# Lentis/Sick Building Syndrome

Sick building syndrome (SBS) is a condition where occupants of a building experience acute health problems and discomfort that seems to be linked directly to time spent in a building. A building is considered sick when 20% or more of its occupants complain of illnesses that are linked to time spent in that building. This term was coined in 1984 by a Yale biophysicist in a Swedish medical publication. Symptoms can range from headaches and cold-like symptoms to respiration problems. SBS differs from other building related illnesses because of the difficulty to pinpoint its specific causes. However, it is most likely due to poor indoor air quality. There is controversy over whether SBS should be considered a real illness or a socio-psychological condition. Green buildings and improved building health standards are possible solutions to sick building syndrome.

## History
#### 1973 Oil Crisis

During the 1973 oil crisis, the need for energy conservation led to a reduction in the amount of outdoor air provided for ventilation. All office buildings had to reduce their indoor ventilation to 5 cfm/person. In addition, carpets and ceilings were redone, walls plastered, and new filtration systems and heating systems installed. However, ASHRAE later found that these reduced ventilation rates were not adequate to maintain the comfort of the building’s occupants and contributed to the effects of SBS. ASHRAE has since increased the standards to 15 cfm/person for normal indoor settings and to 20 cfm/person for office buildings.

#### Sick Building Syndrome in the Media

Sick building syndrome was recognized by the mass media in the 1980s. In 1987, a New York Times article devoted a third of a page to SBS, presenting it as a real problem facing the general public. It identified the dangers of indoor pollutants, including radon, asbestos, and pesticides, and cited poor indoor air quality as a cause of SBS. It emphasized that SBS can affect the workplace and homes of New York Times readers. According to the article, the negative effects of SBS can range widely from discomfort to cancer.
Early articles like this set the stage for sick building syndrome to be recognized as a concern. Studies were conducted to test buildings and air quality, and a few standards standards started to change; however, SBS did not blow up in the media until the case study of SBS at the EPA. More articles started to mimic the New York Times article, however some posed it as a psychological or social problem rather than a physical one.

#### Role of Tobacco Companies

Tobacco companies played an interesting role in SBS research. Companies such as Philip Morris USA, the U.S. tobacco division of Altria Group, invested in SBS and indoor air quality studies in hopes to find a “ventilation solution” so people could smoke indoors. The companies hoped that this would diminish concern over indoor tobacco use as a possible cause of SBS. If they could create and implement a filtration system as a "ventilation solution", they could advertise safe indoor smoking areas. Philip Morris created a system to improve indoor air quality, but it did not meet appropriate standards.

## Sick Building Syndrome at the EPA

An influential case of sick building syndrome occurred at the EPA's Waterside Mall headquarters in southwest D.C. The Waterside Mall offices were the site of the EPA headquarters from 1971 to 1997. Originally built as an apartment complex in 1970, the building was converted to EPA offices in 1971. The office possessed many qualities of a sick building including poor ventilation, inadequate lighting, and ineffective filtration. The converted apartments resulted in tiny, cramped offices without windows and adequate air circulation. The windows that did exist were sealed shut to increase energy efficiency. The HVAC system could not exchange enough air for the occupants to work comfortably. Clogged ventilation grills left a black powder on surfaces, and mice and roaches were a common problem. In 1987, the building owners began renovations, including installation of a new carpet, in an attempt to improve working conditions.
Almost immediately, the building occupants reported sick building syndrome symptoms such as irritated eyes and throats, headaches, shortness of breath, burning lungs, and dizziness. In response, facilities management performed an air quality test of the building which identified 68 airborne chemicals. However, none were present in elevated concentrations. Despite those results, some employees wore gas masks to avoid chemical exposure. EPA scientist Lance Wallace conducted an additional study in 1989 which again identified no acute doses of specific chemicals. However, by 1989 over 40% of employees were suffering from sick building syndrome. Eventually, physicians advised over 50% of employees avoid the building due to their illnesses. By 1990 the EPA headquarters was known as one of the sickest buildings in the country.
In response to the conditions, EPA employees sued S.E.W. Investors, the building owners, for permanent damage caused by the building. “The most affected employees have had their careers, social life, health and for some, the ability to support themselves, destroyed by this incident”, wrote Environmental and Health News Editor Joanne Bahura, one of the 19 plaintiffs. The jury awarded the plaintiffs $948,000, the largest indoor pollution award of the time. However, in 1995 the DC Superior Court overturned the decision and ruled that building owners could not be held responsible for “psychogenetic illnesses”. No matter the validity of the case, the irony of sick building syndrome occurring at the EPA headquarters drew national attention, and instances of “sick building syndrome” in literature peaked in 1995. This case increased environmental anxiety among office workers, as office buildings and carpets were previously thought to be safe and free from chemical exposures. Sick building syndrome was one of the first instances of chemical exposures that could not be avoided due to privilege.

## Controversy

There is considerable debate as to whether or not sick building syndrome should be considered a medical condition. This is because symptoms cannot be traced to a specific origin and because SBS lacks falsifiability. There are known factors that can reduce the indoor air quality and cause symptoms associated with SBS, but they are not always present during investigations into SBS. When this is the case, investigators cite psychological causes instead of physical ones or say there is no cause at all. No matter the validity of the condition, it is important for engineers to understand and analyze it based off of the Thomas Theorem.

#### Psychological Aspects

Symptoms of sick building syndrome have been shown to increase along with factors such as job stress, time spent in front of a computer screen, and decreased job status. In fact, in every study in which work stress has been considered as a factor, it was clearly correlated with SBS symptoms.

#### Gender Roles

Between 1970 and 1980, more middle class women entered office work environments than ever before. Their jobs mostly involved menial office tasks, clerical labor, and some machine work and understanding. As new systems were put into place to make the buildings airtight in the 1970s, the complaints of continued sickness and new discomforts and illnesses were being reported mostly by women. Even though this could be linked to women making up more of the office space, the more common reaction was to write this off as a case of mass hysteria. Doctors were initially instructed to attribute symptoms of SBS in women to “mass hysteria triggered by stress and the female coping style or menstrual irregularities”. However, over time, more and more men reported symptoms, causing doctors and other health experts to pay more attention to these health complaints.

## Participants
#### Building Occupants

All employees in a sick building are affected by sick building syndrome. SBS lowers productivity and increases absenteeism, which increases the workload of those who are not affected. For those suffering from SBS, there is no known cure besides avoiding the affected building. Many times, it is difficult to diagnose SBS, especially if no physical cause can be identified. Many building occupants are told that their symptoms are not real, which could prolong their recovery if the diagnosis is incorrect. This also leads to some occupants feeling as if they have no choice but to suffer. One such person “didn’t try to find any help any more” and felt “in a way, life was over.” Conversely, people suffering from SBS have been told that they have “an innate immune system problem, an inflammation problem, an autoimmune disorder, a blood–brain barrier issue, an oxidative stress problem”. Most are recommended vitamins and supplements, which do not improve symptoms in the majority of cases. Even when patients are diagnosed with sick building syndrome, the main suggestion is to stay away from anything that could trigger further symptoms. This would not be easy for everyone, especially if the problem is at home or work, and is not a cure but merely avoidance.

#### Building Owners

Building owners are potentially liable for the adverse health effects caused by their buildings. Although the ruling in the EPA case was overturned, owners still fear lawsuits concerning SBS from their building occupants. Personal injury lawyers have become increasingly common in sick building syndrome cases, some even listing sick building syndrome as a specialty.

#### Occupational Health Experts

Facilities management employees and occupational health experts play a key role in determining presence of airborne chemicals in a building. The Health and Safety Resource Center at Canada’s University of Western Ontario has devised a routine five-point survey for occupational hygienists to follow. This includes a walk through inspection to look for sources of contamination; measurement of temperature, humidity, air movement and other comfort parameters; measurement of carbon dioxide to assess ventilation efficiency; measurement of formaldehyde, carbon monoxide, ozone, and respirable particles; and an examination of the ventilation system to test for biological organisms.

#### USGBC

The U.S. Green Building Council aims to reshape buildings and communities at every step of the building process to enable “an environmentally and socially responsible, healthy, and prosperous environment that improves the quality of life.” It is in charge of the LEED program which provides certifications and incentives for creating and maintaining green buildings and communities.

#### ASHRAE

The American Society of Heating, Refrigerating and Air-Conditioning Engineers improves the health and sustainability of the environment through “advancing the arts and sciences of heating, ventilation, air conditioning, refrigeration and their allied fields.” It has created a 5-year strategic plan to organize and visualize a way to its goals as well as increase the reach and influence of the organization.

## Symptoms

Symptoms include headache, dizziness, nausea, eye, nose, or throat irritation, dry cough, dry or itching skin, difficulty in concentration, fatigue, sensitivity to odors, allergies, cold, flu-like symptoms, and increased incidence of asthma attacks. These symptoms reduce work efficiency and increase absenteeism, so all workers are affected. Most sufferers report relief soon after leaving the building. The cause of these symptoms is undefined and they can vary from case to case.

## Causes

The US National Institute for Occupational Safety and Health cites poor indoor air quality due to chemical contaminants, biological contaminants, and inadequate ventilation as the main contributor to sick building syndrome. Other causes may include inadequate natural lighting, bad acoustics, and poor ergonomics.

#### Inadequate Ventilation

Inadequate ventilation rates increases the likelyhood of SBS.. Inadequate ventilation can be attributed to: lack of compliance with applicable codes and standards, such as those published by ASHRAE; installation or maintenance problems; and not accounting for ventilation during remodeling or space use changes. SBS is more common in air conditioned buildings than in naturally ventilated buildings.

#### Biological Contaminants

Biological contaminants include pollen, bacteria, viruses, and mold, and can cause fever, chills, cough, chest tightness, muscle aches, and allergic reactions. Bacteria, molds, and viruses can breed in stagnant water that accumulates in ducts, humidifiers, carpeting, insulation or other areas. These contaminants are often the result of poor building maintenance.

#### Indoor Contaminant Sources

Indoor air pollution can come from sources such as adhesives, carpeting, upholstery, copy machines and cleaning products. These sources emit volatile organic compounds (VOCs) which can produce acute reactions in people even at low or moderate levels. Before it was outlawed, smoking indoors was the most severe cause of indoor air pollution in public buildings.

#### Outdoor Contaminant Sources

Outdoor air pollutants such as vehicle exhaust, combustion byproducts, or tobacco smoke enter buildings through air intake vents, windows or other openings. These pollutants then become a form of indoor air pollution and can exacerbate SBS symptoms.

#### Ineffective Filtration

Filtration and air cleaning are the best means of controlling many indoor air pollutants, particularly those beginning as outdoor contaminants. Inadequate levels of particle filtration and poor filter maintenance can result in dirt and allergen accumulation in ventilation systems. This can lead to biological growth and serious indoor air quality problems.

## Solutions

The US Environmental Protection Agency (EPA) has issued information about indoor air in federal facilities. They provide tips for a healthy indoor environment, saying a building occupant’s surroundings should “contribute to productivity, comfort, and a sense of well-being”. They have also created a list (Building Air Quality Action Plan) of preventative measures that can be taken in order to prevent building occupants from experiencing sick building syndrome symptoms. This list emphasizes communication between building occupants, managers and owners. It encourages involvement in making buildings healthy and safe environments.

#### Prevention

It is better to focus on prevention instead of treatment and there are things that each participant group can do to make sure that sick building syndrome does not occur.
Building Occupants:
* Create air flow.
* Limit tobacco usage.
* Install potted plants.
Building Owners:
* Maintain building ventilation rates at or above the minimum rates specified in current applicable codes and professional standards.
* Utilize local exhaust ventilation at localized sources of indoor air pollutants and moisture generation.
* Increase ventilation rates during, and for a period after painting, cleaning, waxing floors, or similar pollutant generating activities.
* Locate the outdoor air intakes of mechanical ventilation systems away from sources of pollutants.
* Ensure dehumidification systems are able to remove sufficient moisture to prevent high levels of indoor humidity during peak and off-peak thermal load conditions.
* Reduce the sources of indoor pollutants.
Occupational Health Experts:
* Create a maintenance schedule that routinely checks the prevalence of all sick building syndrome contributors so that potential issues can be mitigated. This can be done by incorporating codes and procedures that are already in place as well as following up with concerns from building occupants in a timely manner.
ASHRAE:
* Continue to do research and further the knowledge and resources that are available on air conditioning and ventilation
* Make, or continue to make, access to its information easily accessible to everyone

#### Green Buildings

US Green Building Council’s (USGBC) Leadership in Energy and Environmental Design (LEED) standards express concerns about ventilation in buildings. It is possible to gain additional credits toward a certified building by providing increased ventilation, in addition to what is required. Emphasis is also placed on the comfort of the building occupants, by providing credits toward certification for allowing occupants access to temperature and lighting controls. The measures taken by USGBC illustrate the importance that is placed on the comfort and safety of building occupants. However, green buildings come with increased costs, known as the "green premium", which can act as a barrier to implementation. Because of this, if we cannot reduce the cost of green buildings, we may have to look into other options that are not as efficient as green buildings, but are less expensive and can be implemented in more places.

## Conclusion

SBS represents a valuable case on the social interface of technology. Although controversy surrounds the validity of the condition, SBS has inspired substantial technological improvements to building ventilation and design over the past 40 years. ASHRAE standards and the creation of the LEED program both aim to reduce the prevalence of sick buildings. It is important for professionals involved in building design to understand sick building syndrome and the ways that their designs can influence the health of the occupants. By considering the impact on building occupants prior to construction, it may be possible to decrease the number of sick buildings in the country. Instances of SBS in literature have declined from 2001 to 2008, suggesting that this has been the case. While further work is necessary to examine cases both outside the United States and from recent years, the case study of the EPA demonstrates the serious consequences, such as fear and lawsuits, that have arisen from SBS, no matter the validity of the condition.

## References

* 1 2 3 4 5 U.S. Environmental Protection Agency. (2010). Indoor Air Quality (IAQ). Retrieved November 14, 2010, from http://www.epa.gov/iaq/pubs/sbs.html.
* 1 2 3 4 5 Steinman, David. (1993). The Architecture of Illness Millions of Workers Are “Sick of Work”. Retrieved November 21, 2010, from http://www.environmentalhealth.ca/fall93sick.html
* 1 2 3 Buck, Stephanie. “The Mysterious Illness Affecting 1970s Female Office Workers Became 'Sick Building Syndrome'.” Medium, Timeline, 31 May 2017, timeline.com/sick-building-syndrome-cc82f76a07e9
* 1 2 3 4 5 6 7 8 9 10 11 12 Joshi S. M. (2008). The sick building syndrome. Indian journal of occupational and environmental medicine, 12(2), 61–64. doi:10.4103/0019-5278.43262
* ↑ Amadeo, Kimberly. “The Truth About the 1973 Arab Oil Crisis.” The Balance, The Balance, 30 Mar. 2019, www.thebalance.com/opec-oil-embargo-causes-and-effects-of-the-crisis-3305806
* 1 2 3 “Sick Building Syndrome Affects People Too.” New York Times, 17 Apr. 1987, p. 23.
* 1 2 3 Drope, J. “Tobacco Industry Efforts to Present Ventilation as an Alternative to Smoke-Free Environments in North America.” Tobacco Control, vol. 13, no. 90001, 2004, pp. 41i–47., doi:10.1136/tc.2003.004101
* 1 2 3 4 5 6 7 8 9 10 11 Murphy, Michelle. (2006). Sick Building Syndrome and the Problem of Uncertainty: Environmental Politics, Technoscience, and Women Workers. Durham: Duke University Press.
* ↑ Pratt, Sarah. (1996, December). Every Breathe She Takes. Spin, 12, 110-181.
* 1 2 Google Ngram Viewer. (n.d.). Retrieved December 7, 2019, from https://books.google.com/ngrams/graph?content=sick+building+syndrome&year_start=1950&year_end=2000&corpus=15&smoothing=0&share=&direct_url=t1;,sick building syndrome;,c0#t1;,sick building syndrome;,c0.
* 1 2 3 4 Stellman, Jeanne. (Ed.). (1998). Encyclopaedia of Occupational Health and Safety". Switzerland: International Labour Organization.
* 1 2 3 4 Love, S. (2018). Sick building syndrome: is it the buildings or the people who need treatment?. Retrieved December 9, 2019, from https://mosaicscience.com/story/sick-building-syndrome-buildings-or-people/
* ↑ Cook, J. R. (2003). Personal-Injury.com. Retrieved November 14, 2010, from http://www.personal-injury.com/
* ↑ USGBC. (2019). U.S. Green Building Council. Retrieved December 9, 2019, from https://new.usgbc.org/
* ↑ U.S. Green Building Council. (2019). Leadership in Energy and Environmental Design. Retrieved December 9, 2019, from https://new.usgbc.org/leed
* ↑ ASHRAE (2019). American Society of Heating, Refrigerating and Air-Conditioning Engineers. Retrieved December 9, 2019, from https://www.ashrae.org/about
* ↑ ASHRAE. (2019). ASHRAE STRATEGIC PLANNING DOCUMENTS. Retrieved December 9, 2019, from https://www.ashrae.org/about/strategic-plan
* 1 2 Persily, A., & Hewett, M. (2010). Using ASHRAE’s New IAQ Guide. ASHRAE Journal. Retrieved from https://www.ashrae.org/File%20Library/Technical%20Resources/Bookstore/IAQ-Guide-primer-from-the-May-2010.pdf
* 1 2 U.S. Environmental Protection Agency. (2010). Federal Facilities Indoor Air. Retrieved November 14, 2010, from http://www.epa.gov/region1/enforcement/fedfac/iaqbroc.html
* ↑ Pettit, E. (2014). How to improve air quality. Retrieved December 9, 2019, from https://www.usgbc.org/articles/how-improve-air-quality
* ↑ LBNL Indoor Environment Group. (2019). Implications for Good Ventilation Practices. Retrieved December 9, 2019, from https://iaqscience.lbl.gov/vent-practices
* ↑ U.S. Green Building Council. (2010). LEED. Retrieved November 14, 2010, from http://www.usgbc.org/DisplayPage.aspx?CategoryID=19
* ↑ Shannon D. Sentman, Healthy Buildings: Green Building Standards, Benefits, and Incentives. The Journal of Israel Innovation (Special Supplement: Israel Edition of J.BioLaw & Bus.) 2009.