Correspondence

COVID-19: mitigating identified was the interconnectedness whole system performance (for large
of all parts of the building by the or tall buildings). The potential for
transmission via wastewater plumbing system a substantial viral load within the Published Online
wastewater plumbing and, therefore, the potential for wastewater plumbing system (and March 23, 2020
https://doi.org/10.1016/
systems contaminated air to travel throughout therefore the main sewer system), S2214-109X(20)30112-1
the building unhindered. We also in combination with the potential
By its very design, the wastewater identified the short-duration burst of for airborne transmission due to
plumbing system is a harbinger contaminated air from the wastewater aerosolisation of the virus, calls for
of pathogenic microorganisms plumbing system that caused the wastewater plumbing systems to
with, under some circumstances, cross-contamination.5 be considered as a potential trans­
the potential to enable airborne​ The implications of our work are mission pathway for COVID-19. The
transmission of viruses such as far-reaching given the rate of spread interconnectedness of the wastewater
severe acute respiratory syndrome of COVID-19. The interconnectedness plumbing network can facilitate
coronavirus 2 (SARS-CoV-2), which of the wastewater plumbing network, exposure to SARS-CoV-2 within,
causes coronavirus disease 2019 the sensitivity of the system to factors or even between, buildings. This is
(COVID-19). such as overuse, underuse, high of particular concern in high-risk
In 2003, WHO published a final temperatures, and high concentrations transmission settings such as hospitals
report into a superspreading event of infected people raise concerns over and health-care buildings. Following
of SARS within a housing block in the practice of self isolation and the use the recommendations set out above
Hong Kong.1 The 50-storey building of hospital wards as quarantine areas. will help to minimise the risk of
had 342 confirmed cases of SARS and High concentrations of infected people transmission.
42 deaths. The report identified defects contribute to a higher viral load in the MG reports grants from Dyteqta , during the
in the wastewater plumbing system system, thus leading to a higher risk of conduct of some of the studies included in this
Correspondence; MG has a patent for a faulty trap
as a transmission mode within the disease spread. Self-isolation can lead identification system issued. All other authors
building, which facilitated the transport to a greater number of infected people declare no competing interests.
of “virus laden droplets” through in a building and potential system Copyright © 2020 The Author(s). Published by
empty U-bends in bathrooms. This overuse. The use of hospital wards Elsevier Ltd. This is an Open Access article under the
airborne transmission route was aided as quarantine areas is also a concern CC BY 4.0 license.
by bathroom extract ventilation, which because of the interconnectedness of *Michael Gormley, Thomas J Aspray,
drew contaminated air into the room. the whole system. David A Kelly
Since then, our research group has been We recommend the following steps m.gormley@hw.ac.uk
investigating mechanisms of cross be taken to ensure that transmission Institute for Sustainable Building Design,
transmission, improvements in system through the wastewater plumbing Heriot-Watt University, Edinburgh, UK (MG, DAK);
design, and innovations in system system is minimised: (1) do not and Solidsense, Glasgow, UK (TJA)
monitoring, including confirmation of ignore unexplained foul smells in 1 WHO. Consensus document on the
epidemiology of severe acute respiratory
the wastewater plumbing system as a bathrooms, kitchens, or wash areas; syndrome (SARS). 2003. World Health
reservoir for pathogens.2,3 (2) make sure that all water appliances Organization. https://apps.who.int/iris/
handle/10665/70863 (accessed
In 2017, we published results from in bathrooms and kitchens are fitted March 17, 2020).
an experiment on a full-scale two- with a functioning U-bend; (3) to 2 Gormley M, Swaffield JA, Sleigh PA, Noakes CJ.
storey wastewater plumbing test-rig prevent the loss of the water trap seal An assessment of, and response to, potential
cross-contamination routes to defective
in which we used a model organism within a U-bend, open a tap on all appliance water trap seals in building drainage
(Pseudomonas putida) to represent water appliances for at least 5 s twice systems. Build Serv Eng Res Technol 2011;
1: 1–15.
pathogens flushed into the system.4 a day (morning and evening) paying
3 Gormley M, Templeton K, Kelly DA, Hardie A.
Viable organisms were shown to special attention to floor drains in Environmental conditions and the prevalence
be transmitted between rooms on bathrooms and wet rooms; (4) if of norovirus in hospital building drainage
system wastewater and airflows.
different floors of a building, carried the wastewater pipework from an Build Serv Eng Res Technol 2013; 35: 244–53.
within the system airflow. Droplet appliance appears to be disconnected 4 Gormley M, Aspray TJ, Kelly DA, Rodriguez-Gil C.
fallout resulted in contamination of or open, seal it immediately (ie, use Pathogen cross-transmission via building
sanitary plumbing systems in a full scale pilot
surfaces within the system and rooms. an elastic rubber glove to cover the test-rig. PLoS One 2017; 12: e0171556.
We also suggested causes of the end; a plastic bag and some tape will 5 Gormley M, Aspray TJ, Kelly DA. Mechanisms
wastewater plumbing system defects suffice, ensuring the bag has no holes); of bio-aerosol transmission in sanitary
plumbing systems. 14th International
and presented a basic qualitative (5) if there appears to be any crack or Conference on Indoor Air Quality and Climate.
risk assessment for disease spread leak in pipework, seal with tape or International Society of Indoor Air Quality and
Climate; Ghent; July 7–12, 2016.
in buildings. One important factor glue; and (6) continuously monitor

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