--- title: Welcome to the Hotel Influenza date: 2024-09-06T11:30:00-04:00 author: University of Maryland canonical_url: "https://terp.umd.edu/welcome-to-the-hotel-influenza" section: Articles --- # Welcome to the Hotel Influenza *September 6, 2024* — by [Chris Carroll](/authors/chris-carroll) - *Illustrations by Noma Bar* > A groundbreaking UMD researcher investigating how respiratory infections spread asks volunteers to check in—and get sick for science. *Lung illustration with bellhop outline inside. Viruses throughout* **THE STATELY 23-STORY HOTEL OPENED AT** the height of the Jazz Age, but less than a year later, Wall Street’s 1929 crash snuffed out revelry in the opulent ballroom and secret speakeasy. That’s when the property, then one of Baltimore’s tallest buildings, supposedly began accumulating ghosts: failed businessmen, wiped-out tycoons, even a bankrupt couple reputed to have jumped to their deaths on a downtown street with their young daughter. Today, as tour groups try to detect the spectral child bouncing her ball down the halls of the hotel, University of Maryland researchers and colleagues are using the location to track an unseen presence that’s more substantial—and threatening. Each year, according to the World Health Organization, seasonal influenza respiratory infections kill up to 650,000 people; while science has pinned down much of the biology of flu and other dangerous viruses, it hasn’t yet provided a precise account of how they’re passed from person to person to cause illness—or clear answers about preventing their spread. Did you get flu from a dirty doorknob or a sneeze in the face? Or as recent research from UMD and other sources suggests, do airborne viruses “haunt” indoor air around infected people, waiting to be breathed deep into the lungs? As part of an audacious bid to put such questions to rest, paid volunteers have checked into a sealed-off floor of the hotel (which the managers asked *Terp* to avoid naming) over the past two winters, with more on the way this winter. During stays of up to two weeks, they’re participating in a randomized, controlled trial with a surprising objective: to spread, or catch, the flu for science. Supported by $20 million in grants from the National Institutes of Health and Balvi Filantropic Fund, the study could fundamentally alter how health authorities and the public fight respiratory infections. It brings together a multidisciplinary team from UMD’s School of Public Health and A. James Clark School of Engineering, and the School of Medicine at the University of Maryland, Baltimore, led by UMD MPower Professor of Environmental and Occupational Health Donald K. Milton. He has spent much of his 40-year career analyzing airborne pathogens and advocating, at times controversially, for society to take greater precautions. It took the COVID pandemic—when he played a pivotal role in overturning national and global health authorities’ opposition to masking to stop airborne viruses—for his ideas to gain greater traction. But that was a little too late to avoid disastrous shutdowns of schools and other societal institutions. “I tried to find a way to avoid this calamity, but here we are,” he told *[Terp](https://terp.umd.edu/portraits-from-a-pandemic)* in mid-2020. “Maybe this tragedy will get us past our fear of the idea of airborne transmission and prepare to control it, which could help us to avoid all this next time.” Midway through his flu study, Milton finds himself in the odd spot of rooting for a virus—within the walls of the hotel—that he’s fought for decades. --- ## INVISIBLE THREAT Indoor air is about 90% of all the air most of us breathe, Milton says, so he frequently keeps track of what’s in his. In his office in the School of Public Health Building, Milton reaches over and plops a device on his desk reminiscent of a small digital clock. At the beginning of our interview, the big number on its LCD screen reads a little over 400, but some 45 minutes later, the number has risen dramatically. Our breath as we spoke boosted carbon dioxide in the room to nearly 700 parts per million. *man in bed that looks like tissue box* --- ## CLEARING THE AIR Many prominent physicians (not to mention the disinfecting wipe industry—“kills 99.9% of viruses and bacteria!”) still hew to the idea that the primary routes of infection are through the spray of a sneeze or cough directly into the face, or onto a surface to be transferred by touch to the mouth, eyes or nose. The developing idea that “aerosols,” fine particles that can remain suspended in the air for considerable periods, can hold enough exhaled virus to cause infection was increasingly bringing Milton into conflict with the medical establishment. One of Milton’s papers, which examined the possibilities of airborne smallpox soon after the 2001 attacks with the deadly anthrax bacteria when there was concern about bioweapons in Iraq, was met with livid responses from reviewers, including charges he was a “quack and a charlatan,” he says. *Don Milton poses with Gesundheit II machine — Photo by Stephanie S. Cordle* > It’s dogma, not science. I’m allergic to dogma.” — —Donald Milton, *MPower Professor* But in March 2020, Milton and several co-authors posted a paper online that was soon published in *Nature Medicine*. The study used Gesundheit II to confirm that surgical masks could stop coronaviruses as well as influenza when worn by infected people. Its impact was life-changing for much of the world: Mask use soon became widespread—even mandatory in many places—perhaps signaling a growing open-mindedness about the route of transmission Milton had been focused on for two decades. He quickly became a standby source for journalists covering COVID-19 and other respiratory infections, spoke to the White House and Congress, and served on an increasing number of global public health advisory boards. “Although his contributions are now widely recognized, Don has not received the accolades that he has deserved,” says Jonathan M. Samet, professor and former dean of the Colorado School of Public Health. “It took a pandemic ... for his work to finally receive an appropriate level of attention, given its implications.” --- ## HIGH-RISK, HIGH-REWARD Milton’s latest major study began in 2021 with $15 million in funding from the National Institutes for Health, although fieldwork at the hotel didn’t kick off until late 2022. For the first time, it joins a full range of scientific elements and expertise to document in detail a flu transmission, says Professor Jelena Srebric, the Margaret G. and Frederick H. Kohloss Chair in Mechanical Engineering, an expert in indoor air quality and computational fluid dynamics, and one of Milton’s co-principal investigators. “Of course, you can’t actually see individual viruses causing someone to be infected, but the design of this study will give more understanding of every step along the way than we have ever had before,” Srebric says. “We’ll know what made you sick and what didn’t make you sick.” *three people wearing bright yellow vests play dancing video game — Researchers and students from Milton’s lab test technology used to track participants in the flu study’s common room by playing a dancing video game. (Photo by Stephanie S. Cordle)* > It took a pandemic for his work to finally receive and appropriate level of attention, given its implications.” — —Jonathan M. Samet, *Professor, Colorado School of Public Health* In another element of the experiment funded by the Balvi gift, which invests widely in respiratory infectious disease research, the researchers will test whether a new type of germicidal ultraviolet light devices prevents infections. That would support the theory that the flu virus is transmitted in room air and provide a silent and energy-efficient way to sanitize indoor air. All told, the extremely complex project could change how the world thinks about infection, or it could go off the rails. In the experiment’s first year, an unusually early flu season struck before the team was ready to quarantine participants; last year saw several flu donors, but with a dearth of recipients—just 11 in total, despite room for nearly 50—the illness hung back in the shadows like a shy ghost. No volunteer recipients tested positive for the flu virus during quarantine, although one later showed chemical markers of an infection in a blood test. And in an illustration of the challenges of human studies, another participant who developed mild symptoms despite testing negative never returned to confirm whether they had been infected. Ironically, to better fight the flu, the research team needs the flu to do better this winter. “We are going to do everything we can, so all those hotel rooms are filled,” Milton says. “The point is to get more people exposed for more time.” A former colleague at Harvard Medical School uninvolved with the current study says Milton’s scientific reputation and administrative abilities helped him secure funding for a type of study that is rare in the world of science. “It says something about Don that he’s able to launch these human-to-human transmission clinical trials,” says Edward Nardell, a physician who specializes in tuberculosis research. “These are high-risk studies—and high-reward if they succeed.” --- ## ‘LIKE SUMMER CAMP’ *skyscraper that looks like syringe* **Sidebar note:** Interested in sharing your flu or borrowing someone else’s as a paid volunteer to help researchers learn how to conquer the illness? Visit [cvdtrials.org/baltimoreflu](https://www.medschool.umaryland.edu/cvd/trials/emit2/) to get started. **Issue:** [Fall 2024](https://terp.umd.edu/editions/fall-2024) **Types:** [Features](https://terp.umd.edu/category/features)