#13.1 - Stephanie Taylor: Transforming Spaces into Healing Places – The Convergence of Architecture and Medicine for Healthier Indoor Air

Part -1

Stephanie Taylor received her Medical Degree from Harvard and subsequently practised pediatric oncology while researching cellular growth control mechanisms for the next several decades.

While taking care of hospitalised patients, she became increasingly convinced that the
healthcare facility played a significant role in patient healing and in healthcare-associated infections.

Determined better to understand the built environment's impact on patients, she returned to school and obtained her Master's in Architecture.

She is an ASHRAE Distinguished Lecturer and is on the Standards Committee for Performance Metrics for Occupied Buildings. She is also a member of the US Green Building Council technical advisory board on Indoor Air Quality.

In 2019 she founded Building4Health to scale the powerful yet underutilised
approach of managing IAQ from a medical perspective to support occupant health.

She brings together a fascinating convergence of human health, microbiology and architecture, I first met her a few years ago in Athens where she was giving a plenary presentation on the impacts of the microbiom of buildings on human health and it was one of the presentations that has stuck with me ever since.

So it was a real privilege to get to have an extended conversation with her about her journey from medicine to buildings, the philosophy and approach of Build4Health and how these two areas of expertise can come together.

After all, we mostly build buildings for people and a human-centred approach is a perspective we sometimes lose.

Stephanie Taylor -  LinkedIn
Build4Health 

Transcript

Simon: 0:14

Welcome to the Air Quality Matters podcast, and this is a conversation with Stephanie Taylor. She received her medical degree from Harvard and subsequently practiced pediatric oncology while researching cellular growth control mechanisms. For the next several decades, while taking care of hospitalized patients, she became increasingly convinced that the healthcare facility played a significant role in patient healing and in the healthcare associated infections Determined. To better understand the built environment's impact on patients, she returned to school and obtained her master's in architecture. She is an Ashrade Distinguished Lecturer and is on the Standards Committee for Performance Metrics of Occupied Buildings. She is also a member of the US Green Building Council's Technical Advisory Board on indoor air quality. In 2019, she founded Building for Health To scale the powerful yet underutilized approach of managing indoor air quality from a medical perspective to support occupant health.

Simon: 1:24

Stephanie is really interesting to talk to. She brings together a fascinating convergence of human health, microbiology and architecture. I first met her a few years ago in Athens, where she was giving a plenary presentation on the impacts of the microbiome on human health, and it was one of those presentations that has stuck with me ever since. So it was a real privilege to get to have an extended conversation with her about her journey from medicine to buildings, the philosophy and approach of build for health, and how these two areas of expertise can come together. After all, we build buildings for people mostly, and a human-centered approach is a perspective we sometimes lose.

Simon: 2:08

This is the first time on the podcast we've had a bit of a breakdown in internet so we unfortunately had to cut our conversation short. So between our schedules and a rather inconveniently timed AHR Expo and ASHRAE conference, we are busily trying to schedule part two for you. But rather than keep you waiting until we organize ourselves, here is part one. Thanks for listening. As always, this is a conversation with Stephanie Taylor. So from a healthy buildings perspective, what I'm really interested in is how somebody from medicine found themselves in buildings and building health.

Stephanie: 2:52

So I mean it's been an interesting journey for me. I never imagined when I first went to medical school that I would end up working this intersection of medicine and the built environment. But I'm one of these people who I'm always looking for patterns in life and in nature and in science. And as I practice clinical medicine, primarily in pediatric oncology, and I was taking care of children with cancer who are often immunocompromised, we saw way too many infections that the children got from some form of contact with the hospital environment. We call those HAIs or healthcare associated infections and I began to be very suspicious of the building.

Stephanie: 3:38

And so as I started thinking about the patient's health and infectious organisms within the context of the indoor environment, I became more and more certain that the building played an important role. But as a physician I didn't know anything about buildings. I didn't know anything about mechanical systems. The whole concept of building seemed pretty impossible to even understand because it was so foreign for the way I was trained and the way my mind worked. But I decided that I needed to understand building. So I went back in somewhere in my late 40s, got my master's in architecture and designed hospitals for a while. So I could understand buildings, and it's just been a fascinating and very fulfilling journey in transition, I must say.

Simon: 4:27

That's a hell of a leap from medicine, which you invest an enormous amount of time in getting to where you want to in medicine. That was a very brave decision to change direction and have a look at buildings and architecture. How did that kind of play out in your head? You obviously had these suspicions that buildings had an impact on health. But, like you say, it's an alien world, I imagine, to most people in medicine, engineering and buildings and architecture. How did that play out for you? Were there some interesting conversations with the family to say I'm going in this direction?

Stephanie: 5:18

It played out, thankfully, one step at a time, because had I seen the whole picture, I probably would never have had the courage to even start. But I also have a perverse part of my nature and I don't think I'm alone with this, but if something seems really impossible to do, I want to try to do it. It's just sort of a hitting my head against a bolder way of living, I think, and it seemed impossible. So because it seemed impossible, I wanted to try. Just like I love to skydive, because skydiving it just seemed terrifying to me, I thought I want to do it. So it was kind of like that you open the, you put your parachute on, you go up in the sky, you open the airplane door and you just do one thing at a time. But it was very hard and very challenging. But it also has given me much more insight and patience into understanding how hard it is to combine professional silos such as engineering and medicine and microbiology. It's very, I found it very challenging, not just because of the knowledge base but because the way of thinking is so different and for me and again this is a little bit different from talking about indoor air quality per se, but to be.

Stephanie: 6:42

I felt very competent as a physician. I knew what I was doing, I knew the language, I knew my colleagues. But to learn about another profession I had to go through a period of really not knowing, of being a beginner, of being kind of dumb, and that's a hard thing to do, especially, you know, for me. I was in my 40s. I didn't like the feeling of being incompetent, for, you know, I consider myself a lifelong learner. But it was different. I felt actually incompetent for a good period of time and it was uncomfortable. I don't think anybody wants to feel that way.

Simon: 7:20

No, but probably quite healthy in some ways as well, I imagine. You know, I think many people consider themselves lifelong learners, but within a discipline. That's very different to changing disciplines completely and having to learn. Like you say, there's a difference between qualifying and being competent and having experience and understanding context and all of those things that come with time in a career. So that's a big leap. It wasn't a big leap.

Stephanie: 7:54

But also, simon, think about if you were a marine biologist and you were studying, say, the health of coral or the health of marine life, you would probably study the water and you would study the minerals in the water. And so as human beings, we live primarily indoors and so, thinking about health and thinking about physiology and disease, and to extend that query into the human environment, it's not such a big leap. We've made it into a big leap. But I don't think biologically it is a. I think everything's on a continuum, including the effect of the environment on our health. So I kind of see it, that's how I see it anyway.

Simon: 8:43

Yeah, and I think for a lot of us, particularly in the environmental space, at the indoor environment space, we do see these strong links between the environment and health outcomes and people. You know we build buildings predominantly for people, so it's natural that there's this strong link. I wonder if there should be more onus on disciplines, getting some grounding from other areas, from other silos as part of training, just to open up that context a little bit. You know we often think that in medicine one of the questions they should be asking when they're dealing with patients with respiratory problems, for example, is they should be considering their home environment and their work environment much more than they do so and perhaps the right kind of training at the right time might open up the medical community more to that. And vice versa, for engineers, having a perspective of people and health a little bit earlier in their training might open and broaden the perspective a little bit.

Stephanie: 9:59

I 100% agree with you and I find more engineers are open-minded about the medical consequences of indoor indoor building design, operations, maintenance than I'll speak for physicians although there are other clinicians besides physicians, clearly but I think a lot of the problem in medicine, at least in the United States, is that I don't know how to say this in a politically correct way, but prevention is not profitable and it really comes down to a business model, and I think you know, if you go back to the 1700s, environmental hygiene was a bigger part of medical training than it is now and I think, as medicine relies more and more on pharmaceuticals and invasive procedures and expensive diagnostic techniques, that's where the money's made and unfortunately, you know, problems drive, I see what you mean.

Simon: 10:59

Yeah, I also wonder if there's a little bit of the dichotomy between proactivity and reactivity within disciplines. So you know, particularly in parts of medicine that are under a lot of pressure, they effectively become quite reactive spaces. So you're firefighting the whole time and that's really where you're hoping public health and public medicine comes in. That is doing the proactivity work on public health a little bit more. But it's similar. In the built environment we often complain that people aren't being proactive enough in dealing with the buildings to get better outcomes. But often in the more stressed environments education and public housing and so on they tend to be quite reactive environments because of the funds and the pressure that they're under. So it's an interesting one that all right. Where did you study architecture? Was it in the same place that you did medicine, or did you move around quite a bit through that period?

Stephanie: 12:04

Well, so my medical. I went to Harvard Med School again quite a while ago you can see from my gray hair and I did all of my medical training in Boston. When I became a mom, I moved to Vermont where I live now Stowe Vermont. It's a great place to raise a child and I have seven dogs. I love dogs, I love the outdoors. So, living in Vermont, there was only one place in this whole state where I could get a master's in architecture which is what you need in order to become registered and that is at a Norwich University. So that's where I got my architecture degree. I'd never heard of Norwich and I thought, oh my gosh, I'm in for who knows what. It ended up. I loved it. It was. We just had the most fantastic faculty and program. So I was really quite lucky to have the one school where I could get a master's in architecture, have just a beautiful department.

Simon: 13:10

So you had a plan when you were doing architecture you wanted to look at healthcare buildings. Was that really what was driving you, and is that why you ended up working designing hospitals? Or did you just find, was it just natural, that that's where you'd end up being, or was there a purpose? I think we can design these places better. I think we can get better outcomes.

Stephanie: 13:37

You know, I think my plan was not quite as well-formed as you just articulated. I knew that there was a connection between health and buildings and I assumed that I would probably find my next phase of work in hospitals. And I actually began. After I, when I was still designing hospitals, I began my work in infection prevention within hospitals. But one of my aha moments, simon, was when I was working with infection preventionists in a hospital and we were measuring all sorts of surrogate parameters for infection control or for a clean environment. So we were putting petri dishes down, we were filtering the air and then culturing the filters and using different tests to see if the hospital, the patient room, was clean.

Stephanie: 14:35

And I realized I said, wait a minute, we have the most relevant test, the most specific test, the most sensitive test and the most relevant test in the bed. It's called the patient. So why don't we use the patient as kind of like the biomarker for the hospital building? And we could use patient outcomes as a sign of a well-run hospital or a well-run patient room or not. And so when I started thinking about that, I thought that there's so many variables involved. There's the reason the person is in the hospital, they're underlying health. It seemed like there were so many variables that it would be almost impossible to use patient healing as a metric of a well-managed hospital room. But thanks to statistics and thanks to electronic health records and thanks to new ways of analyzing the microbial populations in spaces the metagenomic analysis tools we have massive amounts of data that we can now analyze and in a well-controlled study you can actually use human health as a marker of a good patient room. So that was such a awakening for me.

Stephanie: 15:54

But then I also realized you could take that approach into all buildings. So choose your human outcome metric. If it's a school, it would be student academic achievement, absenteeism. If you can get health records like asthma attacks or viral illnesses whatever you can collect from the human health component you can use that and correlate it with the indoor environment and find the most relevant cause and effect metrics.

Simon: 16:23

That's really interesting, yeah, and a profound shift in perspective. I've had two people on the podcast. Both of them have mentioned the lamppost effect or the drunken fallacy or whatever. There's different names for it.

Simon: 16:43

But it's that idea of just because we can, we're looking over here and there seems to be a lot of that within the built environment and indoor air quality, that a lot of our understanding and focus has come from our ability to measure certain things and understand certain parameters within the built environment, and sometimes there's a sense that we're looking in that place because that's what we happen to be able to measure, whereas actually over here the human, the centered perspective is what really matters, and perhaps we haven't been looking over there because it's darker, we haven't seen it as easily, and that's a really interesting shift in focus.

Simon: 17:33

And there's always these complaints with air quality that the general population generally understands that air quality impacts health, that we've always struggled to join the dots between building performance, indoor air quality outcomes and health outcomes, and so we've tend to got stuck in the middle bits the building performance and the air quality bit and steered away a little bit from the health outcomes, because it appears to be much more difficult to join the dots over there, and that's one of the complaints there's not enough people from the medical side, from the human side of this, involved in these discussions and this research. So that's an enormous shift in perspective.

Stephanie: 18:19

I think I think. Well, I had that realization. I remember very clearly it was in 2013. And once I once I began to think about the human being and human health as being really a building performance metric, especially initially in hospitals. It seems so obvious to me that my next phase of thinking was that well, everybody's doing this and I just haven't realized it. I've somehow missed this perspective. But this is the perspective. And then so it took me several months to realize that that isn't the way people look at building management, but what we were saying about we see what we know to look for. I think that's human nature too. I don't fault anybody for having that perspective, because you don't know, something exists, and how can you really begin to focus on it?

Stephanie: 19:16

And unfortunately, in microbiology and in infectious disease, that way of thinking has, I think, led us into some very problematic waters. And what I'm really talking about is when we rely on petri dishes and microscopes of tissue culture to understand what bacteria and viruses are in our environment make us sick. Over the centuries, we developed very sort of humans versus microbes perspective, that all microbes are bad, try to kill everything. It's us versus them. But with these new measurement techniques, the PCR, which is polymerase chain reaction, we can take the DNA and RNA fingerprints of all the microbes around us. We've realized that it's not humans versus microbes. They make up a huge part of our bodies and they make up by cell number, some huge number like 60, 70% of us are bacteria. So we've developed this us versus them way of thinking because of our previous measurement techniques and we're still seeing consequences of that.

Stephanie: 20:30

I mean these harsh disinfectants that I think actually select for the more pathogenic organisms. I think some of our air cleaning disinfection techniques are very helpful when we use them extremely thoughtfully, but if we use them without that degree of precaution, we run the risk of creating more resistant airborne viruses and bacteria. We're seeing that with some fungal organisms. So I think it's understandable that we think about what we can see, but I think we also need to be learned from the past and not recreate problems like antibiotic resistance by overusing techniques or chemicals to eradicate microbes in this case. So I think a narrow perspective is understandable, but we have to work hard to bring in other disciplines so that we don't create problems from having a narrow perspective.

Simon: 21:28

Pavel Wajcowski, who I was talking to last week, was saying that one of the problems that we have with building performance and air quality is we tend to focus very much on risks, and the danger of that, when we're trying to translate quite complex air chemistry and building physics and fluid dynamics and all of this stuff is it's lost on people and we don't do ourselves any favours. We make this stuff sound really complicated. But actually, if you put humans at the centre of this, it's not just about the risks to humans, it's about the potential benefits, and we don't articulate that very well sometimes. So it's not all about the risk. A lot of this is about framing health and performance, and these things tend to resonate much better than esoteric conversations about air chemistry that nobody really cares about.

Stephanie: 22:29

But it's interesting because I think a lot of people think medicine and biology is very complicated, and it is in its own way. But if you think about environmental exposures from the lens of human health, it actually simplifies things quite a bit because instead of just thinking well, so in my current work I look at the impact of indoor air contaminants within a thermal environment and how that affects our health. I believe we have a medically based indoor air quality health standard. That is very exciting, but when you see, when you begin to quantify indoor air exposures from the perspective of health, you actually simplify your job ironically, because you can begin to categorize contaminants and exposures based on how they diffuse into the human body and how they get into our tissues and organs and affect our health. So instead of thinking about, well, there are 5,000 volatile organic compounds and SVOCs in the air and we have to understand each of them, you can begin to categorize all of these variables according to how polar they are, their size, how they diffuse through membranes, how water soluble they are in our airways, and so using the lens of health to quantify the risks of these exposures in some ways makes your job easier. So, to take the approach that I was talking about earlier, which is using human health as a building metric, I realized, with the help of my colleagues, that that was not a scalable approach because it's very labor intensive. So we decided that we were going to find a way to scale that idea, which is to use health outcomes, so to speak, or, as it turns out, health data, to guide proper building management. So that we formed a company that we call Building for Health, or B for H, and it's interesting because there are lots of people who are doing a similar but actually quite different thing. So what we do now is we monitor continuously 11 different indoor metrics, indoor air constituents and outdoors as well, and that is important when we recommend ventilation or any sort of remediation steps. So, primarily, what I'm doing at my time now Simon is working as the CEO of this company, b for H and in developing, continuing to develop, the underlying analytics which tie medically relevant health outcomes with indoor air exposures. So we monitor, we send our data up to the cloud, where it goes through our algorithm. We actually got a patent on it, which is kind of exciting. I have mixed feelings about patents, to tell you the truth, but nevertheless we have a health algorithm and then we deliver to the building occupant or to the owner, whomever, at whatever scale. You know, whoever wrote the check and paid for the installation wants the health index. So we have an indoor air quality health standard and it's also really exciting because, since we measure holistically indoors and outdoors, we can't if your health score is suboptimal if it's below 50, you need to fix it. But we can make recommendations about how to fix it based on what is present indoors and what is present outdoors.

Stephanie: 26:25

And part of our analysis looks at not only individual things, like you know well temperature, humidity, carbon dioxide, et cetera. We also look at how those compounds and constituents interact and affect your body. So, for example, if you have PM 2.5 indoors it's somewhat elevated and you have low relative humidity indoors, low relative humidity is going to increase the depth of deposition of particle, a particular matter in your body. Then if you add ozone into that mix, you're really in bad shape because ozone is very inflammatory, so you have a particulate matter that can settle more deeply into your lungs. You have low humidity, so the mucus layer and the cilia don't protect you and you have ozone which is going to cause gaps in the cells that line, your nose and your sinuses and your airways. So we look at how these things work together and so if you have a poor score, you know, but you say, for example, you have a high ozone day outdoors.

Stephanie: 27:31

That's the solution is not just to increase your ventilation. Your solution may be to remove whatever indoor source you can identify. It might be to ventilate, it might be to control humidity. But because we measure holistically we can make the most effective and also energy efficient remediation recommendation. Which is really exciting to be able to address both of those issues indoor air quality and energy consumption.

Simon: 28:01

And start from the health perspective.

Simon: 28:04

So, was there a a kind of a chicken and egg situation or car before the horse, where you are saying, how did you decide what health impacts to look at or what impacts on the human to look at, and then say, well, what do I measure in order to understand that? Or is there a little bit of what's possible to measure at the moment realistically and can we find ways of what? Can we figure out what it does at a human level? Because, looking at buildings for health, there's some pillars. Isn't there really of things that you look at like immunity and metabolism and cognition and genetics? So you kind of stack them a little bit and say, right, okay, what impacts it going to have in this area of health, or what impacts it going to have in that area of health? How did you go about that process? Because it's a, you've got the complexity of monitoring and air quality and you've also got the complexity of health outcomes and you've arrived at this algorithm, this human centered buildings for health metric. How did that kind of play out over time? Was that, is it just a balance of the two what we could measure and what we could understand or did you really start with the health side of it and work from there and go right. Okay, I would think we need to measure that, I think we need to measure this and that and so on.

Stephanie: 29:38

So I'll say I instead of we, because I was really responsible. Of course I did it in the most difficult way, you know, not the most practical.

Stephanie: 29:49

The first was to say you know what affects mammalian. You know, were mammals right? What affects mammalian health, physiology and cells. What sorts of things get through cell membranes and what sorts of things affect the brain. What sorts of compounds affect lungs? You know blood circulation and blood clotting, what compounds penetrate the body and then understanding from those compounds, such as you know polar compounds are non polar compounds or In your ozone is a good one to start with.

Stephanie: 30:27

Ozone is very inflammatory. So I really started by saying what affects our physiology and then, okay, so how do how? What is a full set of things that we can reasonably measure. So that's why we have 11 metrics. And then we went out and said, okay, now we need to find somebody to make a sensor that's affordable. And we said, okay, this is a good reputation and we'll do this for us. So we did that and we found TSI. They make our sensor.

Stephanie: 30:59

And then we have began to look at. We began to look at the different disease categories that are affected, and that part's pretty simple, believe it or not. Once you understand, okay, what airborne contaminants are polar and therefore are tend to be more water soluble, so those things will affect your upper airways, for your corneas. What compounds are less soluble and are therefore going to settle more deeply into your body before they exert toxicity or the effect, and how do these compounds affect your skin?

Stephanie: 31:35

The skin is just fascinating as an, as an organ and as an organ that interfaces with the airborne environment. I mean, your skin is actually a huge chemical manufacturing site of immunosuppressant, hydro cortisol. So when your skin is stressed by the indoor environment, you actually produce cortisone, which is an immunosuppressant which makes you more vulnerable to autoimmune disorders, more vulnerable to lignities. I mean, you know, the thing that's exciting, simon, is that the the effect of the indoor environment on our bodies is so profound and as tragic as this pandemic has been, I think it's begun to open people's eyes to not necessarily to the effect of indoor air quality on your immune system and on your metabolism. People are still kind of overlooked that at least people are beginning to look at exposure exposure to viruses or to other things, I think. I think building scientists and engineers have a ways to go in understanding the effect of indoor air quality on your, your basic physiology. Yeah, getting there.

Simon: 32:53

Yeah and like but to answer your question.

Stephanie: 32:56

It wasn't. It wasn't targeted like you suggested. It wasn't like okay, what can we measure there, for what diseases are we going to look at? It was more what affects, what affects with an, a One's body, and how do we measure those things? And then how do we quantify the disease outcomes?

Simon: 33:15

How do we frame that in a way that drives the outcomes that we want? I've been having this conversation quite a bit recently. There's the risk approach, the danger approach, the impacts on health, but there's also the positive impacts, the business case, the use case that the advantages of treating this better. Have you found that taking that human centered approach enables you to open up the business case better for monitoring and providing people with information about building health?

Stephanie: 33:49

That's a great question and that's a whole nother challenge. But what we've found is that by choosing buildings when they are, their profitability is actually aligned with healthy people. When that, when that link is clear, the building owners much more likely to invest in monitoring. So, for example, in the United States and senior living communities. The senior living community profitability is driven by how many people, how many residents there are, how many people are in the beds. And on the other side of things, senior living communities, especially assisted living or skilled nursing communities, are penalized if those patients have to go back to a hospital for evaluation of the flu or a virus. So if you can keep people in those senior living communities Healthy and living a long time and keep those beds full, the owner is going to make more money. So the trick in our experiences is aligning monitoring with building types, that when people have a clear understanding of the profitability of a healthy human being. I know that might sound cold hearted, but that's been our experience. It's not easy either.

Simon: 35:17

No, but that is the business case. So you know, we ultimately we have to sell this stuff, and I don't mean just sell sensors and sell packages, but we have to sell the potential co benefits of getting this stuff right. And the challenge when you limit yourself to building performance is that it can be hard to demonstrate the benefits outside of sometimes just basic business use case, like I get slightly better performance out of my staff or less absenteism and some of the basic things we've been doing. The big challenge is how we extend those benefits out to the senior care, the health care facilities, residential settings, schools, all of these different built environments. And if we can put people at the center of that, we stand a much better chance of building the use cases than just saying we're going to improve their quality and you'll feel better. You can define outcomes more clearly. Is that fair to say exactly?

Stephanie: 36:28

But, but, if, but, if, showing an increase in productivity or a decrease in absenteeism, that is also a valuable business case and kind of unexpected to us, but very fortuitous is that when we compare remediation recommendations such as when to ventilate, when to recirculate, when to filter, you know, staying respectful of ashrays of 62.2, 62.1. We've actually found use cases where you can save energy while you optimize your indoor environment. Because we're measuring so holistically, we can say well, now is not a good time to ventilate, even though you have particles, if you can. If you increase ventilation, you're going to bring in ozone, which is going to create more particles as ozone interacts with, you know, nitrous dioxide or TV OCs. So we've actually had many use cases where we can actually save the building owner energy and have improved indoor air quality. So that's, you know, that's just been. That's another really exciting aspect of this.

Simon: 37:42

Have you found with the slightly more complex approach of measuring multiple parameters and tying that to Human health outcomes? Does that make it harder to create actionable insights in those environments, or easier, do you think?

Stephanie: 38:03

I think probably maybe the same, maybe somewhat easier. It kind of depends. I mean, it doesn't make it harder because you only have so many levers to pull in a building. You can ventilate, you can filter. You know, maybe you can humidify, maybe not. You can maybe lower the temperature a little bit to increase relative humidity, which helps decrease particle, airborne particles. Building buildings don't have the capability of humidification or dehumidification, so you only can do so many things realistically. So it doesn't make it harder, it doesn't make it easier, it just helps balance the right thing to do.

Simon: 38:45

Yeah, yeah, it is this odd world of taking incredibly complex things and boiling it down to effectively, like we all keep saying, just these simple levers that we have at our disposal to pull and out the other side of it. Then you get a. There's a massive potential and complex range of scenarios of results that you can get out the other side. It was reminding me a little bit of the pandemic when it first started, that the going into the pandemic was just a never decreasing set of choices. Basically for governments, you just kept closing stuff down until you got control of the spread.

Simon: 39:28

But it was always going to be more complex coming out the other side of it, because every step you took out the other side there was any number of scenarios that could happen and you could always get it wrong and very difficult to say what would have happened if you'd have done something else, whereas going in we pretty much only have one choice and that was just to keep limiting and keep limiting, and similar in some ways with indoor air quality and the built environment. We've got this incredibly complex set of scenarios that we just have to boil down to some simple actions, and those actions out the other side could create a whole range of scenarios, but the benefit of capturing health as a metric and capturing the impacts on health is you get a much clearer picture of what they're likely to be. I guess Doesn't change what you can do in the moment, necessarily, but you can have a better idea of the benefits out the other side.

Stephanie: 40:31

The more specific. Sometimes you can identify indoor sources or two indoor sources that are converging on each other and creating a problem. So, for example, we were monitoring one senior living community and they were recharging electric scooters in the hallway outside of the craft room and in the craft room they were, among other things, they were gluing fabric and making things, and the ozone from the scooters was interacting with the VOCs from the glue and there was a big bump in particles. So sometimes what we've discovered is there are indoor set sources of contaminants or pollutants that you wouldn't be aware of if you weren't measuring. Yeah, absolutely.

Stephanie: 41:21

We found that bingo night there was an increase in not surprisingly there was an increase in particles as people were getting all excited if they won the bingo game.

Stephanie: 41:35

But it was a time when that community had to increase their ventilation and try to increase humidification slightly to keep the particle count down.

Stephanie: 41:44

And we've also identified times where, for example, fairly early in the pandemic, there are different air cleaning technologies being purchased and installed and one community was about to spend millions of dollars on a certain technology that I'm not going to mention by name and they said well, wait a minute, maybe we should monitor, maybe we should buy one or two of these devices and see if it does what we hope. And we found some interesting things. First of all, we found that their buildings were in good shape to begin with. They didn't really need the. There wasn't a high particle or viral count. Number two, we found that when they did turn these devices on that there was more harm done than good and so they're able to say look, we're monitoring. So they were able to increase the confidence of the residents without spending a lot of money on these devices and they weren't causing the secondary unintended harm from those devices. So again, if you don't look for something, you're not going to find it.

Simon: 42:51

And how do you balance this the nature to investigate when you're collecting so much useful information and it become a consultative approach and balance that with the need to scale tech and automate and create actionable insights that don't require a big bank of consultants interpreting data? Because I imagine there must be an enormous pull to want to go in and investigate the patterns that you're seeing and the data. Just by being the nature that you are With the, we really should be selling thousands of these and we don't have time to be figuring out if it's the scooter or the air cleaner. You know that somehow we've got to find ways of processing this information and creating insights that doesn't require someone with architectural and medical experience to interpret it.

Stephanie: 43:47

You're a very wise man Because you're right. One way we approach that is we have automated recommendations depending on what patterns we see and depending on what the outdoor sensor is telling us. So we actually have a remediation engine that's coded into the dashboard. So we recommend. But you're right, I mean there's always a you know, in the middle of the night I'll be looking at the customer dashboard's point, thinking I wonder if so and so knows that you know such and such is happening right now. Yeah, that is a conflict.

Simon: 44:33

No, for sure, and it always is, I think, for people.

Stephanie: 44:35

Do you have any thoughts about that?

Simon: 44:38

Yeah, you just have to keep your sticky fingers out of the data and try and release it into the wild and have the automation and, like you say, the insights running in the background, because, as interesting as it is, I don't it probably doesn't scale the tech. I think we've come so far in this journey that we're getting quite close now with some of the work that's going on in the background with see the works of Ben Jones and Max Sherman on harm intensities starting to try and provide some metrics behind the public health impact of some of these pollutants and work like yours really putting human health at the centre. I wonder how, for someone that's come from medicine and being in architecture, how would you see, if it goes the right way, this playing out over the next five or 10 years?

Stephanie: 45:40

I think that one of the big obstacles right now, at least in the United States, is the fear of building owners' fear of being sued. If there are suboptimal conditions, I think it's a building occupant going to sue them, or you know. So I think the fear of legal action is very scary for building owners and for hospitals. If the data exists, will it be dragged into court? I think one really important safeguard for quality control data is to say that buildings and hospitals, schools, cannot be penalized for monitoring. I think that has to be worked out. I think that's one.

Stephanie: 46:29

Another one is I agree with Pavel about this and I was so excited when I heard him say this. I think that using ventilation flow rates as a primary indication of a healthy building is a mistake, because we can no longer assume number one, that the outdoor air is quote unquote clean, and not just clean from pollutants, but even, you know, tropospheric ozone, which is generated by the sun, and as well as pollution. We can't assume outdoor air is good and we can't assume that just bringing in more outdoor air is a good thing. So I think we need I really feel we need to shift from flow rates as being a metric and air change rates as being a primary metric to indoor air concentrations, because that's what's affecting our health. So I think changing that metric would be in the engineering world would be very valuable.

Simon: 47:32

Yeah, and you can see it going that way. I'm a little bit torn. Someone that's on the cold face. I've seen enormous difficulty with the built environment, even achieving simple metrics like decent flow rates in buildings. We've been very poor at quality control. We've never really valued ventilation unless it's been around the conditioning of spaces making us comfortable. We've been very poor at recognizing the value of ventilation even from a basic air movement perspective, and every time this is looked at we see widespread non-compliance with meeting even minimum standards for ventilation performance in spaces. And my concern is that as we make this more complex and we start to have grown-up conversations about the impacts on health, what hope do we have of having those kind of conversations if we can't even get basics right? So I think it's parallel.

Stephanie: 48:47

Why do you think flow rates are more basic, say, than concentrations, and pick as many or as few indoor air quality concentrations as you want? I mean, I personally think carbon dioxide is a good indicator of occupancy, but CO2 in itself is not particularly harmful unless you're really really high. But whatever, choose whatever indoor air quality concentration you want. Why does that seem more complicated than measuring flow?

Simon: 49:19

Yeah, I see what you're saying and I think that perhaps is a different conversation now than it would have been a few years ago, as we've seen the development of low cost sensors that can measure this stuff increasingly more easily. My concern is, as you intimated, that we have to take away the fear of people being sued or the fear of buildings not performing because we know they're not going to perform Like we're starting out on this journey. It's a little bit like the sustainability journey. We know we're in deep trouble when it comes to the indoor environment. We've not done this very well.

Simon: 50:06

My concern is that we knew one of the ways, or thought we knew one of the ways to manage that, and that was with decent ventilation and it was fairly straightforward to measure and has been fairly straightforward to measure.

Simon: 50:20

The intent of a lot of these standards has been very clear for a long time Now. They go up and down a bit and we change our approach a little bit, but largely we know what we're supposed to have done in buildings for a while Yet with wholesale failed to deliver in buildings. So even if it is straightforward to measure an air quality metric, I wonder if anything will change in that sense that just because we know CO2 might be a bit high in the building, will it mean we do anything different? I think it's. My hope, I suppose, for your kind of work is that it frames things in a way that resonates better with people. We bring it closer to people as a frame of reference, rather than it being an esoteric conversation about meters cubed an hour or cubic feet per minute of something that I don't really understand in my classroom to a number that impacts me, a health metric that impacts me, and maybe that's where the shift will come, because I think you're right.

Stephanie: 51:44

I think my feeling is, creating visibility is really the first step. It's the first step with anything is saying, okay, we do or do not have a problem, and so in my wildest dreams, I would like every occupied building to be monitored and simply have a very simple output, whether it's a dashboard that you have to log in to see, or an app, or if it's just a sensor that turns red or green or yellow. I think that visibility for the person who's affected is what is going to instigate change. We say that the most motivated customer is the parent of a newborn, because you have all of the motivation and all of the human emotions and the protective instinct there. But that's not a very scalable model as a business, but I think that the more we can bring visibility of either good or bad indoor air quality to the person who's affected by it, the more motivation people will have. I mean, that sounds simplistic, probably, and probably a little bit naive, but I think that's how human nature is.