Former Covid official Deborah Birx joins company behind hazardous air

Ex-White House coronavirus adviser under Trump is now chief medical adviser of ActivePure, one of many companies in a race to capture Covid federal funding

The former top White House coronavirus adviser under President Donald Trump, Dr Deborah Birx, has joined an air-cleaning company that built its business, in part, on technology that is now banned in California due to health hazards.

The company is one of many in a footrace to capture some of the $193bn in federal funding to schools.

Birx is now chief medical and science adviser of ActivePure Technology, a company that counts 50 million customers since its 1924 start as the Electrolux vacuum company and does nearly $500m annually in sales. Its marketing includes photos of outer space, a nod to a 1990s breakthrough with technology to remove a gas from Nasa spaceships.

The company's own studies show that, in its effort to create the "healthiest indoor environments in North America", it leveraged something less impressive: the disinfecting power of ozone – a molecule considered hazardous and linked to the onset and worsening of asthma.

In an interview with KHN, CEO Joe Urso acknowledged that its air cleaners that emit ozone account for 5% of sales, even though its marketing repeatedly claims "no chemicals or ozone".

Conflicts between the science and marketing claims of an air purification company are nothing new to academic air quality experts. They warn that the industry – which sells to dental offices, businesses and gyms – is laser-focused on school officials, who are desperate to convince parents and teachers their buildings are safe. Children can be particularly susceptible to the chemical exposure some of these devices potentially create, experts say.

"The concerns you have raised are legitimate" when it comes to other companies’ products, Birx said, noting that as a grandmother she shared concerns about health. But she added that she had full confidence in ActivePure after reviewing records for the Food and Drug Administration's clearance of a company device.

Schools are getting an infusion of roughly $180bn in federal money to spend on personal protective equipment, physical barriers, air-cleaning systems and other infrastructure improvements. Previously, they could have used $13bn of Cares Act funding. Democrats are pushing for $100bn more that could also be used for school improvements, including air cleaners.

Putting unregulated devices in classrooms is "a giant uncontrolled experiment", said Jeffrey Siegel, a civil engineering professor at the University of Toronto and a member of its Building Engineering Research Group.

Researchers and the Environmental Protection Agency (EPA) say the broader industry advertises products that alter molecules in the air to kill germs, without noting that the reactions can form other harmful substances, such as the carcinogen formaldehyde.

Marwa Zaatari, an indoor air quality consultant and a member of the American Society of Heating, Refrigerating and Air-Conditioning Engineers’ epidemic taskforce, said she has counted more than 125 schools or districts that have already bought air cleaner models the EPA has linked to "potentially harmful byproducts" such as ozone or formaldehyde. She estimated at least $60m was spent.

Instead, air quality experts say, the best solutions come down to basics: adding more outdoor air, buying portable HEPA filters and installing MERV 13 filters within heating systems. But school boards are often lured by aggressive claims of 99.9% efficiency – based on a test of a filter inside a small cabinet and not a classroom. "Every dollar you use for this equipment is a dollar you remove from doing the right solution," Zaatari said.

Urso, of ActivePure Technology, said "other companies that I think are making wrongful claims" have brought scrutiny to the industry. But he said his firm's technology has steadily improved and now emits "gaseous hydrogen peroxide" and other molecules that seek out and destroy viruses, mold and bacteria. He described the technology as active – in contrast to the more passive technology of air filters. A company website says it makes the "safest, fastest and most powerful surface and air-purification technology available".

Urso added: "I have a great technology that is truthful and it does what I say it does."

The Centers for Disease Control and Prevention warns specifically against technologies that release hydrogen peroxide that are "being heavily marketed". The agency says the technology is "emerging" and "consumers are encouraged to exercise caution".

During a Zoom interview, Birx deferred to ActivePure Medical's president, Daniel Marsh, and Urso on the science. She focused instead on the need for products that will increase people's confidence about going maskless indoors.

"Imagine decreasing the number of sick days of your workforce because your air is less contaminated," Birx said. "There are uses of this technology that transcend the current pandemic."

Birx was a controversial figure on Trump's Covid response team. She was criticized for standing by quietly as Trump suggested that people could ingest disinfectant to rid themselves of the virus. She has recently spoken out about her discomfort with such statements – while endorsing ActivePure Technology.

Birx said she was attracted to ActivePure because of its commitment to "hard science" in getting its Medical Guardian cleared by the FDA. The process required the company to prove the device was substantially equivalent to an existing device. Records the company submitted to the FDA describe the Medical Guardian as an "ion generator" and "photocatalytic oxidizer" that showed "a high efficacy against … a broad range of viable bioaerosol".

Birx said she uses a hospital-grade HEPA filter in her home but noted that was only because she wasn't aware of the ActivePure technology when she bought it.

When ActivePure Technology, formerly known as Aerus, tells its story, it's one of seamless progress. Yet its 2009 purchase of the air cleaner company EcoQuest saddled the company with two problematic technologies: one that intentionally generated ozone to clean the air and another that did so incidentally, studies from the subsidiary company show.

The ActivePure companies and subsidiaries made the best of it, though, marketing the technology's purification powers on the basis of a Kansas State University study of how well the devices disinfected the surface of meat compared with chlorine, which is widely used by meatpackers to kill bacteria.

Meanwhile, California lawmakers were outlawing consumer use of air cleaners that emit more than 50 parts per billion of ozone. They got momentum to regulate the industry with a survey that showed that a small percentage of state residents who used such devices at home had children – considered particularly sensitive to ozone. According to the California legislation, ozone can "permanently damage lung tissue and reduce a person's breathing ability".

The CDC also reviewed the ActivePure technology in 2009. At the time, Birx, who served in the agency under three presidents, was directing its global Aids response.

Agency scientists were evaluating the potential of air cleaners to help clear formaldehyde from Federal Emergency Management Agency (Fema) trailers deployed after Hurricane Katrina. They knew the devices could potentially swap one hazard – ozone formed by some air cleaners – for the one they were trying to eliminate. So they tested and found that a device from ActiveTek – an Aerus subsidiary – with ActivePure technology emitted 116 parts per billion of ozone. The scientists deemed that level too high for cleaning the trailers.

Birx said the older ozone-emitting devices were first-generation devices. The newer ActivePure devices are third-generation and one is now validated by FDA clearance. That is not the same as FDA approval, which requires proof the device is safe and effective.

Urso said the company's devices that emit ozone are mostly for commercial use. Although marketing for ActivePure says "no chemicals or ozone", Urso acknowledged that it still sells a Pure & Clean Plus device that emits ozone and cannot be sold in California.

"It is very confusing," Urso said, "and it's confusing because we also match it with [the] ActivePure" logo. The company did not answer questions about five other devices listed for sale on its website, which says they can't be sold in California.

While current ActivePure marketing also says the technology produces no byproducts, Urso said that reflects results from lab studies, not studies from the environment where they might be used. That includes hundreds of schools that have trusted their technology, the company's website says. There, experts say, chemicals that could react with air cleaner technology include car exhaust, spray cleaners, paint and glue.

The company markets to preschools as well. Brent Stephens, an indoor air quality expert who leads the civil, architectural and environmental engineering department at the Illinois Institute of Technology, was asked by the director of his own children's preschool about the Aerus Hydroxyl Blaster.

Aerus had sent the director a sample to test in her home. But Stephens advised against buying one for the preschool, saying that, while the claims of similar machines may sound good, the studies to back them up often were not.

"It's wild out there," he wrote in an email. "Consumers need to know how these things perform and if they are subject to unforeseen consequences like generating byproducts from use."

Kaiser Health News (KHN) is a non-profit news service covering health issues. It is an editorially independent program of the Kaiser Family Foundation that is not affiliated with Kaiser Permanente