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A New Rx For Buildings

How do we give buildings a healthy dose of resilience? We asked a group of specialists to share their thoughts.

Rachel Hodgdon, President and CEO, International WELL Building Institute
Scott E. Frank, P.E., LEED AP Managing Partner Jaros, Baum & Bolles
Arathi Gowda, AIA, AICP, LEED AP BD+C Associate Director and Team Leader, High-Performance Design Group Skidmore, Owings & Merrill
Ronald B. Menzin, M.D. Market Medical Director – Tristate Cigna Corporation

We interviewed Rachel Hodgdon, Arathi Gowda, Scott E. Frank and Ronald B. Menzin about how COVID has altered thinking about healthy buildings. Here are their thoughts, edited lightly for space.


Harvard’s T.H. Chan School of Public Health identified nine foundations for a healthy building. How does this change the way we design or engineer buildings?

RACHEL There’s a lot of overlap between the nine foundations and the 10 concepts of WELL. The best results happen when the needs of those using the space inform an integrated process that includes decisions about air and water quality, as well as operational protocols around facility maintenance. It should also encompass things like HR policies, healthcare benefits and ergonomic amenities. In large cities in China or India, for example, you would expect an increased focus on air quality, but a holistic approach that incorporates all the concepts will have a much greater impact on overall health.

SCOTT Many of the nine foundations are already included in best practices of building design. But we haven’t paid as much attention to the quality of the air we breathe as we have to other aspects of the indoor environment. We’ll probably see more emphasis on this, including ubiquitous and persistent real-time measuring and reporting of air quality.

ARATHI The nine foundations have drawn attention to healthy buildings, but they’re not really new. We’ve been advocating for access to light, air, nature and recreation for a long time; this dates to design principles seen in ancient Rome or the Indus Valley. What’s new is, we can now connect data-driven design choices to the building narrative – meaning what makes it a compelling place where you want to be or that you want to invest in.

What is the top priority in the COVID era?

RACHEL Air quality has taken top priority, but it took a long time for public health organizations to recognize airborne transmission as the greatest risk to the population. Joe Allen’s team [at the Harvard T.H. Chan School of Public Health] proved that enhancements to indoor environmental quality improve people’s health and, importantly for a business, their performance. This year, mental health must be a higher priority. Many organizations will face greater costs for treating mental health issues than for treating COVID-19 itself. It’s critical for organization leaders and building operators and designers to take the impending mental health crisis into account.

ARATHI We’re seeing, with COVID, that you can reoccupy a building faster if it has operable windows or a high level of air filtration – things that perhaps people weren't investing in before. In many buildings, the goal has been to control air quality through air-handling units, not windows. Perhaps we’re seeing a correction and revisiting ideas that haven’t been prioritized.​

China is emerging as a leader in this area. To them, it’s a no-brainer to have air-quality monitoring or advanced filtration of the perimeter, where you’re opening and closing windows. Their code mandates operable windows, so it's not a question of “it costs more.” It’s a design imperative for them, so people expect it there.

RON Employee safety is first and foremost. Everything has to be viewed through that lens. Following that, it’s business continuity: no one wants the disruption of having to send employees home for a 14-day quarantine because of potential exposure at the workplace. Keeping these priorities in mind, and considering that up to 60 percent of COVID-19 spread is from presymptomatic or asymptomatic individuals, it’s necessary to quickly adapt existing workplaces. The most pressing changes are physical adaptations that enable employees to maintain social distancing, and occupancy limitations on conference rooms and other enclosed spaces. Ready availability of hand sanitizer and cleaning supplies is also vital. Employees need to feel safe in the new environment, so signage, visibility of cleaning and disinfection measures – especially in high-touch areas – and temperature scanners are important. Finally, the creature comforts of the workplace need to be considered, so we need to adopt safe cafeteria spaces, with COVID-safe coffee-machine, microwave and refrigerator protocols. Flexibility within enclosed spaces is critical to allow for creative solutions like reconfiguration of workspaces, installation of physical barriers and repurposing of conference rooms and common areas. During the pandemic, we experienced an abrupt increase in people working from home. Should many of those arrangements become permanent, we anticipate increased “hoteling” or collaborative spaces for employees who return to the office intermittently.

Health, in a building, isn’t something you can see or smell. How do we define success – when do we know our buildings provide for optimal health?

SCOTT For each of the nine foundations, we can measure performance outcomes that directly correlate with human health outcomes. In this sense, we can know our buildings are optimal for health from an operational and design standpoint.

RACHEL The pandemic accelerated innovation, particularly among building-system manufacturers. For the first time, airflow, volume exchange rate and filtration capacity are being layered onto environmental-health data collected by sensors on-site. Many of the platforms we’ve seen are open-source, so I think this approach will be embraced quickly by the broader engineering community.

We’re moving from taking the pulse of a building every few months or years to real-time reporting. The COVID-19 pandemic is accelerating the pace of innovation in advanced health-impact metrics. Fifteen years ago, you might have gone three months – or even three years – without understanding your energy footprint. Now, most owners don’t even go three minutes, thanks to advances in technology. We should be measuring environmental health metrics with the same kind of regularity.

Many of these building systems look to WELL as the industry standard, establishing not just best practices but absolute thresholds for performance. That’s why WELL, and all the undergirding research, is publicly available. We want anyone to be able to use it to build a road map toward having spaces that are healthier for people.

ARATHI Discussion of air exchange rates or filtration used to be confined to MEP meetings. Now it comes up in broader updates, and nearly everyone is a stakeholder. There is a lot of interest in making buildings more permeable, and conversations around dechemicalization of materials to limit volatile organic compounds. Amenitization of space related to health is in high demand: is there a space for a fitness center, meditation, maternal health, a women’s room, a bike room? These conversations are moving beyond “a mothers’ room is a code requirement” to allocating commercial space to some of these things. It’s not yet a scientific metric, but I think it will soon become a commercial metric. And we’re starting to see some of those trends, like fitness centers and rock-climbing walls, anywhere in the world – not just in Berkeley, California.

RON It will depend on when we’re able to track whether infections could reasonably be presumed to have originated in the workplace. But the perception of health and safety is also important, and right now, 82 percent of employees have concerns about returning to their workplaces. So we have a long way to go. COVID-19 has taken an enormous toll on our way of life, and people are feeling the effects – both physical and mental – of facing the unknown every day. We know that stress negatively impacts physical health, so assessing the level of stress at the workplace and implementing solutions becomes more important than ever. Our return-to-work solutions are designed to help employers create a safer, healthier work site. Structured, enforced safety protocols help reduce stress while improving whole-person health.

In the infectious-disease arena, what three changes in MEP design or operation contribute most to making a building healthier?

SCOTT Providing adequate ventilation at all times. In practice, design, maintenance and operations issues often conspire to preclude the introduction of adequate outside air into occupied spaces. The quantity of ventilation air also needs to increase. Current standards aren’t adequate for optimizing human health. Also critical is appropriate filtration: minimum efficiency reporting value (MERV) 13 should be the minimum level of filtration for any HVAC system serving occupied spaces, with best-in-class being MERV 16.

Courtesy www.eComfort.com

Humidification during cold seasons should be implemented consistently. Research suggests that specific humidity ranges inhibit many biological agents.

Extensive real-time indoor air quality (IAQ) monitoring and reporting can verify adequate performance and enable a fast response to any problem. So far, IAQ measurement has been an “inside-baseball” metric, available only to HVAC and building-management personnel. COVID-19 is provoking a move to make IAQ a consumer-ready metric. Owners and tenants increasingly understand that users will insist on having access to data about the spaces in which they live and work. They also appreciate that sensors will soon be available on smartphones and wearable devices, and that they should get ahead of the issue to ensure they are providing high-quality indoor air.

If you consider biophilic design at the outset, how does it influence the rest of your design?

RACHEL Biophilic elements – an abundance of plants, water features, views of nature – is core to keeping people healthy. It has been linked to improved focus and shorter healing times. It’s also a bridge to the bigger idea of regenerative design. The central idea, led by proponents like environmentalist Paul Hawken, is that making buildings more efficient is only palliative. Biophilia, and its link to natural systems, helps a building integrate society’s needs with the integrity of nature in ways that restore, renew or revitalize the system as a whole.

SCOTT To the extent that biophilic design uses operable building envelopes and outdoor spaces to increase occupants’ connection to the outdoors, control strategies will need to become more sophisticated to maintain optimal energy/carbon performance (so we don’t accidentally attempt to cool or heat the outdoors). Many people have been conditioned to expect office windows that don’t open. This will continue to change. Historically, the challenge has been primarily about controls. As digital controls become ubiquitous, barriers to implementing this level of sophistication shrink.

ARATHI Understanding the imperative to have direct access to nature and sunlight is growing. There is also a near-pandemic in vitamin D deficiency – which is a risk factor in COVID-19 infection – mainly because we all spend too much time indoors. An estimated 30 to 90 percent of Americans have some vitamin D deficiency, depending on their risk factors. People are now more receptive to bringing “the outdoors indoors,” meaning the rooftop is not just a service location. It’s a destination, an amenity.

Arash Hossein-Nezhad, M.D., Ph.D., and Michael F. Holick, Ph.D., M.D., “Vitamin D for Health: A Global Perspective,” Mayo Clinic Proceedings, https://pubmed.ncbi.nlm.nih.gov/23790560/, May 5, 2011.
Used with permission, Michael F. Holick, Ph.D., M.D., Boston University School of Medicine

We’ve known for decades how to make building interiors safer and healthier. Is anything from the COVID-19 experience especially new or promising?

SCOTT In addition to the big three – adequate ventilation, humidification and IAQ monitoring – we have learned that technologies like bipolar ionization and ultraviolet light are effective at mitigating airborne biological agents. UV light has a record of success in healthcare settings. Far-UV light (~222 nanometer wavelength) seems very promising, as it appears effective at mitigating biological agents without harming people.

We need more research to characterize the correlation between biological particle concentrations and infection rates. We can engineer reductions in airborne particle concentrations, but we don’t yet know what levels yield benefits toward reducing infections. No one yet knows how many particles are too many or how many will cause infection.

RACHEL When the pandemic struck, we were on the cusp of releasing WELL v2. Thanks to our team in China, we had about a two-month head start in researching the relationship between COVID-19 and buildings. They initiated webcasts related to building strategies: air quality, cleaning, sanitization and mental health. These webcasts attracted up to 100,000 participants at once. So we knew that there was a hunger for science-backed interventions to address urgent needs for facility operations and organizational policy.

We paused the WELL v2 launch and enlisted our community’s expertise to help fortify WELL as a tool empowering those who tend to buildings in the fight against COVID-19. Six hundred people, from more than 25 countries, volunteered – from epidemiologists to the former head of the China CDC to a former U.S. surgeon general. We found that the WELL features for improving air quality and implementing high-performance cleaning programs were the same key strategies for reducing COVID-19. The process also led us to include other changes, such as a new feature around minimizing contact with surfaces, as well as between individuals, during ingress and egress. We also added several changes to ensure that any features addressing healthcare, workplace wellness programming and professional development can be delivered remotely.

One silver lining of the pandemic is the shift in corporate mindset. Businesses are beginning to understand their role in caring for the whole person, because they now understand the business consequences when they don’t. Before the pandemic, many were skeptical about the ROI for healthy buildings. COVID-19 has made it clear that cultivating employee resilience is directly related to cultivating business resilience. Companies now see health as material to their businesses and have embraced the notion that the spaces where we work have an impact on our health and well-being.

ARATHI The pandemic downturn stirred interest in adaptive reuse. Often, old buildings have great bones and are excellent candidates to become healthier buildings. They tend to be porous. They often already have operable windows. A less certain area is strip malls and shopping malls, where the investment may be cost-prohibitive. Their future may rely on low-cost innovations.

Has designing for building health become a necessity rather than a nice-to-have or marketing feature?

RACHEL Pre-pandemic, the majority of customers, many of whom are Fortune 500 companies, said they use WELL for reasons of “recruitment and retention.” One global developer told me, “Because of the WELL system, we have reenvisioned our role as developer. We now think of ourselves as partners to our tenants in recruiting and retaining the best talent.” A profound shift. The pandemic has also brought a massive rise in engagement related to environmental, social and corporate governance (ESG). Most of the publicly traded companies approaching us want help enhancing their ESG performance as it relates to human and social capital. This is a huge opportunity. In many instances, large corporations have a greater impact on things like supply chains and resource management than the government does. The pandemic underscores the tremendous potential of the purpose-driven business.

RON Improvements to the work environment can have a significant impact on productivity and healthcare costs. Despite the United States having high levels of employee stress, there’s hope. Office design can make employees up to 33 percent happier at work, and happy employees are 31 percent more productive. Implementing environmental enhancements, like walking paths or healthy vending machine options, can boost employee morale and productivity, and improve workforce health.

How is the pandemic changing the way architects, engineers and owners think about their work?

SCOTT The science seems to be evolving around determining the smallest airborne particle size that can cause infection. While a naked virus spore diameter is about 0.1 micron, to be viable as an infectious agent, it must be bound to much larger particles. This may explain why cloth masks, which are not effective at capturing very small particles, appear to reduce infection risk, since they capture larger particles. Thus, currently available filter products are better at reducing concentrations of infectious particles in recirculated systems than previously thought.

One upshot for HVAC engineers could be how our COVID-related work overlaps with our understanding of how influenza spreads. Influenza infection rates have plummeted, probably due to quarantine, masks, handwashing, etc. Good practices, like providing appropriate ventilation in schools, avoiding contact when infection is suspected, working and schooling from home, better handwashing, etc., could minimize the impact of this disease. We don’t have to accept the status quo with influenza, and I wonder if our COVID experience will change our expectations.

RACHEL The single biggest change is the recognition that design alone cannot solve the COVID-19 problem – or COVID-23 or whatever comes next. We’ve known for a long time that a green building is only as sustainable as the people operating inside it make it. We know we can’t design our way out of COVID-19. It has to involve everyone respecting new rules and practices. For many designers and engineers, it’s daunting to think about incorporating something that has traditionally been outside their scope: how the organization they’re designing for governs itself.

A true culture of health comes from bridging the capabilities of the organization and the building. The workplace interventions that designers contribute fall apart in the last mile unless the organization undergoes a culture shift. People may not be using their ergonomic chairs properly. They may not tend the plants or even understand why plants matter. They may not make healthier food choices or get the exercise they need. I see architecture and engineering practices rising to the challenge. It doesn’t mean you’re driving all those decisions. It means you’re revisiting the integrated process and who needs to be at the table to develop it.

The International WELL Building Institute’s next chapter will focus on shoring up our system as a tool for driving a culture of health and advancing diversity, equity and inclusion. We believe that WELL can help level the playing field and give everyone an equal opportunity to live their healthiest lives.


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