Questioning Spatial Inclusivity during Pandemics: The Increased Prevalence of Sick Building Syndrome during COVID-19 Lockdown

Sick Building Syndrome (SBS) is more prevalent in the modern age due to the increased amount of time an individual faces indoors and the lack of outdoor activities in the day-to-day lifestyle. SBS has many potential health risks, from being the physical ones such as cancer, diabetes, lethargy, fatigue; towards the mental ones such as increased symptoms of anxiety, depression, and loneliness; towards the social ones such as an individual having difficulties interacting with another individual(s). Furthermore, due to the COVID-19 Pandemic that has given rise to ‘work-from-home’ (WFH), employees feel worse than ever before because of the poor quality of their indoors. In this work, recommendations to solve this problem are being provided. (keywords: sick building syndrome (SBS), COVID-19, Work-from-home)


Introduction
The world has changed ever since Q1 of 2020, primarily due to the surge of novel Coronavirus or COVID-19 led Pandemic.However, the presence of COVID-19 has undoubtedly increased this time frame.The primary reason for these increased indoor times is being told to stay-at-home to curb the spread of COVID-19 infections.Health advisors around the globe have asked their citizens to avoid being out in public, wear facemasks, maintain social distancing, and continuously wash their hands either with an available soap or a hand sanitizer.To sustain social distancing, the most significant emphasis has been laid out to ensure a socio-economic structure is built so that occupants can stay at home [1,2].Thus, decreasing the presence and spread of droplets and aerosols containing the COVID-19 virus, thus reducing transmission.Using an interdisciplinary built environment and sociopsychological perspective, this essay highlights the combined impacts of work-from-home on the proliferated Sick Building Syndrome (SBS) during COVID-19 lockdowns.As for the methodology, the present paper employed critical discourse analysis, which was undertaken by evaluating previous publication and contextualizing it with the SBS cases occurring during global COVID-19 restrictions.

Working from home
The advent of the internet and the availability of smartphones & devices could not come at a muchneeded time.Due to this, the majority of the sectors offered their counterparts to work from home or WFH.Educational institutes also offered online classes, and logistic companies and small-medium enterprises (SMEs) started offering at-home services to reduce the number of people outdoors.However, as indoor living has increased, another dilemma has developed: Sick Building Syndrome, which is associated with Building Related Illnesses (BRI) [3].A building's occupant may experience some symptoms associated with SBS, such as headaches, fatigue, skin symptoms, and irritations to the upper respiratory tract, eyes, throat, and hands.SBS can also be attributed to the occupant's risk factors such 1318 (2024) 012013 IOP Publishing doi:10.1088/1755-1315/1318/1/012013 2 as anxiety & stress, along with smoking and lack of time spent communicating with friends and social circle [4].
An Italian study involving surveyed 51 at-home workers has provided an early look at the potential impact of the rise in working from home during COVID-19.According to the findings, low back pain affects 41.2 percent of at-home workers, while neck pain affects 23.5 percent [5].About half of the people polled (50%) said their neck pain had gotten worse since they started working from home.Since the implementation of lockdown measures, many people have spent al-most all of their time at home [6].As a result, the quality of the indoor built environment is more important than ever for the health, well-being, and productivity of occupants.Building designers across the world are assessing how to make their buildings safer in light of the COVID-19 pandemic.Businesses are seeking to figure out how to make their buildings and offices healthier.Over the course of COVID-19, poor ventilation, chemical contaminants, and biological contaminants are all common contributors to Sick Building Syndrome.Then, what would the impact of poor indoor air quality be?
During COVID-19, due to the lack of proper ventilation within buildings, which occurs primarily due to two main reasons: (a) due to the adaptation of HVAC systems, (b) due to the excessive usage of closed windows that often comes as a part of "modern" designs.Ventilation that is not achieved due to natural means is a major contributing factor to the causes of SBS.Popular trends of central air conditioning in modern real estate are often labelled as an essential part of efficient cooling and ventilation; the result of that is the lack of windows.Due to this lack of air to leave indoors and produce a natural ventilation cycle, indoor air quality decreases or IAQ, which comprises a mixture of outdoor air through either mechanical or biological ventilation systems, leading towards the recirculation of indoor air [7].With poor natural ventilation, indoor air contaminants are produced that comprise gas with volatile organic compounds and inorganic compounds with the likes of ozone and radon.According to a survey, poor IAQ has been found to cause acute health issues such as asthma, throat irritation, and shortness of breath [8].Furthermore, poor IAQ is a major contributing factor for the development of multiple types of cancers, chronic lung diseases, along bronchitis.Poor IAQ does not always affect a person's physical health, but it also targets their mental or emotional health with problems such as aggressive behaviors, mental fatigue, and negative emotions.During COVID-19 lockdown, there have been problems in Indoor Air Quality (IAQ).The data analysis looked at the lockdown's impact on two scales: the first fortnight of lockdown was compared to the fortnight before, to quantify the lockdown's immediate impact.Next, three months, mid-lockdown, was compared to three months the previous year with similar weather conditions to get a broader understanding of the overall effect.With the changing patterns of home occupancy, much more attention must be paid to the negative health effects of high indoor pollutant concentrations [9].Another contributing factor to Sick Building Syndrome has been found to be pollutants that come from both indoor and outdoor sources.Pollutants that reduce the indoor air quality of the homes are associated, due to the usage of carpeting in our interior spaces, multiple adhesives to make our furniture's more "aesthetic" and using different kinds of pesticides to keep our indoor "bugs" free.All of such chemical pollutants have been found as contributing factors to Sick Building Syndrome.Biological contamination is found to be a devastating cause of sick buildings.There are plenty of sources of these such as bacteria, animal dander, cat saliva, pollen, cockroaches, and house dust [10].Biological contaminants comprise those that are produced by living things.
Exposure to certain ambient compounds can result in negative health outcomes.This is especially true for PM10 (particulate matter with a diameter of 10 micrometers or less) and PM2.5 (particulate matter with a diameter of 10 micrometers or less) (particulate matter 2.5 micrometers or less in diameter) [11].According to the research, those who work from home are at higher risk because they are exposed to higher levels of certain contaminants for longer periods.Given that many workers will be moving to home-based offices in the coming years, it is critical to better develop interventions to mitigate this reality.Indoor air contaminants are linked to increased negative emotions, increased aggressive behaviors, impaired attention, and mental fatigue, in addition to their direct effect on physical health.Building ventilation aims to improve IAQ by removing pollutants produced by indoor sources and diluting the concentration of indoor contaminants.It is discovered a clear link between lower ventilation rates and a higher likelihood of respiratory symptoms in single-family homes.When ventilation rates were increased from 12 L/s to 24 L/s, sick leaves associated with sick building syndromes decreased by 35% in offices [12].
In the SBS case in Japan during COVID-19 lockdown, the adverse health effects caused by poor indoor air quality and indoor air pollution were reported by a 36-year-old female officer working in Japan.In this case, all the patient's symptoms were developed by her time spent in her workplace [13].Her symptoms comprised of excessive nausea and headache during the working hours within her office that was refurbished.The patient was treated for almost eight months; she was sent to different hospitals and clinics that ran various tests and presented her with further diagnostics.Nothing appeared to work until medical practitioners started to change their treatment strategies.It was found that the patient's antibody cedar to pollen was positive and that TH1/TH2's ratio was about 4.5.ETT findings and anxiety levels were increased over the gradual two-year period [14].Her reaction to the onset of formaldehyde concentration was high even though that being measured in the room ranged from about 0.017 to 0.053 ppm.Later, she was diagnosed with the SBS, and doctors recommended the workplace be changed with less building materials comprised of formaldehyde concentrations, with increased movement within the indoors and good indoor quality.All such changes made her health better in the coming months and ultimately her being stopped feeling nauseate and experiencing long-term headaches.Furthermore, her additional higher state of anxiety was found to be gradually improved.Therefore, it was suggested SBS is not only comprised of chemical insensitivity but along with psychological disorders [13].With this study, mental health is evident to be another cause of Sick Building Syndrome.Mental health problems such as depression and anxiety can also occur due to poor building design with less room for sunlight, natural ventilation, and no common rooms/grounds for the community.The sense of loneliness and workload that a person experiences while staying indoors have been found to help decline the proper functioning mental state of occupants [15].
The COVID-19 led Pandemic had been an altogether a game-changer.Upon learning about the spread of airborne diseases and how frequently they are present within the indoor spaces, WHO issued guidelines asked governments to close down buildings with access to people.In just comparison, according to the research conducted by Lidia Morawska, the researcher based in Brisbane Australia conducted numerous investigations to understand the prevalent presence of airborne diseases [16].The researcher measured different indoors and outdoors.With the help of a device, it was found that: indoors of the buildings, the carbon dioxide monitor read levels to about and around 400 parts per million or p.p.m.However, it was a complete story inside the building as these levels shoot to as high as 2,000 p.p.m.The SBS symptoms are more pronounced in air-conditioned buildings than in naturally ventilated buildings, and in public buildings than in private buildings [17].Based on a more recent publication on WFH-related health problems, 3.8 million people die prematurely each year due to illness caused by household air pollution caused by the inefficient use of solid fuels and kerosene for cooking.Pneumonia accounts for 27% of these 3.8 million deaths, stroke for 18%, ischemic heart disease for 27%, chronic obstructive pulmonary disease COPD for 20%, and lung cancer for 8% [18].One of the factors that can negatively impact a person's immune response is the number of small particulates or pollutants in the air.These things can irritate the airways of the lungs, lower the blood's oxygen conversion rate, therefore lowering the lungs' efficiency.Therefore, governments quickly realized the importance of a national lockdown and reducing the amount people spend indoors are recreational and public spaces.It was done to reduce the droplet transmission and spread of COVID-19 viruses.Having a lockdown in place, and with the prevalence of Work from Home or WFH, residents and home dwellers started to experience different kinds of issues related to their physical, mental, and social well-being.Work From Home is considered a significant reason that has affected the "normal life".At the same time, Sick Building Syndrome had been in consideration and under research by professionals, which is considered to be a cause of globally $75 billion [19].However, COVID-19 led Pandemic, and the review of WFH led new everyday life has increased the symptoms of SBS in individuals.Due to the imposed policy of working from home is inevitable, employees had little to less time to change their substandard conditions into offices.Since many employees did not have a dedicated study room at their homes, they are now supposed to work in places to eat or share with other occupants.According to a survey, only a third number of occupants have a dedicated office space.Due to this, many employees reported they felt lonely, and lack of movement has made gaining weight and other health issues associated with the lack of exercise.Feeling loneliness has been found to boost symptoms of depression and anxiety in employees.Employees are feeling more anxious than ever before.Furthermore, due to not meeting the office requirements, many employees reported they started to experience back pain and joint pains due to the rise in the more sedentary lifestyle [15].
During the COVID-19 lockdown in London in January 2021, research by 38 Simone et al reported on the results of an online survey of 464 home workers [20].The study was the first to use the indoor soundscape model to assess the acoustic environment concerning two main activities carried out at home during the pandemic, namely relaxing and working from home.When it came to relaxation, spaces were rated as more comfortable and content-rich than when it came to WFH.Despite the lack of significance between relaxation and WFH in terms of soundscape appropriateness, the more stringent assessment of the same space in terms of comfort and the analysis of free format responses suggest that WFH is more affected by the acoustic environment than relaxation.
People spent an average of 90% of their time indoors even before the COVID-19 pandemic [21].With work-from-home orders in place, it is more important than ever to radically rethink building design and operation.Indoor Environmental Quality (IEQ) has a direct impact on occupant comfort and wellbeing.When occupants' IEQ is compromised, they are more susceptible to a variety of diseases, which are exacerbated by both social and economic factors.During the COVID-19 pandemic, the annual cost of sick building syndrome in commercial workplaces in the United States is estimated to be between $10 billion and $70 billion [22].It is critical to comprehend how IEQ parameters can be properly designed and how buildings can be operated to provide optimal IEQ and protect health.
Occupants who stay indoors for a more significant period and do not indulge in physical activities such as going out for runs, walking, cycling, doing gym, and so on, are more likely to experience increased depression, loneliness, and anxiety attacks [23].Individuals have also been found to experience anger issues due to being confined in one single space instead of them having a place to "vent out" [24].The increased number of mental health issues reported such as the: increased feeling of loneliness, anxiety, and stress that all comes to the lack of communication these employees used to have, and the social ones being: due to the increased amount of staying at home and having less interaction with people around, individuals have started to experience increased loneliness and lack of desire to socialize further due to the increased amount of newly developed hobby of staying at home [25].

Conclusion
Designers, facility managers, and occupants need practical guidance on reducing health risks in buildings during extreme events like a global pandemic.This paper has addressed the question about the impact of buildings on people's health.The study lays the groundwork for future research and uncovers new research directions and discoveries [26].With the building being built for a purpose to increase the number of occupants while rejecting them is having more than a single purpose: practitioners have to realize the importance of different factors that contribute to Sick Building Syndrome and have to ensure the buildings are designed by keeping in mind their neighbourhoods are alive with an increased number of green spaces.The following are the recommendations in light of understanding as to what Sick Building Syndrome (SBS) and COVID-19 led the rise in the Work from Home (WFH) showed health issues.
Improving the use of windows and fans for better air circulation.One of the significant factors of Sick Building Syndrome is the lack of openable windows.Due to the lack of windows, the air inside a house does not leave the indoor air contaminants; therefore, it increases the risk of airborne disease indoors.Furthermore, the outdoor air quality in urban places globally has declined due to excessive pollutants out in the air Houses even need cross ventilation to be airy.The design of the house must be smartly placed by understanding wind directions around the house so that maximum air can be drawn in.Fans, however, play an important role in cross-ventilation regardless of what strategy is chosen by designers.By leaving trapped air outside and introducing fresh air inside, exhausts ensure that the trapped air is exited.Using indoor plants are pivotal for rehabilitating indoor air quality.Using indoor plants have also been found to have plenty of benefits rather than drawbacks.Plants help to improve the internal air quality of the room; in a way, they act as natural purifiers.Plants such as the areca, Boston Fern, Rubber tree, and Ficus tree are great plants to have indoors that help to freshen up the air naturally.Besides improving the mood of the occupant, they can also help reduce fatigue and stress levels.
Psychological factors were also considered, such as excessive work stress or dissatisfaction, poor interpersonal relationships, and poor communication, all of which are frequently linked to poor work performance [27].So, aside from considering how to improve the structure and internal design of buildings, it is also crucial to 'treat' the self-being of individuals or employees in order to mitigate the Sick Building Syndrome.In other words, improving the mental health and well-being of individuals can also help promote their work quality and performance.One way to do so is by helping individuals alter unwanted behavioural patterns and providing outlets for negative thoughts.This can be done through Cognitive Behavioural Approach whereby individuals are helped to identify and change their negative thought patterns by undergoing certain programs and pieces of training [28].Studies have proven that social connection is one of the greatest predictions of happiness and reduction of stress.Today there are overwhelming evidence that SBS is an increasingly common problem among workers/employees.Thus, more research is needed to be done to address the gap between the impact of SBS (such as buildings, infrastructure, conducive environments, air-conditioned rooms, and so forth) as well as the well-being of the employees (such as job satisfaction, burnout and so forth).

Spatial recommendation
With the building being built for a purpose to increase the number of occupants while rejecting them is having more than a single purpose: practitioners have to realize the importance of different factors that contribute to Sick Building Syndrome and have to ensure the buildings are designed by keeping in mind their neighborhoods are alive with an increased number of green spaces.
The following are the recommendations in light of understanding as to what Sick Building Syndrome (SBS) and COVID-19 led the rise in the Work From Home (WFH) showed health issues.

Designing buildings for social good
Modern buildings lack functionality.An essential part of what makes a human is the social or socializing skills humans have.The architecture of today undermines that completely.In order for architecture to ensure buildings and their occupants are friendly to each other's needs, it is important buildings are designed by keeping the importance of socializing in mind.Reshaping of Architecture is a must that comprises a common sitting area where occupants can sit and socialize with one another.

Figure 1. Green Communal Space with Indoor Plants
A widespread example is a "communal" space that is incorporated in the design of apartment buildings.A dedicated courtyard is placed that helps the natural daylight to pass and for the residents to sit with one another and socialize collectively.With such strategies in place of the architecture practices, this will help resolve the prevalence of increased mental issues reported by employees who are now experiencing work from Home.Secondly, mental issues are a significant contributor to the Sick Building The reason for its prevalence is due to the lack of new buildings giving way for people to find room to socialize.Instead, they are built and designed for one purpose: that is to create more [29].
Furthermore, increased amounts of green spaces are a must that ensures the increased amounts of good and clean air quality; cleans most of the toxins that are present in the air and helps for the natural habitat to flourish; thus, not leaving a more significant environmental impact within the context of where the building is situated.Green spaces also provide a much-needed shade for habitats that are located in the summer locations.However, design practitioners have to ensure they strategically place the green areas with intelligent choices of plants as biochemical hazards can be a cause of SBS.

Use of windows and fans
One of the significant factors of Sick Building Syndrome is the lack of openable windows, air conditioning, and HVAC systems.Due to the lack of windows, the air inside a house does not leave the indoor air contaminants; therefore, it increases the risk of airborne disease indoors.Furthermore, the outdoor air quality in urban places globally has declined due to excessive pollutants out in the air.
To combat this, the design practitioners have to find solutions that ensure the buildings have good indoor air quality and the air that comes in doors is treated with the right amounts of natural cleaners [30].

Figure 2. Green Courtyard Involves Fishpond and Indoor Plants
Incorporating courtyards in indoor spaces is a great strategy that helps keep the house's indoor air quality clean and helps create an indoor-outdoor connection to the place.Furthermore, greenery is another aspect that allows the outdoor air quality to be treated before entering the indoors.Furthermore, to this, courtyards also present a great way to treat direct sunlight, especially in places where the summers are harsh: thus, this helps to reduce the homes from thermal heating and also helps to add large windows to gain as much fresh air that ensures the indoor air quality of the house remains cool [31].Cross ventilation is also an essential feature of a home.Houses need to incorporate cross ventilation.Their design has to be smartly placed by understanding the contextual wind directions so that maximum winds can be used to make the house airy.
Furthermore, using fans as a form of ventilation rather than an HVAC system to keep indoors airy.Other exhausts allow for the indoor air that is being trapped to leave and fresh air to enter.Fans to become an afterthought is rather more criminal on the part of the design practitioners.However, regardless of what strategy is adopted, fans are critical for cross-ventilation.

Communal outdoor spaces
Apart from indoors, the outdoor spaces around the homes are significant as they help the residents to leave the building's confined envelope and participate in much-needed physical exertions.Therefore, urban planners need to make sure the daily necessities of a home and the parks are located close to each Home so that the residents can participate more frequently and be less dependent on their automobiles to reach point A to point B.
Residential blocks with accessible parks and daily-necessity stores are the communities where residents are more likely to indulge in a healthy manner that is profitable for their health.Secondly, the presence of green spaces next to their homes allows the residents to evade the daily monotony of mental and social issues they face.

Using indoor plants
Using indoor plants has also been found to have plenty of benefits rather than drawbacks.Plants help to improve the internal air quality of the room; in a way they act as natural purifiers.Indoor plants also help to ensure the indoor space is clear from pollutants that are used for internal bug busting.Plants such as the areca, Boston Fern, Rubber tree, and Ficus tree are great plants to have for indoors that help to freshen up the air naturally.They have been found to improve the overall mood of the resident, with also helping to reduce the fatigue and stress levels of the occupants.According to another research, the indoor plants have been found to help improve the attention span of the residents, and also have been found to be therapeutic to the residents [32].
It is vital for the interior designers and architects to come up with solutions that organically help to incorporate plants within the indoor spaces after knowing they can be a great way to battle the SBS issues.

8 Figure 3 .
Figure 3. Cross Ventilation and Green Space Integration