1
|
Abstract
Human-infecting pathogens that transmit through the air pose a significant threat to public health. As a prominent instance, the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) that caused the COVID-19 pandemic has affected the world in an unprecedented manner over the past few years. Despite the dissipating pandemic gloom, the lessons we have learned in dealing with pathogen-laden aerosols should be thoroughly reviewed because the airborne transmission risk may have been grossly underestimated. From a bioanalytical chemistry perspective, on-site airborne pathogen detection can be an effective non-pharmaceutic intervention (NPI) strategy, with on-site airborne pathogen detection and early-stage infection risk evaluation reducing the spread of disease and enabling life-saving decisions to be made. In light of this, we summarize the recent advances in highly efficient pathogen-laden aerosol sampling approaches, bioanalytical sensing technologies, and the prospects for airborne pathogen exposure measurement and evidence-based transmission interventions. We also discuss open challenges facing general bioaerosols detection, such as handling complex aerosol samples, improving sensitivity for airborne pathogen quantification, and establishing a risk assessment system with high spatiotemporal resolution for mitigating airborne transmission risks. This review provides a multidisciplinary outlook for future opportunities to improve the on-site airborne pathogen detection techniques, thereby enhancing the preparedness for more on-site bioaerosols measurement scenarios, such as monitoring high-risk pathogens on airplanes, weaponized pathogen aerosols, influenza variants at the workplace, and pollutant correlated with sick building syndromes.
Collapse
Affiliation(s)
- Guangyu Qiu
- Institute of Medical Robotics, School of Biomedical Engineering, Shanghai Jiao Tong University, Shanghai 200240, China.
- Institute of Environmental Engineering, ETH Zürich, Zürich 8093, Switzerland
- Laboratory for Advanced Analytical Technologies, Empa, Swiss Federal Laboratories for Materials Science and Technology, Dübendorf 8600, Switzerland
| | - Xiaole Zhang
- Institute of Environmental Engineering, ETH Zürich, Zürich 8093, Switzerland
- Laboratory for Advanced Analytical Technologies, Empa, Swiss Federal Laboratories for Materials Science and Technology, Dübendorf 8600, Switzerland
| | - Andrew J deMello
- Institute for Chemical and Bioengineering, Department of Chemistry and Applied Biosciences, ETH Zürich, Vladimir-Prelog-Weg1, Zürich, Switzerland
| | - Maosheng Yao
- State Key Joint Laboratory of Environmental Simulation and Pollution Control, College of Environmental Sciences and Engineering, Peking University, China
| | - Junji Cao
- Institute of Atmospheric Physics, Chinese Academy of Science, China
| | - Jing Wang
- Institute of Environmental Engineering, ETH Zürich, Zürich 8093, Switzerland
- Laboratory for Advanced Analytical Technologies, Empa, Swiss Federal Laboratories for Materials Science and Technology, Dübendorf 8600, Switzerland
| |
Collapse
|
2
|
Poydenot F, Lebreton A, Haiech J, Andreotti B. At the crossroads of epidemiology and biology: Bridging the gap between SARS-CoV-2 viral strain properties and epidemic wave characteristics. Biochimie 2023; 213:54-65. [PMID: 36931337 PMCID: PMC10017177 DOI: 10.1016/j.biochi.2023.03.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Revised: 02/08/2023] [Accepted: 03/14/2023] [Indexed: 03/17/2023]
Abstract
The COVID-19 pandemic has given rise to numerous articles from different scientific fields (epidemiology, virology, immunology, airflow physics …) without any effort to link these different insights. In this review, we aim to establish relationships between epidemiological data and the characteristics of the virus strain responsible for the epidemic wave concerned. We have carried out this study on the Wuhan, Alpha, Delta and Omicron strains allowing us to illustrate the evolution of the relationships we have highlighted according to these different viral strains. We addressed the following questions. 1) How can the mean infectious dose (one quantum, by definition in epidemiology) be measured and expressed as an amount of viral RNA molecules (in genome units, GU) or as a number of replicative viral particles (in plaque-forming units, PFU)? 2) How many infectious quanta are exhaled by an infected person per unit of time? 3) How many infectious quanta are exhaled, on average, integrated over the whole contagious period? 4) How do these quantities relate to the epidemic reproduction rate R as measured in epidemiology, and to the viral load, as measured by molecular biological methods? 5) How has the infectious dose evolved with the different strains of SARS-CoV-2? We make use of state-of-the-art modelling, reviewed and explained in the appendix of the article (Supplemental Information, SI), to answer these questions using data from the literature in both epidemiology and virology. We have considered the modification of these relationships according to the vaccination status of the population.
Collapse
Affiliation(s)
- Florian Poydenot
- Laboratoire de Physique de l'Ecole Normale Supérieure (LPENS), CNRS UMR 8023, Ecole Normale Supérieure, Université PSL, Sorbonne Université, and Université de Paris, 75005, Paris, France
| | - Alice Lebreton
- Institut de Biologie de l'ENS (IBENS), École Normale Supérieure, CNRS, INSERM, Université PSL, 75005, Paris, France; INRAE, Micalis Institute, 78350, Jouy-en-Josas, France
| | - Jacques Haiech
- CNRS UMR7242 BSC ESBS, 300 Bd Sébastien Brant, CS 10413, 67412, Illkirch cedex, France.
| | - Bruno Andreotti
- Laboratoire de Physique de l'Ecole Normale Supérieure (LPENS), CNRS UMR 8023, Ecole Normale Supérieure, Université PSL, Sorbonne Université, and Université de Paris, 75005, Paris, France
| |
Collapse
|
3
|
Prabhu RM, Firestone MJ, Bergman KL, Beaudoin AL, Hale T, Lorentz AJ, Garfin J, Wang X, Holzbauer SM. Use of serial testing to interrupt a severe acute respiratory coronavirus virus 2 (SARS-CoV-2) outbreak on a hospital medical floor-Minnesota, October-December 2020. Infect Control Hosp Epidemiol 2023; 44:427-32. [PMID: 35225190 DOI: 10.1017/ice.2022.40] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
OBJECTIVE Describe a severe acute respiratory coronavirus virus 2 (SARS-CoV-2) hospital outbreak and the role of serial testing of patients and healthcare personnel (HCP) in interrupting SARS-CoV-2 transmission. DESIGN Outbreak investigation. SETTING Medical floor of a tertiary-care center in Minnesota. METHODS Serial testing for SARS-CoV-2 and whole-genome sequencing (WGS) of positive specimens from HCP and patients were used. An outbreak-associated case was defined as a positive SARS-CoV-2 molecular test in an HCP who worked on the floor prior to testing positive or in a patient who was hospitalized on the medical floor bewteen October 27 and December 1, 2020. WGS was used to determine potential routes of transmission. RESULTS The outbreak was detected after a patient hospitalized for 12 days tested positive for SARS-CoV-2. Serial testing of patients and HCP was conducted in response. Overall, 247 HCP and 41 patients participated in serial SARS-CoV-2 testing; 52 HCP (21%) and 19 hospitalized patients (46%) tested positive. One additional HCP tested positive outside serial testing. The WGS of specimens from 27 (51%) HCP and 15 (79%) patients identified 3 distinct transmission clusters. WGS and epidemiologic evidence suggested intrafacility transmission. The proportions of asymptomatic and presymptomatic patients who tested positive (63%) and HCP who worked during their infectious period (75%) highlight the need for serial testing of asymptomatic patients and HCP during outbreaks. CONCLUSIONS Coupled with preventive measures such as personal protective equipment use and physical distancing, serial testing of HCP and patients could help detect and prevent transmission within healthcare facilities during outbreaks and when nosocomial transmission is suspected.
Collapse
|
4
|
Andrés M, García MC, Fajardo A, Grau L, Pagespetit L, Plasencia V, Martínez I, Abadía C, Sanahuja A, Bella F. Nosocomial outbreak of COVID-19 in an internal medicine ward: Probable airborne transmission. Rev Clin Esp 2022; 222:578-583. [PMID: 35798645 PMCID: PMC9239913 DOI: 10.1016/j.rceng.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 04/09/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND OBJECTIVES Despite the increasing evidence supporting the importance of airborne transmission in SARS-CoV-2 infection, it has not been considered relevant in the vast majority of reported nosocomial outbreaks of COVID-19. The aim of this study is to describe a nosocomial outbreak of SARS-CoV-2 infection whose features suggest that aerosol transmission had an important role. METHODS This is a descriptive analysis of a nosocomial outbreak of SARS-CoV-2 infection in an internal medicine ward that occurred in December 2020. All cases were confirmed by a positive PCR test for SARS-CoV-2. RESULTS From December 5 to December 17, 21 patients and 44 healthcare workers (HCWs) developed a nosocomial SARS-CoV-2 infection. Fifty-one of the 65 cases (78.5%) were diagnosed between December 6 and 9. The attack rate in patients was 80.8%. Among HCWs, the attack rate was higher in those who had worked at least one full working day in the ward (56.3%) than in those who had occasionally been in the ward (25.8%; p = 0.005). Three days before the first positive case was detected, two extractor fans were found to be defective, affecting the ventilation of three rooms. Sixteen cases were asymptomatic, 48 cases had non-severe symptoms, and 2 cases required admission to the intensive care unit. All patients eventually recovered. CONCLUSION The high attack rate, the explosive nature of the outbreak, and the coincidence in time with the breakdown in air extractors in some rooms of the ward suggest that airborne transmission played a key role in the development of the outbreak.
Collapse
Affiliation(s)
- M. Andrés
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital de Terrassa (Consorci Sanitari de Terrassa), Terrassa (Barcelona), Spain,Corresponding author
| | - M.-C. García
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital de Terrassa (Consorci Sanitari de Terrassa), Terrassa (Barcelona), Spain
| | - A. Fajardo
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital de Terrassa (Consorci Sanitari de Terrassa), Terrassa (Barcelona), Spain
| | - L. Grau
- Equipo de Control de Infecciones, Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital de Terrassa (Consorci Sanitari de Terrassa), Terrassa (Barcelona), Spain
| | - L. Pagespetit
- Equipo de Control de Infecciones, Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital de Terrassa (Consorci Sanitari de Terrassa), Terrassa (Barcelona), Spain
| | - V. Plasencia
- Laboratorio de Microbiología, CATLAB, Viladecavalls (Barcelona), Spain
| | - I. Martínez
- Servicio de Prevención de Riesgos Laborales, Hospital de Terrassa (Consorci Sanitari de Terrassa), Terrassa (Barcelona), Spain
| | - C. Abadía
- Servicio de Salud Laboral, Hospital de Terrassa (Consorci Sanitari de Terrassa), Terrassa (Barcelona), Spain
| | - A. Sanahuja
- Departamento de Recursos Físicos, Hospital de Terrassa (Consorci Sanitari de Terrassa), Terrassa (Barcelona), Spain
| | - F. Bella
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital de Terrassa (Consorci Sanitari de Terrassa), Terrassa (Barcelona), Spain
| |
Collapse
|
5
|
Mikszewski A, Stabile L, Buonanno G, Morawska L. The airborne contagiousness of respiratory viruses: A comparative analysis and implications for mitigation. Geosci Front 2022; 13:101285. [PMID: 38620948 PMCID: PMC8378671 DOI: 10.1016/j.gsf.2021.101285] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Revised: 07/22/2021] [Accepted: 08/06/2021] [Indexed: 05/07/2023]
Abstract
The infectious emission rate is a fundamental input parameter for airborne transmission risk assessment, but data are limited due to reliance on estimates from chance superspreading events. This study assesses the strength of a predictive estimation approach developed by the authors for SARS-CoV-2 and uses novel estimates to compare the contagiousness of respiratory pathogens. We applied the approach to SARS-CoV-1, SARS-CoV-2, MERS, measles virus, adenovirus, rhinovirus, coxsackievirus, seasonal influenza virus and Mycobacterium tuberculosis (TB) and compared quanta emission rate (ERq) estimates to literature values. We calculated infection risk in a prototypical classroom and barracks to assess the relative ability of ventilation to mitigate airborne transmission. Our median standing and speaking ERq estimate for SARS-CoV-2 (2.7 quanta h-1) is similar to active, untreated TB (3.1 quanta h-1), higher than seasonal influenza (0.17 quanta h-1), and lower than measles virus (15 quanta h-1). We calculated event reproduction numbers above 1 for SARS-CoV-2, measles virus, and untreated TB in both the classroom and barracks for an activity level of standing and speaking at low, medium and high ventilation rates of 2.3, 6.6 and 14 L per second per person (L s-1 p-1), respectively. Our predictive ERq estimates are consistent with the range of values reported over decades of research. In congregate settings, current ventilation standards are unlikely to control the spread of viruses with upper quartile ERq values above 10 quanta h-1, such as SARS-CoV-2, indicating the need for additional control measures.
Collapse
Affiliation(s)
- Alex Mikszewski
- International Laboratory for Air Quality and Health, Queensland University of Technology, Brisbane, Queensland, Australia
- CIUS Building Performance Lab, The City University of New York, New York, NY, USA
| | - Luca Stabile
- Department of Civil and Mechanical Engineering, University of Cassino and Southern Lazio, Cassino, FR, Italy
| | - Giorgio Buonanno
- International Laboratory for Air Quality and Health, Queensland University of Technology, Brisbane, Queensland, Australia
- Department of Civil and Mechanical Engineering, University of Cassino and Southern Lazio, Cassino, FR, Italy
| | - Lidia Morawska
- International Laboratory for Air Quality and Health, Queensland University of Technology, Brisbane, Queensland, Australia
- Global Centre for Clean Air Research (GCARE), Department of Civil and Environmental Engineering, Faculty of Engineering and Physical Sciences, University of Surrey, Guildford GU2 7XH, United Kingdom
| |
Collapse
|
6
|
Ludewick H, Hahn R, Italiano C, Pereira L, Fatovich D, Saxton J, Hunt R, Ho KM, Boan P, Pavey W. COVID-19 Serosurvey of Frontline Healthcare Workers in Western Australia. J Epidemiol Glob Health 2022; 12:472-477. [PMID: 36131202 PMCID: PMC9491653 DOI: 10.1007/s44197-022-00065-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2021] [Accepted: 09/10/2022] [Indexed: 11/25/2022] Open
Abstract
We aimed to study COVID-19 infection in healthcare workers (HCWs) during the first wave in a setting of low community incidence prior to HCW vaccination. We performed a cross-sectional study of frontline HCWs in two tertiary hospitals in Western Australia with questionnaire and testing for SARS-CoV-2 IgG antibodies, using a screening assay followed by confirmatory assays for initial reactive results. 799 Frontline HCWs were enrolled in the study, working in the emergency department (n = 194, 24.2%), ICU (n = 176, 22.0%), respiratory ward (n = 20, 2.5%), COVID clinic (n = 37, 4.6%), and theatre (n = 222, 28%). 189 (23.6%) were doctors, 327 (41.0%) nurses, and 283 (35.4%) other. Contact with a known COVID-19-positive patient occurred at work for 337 (42.1%), and outside work for 10 (1.2%). Four were diagnosed with COVID-19 by PCR, acquired overseas in two cases and related to healthcare work in two cases (one acquired from a colleague and one possibly acquired from patient contact in the healthcare setting). Nine HCWs had reactive screening serology, and three had confirmed positive IgG (these three were PCR-positive cases). Infection control procedures in the setting of low community incidence were effective at preventing HCW acquisition of COVID-19 infection.
Collapse
Affiliation(s)
- Herbert Ludewick
- Heart and Lung Research Institute of Western Australia Inc, Harry Perkins Institute of Medical Research, 5 Robin Warren Drive, Perth, WA, Australia
| | - Rebecca Hahn
- Heart and Lung Research Institute of Western Australia Inc, Harry Perkins Institute of Medical Research, 5 Robin Warren Drive, Perth, WA, Australia
| | - Claire Italiano
- Department of Infectious Diseases, Royal Perth Hospital, Perth, WA, Australia
| | - Lynette Pereira
- Department of Infectious Diseases, Royal Perth Hospital, Perth, WA, Australia
- Department of Microbiology, PathWest Laboratory Medicine, Fiona Stanley Hospital, Perth, WA, Australia
| | - Daniel Fatovich
- Department of Emergency Medicine, Royal Perth Hospital, University of Western Australia, Perth, WA, Australia
- Centre for Clinical Research in Emergency Medicine, Harry Perkins Institute of Medical Research, Perth, WA, Australia
| | - Jemma Saxton
- Heart and Lung Research Institute of Western Australia Inc, Harry Perkins Institute of Medical Research, 5 Robin Warren Drive, Perth, WA, Australia
| | - Richard Hunt
- Department of Anaesthesia, Fiona Stanley Hospital, Perth, WA, Australia
| | - Kwok M Ho
- Department of Intensive Care, Royal Perth Hospital, Perth, WA, Australia
| | - Peter Boan
- Department of Infectious Diseases, Fiona Stanley Hospital, Perth, WA, Australia.
- Department of Microbiology, PathWest Laboratory Medicine WA, Fiona Stanley Hospital, Perth, 11 Robin Warren Dve, Murdoch, WA, 6150, Australia.
| | - Warren Pavey
- Heart and Lung Research Institute of Western Australia Inc, Harry Perkins Institute of Medical Research, 5 Robin Warren Drive, Perth, WA, Australia
- Department of Anaesthesia, Fiona Stanley Hospital, Perth, WA, Australia
| |
Collapse
|
7
|
Rhee C, Baker MA, Klompas M. Prevention of SARS-CoV-2 and respiratory viral infections in healthcare settings: current and emerging concepts. Curr Opin Infect Dis 2022; 35:353-62. [PMID: 35849526 DOI: 10.1097/QCO.0000000000000839] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
PURPOSE OF REVIEW COVID-19 has catalyzed a wealth of new data on the science of respiratory pathogen transmission and revealed opportunities to enhance infection prevention practices in healthcare settings. RECENT FINDINGS New data refute the traditional division between droplet vs airborne transmission and clarify the central role of aerosols in spreading all respiratory viruses, including Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), even in the absence of so-called 'aerosol-generating procedures' (AGPs). Indeed, most AGPs generate fewer aerosols than talking, labored breathing, or coughing. Risk factors for transmission include high viral loads, symptoms, proximity, prolonged exposure, lack of masking, and poor ventilation. Testing all patients on admission and thereafter can identify early occult infections and prevent hospital-based clusters. Additional prevention strategies include universal masking, encouraging universal vaccination, preferential use of N95 respirators when community rates are high, improving native ventilation, utilizing portable high-efficiency particulate air filters when ventilation is limited, and minimizing room sharing when possible. SUMMARY Multifaceted infection prevention programs that include universal testing, masking, vaccination, and enhanced ventilation can minimize nosocomial SARS-CoV-2 infections in patients and workplace infections in healthcare personnel. Extending these insights to other respiratory viruses may further increase the safety of healthcare and ready hospitals for novel respiratory viruses that may emerge in the future.
Collapse
|
8
|
|
9
|
Gopinath S, Ishak A, Dhawan N, Poudel S, Shrestha PS, Singh P, Xie E, Tahir P, Marzaban S, Michel J, Michel G. Characteristics of COVID-19 Breakthrough Infections among Vaccinated Individuals and Associated Risk Factors: A Systematic Review. Trop Med Infect Dis 2022; 7:81. [PMID: 35622708 PMCID: PMC9144541 DOI: 10.3390/tropicalmed7050081] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 05/17/2022] [Accepted: 05/20/2022] [Indexed: 11/17/2022] Open
Abstract
We sought to assess breakthrough SARS-CoV-2 infections in vaccinated individuals by variant distribution and to identify the common risk associations. The PubMed, Web of Science, ProQuest, and Embase databases were searched from 2019 to 30 January 2022. The outcome of interest was breakthrough infections (BTIs) in individuals who had completed a primary COVID-19 vaccination series. Thirty-three papers were included in the review. BTIs were more common among variants of concern (VOC) of which Delta accounted for the largest number of BTIs (96%), followed by Alpha (0.94%). In addition, 90% of patients with BTIs recovered, 11.6% were hospitalized with mechanical ventilation, and 0.6% resulted in mortality. BTIs were more common in healthcare workers (HCWs) and immunodeficient individuals with a small percentage found in fully vaccinated healthy individuals. VOC mutations were the primary cause of BTIs. Continued mitigation approaches (e.g., wearing masks and social distancing) are warranted even in fully vaccinated individuals to prevent transmission. Further studies utilizing genomic surveillance and heterologous vaccine regimens to boost the immune response are needed to better understand and control BTIs.
Collapse
|
10
|
Andrés M, García MC, Fajardo A, Grau L, Pagespetit L, Plasencia V, Martínez I, Abadía C, Sanahuja A, Bella F. Brote nosocomial de COVID-19 en una planta de medicina interna: probable transmisión aérea. Rev Clin Esp 2022; 222:578-583. [PMID: 35541500 PMCID: PMC9072947 DOI: 10.1016/j.rce.2022.04.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Accepted: 04/09/2022] [Indexed: 11/28/2022]
Abstract
Antecedentes y objetivos A pesar de los datos cada vez mayores que respaldan la importancia de la transmisión aérea en la infección por el SARS-CoV-2, en la inmensa mayoría de los brotes nosocomiales descritos de COVID-19 no se ha considerado relevante. El objetivo de este estudio consiste en describir un brote nosocomial de infección por el SARS-CoV-2 cuyas características indican que la transmisión por aerosoles desempeñó un papel importante. Métodos Se trata de un análisis descriptivo de un brote nosocomial de infección por el SARS-CoV-2 en una planta de medicina interna que tuvo lugar en diciembre de 2020. Todos los casos se confirmaron mediante una PCR positiva para SARS-CoV-2. Resultados Entre el 5 y el 17 de diciembre, 21 pacientes y 44 profesionales sanitarios contrajeron una infección nosocomial por el SARS-CoV-2. De los 65 casos, 51 (78,5%) se diagnosticaron entre el 6 y el 9 de diciembre. La tasa de afectación en los pacientes fue del 80,8%. Entre los profesionales sanitarios, la tasa fue mayor en los que habían trabajado al menos una jornada laboral completa en la planta (56,3%) que en los que habían estado ocasionalmente en ella (25,8%; p = 0,005). Tres días antes de detectar el primer caso positivo se identificó una avería en 2 extractores de aire, que afectó a la ventilación de 3 habitaciones. Dieciséis casos cursaron de forma asintomática, 48 manifestaron síntomas leves y 2 precisaron ingreso en la unidad de cuidados intensivos. Todos los casos se recuperaron finalmente. Conclusiones La elevada tasa de afectación, la naturaleza explosiva del brote y la coincidencia en el tiempo con la avería de los extractores de aire en algunas habitaciones de la planta indican que la transmisión aérea desempeñó un papel fundamental en el desarrollo del brote.
Collapse
Affiliation(s)
- M Andrés
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital de Terrassa (Consorci Sanitari de Terrassa), Tarrassa (Barcelona), España
| | - M-C García
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital de Terrassa (Consorci Sanitari de Terrassa), Tarrassa (Barcelona), España
| | - A Fajardo
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital de Terrassa (Consorci Sanitari de Terrassa), Tarrassa (Barcelona), España
| | - L Grau
- Equipo de Control de Infecciones, Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital de Terrassa (Consorci Sanitari de Terrassa) , Tarrassa (Barcelona), España
| | - L Pagespetit
- Equipo de Control de Infecciones, Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital de Terrassa (Consorci Sanitari de Terrassa) , Tarrassa (Barcelona), España
| | - V Plasencia
- Laboratorio de Microbiología, CATLAB, Viladecavalls (Barcelona), España
| | - I Martínez
- Servicio de Prevención de Riesgos Laborales, Hospital de Terrassa (Consorci Sanitari de Terrassa) , Tarrassa (Barcelona), España
| | - C Abadía
- Servicio de Salud Laboral, Hospital de Terrassa (Consorci Sanitari de Terrassa) , Tarrassa (Barcelona), España
| | - A Sanahuja
- Departamento de Recursos Físicos, Hospital de Terrassa (Consorci Sanitari de Terrassa) , Tarrassa (Barcelona), España
| | - F Bella
- Unidad de Enfermedades Infecciosas, Servicio de Medicina Interna, Hospital de Terrassa (Consorci Sanitari de Terrassa), Tarrassa (Barcelona), España
| |
Collapse
|
11
|
Abstract
The COVID-19 pandemic is the most severe pandemic caused by a respiratory virus since the 1918 influenza pandemic. As is the case with other respiratory viruses, three modes of transmission have been invoked: contact (direct and through fomites), large droplets and aerosols. This narrative review makes the case that aerosol transmission is an important mode for COVID-19, through reviewing studies about bioaerosol physiology, detection of infectious SARS-CoV-2 in exhaled bioaerosols, prolonged SARS-CoV-2 infectivity persistence in aerosols created in the laboratory, detection of SARS-CoV-2 in air samples, investigation of outbreaks with manifest involvement of aerosols, and animal model experiments. SARS-CoV-2 joins influenza A virus as a virus with proven pandemic capacity that can be spread by the aerosol route. This has profound implications for the control of the current pandemic and for future pandemic preparedness.
Collapse
Affiliation(s)
- Raymond Tellier
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| |
Collapse
|
12
|
Howard MJ, Chambers CNL, Mohr NM. New Zealand Emergency Department COVID-19 Preparedness: a cross-sectional survey and narrative view. BMJ Open 2022; 12:e053611. [PMID: 35177449 PMCID: PMC8889447 DOI: 10.1136/bmjopen-2021-053611] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
OBJECTIVE Our objective was to assess the level of COVID-19 preparedness of emergency departments (EDs) in Aotearoa New Zealand (NZ) through the views of emergency medicine specialists working in district health boards around the country. Given the limited experience NZ hospitals have had with SARS-CoV-2, a comparison of current local practice with recent literature from other countries identifying known weaknesses may help prevent future healthcare worker infections in NZ. METHODS We conducted a cross-sectional survey of NZ emergency specialists in November 2020 to evaluate preparedness of engineering, administrative policy and personal protective equipment (PPE) use. RESULTS A total of 137 surveys were completed (32% response rate). More than 12% of emergency specialists surveyed reported no access to negative pressure rooms. N95 fit testing had not been performed in 15 (12%) of respondents. Most specialists (77%) work in EDs that cohort patients with COVID-19, about one-third (34%) do not use spotters during PPE doffing, and most (87%) do not have required space for physical distancing in non-patient areas. Initial PPE training, simulations and segregating patients were widespread but appear to be waning with persistent low SARS-CoV-2 prevalence. PPE shortages were not identified in NZ EDs, yet 13% of consultants do not plan to use respirators during aerosol-generating procedures on patients with COVID-19. CONCLUSIONS NZ emergency specialists identified significant gaps in COVID-19 preparedness, and they have a unique opportunity to translate lessons from other locations into local action. These data provide insight into weaknesses in hospital engineering, policy and PPE practice in advance of future SARS-CoV-2 endemic transmission.
Collapse
Affiliation(s)
| | - Charlotte N L Chambers
- Policy and Research, Association of Salaried Medical Specialists, Wellington, New Zealand
| | - Nicholas M Mohr
- Department of Emergency Medicine, The University of Iowa Roy J and Lucille A Carver College of Medicine, Iowa City, Iowa, USA
| |
Collapse
|
13
|
Klompas M, Rhee C, Baker MA. Universal Use of N95 Respirators in Healthcare Settings When Community Coronavirus Disease 2019 Rates Are High. Clin Infect Dis 2022; 74:529-531. [PMID: 34113977 PMCID: PMC8384408 DOI: 10.1093/cid/ciab539] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Indexed: 12/23/2022] Open
Abstract
The Centers for Disease Control and Prevention recommends N95 respirators for all providers who see patients with possible or confirmed coronavirus disease 2019 (COVID-19). We suggest that N95 respirators may be just as important for the care of patients without suspected COVID-19 when community incidence rates are high. This is because severe acute respiratory syndrome coronavirus 2 is most contagious before symptom onset. Ironically, by the time patients are sick enough to be admitted to the hospital with COVID-19, they tend to be less contagious. The greatest threat of transmission in healthcare facilities may therefore be patients and healthcare workers with early occult infection. N95 respirators' superior fit and filtration provide superior exposure protection for healthcare providers seeing patients with early undiagnosed infection and superior source control to protect patients from healthcare workers with early undiagnosed infection. The probability of occult infection in patients and healthcare workers is greatest when community incidence rates are high. Universal use of N95 respirators may help decrease nosocomial transmission at such times.
Collapse
Affiliation(s)
- Michael Klompas
- Department of Population Medicine, Harvard Medical School
and Harvard Pilgrim Health Care Institute, Boston,
Massachusetts, USA
- Department of Medicine, Brigham and Women’s
Hospital, Boston, Massachusetts, USA
| | - Chanu Rhee
- Department of Population Medicine, Harvard Medical School
and Harvard Pilgrim Health Care Institute, Boston,
Massachusetts, USA
- Department of Medicine, Brigham and Women’s
Hospital, Boston, Massachusetts, USA
| | - Meghan A Baker
- Department of Population Medicine, Harvard Medical School
and Harvard Pilgrim Health Care Institute, Boston,
Massachusetts, USA
- Department of Medicine, Brigham and Women’s
Hospital, Boston, Massachusetts, USA
| |
Collapse
|
14
|
Ribaric NL, Vincent C, Jonitz G, Hellinger A, Ribaric G. Hidden hazards of SARS-CoV-2 transmission in hospitals: A systematic review. Indoor Air 2022; 32:e12968. [PMID: 34862811 DOI: 10.1111/ina.12968] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 09/17/2021] [Accepted: 11/19/2021] [Indexed: 05/04/2023]
Abstract
Despite their considerable prevalence, dynamics of hospital-associated COVID-19 are still not well understood. We assessed the nature and extent of air- and surface-borne SARS-CoV-2 contamination in hospitals to identify hazards of viral dispersal and enable more precise targeting of infection prevention and control. PubMed, ScienceDirect, Web of Science, Medrxiv, and Biorxiv were searched for relevant articles until June 1, 2021. In total, 51 observational cross-sectional studies comprising 6258 samples were included. SARS-CoV-2 RNA was detected in one in six air and surface samples throughout the hospital and up to 7.62 m away from the nearest patients. The highest detection rates and viral concentrations were reported from patient areas. The most frequently and heavily contaminated types of surfaces comprised air outlets and hospital floors. Viable virus was recovered from the air and fomites. Among size-fractionated air samples, only fine aerosols contained viable virus. Aerosol-generating procedures significantly increased (ORair = 2.56 (1.46-4.51); ORsurface = 1.95 (1.27-2.99)), whereas patient masking significantly decreased air- and surface-borne SARS-CoV-2 contamination (ORair = 0.41 (0.25-0.70); ORsurface = 0.45 (0.34-0.61)). The nature and extent of hospital contamination indicate that SARS-CoV-2 is likely dispersed conjointly through several transmission routes, including short- and long-range aerosol, droplet, and fomite transmission.
Collapse
Affiliation(s)
- Noach Leon Ribaric
- Faculty of Medicine, University Medical Center Hamburg-Eppendorf, University of Hamburg, Hamburg, Germany
| | - Charles Vincent
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Günther Jonitz
- German Medical Association, Berlin, Germany
- State Chamber of Physicians Berlin, Berlin, Germany
| | - Achim Hellinger
- Department of General, Visceral, Endocrine and Oncologic Surgery, Fulda Hospital, University Medicine Marburg Campus Fulda, Fulda, Germany
| | - Goran Ribaric
- Johnson & Johnson Institute, Norderstedt, Germany
- MedTech Europe, Antimicrobial Resistance (AMR) and Healthcare Associated Infections (HAI) Sector Group, Brussels, Belgium
| |
Collapse
|
15
|
Klompas M, Rhee C. OUP accepted manuscript. J Infect Dis 2022; 226:191-194. [PMID: 35535586 PMCID: PMC9384050 DOI: 10.1093/infdis/jiac197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Accepted: 05/06/2022] [Indexed: 11/29/2022] Open
Affiliation(s)
- Michael Klompas
- Correspondence: Michael Klompas, MD, MPH, Department of Population Medicine, 401 Park Drive, Suite 401 E, Boston, MA 02215, USA ()
| | - Chanu Rhee
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
- Department of Medicine, Brigham and Women’s Hospital, Boston, Massachusetts, USA
| |
Collapse
|
16
|
Bueno de Mesquita PJ, Delp WW, Chan WR, Bahnfleth WP, Singer BC. Control of airborne infectious disease in buildings: Evidence and research priorities. Indoor Air 2022; 32:e12965. [PMID: 34816493 DOI: 10.1111/ina.12965] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/18/2021] [Revised: 10/07/2021] [Accepted: 11/11/2021] [Indexed: 06/13/2023]
Abstract
The evolution of SARS-CoV-2 virus has resulted in variants likely to be more readily transmitted through respiratory aerosols, underscoring the increased potential for indoor environmental controls to mitigate risk. Use of tight-fitting face masks to trap infectious aerosol in exhaled breath and reduce inhalation exposure to contaminated air is of critical importance for disease control. Administrative controls including the regulation of occupancy and interpersonal spacing are also important, while presenting social and economic challenges. Indoor engineering controls including ventilation, exhaust, air flow control, filtration, and disinfection by germicidal ultraviolet irradiation can reduce reliance on stringent occupancy restrictions. However, the effects of controls-individually and in combination-on reducing infectious aerosol transfer indoors remain to be clearly characterized to the extent needed to support widespread implementation by building operators. We review aerobiologic and epidemiologic evidence of indoor environmental controls against transmission and present a quantitative aerosol transfer scenario illustrating relative differences in exposure at close-interactive, room, and building scales. We identify an overarching need for investment to implement building controls and evaluate their effectiveness on infection in well-characterized and real-world settings, supported by specific, methodological advances. Improved understanding of engineering control effectiveness guides implementation at scale while considering occupant comfort, operational challenges, and energy costs.
Collapse
Affiliation(s)
| | - William W Delp
- Indoor Environment Group, Lawrence Berkeley National Laboratory, Berkeley, California, USA
| | - Wanyu R Chan
- Indoor Environment Group, Lawrence Berkeley National Laboratory, Berkeley, California, USA
| | - William P Bahnfleth
- Department of Architectural Engineering, Pennsylvania State University, State College, Pennsylvania, USA
| | - Brett C Singer
- Indoor Environment Group, Lawrence Berkeley National Laboratory, Berkeley, California, USA
| |
Collapse
|
17
|
Landry SA, Subedi D, Barr JJ, MacDonald MI, Dix S, Kutey DM, Mansfield D, Hamilton GS, Edwards BA, Joosten SA. OUP accepted manuscript. J Infect Dis 2022; 226:199-207. [PMID: 35535021 PMCID: PMC9400421 DOI: 10.1093/infdis/jiac195] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2022] [Accepted: 05/06/2022] [Indexed: 11/17/2022] Open
Abstract
Background Healthcare workers (HCWs) are at risk from aerosol transmission of severe acute respiratory syndrome coronavirus 2. The aims of this study were to (1) quantify the protection provided by masks (surgical, fit-testFAILED N95, fit-testPASSED N95) and personal protective equipment (PPE), and (2) determine if a portable high-efficiency particulate air (HEPA) filter can enhance the benefit of PPE. Methods Virus aerosol exposure experiments using bacteriophage PhiX174 were performed. An HCW wearing PPE (mask, gloves, gown, face shield) was exposed to nebulized viruses (108 copies/mL) for 40 minutes in a sealed clinical room. Virus exposure was quantified via skin swabs applied to the face, nostrils, forearms, neck, and forehead. Experiments were repeated with a HEPA filter (13.4 volume-filtrations/hour). Results Significant virus counts were detected on the face while the participants were wearing either surgical or N95 masks. Only the fit-testPASSED N95 resulted in lower virus counts compared to control (P = .007). Nasal swabs demonstrated high virus exposure, which was not mitigated by the surgical/fit-testFAILED N95 masks, although there was a trend for the fit-testPASSED N95 mask to reduce virus counts (P = .058). HEPA filtration reduced virus to near-zero levels when combined with fit-testPASSED N95 mask, gloves, gown, and face shield. Conclusions N95 masks that have passed a quantitative fit-test combined with HEPA filtration protects against high virus aerosol loads at close range and for prolonged periods of time.
Collapse
Affiliation(s)
- Shane A Landry
- Correspondence: Shane Landry, PhD, Monash University BASE facility, 264 Ferntree Gully Road, Ground Floor, Notting Hill, 3168, VIC, Australia ()
| | - Dinesh Subedi
- School of Biological Sciences, Monash University, Clayton, Victoria, Australia
| | - Jeremy J Barr
- School of Biological Sciences, Monash University, Clayton, Victoria, Australia
| | - Martin I MacDonald
- Monash Lung, Sleep, Allergy and Immunology, Monash Health, Clayton, Victoria, Australia
| | - Samantha Dix
- Monash Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
| | - Donna M Kutey
- Monash Nursing and Midwifery, Monash University, Clayton, Victoria, Australia
| | - Darren Mansfield
- Monash Lung, Sleep, Allergy and Immunology, Monash Health, Clayton, Victoria, Australia
- School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
- Monash Partners–Epworth, Victoria, Victoria, Australia
| | - Garun S Hamilton
- Monash Lung, Sleep, Allergy and Immunology, Monash Health, Clayton, Victoria, Australia
- School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
- Monash Partners–Epworth, Victoria, Victoria, Australia
| | - Bradley A Edwards
- Department of Physiology, School of Biomedical Sciences and Biomedical Discovery Institute, Monash University, Melbourne, Victoria, Australia
- Turner Institute for Brain and Mental Health, Monash University, Melbourne, Victoria, Australia
| | - Simon A Joosten
- Monash Lung, Sleep, Allergy and Immunology, Monash Health, Clayton, Victoria, Australia
- School of Clinical Sciences, Monash University, Melbourne, Victoria, Australia
- Monash Partners–Epworth, Victoria, Victoria, Australia
| |
Collapse
|
18
|
Dancer SJ, Cormack K, Loh M, Coulombe C, Thomas L, Pravinkumar SJ, Kasengele K, King MF, Keaney J. Healthcare-acquired clusters of COVID-19 across multiple wards in a Scottish health board. J Hosp Infect 2021; 120:23-30. [PMID: 34863874 PMCID: PMC8634690 DOI: 10.1016/j.jhin.2021.11.019] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 11/10/2021] [Accepted: 11/22/2021] [Indexed: 12/23/2022]
Abstract
Background Healthcare-acquired COVID-19 has been an additional burden on hospitals managing increasing numbers of patients with SARS-CoV-2. One acute hospital (W) among three in a Scottish healthboard experienced an unexpected surge of COVID-19 clusters. Aim To investigate possible causes of COVID-19 clusters at Hospital W. Methods Daily surveillance provided total numbers of patients and staff involved in clusters in three acute hospitals (H, M and W) and care homes across the healthboard. All clusters were investigated and documented, along with patient boarding, community infection rates and outdoor temperatures from October 2020 to March 2021. Selected SARS-CoV-2 strains were genotyped. Findings There were 19 COVID-19 clusters on 14 wards at Hospital W during the six-month study period, lasting from two to 42 days (average, five days; median, 14 days) and involving an average of nine patients (range 1–24) and seven staff (range 0–17). COVID-19 clusters in Hospitals H and M reflected community infection rates. An outbreak management team implemented a control package including daily surveillance; ward closures; universal masking; screening; restricting staff and patient movement; enhanced cleaning; and improved ventilation. Forty clusters occurred across all three hospitals before a January window-opening policy, after which there were three during the remainder of the study. Conclusion The winter surge of COVID-19 clusters was multi-factorial, but clearly exacerbated by moving trauma patients around the hospital. An extended infection prevention and control package including enhanced natural ventilation helped reduce COVID-19 clusters in acute hospitals.
Collapse
Affiliation(s)
- S J Dancer
- Department of Microbiology, NHS Lanarkshire & Edinburgh Napier University, UK.
| | - K Cormack
- Quality Directorate, NHS Lanarkshire, UK
| | - M Loh
- Institute of Occupational Medicine, Edinburgh, UK
| | - C Coulombe
- Infection Prevention & Control, NHS Lanarkshire, UK
| | - L Thomas
- Infection Prevention & Control, NHS Lanarkshire, UK
| | | | - K Kasengele
- Department of Public Health, NHS Lanarkshire, UK
| | - M-F King
- School of Civil Engineering, University of Leeds, Leeds, UK
| | | |
Collapse
|
19
|
Klompas M, Milton DK, Rhee C, Baker MA, Leekha S. Current Insights Into Respiratory Virus Transmission and Potential Implications for Infection Control Programs : A Narrative Review. Ann Intern Med 2021; 174:1710-1718. [PMID: 34748374 DOI: 10.7326/m21-2780] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Policies to prevent respiratory virus transmission in health care settings have traditionally divided organisms into Droplet versus Airborne categories. Droplet organisms (for example, influenza) are said to be transmitted via large respiratory secretions that rapidly fall to the ground within 1 to 2 meters and are adequately blocked by surgical masks. Airborne pathogens (for example, measles), by contrast, are transmitted by aerosols that are small enough and light enough to carry beyond 2 meters and to penetrate the gaps between masks and faces; health care workers are advised to wear N95 respirators and to place these patients in negative-pressure rooms. Respirators and negative-pressure rooms are also recommended when caring for patients with influenza or SARS-CoV-2 who are undergoing "aerosol-generating procedures," such as intubation. An increasing body of evidence, however, questions this framework. People routinely emit respiratory particles in a range of sizes, but most are aerosols, and most procedures do not generate meaningfully more aerosols than ordinary breathing, and far fewer than coughing, exercise, or labored breathing. Most transmission nonetheless occurs at close range because virus-laden aerosols are most concentrated at the source; they then diffuse and dilute with distance, making long-distance transmission rare in well-ventilated spaces. The primary risk factors for nosocomial transmission are community incidence rates, viral load, symptoms, proximity, duration of exposure, and poor ventilation. Failure to appreciate these factors may lead to underappreciation of some risks (for example, overestimation of the protection provided by medical masks, insufficient attention to ventilation) or misallocation of limited resources (for example, reserving N95 respirators and negative-pressure rooms only for aerosol-generating procedures or requiring negative-pressure rooms for all patients with SARS-CoV-2 infection regardless of stage of illness). Enhanced understanding of the factors governing respiratory pathogen transmission may inform the development of more effective policies to prevent nosocomial transmission of respiratory pathogens.
Collapse
Affiliation(s)
- Michael Klompas
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, and Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts (M.K., C.R., M.A.B.)
| | - Donald K Milton
- Maryland Institute for Applied Environmental Health, School of Public Health, University of Maryland, College Park, Maryland (D.K.M.)
| | - Chanu Rhee
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, and Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts (M.K., C.R., M.A.B.)
| | - Meghan A Baker
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, and Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts (M.K., C.R., M.A.B.)
| | - Surbhi Leekha
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore, Maryland (S.L.)
| |
Collapse
|
20
|
Abstract
Hospitals under pressure from the COVID-19 pandemic have experienced an additional challenge due to clusters of hospital-acquired COVID-19 infection occurring on non-COVID-19 wards. These clusters have involved both staff and patients and compromise staffing, bed management and routine care, especially delivery of elective surgical procedures. They have also contributed towards the overall morbidity and mortality of the pandemic. COVID-19 infection rates are rising again, so it is important to consider implementing additional activities designed to impede transmission of SARS-CoV-2 in acute hospitals. These aim to protect staff, patients and visitors, and conserve safe and continued access for patients needing routine and emergency surgical interventions. Current infection prevention strategies include hand hygiene; patient and staff screening; surveillance; personal protective equipment; cohorting and isolation; and enhanced cleaning. Additional activities include restriction of staff and patient movement; COVID-19 pathways for wards, operating theatres and outpatient services; bathroom management; and ensuring fresh air in the absence of effective mechanical ventilation systems. Seasonal pressures and spread of more contagious and/or vaccine-tolerant variants will continue to disrupt routine and emergency care of non-COVID-19 patients, as well as increase the risk of COVID-19 infection for staff and patients. Supplementary practical and cost-effective actions to limit spread in hospitals are explored in this article.
Collapse
Affiliation(s)
- Stephanie J Dancer
- is a Consultant Microbiologist in NHS Lanarkshire and Professor of Microbiology at Edinburgh Napier University, Edinburgh, UK. Conflicts of interest: The author is a member of the 'Group of 36', which is an international collaboration of scientists and clinicians working on the role of airborne transmission of SARS-CoV-2; she was also a member of the 2020 COVID-19 DEFRA committee reporting to SAGE
| |
Collapse
|
21
|
Klompas M, Ye S, Vaidya V, Ochoa A, Baker MA, Hopcia K, Hashimoto D, Wang R, Rhee C. Association between Airborne Infection Isolation Room Utilization Rates and Healthcare Worker COVID-19 Infections in Two Academic Hospitals. Clin Infect Dis 2021; 74:2230-2233. [PMID: 34599821 PMCID: PMC8500060 DOI: 10.1093/cid/ciab849] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Indexed: 12/12/2022] Open
Abstract
We compared healthcare worker SARS-CoV-2 infection rates between March-August 2020 in two similar hospitals with high versus low airborne infection isolation room utilization rates but otherwise identical infection control policies. We found no difference in healthcare worker infection rates between the two hospitals nor between patient-facing vs non-patient-facing providers.
Collapse
Affiliation(s)
- Michael Klompas
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA.,Infection Control Department, Brigham and Women's Hospital, Boston, MA, USA
| | - Shangyuan Ye
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Vineeta Vaidya
- Infection Control Department, Brigham and Women's Hospital, Boston, MA, USA
| | - Aileen Ochoa
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA.,Infection Control Department, Brigham and Women's Hospital, Boston, MA, USA
| | - Meghan A Baker
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA.,Infection Control Department, Brigham and Women's Hospital, Boston, MA, USA
| | - Karen Hopcia
- Occupational Health Services, Mass General Brigham, Boston, MA, USA
| | - Dean Hashimoto
- Occupational Health Services, Mass General Brigham, Boston, MA, USA
| | - Rui Wang
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA
| | - Chanu Rhee
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA, USA.,Infection Control Department, Brigham and Women's Hospital, Boston, MA, USA
| |
Collapse
|
22
|
Abstract
The COVID-19 pandemic has revealed critical knowledge gaps in our understanding of and a need to update the traditional view of transmission pathways for respiratory viruses. The long-standing definitions of droplet and airborne transmission do not account for the mechanisms by which virus-laden respiratory droplets and aerosols travel through the air and lead to infection. In this Review, we discuss current evidence regarding the transmission of respiratory viruses by aerosols-how they are generated, transported, and deposited, as well as the factors affecting the relative contributions of droplet-spray deposition versus aerosol inhalation as modes of transmission. Improved understanding of aerosol transmission brought about by studies of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection requires a reevaluation of the major transmission pathways for other respiratory viruses, which will allow better-informed controls to reduce airborne transmission.
Collapse
Affiliation(s)
- Chia C Wang
- Department of Chemistry, National Sun Yat-sen University, Kaohsiung, Taiwan 804, Republic of China.
- Scripps Institution of Oceanography, University of California San Diego, La Jolla, CA 92037, USA
- Aerosol Science Research Center, National Sun Yat-sen University, Kaohsiung, Taiwan 804, Republic of China
- Department of Chemistry, National Sun Yat-sen University, Kaohsiung, Taiwan 804, Republic of China
| | - Kimberly A Prather
- Scripps Institution of Oceanography, University of California San Diego, La Jolla, CA 92037, USA.
| | - Josué Sznitman
- Department of Biomedical Engineering, Israel Institute of Technology, Haifa 32000, Israel
| | - Jose L Jimenez
- Department of Biomedical Engineering, Israel Institute of Technology, Haifa 32000, Israel
- Department of Chemistry and CIRES, University of Colorado, Boulder, CO 80309, USA
| | - Seema S Lakdawala
- Department of Microbiology and Molecular Genetics, University of Pittsburgh School of Medicine, Pittsburgh, PA 15219, USA
| | - Zeynep Tufekci
- School of Information and Department of Sociology, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Linsey C Marr
- Aerosol Science Research Center, National Sun Yat-sen University, Kaohsiung, Taiwan 804, Republic of China
- Department of Civil and Environmental Engineering, Virginia Tech, Blacksburg, VA 24061, USA
| |
Collapse
|
23
|
Abstract
The COVID-19 pandemic has revealed critical knowledge gaps in our understanding of and a need to update the traditional view of transmission pathways for respiratory viruses. The long-standing definitions of droplet and airborne transmission do not account for the mechanisms by which virus-laden respiratory droplets and aerosols travel through the air and lead to infection. In this Review, we discuss current evidence regarding the transmission of respiratory viruses by aerosols-how they are generated, transported, and deposited, as well as the factors affecting the relative contributions of droplet-spray deposition versus aerosol inhalation as modes of transmission. Improved understanding of aerosol transmission brought about by studies of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection requires a reevaluation of the major transmission pathways for other respiratory viruses, which will allow better-informed controls to reduce airborne transmission.
Collapse
Affiliation(s)
- Chia C Wang
- Department of Chemistry, National Sun Yat-sen University, Kaohsiung, Taiwan 804, Republic of China.
- Scripps Institution of Oceanography, University of California San Diego, La Jolla, CA 92037, USA
- Aerosol Science Research Center, National Sun Yat-sen University, Kaohsiung, Taiwan 804, Republic of China
- Department of Chemistry, National Sun Yat-sen University, Kaohsiung, Taiwan 804, Republic of China
| | - Kimberly A Prather
- Scripps Institution of Oceanography, University of California San Diego, La Jolla, CA 92037, USA.
| | - Josué Sznitman
- Department of Biomedical Engineering, Israel Institute of Technology, Haifa 32000, Israel
| | - Jose L Jimenez
- Department of Biomedical Engineering, Israel Institute of Technology, Haifa 32000, Israel
- Department of Chemistry and CIRES, University of Colorado, Boulder, CO 80309, USA
| | - Seema S Lakdawala
- Department of Microbiology and Molecular Genetics, University of Pittsburgh School of Medicine, Pittsburgh, PA 15219, USA
| | - Zeynep Tufekci
- School of Information and Department of Sociology, University of North Carolina, Chapel Hill, NC 27599, USA
| | - Linsey C Marr
- Aerosol Science Research Center, National Sun Yat-sen University, Kaohsiung, Taiwan 804, Republic of China
- Department of Civil and Environmental Engineering, Virginia Tech, Blacksburg, VA 24061, USA
| |
Collapse
|
24
|
Wu T, Kang S, Peng W, Zuo C, Zhu Y, Pan L, Fu K, You Y, Yang X, Luo X, Jiang L, Deng M. Original Hosts, Clinical Features, Transmission Routes, and Vaccine Development for Coronavirus Disease (COVID-19). Front Med (Lausanne) 2021; 8:702066. [PMID: 34295915 PMCID: PMC8291337 DOI: 10.3389/fmed.2021.702066] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2021] [Accepted: 05/31/2021] [Indexed: 01/08/2023] Open
Abstract
The pandemic of coronavirus disease 2019 (COVID-19), which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has led to public concern worldwide. Although a variety of hypotheses about the hosts of SARS-CoV-2 have been proposed, an exact conclusion has not yet been reached. Initial clinical manifestations associated with COVID-19 are similar to those of other acute respiratory infections, leading to misdiagnoses and resulting in the outbreak at the early stage. SARS-CoV-2 is predominantly spread by droplet transmission and close contact; the possibilities of fecal-oral, vertical, and aerosol transmission have not yet been fully confirmed or rejected. Besides, COVID-19 cases have been reported within communities, households, and nosocomial settings through contact with confirmed COVID-19 patients or asymptomatic individuals. Environmental contamination is also a major driver for the COVID-19 pandemic. Considering the absence of specific treatment for COVID-19, it is urgent to decrease the risk of transmission and take preventive measures to control the spread of the virus. In this review, we summarize the latest available data on the potential hosts, entry receptors, clinical features, and risk factors of COVID-19 and transmission routes of SARS-CoV-2, and we present the data about development of vaccines.
Collapse
Affiliation(s)
- Ting Wu
- Department of Biochemistry and Molecular Biology, Hunan Province Key Laboratory of Basic and Applied Hematology, School of Life Sciences, Central South University, Changsha, China
- Department of Cardiovascular Medicine, The Third Xiangya Hospital, Central South University, Changsha, China
- Hunan Key Laboratory of Animal Models for Human Diseases, Hunan Key Laboratory of Medical Genetics, School of Life Sciences, Central South University, Changsha, China
| | - Shuntong Kang
- Department of Biochemistry and Molecular Biology, Hunan Province Key Laboratory of Basic and Applied Hematology, School of Life Sciences, Central South University, Changsha, China
- Hunan Key Laboratory of Animal Models for Human Diseases, Hunan Key Laboratory of Medical Genetics, School of Life Sciences, Central South University, Changsha, China
- Xiangya School of Medicine, Central South University, Changsha, China
| | - Wenyao Peng
- Department of Biochemistry and Molecular Biology, Hunan Province Key Laboratory of Basic and Applied Hematology, School of Life Sciences, Central South University, Changsha, China
- Xiangya School of Medicine, Central South University, Changsha, China
| | - Chenzhe Zuo
- Department of Biochemistry and Molecular Biology, Hunan Province Key Laboratory of Basic and Applied Hematology, School of Life Sciences, Central South University, Changsha, China
- Xiangya School of Medicine, Central South University, Changsha, China
| | - Yuhao Zhu
- Department of Biochemistry and Molecular Biology, Hunan Province Key Laboratory of Basic and Applied Hematology, School of Life Sciences, Central South University, Changsha, China
- Xiangya School of Medicine, Central South University, Changsha, China
| | - Liangyu Pan
- Department of Biochemistry and Molecular Biology, Hunan Province Key Laboratory of Basic and Applied Hematology, School of Life Sciences, Central South University, Changsha, China
| | - Keyun Fu
- Department of Biochemistry and Molecular Biology, Hunan Province Key Laboratory of Basic and Applied Hematology, School of Life Sciences, Central South University, Changsha, China
- Xiangya School of Medicine, Central South University, Changsha, China
| | - Yaxian You
- Department of Biochemistry and Molecular Biology, Hunan Province Key Laboratory of Basic and Applied Hematology, School of Life Sciences, Central South University, Changsha, China
| | - Xinyuan Yang
- Department of Biochemistry and Molecular Biology, Hunan Province Key Laboratory of Basic and Applied Hematology, School of Life Sciences, Central South University, Changsha, China
- Xiangya School of Medicine, Central South University, Changsha, China
| | - Xuan Luo
- Department of Biochemistry and Molecular Biology, Hunan Province Key Laboratory of Basic and Applied Hematology, School of Life Sciences, Central South University, Changsha, China
- Hunan Yuanpin Cell Biotechnology Co., Ltd, Changsha, China
| | - Liping Jiang
- Xiangya School of Medicine, Central South University, Changsha, China
| | - Meichun Deng
- Department of Biochemistry and Molecular Biology, Hunan Province Key Laboratory of Basic and Applied Hematology, School of Life Sciences, Central South University, Changsha, China
- Hunan Key Laboratory of Animal Models for Human Diseases, Hunan Key Laboratory of Medical Genetics, School of Life Sciences, Central South University, Changsha, China
- Xiangya School of Medicine, Central South University, Changsha, China
| |
Collapse
|
25
|
Hyde Z, Berger D, Miller A. Australia must act to prevent airborne transmission of SARS-CoV-2. Med J Aust 2021; 215:7-9.e1. [PMID: 34131921 PMCID: PMC8447137 DOI: 10.5694/mja2.51131] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2021] [Revised: 04/20/2021] [Accepted: 04/20/2021] [Indexed: 12/19/2022]
Affiliation(s)
- Zoë Hyde
- WA Centre for Health and Ageing, University of Western Australia, Perth, WA
| | | | | |
Collapse
|
26
|
Heimes D, Müller LK, Schellin A, Naujokat H, Graetz C, Schwendicke F, Goedecke M, Beck-Broichsitter B, Kämmerer PW. Consequences of the COVID-19 Pandemic and Governmental Containment Policies on the Detection and Therapy of Oral Malignant Lesions-A Retrospective, Multicenter Cohort Study from Germany. Cancers (Basel) 2021; 13:cancers13122892. [PMID: 34207863 PMCID: PMC8227890 DOI: 10.3390/cancers13122892] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Revised: 06/04/2021] [Accepted: 06/06/2021] [Indexed: 12/23/2022] Open
Abstract
Simple Summary Due to the COVID-19 pandemic, the oncology community was challenged with the need to protect a vulnerable population from a potentially fatal infection without jeopardizing cancer treatments. The impact of the crisis on the medical care of patients with oral cancer is largely unexplored. This multicenter cohort study from Germany aims to assess the consequences of the COVID-19 pandemic by comparing the healthcare of patients during the lockdown and post-lockdown periods in 2020 with the corresponding periods in 2018/19. We found the closure of dental practices during lockdown to possibly delay the diagnosis of oral cancer. Even if during this period no higher incidence of oral cancer was observed, data point to potentially fatal consequences for longer periods of treatment delay. Abstract (1) Background: In response to the global COVID-19 pandemic, governmental measures have been undertaken. The impact of the crisis on the healthcare of patients with cancer is largely unexplored. This multicenter cohort study aimed to investigate a potential screening delay and its consequences in patients with oral cancer (OC) during the pandemic. (2) Material and Methods: Data of patients who were first diagnosed with OC during different periods were collected, especially in terms of OC incidence, tumor stage/entity and time to intervention. The periods lockdown (LD) (13 March–16 June 2020), post-lockdown (PLD) (17 June–1 November 2020), and the corresponding equivalents in 2018/19 were differentiated and compared. (3) Results: There was no obvious trend towards a higher incidence of OC or higher tumor stages, whereas a trend towards a shorter time to intervention during the LD2020 could be observed. Subgroup analyses revealed an increased incidence in OC within the PLD2020 in Mainz, which might be explained by the partial closure of dental practices in this federal state during LD. (4) Conclusions: While there was no overall higher incidence of OC, we found closure of practices during LD to possibly delay cancer diagnosis. Therefore, measures must be taken to identify patients at risk and to ensure basic healthcare, especially in the context of dental screening measures.
Collapse
Affiliation(s)
- Diana Heimes
- Department of Oral- and Maxillofacial Surgery, University Medical Center Mainz, Augustusplatz 2, 55131 Mainz, Germany; (L.K.M.); (P.W.K.)
- Correspondence: ; Tel.: +49-6131-17-5086
| | - Lena Katharina Müller
- Department of Oral- and Maxillofacial Surgery, University Medical Center Mainz, Augustusplatz 2, 55131 Mainz, Germany; (L.K.M.); (P.W.K.)
| | - Alexandra Schellin
- Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, 24105 Kiel, Germany; (A.S.); (H.N.)
| | - Hendrik Naujokat
- Department of Oral and Maxillofacial Surgery, University Hospital of Schleswig-Holstein, 24105 Kiel, Germany; (A.S.); (H.N.)
| | - Christian Graetz
- Clinic for Conservative Dentistry and Periodontology, School of Dental Medicine, Christian-Albrechts-University of Kiel, 24118 Kiel, Germany;
| | - Falk Schwendicke
- Department of Operative and Preventive Dentistry, Charité University of Berlin, 10117 Berlin, Germany;
| | - Maximilian Goedecke
- Department of Oral- and Maxillofacial Surgery, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany; (M.G.); (B.B.-B.)
| | - Benedicta Beck-Broichsitter
- Department of Oral- and Maxillofacial Surgery, Charité-Universitätsmedizin Berlin, 10117 Berlin, Germany; (M.G.); (B.B.-B.)
| | - Peer W. Kämmerer
- Department of Oral- and Maxillofacial Surgery, University Medical Center Mainz, Augustusplatz 2, 55131 Mainz, Germany; (L.K.M.); (P.W.K.)
| |
Collapse
|
27
|
Shishkin A, Goel G, Baronins J, Ozolins J, Hoskins C, Goel S. Using circular economy principles to recycle materials in guiding the design of a wet scrubber-reactor for indoor air disinfection from coronavirus and other pathogens. Environ Technol Innov 2021; 22:101429. [PMID: 33614862 PMCID: PMC7879061 DOI: 10.1016/j.eti.2021.101429] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/18/2020] [Revised: 02/05/2021] [Accepted: 02/07/2021] [Indexed: 06/12/2023]
Abstract
An arduous need exists to discover rapid solutions to avoid the accelerated spread of coronavirus especially through the indoor environments like offices, hospitals, and airports. One such measure could be to disinfect the air, especially in indoor environments. The goal of this work is to propose a novel design of a wet scrubber-reactor to deactivate airborne microbes using circular economy principles. Based on Fenton's reaction mechanism, the system proposed here will deactivate airborne microbes (bioaerosols) such as SARS-CoV-2. The proposed design relies on using a highly porous clay-glass open-cell structure as an easily reproducible and cheap material. The principle behind this technique is an in-situ decomposition of hydrogen peroxide into highly reactive oxygen species and free radicals. The high porosity of a tailored ceramic structure provides a high contact area between atomized oxygen, free radicals and supplied polluted air. The design is shown to comply with the needs of achieving sustainable development goals.
Collapse
Affiliation(s)
- Andrei Shishkin
- Rudolfs Cimdins Riga Biomaterials Innovations and Development Centre of RTU, Institute of General Chemical Engineering, Faculty of Materials Science and Applied Chemistry, Riga Technical University, LV 1007, Riga, Latvia
| | - Gaurav Goel
- School of Engineering, London South Bank University, SE1 0AA, UK
- School of Aerospace, Transport & Manufacturing, Cranfield University, MK43 0AL, UK
| | - Janis Baronins
- Maritime Transport department, Latvian Maritime Academy, 12, k-1, Flotes Str., Riga, LV 1016, Latvia
| | - Jurijs Ozolins
- Rudolfs Cimdins Riga Biomaterials Innovations and Development Centre of RTU, Institute of General Chemical Engineering, Faculty of Materials Science and Applied Chemistry, Riga Technical University, LV 1007, Riga, Latvia
| | - Clare Hoskins
- Pure and Applied Chemistry, University of Strathclyde, Glasgow, G1 1RD, UK
| | - Saurav Goel
- School of Engineering, London South Bank University, SE1 0AA, UK
- School of Aerospace, Transport & Manufacturing, Cranfield University, MK43 0AL, UK
- Department of Mechanical Engineering, Shiv Nadar University, Gautam Budh Nagar, 201314, India
| |
Collapse
|
28
|
Martín-Sánchez M, Lim WW, Yeung A, Adam DC, Ali ST, Lau EHY, Wu P, Yuen KY, Leung GM, Cowling BJ. COVID-19 transmission in Hong Kong despite universal masking. J Infect 2021; 83:92-95. [PMID: 33895227 PMCID: PMC8061183 DOI: 10.1016/j.jinf.2021.04.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2021] [Accepted: 04/18/2021] [Indexed: 12/23/2022]
Abstract
Objectives mask-wearing outside the home has been almost universal in Hong Kong since late January 2020 with very high compliance. Nevertheless, community spread of COVID-19 has still occurred. We aimed to assess the settings where COVID-19 transmission occurred and determine the fraction of transmission events that occurred in settings where masks are not usually worn. Methods we reviewed detailed information provided by the Hong Kong Department of Health on local COVID-19 cases diagnosed up to 30 September 2020 to determine the most likely settings in which transmission occurred. We classified them in probably mask-on or mask-of and compared the prevalence of asymptomatic infections in these settings. Results among the 2425 cases (65.3%, 2425/3711) with information on transmission setting, 77.6% of the transmission occurred in household and social settings where face masks are not usually worn. Infections that occurred in mask-on settings were more likely to be asymptomatic (adjusted odds ratio 1.33; 95% confidence interval: 1.04, 1.68). Conclusions we conclude that universal mask-wearing can reduce transmission, but transmission can continue to occur in settings where face masks are not usually worn. The higher proportion of asymptomatic cases in mask-on settings could be related to a milder disease presentation or earlier case detection.
Collapse
Affiliation(s)
- Mario Martín-Sánchez
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Wey Wen Lim
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Amy Yeung
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Dillon C Adam
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Sheikh Taslim Ali
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China; Laboratory of Data Discovery for Health, Hong Kong Science and Technology Park, Hong Kong Special Administrative Region, China
| | - Eric H Y Lau
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China; Laboratory of Data Discovery for Health, Hong Kong Science and Technology Park, Hong Kong Special Administrative Region, China
| | - Peng Wu
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China; Laboratory of Data Discovery for Health, Hong Kong Science and Technology Park, Hong Kong Special Administrative Region, China
| | - Kwok-Yung Yuen
- State Key Laboratory for Emerging Infectious Diseases, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, Pokfulam, China; Department of Microbiology, Carol Yu Centre for Infection, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, Pokfulam, China; Department of Microbiology, Queen Mary Hospital, Hong Kong Special Administrative Region, Pokfulam, China; Department of Clinical Microbiology and Infection Control, The University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Gabriel M Leung
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China; Laboratory of Data Discovery for Health, Hong Kong Science and Technology Park, Hong Kong Special Administrative Region, China
| | - Benjamin J Cowling
- WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, LKS Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China; Laboratory of Data Discovery for Health, Hong Kong Science and Technology Park, Hong Kong Special Administrative Region, China.
| |
Collapse
|
29
|
Affiliation(s)
- Julian W Tang
- Respiratory Sciences, University of Leicester, Leicester, UK
| | - Linsey C Marr
- Civil and Environmental Engineering, Virginia Tech, USA
| | - Yuguo Li
- Department of Mechanical Engineering, University of Hong Kong, Hong Kong, China
| | | |
Collapse
|
30
|
Rhee C, Baker MA, Tucker R, Griesbach D, Mcdonald D, Williams SA, Fiumara K, Resnick A, Klompas M; for the CDC Prevention Epicenters Program. Sources of exposure identified through structured interviews of healthcare workers who test positive for severe acute respiratory coronavirus virus 2 (SARS-CoV-2): A prospective analysis at two teaching hospitals. ASHE 2021; 1. [PMID: 36168475 PMCID: PMC9495409 DOI: 10.1017/ash.2021.243] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/08/2021] [Accepted: 11/09/2021] [Indexed: 12/17/2022]
Abstract
Abstract
We interviewed 1,208 healthcare workers with positive SARS-CoV-2 tests between October 2020 and June 2021 to determine likely exposure sources. Overall, 689 (57.0%) had community exposures (479 from household members), 76 (6.3%) had hospital exposures (64 from other employees including 49 despite masking), 11 (0.9%) had community and hospital exposures, and 432 (35.8%) had no identifiable source of exposure.
Collapse
|
31
|
Jung J, Lee J, Jo S, Bae S, Kim JY, Cha HH, Lim YJ, Kwak SH, Hong MJ, Kim EO, Bae JY, Kang C, Sung M, Park MS, Kim SH. Nosocomial Outbreak of COVID-19 in a Hematologic Ward. Infect Chemother 2021; 53:332-341. [PMID: 34216126 PMCID: PMC8258301 DOI: 10.3947/ic.2021.0046] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 06/08/2021] [Indexed: 02/06/2023] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) outbreaks occur in hospitals in many parts of the world. In hospital settings, the possibility of airborne transmission needs to be investigated thoroughly. Materials and Methods There was a nosocomial outbreak of COVID-19 in a hematologic ward in a tertiary hospital, Seoul, Korea. We found 11 patients and guardians with COVID-19 through vigorous contact tracing and closed-circuit television monitoring. We found one patient who probably had acquired COVID-19 through airborne-transmission. We performed airflow investigation with simulation software, whole-genome sequencing of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Results Of the nine individuals with COVID-19 who had been in the hematologic ward, six stayed in one multi-patient room (Room 36), and other three stayed in different rooms (Room 1, 34, 35). Guardian in room 35 was close contact to cases in room 36, and patient in room 34 used the shared bathroom for teeth brushing 40 minutes after index used. Airflow simulation revealed that air was spread from the bathroom to the adjacent room 1 while patient in room 1 did not used the shared bathroom. Airflow was associated with poor ventilation in shared bathroom due to dysfunctioning air-exhaust, grill on the door of shared bathroom and the unintended negative pressure of adjacent room. Conclusion Transmission of SARS-CoV-2 in the hematologic ward occurred rapidly in the multi-patient room and shared bathroom settings. In addition, there was a case of possible airborne transmission due to unexpected airflow.
Collapse
Affiliation(s)
- Jiwon Jung
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.,Office for Infection Control, Asan Medical Center, Seoul, Korea
| | - Jungmin Lee
- Department of Microbiology, Institute for Viral Diseases, Biosafety Center, College of Medicine, Korea University, Seoul, Korea
| | - Seongmin Jo
- Department of Architectural Engineering, Sejong University, Seoul, Korea
| | - Seongman Bae
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ji Yeun Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Hye Hee Cha
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young Ju Lim
- Office for Infection Control, Asan Medical Center, Seoul, Korea
| | - Sun Hee Kwak
- Office for Infection Control, Asan Medical Center, Seoul, Korea
| | - Min Jee Hong
- Office for Infection Control, Asan Medical Center, Seoul, Korea
| | - Eun Ok Kim
- Office for Infection Control, Asan Medical Center, Seoul, Korea
| | - Joon Yong Bae
- Department of Microbiology, Institute for Viral Diseases, Biosafety Center, College of Medicine, Korea University, Seoul, Korea
| | - Changmin Kang
- Department of Microbiology, Institute for Viral Diseases, Biosafety Center, College of Medicine, Korea University, Seoul, Korea
| | - Minki Sung
- Department of Architectural Engineering, Sejong University, Seoul, Korea.
| | - Man Seong Park
- Department of Microbiology, Institute for Viral Diseases, Biosafety Center, College of Medicine, Korea University, Seoul, Korea.
| | - Sung Han Kim
- Department of Infectious Diseases, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.,Office for Infection Control, Asan Medical Center, Seoul, Korea.
| |
Collapse
|