SICK BUILDING SYNDROME

About two weeks after beginning medical practice Dr. Harry Schmidt, Sr., a Biloxi generalist, now deceased, called me to welcome me to the medical community.  In the course of our conversation I quizzed him about the common health problems of the community.  He shared that summer colds had become more common than before and he believed it had been because of the advent of air-conditioners being installed in cars, homes, and places of business.  Dr. Schmidt, as a young physician, had begun his medical practice when air-conditioning was not readily available to many.  He opined that frequent exposure to alternately hot and cool environments somehow made people's immune systems vulnerable to infections.

For the past 4-5 weeks I've been seeing a steady trickle of people with "summer colds" and sinus congestion, usually manifested by either a sore throat, pressure around the eyes, cough, or a combination of these symptoms.  A few have had lower respiratory tract signs.  Some work in jobs that require them to move in and out of air-conditioned vehicles and buildings frequently during the day as opposed to people who work outside or inside the majority of their working day.

But there's a more likely explanation for these summer colds, which are so frequent that probably any particular physician's waiting room these days could be a snapshot of what one sees in January and February, during the flu season.

There's a group of germs most responsible for triggering winter colds and respiratory illnesses, called rhinoviruses.  They best survive in cool weather and their numbers surge in September and begin to fade in March.  In the summer, this viral landscape shifts and we begin to see a different group of viruses, called enteroviruses.  They're the second most common type of viruses infecting humans, second to rhinoviruses.

Enteroviruses can infect the tissues lining your nose, throat, and digestive tract.  Enteroviruses cause a surge of illness occurring between June and October of each year.  The symptoms are typically mild respiratory symptoms, headache, muscle aches, nausea and vomiting.  Even pink eye.  While some enterovirus illnesses can last more than a few days, most are typically over in 3-5 days.

It's when the viral symptoms continue for much longer, weeks and months, that we begin to think of other causes.  I recently saw a nice gentleman who works in a building that was recently renovated whose hard cough, sore throat, and sinus congestion has persisted for two months, waxing and waning in a feeble way in response to medications.  His tests are unremarkable and unrevealing.  More importantly, about 20% of his staff and coworkers are suffering similar symptoms and have a similar experience from their doctors about failure to respond adequately to antibiotics and other medications.

We are currently entertaining the possible diagnosis of "Sick Building Syndrome" as he and his coworkers didn't begin having dramatic symptoms until about 10 days after he and his staff moved into the newly renovated building.

In most cases, the cause of "Sick Building Syndrome" is not known or discovered.  One common feature in some cases though is the inadequate cooling and heating ventilations in some buildings.  After the oil embargo in the 70s, in an effort to improve energy efficiency, ventilation flow rates in newly constructed buildings were reduced to 5 cfm/person (cubic feet per minute) which was found to be inadequate, producing indoor air pollution.  The American Society of Heating, Refrigeration and Air-Conditioning Engineers revised ventilation standards to a minimum outdoor air flow rate of 15 cfm/person to avoid the problems related to inadequate ventilation.  The standards are 20 cfm/person in office spaces and 60 cfm/person in smoking lounges.  Poor design and construction of buildings with more number of offices cramped in a building to increase the salable area also contribute to inadequate ventilation.

There are many other potential causes for what might make a building "sick" for its workers.  Contaminants from outside like pollutants from motor vehicle exhaust, plumbing vents and building exhausts (bathrooms and kitchens) can enter the building through poorly located air intake vents, windows and other openings.  The most common contaminant of indoor air includes the volatile organic compounds (VOC).  The main sources of VOC are adhesives, upholstery, carpeting, copy machines, manufactured wood products, pesticides, and cleaning agents.

The biological contaminants include pollen, bacteria, viruses, fungus, molds, etc.  These contaminants can breed in stagnant water that has accumulated in humidifiers, drainpipes and ducts or where water has collected on ceiling tiles, insulation, carpets and upholstery.  Insect and bird droppings can also be a source of biological contamination.

Gadgets like microwaves, televisions and computers emit electromagnetic radiation, which ionizes the air.  Extensive wiring without proper grounding also creates high magnetic fields, which have also been linked to cancer.

In the summertime we don't hear the public health advice about covering your coughs and washing your hands frequently like we do in the winter.  But if you're working or living around people with respiratory symptoms, to the extent you're able to, avoidance and washing your hands after contact is still good advice.