Equitable Access to the Air We Share

Disclosure: The author is CEO of a company that manufactures germicidal ultraviolet and HEPA filtration air-treatment technologies. The legal, economic, and engineering arguments below are offered for evaluation on their merits.

The Americans with Disabilities Act changed the built environment after the nation recognized that a doorway, stair, or restroom designed for only some bodies could exclude people from work, education, commerce, and civic life. For people whose immune systems make respiratory infection unusually consequential, the barrier may be less visible but no less practical: they can enter a building and still be unable to participate safely in the activity inside it. The policy question is therefore narrow but consequential: when should cleaner indoor air be evaluated as a reasonable accommodation or modification, and when should it be treated as ordinary accessible infrastructure?

Existing federal law does not supply a universal clean-air mandate, and this paper does not assume one. It asks whether the ADA’s governing idea—remove avoidable environmental barriers so qualified people can participate— offers a useful framework for individualized accommodations, targeted public investment, and future building standards.

The ADA’s historical lesson is not that every barrier warrants the same remedy. It is that design choices can determine who gets to participate—and that the economic value of access can far exceed the cost of providing it.

In brief
Who is affected. About 7.7 million U.S. adults are moderately to severely immunocompromised; up to about 17 million report some immunosuppression.
What the law requires today. No universal clean-air standard, but individualized review of accommodations that can include engineered air.
What the evidence shows. Severe subgroups lose months of work. Each $1 billion of annualized program cost breaks even if about 0.2% of work among the clinically immunocompromised population is preserved.
What this paper asks for. Device-neutral federal guidance, a funded costing study and pilots, and performance-based targets in future building standards—with individualized ADA review preserved (see “What We Are Asking For”).

The constituency is both larger and more varied than the public discussion often suggests. CDC has historically estimated that people who are moderately to severely immunocompromised comprise about 3% of U.S. adults. A nationally representative 2021 survey published in JAMA estimated broader self-reported immunosuppression at 6.6%—roughly one in fifteen adults, or about 17 million people when applied to the adult population. The estimates should be presented as a range, not merged (Table 1).

Sizing a severity-anchored cost estimate off the broader population would overstate its plausibility.

Common pathways include active treatment for solid tumors or blood cancers; organ or stem-cell transplantation and anti-rejection therapy; moderate or severe primary immunodeficiency present from birth; advanced or untreated HIV; and high-dose corticosteroids, biologics, chemotherapy, and other immunosuppressive medicines. CDC’s clinical examples illustrate why this is not a single disease constituency.

Exclusion does not stop with the individual. Census QuickFacts reports 2.53 persons per U.S. household; applied mechanically to the broader 17 million-person constituency, that yields roughly 43 million person-household connections—a ceiling for illustration, not a precise count, and evidence that accessible air is a household- and community-level question

The ADA does not currently require every covered building to meet a single infectious-aerosol standard. It does require covered employers, public entities, and public accommodations to consider reasonable accommodations or modifications for qualifying disabilities, subject to setting-specific limits such as undue hardship, direct threat, or fundamental alteration. The analysis is individualized: a diagnosis alone does not dictate the result, and an organization may provide an effective reasonable option even if it is not the requester’s preferred option. The statute and implementing framework therefore support evaluation, not a predetermined engineering prescription.

Depending on the setting and documented need, options can include remote or hybrid participation, schedule or room changes, masking in defined circumstances, increased outdoor air, improved HVAC filtration, portable HEPA filtration, or appropriately designed germicidal ultraviolet air treatment. Each option carries its own cost, maintenance, and safety profile—germicidal UV, for instance, requires attention to wavelength selection and exposure limits—that a case-specific reasonableness analysis should weigh rather than assume away. The legal question is whether the measure is effective and reasonable in context—not whether all infection risk can be eliminated.

Courts have begun to apply this framework to respiratory vulnerability. In the Third Circuit’s nonprecedential August 2026 ruling in Gardner v. Kutztown University, a package that included specialized air filters was held reasonable as a matter of law. That outcome favored the institution’s substitute measure over the professor’s preferred remote teaching, which is precisely why it matters here: it is not binding precedent, but it is a concrete example of a federal appellate court treating engineered air-risk mitigation, on its own, as a legally sufficient accommodation. Brown and L.E. confirm that disability status and reasonableness are decided case by case. Engineering controls also avoid the compliance friction of masks, because the protection operates in the background—a reasonable inference, though not yet proven by comparative political research.

The ADA’s governing idea is to change the environment rather than the person. It grew out of Section 504 of the Rehabilitation Act of 1973 and passed with unusually broad bipartisan support before President George H.W. Bush signed it on July 26, 1990. Its most visible architectural expression, wheelchair access, serves a small share of the population—about 1.4% of Americans age 15 or older used a wheelchair or similar mobility device—and the country built it into new construction anyway. The underlying judgment was not that ramps eliminated disability; it was that design should not impose a needless barrier.

A useful economic precedent exists, although not a ramp-only ROI. DOJ’s 2010 benefit-cost analysis of the revised ADA design standards found benefits exceeding costs at both discount rates it tested (1.7-to-1 at 7%; 2.6-to-1 at 3%). The mechanism differs from the earnings-based estimates used later in this paper—those benefits were mostly user time savings—so the parallel should be read at the level of category, not magnitude: rigorous accessibility analysis can find net-positive economic value, not that a ramp’s return rate predicts an air-quality return rate.

A single national participation-loss rate for immunocompromised Americans does not exist, and applying a small arbitrary percentage to the full 17 million would obscure the real pattern: burden varies sharply, while severe subgroups can lose months or leave circulation entirely. More specific evidence provides a better anchor (Table 2).

These subgroup findings cannot be generalized to every immunocompromised person, but they support duration-based scenarios measured in months rather than fractions of a percentage point.

Using the 2024 BLS median full-time wage of $1,192 per week ($61,984 annually), the direct-earnings scale is substantial. Table 3 applies three illustrative combinations of share unavailable and duration to the narrower, 7.7 million-person clinically-severe cohort.5

These are transparent scenarios, not prevalence estimates or causal forecasts. They exclude nonworkers, part-time variation, employer output, tax receipts, replacement costs, health spending, unpaid care, and missed education. They also assume, generously, that cleaner air could recover the full loss; in practice it addresses only the infection-risk share of absence—not the fatigue, treatment toxicity, or recovery time that drive much of the leave data cited above—so realized recovery would likely be a fraction of these totals.

How to read Table 4. The scenario assumes cleaner-air measures preserve 154,000 FTE-years—2% of the narrower, 7.7 million-person cohort, bounded to the infection-risk-attributable share of the leave data cited above—worth about $9.5 billion in direct earnings. Ratios and net ROI are derived directly from that rounded figure (benefit ÷ cost; net ROI is the ratio minus 1), so every number in the table is reproducible by hand. The $10 billion row lands just below break-even: it requires 2.095% of the cohort, and the scenario assumes 2%. This remains a sensitivity analysis, not a forecast; it excludes health- care savings and spillover benefits, and it assumes the preserved work is attributable specifically to reduced infection exposure rather than to the other clinical factors that also drive leave.

The most defensible next step is to evaluate cleaner air with the same disciplines applied to other accessibility investments: define the covered setting and population; measure baseline air performance; select an equivalent- clean-air target; compare capital, operating, and maintenance costs with attendance, leave, health-utilization, and participation outcomes; and preserve individualized ADA review. Priority settings could be tested first where exclusion carries the highest consequences—health care, schools, workplaces, transportation, and essential public services.

This paper does not ask for a universal clean-air mandate. It asks for four specific actions:

If the return in some settings is genuinely this favorable, the more interesting question is why it has not already been captured voluntarily; split incentives between building owners and occupants, and the same coordination and information failures that justified the ADA’s original mandates, are the likely answers—and both point toward a policy role rather than away from one.

Cleaner indoor air should be evaluated—not assumed—as an accessibility question. Millions of people are affected; current law already requires individualized consideration of accommodations that can include engineered air; severe subgroups lose months of work; and the return depends on costs no one has yet measured. That is why this paper asks for guidance, costing, pilots, and performance-based standards rather than a mandate. For millions of people whose immune defenses are compromised by treatment, transplantation, medication, congenital disease, HIV, or other conditions, access to the air we share is now a concrete legal, engineering, and economic question.

Access to the building. Access to the air inside. Engineered air treatment—filtration, ventilation, or germicidal UV among them—can extend an accessible-design mindset from the entrance to the room itself. Illustrated conceptually.

Background and supporting detail referenced in the footnotes. Nothing here is required to follow the argument.

The legal origin story begins with Section 504 of the Rehabilitation Act of 1973, the first federal civil-rights protection against disability discrimination in federally funded programs. The ADA extended that principle across employment, state and local government, public accommodations, transportation, and communications. Its support was unusually broad: the Senate initially passed the bill 76–8; the final conference measure passed the House 377–28 and the Senate 91–6 before President George H.W. Bush signed it on July 26, 1990. Congressional action and vote history confirms that bipartisan record.

Wheelchair access became the ADA’s most visible architectural expression, even though the statute protects a much wider range of disabilities. DOJ’s demographic analysis estimated that about 1.4% of Americans age 15 or older used a wheelchair or similar mobility device. The country nonetheless made accessible routes, entrances, door clearances, parking, and restrooms routine features of new construction and alterations under the ADA Standards for Accessible Design. The underlying judgment was not that ramps eliminated disability; it was that design should not impose a needless barrier.

In 2010, DOJ commissioned a benefit-cost analysis of the revised ADA design standards (Table A1). DOJ attributed 93% of quantified benefits to time savings for users and noted additional benefits it could not monetize. These figures evaluate the 2010 revisions, not the entire 1990 ADA and not wheelchair ramps alone; they nonetheless show that accessibility rules can create measurable economic value as well as civil-rights value. The mechanism is not identical to the earnings-based estimates used in this paper—these benefits were driven by physical-navigation time savings, not preserved wages—so the parallel should be read at the level of category, not magnitude: rigorous accessibility analysis can find net-positive economic value, not that a ramp’s return rate predicts an air-quality return rate.

Net present value at 3% is benefits minus costs ($66.2 billion − $25.8 billion). Source: DOJ regulatory impact analysis of the 2010 standards (linked above).

Long COVID is best treated as a recent catalyst and an overlapping disability population: HHS and DOJ guidance states that it can qualify as a disability when it substantially limits a major life activity, but qualification remains individualized and Long COVID should not be described as universally immunocompromising.

The product is not a count of unique indirectly affected people; it is used only as evidence that accessible air is a household- and community- level question.

The mask cases also expose an implementation distinction. Mask requirements regulate visible human behavior and depend on repeated individual compliance; they became subjects of statutes, litigation, and political conflict. By contrast, NIOSH ranks engineering controls above administrative controls and personal protective equipment and notes that effective engineering controls need minimal user action. It is reasonable to infer—not yet proven by comparative political research—that well-designed ventilation, filtration, or air cleaning may encounter different and potentially lower compliance friction because the protection operates in the background.

Rounding convention: break-even FTE-years are rounded to the nearest 100; shares are computed from the rounded FTE-years; ratios and net ROI are derived from the rounded $9.5 billion benefit so that every printed figure can be reproduced by hand. All figures are scenarios or thresholds, not forecasts.

This article is a thought-leadership perspective by PJ Piper, CEO of Far UV Technologies. Far UV Technologies provides air-cleaning technologies discussed in this article.