How COVID-19 Actually Spreads in an Office Context

In order to understand how to keep us and our employees safe, it is important to begin with a review of how COVID-19 appears to actually spread in real-world office contexts.  As you know, we are not public health officials.  What is conveyed here is our best understanding based on the scientific studies we have reviewed.  We expect to learn more daily over the coming months, and what we learn will impact our response.

The best view we have found of the threat from COVID in offices today comes from an excellent CDC-published study about an outbreak in a Korean office building in early March.  It is really worth a read.  They obtained cell-phone data for every single person who had spent more than 5 minutes in or near the building, tested everyone, and got a crystal-clear picture of how this transpires.  

The key findings were that: (a) the virus did not meaningfully appear to spread throughout the building through the HVAC systems, (b) there appears to have been little spread in common areas of the building (elevators and lobbies and such), (c) nearly everyone who contracted it sat immediately next to each other in the same room for a prolonged period of time.  

In short, in the real world this virus appears to spread nearly entirely through one path: directly from person-to-person, over short distances (e.g. a few feet), and only when there is prolonged contact.  The virus appears to be able to travel a few more feet when there is air blowing strongly past one person toward another (e.g. due to a fan), such as in this case in a Guangzhou restaurant.

Notably, in practice, the studies we have reviewed suggest that touching contaminated surfaces is, relatively speaking, a lesser threat. While we are told to use hand sanitizer and hand washing regularly to avoid transmission through touch (e.g. elevator buttons, doorknobs), and we should, there is good news here.  This study in the American Journal of Microbiology notes “it should be noted that there are no documented cases thus far of a COVID-19 infection originating from a fomite [touch]”.  This comprehensive article from the American Bankers Association looking directly at this issue notes “it is possible to be infected with SARS-CoV-2 through indirect transmission, but it appears to be exceedingly rare”.  This isn’t to say the virus doesn’t last on surfaces.  It does appear to.  And absence of evidence is not evidence of absence.  But as of this writing, available studies don’t seem to suggest that in practice COVID-19 is transmitted frequently via touch. The CDC generally seems to concur.  In their April 13th guidance, they write (emphasis ours): “Current data suggest person-to-person transmission most commonly happens during close exposure to a person infected with the virus that causes COVID-19, primarily via respiratory droplets produced when the infected person speaks, coughs, or sneezes. Droplets can land in the mouths, noses, or eyes of people who are nearby or possibly be inhaled into the lungs of those within close proximity.”

With regard to touch-based infection, they write: “transmission also might occur through contact with contaminated surfaces followed by self-delivery to the eyes, nose, or mouth.” With regard to airborne transmission, the CDC says: “airborne transmission from person-to-person over long distances is unlikely”.  This WHO study observes “in an analysis of 75,465 COVID-19 cases in China, airborne transmission was not reported.”  For this reason, while we are taking actions to make our HVAC systems safer, this is also not our principal focus.  As with touch, some virus does indeed spread in an airborne manner. This just doesn’t appear to be a significant way that people actually contract COVID-19.

If new studies change these views, so will our response, and we will update this document. With regard to person-to-person spread of the virus, the need for “prolonged contact” to communicate this virus is an important, relatively recent observation. There is growing evidence, echoed in the South Korea study, that infections principally occur based on prolonged exposure to an infected individual, as opposed to casual contact.  The CDC has gotten on board with this, and now only recommends quarantine if you have come in contact with a COVID-19 infected individual, and that contact was “prolonged”.  The CDC seems to define “prolonged” as a period of 10 to 30 minutes.  Partners in Health, which conducts contact tracing in the State of Massachusetts, uses a 15 minute guideline.  The South Korea study notes: “Despite considerable interaction between workers on different floors of building X in the elevators and lobby, spread of COVID-19 was limited almost exclusively to the 11th floor, which indicates that the duration of interaction (or contact) was likely the main facilitator for further spreading of SARS-CoV-2.”

Arquitectonica will take steps to mitigate spread through all possible modes of transmission, including casual contact. We will pay particular attention to the mode that current best practice suggests represents the largest risk: close person-to-person contact for 15 minutes or longer.

How We Can Prevent the Spread of COVID-19 in an Office Context?

The world’s growing appreciation that the disease spreads principally via prolonged, direct person-to-person contact, through breathing in droplets, calls on us to put our focus on face coverings and masks. To prevent this, the CDC now strongly encourages the use of face coverings in public.  Some jurisdictions now require face coverings, including in offices.  This meta-analysis of 21 studies on mask use and this very detailed write-up of the whys suggest that face coverings really do work to keep us safe.  Here are some highlights drawn from these articles (emphasis ours):

• From a study on the Wuhan COVID-19 outbreak published in the British Journal of Hospital Infection, "Among the 493 medical staff, none of the 278 staff (56 doctors and 222 nurses) in the N95 group became infected, but 10 of 213 staff (77 doctors and 136 nurses) from the no-mask group were confirmed as infected".
• From an NIH study on a previous coronavirus outbreak looking at passengers on a flight from New York to China where the virus spread, of the 9 people they tracked down who got sick on the flight and 32 who didn’t, they found none of mask-wearers got sick, while 35% of non-wearers did.

What these studies show is how masks can help keep you safe.  Many believe that the bigger function of the masks is to keep others around you safe, for instance if you are an asymptomatic COVID-19 carrier.  

While it is less deeply studied at this point, there is some research.  This recent study in Nature Medicine found that surgical masks (the inexpensive type many people wear on the street now) blocked the spread of seasonal coronavirus (e.g. cold) droplets 100% of the time, and this study showed surgical masks blocked 89% of droplets for another disease; relatively close to the 95%+ for N95 masks.  A possible laboratory for this approach has been Japan.  As of this writing, Japan reports less than 500 COVID-19 deaths vs. over 65,000 in the US.  High public mask use in Japan may be a factor. (This said, there are wide discrepancies between the spread in different countries, and we may find there are other factors at play.) Again, more research may alter our views of this.  But given what we know now, it seems that any responsible safety plan for an office must include a clear focus on mask use. Beyond face coverings, we have identified 11 other areas we believe we can make offices safer.  These are detailed below.

Our Measures to Keep Our Offices Safe

Arquitectonica plans to take the following safety-precautions prior to re-opening.  We expect that there will be different “phases” of re-opening over time, with graduated responses.  The plan below addresses our first phase.  No organization can guarantee safety, but we will make our best efforts to make you safer.

1. Face coverings
   As mentioned above, the CDC now strongly encourages the use of face coverings in public, and many jurisdictions require it.Arquitectonica has decided we will require face coverings in shared spaces, and in private workspaces with multiple people present.  This can be any type of mask or cloth face covering as described here by the CDC.
   
   Hospitals now proactively take steps to ensure proper mask use, creating a culture in which it is universal. We will designate individuals in each Arquitectonica office who are responsible for proactively approaching people who are not using their masks correctly, showing them how to wear it in a way that reduces transmission.

   Arquitectonica has ordered masks for those who don't have their own.  For clarity, we do not use the same type of masks that hospital workers need.

2. “Touchless” facilities
   With an abundance of caution, we are going “touchless” in our core facility usage paths.  Our goal is that there be no “common touch” surfaces that you are required to touch in order to use your office at Arquitectonica.  This means that from the building door to your desk, as well as moving within common spaces, including halls, restrooms, and kitchens—you will not be required to directly touch anything with your hands.  We provide a variety of methods to achieve this goal to ensure that there is an option for everyone, regardless of abilities.  We are investigating ways in each office to address all doors, with a goal of not having to touch a door at all.

3. Physical Changes
   The above precautions will require a variety of physical changes to our spaces, as well as cooperation from our landlords. Therefore, we presume we will not be 100% there by reopening day but, as always, we will do our best. Note, high-touch surfaces like door handles and elevator buttons will still be there and will be disinfected regularly.

4. Hygiene
   We will continue to provide hand-hygiene stations on the work floors as an extra layer of protection.  Another extra layer of protection that we are looking into is a “nano-septic” antimicrobial film applied to many door handles, in case they are touched by a bare hand, and we are exploring other antimicrobial coatings.  These kill the virus in about an hour--so very helpful, but not sufficient alone.
   
   We ask all Arquitectonica employees to sanitize and/or wash their hands multiple times a day, especially after using the restroom, and/or to use gloves strategically.Note that gloves can transmit viruses from surface to surface just like a hand. Unlike a hand, many gloves cannot easily be cleaned or gelled.  If you wear gloves they need to be washed, gelled, or changed as often as you would clean your hands.
   
   Arquitectonica is not requiring the use of gloves by employees, although you are welcome to use them if you use them properly.  Gloves may help you touch your nose and mouth less.  If you have sensitive skin, you may wish to consider using nitrile surgical gloves.  You can wash or gel the outside of these gloves multiple times a day just as you would your hands.

5. Symptom Self-Checking
   Arquitectonica has created a self-checking system for those seeking to work in the office.  This will be a linked accessed on our website.  The goal is to encourage everyone (staff, and vendors, such as our cleaners) to develop a better awareness of their own health, and to institute the habit of reviewing their own COVID-19 symptoms daily. We will be sharing this check with anyone who may be in our space.

6. Symptom Check
   Many large companies are requiring symptom checking now, including at least one very large corporation we talked with. The CEO of a large US manufacturer is adopting similar measures at several facilities told us that their employees have welcomed this precaution.  Rhode Island has made this a requirement for companies wishing to bring employees back to the office, and other states have rules related this as well.  For clarity, we are told by our HR attorneys that there are no legal impediments to this.There are multiple ways this sort of system can be implemented: honor system vs. a kind of “temperature gate” at the front door.  
   
   Arquitectonica is opting for a home-based honor system.  The logic is that we believe our employees are honest, but that individuals can occasionally not notice or not pay full attention symptoms they have.  It is true that symptoms of COVID-19 can also be symptoms of other conditions.  And that some sick people don’t have symptoms.  
   
   But most do, and we will all be safer if everyone pays attention to this.Given that we expect many of us will work from home some days anyhow, we are simply saying: “On those days that you are feeling off, choose to work from home that day.”  We are also requiring our cleaning companies to offer unlimited sick time, so people who can’t work from home don’t feel pressure to come in. Importantly, we don’t store *any* of the information you provide… we are simply prompting you to check yourself in a structured way each day.  
   
   
   And if you prefer not to put anything into a data system at all, as mentioned, you can do this in the lobbies of our offices instead, in person. The above mentioned web application gathers daily wellness confirmations from each individual wishing to enter Arquitectonica.  Amongst other things, you are asked to input your temperature from home first thing in the morning after you wake up.  The official CDC threshold is 100.4°F, or 1.8°F above the average human “normal” temperature.  Each person actually has a different normal temperature, and that varies by as much as a degree depending on the time of day, and, for some people, by time of month.  So please find your “normal” temperature when you wake up in the morning. Then, if you find yourself one morning 1.8°F or more above your morning normal level, please don’t come in.  Again, if you forget to check at home, there will be a way to do this in our lobbies as well.  Our wellness check-list includes reporting body temperature, any COVID-19-related symptoms, and whether or not they have come in close contact for a prolonged period with an individual diagnosed with COVID-19. For the time being, we will not allow visitors into our space.

7. Desk Space
   Because we are in an open space, desks will be designated to one user. You will be properly distanced from your team, but it is likely your team will be the only team in the office at the time.  We will impose limits on daily attendance to ensure safe distancing. We will provide wipes to disinfect your desk and chair arms when you arrive (“clean in”) and when you leave (“clean out”).   We will set an appropriate density level with the help of experts.

8. Our Offices
   We will work with our landlords to adjust building-level responses.  The CDC recommends that building owners increase the ventilation and circulation of outside air in office buildings.  One of the effects of this will be to increase the humidity slightly in the buildings. Achieving ~40% relative humidity is believed to shorten the lifespan of the virus on surfaces, while also being in the range considered ideal for humans.We are also discussing with our landlords other building-wide standards, such as setting a limit on how many can use an elevator at one time (four people), and seeking their help to create ways for people to enter the building without touching the front doors.  Because transmission of the virus appears to require prolonged exposure, we do not see elevators as a significant area of transmission. Related to this we are exploring safe setups for all administrative staff, people who have face to face contact with large numbers of different people are at the highest risk.  This may involve using plexiglass screens, or potentially a receptionist appearing by video at the desk. Finally, we will be deploying signage to encourage safe spacing in lobbies, corridors and common areas, and to establish directions of flow in corridors to reduce people passing directly by one another.

9. Conference rooms
   We will ensure a standard 6’ (1.8 meter) distance between users and will set a capacity limit at the standard set by local authorities. We will ask you to continue to hold larger meetings via videoconferencing or other means.We will provide disinfecting supplies in all conference rooms and common seating areas.  We will ask all employees who use the room to disinfect the common-touch surfaces—the table surface, the chair arms, and any other equipment like remotes, conference phones and markers—before and after conference room use. We will ask you to disinfect the door handles for good measure, even though we will likely prop those doors open at all times, even with a meeting on progress, to increase ventilation.
   
   These combined steps will make conference room use much safer.  We will refer to this as the “clean in” and the “clean out” steps for conference room usage.  We count on everyone to follow all these requirements.

10. Kitchen Space
    The Arquitectonica kitchens represent an important “communal space”. We are currently devising safe ways to stock and service our kitchens. It is just as important to us, as it is to you, to have amenities available in some capacity when restrictions loosen.  You can expect the kitchens to be different and during the higher-risk period, but we are intending to keep them available to you.  At this point there are no studies suggesting that people are getting the virus from coffee machines or the like.  We will ask people to operate them using our no-touch tools, which we will provide, and, again, to wear masks in common areas, but there will be coffee!

11. Restrooms
    We are going to try to limit the use of restrooms to one person at a time.  We will initiate a sanitizing protocol each employee will be asked to undertake after they use the restroom.  This will involve wiping down fixtures and anything touched, multiple flushes of the toilet fixtures used, and a cleaning of the door handle on the way out, unless we can determine a way to make this touchless.

12. Testing
    We are working to obtain a means for rapid opt-in (optional) COVID-19 testing and antibody testing (to identify individuals who may be immune) through an outside party to augment safety.  We are tracking test pooling as an interesting concept to bring costs down substantially.  In time, we expect testing to become more widely available. We believe such opt-in testing could add to the resilience of the above solutions.

13. Infection Protocol
    In the event an infected individual is discovered to have been in our spaces, we will close the office for 24 hours, and disinfect those spaces (unless already disinfected after the last presence of the individual, through our preemptive cleaning).  Finally, we will make best efforts to identify anyone who had prolonged contact with the infected individual, so that they can be informed.
    
    Per CDC guidance, anyone who has had close contact with that individual (been within six feet) for a prolonged period of time (10-30 mins+) will be asked to quarantine for 14 days.  We will require all employees to agree to tell us if they have been diagnosed with COVID, and to allow us to alert others they were in prolonged, close contact with that they may have been exposed. The identity of the individual will be as protected as we possibly can protect it in keeping with HIPPA rules and regulations.