Heating, Ventilation and Air Conditioning systems

in the covid-19 context

Roadmap to improve and ensure good indoor ventilation

Introduction removed in an efficient manner.

COVID-19 mainly spreads between people through direct, indirect
(through contaminated objects or surfaces), or close contact with
infected people via mouth and nose secretions. These include saliva,
respiratory secretions or secretion droplets. These are released from
the mouth or nose when an infected person coughs, sneezes, speaks or
sings, for example. People who are in close contact (within 1 metre) with
an infected person can catch COVID-19 when those infectious droplets
get into their mouth, nose or eyes.
Airborne transmission of the virus can occur in health care settings where
specific medical procedures, called aerosol generating procedures,
generate very small droplets called aerosols. Some outbreak reports
related to indoor crowded spaces have suggested the possibility of
aerosol transmission, combined with droplet transmission, for example,
during choir practice, in restaurants or in fitness classes.
WHO recommends a set of measures to prevent person-to-person
spread of COVID-19 among which ensuring good ventilation in indoor
settings, including healthcare facilities, public spaces and homes. A well-
maintained and operated system can reduce the spread of COVID-19 in
indoor spaces by increasing the rate of air change, reducing recirculation
of air and increasing the use of outdoor air.
There are straightforward steps that can be taken to improve and
ensure good indoor ventilation and the focus of this material is on those
measures. However, several variables should be considered when
improving the ventilation such as the layout and design of a building, as
well as occupancy and type of heating, ventilation, and air conditioning
(HVAC) system installed.
There are three methods that may be used to ventilate a building:
natural, mechanical and hybrid (mixed mode) ventilation.
For more comprehensive information consult the documents in
bibliography
How to use the roadmap
Owners and building manager should consider evaluating their building
systems to check that it is operating in proper order (per design conditions
or current operational strategies), is capable of being modified to align
with HVAC mitigation strategies, and to identify deficiencies that should
be repaired. Several steps should be considered in consultation with a
heating, ventilation and air conditioning (HVAC) professional.
The proposed roadmap is divided in 3 settings, healthcare, indoor
public and high-density spaces and residential space such as private
houses. For each category there is a further stratification according to
ventilation system such as mechanical, hybrid and natural ventilation.
Once identified the correct setting and ventilation system, the reader
should start from the top beginning with the central column labelled
‘’step’’. On the left side the minimum requirements and standards
proposed for each step while on the right side the different strategies to
improve the specific matter. Strategies are listed in order of preference.
i.e. if more than one strategy can be implemented, the first one, the
one on top, should be preferred. For few specific cases is preferable
to implement two or more strategies simultaneously. Those cases are
marked with a symbol plus (+) in between the strategies to be combined.

Scope of the document

This roadmap aims to defines the major steps needed to reach the
expected ventilation requirements or simply improving indoor air
quality including recommendations on how to assess and measure the
different parameters. It also serves as a communication tool, a high-
level document that helps articulate strategic thinking—the why—
behind both the goal and the plan for getting there. It’s not meant to be a
technical document but a strategic plan helping the users to understand
how to analyse the HVAC systems are working in order to undertake the
different steps needed to improve HVAC ability to mitigate and reduce
the risk of COVID-19 transmission.
Multiple documents published by international and regional Heating,
Refrigerating and Air-Conditioning associations, institutions and
organizations have been considered to produce the following technical
recommendations which, seeing the specific objective of this roadmap,
have been reviewed under an Infection Prevention and Control
perspective. healthcare settings
covid-19 services including
quarantine facilities
Basic information
Ventilation is the intentional introduction of fresh air into a space while
the stale air is removed. Ventilation moves outdoor air into a building
or a room and distributes the air within the building or room.
The general purpose of ventilation in buildings is to provide healthy air
for breathing by both diluting the pollutants originating in the building
and removing the pollutants from it.
Building ventilation has three basic elements:
mechanical natural
- ventilation rate — the amount of outdoor air that is provided
into the space, and the quality of the outdoor air HVAC
- airflow direction — the overall airflow direction in a building,
which should be from clean zones to dirty zones; and
system
- air distribution or airflow pattern — the external air should hybrid
be delivered to each part of the space in an efficient manner and the
airborne pollutants generated in each part of the space should also be

Indoor public and high Private houses

density spaces home care & home
quarantine

areas and requirements
ventilation rate minimum
requirements1:
• 160 l/s/p or 12ACH where
AGP are performed
• 60 l/s/p or 6 ACH other
The airflow direction
should be from clean to
less-clean area2
Air should be exhausted
directly to the outside
away from air-intake vents,
people and animals3
or HEPA filters should be
used
Air recirculation should be
avoided
Verify heat recovery unit
HVAC system should
be regularly inspected,
maintained, cleaned and
operated
Heating and air
conditioning with
recirculating units should
be used carefully and after
assessment
1. Minimum ventilation rate. How to assess it?
Each mechanical ventilation system is designed for specific airflow rate. Consult the technical manual to verify the system capacity.
Or use an anemometer close to the air extractor to check the volumetric flow rate. [m3/s]
HVAC in healthcare settings
covid-19 services including quarantine facilities
mechanical ventilation
steps strategies
In consultation with a heating, ventilation and air conditioning (HVAC) professional assess
the opportunity to increase the ventilation rate according to system capabilities.
Disable demand-control ventilation controls that reduce air supply based on temperature
Does the ventilation rate meet the WHO minimum or occupancy.
requirements? NO
To assess the ventilation rate consult point 1 underneath If the system doesn’t allow to increase the ventilation up to recommended minimum
requirements (ACH), consider to reduce the maximum room occupancy till meeting the
YES l/s/patient standard.
If the mechanical system does not allow to increase the ventilation rate, consider
integrating with natural ventilation such as window opening which can be used to boost
ventilation further14
+ In consultation with a heating, ventilation and air conditioning (HVAC) professional assess
the opportunity to modify airflow. i.e. modify air extractors and air inlet location
Does the airflow
moves from clean-to-
less-clean area?
NO Add ante-rooms in order to have strictly control on
To assess the airflow + airflow direction. Doors in anteroom shouldn’t be open
at the same time in order to clearly separate the air
consult point 2
between patient room and corridor (cleaner area)
+ Consider modifing the areas distribution. i.e. swapping the patient’ with the healthcare
YES staff area.
In consultation with a heating, ventilation and air conditioning (HVAC) professional assess
the opportunity to install HEPA filter according to system capability.
Is the exhausted air correctly managed? NO
If the system does not allow HEPA filter installation, consider to fence the area nearby the
YES exhausted outlet.
Increase the percentage of outdoor air, using economizer modes of HVAC operations and
potentially as high as 100%. Before increasing outdoor air percentage, verify compatibility
with HVAC system capabilities for both temperature and humidity control as well as
compatibility with outdoor/indoor air quality considerations.5
In consultation with a heating, ventilation and air conditioning (HVAC) professional assess
Does the HVAC system work with recirculation of indoor the opportunity to install HEPA filter according to system capability. Increased filter
air? YES
efficiency generally results in increased pressure drop through the filter. Ensure HVAC
systems can handle filter upgrades without negative impacts to pressure differentials and/
or air flow rates prior to changing filters.4
NO If not other strategy can be adopted, consider to use a stand-alone air cleaners with
HEPA filters. Pay attention to the airflow direction (from clean to less clean areas) while
positioning . Stand-alone air cleaners should be operated continuously.
Virus particle transmission via heat recovery devices is not an issue when an HVAC system
is equipped with a twin coil unit or another heat recovery device that guarantees 100% air
separation between the return and supply side.12
For properly operating rotary heat exchangers, fitted with purging sectors and correctly
set up, leakage rates are very low, being in the range of 1-2%.13
Is the HVAC system
equipped with heat
recovery? YES If critical leaks are detected in the heat recovery, in consultation with HVAC professional,
assess the opportunity to install HEPA filter according to system capability. Increased filter
efficiency generally results in increased pressure drop through the filter. Ensure HVAC
systems can handle filter upgrades without negative impacts to pressure differentials and/
or air flow rates prior to changing filters.6
NO If critical leaks are detected in the heat recovery sections and the system doesn’t allow
HEPA filter installation, pressure adjustment7, deactivation or by-pass of the heat-
exchanger could be adopted8
HVAC systems should be regularly inspected, maintained, and cleaned according to
Is the HVAC system regularly inspected, maintained, manufactory recommendations. Contact a HVAC professional, manufactory or a specialized
cleaned and operated? including HEPA filter cleaning company to verify that the system comply with manufactory maintenance requirements.
NO
and replacement
+
Clean or replace HEPA filter according to manufactory recommendations
YES
Use of splits and fan-coils units is discouraged because difficult to mantain, provide poor
filtration and contribute to turbulence potentially increasing the risk of infection9.
Avoid use of air recirculating units for COVID patients if possible10 and consider using
alternative systems. Except for single room and COVID-19 confirmed patients.
Conditioning and heating is performed by non-ducted
(with indoor air recirculation) convectors such as split YES If alternative conditioning and heating are not available/feasible, create negative pressure
or fan coil units relative to corridor (outside the room) by increasing general or toilet exhaust airflow.
Carefully perform room units cleaning and disinfection in between patients.11
If alternative conditioning and heating are not available/feasible, consider running the
conditioning and heating units at minimum velocity allow in order to reduce turbulences.
Considering to modify the position of the heating/cooling unit to direct airflow to the less-
clean zone or install an extractor to controll the airflow
NO
END
2. Airflow direction. How to assess it?
Smoke test: to highlight the direction of the airflow. Smoke
test tools are available on the market, however other smoke
generators such as incense stick could be used.

areas and requirements
ventilation rate minimum
requirements17:
• 160 l/s/p or 12ACH where
AGP are performed
• 60 l/s/p or 6 ACH other
The airflow direction
should be from clean to
less-clean area15
Air should be exhausted
directly to the outside
away from air-intake vents,
people and animals16
or HEPA filters should be
used
HVAC system should
be regularly inspected,
maintained, cleaned and
operated
Heating and air
conditioning with
recirculating units should
be used carefully and after
assessment
1. Minimum ventilation rate. How to assess it?
Use an anemometer close to the air extractor to check the volumetric flow rate. [m3/s]
HVAC in healthcare settings
covid-19 services including quarantine facilities
hybrid ventilation
steps strategies
In consultation with a heating, ventilation and air conditioning (HVAC) professional assess
the opportunity to increase the ventilation rate according to system capabilities.
Disable demand-control ventilation controls that reduce air supply based on temperature
or occupancy.
Does the ventilation rate meet the WHO minimum
requirements? NO If the system doesn’t allow to increase the ventilation up to recommended minimum
To assess the ventilation rate consult point 1 underneath requirements (ACH), consider to reduce the maximum room occupancy till meeting the
l/s/patient standard.
YES If the mechanical system does not allow to increase the ventilation rate, consider
integrating with natural ventilation such as window opening which can be used to boost
ventilation further21
NOTE: air cleaners do NOT replace ventilation but could increase
dilution!!
If not other strategy can be adopted, consider to use a stand-alone air
cleaners with HEPA filters. Pay attention to the airflow direction (from
clean to less clean areas) while positioning . Stand-alone air cleaners
should be operated continuously.
+ In consultation with a heating, ventilation and air conditioning (HVAC) professional assess
Does the airflow the opportunity to modify airflow. i.e. modify air extractors and air inlet location
moves from clean-to-
less-clean area?
NO Add ante-rooms in order to have strictly control on
To assess the airflow + airflow direction. Doors in anteroom shouldn’t be open
at the same time in order to clearly separate the air
consult point 2 between patient room and corridor (cleaner area)
+ Consider modifing the areas distribution. i.e. swapping the patient’ with the healthcare
YES staff area.
In consultation with a heating, ventilation and air conditioning (HVAC) professional assess
Is the exhausted air correctly managed? the opportunity to install HEPA filter according to system capability
NO
If the system does not allow HEPA filter installation, consider to fence the area nearby the
exhausted outlet.
YES
HVAC systems should be regularly inspected, maintained, and cleaned according to
manufactory recommendations. Contact a HVAC professional, manufactory or a specialized
Is the HVAC system regularly inspected, maintained, company to verify that the system comply with manufactory maintenance requirements.
cleaned and operated? including HEPA filter cleaning NO
and replacement
+ Clean or replace HEPA filter according to manufactory recommendations
YES
Use of splits and fan-coils units is discouraged because difficult to mantain, provide poor
filtration and contribute to turbulence potentially increasing the risk of infection18.
Avoid use of air recirculating units for COVID patients if possible19 and consider using
alternative systems. Except for single room and COVID-19 confirmed patients.
Conditioning and heating is performed by non-ducted
(with indoor air recirculation) convectors such as split YES
If alternative conditioning and heating are not available/feasible, create negative pressure
or fan coil units relative to corridor (outside the room) by increasing general or toilet exhaust airflow.
Carefully perform room units cleaning and disinfection in between patients.20
If alternative conditioning and heating are not available/feasible, consider running the
conditioning and heating units at minimum velocity allow in order to reduce turbulences.
Considering to modify the position of the heating/cooling unit to direct airflow to the less-
clean zone or install an extractor to controll the airflow
NO
END
2. Airflow direction. How to assess it?
Smoke test: to highlight the direction of the airflow. Smoke
test tools are available on the market, however other smoke
generators such as incense stick could be used.

areas and requirements
ventilation rate minimum
requirements26:
• 160 l/s/p or 12ACH where
AGP are performed
• 60 l/s/p or 6 ACH other
The airflow direction
should be from clean to
less-clean zones24
Air should be exhausted
directly to the outside
away from air-intake vents,
people and animals25
Heating and air
conditioning with
recirculating units should
be used carefully and after
assessment
* Cross ventilation
cross ventilation should NOT be implemented only in specific cases:
- within a room or wards for COVID-19 suspected cases where Aerosol Generating Procedure (AGP) may take place and when the exhaust air is not properly managed.
- when airflow is moving from less-clean to clean area.
1. Minimum ventilation rate. How to check it22?
Ventilation rate [l/s]= k x wind speed [m/s] x smallest opening area [m2]x 1000 [l/m3]
k = 0,05 in case of single side ventilation
k= 0,65 in case of cross ventilation
in case of mosquito net presence = ventilation rate x 0,5
wind speed: https://globalwindatlas.info/
HVAC in healthcare settings
covid-19 services including quarantine facilities
natural ventilation
steps strategies
Asses the opening location and opening surface considering potential new opening (add /
+ modify windows’ or doors’ dimensions)
Considering realize cross-ventilation rather than single side ventilation*
+
single side ventilation
Does the ventilation rate meet the WHO minimum
requirements? NO cross ventilation
To assess the ventilation rate consult point 1 underneath
If the system doesn’t allow to increase the ventilation up to recommended minimum
requirements (ACH), consider to reduce the maximum room occupancy till meeting the
YES
l/s/patient standard.
NOTE: air cleaners do NOT replace ventilation but could increase
+ dilution!!
If not other strategy can be adopted, consider to use a stand-alone air
cleaners with HEPA filters. Pay attention to the airflow direction (from
clean to less clean areas) while positioning . Stand-alone air cleaners
should be operated continuously.
+ Installation of air extractors or whirlybirds23
Does the airflow
moves from clean-to- Add ante-rooms in order to have strictly control
NO
less-clean area?
To assess the airflow
+ on airflow direction. Double doors in anteroom
shouldn’t be open at the same time in order to clearly
consult point 2 separate the air between patient room and corridor
(clean area)
+ Building works to enable/improve stack effect or other natural stack effect
ventilation strategies
YES
+ Consider modifing the area distribution. i.e. changing patients
and staffs’ areas in order to have natural negative pressure (ex.
due to stack effect) close to patients’ rooms
NO
Is the exhausted air correctly managed? Use of fences to avoid people passage close to openings (windows and doors)
YES
Use of splits and fan-coils units is discouraged because difficult to mantain, provide poor
filtration and contribute to turbulence potentially increasing the risk of infection27.
Avoid use of air recirculating units for COVID patients if possible28 and consider using
Conditioning and heating is performed by non-ducted alternative systems. Except for single room and COVID-19 confirmed patients.
(with indoor air recirculation) convectors such as split YES
or fan coil units If alternative conditioning and heating are not available/feasible, create negative pressure
relative to corridor (outside the room) by increasing general or toilet exhaust airflow.
Carefully perform room units cleaning and disinfection in between patients.29
If alternative conditioning and heating are not available/feasible, consider running the
conditioning and heating units at minimum velocity allow in order to reduce turbulences.
Considering to modify the position of the heating/cooling unit to direct airflow to the less-
clean zone or install an extractor to controll the airflow
NO
END
2. Airflow direction. How to assess it?
Smoke test: to highlight the direction of the airflow. Smoke
test tools are available on the market, however other smoke
generators such as incense stick could be used.

areas and requirements
Increase the ventilation
rate within the facility
aggiungere come misurare
Air recirculation is not
recommended
Verify heat recovery unit
HVAC system should
be regularly inspected,
maintained, cleaned and
operated
Heating and air
conditioning with
recirculating units should
be used carefully and after
assessment
Air should be exhausted
directly to the outside
away from air-intake vents,
people and animals42
or HEPA filters should be
used
Occupancy and HVAC
temperature and humidity
1. Minimum ventilation rate. How to assess it?
Each mechanical ventilation system is designed for specific airflow rate. Consult the technical manual to verify the system capacity.
Or use an anemometer close to the air extractor to check the volumetric flow rate. [m3/s]
HVAC in indoor public and high density spaces
mechanical ventilation
steps strategies
In consultation with a (HVAC) professional assess the opportunity to increase the ventilation
Does the ventilation rate meet at least the national rate according to system capabilities.
regulations requirements*? if national regulation is not Disable demand-control ventilation controls that reduce air supply based on temperature
available consult regional or international regulations. NO or occupancy.
To assess the ventilation rate consult point 1 underneath If the mechanical system does not allow to increase the ventilation rate, consider
integrating with natural ventilation such as window opening which can be used to boost
YES ventilation further43
Increase the percentage of outdoor air, using economizer modes of HVAC operations and
potentially as high as 100%. Before increasing outdoor air percentage, verify compatibility
with HVAC system capabilities for both temperature and humidity control as well as
Recirculation of indoor air is performed. The ventilation
system use part of external air mixed with internal air. YES compatibility with outdoor/indoor air quality considerations.31
Update or replace existing air filters with MERV 13 or the highest compatible with the filter
rack. Make sure the air handling systems and fans can overcome the additional pressure
drop of the new filters.30
NOTE: air cleaners do NOT replace ventilation but could increase
dilution!!
If other strategies are not available or feasable, consider to use stand-
NO alone air cleaners (often called air purifiers) with particle filters. It
should be operated continuously. Use high-efficiency media filters
(such as MERV14 or higher).32
Virus particle transmission via heat recovery devices is not an issue when an HVAC system
is equipped with a twin coil unit or another heat recovery device that guarantees 100% air
separation between the return and supply side.40
For properly operating rotary heat exchangers, fitted with purging sectors and correctly
set up, leakage rates are very low, being in the range of 1-2%.41
Is the HVAC system
is designed with heat If critical leaks are detected in the heat recovery, in consultation with HVAC professional,
recovery? YES assess the opportunity to install HEPA filter according to system capability. Increased filter
efficiency generally results in increased pressure drop through the filter. Ensure HVAC
systems can handle filter upgrades without negative impacts to pressure differentials and/
or air flow rates prior to changing filters.37
If critical leaks are detected in the heat recovery sections and the system doesn’t allow
MERV 13 filter installation or the highest compatible with the filter rack, pressure
NO adjustment38, deactivation or by-pass of the heat-exchanger could be adopted39
HVAC systems should be regularly inspected, maintained, and cleaned according to
manufactory recommendations. Contact a HVAC professional, manufactory or a specialized
Are the system and the air filters correctly mantained? company to verify that the system comply with manufactory maintenance requirements.
[periodical reviews according to design prescriptions] NO
Clean or replace the air filter according to manufactory recommendations. Conditioning
YES and heating units should be periodically cleaned and mainteined.
Use of splits and fan-coils units is discouraged because difficult to mantain, provide poor
filtration and contribute to turbulence potentially increasing the risk of infection44.
Consider using alternative systems such as radiators.
Conditioning and heating is performed by non-ducted
(with indoor air recirculation) convectors such as split YES
or fan coil units If alternative conditioning and heating are not available/feasible, create negative pressure
relative to corridor (outside the room) by increasing general or toilet exhaust airflow.
Carefully perform room units cleaning and disinfection45
If alternative conditioning and heating are not available/feasible, consider running the
conditioning and heating units at minimum velocity allow in order to reduce turbulences.
Considering to modify the position of the heating/cooling unit to direct airflow to the less-
clean zone or install an extractor to controll the airflow
NO
In consultation with a heating, ventilation and air conditioning (HVAC) professional assess
the opportunity to install air filter according to system capability
Is the exhausted air correctly managed? NO
If the system does not allow air filter installation, consider to fence the area nearby the
YES exhausted outlet.
Operate the HVAC system with maximum outside air flow for two hours33 at normal speed
YES before and at low speed after occupied times, or, achieve 3 air changes of outside air in
Has the facility periods of non occupancy? the space34.
Keep the ventilation on 24/7, with lower (but not switched off) ventilation rates when
people are absent.35
NO
Has the HVAC systems the possibility to direct control YES Maintain relative humidity between 40% and 60%, where possible36.
temperature and humidity?
NO
END

areas and requirements
Increase the ventilation
rate within the facility
aggiungere come misurare
system and filter
manteinance
Heating and air
conditioning units
manteinance
occupancy and HVAC
Air should be exhausted
directly to the outside
away from air-intake vents,
people and animals51
or HEPA filters should be
used
temperature and humidity
Heating and air
conditioning with
recirculating units should
be used carefully and after
assessment
1. Minimum ventilation rate. How to assess it?
Use an anemometer close to the air extractor to check the volumetric flow rate. [m3/s]
HVAC in indoor public and high density spaces
hybrid ventilation
steps
Does the ventilation rate meet at least the national
regulations requirements*? if national regulation is not
available consult regional or international regulations.
To assess the ventilation rate consult point 1 underneath
YES
Are the air extractors correctly mantained?
[periodical reviews according to design prescriptions]
YES
Are conditioning and heating units available?
NO
Has the facility periods of non occupancy?
NO
Is the exhausted air correctly managed?
YES
Has the HVAC systems the possibility to direct control
temperature and humidity?
NO
Conditioning and heating is performed by non-ducted
(with indoor air recirculation) convectors such as split
or fan coil units
NO
END
strategies
In consultation with a HVAC professional assess the opportunity to increase the ventilation
rate according to system capabilities.
+
Increased air motion within a room, such as from a ceiling fan.50 ceiling fan
allowed air mix and a more uniform age of the air within a room.
+
NO If the hybrid system does not allow to increase the ventilation rate, consider integrating
+ with natural ventilation such as window opening which can be used to boost ventilation
further52
NOTE: air cleaners do NOT replace ventilation but could increase
dilution!!
+ If other strategies are not available or feasable, consider to use stand-
alone air cleaners (often called air purifiers) with particle filters. It
should be operated continuously. Use high-efficiency media filters (such
as MERV14 or higher).55
HVAC systems should be regularly inspected, maintained, and cleaned according to
manufactory recommendations. Contact the responsible for the mantainance to review
the functioning of the system
NO
Clean or replace the air filter according to manufactory recommendations
YES
Conditioning and heating units should be periodically cleaned and mainteined.
Operate the exhausted fans with maximum outside air flow for two hours before and after
occupied times, or, achieve 3 air changes of outside air in the space.46
Windows should be opened for 15 min or so when entering the room (especially when the
YES room was occupied by others beforehand).47
Exhaust ventilation systems for toilets should be operated 24/7 in similar fashion to the
main ventilation system. It should be switched to the nominal speed at least 2 hours before
the building opening time and may be switched to a lower speed 2 hours after the building
usage time. If it is not possible to control the fan speed, then the toilet ventilation should
operate 24/7 at full speed.48
In consultation with a heating, ventilation and air conditioning (HVAC) professional assess
the opportunity to install air filter according to system capability
NO
If the system does not allow air filter installation, consider to fence the area nearby the
exhausted outlet.
YES Maintain relative humidity between 40% and 60%, where possible.49
Use of splits and fan-coils units is discouraged because difficult to mantain, provide poor
filtration and contribute to turbulence potentially increasing the risk of infection53.
Consider using alternative systems such as radiators.
YES
If alternative conditioning and heating are not available/feasible, create negative pressure
relative to corridor (outside the room) by increasing general or toilet exhaust airflow.
Carefully perform room units cleaning and disinfection54
If alternative conditioning and heating are not available/feasible, consider running the
conditioning and heating units at minimum velocity allow in order to reduce turbulences.
Considering to modify the position of the heating/cooling unit to direct airflow to the less-
clean zone or install an extractor to controll the airflow
 HVAC in indoor public and high density spaces

natural ventilation

areas and requirements steps strategies

+ Asses the opening location and opening surface considering potential new opening (add /
modify windows’ or doors’ dimensions)

+ Realize cross-ventilation, if not yet present, instead of single side ventilation. Keep open
doors to allow air movement.
Does the ventilation rate meet at least the national
single side ventilation
regulations requirements*? if national regulation is not
available consult regional or international regulations. cross ventilation
To assess the ventilation rate consult point 1 underneath NO

+ Increased air motion within a room, such as from a ceiling fan.56 Ceiling fan allowed air
mix and a more uniform age of the air within a room.

increase the ventilation

rate within the facility + Installation of air extractors or whirlybirds;
building works to improve stack effect of
YES other natural ventilation strategies

NOTE: air cleaners do NOT replace ventilation but could increase

dilution!!
+ If other strategies are not available or feasable, consider to use stand-
alone air cleaners (often called air purifiers) with particle filters. It
should be operated continuously. Use high-efficiency media filters (such
as MERV14 or higher).57

Heating and air

Are conditioning and heating units available? YES Conditioning and heating units should be periodically cleaned and mainteined.
conditioning units
manteinance
NO

Has the facility periods of non occupancy? YES Open the windows to allow proper ventilation before and after occupied times.
occupancy and HVAC Windows should be opened for 15 min or so when entering the room (especially when the
room was occupied by others beforehand).58
NO

Has the HVAC systems the possibility to direct control YES Maintain relative humidity between 40% and 60%, where possible.59
temperature and humidity temperature and humidity?

NO

Use of splits and fan-coils units is discouraged because difficult to mantain, provide poor
filtration and contribute to turbulence potentially increasing the risk of infection60.
Consider using alternative systems such as radiators.
Conditioning and heating is performed by non-ducted
(with indoor air recirculation) convectors such as split YES
Heating and air or fan coil units If alternative conditioning and heating are not available/feasible, create negative pressure
conditioning with relative to corridor (outside the room) by increasing general or toilet exhaust airflow.
recirculating units should Carefully perform room units cleaning and disinfection61
be used carefully and after
assessment
If alternative conditioning and heating are not available/feasible, consider running the
conditioning and heating units at minimum velocity allow in order to reduce turbulences.

Considering to modify the position of the heating/cooling unit to direct airflow to the less-
clean zone or install an extractor to controll the airflow

NO

END

1. Minimum ventilation rate. How to check it62?

Ventilation rate [l/s]= k x wind speed [m/s] x smallest opening area [m2]x 1000 [l/m3]

k = 0,05 in case of single side ventilation

k= 0,65 in case of cross ventilation
in case of mosquito net presence = ventilation rate x 0,5

wind speed: https://globalwindatlas.info/

 HVAC in private houses - home care and self quarantine at home
areas and requirements
Ventilation rate minimum
requirements:
• 60 l/s/p or 6 ACH other
Separate HVAC system for
the isolation area67
Air recirculation should be
avoided
Verify heat recovery unit
Air should be exhausted
directly to the outside
away from air-intake vents,
people and animals68
or MERV 13 or higher
HVAC system should
be regularly inspected,
maintained, cleaned and
operated
Heating and air
conditioning with
recirculating units should
be used carefully and after
assessment
1. Minimum ventilation rate. How to assess it?
Each mechanical ventilation system is designed for specific airflow rate. Consult the technical manual to verify the system capacity.
Or use an anemometer close to the air extractor to check the volumetric flow rate. [m3/s]
mechanical ventilation
steps strategies
In consultation with a heating, ventilation and air conditioning (HVAC) professional assess
the opportunity to increase the ventilation rate according to system capabilities.
Does the ventilation rate meet the WHO minimum Disable demand-control ventilation controls that reduce air supply based on temperature
requirements? NO or occupancy.
To assess the ventilation rate consult point 1 underneath
Forced air systems should be run as much as possible, such as by using a “FAN ON” setting63
If the mechanical system does not allow to increase the ventilation rate, consider
YES
integrating with natural ventilation such as window opening which can be used to boost
ventilation further78
+ If there is a forced-air system that would mix the air between the household and the
isolation space, return grills or supply grills should be sealed64
Portable room heaters or room air conditioners
could be used in the isolation space65
The isolation area has a separate HVAC system from the
other rooms
NO +
Even if there is a closable door, plastic sheets, strips or similar
YES
+ material should be hung between the isolation space and the
common space. Seal any grills connecting the isolation space to the
rest of the home24
+ Operate Stand-Alone Air Cleaner in the isolation room could be adopted.66
Increase the percentage of outdoor air, using economizer modes of HVAC operations and
potentially as high as 100%. Before increasing outdoor air percentage, verify compatibility
with HVAC system capabilities for both temperature and humidity control as well as
compatibility with outdoor/indoor air quality considerations.70
Does the HVAC system work with recirculation of indoor In consultation with a heating, ventilation and air conditioning (HVAC) professional assess
air? YES the opportunity to install HEPA filter according to system capability. Increased filter
efficiency generally results in increased pressure drop through the filter. Ensure HVAC
systems can handle filter upgrades without negative impacts to pressure differentials and/
or air flow rates prior to changing filters.69
NO If not other strategy can be adopted, consider to use a stand-alone air cleaners with
MERV13 filters. Pay attention to the airflow direction (from clean to less clean areas) while
positioning . Stand-alone air cleaners should be operated continuously.
Virus particle transmission via heat recovery devices is not an issue when an HVAC system
is equipped with a twin coil unit or another heat recovery device that guarantees 100% air
separation between the return and supply side.74
For properly operating rotary heat exchangers, fitted with purging sectors and correctly
set up, leakage rates are very low, being in the range of 1-2%.75
Is the HVAC system
is designed with heat YES If critical leaks are detected in the heat recovery, in consultation with HVAC professional,
recovery? assess the opportunity to install MERV13 or higher filter according to system capability.
Increased filter efficiency generally results in increased pressure drop through the filter.
Ensure HVAC systems can handle filter upgrades without negative impacts to pressure
differentials and/or air flow rates prior to changing filters.71
NO If critical leaks are detected in the heat recovery sections and the system doesn’t allow
MERV 13 filter installation or the highest compatible with the filter rack, pressure
adjustment72, deactivation or by-pass of the heat-exchanger could be adopted73
In consultation with a heating, ventilation and air conditioning (HVAC) professional assess
the opportunity to install MERV 13 or higher filter according to system capability
Is the exhausted air correctly managed? NO
If the system does not allow MERV 13or higher filter installation, consider to fence the area
YES nearby the exhausted outlet.
HVAC systems should be regularly inspected, maintained, and cleaned according to
Is the HVAC system regularly inspected, maintained, manufactory recommendations. Contact a HVAC professional, manufactory or a specialized
cleaned and operated? including filter cleaning and company to verify that the system comply with manufactory maintenance requirements.
replacement
NO
Clean or replace filter according to manufactory recommendations.
YES Conditioning and heating units should be periodically cleaned and mainteined.
Use of splits and fan-coils units is discouraged because difficult to mantain, provide poor
filtration and contribute to turbulence potentially increasing the risk of infection76.
Consider using alternative systems such as radiators.
Conditioning and heating is performed by non-ducted
(with indoor air recirculation) convectors such as split YES
or fan coil units If alternative conditioning and heating are not available/feasible, create negative pressure
relative to corridor (outside the room) by increasing general or toilet exhaust airflow.
Carefully perform room units cleaning and disinfection77
If alternative conditioning and heating are not available/feasible, consider running the
conditioning and heating units at minimum velocity allow in order to reduce turbulences.
Considering to modify the position of the heating/cooling unit to direct airflow to the less-
clean zone or install an extractor to controll the airflow
NO
END
 HVAC in private houses - home care and self quarantine at home

hybrid ventilation

areas and requirements steps strategies

In consultation with a heating, ventilation and air conditioning (HVAC) professional assess
the opportunity to increase the ventilation rate according to system capabilities.
Does the ventilation rate meet the WHO minimum Disable demand-control ventilation controls that reduce air supply based on temperature
requirements? NO or occupancy.
To assess the ventilation rate consult point 1 underneath
Forced air systems should be run as much as possible, such as by using a “FAN ON” setting80
Ventilation rate minimum
requirements: Exhaust fans in bathrooms, toilets and kitchen should be operated continuously in the
YES isolation area
• 60 l/s/p or 6 ACH other
NOTE: air cleaners do NOT replace ventilation but could increase
dilution!!
If other strategies are not available or feasable, consider to use stand-
alone air cleaners (often called air purifiers) with particle filters. It
should be operated continuously. Use high-efficiency media filters (such
as MERV14 or higher)85

+ Choose a room with air extractors and and the use exhaust fans in the main part of the
home should be minimized and operated only on an as needed basis81

Portable room heaters or room air conditioners

The isolation area has a separate hvac system from the NO could be used in the isolation space84
other rooms +

Separate HVAC system for

the isolation area79
YES + Even if there is a closable door, plastic sheets, strips or similar
material should be hung between the isolation space and the
common space. Seal any grills connecting the isolation space to
the rest of the home83

+ Operate Stand-Alone Air Cleaner in the isolation room could be adopted.82

HVAC systems should be regularly inspected, maintained, and cleaned according to

HVAC system should manufactory recommendations. Contact a HVAC professional, manufactory or a specialized
Is the HVAC system regularly inspected, maintained, company to verify that the system comply with manufactory maintenance requirements.
be regularly inspected,
maintained, cleaned and
cleaned and operated? including filter cleaning and NO
replacement
operated
Clean or replace filter according to manufactory recommendations.
Conditioning and heating units should be periodically cleaned and mainteined.
YES

In consultation with a heating, ventilation and air conditioning (HVAC) professional assess
Air should be exhausted
Is the exhausted air correctly managed? the opportunity to install MERV 13 or higher filter according to system capability
directly to the outside
NO
away from air-intake vents,
people and animals86 If the system does not allow MERV 13or higher filter installation, consider to fence the area
or MERV 13 or higher87 nearby the exhausted outlet.
YES

Use of splits and fan-coils units is discouraged because difficult to mantain, provide poor
filtration and contribute to turbulence potentially increasing the risk of infection88.
Consider using alternative systems such as radiators.
Conditioning and heating is performed by non-ducted
(with indoor air recirculation) convectors such as split YES
Heating and air or fan coil units If alternative conditioning and heating are not available/feasible, create negative pressure
conditioning with relative to corridor (outside the room) by increasing general or toilet exhaust airflow.
recirculating units should Carefully perform room units cleaning and disinfection89
be used carefully and after
assessment
If alternative conditioning and heating are not available/feasible, consider running the
conditioning and heating units at minimum velocity allow in order to reduce turbulences.

Considering to modify the position of the heating/cooling unit to direct airflow to the less-
clean zone or install an extractor to controll the airflow

NO

END

1. Minimum ventilation rate. How to assess it?

Use an anemometer close to the air extractor to check the volumetric flow rate. [m3/s]
 HVAC in private houses - home care and self quarantine at home

natural ventilation

areas and requirements steps strategies

+ Asses the opening location and opening surface considering potential new opening (add /
modify windows’ or doors’ dimensions)
+ Realize cross-ventilation, if not yet present, instead of single side ventilation. Keep open
doors to allow air movement.

single side ventilation

Does the ventilation rate meet the WHO minimum cross ventilation
requirements? NO
To assess the ventilation rate consult point 1 underneath
+ exhaust fans in bathrooms, toilets and kitchen should be operated continuously in the
isolation area
Ventilation rate minimum
requirements: + Window-installable products are available to provide
exhaust ventilation
• 60 l/s/p or 6 ACH other
YES

NOTE: air cleaners do NOT replace ventilation but could increase

+ dilution!!
If other strategies are not available or feasable, consider to use stand-
alone air cleaners (often called air purifiers) with particle filters. It
should be operated continuously. Use high-efficiency media filters
(such as MERV14 or higher).96

+ If available, choose a room with private toilet with air extractor. That fan should run
continuously at high speed 92

Portable room heaters or room air conditioners

NO could be used in the isolation space95
The isolation area has a separate hvac system from the
other rooms +

Separate HVAC system for

the isolation area90
+ Even if there is a closable door, plastic sheets, strips or similar
material should be hung between the isolation space and the
common space. Seal any grills connecting the isolation space to
the rest of the home94
YES

+ Operate Stand-Alone Air Cleaner in the isolation room could be adopted.93

Use of splits and fan-coils units is discouraged because difficult to mantain, provide poor
filtration and contribute to turbulence potentially increasing the risk of infection97.
Consider using alternative systems such as radiators.
Conditioning and heating is performed by non-ducted
(with indoor air recirculation) convectors such as split YES
Heating and air or fan coil units If alternative conditioning and heating are not available/feasible, create negative pressure
conditioning with relative to corridor (outside the room) by increasing general or toilet exhaust airflow.
recirculating units should Carefully perform room units cleaning and disinfection98
be used carefully and after
assessment
If alternative conditioning and heating are not available/feasible, consider running the
conditioning and heating units at minimum velocity allow in order to reduce turbulences.

Considering to modify the position of the heating/cooling unit to direct airflow to the less-
clean zone or install an extractor to controll the airflow

NO

END

1. Minimum ventilation rate. How to check it91?

Ventilation rate [l/s]= k x wind speed [m/s] x smallest opening area [m2]x 1000 [l/m3]

k = 0,05 in case of single side ventilation

k= 0,65 in case of cross ventilation
in case of mosquito net presence = ventilation rate x 0,5

wind speed: https://globalwindatlas.info/

 Notes

1 Atkinson, J., Chartier, Y., Pessoa-silva, C. L., Jensen, P. & Li, Y. Natural Ventilation for Infection Control in Health-Care Settings Edited by : WHO Publ. (2009)
2 Atkinson, J., Chartier, Y., Pessoa-silva, C. L., Jensen, P. & Li, Y. Natural Ventilation for Infection Control in Health-Care Settings Edited by : WHO Publ. (2009)
3 Tuberculosis infection control. Atlanta, GA: Centers for Disease Control and Prevention; 2017
4 ASHRAE, Mechanical Air Filters, https://www.ashrae.org/technical-resources/filtration-disinfection
5 CDC, COVID-19 Employer Information for Office Buildings, https://www.cdc.gov/coronavirus/2019-ncov/community/office-buildings.html
6 ASHRAE, Mechanical Air Filters, https://www.ashrae.org/technical-resources/filtration-disinfection
7 REHVA. Covid19 HVAC Guidance. Eur. Univ. Inst. 2020, 2–5 (2012)
8 AICARR. Protocollo per la riduzione del rischio da diffusione del del SARS-CoV2-19 mediante gli impianti di climatizzazione e ventilazione in ambienti sanitari. 1–4 (2020)
9 ASHRAE. HVAC Design Manual for Hospitals and Clinics Second Edition.
10 ASHRAE, Healthcare guide, https://www.ashrae.org/technical-resources/healthcare
11 ASHRAE, Healthcare guide, https://www.ashrae.org/technical-resources/healthcare
12 Pi, C. H., Chang, Y. S. & Kang, B. H. an Experimental Study on Air Leakage and Performance Characteristics of a Desiccant Rotor. Young (2011).
13 REHVA. Covid19 HVAC Guidance. Eur. Univ. Inst. 2020, 2–5 (2012)
14 REHVA. Covid19 HVAC Guidance. Eur. Univ. Inst. 2020, 2–5 (2012)
15 Atkinson, J., Chartier, Y., Pessoa-silva, C. L., Jensen, P. & Li, Y. Natural Ventilation for Infection Control in Health-Care Settings Edited by : WHO Publ. (2009).
16 Tuberculosis infection control. Atlanta, GA: Centers for Disease Control and Prevention; 2017
17 Atkinson, J., Chartier, Y., Pessoa-silva, C. L., Jensen, P. & Li, Y. Natural Ventilation for Infection Control in Health-Care Settings Edited by : WHO Publ. (2009).
18 ASHRAE. HVAC Design Manual for Hospitals and Clinics Second Edition.
19 ASHRAE, Healthcare guide, https://www.ashrae.org/technical-resources/healthcare
20 ASHRAE, Healthcare guide, https://www.ashrae.org/technical-resources/healthcare
21 REHVA. Covid19 HVAC Guidance. Eur. Univ. Inst. 2020, 2–5 (2012)
22 Kleiven, T. Natural Ventilation in Buildings. PhD Thesis 10 (2003) doi:10.1002/9781119951773.
23 MSF. Environmental measures to prevent TB transmission in resource-limited settings having a high TB-HIV burden. (2011).
24 Atkinson, J., Chartier, Y., Pessoa-silva, C. L., Jensen, P. & Li, Y. Natural Ventilation for Infection Control in Health-Care Settings Edited by : WHO Publ. (2009)
25 Tuberculosis infection control. Atlanta, GA: Centers for Disease Control and Prevention; 2017
26 Atkinson, J., Chartier, Y., Pessoa-silva, C. L., Jensen, P. & Li, Y. Natural Ventilation for Infection Control in Health-Care Settings Edited by : WHO Publ. (2009)
27 ASHRAE. HVAC Design Manual for Hospitals and Clinics Second Edition.
28 ASHRAE, Healthcare guide, https://www.ashrae.org/technical-resources/healthcare
29 ASHRAE, Healthcare guide, https://www.ashrae.org/technical-resources/healthcare
30 ASHRAE, Commercial Building Guide, https://www.ashrae.org/technical-resources/commercial
31 CDC, COVID-19 Employer Information for Office Buildings, https://www.cdc.gov/coronavirus/2019-ncov/community/office-buildings.html
32 ASHRAE, Residential Guide, https://www.ashrae.org/technical-resources/residential
33 REHVA. Covid19 HVAC Guidance. Eur. Univ. Inst. 2020, 2–5 (2012)
34 ASHRAE, Commercial Building Guide, https://www.ashrae.org/technical-resources/commercial
35 REHVA. Covid19 HVAC Guidance. Eur. Univ. Inst. 2020, 2–5 (2012)
36 ASHRAE, Commercial Building Guide, https://www.ashrae.org/technical-resources/commercial
37 ASHRAE, Mechanical Air Filters, https://www.ashrae.org/technical-resources/filtration-disinfection
38 REHVA. Covid19 HVAC Guidance. Eur. Univ. Inst. 2020, 2–5 (2012)
39 AICARR. Protocollo per la riduzione del rischio da diffusione del del SARS-CoV2-19 mediante gli impianti di climatizzazione e ventilazione in ambienti sanitari. 1–4 (2020)
40 Pi, C. H., Chang, Y. S. & Kang, B. H. an Experimental Study on Air Leakage and Performance Characteristics of a Desiccant Rotor. Young (2011).
41 REHVA. Covid19 HVAC Guidance. Eur. Univ. Inst. 2020, 2–5 (2012)
42 Tuberculosis infection control. Atlanta, GA: Centers for Disease Control and Prevention; 2017
43 REHVA. Covid19 HVAC Guidance. Eur. Univ. Inst. 2020, 2–5 (2012)
44 ASHRAE. HVAC Design Manual for Hospitals and Clinics Second Edition.
45 ASHRAE, Healthcare guide, https://www.ashrae.org/technical-resources/healthcare
46 ASHRAE, Commercial Building Guide, https://www.ashrae.org/technical-resources/commercial
47 REHVA. Covid19 HVAC Guidance. Eur. Univ. Inst. 2020, 2–5 (2012)
48 REHVA. Covid19 HVAC Guidance. Eur. Univ. Inst. 2020, 2–5 (2012)
49 ASHRAE, Commercial Building Guide, https://www.ashrae.org/technical-resources/commercial
50 ASHRAE, Residential Guide, https://www.ashrae.org/technical-resources/residential
51 Tuberculosis infection control. Atlanta, GA: Centers for Disease Control and Prevention; 2017
52 REHVA. Covid19 HVAC Guidance. Eur. Univ. Inst. 2020, 2–5 (2012)
53 ASHRAE. HVAC Design Manual for Hospitals and Clinics Second Edition.
54 ASHRAE, Healthcare guide, https://www.ashrae.org/technical-resources/healthcare
55 ASHRAE, Residential Guide, https://www.ashrae.org/technical-resources/residential
56 ASHRAE, Residential Guide, https://www.ashrae.org/technical-resources/residential
57 ASHRAE, Residential Guide, https://www.ashrae.org/technical-resources/residential
58 REHVA. Covid19 HVAC Guidance. Eur. Univ. Inst. 2020, 2–5 (2012)
59 ASHRAE, Commercial Building Guide, https://www.ashrae.org/technical-resources/commercial
60 ASHRAE. HVAC Design Manual for Hospitals and Clinics Second Edition.
61 ASHRAE, Healthcare guide, https://www.ashrae.org/technical-resources/healthcare
62 Kleiven, T. Natural Ventilation in Buildings. PhD Thesis 10 (2003) doi:10.1002/9781119951773.
63 ASHRAE, Residential Guide, https://www.ashrae.org/technical-resources/residential
64 ASHRAE, Residential Guide, https://www.ashrae.org/technical-resources/residential
65 ASHRAE, Residential Guide, https://www.ashrae.org/technical-resources/residential
66 ASHRAE, Residential Guide, https://www.ashrae.org/technical-resources/residential
67 ASHRAE, Residential Guide, https://www.ashrae.org/technical-resources/residential
68 Tuberculosis infection control. Atlanta, GA: Centers for Disease Control and Prevention; 2017
69 ASHRAE, Mechanical Air Filters, https://www.ashrae.org/technical-resources/filtration-disinfection
70 CDC, COVID-19 Employer Information for Office Buildings, https://www.cdc.gov/coronavirus/2019-ncov/community/office-buildings.html
71 ASHRAE, Mechanical Air Filters, https://www.ashrae.org/technical-resources/filtration-disinfection
72 REHVA. Covid19 HVAC Guidance. Eur. Univ. Inst. 2020, 2–5 (2012)
73 AICARR. Protocollo per la riduzione del rischio da diffusione del del SARS-CoV2-19 mediante gli impianti di climatizzazione e ventilazione in ambienti sanitari. 1–4 (2020)
74 Pi, C. H., Chang, Y. S. & Kang, B. H. an Experimental Study on Air Leakage and Performance Characteristics of a Desiccant Rotor. Young (2011).
75 REHVA. Covid19 HVAC Guidance. Eur. Univ. Inst. 2020, 2–5 (2012)
76 ASHRAE. HVAC Design Manual for Hospitals and Clinics Second Edition.
77 ASHRAE, Healthcare guide, https://www.ashrae.org/technical-resources/healthcare
78 REHVA. Covid19 HVAC Guidance. Eur. Univ. Inst. 2020, 2–5 (2012)
79 ASHRAE, Residential Guide, https://www.ashrae.org/technical-resources/residential
80 ASHRAE, Residential Guide, https://www.ashrae.org/technical-resources/residential
81 ASHRAE, Residential Guide, https://www.ashrae.org/technical-resources/residential
82 ASHRAE, Residential Guide, https://www.ashrae.org/technical-resources/residential
83 ASHRAE, Residential Guide, https://www.ashrae.org/technical-resources/residential
84 ASHRAE, Residential Guide, https://www.ashrae.org/technical-resources/residential
85 ASHRAE, Residential Guide, https://www.ashrae.org/technical-resources/residential
86 Tuberculosis infection control. Atlanta, GA: Centers for Disease Control and Prevention; 2017
87 Tuberculosis infection control. Atlanta, GA: Centers for Disease Control and Prevention; 2017
88 ASHRAE. HVAC Design Manual for Hospitals and Clinics Second Edition.
89 ASHRAE, Healthcare guide, https://www.ashrae.org/technical-resources/healthcare
90 ASHRAE, Residential Guide, https://www.ashrae.org/technical-resources/residential
91 Kleiven, T. Natural Ventilation in Buildings. PhD Thesis 10 (2003) doi:10.1002/9781119951773.
92 ASHRAE, Residential Guide, https://www.ashrae.org/technical-resources/residential
93 ASHRAE, Residential Guide, https://www.ashrae.org/technical-resources/residential
94 ASHRAE, Residential Guide, https://www.ashrae.org/technical-resources/residential
95 ASHRAE, Residential Guide, https://www.ashrae.org/technical-resources/residential
96 ASHRAE, Residential Guide, https://www.ashrae.org/technical-resources/residential
97 ASHRAE. HVAC Design Manual for Hospitals and Clinics Second Edition.
98 ASHRAE, Healthcare guide, https://www.ashrae.org/technical-resources/healthcare
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1. World Health Organization (WHO). COVID-19 management in hotels and other entities of the accommodation sector.
https://www.who.int/publications/i/item/operational-considerations-for-covid-19-management-in-the-accommodation-sector-interim-guidance (2020).

2. World Health Organization (WHO). Considerations for school-related public health measures in the context of Annex to Considerations in adjusting
public health and social measures in the context of COVID-19.
https://www.who.int/publications/i/item/considerations-for-school-related-public-health-measures-in-the-context-of-covid-19 (2020).

3. World Health Organization (WHO). Considerations for quarantine of contacts of COVID-19 cases.
https://www.who.int/publications/i/item/considerations-for-quarantine-of-individuals-in-the-context-of-containment-for-coronavirus-disease-(covid-19)
(2020).

4. World Health Organization (WHO). Home care for patients with suspected or confirmed COVID-19 and management of their contacts.
https://www.who.int/publications/i/item/home-care-for-patients-with-suspected-novel-coronavirus-(ncov)-infection-presenting-with-mild-symptoms-
and-management-of-contacts

5. World Health Organization (WHO). Severe Acute Respiratory Infections Treatment Centre.
https://www.who.int/publications-detail/severe-acute-respiratory-infections-treatment-centre (2020).