Carbon dioxide as an indicator of bioaerosol activity and human health in K-12 school systems: a scoping review of current knowledge

Indoor Air Quality (IAQ) in schools has received attention over the past decades but still lacks specific standards and regulations. This study aimed to review the impact of bioaerosol activity in indoor environments on acute respiratory diseases and explore whether carbon dioxide can be used as an indicator of bioaerosol and respiratory diseases in indoor environments in K-12 school systems. Findings suggest a lack of a consensual approach to evaluate bioaerosols impacting IAQ in indoor infrastructures, particularly in school environments; an elevated CO2 concentration inside the school classrooms was not uncommon, and the evidence of unsatisfactory and degraded IAQ (surpassing ASHRAE standards) at public schools in rural and urban settings in one of the North Central County, Florida. It was found that CO2 levels can be associated with bioaerosol activity, and sufficient ventilation within the space substantially reduces the airborne time of respiratory droplets and CO2 levels. CO2 monitoring can act as an effective, low-cost alternative to surveying or detecting the prevalence of respiratory diseases, which may hold strength through establishing critical CO2 thresholds and, thereafter associating it with the infectious doses of pathogen activity.