The DOI matches its Crossref record; 7 of the 10 references it cites were found in a registry or an index.
Indoor Air Changes and Potential Implications for SARS-CoV-2 Transmission
Abstract
This JAMA Insights review summarizes basic measures of indoor air ventilation as a means to explain how increases in frequency of air exchange and filtration capture efficiency could mitigate far-field airborne transmission of SARS-CoV-2 inside rooms and buildings.
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“To reduce indoor airborne transmission, it is necessary to perform control measures through source (masking and physical distancing) and engineering controls (ventilation and filtration) [3].”
From Bacteria Filtration Efficiency for Different Types of Protective Face Masks (2023) · cites this paper as [3]
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Ventilation rates and health: Multidisciplinary review of the scientific literature
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The ventilation problem in schools: literature review
Fisk, W. J. (2017) · Indoor Air · doi:10.1111/ina.12403 · Cited by 338
Persily, A. (2015) · Building and Environment · doi:10.1016/j.buildenv.2015.02.026 · Cited by 249
Role of mechanical ventilation in the airborne transmission of infectious agents in buildings
Luongo, J., Fennelly, K., Keen, J., Zhai, Z., Jones, B. W., & Miller, S. (2015) · Indoor Air: International Journal of Indoor Environment and Health · doi:10.1111/ina.12267 · Cited by 134
Preventing the Spread of SARS-CoV-2 With Masks and Other “Low-tech” Interventions
Lerner, A. M., Folkers, G. K., & Fauci, A. S. (2020) · JAMA · doi:10.1001/jama.2020.21946 · Cited by 70
Allen, J. G., & Macomber, J. D. (2020) · Harvard University Press eBooks · doi:10.4159/9780674246102 · Cited by 57
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“Allen and Ibrahim 22 emphasized the importance of increasing outdoor air ventilation and enhancing fi ltration to limit airborne transmission of SARS-CoV-2.”
BackgroundShin, H. H., Kabasakal, M., Owen, J. G., Delic, A. O., Kunarac, K., & Buteau, S. (2025) · Chemosphere · doi:10.1016/j.chemosphere.2025.144796 · Cited by 3
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Is line-source modeling suitable for ultraviolet light application in an air cleaner duct?
Li, P., Koziel, J. A., Yedilbayev, B., Paris, R. V., Walz, W. B., & Ramirez, B. C. (2024) · Frontiers in Built Environment · doi:10.3389/fbuil.2024.1325267 · Cited by 3
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“Research has indicated that minimum targets of “good” or “excellent” air exchange rates of 4–6 ACH (Allen et al. 2020) in small rooms, even with just outdoor air ventilation, can be effective in reducing the spread of SARS CoV-2 (Allen and Ibrahim 2021).”
BackgroundAggarwal, J., Shendell, D. G., Nguyen, K. T., Rehman, M., & Campbell, M. L. F. (2024) · International Journal of Environmental Health Research · doi:10.1080/09603123.2024.2378097 · Cited by 3
“…improved IAQ, which can impact both the attendance and academic performance of students in schools (Seppänen and Fisk 2004; Shendell et al. 2004, 2004b; Shaughnessy et al. 2006; Wargocki and Wyon 2013; Allen and Ibrahim 2021; Ahmed et al. 2022; United States Environmental Protection Agency 2023).”
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HPV Positive Oropharyngeal Cancer in Two Gynaecologists Exposed to Electrosurgical Smoke Plume
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Permana, I., Wang, F., Rakhsit, D., & Huang, J. (2022) · Buildings · doi:10.3390/buildings12111849 · Cited by 3
“Ventilation rates were established for both odor management in the lab air space as well as for effective protection of airborne contamination [11].”
BackgroundSARS-CoV-2 Reduction in Shared Indoor Air—Reply
Dowell, D., Lindsley, W. G., & Brooks, J. T. (2022) · JAMA · doi:10.1001/jama.2022.18031 · Cited by 3
Venkat, H., Yaglom, H. D., Hecht, G., Goedderz, A., Ely, J. L., Sprenkle, M., Martins, T., Jasso‐Selles, D. E., Lemmer, D., Gesimondo, J., et al. (2024) · Pathogens · doi:10.3390/pathogens13060466 · Cited by 3
“Indoor air space is one factor that has been studied to determine risk for the infection and spread of SARS-CoV-2; these more nuanced environmental factors were not practical for us to fully explore in this study [29,30].”
BackgroundPreventing indoor contamination in private physiotherapy practices
Polastri, M., & Pehlivan, E. (2021) · International Journal of Therapy and Rehabilitation · doi:10.12968/ijtr.2021.0118 · Cited by 3
Alfowzan, N., Valipoor, S., & Portillo, M. (2024) · Journal of Interior Design · doi:10.1177/10717641241241293 · Cited by 2
“The importance of controlling airflow, especially in public and shared spaces, emerged as a critical theme for curbing aerosol transmission (Afshari et al., 2021; Agarwal et al., 2021; Allen & Ibrahim, 2021; Dancer et al., 2021; Fadaei, 2021; Zheng et al., 2021).”
Koiso, S., Gulbas, E., Dike, L., Mulroy, N. M., Ciaranello, A. L., Freedberg, K. A., Jalali, M. S., Walker, A. T., Ryan, E. T., LaRocque, R. C., et al. (2024) · Travel Medicine and Infectious Disease · doi:10.1016/j.tmaid.2024.102730 · Cited by 2
Kaple, C. E., Memic, S., Cadnum, J. L., Eckstein, E. C., Klonowski, B., Wilson, B. M., Hwang, M., Jinadatha, C., & Donskey, C. J. (2024) · American Journal of Infection Control · doi:10.1016/j.ajic.2024.07.001 · Cited by 2
Moltedo-Medina, J., Trebilcock, M., Rubio-Bellido, C., & Pérez-Fargallo, A. (2026) · Buildings · doi:10.3390/buildings16101943 · Cited by 2
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“As such, air filtration specialists and public health experts have dedicated themselves to reforming air filtration to stop the spread of COVID-19, the common cold, and influenza viruses [1, 2].”
Sachse, S., Kraiselburd, I., Anastasiou, O. E., Elsner, C., Goretzki, S. C., Goer, S., Koldehoff, M., Thomas, A. S., Schoth, J., Voigt, S., et al. (2025) · Viruses · doi:10.3390/v17040477 · Cited by 2
Ruangsuwan, T., Phanprasit, W., Yoosook, W., Boonyayothin, V., Konthonbut, P., Cherrie, J. W., & Nankongnab, N. (2025) · Buildings · doi:10.3390/buildings15081313 · Cited by 2
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“In the COVID-19 procedure, the use of natu-ral or mechanical ventilation or portable air cleaners with an ACH of 6 and above reduces the risk of transmission (Allen and Ibrahim 2021; Minguillon et al. 2020).”
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“, ethnicity) [11] and the application of mitigations measures such as mask use (by teachers and/or pupils) [12], ventilation [13] and vaccination coverage [14].”
BackgroundShoemaker, R., McMahon, S., Heyman, A., Lark, D., der Westhuizen, M. V., & Ryan, J. (2021) · Medical Research Archives · doi:10.18103/mra.v9i7.2493 · Cited by 2
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“…screening, isolation of infected people, tracking and quarantin-ing of contacts, frequent disinfection of the workplace (especially excessive-contact surfaces), hand hygiene, environmental monitoring and proper use of PPE – are backed by scientific evidence 40 and WHO 39 and ILO 41 recommendations.”
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Putra, W. E., Sustiprijatno, Pratikno, H., Hidayah, N. B., Widiastuti, D., Lovely, F. C., & Aziizah, A. (2022) · Routledge eBooks · doi:10.1201/9781003324492-9 · Cited by 2
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Zomuanpuii, R., Lalrohlua, P. C., Lalbiakmawia, B., Chawngthu, Z., Hmar, L., Roy, S., Laldinmawii, G., Zohmingthanga, J., Kumar, N. S., Zothanzama, J., et al. (2023) · Environmental Sustainability · doi:10.1007/s42398-023-00292-7 · Cited by 2
Park, D. H., Park, S. J., Hwang, J., Kim, Y., Lee, G., Park, I., Lee, Y., Kim, Y., Kim, H., Kim, S. B., et al. (2024) · IEEE Transactions on Industry Applications · doi:10.1109/tia.2024.3379955 · Cited by 2
“…have garnered significant attention among air pollutants due to their capacity to spread diseases through aerosol transmission, as exemplified by the global outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), which recently led to the COVID-19 pandemic [5], [6], [7], [8].”
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Zhu, A., Bahnfleth, W. P., Bruns, R., Buonanno, G., Fisman, D. N., Gregory, C. O., Haas, C. N., Jones, B., Kumagai, K., Lagoudas, G., et al. (2026) · Health Security · doi:10.1177/23265094261418814 · Cited by 2
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Loraas, D. M. (2024) · HERD Health Environments Research & Design Journal · doi:10.1177/19375867241248598 · Cited by 1
“The COVID-19 pandemic has renewed focus on airborne hazards and ventilation, underscoring IAQ’s links to psychosocial health (Allen & Ibrahim, 2021).”
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Ahmed, F., Ramana, A. S., Durai, C. C. S., & Dhamodharan, P. (2024) · International Journal of Environmental Science and Technology · doi:10.1007/s13762-024-05715-4 · Cited by 1
“To minimize the air-borne transmission of pathogens in small-volume indoor spaces the researchers have recommended 4–6 air changes per hour (Allen and Ibrahim 2021).”
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“On the other hand, a low-tech but potentially powerful method of mitigation would be to simply increase ventilation rates [144] (however cf [145] for cases where increased ventilation led to increased infection exposure) and/or trigger decontamination/cleaning procedures [146].”
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Williams, V. R., Tan, C., Kozak, R. A., & Leis, J. A. (2023) · Infection Control and Hospital Epidemiology · doi:10.1017/ice.2023.29 · Cited by 1
“Strategies for responding to the increased risk of HA – COVID-19 in the post-omicron era include uptake of omicron-adapted COVID-19 vaccine boosters for patients and HCWs, 6 optimizing ventilation in inpatient areas, 7 and inpatient SARS-CoV-2 testing protocols.”
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“It also implies informing and educating about the importance of adequate ventilation and how we can evaluate and achieve it (Allen and Ibrahim, 2021).”
BackgroundA simple method for SARS-CoV-2 RNA detection in the air of an enclosed space
Capeyron, O., Squinazi, F., Dumoulin, P., Destras, G., Dorin, J., Dalmasso, M., Nicot, N., Liguori, S., & Blanc, V. (2021) · Journal of Hospital Infection · doi:10.1016/j.jhin.2021.09.003 · Cited by 1
“Airborne transmission is difficult to demonstrate, but is often suggested [3,4].”
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“For modelling, a closed space is set at 1 emitting person per 20m The survey by [51] indicates the importance of ventilation for infection prevention also for SARS-CoV-2 but lacks mass balancing for inflows, decay, and ventilation.”
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Whyte, H. E., Montigaud, Y., Audoux, E., Verhoeven, P. O., Prier, A., Leclerc, L., Sarry, G., Laurent, C., Coq, L. L., Joubert, A., et al. (2021) · Research Square · doi:10.21203/rs.3.rs-882698/v1
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Parisi, G., Renault, V., Humblet, M., Ochelen, N., Diep, A. N., Guillaume, M., Donneau, A., Bureau, F., Gillet, L., Lange, A.-C., et al. (2022) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph191811523
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BackgroundShirreff, G., Huynh, B.-T., Duval, A., Pereira, L. C., Annane, D., Dinh, A., Lambotte, O., Bulifon, S., Guichardon, M., Beaune, S., et al. (2022) · medRxiv · doi:10.1101/2022.09.13.22279837
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“Allen and Ibrahim [13] explains how ventilation is essential in limiting the spread of COVID-19 and that part of the current issue is how previously most buildings were not designed for infection control.”
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Çetin, H. M. (2023) · Gazi Üniversitesi Mühendislik-Mimarlık Fakültesi Dergisi · doi:10.17341/gazimmfd.1252002
“Allen ve Ibrahim [12], COVID-19 sürecinde sınıflarda 4-6 ACH (air change hour, saatte hava değişim oranı) havalandırma oranlarının hedeflenmesi gerektiğini söylemektedir.”
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Albertini, R., Colucci, M. E., Viani, I., Capobianco, E., Serpentino, M., Coluccia, A., Ibrahim, M. M. M., Zoni, R., Affanni, P., Veronesi, L., et al. (2024) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph21091200
“…treatment, ozone treatment, plasma treatment, or a combination of some of the different methods Ventilation and air disinfection were a valuable prevention tool during the SARS-CoV-2 pandemic, and portable air purification devices have also been used [48–52] in different kinds of environments.”
BackgroundMethodLi, V. O. K., Lam, J. C. K., Sun, Y., Han, Y., Chan, K., Wang, S., Crowcroft, J., Downey, J., & Zhang, Q. (2024) · Risk Analysis · doi:10.1111/risa.17673 · Cited by 1
“At the environmental level, ventilation plays a critical role in airborne SARS-CoV-2 transmission (Allen & Ibrahim, 2021; Blocken et al., 2021; Buonanno et al., 2020; Guo et al., 2021; Moritz et al., 2021) by directing, dispersing, and diluting expelled infectious droplets/aerosols (Morawska et…”
THE EFFECT OF FAN COIL UNIT LAYOUT ON AIR QUALITY AND THERMAL COMFORT IN CLASSROOM
Tkachenko, S. A., Liu, H., Menictas, C., Swan, P., & Timchenko, V. (2024) · International Symposium on Advances in Computational Heat Transfer (CHT) · doi:10.1615/ichmt.2024.cht-24.410
A life course approach to health in the age of pandemics
Kuh, D. J., Blodgett, J. M., Lipkin, W. I., & Susser, E. (2025) · Oxford University Press eBooks · doi:10.1093/oso/9780198895961.003.0002
Kowalski, W. J., Luo, H., & Brais, N. (2025) · SSRN Electronic Journal · doi:10.2139/ssrn.5251484
Air Handling Unit with Electrostatic Precipitator via Antimicrobial Aerosol Coating Method
Park, D. H., Kim, J. R., Hwang, J., Kim, Y., Lee, G., Park, I., Kim, S.-B., & Han, B. (2024) · IEEE Industry Applications Society Annual Meeting (IAS) · doi:10.1109/ias55788.2024.11023742
“A prime illustration is the global outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), responsible for the recent COVID-19 pandemic, notably in indoor environments [2].”
COVID-19 as an Occupational Disease
Fulekar, M. H., Patel, G. M., & Rai, A. (2025) · Springer eBooks · doi:10.1007/978-3-031-94270-9_8
Study on the building energy analysis with the Phase changing Material
Christy, C. F., Lokesh, K., & Reddy, A. V. M. (2025) · Journal of Physics Conference Series · doi:10.1088/1742-6596/3047/1/012006
“The pace of air exchange with open doors and windows takes 15 minutes with 4 changes per hour, (Joseph Allen et al, 2021).”
How safe are Ontario’s shelters and other shared living settings from airborne COVID-19?
James, L., O'Campo, P. J., & Siegel, J. A. (2021) · doi:10.64628/aam.p9maman6w
Tactical Technical Communication as Expert Communication: Strategic Ethos in Corsi-Rosenthal Boxes
Brooks, S. S., & Doan, S. C. (2025) · Technical Communication Quarterly · doi:10.1080/10572252.2025.2554610
Ijaz, M. K., Sattar, S. A., Boone, S. A., Nims, R. W., McKinney, J., & Gerba, C. P. (2025) · Antimicrobial Stewardship & Healthcare Epidemiology · doi:10.1017/ash.2025.10147
“This may be accomplished through use of air-sanitization technologies, or by increasing the room ventilation by opening of windows and/or increasing the rate of air exchange 26 through heating and air ventilation system upgrades.”
Nepali, K., Sharma, R., Sharma, S., Thakur, A., & Liou, J.-P. (2022) · Figshare · doi:10.6084/m9.figshare.20962344
Herbal formula volatile oil inhibit SARS-CoV-2 viral entry and replication in vitro
Zhang, H., Guo, W., Shen, J., Song, X., & Zhang, B. (2025) · Journal of Food Bioactives · doi:10.26599/jfb.2025.95031422
The role of ultraviolet light in air cleaning: A mini review on microbial and pollution control
Yedilbayev, B., Amirtayeva, S., Ismailov, Z., Akimbaeva, Z., & Shokanova, A. (2026) · E3S Web of Conferences · doi:10.1051/e3sconf/202668804001
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Chung, Y. T., Kuan, K. L., Ip, D. Y. K., Ip, W. H. M., Ko, K., & Lau, A. K. H. (2026) · SSRN Electronic Journal · doi:10.2139/ssrn.6478239
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Epilogue: Living with the Invisible—A Manual for the Post-pandemic Built Environment
Singh, R., Madaan, N., & Dewan, A. (2026) · Springer eBooks · doi:10.1007/978-981-95-8624-0_8
Paydar, A., Maharjan, S., Wang, A. J., Mellon, E., Gates, J., Hlavinka, B., Taylor, A. J., Curran, M., Gutierrez, J., Pham, L., et al. (2026) · ACS ES&T Engineering · doi:10.1021/acsestengg.6c00372
Grossbard, S., Elad, D., Bodek, M., Neuman, E., Marom, G., & Ringel, G. (2026) · SSRN Electronic Journal · doi:10.2139/ssrn.6593959
Metadata
- Authors
- Allen, J. G., & Ibrahim, A. M.
- Affiliations
- Harvard University (US)
- University of Michigan (US)
- Corresponding author
- Allen, Joseph G.
- Venue
- JAMA
- Publisher
- American Medical Association (AMA)
- Published
- 2021-05-25
- Volume
- 325
- Issue
- 20
- Pages
- 2112
- ISSN
- 0002-9955 (ISSN-L)
- 0098-7484
- OpenAlex
- W3155295303
- Cited by
- 208
- References
- 10
- Citations by year
- 2026: 16 · 2025: 19 · 2024: 38 · 2023: 41 · 2022: 48 · 2021: 46
- FWCI
- 28.31
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- JAMA (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Infection Control and Ventilation
- Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Indoor Air Quality and Microbial Exposure
- Physical Sciences › Environmental Science › Global and Planetary Change › COVID-19 impact on air quality
- Keywords
- indoor ventilation, SARS-CoV-2 transmission, airborne transmission, air exchange rate, air filtration efficiency, indoor air quality, COVID-19 pandemic, building ventilation
- MeSH terms
- COVID-19, SARS-CoV-2, Aerosols, Air Microbiology, Filtration, Housing, Humans, Schools, Time Factors, Ventilation, Air Pollution, Indoor, Air Filters
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