Airborne transmission of respiratory viruses

Aerosol concentrations and size distributions during clinical dental procedures

Background

Suspected aerosol-generating dental instruments may cause risks for operators by transmitting pathogens, such as the SARS-CoV-2 virus. The aim of our study was to measure aerosol generation in various dental procedures in clinical settings.

Methods

The study population comprised of 84 patients who underwent 253 different dental procedures measured with Optical Particle Sizer in a dental office setting. Aerosol particles from 0.3 to 10 μm in diameter were measured. Dental procedures included oral examinations (N = 52), restorative procedures with air turbine handpiece (N = 8), high-speed (N = 6) and low-speed (N = 30) handpieces, ultrasonic scaling (N = 31), periodontal treatment using hand instruments (N = 60), endodontic treatment (N = 12), intraoral radiographs (N = 24), and dental local anesthesia (N = 31).

Results

Air turbine handpieces significantly elevated <1 μm particle median (p = 0.013) and maximum (p = 0.016) aerosol number concentrations as well as aerosol particle mass concentrations (p = 0.046 and p = 0.006) compared to the background aerosol levels preceding the operation. Low-speed dental handpieces elevated >5 μm median (p = 0.023), maximum (p = 0.013) particle number concentrations,> 5 μm particle mass concentrations (p = 0.021) and maximum total particle mass concentrations (p = 0.022). High-speed dental handpieces elevated aerosol concentration levels compared to the levels produced during oral examination.

Conclusions

Air turbine handpieces produced the highest levels of <1 μm aerosols and total particle number concentrations when compared to the other commonly used instruments. In addition, high- and low-speed dental handpieces and ultrasonic scalers elevated the aerosol concentration levels compared to the aerosol levels measured during oral examination. These aerosol-generating procedures, involving air turbine, high- and low-speed handpiece, and ultrasonic scaler, should be performed with caution.

Clinical significance

Aerosol generating dental instruments, especially air turbine, should be used with adequate precautions (rubber dam, high-volume evacuation, FFP-respirators), because aerosols can cause a potential risk for operators and substitution of air turbine for high-speed dental handpiece in poor epidemic situations should be considered to reduce the risk of aerosol transmission.

How the COVID-19 Pandemic Muted and Remixed the World's Acoustics for a While

PURPOSE OF REVIEW

This review aims to analyze the effects of the pandemic on the world's sound environment.

RECENT FINDINGS

The confinements associated with the pandemic led to a reduction in sound levels worldwide and a change in the perception of soundscapes in the absence of traffic noise and human-generated noise.

SUMMARY

In response to the COVID-19 pandemic, many countries and regions around the world adopted a series of interventions in 2020 that have been referred to as "lockdown" or "confinement." These sets of restrictions had a clear and obvious consequence derived from the absence of people in the streets and the reduction of daily activity and commuting, which caused an unprecedented silencing on a large scale. Along with the silence that ensued, the pandemic and the confinements affected acoustics and our relationship with sounds on different scales. In the cities, this phenomenon had a strong reduction in acoustic intensity due to the absence of vehicles on the streets. Perhaps this was more perceptible in our neighborhoods, with notable changes in their soundscapes, first due to the absence of people in the streets and later due to more outdoor activity derived from the fear of the spread of the virus in indoor spaces. The longer periods of time spent in our homes during the lockdowns also highlighted the importance of sound insulation in buildings and the acoustic conditioning of our schools or homes.

Remdesivir-related cost-effectiveness and cost and resource use evidence in COVID-19: a systematic review

Background

The coronavirus disease 2019 (COVID-19) pandemic has been a global health emergency since December 2019, leading to millions of deaths worldwide and placing significant pressures, including economic burden, on individual patients and healthcare systems. As of February 2022, remdesivir is the only US Food and Drug Administration (FDA)-approved treatment for severe COVID-19. This systematic literature review (SLR) aimed to summarise economic evaluations, and cost and resource use (CRU) evidence related to remdesivir during the COVID-19 pandemic.

Methods

Searches of MEDLINE, Embase the International Health Technology Assessment (HTA) database, reference lists, congresses and grey literature were performed in May 2021. Articles were reviewed for relevance against pre-specified criteria by two independent reviewers and study quality was assessed using published checklists.

Results

Eight studies reported resource use and five reported costs related to remdesivir. Over time, the prescription rate of remdesivir increased and time from disease onset to remdesivir initiation decreased. Remdesivir was associated with a 6% to 21.3% decrease in bed occupancy. Cost estimates for remdesivir ranged widely, from $10 to $780 for a 10-day course. In three out of four included economic evaluations, remdesivir treatment scenarios were cost-effective, ranging from ~ 8 to ~ 23% of the willingness-to-pay threshold for the respective country.

Conclusions

Economic evidence relating to remdesivir should be interpreted with consideration of the broader clinical context, including patients’ characteristics and the timing of its administration. Nonetheless, remdesivir remains an important option for physicians in aiming to provide optimal care and relieve pressure on healthcare systems through shifting phases of the pandemic.

Supplementary Information

The online version contains supplementary material available at 10.1007/s15010-022-01930-8.

Ventilation reconstruction in bathrooms for restraining hazardous plume: Mitigate COVID-19 and beyond

Converging evidence reports that the probability of vertical transmission patterns via shared drainage systems, may be responsible for the huge contactless community outbreak in high-rise buildings. Publications indicate that a faulty bathroom exhaust fan system is ineffective in removing lifted hazardous virus-laden aerosols from the toilet bowl space. Common strategies (boosting ventilation capability and applying disinfection tablets) seem unsustainable and remain to date untested. Using combined simulation and experimental approaches, we compared three ventilation schemes in a family bathroom including the traditional ceiling fan, floor fan, and side-wall fan. We found that the traditional ceiling fan was barely functional whereby aerosol particles were not being adequately removed. Conversely, a side-wall fan could function efficiently and an enhanced ventilation capability can have increased performance whereby nearly 80.9% of the lifted aerosol particles were removed. There exists a common, and easily-overlooked mistake in the layout of the bathroom, exposing occupants to a contactless vertical pathogen aerosol transmission route. Corrections and dissemination are thus imperative for the reconstruction of these types of family bathrooms. Our findings provide evidence for the bathroom and smart ventilation system upgrade, promoting indoor public health and human hygiene.

Virus transport and infection evaluation in a passenger elevator with a COVID-19 patient

Contaminant transport and flow distribution are very important during an elevator ride, as the reduced social distancing may increase the infection rate of airborne diseases such as COVID-19. Studying the airflow and contaminant concentration in an elevator is not straightforward because the flow pattern inside an elevator changes dramatically with passenger movement and frequent door opening. Since very little experimental data were available for elevators, this investigation validated the use of computational fluid dynamics (CFD) based on the RNG k-∈ $$ \in $$ turbulence model to predict airflow and contaminant transport in a scaled, empty airliner cabin with a moving passenger. The movement of the passenger in the cabin created a dynamic airflow and transient contaminant dispersion that were similar to those in an elevator. The computed results agreed reasonably well with the experimental data for the cabin. The validated CFD program was then used to calculate the distributions of air velocity, air temperature, and particle concentration during an elevator ride with an index patient. The CFD results showed that the airflow pattern in the elevator was very complex due to the downward air supply from the ceiling and upward thermal plumes generated by passengers. This investigation studied different respiratory activities of the index patient, that is, breathing only, breathing, and coughing with and without a mask, and talking. The results indicated that the risk of infection was generally low because of the short duration of the elevator ride. If the index patient talked in the elevator, two passengers in the closest proximity to distance would be infected.

A computed tomography imaging-based subject-specific whole-lung deposition model

The respiratory tract is an important route for beneficial drug aerosol or harmful particulate matter to enter the body. To assess the therapeutic response or disease risk, whole-lung deposition models have been developed, but were limited by compartment, symmetry or stochastic approaches. In this work, we proposed an imaging-based subject-specific whole-lung deposition model. The geometries of airways and lobes were segmented from computed tomography (CT) lung images at total lung capacity (TLC), and the regional air-volume changes were calculated by registering CT images at TLC and functional residual capacity (FRC). The geometries were used to create the structure of entire subject-specific conducting airways and acinar units. The air-volume changes were used to estimate the function of subject-specific ventilation distributions among acinar units and regulate flow rates in respiratory airway models. With the airway dimensions rescaled to a desired lung volume and the airflow field simulated by a computational fluid dynamics model, particle deposition fractions were calculated using deposition probability formulae adjusted with an enhancement factor to account for the effects of secondary flow and airway geometry in proximal airways. The proposed model was validated in silico against existing whole-lung deposition models, three-dimensional (3D) computational fluid and particle dynamics (CFPD) for an acinar unit, and 3D CFPD deep lung model comprising conducting and respiratory regions. The model was further validated in vivo against the lobar particle distribution and the coefficient of variation of particle distribution obtained from CT and single-photon emission computed tomography (SPECT) images, showing good agreement. Subject-specific airway structure increased the deposition fraction of 10.0-μm particles and 0.01-μm particles by approximately 10%. An enhancement factor increased the overall deposition fractions, especially for particle sizes between 0.1 and 1.0 μm.

SARS-CoV-2 indoor environment contamination with epidemiological and experimental investigations

SARS-CoV-2 has been detected both in air and on surfaces, but questions remain about the patient-specific and environmental factors affecting virus transmission. Additionally, more detailed information on viral sampling of the air is needed. This prospective cohort study (N = 56) presents results from 258 air and 252 surface samples from the surroundings of 23 hospitalized and eight home-treated COVID-19 index patients between July 2020 and March 2021 and compares the results between the measured environments and patient factors. Additionally, epidemiological and experimental investigations were performed. The proportions of qRT-PCR-positive air (10.7% hospital/17.6% homes) and surface samples (8.8%/12.9%) showed statistical similarity in hospital and homes. Significant SARS-CoV-2 air contamination was observed in a large (655.25 m³ ) mechanically ventilated (1.67 air changes per hour, 32.4-421 L/s/patient) patient hall even with only two patients present. All positive air samples were obtained in the absence of aerosol-generating procedures. In four cases, positive environmental samples were detected after the patients had developed a neutralizing IgG response. SARS-CoV-2 RNA was detected in the following particle sizes: 0.65-4.7 μm, 7.0-12.0 μm, >10 μm, and <100 μm. Appropriate infection control against airborne and surface transmission routes is needed in both environments, even after antibody production has begun.

Current clinical status of new COVID-19 vaccines and immunotherapy

COVID-19, caused by SARS-CoV-2, is a positive-strand RNA belonging to Coronaviridae family, along with MERS and SARS. Since its first report in 2019 in Wuhan, China, it has affected over 530 million people and led to 6.3 million deaths worldwide until June 2022. Despite eleven vaccines being used worldwide already, new variants are of concern. Therefore, the governing bodies are re-evaluating the strategies for achieving universal vaccination. Initially, the WHO expected that vaccines showing around 50-80% efficacy would develop in 1-2 years. However, US-FDA announced emergency approval of the two m-RNA vaccines within 11 months of vaccine development, which enabled early vaccination for healthcare workers in many countries. Later, in January 2021, 63 vaccine candidates were under human clinical trials and 172 under preclinical development. Currently, the number of such clinical studies is still increasing. In this review, we have summarized the updates on the clinical status of the COVID-19 and the available treatments. Additionally, COVID-19 had created negative impacts on world's economy; affected agriculture, industries, and tourism service sectors; and majorly affected low-income countries. The review discusses the clinical outcomes, latest statistics, socio-economic impacts of pandemic and treatment approaches against SARS-CoV-2, and strategies against the new variant of concern. The review will help understand the current status of vaccines and other therapies while also providing insights about upcoming vaccines and therapies for COVID-19 management.

Improving Estimates of Social Contact Patterns for Airborne Transmission of Respiratory Pathogens

Data on social contact patterns are widely used to parameterize age-mixing matrices in mathematical models of infectious diseases. Most studies focus on close contacts only (i.e., persons spoken with face-to-face). This focus may be appropriate for studies of droplet and short-range aerosol transmission but neglects casual or shared air contacts, who may be at risk from airborne transmission. Using data from 2 provinces in South Africa, we estimated age mixing patterns relevant for droplet transmission, nonsaturating airborne transmission, and Mycobacterium tuberculosis transmission, an airborne infection where saturation of household contacts occurs. Estimated contact patterns by age did not vary greatly between the infection types, indicating that widespread use of close contact data may not be resulting in major inaccuracies. However, contact in persons >50 years of age was lower when we considered casual contacts, and therefore the contribution of older age groups to airborne transmission may be overestimated.

Impact of COVID-19 vaccination on transmission risk of breakthrough infections: Lessons from adapted N95 mask sampling for emerging variants and interventions

This study used an adapted N95 mask sampling to understand the effect of COVID-19 vaccination in the context of circulating variants on infected individuals to emit the virus into the air, a key risk factor of transmission. Mask, swab, and blood samples were collected from 92 COVID-19 patients vaccinated (Covishield/COVAXIN-partial/fully) or unvaccinated between July and September 2021 during the Delta-dominated period in Mumbai. Mask/swab samples were analyzed by reverse transcription polymerase chain reaction for viral RNA. Blood was evaluated for SARS-CoV-2 anti-spike and nucleocapsid antibody responses. At <48 h of diagnosis, 93% of the patients emitted detectable viral RNA, with 40% emitting >1000 copies in 30 min (high emitters). About 8% continued to be high emitters even after 8 days of symptom onset. No significant difference was observed in emission patterns between partial, full, and unvaccinated patients. However, when vaccinated patients were stratified based on spike protein neutralization and nucleocapsid immunoglobulin G (IgG), the group with moderate/high neutralization showed a significantly lower proportion of high emitters and viral RNA copies than the group with no/low neutralization, which further reduced in the group having antinucleocapsid IgG. In conclusion, mask sampling showed that Delta infections were associated with greater virus emission in patients, which was significantly reduced only in vaccinated patients with moderate/high SARS-CoV-2 neutralization, especially with evidence of past infection. The study demonstrated that mask sampling could be useful for understanding the transmission risk of emerging variants, screening vaccine/booster candidates, and guiding control interventions.

Lessons Learned from the COVID-19 Pandemic and How Blood Operators Can Prepare for the Next Pandemic

Humans interact with virus-infected animal hosts, travel globally, and maintain social networks that allow for novel viruses to emerge and develop pandemic potential. There are key lessons-learned from the coronavirus diseases 2019 (COVID-19) pandemic that blood operators can apply to the next pandemic. Warning signals to the COVID-19 pandemic included outbreaks of Severe acute respiratory syndrome-related coronavirus-1 (SARS-CoV-1) and Middle East respiratory syndrome-related coronavirus (MERS-CoV) in the prior two decades. It will be critical to quickly determine whether there is a risk of blood-borne transmission of a new pandemic virus. Prior to the next pandemic blood operators should be prepared for changes in activities, policies, and procedures at all levels of the organization. Blood operators can utilize "Plan-Do-Study-Act" cycles spanning from: vigilance for emerging viruses, surveillance activities and studies, operational continuity, donor engagement and trust, and laboratory testing if required. Occupational health and donor safety issues will be key areas of focus even if the next pandemic virus is not transfusion transmitted. Blood operators may also be requested to engage in new activities such as the development of therapeutics or supporting public health surveillance activities. Activities such as scenario development, tabletop exercises, and drills will allow blood operators to prepare for the unknowns of the next pandemic.

Ultrathin fluoroacrylic coating wrapped microporous non-woven fabrics as efficient air filtration membranes

Ultrathin fluoroacrylic emulsion coating wrapped effective microporous non-woven air filtration membranes of 0.2 μm thickness were made for PPE masks with up to 99.9% filtration efficiencies for both 0.3 μm NaCl aerosol particles and oily DEHS aerosols. An ultrasonic dip-coating process was applied for the controllable formation of a nano-protrusion morphology on the fiber surface.

Impact of washing parameters on bacterial filtration efficiency and breathability of community and medical facemasks

Can medical face masks be replaced by reusable community face masks with similar performance? The influence of the number of wash cycles, the wash temperature and the use of detergent was evaluated on the performance of one medical face masks (MFM) and ten community face masks (CFM). The performance of the new and washed masks was characterized from the bacterial filtration efficiency (BFE) and the differential pressure (DP). The tests on the new masks showed that the MFM had always better BFE than CFMs. Although two of the CFMs showed a BFE value exceeding 95%, only one can be classified as type I MFM based on both BFE and DP requirements. The influence of the washing parameters was investigated on the MFM and these two CMFs with excellent BFE properties. The parameters had no effect on the BFE of CFMs whilst the MFM exhibited a loss in efficiency when washed with detergent. The DP of masks were not impacted by the washing. The results clearly show that even though a compromise has to be made between the BFE and breathability, it seems possible to manufacture CFMs with performances similar to a type I MFM, without achieving type II requirements.

Cumulative incidence, prevalence, seroconversion, and associated factors for SARS-CoV-2 infection among healthcare workers of a University Hospital in Bogotá, Colombia

This study aimed to determine the cumulative incidence, prevalence, and seroconversion of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) and its associated factors among healthcare workers (HCWs) of a University Hospital in Bogotá, Colombia. An ambispective cohort was established from March 2020 to February 2021. From November 2020 to February 2021, SARS-CoV-2 antibodies were measured on two occasions 14-90 days apart to determine seroprevalence and seroconversion. We used multivariate log-binomial regression to evaluate factors associated with SARS-CoV-2 infection. Among 2,597 HCWs, the cumulative incidence of infection was 35.7%, and seroprevalence was 21.5%. A reduced risk of infection was observed among those aged 35-44 and ≥45 years (adjusted relative risks [aRRs], 0.84 and 0.83, respectively), physicians (aRR, 0.77), those wearing N95 respirators (aRR, 0.82) and working remotely (aRR, 0.74). Being overweight (aRR, 1.18) or obese (aRR, 1.24); being a nurse or nurse assistant (aRR, 1.20); working in the emergency room (aRR, 1.45), general wards (aRR, 1.45), intensive care unit (aRR, 1.34), or COVID-19 areas (aRR, 1.17); and close contact with COVID-19 cases (aRR, 1.47) increased the risk of infection. The incidence of SARS-CoV-2 infection found in this study reflects the dynamics of the first year of the pandemic in Bogotá. A high burden of infection calls for strengthening prevention and screening measures for HCWs, focusing especially on those at high risk.

SARS-CoV-2 in the Air Surrounding Patients during Nebulizer Therapy

Nebulizer therapy is commonly used for patients with obstructive pulmonary disease or acute pulmonary infections with signs of obstruction. It is considered a "potential aerosol-generating procedure," and the risk of disease transmission to health care workers is uncertain. The aim of this pilot study was to assess whether nebulizer therapy in hospitalized COVID-19 patients is associated with increased dispersion of SARS-CoV-2. Air samples collected prior to and during nebulizer therapy were analyzed by RT-PCR and cell culture. Total aerosol particle concentrations were also quantified. Of 13 patients, seven had quantifiable virus in oropharynx samples, and only two had RT-PCR positive air samples. For both these patients, air samples collected during nebulizer therapy had higher SARS-CoV-2 RNA concentrations compared to control air samples. Also, for particle sizes 0.3-5 µm, particle concentrations were significantly higher during nebulizer therapy than in controls. We were unable to cultivate virus from any of the RT-PCR positive air samples, and it is therefore unknown if the detected virus were replication-competent; however, the significant increase in smaller particles, which can remain airborne for extended periods of time, and increased viral RNA concentrations during treatment may indicate that nebulizer therapy is associated with increased risk of SARS-CoV-2 transmission.

Associative evidence for the potential of humidification as a non-pharmaceutical intervention for influenza and SARS-CoV-2 transmission

BACKGROUND

Both influenza and SARS-CoV-2 viruses show a strong seasonal spreading in temperate regions. Several studies indicated that changes in indoor humidity could be one of the key factors explaining this.

OBJECTIVE

The purpose of this study is to quantify the association between relevant epidemiological metrics and humidity in both influenza and SARS-CoV-2 epidemic periods.

METHODS

The atmospheric dew point temperature serves as a proxy for indoor relative humidity. This study considered the weekly mortality rate in the Netherlands between 1995 and 2019 to determine the correlation between the dew point and the spread of influenza. During influenza epidemic periods in the Netherlands, governmental restrictions were absent; therefore, there is no need to control this confounder. During the SARS-CoV-2 pandemic, governmental restrictions strongly varied over time. To control this effect, periods with a relatively constant governmental intervention level were selected to analyze the reproduction rate. We also examine SARS-CoV-2 deaths in the nursing home setting, where health policy and social factors were less variable. Viral transmissibility was measured by computing the ratio between the estimated daily number of infectious persons in the Netherlands and the lagged mortality figures in the nursing homes.

RESULTS

For both influenza and SARS-CoV-2, a significant correlation was found between the dew point temperature and the aforementioned epidemiological metrics. The findings are consistent with the anticipated mechanisms related to droplet evaporation, stability of virus in the indoor environment, and impairment of the natural defenses of the respiratory tract in dry air.

SIGNIFICANCE

This information is helpful to understand the seasonal pattern of respiratory viruses and motivate further study to what extent it is possible to alter the seasonal pattern by actively intervening in the adverse role of low humidity during fall and winter in temperate regions.

IMPACT

A solid understanding and quantification of the role of humidity on the transmission of respiratory viruses is imperative for epidemiological modeling and the installation of non-pharmaceutical interventions. The results of this study indicate that improving the indoor humidity by humidifiers could be a promising technology for reducing the spread of both influenza and SARS-CoV-2 during winter and fall in the temperate zone. The identification of this potential should be seen as a strong motivation to invest in further prospective testing of this non-pharmaceutical intervention.

Characterizing respiratory aerosol emissions during sustained phonation

OBJECTIVE

To elucidate the role of phonation frequency (i.e., pitch) and intensity of speech on respiratory aerosol emissions during sustained phonations.

METHODS

Respiratory aerosol emissions are measured in 40 (24 males and 16 females) healthy, non-trained singers phonating the phoneme /a/ at seven specific frequencies at varying vocal intensity levels.

RESULTS

Increasing frequency of phonation was positively correlated with particle production (r = 0.28, p < 0.001). Particle production rate was also positively correlated (r = 0.37, p < 0.001) with the vocal intensity of phonation, confirming previously reported findings. The primary mode (particle diameter ~0.6 μm) and width of the particle number size distribution were independent of frequency and vocal intensity. Regression models of the particle production rate using frequency, vocal intensity, and the individual subject as predictor variables only produced goodness of fit of adjusted R² = 40% (p < 0.001). Finally, it is proposed that superemitters be defined as statistical outliers, which resulted in the identification of one superemitter in the sample of 40 participants.

SIGNIFICANCE

The results suggest there remain unexplored effects (e.g., biomechanical, environmental, behavioral, etc.) that contribute to the high variability in respiratory particle production rates, which ranged from 0.2 particles/s to 142 particles/s across all trials. This is evidenced as well by changes in the distribution of participant particle production that transitions to a more bimodal distribution (second mode at particle diameter ~2 μm) at higher frequencies and vocal intensity levels.

COVID-19 mortality and excess mortality among working-age residents in California, USA, by occupational sector: a longitudinal cohort analysis of mortality surveillance data

BACKGROUND

During the first year of the COVID-19 pandemic, workers in essential sectors had higher rates of SARS-CoV-2 infection and COVID-19 mortality than those in non-essential sectors. It is unknown whether disparities in pandemic-related mortality across occupational sectors have continued to occur during the periods of SARS-CoV-2 variants and vaccine availability.

METHODS

In this longitudinal cohort study, we obtained data from the California Department of Public Health on all deaths occurring in the state of California, USA, from Jan 1, 2016, to Dec 31, 2021. We restricted our analysis to residents of California who were aged 18-65 years at time of death and died of natural causes. We classified the occupational sector into nine essential sectors; non-essential; or unemployed or without an occupation provided on the death certificate. We calculated the number of COVID-19 deaths in total and per capita that occurred in each occupational sector. Separately, using autoregressive integrated moving average models, we estimated total, per-capita, and relative excess natural-cause mortality by week between March 1, 2020, and Nov 30, 2021, stratifying by occupational sector. We additionally stratified analyses of occupational risk into counties with high versus low vaccine uptake, categorising high-uptake regions as counties where at least 50% of the population were fully vaccinated according to US guidelines by Aug 1, 2021.

FINDINGS

From March 1, 2020, to Nov 30, 2021, 24 799 COVID-19 deaths were reported in residents of California aged 18-65 years and an estimated 28 751 (95% prediction interval 27 853-29 653) excess deaths. People working in essential sectors were associated with higher COVID-19 deaths and excess deaths than were those working in non-essential sectors, with the highest per-capita COVID-19 mortality in the agriculture (131·8 per 100 000 people), transportation or logistics (107·1 per 100 000), manufacturing (103·3 per 100 000), facilities (101·1 per 100 000), and emergency (87·8 per 100 000) sectors. Disparities were wider during periods of increased infections, including during the Nov 29, 2020, to Feb 27, 2021, surge in infections, which was driven by the delta variant (B.1.617.2) and occurred during vaccine uptake. During the June 27 to Nov 27, 2021 surge, emergency workers had higher COVID-19 mortality (113·7 per 100 000) than workers from any other sector. Workers in essential sectors had the highest COVID-19 mortality in counties with low vaccination uptake, a difference that was more pronounced during the period of the delta infection surge during Nov 29, 2020, to Feb 27, 2021.

INTERPRETATION

Workers in essential sectors have continued to bear the brunt of high COVID-19 and excess mortality throughout the pandemic, particularly in the agriculture, emergency, manufacturing, facilities, and transportation or logistics sectors. This high death toll has continued during periods of vaccine availability and the delta surge. In an ongoing pandemic without widespread vaccine coverage and with anticipated threats of new variants, the USA must actively adopt policies to more adequately protect workers in essential sectors.

FUNDING

US National Institute on Aging, Swiss National Science Foundation, and US National Institute on Drug Abuse.

HEPA filters for airliner cabins: State of the art and future development

The airliner cabin environment is very important to the health of passengers and crew members, and the use of high-efficiency particulate air (HEPA) filters for recirculated air in the environmental control systems (ECS) is essential for the removal of airborne particles such as SARS CoV-2 aerosols. A HEPA filter should be high efficiency, low-pressure drop, high dust-holding capacity (DHC), lightweight, and strong for use in aircraft. We conducted an experimental study on 23 HEPA filters with glass fiber media that are used in different commercial airliner models. The tested filters had a median filtration efficiency of >99.97% for particles with a diameter of 0.3-0.5 μm, a pressure drop of 134-412 Pa at rated airflow rate, and a DHC of 32.2-37.0 g/m² . The use of nanofiber media instead of glass fiber media can reduce the pressure drop by 66.4%-94.3% and significantly increase the quality factor by analysis of literature data. The disadvantages of poor fire resistance and small DHC can be overcome by the use of flame-retardant polymers and fiber structural design. As a new lightweight and environmentally friendly filter material, nanofiber media could be used as air filters in ECS in the future.

Pulmonary function testing during SARS-CoV-2: An ANZSRS/TSANZ position statement

The Thoracic Society of Australia and New Zealand (TSANZ) and the Australian and New Zealand Society of Respiratory Science (ANZSRS) commissioned a joint position paper on pulmonary function testing during coronavirus disease 2019 (COVID-19) in July 2021. A working group was formed via an expression of interest to members of both organizations and commenced work in September 2021. A rapid review of the literature was undertaken, with a 'best evidence synthesis' approach taken to answer the research questions formed. This allowed the working group to accept findings of prior relevant reviews or societal document where appropriate. The advice provided is for providers of pulmonary function tests across all settings. The advice is intended to supplement local infection prevention and state, territory or national directives. The working group's key messages reflect a precautionary approach to protect the safety of both healthcare workers (HCWs) and patients in a rapidly changing environment. The decision on strategies employed may vary depending on local transmission and practice environment. The advice is likely to require review as evidence grows and the COVID-19 pandemic evolves. While this position statement was contextualized specifically to the COVID-19 pandemic, the working group strongly advocates that any changes to clinical/laboratory practice, made in the interest of optimizing the safety and well-being of HCWs and patients involved in pulmonary function testing, are carefully considered in light of their potential for ongoing use to reduce transmission of other droplet and/or aerosol borne diseases.

Maintaining differential pressure gradients does not increase safety inside modern BSL-4 laboratories

This article discusses a previously unrecognized contradiction in the design of biosafety level-4 (BSL-4) suit laboratories, also known as maximum or high containment laboratories. For decades, it is suggested that both directional airflow and pressure differentials are essential safety measures to prevent the release of pathogens into the environment and to avoid cross-contamination between laboratory rooms. Despite the absence of an existing evidence-based risk analyses demonstrating increased safety by directional airflow and pressure differentials in BSL-4 laboratories, they were anchored in various national regulations. Currently, the construction and operation of BSL-4 laboratories are subject to rigorous quality and technical requirements including airtight containment. Over time, BSL-4 laboratories evolved to enormously complex technical infrastructures. With the aim to counterbalance this development towards technical simplification while still maintaining maximum safety, we provide a detailed risk analysis by calculating pathogen mitigation in maximum contamination scenarios. The results presented and discussed herein, indicate that both directional airflow or a differential pressure gradient in airtight rooms within a secondary BSL-4 containment do not increase biosafety, and are not necessary. Likewise, reduction of pressure zones from the outside into the secondary containment may also provide sufficient environmental protection. We encourage laboratory design professionals to consider technical simplification and policymakers to adapt corresponding legislation and regulations surrounding directional airflow and pressure differentials for technically airtight BSL-4 laboratories.

Modelling airborne transmission of SARS-CoV-2 at a local scale

The coronavirus disease (COVID-19) pandemic has changed our lives and still poses a challenge to science. Numerous studies have contributed to a better understanding of the pandemic. In particular, inhalation of aerosolised pathogens has been identified as essential for transmission. This information is crucial to slow the spread, but the individual likelihood of becoming infected in everyday situations remains uncertain. Mathematical models help estimate such risks. In this study, we propose how to model airborne transmission of SARS-CoV-2 at a local scale. In this regard, we combine microscopic crowd simulation with a new model for disease transmission. Inspired by compartmental models, we describe virtual persons as infectious or susceptible. Infectious persons exhale pathogens bound to persistent aerosols, whereas susceptible ones absorb pathogens when moving through an aerosol cloud left by the infectious person. The transmission depends on the pathogen load of the aerosol cloud, which changes over time. We propose a ‘high risk’ benchmark scenario to distinguish critical from non-critical situations. A parameter study of a queue shows that the new model is suitable to evaluate the risk of exposure qualitatively and, thus, enables scientists or decision-makers to better assess the spread of COVID-19 and similar diseases.

From the nose to the lungs: the intricate journey of airborne pathogens amidst commensal bacteria

The recent COVID-19 pandemic has dramatically brought the pitfalls of airborne pathogens to the attention of the scientific community. Not only viruses but also bacteria and fungi may exploit air transmission to colonize and infect potential hosts and be the cause of significant morbidity and mortality in susceptible populations. The efforts to decipher the mechanisms of pathogenicity of airborne microbes have brought to light the delicate equilibrium that governs the homeostasis of mucosal membranes. The microorganisms already thriving in the permissive environment of the respiratory tract represent a critical component of this equilibrium and a potent barrier to infection by means of direct competition with airborne pathogens or indirectly via modulation of the immune response. Moving down the respiratory tract, physicochemical and biological constraints promote site-specific expansion of microbes that engage in cross talk with the local immune system to maintain homeostasis and promote protection. In this review, we critically assess the site-specific microbial communities that an airborne pathogen encounters in its hypothetical travel along the respiratory tract and discuss the changes in the composition and function of the microbiome in airborne diseases by taking fungal and SARS-CoV-2 infections as examples. Finally, we discuss how technological and bioinformatics advancements may turn microbiome analysis into a valuable tool in the hands of clinicians to predict the risk of disease onset, the clinical course, and the response to treatment of individual patients in the direction of personalized medicine implementation.

Clinical Progression and Outcome of Hospitalized Patients Infected with SARS-CoV-2 Omicron Variant in Shanghai, China

Background: Studies on the Omicron variant infection have generally been restricted to descriptions of its initial clinical and epidemiological characteristics. We investigated the timeline-related progression and clinical outcome in hospitalized individuals with the Omicron variant. Methods: We conducted a retrospective, single-centered study including 226 laboratory-confirmed cases with the Omicron variant between 6 April and 11 May 2022 in Shanghai, China. The final date of follow-up was 30 May 2022. Results: Among 226 enrolled patients, the median age was 52 years, and 118 (52.2%) were female. The duration from onset of symptoms to hospitalization was 3 days (interquartile range (IQR): 2–4 days) for symptomatic patients. Cough occurred in 168 patients (74.3%). The median interval to negative reverse-transcriptase PCR tests of nasopharynx swab was 10 days ((IQR): 8–13 days). No radiographic progressions were found in 196 patients on the 7th day after onset of symptoms. The median duration of fever in all participants was 5 days (IQR: 4–6 days). The median PCR conversion time of Paxlovid-treated patients was 8 days (IQR: 7–10 days) compared with that of a traditional Chinese herb medicine lianhuaqingwen (10 days, IQR: 8–13 days) (p = 0.00056). Booster vaccination can significantly decrease the severity of Omicron infection when compared with unvaccinated patients (p = 0.009). In multivariate logistic analysis, erythrocyte sedimentation rate (ESR) (OR = 1.05) was independently related to the severity of the infection. Conclusions: The majority of clinical symptoms of Omicron infection were not severe. Early and aggressive administration of Paxlovid can significantly reduce the PCR conversion time. Booster vaccination should also be highly recommended in the population over 14 years old.

Expansion of droplets during speaking and singing in Japanese

During the COVID-19 pandemic, a number of infection clusters associated with choral singing have been reported. Singing generates droplets and carries the risk of spreading infection. However, no reports have explored droplet flight and aerosol production rates by singing and speaking in Japanese. First, we conducted an observation experiment evaluating the maximum flight distance and number of droplets generated by singing in Japanese, using a high-speed camera and particle counter. Twenty amateur choir members, 10 male and 10 female (five members for each of the four voices), participated in the experiment. Subsequently, although the maximum distance that droplets traveled by singing in Japanese was 61 cm for men (median of 46.5, interquartile range, 36–57) and 56 cm for women (median of 27.5, interquartile range, 20–50), droplets were observed anteriorly and laterally to be up to 66.8 cm. At the singer’s mouth, ≥ 5 μm droplets were observed, whereas not observed at 1 meter toward the front of the singers in women and men, respectively. In German singing, droplets were observed up to 111 cm toward the front of the singer, possibly reflecting differences in pronunciation. In Japanese reading aloud, droplets were also observed up to 47 cm toward the front, whereas no droplet dispersion was observed by speaking the Japanese /a/ vowel or singing with wearing surgical mask toward the front. The aerosols produced when reading singing the /u/ vowels were significantly higher than those in other vowels. When singing in a choral group, keeping a sufficient distance at the front and side is recommended in minimizing infectious spread. If distance is not possible, practicing with /a/ vowels and avoiding consonants may be an alternative method. Our observations lasted only 50 seconds per song, and further observational studies are needed to determine the dynamics of aerosols that stay for long periods.

Reducing the Effectiveness of Ward Particulate Matter, Bacteria and Influenza Virus by Combining Two Complementary Air Purifiers

Air purifiers should pay much attention to hospital-associated infections, but the role of a single air purifier is limited. The goal of this study was to evaluate the effectiveness of the combined application of the nonequilibrium positive and negative oxygen ion purifier (PNOI) and the high-efficiency particulate air filter (HEPA) on a complex, polluted environment. Two of the better performing purifiers were selected before the study. The efficacy of their use alone and in combination for purification of cigarette particulate matter (PM), Staphylococcus albicans, and influenza virus were then evaluated under a simulated contaminated ward. PNAI and HEPA alone are deficient. However, when they were combined, they achieved 98.44%, 99.75%, and 100% 30 min purification rates for cigarette PM, S. albus, and influenza virus, respectively. The purification of pollution of various particle sizes and positions was optimized and reduced differentials, and a subset of airborne influenza viruses is inactivated. Furthermore, they were superior to ultraviolet disinfection for microbial purification in air. This work demonstrates the strong purification capability of the combined application of these two air purifiers for complex air pollution, which provides a new idea for infection control in medical institutions.

Support for mask use as a COVID-19 public health measure among a large sample of Canadian secondary school students

BACKGROUND

Youth voice has been largely absent from deliberations regarding public health measures intended to prevent SARS-CoV-2 transmission, despite being one of the populations most impacted by school-based policies. To inform public health strategies and messages, we examined the level of student support of mask use in public spaces and school mask requirements, as well as factors associated with students' perspectives.

METHODS

We used cross-sectional survey data from 42,767 adolescents attending 133 Canadian secondary schools that participated in the COMPASS study during the 2020/2021 school year. Multinomial regression models assessed support for i) wearing a mask in indoor public spaces and ii) schools requiring students to wear masks, in association with COVID-19 knowledge, concerns, and perceived risk.

RESULTS

Wearing masks in indoor public spaces was supported by 81.9% of students; 8.7% were unsupportive and 9.4% were neutral/undecided. School mask requirements were supported by 67.8%, with 23.1% neutral and 9.1% unsupportive. More females supported mask wearing in public spaces (83.9% vs. 79.1%) and school mask requirements (70.8% vs. 63.5%) than males. Students had increased odds of supporting mask use in public spaces and school mask requirements if they reported concerns about their own or their family's health, had discussions regarding ways to prevent infection, perceived COVID-19 to be a risk to young people, and knew that signs are not always present in COVID-19 cases and that masks prevent SARS-CoV-2 transmission if someone coughs.

CONCLUSIONS

During the year following the beginning of the pandemic, most students supported the required use of masks in schools and wearing masks in indoor public spaces. Improving knowledge around the effectiveness of masks appears likely to have the largest impact on mask support in adolescent populations among the factors studied.

Numerical simulation of air age in dental offices

Dental professionals are at high risk of exposure to communicable diseases during clinical practice, but many dental clinics provide clinical care in closed spaces. Therefore, it is essential to develop efficient ventilation methods in dental clinics that do not rely on natural ventilation. In this study, to clarify the factors that cause air retention in dental offices, we conducted computational flow dynamics simulations focusing on (1) the flow path from the entrance to the exhaust port and (2) the presence of partitions. A three-dimensional model of a dental clinic with three dental chairs was created, and simulations were conducted for scenarios with and without partitions with different entrance and exhaust port positions. Evaluation of these simulations on the basis of the age of air, an indicator of ventilation efficiency, showed that the value of the air age near the partition was locally high in the scenarios with partitions. In the scenarios where the exhaust port was located close to the entrance, the air age near the exhaust port was high, regardless of the presence of a partition. In addition to wearing protective clothing and sterilizing instruments, it is important to consider air quality improvement as a countermeasure against airborne and droplet infections, such as virus infections, in dental clinics.

Antiviral effect of cetylpyridinium chloride in mouthwash on SARS-CoV-2

Cetylpyridinium chloride (CPC), a quaternary ammonium compound, which is present in mouthwash, is effective against bacteria, fungi, and enveloped viruses. This study was conducted to explore the antiviral effect of CPC on SARS-CoV-2. There are few reports on the effect of CPC against wild-type SARS-CoV-2 at low concentrations such as 0.001%–0.005% (10–50 µg/mL). Interestingly, we found that low concentrations of CPC suppressed the infectivity of human isolated SARS-CoV-2 strains (Wuhan, Alpha, Beta, and Gamma) even in saliva. Furthermore, we demonstrated that CPC shows anti-SARS-CoV-2 effects without disrupting the virus envelope, using sucrose density analysis and electron microscopic examination. In conclusion, this study provided experimental evidence that CPC may inhibit SARS-CoV-2 infection even at lower concentrations.

Enhancing search efficiency through diffusive echo

Despite having been studied for decades, first passage processes remain an active area of research. In this contribution we examine a particle diffusing in an annulus with an inner absorbing boundary and an outer reflective boundary. We obtain analytic expressions for the joint distribution of the hitting time and the hitting angle in two and three dimensions. For certain configurations we observe a ``diffusive echo", i.e. two well-defined maxima in the first passage time distribution to a targeted position on the absorbing boundary. This effect, which results from the interplay between the starting location and the environmental constraints, may help to significantly increase the efficiency of the random search by generating a high, sustained flux to the targeted position over a short period. Finally, we examine the corresponding one-dimensional system for which there is no well-defined echo. In a confined system, the flux integrated over all target positions always displays a shoulder. This does not, however, guarantee the presence of an echo in the joint distribution.

Mucosal immunity: The missing link in comprehending SARS-CoV-2 infection and transmission

SARS-CoV-2 is primarily an airborne infection of the upper respiratory tract, which on reaching the lungs causes the severe acute respiratory disease, COVID-19. Its first contact with the immune system, likely through the nasal passages and Waldeyer's ring of tonsils and adenoids, induces mucosal immune responses revealed by the production of secretory IgA (SIgA) antibodies in saliva, nasal fluid, tears, and other secretions within 4 days of infection. Evidence is accumulating that these responses might limit the virus to the upper respiratory tract resulting in asymptomatic infection or only mild disease. The injectable systemic vaccines that have been successfully developed to prevent serious disease and its consequences do not induce antibodies in mucosal secretions of naïve subjects, but they may recall SIgA antibody responses in secretions of previously infected subjects, thereby helping to explain enhanced resistance to repeated (breakthrough) infection. While many intranasally administered COVID vaccines have been found to induce potentially protective immune responses in experimental animals such as mice, few have demonstrated similar success in humans. Intranasal vaccines should have advantage over injectable vaccines in inducing SIgA antibodies in upper respiratory and oral secretions that would not only prevent initial acquisition of the virus, but also suppress community spread via aerosols and droplets generated from these secretions.

Nanocellulose-based membrane as a potential material for high performance biodegradable aerosol respirators for SARS-CoV-2 prevention: a review

The controversy surrounding the transmission of COVID-19 in 2020 has revealed the need to better understand the airborne transmission route of respiratory viruses to establish appropriate strategies to limit their transmission. The effectiveness in protecting against COVID-19 has led to a high demand for face masks. This includes the single-use of non-degradable masks and Filtering Facepiece Respirators by a large proportion of the public, leading to environmental concerns related to waste management. Thus, nanocellulose-based membranes are a promising environmental solution for aerosol filtration due to their biodegradability, renewability, biocompatibility, high specific surface area, non-toxicity, ease of functionalization and worldwide availability. Although the technology for producing high-performance aerosol filter membranes from cellulose-based materials is still in its initial stage, several promising results show the prospects of the use of this kind of materials. This review focuses on the overview of nanocellulose-based filter media, including its processing, desirable characteristics and recent developments regarding filtration, functionalization, biodegradability, and mechanical behavior. The porosity control, surface wettability and surface functional groups resulting from the silylation treatment to improve the filtration capacity of the nanocellulose-based membrane is discussed. Future research trends in this area are planned to develop the air filter media by reinforcing the filter membrane structure of CNF with CNCs. In addition, the integration of sol-gel technology into the production of an air filter can tailor the pore size of the membrane for a viable physical screening solution in future studies.

Graphical abstract

Crowdsourcing homemade facemasks: 772 U.S. health facilities' responses to personal protective equipment shortages in the first half of 2020

Purpose

We examined 772 U.S. health facilities' responses to Personal Protective Equipment (PPE) shortages in the first half of 2020, as they crowdsourced face coverings from volunteer makers to be used as respiratory protection during crisis surge capacity. The purpose was to examine facemask specification requests from health facilities and develop a framework for crowdsourcing last resort PPE.

Design/methodology/approach

Homemade facemask donation requests from health facilities in 47 states systematically recorded in a public database maintained by public health graduate students at a major U.S. university were analysed. Open coding was used to content analyse facemask types and specifications, intended uses, delivery logistics and donation management strategies.

Findings

Our analysis revealed information gaps: Science‐based information was scarce in 2020, leading to improvised specifications for facemask materials and designs. It also revealed the emergence of a crowdsourcing structure: Task specifications for volunteer facemasks makers, delivery logistics, and practical management of donations within the pandemic context. In anticipation of future pandemics and localised PPE shortages, we build on this empirical evidence to propose a framework for crowdsourcing science‐informed facemasks from volunteers. Categorised within (a) logistics and workflow management, (b) task specifications and management, and (c) practical management of contributions functional areas, the framework outlines the required tasks and specifications for crowdsourcing.

Originality

A novel empirically derived framework for crowdsourcing homemade facemasks is proposed, based on empirical analysis and crowdsourcing system design strategies. Our findings and the framework may be used for refining crisis capacity guidelines, as part of strategic planning and preparation for future pandemics that disrupt supply chains and cause shortages in protective equipment.

At least 772 health facilities in 47 U.S. states experienced Personal Protective Equipment (PPE) shortages in 2020.

During crisis surge capacity, they crowdsourced homemade masks from volunteers.

The database shows information gaps and an emerging crowdsourcing structure.

A crowdsourcing framework is essential for effective sourcing of homemade face coverings from volunteer makers during pandemics and surge capacity.

Temporal and spatial far-ultraviolet disinfection of exhaled bioaerosols in a mechanically ventilated space

Far-UVC with a peak wavelength of 222 nm can potentially be used to inactivate exhaled bioaerosols in an efficient and safe manner. Therefore, this study aimed to experimentally explore the effectiveness of a 222 nm far-UVC light for inactivating bioaerosols, represented by E. coli, exhaled from a manikin in a chamber with mechanical ventilation. The spatial irradiance distribution from the far-UVC light was measured. The susceptibility constant (z-value) for E. coli under the far-UVC light was experimentally obtained. The temporal and spatial concentrations of the bioaerosols exhaled from the manikin were measured under three typical ventilation rates (4, 10, and 36 ACH). According to the results, when the far-UVC light was turned on, the bioaerosol concentrations were lower than those without the far-UVC light under all three ventilation rates, suggesting that far-UVC light can effectively disinfect E. coli under mechanical ventilation. However, the disinfection efficiency of the far-UVC light decreased as the ventilation rate increased, which indicated that the far-UVC light played a more important role in bioaerosol removal under a lower ventilation rate. In general, the results supported the feasibility of using 222 nm far-UVC light for disinfection of exhaled bioaerosols in mechanically ventilated spaces to reduce infection risks.

Empirical evidence on the efficiency of backward contact tracing in COVID-19

Standard contact tracing practice for COVID-19 is to identify persons exposed to an infected person during the contagious period, assumed to start two days before symptom onset or diagnosis. In the first large cohort study on backward contact tracing for COVID-19, we extended the contact tracing window by 5 days, aiming to identify the source of the infection and persons infected by the same source. The risk of infection amongst these additional contacts was similar to contacts exposed during the standard tracing window and significantly higher than symptomatic individuals in a control group, leading to 42% more cases identified as direct contacts of an index case. Compared to standard practice, backward traced contacts required fewer tests and shorter quarantine. However, they were identified later in their infectious cycle if infected. Our results support implementing backward contact tracing when rigorous suppression of viral transmission is warranted.

Nebulization as a more efficient method than atomizer for experimental reproduction of avian colibacillosis in young chickens

ABSTRACTInfection and immunity studies involving genetically modified organisms (GMOs), such as gene knockout bacterial mutants require stringent physical containment to prevent the accidental spread of these organisms into the environment. Experimental respiratory tract infection models often require the animals, for example birds, to be transported several times between a negative pressure housing isolator and a bespoke aerosol exposure chamber under positive pressure. While the exposure chamber is sealed and fitted with HEPA filters, the repeated movements of infected animals and opening of the chamber can still pose a serious risk of breaching containment of the organism in the experimental facility. In the current study, the ability of two aerosol infection protocols that expose birds to avian pathogenic E. coli (APEC) aerosols directly within the housing isolator was evaluated. Young chicks were exposed to APEC E956 within the negative pressure housing isolators using either a nebulizer or an atomizer. Birds exposed twice (days 1 and 4) to aerosols of APEC E956 produced by the nebulizer developed a rapidly progressing disease mimicking field cases of avian colibacillosis. However, birds exposed to aerosols of APEC E956 produced by an atomizer, did not develop colibacillosis even after 3 exposures to APEC E956 on days 1, 4 and 7. Consequently, the current study reports the nebulizer was more efficacious in producing avian colibacillosis under stricter bacterial containment settings.

SARS-CoV-2 and other respiratory pathogens are detected in continuous air samples from congregate settings

Two years after the emergence of SARS-CoV-2, there is still a need for better ways to assess the risk of transmission in congregate spaces. We deployed active air samplers to monitor the presence of SARS-CoV-2 in real-world settings across communities in the Upper Midwestern states of Wisconsin and Minnesota. Over 29 weeks, we collected 527 air samples from 15 congregate settings. We detected 106 samples that were positive for SARS-CoV-2 viral RNA, demonstrating that SARS-CoV-2 can be detected in continuous air samples collected from a variety of real-world settings. We expanded the utility of air surveillance to test for 40 other respiratory pathogens. Surveillance data revealed differences in timing and location of SARS-CoV-2 and influenza A virus detection. In addition, we obtained SARS-CoV-2 genome sequences from air samples to identify variant lineages. Collectively, this shows air sampling is a scalable, high throughput surveillance tool that could be used in conjunction with other methods for detecting respiratory pathogens in congregate settings.

Assessing suspension and infectivity times of virus-loaded aerosols involved in airborne transmission

Airborne transmission occurs through droplet-mediated transport of viruses following the expulsion of an aerosol by an infected host. Transmission efficiency results from the interplay between virus survival in the drying droplet and droplet suspension time in the air, controlled by the coupling between water evaporation and droplet sedimentation. Furthermore, droplets are made of a respiratory fluid and thus, display a complex composition consisting of water and nonvolatile solutes. Here, we quantify the impact of this complex composition on the different phenomena underlying transmission. Solutes lead to a nonideal thermodynamic behavior, which sets an equilibrium droplet size that is independent of relative humidity. In contrast, solutes do not significantly hinder transport due to their low initial concentration. Realistic suspension times are computed and increase with increasing relative humidity or decreasing temperature. By uncoupling drying and suspended stages, we observe that enveloped viruses may remain infectious for hours in dried droplets. However, their infectivity decreases with increasing relative humidity or temperature after dozens of minutes. Examining expelled droplet size distributions in the light of these results leads to distinguishing two aerosols. Most droplets measure between 0 and 40 µm and compose an aerosol that remains suspended for hours. Its transmission efficiency is controlled by infectivity, which decreases with increasing humidity and temperature. Larger droplets form an aerosol that only remains suspended for minutes but corresponds to a much larger volume and thus, viral load. Its transmission efficiency is controlled by droplet suspension time, which decreases with increasing humidity and decreasing temperature.

In-duct grating-like dielectric barrier discharge system for air disinfection

In the context of spreading Coronavirus disease 2019 (COVID-19), the combination of heating, ventilation, and air-conditioning (HVAC) system with air disinfection device is an effective way to reduce transmissible infections. Atmospheric-pressure non-equilibrium plasma is an emerging technique for fast pathogen aerosol abatement. In this work, in-duct disinfectors based on grating-like dielectric barrier discharge (DBD) plasmas with varied electrode arrangements were established and evaluated. The highest airborne bacterial inactivation efficiency was achieved by 'vertical' structure, namely when aerosol was in direct contact with the discharge region, at a given discharge power. For all reactors, the efficiency was linearly correlated to the discharge power (R² =0.929-0.994). The effects of environmental factors were examined. Decreased airflow rates boosted the efficiency, which reached 99.8% at the velocity of 0.5 m/s with an aerosol residence time of ~3.6 ms. Increasing humidity (relative humidity (RH)=20-60%) contributed to inactivation efficacy, while high humidity (RH=70%-90%) led to a saturated efficiency, possibly due to the disruption of discharge uniformity. As suggested by the plasma effluent treatment and scavenger experiments, gaseous short-lived chemical species or charged particles were concluded as the major agents accounting for bacterial inactivation. This research provides new hints for air disinfection by DBD plasmas.

Pathways to community transmission of COVID-19 due to rapid evaporation of respiratory virulets

HYPOTHESIS

The formation of virus-laden colloidal respiratory microdroplets - the sneeze or cough virulets and their evaporation driven miniaturization in the open air are found to have a significant impact on the community transmission of COVID-19 pandemic.

SIMULATION DETAILS

We simulate the motions and trajectories of virulets by employing laminar fluid flow coupled with droplet tracing physics. A force field analysis has been included considering the gravity, drag, and inertial forces to unleash some of the finer features of virulet trajectories leading to the droplet and airborne transmissions of the virus. Furthermore, an analytical model corroborates temperature (T) and relative humidity (RH) controlled droplet miniaturization.

RESULTS

The study elucidates that the tiny (1-50 µm) and intermediate (60-100 µm) size ranged virulets tend to form bioaerosol and facilitate an airborne transmission while the virulets of larger dimensions (300 to 500 µm) are more prone to gravity dominated droplet transmission. Subsequently, the mapping between the T and RH guided miniaturization of virulets with the COVID-19 cases for six different cities across the globe justifies the significant contribution of miniaturization-based bioaerosol formation for community transmission of the pandemic.

Deep transfer learning for the recognition of types of face masks as a core measure to prevent the transmission of COVID-19

The use of face masks in public places has emerged as one of the most effective non-pharmaceutical measures to lower the spread of COVID-19 infection. This has led to the development of several detection systems for identifying people who do not wear a face mask. However, not all face masks or coverings are equally effective in preventing virus transmission or illness caused by viruses and therefore, it appears important for those systems to incorporate the ability to distinguish between the different types of face masks. This paper implements four pre-trained deep transfer learning models (NasNetMobile, MobileNetv2, ResNet101v2, and ResNet152v2) to classify images based on the type of face mask (KN95, N95, surgical and cloth) worn by people. Experimental results indicate that the deep residual networks (ResNet101v2 and ResNet152v2) provide the best performance with the highest accuracy and the lowest loss.

A population framework for predicting the proportion of people infected by the far-field airborne transmission of SARS-CoV-2 indoors

The number of occupants in a space influences the risk of far-field airborne transmission of SARS-CoV-2 because the likelihood of having infectious and susceptible people both correlate with the number of occupants. This paper explores the relationship between occupancy and the probability of infection, and how this affects an individual person and a population of people. Mass-balance and dose-response models determine far-field transmission risks for an individual person and a population of people after sub-dividing a large reference space into 10 identical comparator spaces. For a single infected person, the dose received by an individual person in the comparator space is 10 times higher because the equivalent ventilation rate per infected person is lower when the per capita ventilation rate is preserved. However, accounting for population dispersion, such as the community prevalence of the virus, the probability of an infected person being present and uncertainty in their viral load, shows the transmission probability increases with occupancy and the reference space has a higher transmission risk. Also, far-field transmission is likely to be a rare event that requires a high emission rate, and there are a set of Goldilocks conditions that are just right when equivalent ventilation is effective at mitigating against transmission. These conditions depend on the viral load, because when they are very high or low, equivalent ventilation has little effect on transmission risk. Nevertheless, resilient buildings should deliver the equivalent ventilation rate required by standards as minimum.

What were the historical reasons for the resistance to recognizing airborne transmission during the COVID-19 pandemic?

The question of whether SARS-CoV-2 is mainly transmitted by droplets or aerosols has been highly controversial. We sought to explain this controversy through a historical analysis of transmission research in other diseases. For most of human history, the dominant paradigm was that many diseases were carried by the air, often over long distances and in a phantasmagorical way. This miasmatic paradigm was challenged in the mid to late 19th century with the rise of germ theory, and as diseases such as cholera, puerperal fever, and malaria were found to actually transmit in other ways. Motivated by his views on the importance of contact/droplet infection, and the resistance he encountered from the remaining influence of miasma theory, prominent public health official Charles Chapin in 1910 helped initiate a successful paradigm shift, deeming airborne transmission most unlikely. This new paradigm became dominant. However, the lack of understanding of aerosols led to systematic errors in the interpretation of research evidence on transmission pathways. For the next five decades, airborne transmission was considered of negligible or minor importance for all major respiratory diseases, until a demonstration of airborne transmission of tuberculosis (which had been mistakenly thought to be transmitted by droplets) in 1962. The contact/droplet paradigm remained dominant, and only a few diseases were widely accepted as airborne before COVID-19: those that were clearly transmitted to people not in the same room. The acceleration of interdisciplinary research inspired by the COVID-19 pandemic has shown that airborne transmission is a major mode of transmission for this disease, and is likely to be significant for many respiratory infectious diseases.

Multi-objective performance assessment of HVAC systems and physical barriers on COVID-19 infection transmission in a high-speed train

A computational fluid dynamics (CFD) simulation was performed to model and study the transmission risk associated with cough-related SARS-CoV-2 droplets in a real-world high-speed train (HST). In this study, the evaporating of the droplets was considered. Simulation data were post-processed to assess the fraction of the particles deposited on each passenger's face and body, suspended in air, and escaped from exhausts. Firstly, the effects of temperature, relative humidity, ventilation rate, injection source, exhausts' location and capacity, and adding the physical barriers on evaporation and transport of respiratory droplets are investigated in long distance HST. The results demonstrate that overall, 6–43% of the particles were suspended in the cabin after 2.7 min, depending on conditions, and 3–58% of the particles were removed from the cabin in the same duration. Use of physical barriers and high ventilation rate is therefore recommended for both personal and social protection. We found more exhaust capacity and medium relative humidity to be effective in reducing the particles' transmission potential across all studied scenarios. The results indicate that reducing ventilation rate and exhaust capacity, increased aerosols shelf time and dispersion throughout the cabin.

Maintaining safe office spaces to minimise risks of SARS-CoV-2 transmission

BACKGROUND

SARS-CoV-2 can be transmitted within offices. Traditional respiratory transmission modes have undergone reassessment and a new paradigm has emerged. This paradigm needs examining prior to identifying control measures to prevent office acquired infections (OAI).

METHODS

An ongoing assessment of the SARS-CoV-2 transmission literature, including international public health guidance, began 30/1/2020 and continued to submission 7/2/2022. The evidence for the established respiratory transmission paradigm (either droplet or aerosols) and that of a newly emerging paradigm (aerosol and/or droplets) were explored. Based on the new paradigm control measures needed to minimise OAI were produced.

RESULTS

The old paradigm of respiratory transmission of being either droplet or airborne cannot be evidenced. SARS-CoV-2 is emitted in virus laden particles that can be inhaled and/or sprayed on facial mucous membranes (Airborne being the dominant route). Office hygiene measures include: minimising the opportunities for the virus to enter the building. Reducing the susceptibility of people to the virus. Minimising exposure risks within offices, and optimising success in deployment.

CONCLUSION

Standard office hygiene precautions are needed to reduce OAI risks from SARS-CoV-2. Efforts should focus on enabling the smooth functioning of the office whilst minimising risks that the virus will transmit therein. This includes: local risk assessments as transmission risks vary based on building design, ventilation, capacity, and ways of working. Additionally, using experts to optimise ventilation systems.

Invariant in variants

The coronavirus Covid-19 mutates quickly in the pandemic, leaves people struggling to verify and improve the effectiveness of the vaccine based on biochemistry. Is there any physical invariant in the variants of such kind of pathogen that could be taken advantage to ease the tensions? To this point, extensive numerical experiments based on continuity mechanics have been accomplished to discover the consistent vibration modes and the range of natural frequency of coronavirus Covid-19. Such invariant could help us in developing some flexible technique to deactivate the coronavirus, like as resonantly breaking the viral spike by ultrasound wave. The fundamental mechanisms governing such process are demonstrated via solving the coupled acoustic wave and elastic dynamic equations, after which the practical strategies are proposed to efficiently realize the technique concept.

Aerosol-Generating Procedures and Virus Transmission

During the early phase of the COVID-19 pandemic, many respiratory therapies were classified as aerosol-generating procedures. This categorization resulted in a broad range of clinical concerns and a shortage of essential medical resources for some patients. In the past 2 years, many studies have assessed the transmission risk posed by various respiratory care procedures. These studies are discussed in this narrative review, with recommendations for mitigating transmission risk based on the current evidence.