Air care: an ‘aerography’ of breath, buildings and bugs in the cystic fibrosis clinic

Abstract

With significant relevance to the Covid-19 pandemic, this paper contributes to emerging 'aerographic' research on the socio-materialities of air and breath, based on an in-depth empirical study of three hospital-based lung infection clinics treating people with cystic fibrosis. We begin by outlining the changing place of atmosphere in hospital design from the pre-antibiotic period and into the present. We then turn to the first of three aerographic themes where air becomes a matter of grasping and visualising otherwise invisible airborne infections. This includes imagining patients located within bodily spheres or 'cloud bodies', conceptually anchored in Irigaray's thoughts on the 'forgetting of the air' and Sloterdijk's immunitary 'spherology' of the body. Our second theme explores the material politics of air, air conditioning, window design and the way competing 'air regimes' come into conflict with each other at the interface of buildings, bodies and the biotic. Our final theme attends to the 'cost of air', the aero-economic problem of atmospheric scarcity within modern high-rise, deep-density healthcare architectures.

The coughing body: etiquettes, techniques, sonographies and spaces

“…However, it also reflects on practices that now have far wider significance in the context of a pandemic. As one sociological contribution on Covid-19 has recently put it, “our current experience of the pandemic is all about breath… risks in the simple act of breathing” (Will 2020 ; see also Brown et al 2020 ).…”

“…Incidental observations were conducted during visits to each site over a 9–10-month period, in addition to 72 hours of ‘targeted ethnography’ (Sage and Dainty 2012 ) involving focused observations of clinics during those days on which people with CF were being treated in hospital. Our project also involved archival and historical research into hospital building design (see also Prior 1992 ; Brown et al 2020 ), including patent applications related to respiratory devices and infection control equipment.…”

“…Here, clouds recast the body as a spatially transgressive bioaerosol echoing more recent debates and uncertainties on air as a medium of coronavirus transmission (Lewis 2020 ; Bourouiba 2020 ). The borders of the coughing body are not delimited by the skin but by its ‘atmospheric halo’ (Brown et al 2020 ).…”

“…In opening a window, “you’re flushing the air in your room, in the way that you’re flushing a toilet, you’re flushing everything away… dispersing it”. Managing the risks of the coughing body in CF care routinely depends on being able to open the windows However, in the context of modern buildings, openable windows have often been ‘designed-out’ (Brown et al 2020 ). Many respondents spoke of opening doors to treatment rooms to recirculate the air, although other participants in the study were just as anxious about open doors allowing infections to be carried on the air into adjoining corridors.…”

“…Each of these geometries have come into play, in one way or another, both in our own more focussed study and now in the wider context of a pandemic emergency. However, as we go on to show below, both CF and Covid-19 unquestionably focus attention on the immediate atmospheric environment of the coughing body, its ‘halo of air’ (Brown et al 2020 ), and its containment.…”