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Zhang Y, Shankar SN, Vass WB, Lednicky JA, Fan ZH, Agdas D, Makuch R, Wu CY. Air Change Rate and SARS-CoV-2 Exposure in Hospitals and Residences: A Meta-Analysis. AEROSOL SCIENCE AND TECHNOLOGY : THE JOURNAL OF THE AMERICAN ASSOCIATION FOR AEROSOL RESEARCH 2024; 58:217-243. [PMID: 38764553 PMCID: PMC11101186 DOI: 10.1080/02786826.2024.2312178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 01/16/2024] [Indexed: 05/21/2024]
Abstract
As SARS-CoV-2 swept across the globe, increased ventilation and implementation of air cleaning were emphasized by the US CDC and WHO as important strategies to reduce the risk of inhalation exposure to the virus. To assess whether higher ventilation and air cleaning rates lead to lower exposure risk to SARS-CoV-2, 1274 manuscripts published between April 2020 and September 2022 were screened using key words "airborne SARS-CoV-2 or "SARS-CoV-2 aerosol". Ninety-three studies involved air sampling at locations with known sources (hospitals and residences) were selected and associated data were compiled. Two metrics were used to assess exposure risk: SARS-CoV-2 concentration and SARS-CoV-2 detection rate in air samples. Locations were categorized by type (hospital or residence) and proximity to the sampling location housing the isolated/quarantined patient (primary or secondary). The results showed that hospital wards had lower airborne virus concentrations than residential isolation rooms. A negative correlation was found between airborne virus concentrations in primary-occupancy areas and air changes per hour (ACH). In hospital settings, sample positivity rates were significantly reduced in secondary-occupancy areas compared to primary-occupancy areas, but they were similar across sampling locations in residential settings. ACH and sample positivity rates were negatively correlated, though the effect was diminished when ACH values exceeded 8. While limitations associated with diverse sampling protocols exist, data considered by this meta-analysis support the notion that higher ACH may reduce exposure risks to the virus in ambient air.
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Affiliation(s)
- Yuetong Zhang
- Department of Environmental Engineering Sciences, University of Florida, Gainesville, Florida, USA
- Department of Mechanical Engineering, University of British Columbia, Vancouver, British Columnia, Canada
| | - Sripriya Nannu Shankar
- Department of Environmental Engineering Sciences, University of Florida, Gainesville, Florida, USA
- Department of Environmental & Public Health Sciences, University of Cincinnati, Cincinnati, Ohio, USA
| | - William B. Vass
- Department of Environmental Engineering Sciences, University of Florida, Gainesville, Florida, USA
| | - John A. Lednicky
- Department of Environmental and Global Health, University of Florida, Gainesville, Florida, USA
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida, USA
| | - Z. Hugh Fan
- Mechanical and Aerospace Engineering, University of Florida, Gainesville, Florida, USA
- J. Crayton Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Florida, USA
| | - Duzgun Agdas
- Engineering School of Sustainable Infrastructure & Environment, University of Florida, Gainesville, Florida, USA
| | - Robert Makuch
- Department of Biostatistics, Yale University School of Public Health, New Haven, Connecticut, USA
| | - Chang-Yu Wu
- Department of Environmental Engineering Sciences, University of Florida, Gainesville, Florida, USA
- Department of Chemical, Environmental, and Materials Engineering, University of Miami, Coral Gables, Florida, USA
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Vass WB, Shankar SN, Lednicky JA, Yang Y, Manzanas C, Zhang Y, Boyette J, Chen J, Chen Y, Shirkhani A, Washeem M, Fan ZH, Eiguren-Fernandez A, Jutla A, Wu CY. Detection and isolation of infectious SARS-CoV-2 omicron subvariants collected from residential settings. AEROSOL SCIENCE AND TECHNOLOGY : THE JOURNAL OF THE AMERICAN ASSOCIATION FOR AEROSOL RESEARCH 2023; 57:1142-1153. [PMID: 38143528 PMCID: PMC10735208 DOI: 10.1080/02786826.2023.2251537] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 08/17/2023] [Indexed: 12/26/2023]
Abstract
Airborne transmission of infectious (viable) SARS-CoV-2 is increasingly accepted as the primary manner by which the virus is spread from person to person. Risk of exposure to airborne virus is higher in enclosed and poorly ventilated spaces. We present a study focused on air sampling within residences occupied by individuals with COVID-19. Air samplers (BioSpot-VIVAS, VIVAS, and BC-251) were positioned in primary- and secondary-occupancy regions in seven homes. Swab samples were collected from high-touch surfaces. Isolation of SARS-CoV-2 was attempted for samples with virus detectable by RT-qPCR. Viable virus was quantified by plaque assay, and complete virus genome sequences were obtained for selected samples from each sampling day. SARS-CoV-2 was detected in 24 of 125 samples (19.2%) by RT-qPCR and isolated from 14 (11.2%) in cell cultures. It was detected in 80.9% (17/21) and cultured from 61.9% (13/21) of air samples collected using water condensation samplers, compared to swab samples which had a RT-qPCR detection rate of 10.5% (4/38) and virus isolation rate of 2.63% (1/38). No statistically significant differences existed in the likelihood of virus detection by RT-qPCR or amount of infectious virus in the air between areas of primary and secondary occupancy within residences. Our work provides information about the presence of SARS-CoV-2 in the air within homes of individuals with COVID-19. Information herein can help individuals make informed decisions about personal exposure risks when sharing indoor spaces with infected individuals isolating at home and further inform health departments and the public about SARS-CoV-2 exposure risks within residences.
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Affiliation(s)
- William B. Vass
- Department of Environmental Engineering Sciences, University of Florida, Gainesville, Florida, USA
| | - Sripriya Nannu Shankar
- Department of Environmental Engineering Sciences, University of Florida, Gainesville, Florida, USA
| | - John A. Lednicky
- Department of Environmental and Global Health, University of Florida, Gainesville, Florida, USA
- Emerging Pathogens Institute, University of Florida, Gainesville, Florida, USA
| | - Yang Yang
- Department of Statistics, University of Georgia, Athens, Georgia, USA
| | - Carlos Manzanas
- Department of Mechanical & Aerospace Engineering, University of Florida, Gainesville, Florida, USA
| | - Yuetong Zhang
- Department of Environmental Engineering Sciences, University of Florida, Gainesville, Florida, USA
| | - Jessica Boyette
- Department of Environmental Engineering Sciences, University of Florida, Gainesville, Florida, USA
| | - Jiayi Chen
- Department of Environmental Engineering Sciences, University of Florida, Gainesville, Florida, USA
| | - Yuqiao Chen
- Department of Environmental Engineering Sciences, University of Florida, Gainesville, Florida, USA
| | - Amin Shirkhani
- Department of Environmental Engineering Sciences, University of Florida, Gainesville, Florida, USA
| | - Mo Washeem
- Department of Environmental Engineering Sciences, University of Florida, Gainesville, Florida, USA
| | - Z. Hugh Fan
- Department of Mechanical & Aerospace Engineering, University of Florida, Gainesville, Florida, USA
- Pruitt Family Department of Biomedical Engineering, University of Florida, Gainesville, Florida, USA
| | | | - Antarpreet Jutla
- Department of Environmental Engineering Sciences, University of Florida, Gainesville, Florida, USA
| | - Chang-Yu Wu
- Department of Environmental Engineering Sciences, University of Florida, Gainesville, Florida, USA
- Department of Chemical, Environmental, and Materials Engineering, University of Miami, Coral Gables, Florida, USA
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Ong DSY, de Man P, Verhagen T, Doejaaren G, Dallinga MA, Alibux E, Janssen ML, Wils EJ. Airborne virus shedding of the alpha, delta, omicron SARS-CoV-2 variants and influenza virus in hospitalized patients. J Med Virol 2023; 95:e28748. [PMID: 37185846 DOI: 10.1002/jmv.28748] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Revised: 03/22/2023] [Accepted: 04/10/2023] [Indexed: 05/17/2023]
Abstract
Airborne transmission is an important transmission route for the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Epidemiological data indicate that certain SARS-CoV-2 variants, like the omicron variant, are associated with higher transmissibility. We compared virus detection in air samples between hospitalized patients infected with different SARS-CoV-2 variants or influenza virus. The study was performed during three separate time periods in which subsequently the alpha, delta, and omicron SARS-CoV-2 variants were predominant. In total, 79 patients with coronavirus disease 2019 (COVID-19) and 22 patients with influenza A virus infection were included. Collected air samples were positive in 55% of patients infected with the omicron variant in comparison to 15% of those infected with the delta variant (p < 0.01). In multivariable analysis, the SARS-CoV-2 omicron BA.1/BA.2 variant (as compared to the delta variant) and the viral load in nasopharynx were both independently associated with air sample positivity, but the alpha variant and COVID-19 vaccination were not. The proportion of positive air samples patients infected with the influenza A virus was 18%. In conclusion, the higher air sample positivity rate of the omicron variant compared to previous SARS-CoV-2 variants may partially explain the higher transmission rates seen in epidemiological trends.
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Affiliation(s)
- David S Y Ong
- Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
- Department of Epidemiology, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Peter de Man
- Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Tim Verhagen
- Department of Intensive Care, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Gerda Doejaaren
- Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Marloes A Dallinga
- Department of Pulmonary Medicine, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Esmee Alibux
- Department of Medical Microbiology and Infection Control, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
| | - Matthijs L Janssen
- Department of Intensive Care, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
- Department of Pulmonary Medicine, Erasmus MC, Rotterdam, The Netherlands
- Department of Intensive Care, Erasmus MC, Rotterdam, The Netherlands
| | - Evert-Jan Wils
- Department of Intensive Care, Franciscus Gasthuis & Vlietland, Rotterdam, The Netherlands
- Department of Intensive Care, Erasmus MC, Rotterdam, The Netherlands
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Zahedi A, Seif F, Golshan M, Khammar A, Rezaei Kahkha MR. Air Surveillance for Viral Contamination with SARS-CoV-2 RNA at a Healthcare Facility. FOOD AND ENVIRONMENTAL VIROLOGY 2022; 14:374-383. [PMID: 35610444 PMCID: PMC9129059 DOI: 10.1007/s12560-022-09524-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 05/10/2022] [Indexed: 05/13/2023]
Abstract
The transmission pathway of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 also called COVID-19 disease) in indoor environments are the main area of contention between health systems and scientists. In this context, little has been investigated about the collection of airborne viral shedding. Here, we collected air samples from 24 locations inside the sole COVID-19 patient care center in Zabol, Iran, for screening SARS-CoV-2 RNA from March to May 2021. Locations included the ICU, COVID-19 wards (CWs) rooms, corridors, nearby nurses' stations, and toilets. We identified the SARS-CoV-2 RNA in breathing zone of CW, in room air, with the positivity rate of 2.5% at a concentration of 17 × 103 virus genome copies/m3 air. It also investigates the relationship between local climate conditions [i.e., temperature and relative humidity] and COVID-19 transmission with the evolution of daily official data on the number of new cases, hospitalizations, and deaths. Current data explained that the difference of temperature and humidity may affect the behavior of virus along with other factors, i.e., population density, individual viral shedding, and infectious dose of SARS-CoV-2 (both indoor and outdoor). Our data support the potential SARS-CoV-2 airborne transmission indoors suggesting the specific safety assessment of building to improve ventilation solutions besides proper using face masks and extensive public health interventions.
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Affiliation(s)
- Amir Zahedi
- Department of Environmental Health Engineering, Shoushtar Faculty of Medical Sciences, Shoushtar, Iran
| | - Faezeh Seif
- Department of Basic Sciences, Shoushtar Faculty of Medical Sciences, Shoushtar, Iran
| | - Masoumeh Golshan
- Department of Environmental Health Engineering, Faculty of Health, Zabol University of Medical Sciences, Zabol, Iran.
| | - Alireza Khammar
- Department of Occupational Health, Faculty of Health, Zabol University of Medical Sciences, Zabol, Iran
| | - Mohammad Reza Rezaei Kahkha
- Department of Environmental Health Engineering, Faculty of Health, Zabol University of Medical Sciences, Zabol, Iran
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Klompas M, Baker M, Rhee C. COVID-19's Challenges to Infection Control Dogma Regarding Respiratory Virus Transmission. Clin Infect Dis 2022; 75:e102-e104. [PMID: 35271714 DOI: 10.1093/cid/ciac204] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Indexed: 12/29/2022] Open
Affiliation(s)
- Michael Klompas
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA.,Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Meghan Baker
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA.,Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Chanu Rhee
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA.,Department of Medicine, Brigham and Women's Hospital, Boston, MA
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Airborne SARS-CoV-2 RNA excretion by patients with COVID-19 on different oxygen delivery systems: a prospective observational study. J Hosp Infect 2022; 123:87-91. [PMID: 35288255 PMCID: PMC8917005 DOI: 10.1016/j.jhin.2022.03.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 02/23/2022] [Accepted: 03/06/2022] [Indexed: 12/23/2022]
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