Background: A cough is known to transmit an aerosol cloud up to 2 m. During the COVID-19 pandemic of 2020 the United Kingdom’s National Health Service (NHS), other UK government agencies and the World Health Organization (WHO) advised people to cough into their elbows. It was thought that this would reduce viral spread and protect the public. However, there is limited peer reviewed evidence to support this. Objectives: To determine if cough related interventions reduce environmental contamination, protecting members of the public from infection. Methods: Scientists and engineers at the Health and Safety Executive (HSE) laboratory used a human cough simulator that provided a standardised cough challenge using a solution of simulated saliva and a SARS-CoV-2 surrogate virus; Phi6. Pseudomonas syringae settle plates were used to detect viable Phi6 virus following a simulated cough into a 4 × 4 m test chamber. The unimpeded pattern of contamination was compared to that when a hand or elbow was placed over the mouth during the cough. High speed back-lit video was also taken to visualise the aerosol dispersion. Results and Discussion: Viable virus spread up to 2 m from the origin of the cough outwards in a cloud. Recommended interventions, such as putting a hand or elbow in front of the mouth changed the pattern of cough aerosol dispersion. A hand deflected the cough to the side, protecting those in front from exposure, however it did not prevent environmental contamination. It also allowed for viral transfer from the hand to surfaces such as door handles. A balled fist in front of the mouth did not deflect the cough. Putting an elbow in front of the mouth deflected the aerosol cloud to above and below the elbow, but would not have protected any individuals standing in front. However, if the person coughed into a sleeved elbow more of the aerosol seemed to be absorbed. Coughing into a bare elbow still allowed for transfer to the environment if people touched the inside of their elbow soon after coughing. Conclusions: Interventions can change the environmental contamination pattern resulting from a human cough but may not reduce it greatly.

It is anticipated that by 2028 there will be a significant increase in the use of HWHP systems in Great Britain (GB). Such systems are considered a better, energy-efficient alternative to fossil fuel-based burners and furnaces, as they use electricity. There are concerns that these systems are susceptible to microbial contamination because they hold water at lower temperatures. In particular, the concern is regarding Legionella contamination, as it can potentially cause disease in the general public and those who are maintaining and replacing these systems. Therefore, this review was focused on understanding the potential risk posed by their increased use and maintenance requirements. This review was approached systematically but was not a full systematic review. There were 61 papers that were considered potentially relevant to the research questions. Of these, 40 papers were considered relevant to the topic of Legionella in HWHP and underwent full article assessment and data extraction. The remaining papers were considered useful for background information. The scope of this review established that Legionella are a known risk in hot water systems that can be carried over to HWHP systems, yet there is minimal evidence to suggest that the current control measures are being appropriately applied to reduce the risk of exposure. When considering countrywide legislation and guidance, it appears that the risk is considered lower in single- or multi-family homes that do not require a centralised system. This review included the assessment of information regarding the safety of working with HWHP systems with regards to maintenance and replacement. The authors found a lack of information regarding these safety concerns. This review is among the first to systematically evaluate the risks of Legionella contamination in HWHP systems.

Fungal bioaerosols, including spores and fragments, are significant components of urban air and are associated with infectious and allergic disease. Despite their importance, fungal bioaerosols are less well studied compared to bacteria and viruses. Mass transit environments, such as railway stations, represent a potential source of occupational and community exposure to fungal bioaerosols. While some studies have analysed the fungal composition of subway systems, there is limited information on overground stations. Here we combined metabarcoding of the ITS2 region with ecological guild assignment to analyse a subset of 259 settled dust samples collected from 9 stations across England over a 12-month period. These samples were part of a larger set of 1287 samples collected from 17 English and Scottish overground railway stations that had been previously analysed with traditional culture methods. Our approach enabled the identification of a wider range of fungal taxa than the original study, demonstrating that the urban mycobiome of the railway stations was a dynamic balance of taxa from both environmental and human sources covering diverse functional guilds. Station location, layout and season independently contributed to urban fungal richness, diversity, and composition. Functional guild analysis enabled identification of possible fungal sources and highlighted those of potential concern for workers and commuters. Future research should focus on better understanding source apportionment, the biological mechanisms linking fungal exposures to adverse health outcomes and, developing and evaluating targeted interventions to improve air quality within railway stations and other urban public spaces to minimise associated health risks.