to in the Universities Act (558/2009), the university of applied sciences referred to in the Universities of Applied Sciences Act (932/2014), the upper secondary school referred to in the Act on General Upper Secondary Education (714/2018), the organizer of vocational education referred to in the Act on Vocational Education and Training (531/2017), the maintainer of a public library referred to in the Public Libraries Act (1492/2016), and in the transportation of persons falling within the scope of the Act on Transport Services (320/2017), it must be ensured that the indoor air in the premises or means of transport is free from infectious agents. For this purpose, the carbon dioxide concentration in the indoor air must be monitored and constantly visible to every user of the premises or means of transport. This information must also be automatically logged into a log file and maintained in a public database maintained by the National Institute for Health and Welfare.
If the measurement of indoor carbon dioxide concentration referred to in the first subparagraph of paragraph 1 indicates that the carbon dioxide concentration has repeatedly exceeded 800 parts per million continuously for at least 15 minutes, immediate measures must be taken to prevent the spread of airborne diseases in the space.
For the purpose of supervising compliance with this Act and the provisions issued under it, the Regional State Administrative Agency has the right to inspect the premises, activities, and equipment referred to in paragraph 1, in order to ensure compliance with the obligations set out in this section. When the indoor carbon dioxide concentration in the premises or means of transport has repeatedly exceeded 800 parts per million, the Regional State Administrative Agency has the right to order that ventilation be supplemented with mechanically operated air purifiers meeting the requirements specified in the order or with other suitable means for the space.
Justifications
Summary
In this citizen’s initiative, we propose a legislative amendment aimed at preventing the spread of airborne diseases. This is achieved by ensuring proper ventilation and, if necessary, air purification in spaces owned or managed by public entities. Several studies have confirmed the effectiveness of ventilation and air purification in reducing viral concentrations in indoor air. Improving ventilation and air purification not only reduces infections but also addresses other health issues. Many European countries have already implemented air quality laws to prevent infections. Now we have the opportunity to introduce such legislation in Finland!
Introduction
Even before the COVID-19 pandemic, influenza, adenoviruses, rotavirus, enterovirus, streptococcus, and other airborne diseases caused significant health problems and societal costs. However, there was no consensus on the airborne nature of these diseases. Now that airborne transmission has been confirmed, this knowledge compels society to take immediate action. Recent concerns about avian influenza and measles, which are also airborne, have further emphasized this.
The ongoing COVID-19 pandemic has exacerbated the situation. As an immediate consequence of COVID-19 infections, deaths, sick leave, and the need for hospitalization have increased. In addition, the SARS-CoV-2 coronavirus causes many complications and long-term health problems, including vascular thrombosis and cerebrovascular events.
In the years 2020-2021, we collectively managed to reduce the number of infections of all airborne diseases in Finland. This was partially achieved through restrictions, but their long-term use is neither ethically nor economically sustainable. However, there are several effective measures to reduce infections that do not restrict daily life, and in recent years, ample scientific evidence has accumulated regarding their effectiveness. Ensuring clean indoor air is one of the most cost-effective methods among these. Ventilation and air purification reduce the amount of viruses and other impurities in indoor air, making it closer to fresh outdoor air and lowering the likelihood of infection.
Carbon dioxide concentration is one of the most important indicators of indoor air quality. The primary source of carbon dioxide indoors is human respiration. High carbon dioxide levels lead to a feeling of stuffiness, fatigue, headaches, and reduced work efficiency. Additionally, the level of carbon dioxide indicates the accumulation of impurities originating from humans in indoor air. Carbon dioxide measurement helps to ensure that the ventilation in a space is functioning properly. Therefore, we propose the following:
- The entities maintaining public transportation, schools, daycare centers, public libraries, universities and other spaces that are owned or managed by public entities are obligated to ensure that indoor carbon dioxide concentrations remain below the specified threshold.
- The primary method to maintain carbon dioxide levels below the threshold is effective ventilation.
- In case the threshold is exceeded, temporary additional measures to prevent airborne infections must be implemented, such as the use of air purifiers or other measures.
With these measures, we can significantly reduce the harm caused by airborne diseases, such as sick leave, long-term illnesses, and deaths. Furthermore, the effectiveness of other protective measures is significantly enhanced when combined with effective ventilation. For example, a respirator worn by an individual is most effective in a space with good ventilation. This also enables high-risk groups for infectious diseases to fully participate in society. Good ventilation means clean, safe, breathable air, a right that should be as fundamental as access to clean water for each and every one of us.
Airborne diseases cause significant harm in society
SARS-CoV-2, influenza, and common cold viruses spread in the air as fine aerosols. Aerosols are generated when people breathe, talk, cough, or sing. The aerosols produced by breathing and talking accumulate indoors, much like cigarette smoke, but imperceptibly. In poorly ventilated indoor spaces, aerosols can linger in the air for hours. Poor ventilation and the resulting stuffy air increase the spread of viruses.
Even before the COVID-19 pandemic, adults experienced an average of two to three respiratory infections per year, while children experienced an average of six respiratory infections. The pandemic has multiplied the harms caused by infectious diseases. In the autumn of 2021, Finland eased almost all containment measures in addition to COVID-19 restrictions. After this, COVID-19 infection rates sharply increased and have remained significantly high, based on wastewater monitoring and mortality.
Excess mortality was historically high in 2022. Estimates regarding COVID-19’s contribution vary, but experts agree on its significant role in the rise of mortality. The risk of children and young people dying as a direct result of acute COVID-19 infection is small compared to that of adults. Nevertheless, in countries like the United States, COVID-19 has become the most common infectious cause of death among children and the eighth leading cause of death overall. In addition to COVID-19, hundreds or even thousands of people in Finland die annually due to influenza and its complications.
Mortality represents only the tip of the iceberg of the harms caused by COVID-19 and other airborne diseases. According to the World Health Organization (WHO), 10-20% of those who contract COVID-19 suffer from symptoms of long COVID. These symptoms include severe fatigue, shortness of breath, memory impairment, and difficulty concentrating. Numerous studies have also shown that COVID-19 infections predispose individuals to immune system disorders and organ damage, as well as heart and brain events. One can become chronically ill even if the acute COVID-19 illness was asymptomatic. Furthermore, the risk of long COVID increases with each new infection. There is no curative treatment for long COVID.
Children are also at risk of experiencing prolonged symptoms. For children, this may mean changes in their sense of smell and taste, respiratory and gastrointestinal symptoms, fatigue, headaches, difficulty concentrating, memory problems, or more serious symptoms such as myocarditis. Therefore, the WHO has urged both states and individuals to continue combatting COVID-19.
In the UK, the number of people out of the workforce due to illness rose dramatically after the beginning of the pandemic, especially in younger age groups. A significant portion of this increase is believed to be due to long COVID. In the United States, it has been estimated that in 2022, COVID-19-related sick leaves accounted for up to a 2.6% annual loss of labor input.
In Finland, the Finnish Institute of Occupational Health has estimated that the significant increase in absences in the municipal sector is likely due to COVID-19. Statistics from the Social Insurance Institution of Finland (Kela) support this interpretation. An assessment of the economic losses caused by COVID-19 infections has not been made, but if the magnitude is similar to other countries, it would mean losses in the billions of euros. According to the Confederation of Finnish Industries (EK), one day of sick leave costs the employer an average of 370 euros, so even a small reduction in sick leave can lead to significant savings.
We can prevent the spread of infections with clean indoor air
The effectiveness of ventilation and air purification in reducing viral levels in indoor air has been confirmed in several studies, including in Finland. According to research conducted by the Finnish Meteorological Institute, Helsinki University Hospital (HUS), the University of Helsinki, and the Finnish Institute of Occupational Health, ventilation and air purification significantly decrease airborne virus concentrations. Studies by VTT (Technical Research Centre of Finland) suggest that ventilation can reduce virus concentrations by up to 90%. In a study by Aalto University, air purifiers effectively protected against airborne pathogens.
Improving building ventilation and air purification can reduce not only respiratory infections but also other health problems. Air quality is known to affect cardiovascular diseases, respiratory diseases, and cancer risk, among others. Air quality has also been shown to impact learning and work efficiency. In addition, proper ventilation can reduce feelings of fatigue, headaches, difficulty concentrating, and allergy symptoms caused by stale air.
Currently, the World Health Organization (WHO) recommends enhancing ventilation as one of the most important measures against COVID-19. In the United States, the Centers for Disease Control and Prevention (CDC) recommends improving ventilation, using air purifiers, and employing carbon dioxide monitors in indoor spaces. The COVID-19 Task Force of the esteemed scientific journal The Lancet has repeatedly recommended ventilation and air purification, not only for combating COVID-19 but also for preparing for future pandemics. Legislation is already in effect in Belgium and France for monitoring indoor air quality and improving ventilation in public spaces. Ventilation and air purifiers have been utilized in Australia, New Zealand, and Japan for years to reduce COVID-19 infections. In these countries, COVID-19 mortality has been significantly lower than in Finland.
Ensuring clean indoor air requires clear objectives, guidelines, and a monitoring system. Since pathogens spread with exhaled air, carbon dioxide levels can be used indirectly to assess the amount of pathogens in indoor air. The closer indoor carbon dioxide levels are to outdoor levels, the less it contains exhaled air and thus potential pathogens.
Current ventilation standards are insufficient for preventing diseases. According to a regulation by the Ministry of the Environment (1009/2017), outdoor air flow rates should be at least 6 l/s per person. However, the WHO recommends a rate of 10 l/s per person. In addition, indoor air quality monitoring is currently inadequate. Carbon dioxide concentration has been found to be a good indicator for this purpose.
Carbon dioxide monitors measure carbon dioxide concentration in parts per million (ppm). Currently, outdoor air typically contains 400-450 ppm of carbon dioxide. When there are people indoors, levels below 800 ppm usually indicate reasonably good ventilation. For instance, in French legislation, 800 ppm serves as the threshold for good air quality. The Finnish Indoor Air Association’s target level is nearly the same, at 350 ppm above typical outdoor concentrations. Changes and monitoring incur costs, but their price is small compared to the total costs incurred by sick leaves, healthcare, prolonged symptoms, and learning deficits.
Improving indoor air quality through ventilation and air purification involves no health risks when appropriate equipment is used. Clean indoor air is also crucial for preparing for future pandemics. For example, the WHO has already warned about the potential for airborne H5N1 avian influenza to mutate into a virus capable of human-to-human transmission. Clean indoor air reduces the need for implementing other, more disruptive containment measures in pandemic situations.
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