Close contact behavior in indoor environment and transmission of respiratory infection

Reducing Transmission of Airborne Respiratory Pathogens: A New Beginning as the COVID-19 Emergency Ends

BACKGROUND

In response to the COVID-19 pandemic, new evidence-based strategies have emerged for reducing transmission of respiratory infections through management of indoor air.

OBJECTIVES

This paper reviews critical advances that could reduce the burden of disease from inhaled pathogens and describes challenges in their implementation.

DISCUSSION

Proven strategies include assuring sufficient ventilation, air cleaning by filtration, and air disinfection by germicidal ultraviolet (UV) light. Layered intervention strategies are needed to maximize risk reduction. Case studies demonstrate how to implement these tools while also revealing barriers to implementation. Future needs include standards designed with infection resilience and equity in mind, buildings optimized for infection resilience among other drivers, new approaches and technologies to improve ventilation, scientific consensus on the amount of ventilation needed to achieve a desired level of risk, methods for evaluating new air-cleaning technologies, studies of their long-term health effects, workforce training on ventilation systems, easier access to federal funds, demonstration projects in schools, and communication with the public about the importance of indoor air quality and actions people can take to improve it. https://doi.org/10.1289/EHP13878.

Analysis of SARS-CoV-2 transmission in a university classroom based on real human close contact behaviors

Due to high-population density, frequent close contact, possible poor ventilation, university classrooms are vulnerable for transmission of respiratory infectious diseases. Close contact and long-range airborne are possibly main routes for SARS-CoV-2 transmission. In this study, taking a university classroom in Beijing for example, close contact behaviors of students were collected through a depth-detection device, which could detect depth to each pixel of the image, based on semi-supervised learning. Finally, >23 h of video data were obtained. Using Computational Fluid Dynamics, the relationship between viral exposure and close contact behaviors (e.g. interpersonal distance, relative facial orientations, and relative positions) was established. A multi-route transmission model (short-range airborne, mucous deposition, and long-range airborne) of infectious diseases considering real close contact behaviors was developed. In the case of Omicron, the risk of infection in university classrooms and the efficacy of different interventions were assessed based on dose-response model. The average interpersonal distance in university classrooms is 0.9 m (95 % CI, 0.5 m-1.4 m), with the highest proportion of face-to-back contact at 87.0 %. The risk of infection of susceptible students per 45-min lesson was 1 %. The relative contributions of short-range airborne and long-range airborne transmission were 40.5 % and 59.5 %, respectively, and the mucous deposition was basically negligible. When all students are wearing N95 respirators, the infection risk could be reduced by 96 %, the relative contribution of long-range airborne transmission increases to 95.6 %. When the fresh air per capita in the classroom is 24 m3/h/person, the virus exposure could be decreased by 81.1 % compared to the real situation with 1.02 m3/h/person. In a classroom with an occupancy rate of 50 %, after optimized arrangement of student distribution, the infection risk could be decreased by 62 %.

Seroprevalence survey of SARS-CoV-2, community behaviors, and practices in Kansanshi and Kalumbila mining towns

Background

Coronavirus disease 2019 (SARS-CoV-2) was declared a global pandemic by WHO after it spreads quickly around the world from its source city in Wuhan. Africa has some of the lowest documented SARS-CoV-2 incidences globally, with over 9 million confirmed cases as of December 2022. This may be due to efficient mitigation, outbreak response, or demographic traits. Surveillance capability may have suffered as nations changed funding, regulations, and testing plans. Therefore, this study was to document the prevalence of SARS-CoV-2, its characteristics, and the socio-economic characteristics in the two mining districts of Solwezi and Kalumbila of Zambia.

Methods

Between 28 March and 26 April 2021, a cross-sectional cluster-sample survey of households in two mining districts of Zambia was conducted. Twenty standard enumeration areas (SEAs) were randomly selected in Kansanshi (17 SEA) and Kalumbila (3 SEA) from a total of 67 SEA that encompass the two mines. Members of households aged <5 years were not eligible to participate in the survey. All participants that consented to participate in the interview were also asked to consent to test for SARS-CoV-2 infection using a rapid diagnostic test (RDT), which tested for recent infection and past exposure to the virus (IgM and IgG, respectively).

Result

Out of the total sample of 3,047 that were present for the interview, 622 of them agreed to test for COVID-19. Of the total that tested for SARS-CoV-2, 2.6% were IgM positive while 9.0% were IgG positive. Despite the above results, 1,586 participants that agreed to the interview indicated a low self-risk assessment of getting COVID-19 (46.5%) or someone (45.5%). On the public health measures, participants who did handwashing more than usual (65.0%), not hand sanitizing more than usual (69.0%), not disinfecting surfaces in their households than usual (87.5%), not avoiding drinking from bars or nightclubs (90.6%), and not wearing a mask when out in public places (71.1%). In the logistic multivariable model, participants with age 24 years and above (AOR = 2.94; 95% CI = 1.10, 7.81) and having experienced symptoms of SARS-CoV-2 (AOR = 2.60; 95% CI: 1.33, 5.05) had a significant effect on testing positive for SARS-CoV-2.

Conclusion

Although the results showed that active COVID-19 prevalence in Solwezi and Kalumbila communities surrounding the two mines was low, exposure to infection was five times high. Government and mining firms should continue to sensitize the community members on the preventive measures of COVID-19 and continue with community testing so that all those positive but without symptoms can self-isolate and those with symptoms and sick can be admitted to the hospital.

Close contact behaviors of university and school students in 10 indoor environments

Close contact routes, including short-range airborne and large-droplet routes, play an important role in the transmission of SARS-CoV-2 in indoor environments. However, the exposure risk of such routes is difficult to quantify due to the lack of data on the close contact behavior of individuals. In this study, a digital wearable device, based on semi-supervised learning, was developed to automatically record human close contact behavior. We collected 337,056 s of indoor close contact of school and university students from 194.5 h of depth video recordings in 10 types of indoor environments. The correlation between aerosol exposure and close contact behaviors was then evaluated. Individuals in restaurants had the highest close contact ratio (64%), as well as the highest probability of face-to-face pattern (78%) during close contact. Accordingly, university students showed greater exposure potential in dormitories than school students in homes, however, a lower exposure was observed in classrooms and postgraduate student offices in comparison with school students in classrooms. In addition, restaurants had the highest aerosol exposure volume for both short-range inhalation and direct deposition on the facial mucosa. Thus, the classroom was established as the primary indoor environment where school students are exposed to aerosols.

Impact of a Serious Game (#RedPingüiNO) to Reduce Facial Self-Touches and Prevent Exposure to Pathogens Transmitted via Hands: Quasi-Experimental Intervention

BACKGROUND

After the COVID-19 pandemic, society has become more aware of the importance of some basic hygienic habits to avoid exposure to pathogens transmitted via hands. Given that a high frequency of touching mucous membranes can lead to a high risk of infection, it is essential to establish strategies to reduce this behavior as a preventive measure against contagion. This risk can be extrapolated to a multitude of health scenarios and transmission of many infectious diseases. #RedPingüiNO was designed as an intervention to prevent the transmission of SARS-CoV-2 and other pathogens through the reduction of facial self-touches by thoughtfully engaging participants in a serious game.

OBJECTIVE

Facial self-touches should be understood as behaviors of limited control and awareness, used to regulate situations of cognitive and emotional demands, or as part of nonverbal communication. The objective of this study was to ensure that participants become aware of and reduce these behaviors through a game of self-perception.

METHODS

The quasi-experimental intervention was applied to 103 healthy university students selected by convenience sampling and put into practice for 2 weeks, with 1 control group (n=24, 23.3%) and 2 experimental groups (experimental group with no additional social reinforcement interventions: n=36, 35%; experimental group with additional social reinforcement interventions: n=43, 41.7%). The objective was to improve knowledge and perception and reduce facial self-touches to prevent exposure to pathogens transmitted via hands not only in health multihazard scenarios but also in ordinary circumstances. The ad hoc instrument used to analyze the experience consisted of 43 items and was valid and reliable for the purpose of this study. The items were divided into 5 blocks extracted from the theoretical framework: sociological issues (1-5); hygiene habits (6-13); risk awareness (14-19); strategies for not touching the face (20-26); and questions after the intervention (27-42), designed as a postintervention tool assessing the game experience. Validation of the content was achieved through assessment by 12 expert referees. External validation was performed using a test-retest procedure, and reliability was verified using the Spearman correlation.

RESULTS

The results of the ad hoc questionnaire, which were analyzed using the Wilcoxon signed-rank test and McNemar index to identify significant differences between test and retest for a 95% CI, showed that facial self-touches were reduced (item 20, P<.001; item 26, P=.04), and awareness of this spontaneous behavior and its triggers increased (item 15; P=.007). The results were reinforced by qualitative findings from the daily logs.

CONCLUSIONS

The intervention exhibited a greater effect from sharing the game, with interactions between people; however, in both cases, it was helpful in reducing facial self-touches. In summary, this game is suitable for reducing facial self-touches, and owing to its free availability and design, it can be adapted to various contexts.

Electrospun nanofibers for medical face mask with protection capabilities against viruses: State of the art and perspective for industrial scale-up

Face masks have proven to be a useful protection from airborne viruses and bacteria, especially in the recent years pandemic outbreak when they effectively lowered the risk of infection from Coronavirus disease (COVID-19) or Omicron variants, being recognized as one of the main protective measures adopted by the World Health Organization (WHO). The need for improving the filtering efficiency performance to prevent penetration of fine particulate matter (PM), which can be potential bacteria or virus carriers, has led the research into developing new methods and techniques for face mask fabrication. In this perspective, Electrospinning has shown to be the most efficient technique to get either synthetic or natural polymers-based fibers with size down to the nanoscale providing remarkable performance in terms of both particle filtration and breathability. The aim of this Review is to give further insight into the implementation of electrospun nanofibers for the realization of the next generation of face masks, with functionalized membranes via addiction of active material to the polymer solutions that can give optimal features about antibacterial, antiviral, self-sterilization, and electrical energy storage capabilities. Furthermore, the recent advances regarding the use of renewable materials and green solvent strategies to improve the sustainability of electrospun membranes and to fabricate eco-friendly filters are here discussed, especially in view of the large-scale nanofiber production where traditional membrane manufacturing may result in a high environmental and health risk.

Student close contact behavior and COVID-19 transmission in China's classrooms

Classrooms are high-risk indoor environments, so analysis of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission in classrooms is important for determining optimal interventions. Due to the absence of human behavior data, it is challenging to accurately determine virus exposure in classrooms. A wearable device for close contact behavior detection was developed, and we recorded >250,000 data points of close contact behaviors of students from grades 1 to 12. Combined with a survey on students' behaviors, we analyzed virus transmission in classrooms. Close contact rates for students were 37 ± 11% during classes and 48 ± 13% during breaks. Students in lower grades had higher close contact rates and virus transmission potential. The long-range airborne transmission route is dominant, accounting for 90 ± 3.6% and 75 ± 7.7% with and without mask wearing, respectively. During breaks, the short-range airborne route became more important, contributing 48 ± 3.1% in grades 1 to 9 (without wearing masks). Ventilation alone cannot always meet the demands of COVID-19 control; 30 m3/h/person is suggested as the threshold outdoor air ventilation rate in a classroom. This study provides scientific support for COVID-19 prevention and control in classrooms, and our proposed human behavior detection and analysis methods offer a powerful tool to understand virus transmission characteristics and can be employed in various indoor environments.

Mechanisms controlling the transport and evaporation of human exhaled respiratory droplets containing the severe acute respiratory syndrome coronavirus: a review

Transmission of the coronavirus disease 2019 is still ongoing despite mass vaccination, lockdowns, and other drastic measures to control the pandemic. This is due partly to our lack of understanding on the multiphase flow mechanics that control droplet transport and viral transmission dynamics. Various models of droplet evaporation have been reported, yet there is still limited knowledge about the influence of physicochemical parameters on the transport of respiratory droplets carrying the severe acute respiratory syndrome coronavirus 2. Here we review the effects of initial droplet size, environmental conditions, virus mutation, and non-volatile components on droplet evaporation and dispersion, and on virus stability. We present experimental and computational methods to analyze droplet transport, and factors controlling transport and evaporation. Methods include thermal manikins, flow techniques, aerosol-generating techniques, nucleic acid-based assays, antibody-based assays, polymerase chain reaction, loop-mediated isothermal amplification, field-effect transistor-based assay, and discrete and gas-phase modeling. Controlling factors include environmental conditions, turbulence, ventilation, ambient temperature, relative humidity, droplet size distribution, non-volatile components, evaporation and mutation. Current results show that medium-sized droplets, e.g., 50 µm, are sensitive to relative humidity. Medium-sized droplets experience delayed evaporation at high relative humidity, and increase airborne lifetime and travel distance. By contrast, at low relative humidity, medium-sized droplets quickly shrink to droplet nuclei and follow the cough jet. Virus inactivation within a few hours generally occurs at temperatures above 40 °C, and the presence of viral particles in aerosols impedes droplet evaporation.

Conversational head movement decreases close-contact exposure to expired respiratory droplets

People constantly move their heads during conversation, as such movement is an important non-verbal mode of communication. Head movement alters the direction of people's expired air flow, therefore affecting their conversational partners' level of exposure. Nevertheless, there is a lack of understanding of the mechanism whereby head movement affects people's exposure. In this study, a dynamic meshing method in computational fluid dynamics was used to simulate the head movement of a human-shaped thermal manikin. Droplets were released during the oral expiration periods of the source manikin, during which it was either motionless, was shaking its head or was nodding its head, while the head of a face-to-face target manikin remained motionless. The results indicate that the target manikin had a high level of exposure to respiratory droplets when the source manikin was motionless, whereas the target manikin's level of exposure was significantly reduced when the source manikin was shaking or nodding its head. The source manikin had the highest level of self-exposure when it was nodding its head and the lowest level of self-exposure when its head was motionless. People's level of exposure during close contact is highly variable, highlighting the need for further investigations in more realistic conversational scenarios.

Quantitative evaluation of precautions against the COVID-19 indoor transmission through human coughing

In this work, we focus on the dispersion of COVID-19-laden droplets using the transient computational fluid dynamics (CFD) modeling and simulation of the coughing process of virus carriers in an enclosure room, aiming to set up the basic prototype of popular precautionary strategies, i.e., face mask, upward ventilation, protective screen, or any combination thereof, against the indoor transmission of COVID-19 and other highly contagious diseases in the future. A multi-component Eulerian-Lagrangian CFD particle-tracking model with user-defined functions is utilized under 8 cases to examine the characteristics of droplet dispersion concerning the mass and heat transfer, droplet evaporation, air buoyancy, air convection, air-droplet friction, and turbulent dispersion. The result shows that implementing upward ventilation is the most effective measure, followed by wearing face masks. Protective screens can restrict the movement of the coughing droplets (though it will not reduce viral load). However, applying protective screens arranged with lean can be counterproductive in preventing the spread of COVID-19 when it is inappropriately placed with ventilation. The soundest solution is the combination of the face mask and upward ventilation, which can reduce the indoor infectious concentration by nearly 99.95% compared with the baseline without any precautionary strategies. With the resumption of school and work in the post-epidemic era, this study would provide intelligence-enhancing advice for the masses and rule-makers to curb the pandemic.

Predominance of inhalation route in short-range transmission of respiratory viruses: Investigation based on computational fluid dynamics

During the Coronavirus disease 2019 pandemic, short-range virus transmission has been observed to have a higher risk of causing infection than long-range virus transmission. However, the roles played by the inhalation and large droplet routes cannot be distinguished in practice. A recent analytical study revealed the predominance of short-range inhalation over the large droplet spray route as causes of respiratory infections. In the current study, short-range exposure was analyzed via computational fluid dynamics (CFD) simulations using a discrete phase model. Detailed facial membranes, including eyes, nostrils, and a mouth, were considered. In CFD simulations, there is no need for a spherical approximation of the human head for estimating deposition nor the "anisokinetic aerosol sampling" approximation for estimating inhalation in the analytical model. We considered two scenarios (with two spheres [Scenario 1] and two human manikins [Scenario 2]), source-target distances of 0.2 to 2 m, and droplet diameters of 3 to 1,500 µm. The overall CFD exposure results agree well with data previously obtained from a simple analytical model. The CFD results confirm the predominance of the short-range inhalation route beyond 0.2 m for expiratory droplets smaller than 50 µm during talking and coughing. A critical droplet size of 87.5 µm was found to differentiate droplet behaviors. The number of droplets deposited on the target head exceeded those exposed to facial membranes, which implies a risk of exposure through the immediate surface route over a short range.

Electronic Supplementary Material ESM

the Supplementary Materials are available in the online version of this article at 10.1007/s12273-022-0968-y.

Airborne transmission of biological agents within the indoor built environment: a multidisciplinary review

The nature and airborne dispersion of the underestimated biological agents, monitoring, analysis and transmission among the human occupants into building environment is a major challenge of today. Those agents play a crucial role in ensuring comfortable, healthy and risk-free conditions into indoor working and leaving spaces. It is known that ventilation systems influence strongly the transmission of indoor air pollutants, with scarce information although to have been reported for biological agents until 2019. The biological agents' source release and the trajectory of airborne transmission are both important in terms of optimising the design of the heating, ventilation and air conditioning systems of the future. In addition, modelling via computational fluid dynamics (CFD) will become a more valuable tool in foreseeing risks and tackle hazards when pollutants and biological agents released into closed spaces. Promising results on the prediction of their dispersion routes and concentration levels, as well as the selection of the appropriate ventilation strategy, provide crucial information on risk minimisation of the airborne transmission among humans. Under this context, the present multidisciplinary review considers four interrelated aspects of the dispersion of biological agents in closed spaces, (a) the nature and airborne transmission route of the examined agents, (b) the biological origin and health effects of the major microbial pathogens on the human respiratory system, (c) the role of heating, ventilation and air-conditioning systems in the airborne transmission and (d) the associated computer modelling approaches. This adopted methodology allows the discussion of the existing findings, on-going research, identification of the main research gaps and future directions from a multidisciplinary point of view which will be helpful for substantial innovations in the field.

Combining Phi6 as a surrogate virus and computational large-eddy simulations to study airborne transmission of SARS-CoV-2 in a restaurant

COVID-19 has highlighted the need for indoor risk-reduction strategies. Our aim is to provide information about the virus dispersion and attempts to reduce the infection risk. Indoor transmission was studied simulating a dining situation in a restaurant. Aerosolized Phi6 viruses were detected with several methods. The aerosol dispersion was modeled by using the Large-Eddy Simulation (LES) technique. Three risk-reduction strategies were studied: (1) augmenting ventilation with air purifiers, (2) spatial partitioning with dividers, and (3) combination of 1 and 2. In all simulations infectious viruses were detected throughout the space proving the existence long-distance aerosol transmission indoors. Experimental cumulative virus numbers and LES dispersion results were qualitatively similar. The LES results were further utilized to derive the evolution of infection probability. Air purifiers augmenting the effective ventilation rate by 65% reduced the spatially averaged infection probability by 30%-32%. This relative reduction manifests with approximately 15 min lag as aerosol dispersion only gradually reaches the purifier units. Both viral findings and LES results confirm that spatial partitioning has a negligible effect on the mean infection-probability indoors, but may affect the local levels adversely. Exploitation of high-resolution LES jointly with microbiological measurements enables an informative interpretation of the experimental results and facilitates a more complete risk assessment.

Overview of the Role of Spatial Factors in Indoor SARS-CoV-2 Transmission: A Space-Based Framework for Assessing the Multi-Route Infection Risk

The COVID-19 pandemic has lasted from 2019 to 2022, severely disrupting human health and daily life. The combined effects of spatial, environmental, and behavioral factors on indoor COVID-19 spread and their interactions are usually ignored. Especially, there is a lack of discussion on the role of spatial factors in reducing the risk of virus transmission in complex and diverse indoor environments. This paper endeavours to summarize the spatial factors and their effects involved in indoor virus transmission. The process of release, transport, and intake of SARS-CoV-2 was reviewed, and six transmission routes according to spatial distance and exposure way were classified. The triangular relationship between spatial, environmental and occupant behavioral parameters during virus transmission was discussed. The detailed effects of spatial parameters on droplet-based, surface-based and air-based transmission processes and virus viability were summarized. We found that spatial layout, public-facility design and openings have a significant indirect impact on the indoor virus distribution and transmission by affecting occupant behavior, indoor airflow field and virus stability. We proposed a space-based indoor multi-route infection risk assessment framework, in which the 3D building model containing detailed spatial information, occupant behavior model, virus-spread model and infection-risk calculation model are linked together. It is also applicable to other, similar, respiratory infectious diseases such as SARS, influenza, etc. This study contributes to developing building-level, infection-risk assessment models, which could help building practitioners make better decisions to improve the building's epidemic-resistance performance.

Close contact behavior-based COVID-19 transmission and interventions in a subway system

During COVID-19 pandemic, analysis on virus exposure and intervention efficiency in public transports based on real passenger's close contact behaviors is critical to curb infectious disease transmission. A monitoring device was developed to gather a total of 145,821 close contact data in subways based on semi-supervision learning. A virus transmission model considering both short- and long-range inhalation and deposition was established to calculate the virus exposure. During rush-hour, short-range inhalation exposure is 3.2 times higher than deposition exposure and 7.5 times higher than long-range inhalation exposure of all passengers in the subway. The close contact rate was 56.1 % and the average interpersonal distance was 0.8 m. Face-to-back was the main pattern during close contact. Comparing with random distribution, if all passengers stand facing in the same direction, personal virus exposure through inhalation (deposition) can be reduced by 74.1 % (98.5 %). If the talk rate was decreased from 20 % to 5 %, the inhalation (deposition) exposure can be reduced by 69.3 % (73.8 %). In addition, we found that virus exposure could be reduced by 82.0 % if all passengers wear surgical masks. This study provides scientific support for COVID-19 prevention and control in subways based on real human close contact behaviors.

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

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

Exposure and respiratory infection risk via the short-range airborne route

Leading health authorities have suggested short-range airborne transmission as a major route of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). However, there is no simple method to assess the short-range airborne infection risk or identify its governing parameters. We proposed a short-range airborne infection risk assessment model based on the continuum model and two-stage jet model. The effects of ventilation, physical distance and activity intensity on the short-range airborne exposure were studied systematically. The results suggested that increasing physical distance and ventilation reduced short-range airborne exposure and infection risk. However, a diminishing return phenomenon was observed when the ventilation rate or physical distance was beyond a certain threshold. When the infectious quantum concentration was less than 1 quantum/L at the mouth, our newly defined threshold distance and threshold ventilation rate were independent of quantum concentration. We estimated threshold distances of 0.59, 1.1, 1.7 and 2.6 m for sedentary/passive, light, moderate and intense activities, respectively. At these distances, the threshold ventilation was estimated to be 8, 20, 43, and 83 L/s per person, respectively. The findings show that both physical distancing and adequate ventilation are essential for minimising infection risk, especially in high-intensity activity or densely populated spaces.

Assessing personal exposure to COVID-19 transmission in public indoor spaces based on fine-grained trajectory data: A simulation study

The coronavirus disease 2019 (COVID-19) pandemic has posed substantial challenges to worldwide health systems in quick response to epidemics. The assessment of personal exposure to COVID-19 in enclosed spaces is critical to identifying potential infectees and preventing outbreaks. However, traditional contact tracing methods rely heavily on a manual interview, which is costly and time consuming given the large population involved. With advanced indoor localisation techniques, it is possible to collect people's footprints accurately by locating their smartphones. This study presents a new framework for the assessment of personal exposure to COVID-19 carriers using their fine-grained trajectory data. An integral model was established to quantify the exposure risk, in which the spatial and temporal decay effects are simultaneously considered when modelling the airborne transmission of COVID-19. Regarding the obstacle effect of the indoor layout on airborne transmission, a weight graph based on the space syntax technique was further introduced to constrain the transmission strength between subspaces that are less inter-visible. The proposed framework was demonstrated by a simulation study, in which external comparison and internal analysis were conducted to justify its validity and robustness in different scenarios. Our method is expected to promote the efficient identification of potential infectees and provide an extensible spatial-temporal model to simulate different control measures and examine their effectiveness in a built environment.

Environmental Design Strategies to Decrease the Risk of Nosocomial Infection in Medical Buildings Using a Hybrid MCDM Model

The prevention and control of nosocomial infection (NI) are becoming increasingly difficult, and its mechanism is becoming increasingly complex. A globally aging population means that an increasing proportion of patients have a susceptible constitution, and the frequent occurrence of severe infectious diseases has also led to an increase in the cost of prevention and control of NI. Medical buildings' spatial environment design for the prevention of NI has been a hot subject of considerable research, but few previous studies have summarized the design criteria for a medical building environment to control the risk of NI. Thus, there is no suitable evaluation framework to determine whether the spatial environment of a medical building is capable of inhibiting the spread of NI. In the context of the global spread of COVID-19, it is necessary to evaluate the performance of the existing medical building environment in terms of inhibiting the spread of NI and to verify current environmental improvement strategies for the efficient and rational use of resources. This study determines the key design elements for the spatial environment of medical buildings, constructs an evaluation framework using exploratory factor analysis, verifies the complex dominant influence relationship, and prioritizes criteria in the evaluation framework using the decision-making trial and evaluation laboratory- (DEMATEL-) based analytical network process (ANP) (DANP). Using representative real cases, this study uses the technique for order preference by similarity to ideal solution (TOPSIS) to evaluate and analyze the performance with the aspiration level of reducing the NI risk. A continuous and systematic transformation design strategy for these real cases is proposed. The main contributions of this study include the following: (1) it creates a systematic framework that allows hospital decision-makers to evaluate the spatial environment of medical buildings; (2) it provides a reference for making design decisions to improve the current situation using the results of a performance evaluation; (3) it draws an influential network relation map (INRM) and the training of influence weights (IWs) for criteria. The sources of practical problems can be identified by the proposed evaluation framework, and the corresponding strategy can be proposed to avoid the waste of resources for the prevention of epidemics.

Reduction of exposure to simulated respiratory aerosols using ventilation, physical distancing, and universal masking

To limit community spread of SARS-CoV-2, CDC recommends universal masking indoors, maintaining 1.8 m of physical distancing, adequate ventilation, and avoiding crowded indoor spaces. Several studies have examined the independent influence of each control strategy in mitigating transmission in isolation, yet controls are often implemented concomitantly within an indoor environment. To address the influence of physical distancing, universal masking, and ventilation on very fine respiratory droplets and aerosol particle exposure, a simulator that coughed and exhaled aerosols (the source) and a second breathing simulator (the recipient) were placed in an exposure chamber. When controlling for the other two mitigation strategies, universal masking with 3-ply cotton masks reduced exposure to 0.3-3 µm coughed and exhaled aerosol particles by >77% compared to unmasked tests, whereas physical distancing (0.9 or 1.8 m) significantly changed exposure to cough but not exhaled aerosols. The effectiveness of ventilation depended upon the respiratory activity, that is, coughing or breathing, as well as the duration of exposure time. Our results demonstrate that a layered mitigation strategy approach of administrative and engineering controls can reduce personal inhalation exposure to potentially infectious very fine respiratory droplets and aerosol particles within an indoor environment.

Control of airborne infectious disease in buildings: Evidence and research priorities

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.

Reconstitution and Transmission of Gut Microbiomes and Their Genes between Generations

Microbiomes are transmitted between generations by a variety of different vertical and/or horizontal modes, including vegetative reproduction (vertical), via female germ cells (vertical), coprophagy and regurgitation (vertical and horizontal), physical contact starting at birth (vertical and horizontal), breast-feeding (vertical), and via the environment (horizontal). Analyses of vertical transmission can result in false negatives (failure to detect rare microbes) and false positives (strain variants). In humans, offspring receive most of their initial gut microbiota vertically from mothers during birth, via breast-feeding and close contact. Horizontal transmission is common in marine organisms and involves selectivity in determining which environmental microbes can colonize the organism's microbiome. The following arguments are put forth concerning accurate microbial transmission: First, the transmission may be of functions, not necessarily of species; second, horizontal transmission may be as accurate as vertical transmission; third, detection techniques may fail to detect rare microbes; lastly, microbiomes develop and reach maturity with their hosts. In spite of the great variation in means of transmission discussed in this paper, microbiomes and their functions are transferred from one generation of holobionts to the next with fidelity. This provides a strong basis for each holobiont to be considered a unique biological entity and a level of selection in evolution, largely maintaining the uniqueness of the entity and conserving the species from one generation to the next.

Respiratory Disease Risk of Zoo-Housed Bonobos Is Associated with Sex and Betweenness Centrality in the Proximity Network

Infectious diseases can be considered a threat to animal welfare and are commonly spread through both direct and indirect social interactions with conspecifics. This is especially true for species with complex social lives, like primates. While several studies have investigated the impact of sociality on disease risk in primates, only a handful have focused on respiratory disease, despite it being a major cause of morbidity and mortality in both wild and captive populations and thus an important threat to primate welfare. Therefore, we examined the role of social-network position on the occurrence of respiratory disease symptoms during one winter season in a relatively large group of 20 zoo-housed bonobos with managed fission-fusion dynamics. We found that within the proximity network, symptoms were more likely to occur in individuals with higher betweenness centrality, which are individuals that form bridges between different parts of the network. Symptoms were also more likely to occur in males than in females, independent of their social-network position. Taken together, these results highlight a combined role of close proximity and sex in increased risk of attracting respiratory disease, two factors that can be taken into account for further welfare management of the species.

Weakening personal protective behavior by Chinese university students after COVID-19 vaccination

Personal protective behaviors and their dynamic change are known to play a major role in the community spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the causal pathogen of the coronavirus disease 2019 (COVID-19) pandemic. In this study, a total of 3229 students in Chinese universities completed an online survey about their knowledge on transmission and personal protective behavior before and after COVID-19 vaccination. Of the respondents, 87.6% had been vaccinated. Most students believed that the large droplet (97.0%) and short-range airborne (89.3%) routes were the two most likely SARS-CoV-2 transmission routes, whereas only 24.1% considered long-range airborne transmission to be possible. Students who would be expected to possess better knowledge about virus transmission (e.g., students of medicine) reported better personal protective behaviors. Female students reported relatively better personal hygiene practices than male students, so did the confident students than their diffident peers. Students washed their hands on average of 5.76 times per day during the pandemic. Students at universities in southern regions washed their hands more frequently but paid less attention to indoor ventilation than did their northern counterparts. Interestingly, students who are fear of being infected had the bad personal hygiene. University students wore 22% less masks in public indoor environments after vaccination. Chinese university students weakened their personal protective behavior after vaccination and it may increase the potential risk of infection in the new waves of variant virus (e.g. delta).

A Paradigm Shift to Align Transmission Routes With Mechanisms

Current infection-control guidelines subscribe to a contact/droplet/airborne paradigm that is based on outdated understanding. Here, we propose to modify and align existing guidelines with a more accurate description of the different transmission routes. This will improve the effectiveness of control measures as more transmissible variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) emerge.

Close proximity risk assessment for SARS-CoV-2 infection

Although the interpersonal distance represents an important parameter affecting the risk of infection due to respiratory viruses, the mechanism of exposure to exhaled droplets remains insufficiently characterized. In this study, an integrated risk assessment is presented for SARS-CoV-2 close proximity exposure between a speaking infectious subject and a susceptible subject. It is based on a three-dimensional transient numerical model for the description of exhaled droplet spread once emitted by a speaking person, coupled with a recently proposed SARS-CoV-2 emission approach. Particle image velocimetry measurements were conducted to validate the numerical model. The contribution of the large droplets to the risk is barely noticeable only for distances well below 0.6 m, whereas it drops to zero for greater distances where it depends only on airborne droplets. In particular, for short exposures (10 s) a minimum safety distance of 0.75 m should be maintained to lower the risk below 0.1%; for exposures of 1 and 15 min this distance increases to about 1.1 and 1.5 m, respectively. Based on the interpersonal distances across countries reported as a function of interacting individuals, cultural differences, and environmental and sociopsychological factors, the approach presented here revealed that, in addition to intimate and personal distances, particular attention must be paid to exposures longer than 1 min within social distances (of about 1 m).

A review of epidemic investigation on cold-chain food-mediated SARS-CoV-2 transmission and food safety consideration during COVID-19 pandemic

COVID‐19 has brought speculations on potential transmission routes of the severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2), the causal agent of the pandemic. It is reported that the main route of virus transmission to be person‐to‐person by respiratory droplets; however, people have raised concerns on the possible transmission of SARS‐CoV‐2 to humans via food and packaging and its potential effects on food safety. This review discusses food safety issues in the COVID‐19 pandemic and reveals its possible transmission in cold‐chain food. The first outbreak of COVID‐19 in late 2019 was associated with a seafood market in Wuhan, China, while the second outbreak of COVID‐19 in June 2020 was also related to a seafood market in Beijing, China. As of 2020, several frozen seafood products linked with SARS‐CoV‐2 have been reported in China. According to the current survey and scientific studies, the risk of infection by SARS‐CoV‐2 from cold‐chain food, food products, and food packaging is thought to be very low. However, studies on food cold chain contamination have shown that SARS‐CoV‐2 remained highly stable under refrigerated (4°C) and even in freezing conditions (−10 to −80°C). Since one mode of SARS‐CoV‐2 transmission appears to be touching contaminated surfaces, it is important to clean and sanitize food contact surfaces properly. Understanding food safety hazard risks is essential to avoid potential negative health effects and SARS‐CoV‐2 transmission in the food supply chain during the COVID‐19 pandemic.

Recent research on expiratory particles in respiratory viral infection and control strategies: A review

The global spread of coronavirus disease 2019 poses a significant threat to human health. In this study, recent research on the characteristics of expiratory particles and flow is reviewed, with a special focus on different respiratory activities, to provide guidance for reducing the viral infection risk in the built environment. Furthermore, environmental influence on particle evaporation, dispersion, and virus viability after exhalation and the current methods for infection risk assessment are reviewed. Finally, we summarize promising control strategies against infectious expiratory particles. The results show that airborne transmission is a significant viral transmission route, both in short and long ranges, from infected individuals. Relative humidity affects the evaporation and trajectories of middle-sized droplets most, and temperature accelerates the inactivation of SARS-CoV-2 both on surfaces and in aerosols. Future research is needed to improve infection risk models to better predict the infection potential of different transmission routes. Moreover, further quantitative studies on the expiratory flow features after wearing a mask are needed. Systematic investigations and the design of advanced air distribution methods, portable air cleaners, and ultraviolet germicidal irradiation systems, which have shown high efficacy in removing contaminants, are required to better control indoor viral infection.

Short-range exposure to airborne virus transmission and current guidelines

After the Spanish flu pandemic, it was apparent that airborne transmission was crucial to spreading virus contagion, and research responded by producing several fundamental works like the experiments of Duguid [J. P. Duguid, J. Hyg. 44, 6 (1946)] and the model of Wells [W. F. Wells, Am. J. Hyg. 20, 611-618 (1934)]. These seminal works have been pillars of past and current guidelines published by health organizations. However, in about one century, understanding of turbulent aerosol transport by jets and plumes has enormously progressed, and it is now time to use this body of developed knowledge. In this work, we use detailed experiments and accurate computationally intensive numerical simulations of droplet-laden turbulent puffs emitted during sneezes in a wide range of environmental conditions. We consider the same emission-number of drops, drop size distribution, and initial velocity-and we change environmental parameters such as temperature and humidity, and we observe strong variation in droplets' evaporation or condensation in accordance with their local temperature and humidity microenvironment. We assume that 3% of the initial droplet volume is made of nonvolatile matter. Our systematic analysis confirms that droplets' lifetime is always about one order of magnitude larger compared to previous predictions, in some cases up to 200 times. Finally, we have been able to produce original virus exposure maps, which can be a useful instrument for health scientists and practitioners to calibrate new guidelines to prevent short-range airborne disease transmission.

Estimation of the SARS-CoV-2 transmission probability in confined traffic space and evaluation of the mitigation strategies

Public transport is a fundamental service for the resumption of work and production, but the enclosed environment and dense population create very favorable conditions for the spread of epidemic infections. Thus, effective public health interventions are urgently introduced. The objective of this paper is to quantitatively estimate the SARS-CoV-2 transmission probability and evaluate the influence of environmental parameters and individual intervention on the epidemic prevention. For this purpose, (1) we estimate the virus emission rate with Diamond Princess Cruise Ship infection data by Monte Carlo simulation and the improved Wells-Riley model, and (2) employ the reproductive number R to quantify diverse mitigation strategies. Different determinants are examined such as the duration of exposure, the number of passengers combined with individual interventions such as mask type and mask-wearing rate. The results show that the SARS-CoV-2 quantum generation rate is 185.63. The R shows a stronger positive correlation with the exposure time comparing to the number of passengers. In this light, reducing the frequency of long-distance journeys on crowded public transportation may be required to reduce the spread of the virus during the pandemic. N95 mask and surgical mask can reduce the transmission risk by 97 and 84%, respectively, and even homemade mask can reduce the risk by 67%, which indicates that it is necessary to advocate wearing masks on public transportation.

Evidence for lack of transmission by close contact and surface touch in a restaurant outbreak of COVID-19

BACKGROUND

Coronavirus disease 2019 (COVID-19) is primarily a respiratory disease that has become a global pandemic. Close contact plays an important role in infection spread, while fomite may also be a possible transmission route. Research during the COVID-19 pandemic has identified long-range airborne transmission as one of the important transmission routes although lack solid evidence.

METHODS

We examined video data related to a restaurant associated COVID-19 outbreak in Guangzhou. We observed more than 40,000 surface touches and 13,000 episodes of close contacts in the restaurant during the entire lunch duration. These data allowed us to analyse infection risk via both the fomite and close contact routes.

RESULTS

There is no significant correlation between the infection risk via both fomite and close contact routes among those who were not family members of the index case. We can thus rule out virus transmission via fomite contact and interpersonal close contact routes in the Guangzhou restaurant outbreak. The absence of a fomite route agrees with the COVID-19 literature.

CONCLUSIONS

These results provide indirect evidence for the long-range airborne route dominating SARS-CoV-2 transmission in the restaurant. We note that the restaurant was poorly ventilated, allowing for increasing airborne SARS-CoV-2 concentration.

Indoor airborne disinfection with electrostatic disinfector (ESD): Numerical simulations of ESD performance and reduction of computing time

Airborne transmissions of infectious disease (e.g. SARS-CoV-2) in indoor environments may induce serious threat to public health. Air purification devices are necessary to remove and/or inactivate airborne biological species from indoor air environment. Corona discharge in an electrostatic precipitator is capable of removing particulate matter and disinfecting biological aerosols to act as electrostatic disinfector (ESD). The ions generated by ESD can effectively inactivate bacteria/viruses. However, the available research rarely investigated disinfection effect of ESD, and it is urgent to develop quantitative ESD design methods for building mechanical ventilation applications. This study developed an integrated numerical model to simulate disinfection performance of ESD. The numerical model considers the ionized electric field, electrohydrodynamic flow, and biological disinfection. The model prediction was validated with the experimental data (E. coli): Good agreement was observed. The validated model then was used to study the influences of essential design parameters (e.g. voltage, inlet velocity) of ESD on disinfection efficiency. The effects of modeling of electrophoretic force and EHD (electrohydrodynamic) flow patterns on disinfection efficiency and computing time were also analyzed. The disinfection efficiency of well-designed ESD (with space charge density of 3.6 × 10^-06 C/m³) could be as high as 100%. Compared with HEPA, ESD could save 99% of energy consumed by HEPA without sacrificing disinfection efficiency.

Study on the variation of air pollutant concentration and its formation mechanism during the COVID-19 period in Wuhan

To prevent the spread of COVID-19 (2019 novel coronavirus), from January 23 to April 8 in 2020, the highest Class 1 Response was ordered in Wuhan, requiring all residents to stay at home unless absolutely necessary. This action was implemented to cut down all unnecessary human activities, including industry, agriculture and transportation. Reducing these activities to a very low level during these hard times meant that some unprecedented naturally occurring measures of controlling emissions were executed. Ironically, however, after these measures were implemented, ozone levels increased by 43.9%. Also worthy of note, PM_2.5 decreased 31.7%, which was found by comparing the observation data in Wuhan during the epidemic from 8th Feb. to 8th Apr. in 2020 with the same periods in 2019. Utilizing CMAQ (The Community Multiscale Air Quality modeling system), this article investigated the reason for these phenomena based on four sets of numerical simulations with different schemes of emission reduction. Comparing the four sets of simulations with observation, it was deduced that the emissions should decrease to approximately 20% from the typical industrial output, and 10% from agriculture and transportation sources, attributed to the COVID-19 lockdown in Wuhan. More importantly, through the CMAQ process analysis, this study quantitatively analyzed differences of the physical and chemical processes that were affected by the COVID-19 lockdown. It then examined the differences of the COVID-19 lockdown impact and determined the physical and chemical processes between when the pollution increased and decreased, determining the most affected period of the day. As a result, this paper found that (1) PM_2.5 decreased mainly due to the reduction of emission and the contrary contribution of aerosol processes. The North-East wind was also in favor of the decreasing of PM_2.5. (2) O₃ increased mainly due to the slowing down of chemical consumption processes, which made the concentration change of O₃ pollution higher at about 4 p.m.-7 p.m. of the day, while increasing the concentration of O₃ at night during the COVID-19 lockdown in Wuhan. The higher O₃ concentration in the North-East of the main urban area also contributed to the increasing of O₃ with unfavorable wind direction.

Food Safety in Post-COVID-19 Pandemic: Challenges and Countermeasures

Understanding food safety hazard risks is essential to avoid potential negative heath impacts in the food supply chain in a post-COVID-19 pandemic era. Development of strategies for virus direction in foods plays an important role in food safety and verification. Early warning, tracing, and detection should be implemented as an integrated system in order to mitigate thecoronavirus disease 2019 (COVID-19) outbreak, in which the detection of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is critical as it not only concerns screening of populations but also monitoring of possible contaminated sources such as the food supply chain. In this review, we point out the consequences in different aspects of our daily life in the post-COVID-19 pandemic from the perspective of the food supply chain and the food industry. We summarize the possible transmission routes of COVID-19 in the food supply chain before exploring the development of corresponding detection tools of SARS-CoV-2. Accordingly, we compare different detection methods for the virus in foods, including different pretreatments of food matrices in the virus detection. Finally, the future perspectives are proposed.

Transmissibility and transmission of respiratory viruses

Human respiratory virus infections lead to a spectrum of respiratory symptoms and disease severity, contributing to substantial morbidity, mortality and economic losses worldwide, as seen in the COVID-19 pandemic. Belonging to diverse families, respiratory viruses differ in how easy they spread (transmissibility) and the mechanism (modes) of transmission. Transmissibility as estimated by the basic reproduction number (R₀) or secondary attack rate is heterogeneous for the same virus. Respiratory viruses can be transmitted via four major modes of transmission: direct (physical) contact, indirect contact (fomite), (large) droplets and (fine) aerosols. We know little about the relative contribution of each mode to the transmission of a particular virus in different settings, and how its variation affects transmissibility and transmission dynamics. Discussion on the particle size threshold between droplets and aerosols and the importance of aerosol transmission for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and influenza virus is ongoing. Mechanistic evidence supports the efficacies of non-pharmaceutical interventions with regard to virus reduction; however, more data are needed on their effectiveness in reducing transmission. Understanding the relative contribution of different modes to transmission is crucial to inform the effectiveness of non-pharmaceutical interventions in the population. Intervening against multiple modes of transmission should be more effective than acting on a single mode.

Effects of human behaviour changes during the COVID-19 pandemic on influenza spread in Hong Kong

Background

COVID-19 continues to threaten human life worldwide. We explored how human behaviours have been influenced by the COVID-19 pandemic in Hong Kong, and how the transmission of other respiratory diseases (e.g. influenza) has been influenced by human behaviour.

Methods

We focused on the spread of COVID-19 and influenza infections based on reported COVID-19 cases and influenza surveillance data, and investigated the changes in human behaviour due to COVID-19 based on mass transit railway data and the data from a telephone survey. We did the simulation based on SEIR model to assess the risk reduction of influenza transmission caused by the changes in human behaviour.

Results

During the COVID-19 pandemic, the number of passengers fell by 52.0% compared with the same period in 2019. Residents spent 32.2% more time at home. Each person on average came into close contact with 17.6 and 7.1 people per day during the normal and pandemic periods, respectively. Students, workers, and older people reduced their daily number of close contacts by 83.0%, 48.1%, and 40.3%, respectively. The close contact rates in residences, workplaces, places of study, restaurants, shopping centres, markets, and public transport decreased by 8.3%, 30.8%, 66.0%, 38.5%, 48.6%, 41.0%, and 36.1%, respectively. Based on the simulation, these changes in human behaviours reduced the effective reproduction number of influenza by 63.1%.

Conclusions

Human behaviours were significantly influenced by the COVID-19 pandemic in Hong Kong. Close contact control contributed more than 47% to the reduction in infection risk of COVID-19.

Transmission risk of infectious droplets in physical spreading process at different times: A review

Droplets provide a well-known transmission media in the COVID-19 epidemic, and the particle size is closely related to the classification of the transmission route. However, the term "aerosol" covers most particle sizes of suspended particulates because of information asymmetry in different disciplines, which may lead to misunderstandings in the selection of epidemic prevention and control strategies for the public. In this review, the time when these droplets are exhaled by a patient was taken as the initial time. Then, all available viral loads and numerical distribution of the exhaled droplets was analyzed, and the evaporation model of droplets in the air was combined with the deposition model of droplet nuclei in the respiratory tract. Lastly, the perspective that physical spread affects the transmission risk of different size droplets at different times was summarized for the first time. The results showed that although the distribution of exhaled droplets was dominated by small droplets, droplet volume was proportional to the third power of particle diameter, meaning that the viral load of a 100 μm droplet was approximately 10⁶ times that of a 1 μm droplet at the initial time. Furthermore, the exhaled droplets are affected by heat and mass transfer of evaporation, water fraction, salt concentration, and acid-base balance (the water fraction > 98%), which lead them to change rapidly, and the viral survival condition also deteriorates dramatically. The time required for the initial diameter (d_o) of a droplet to shrink to the equilibrium diameter (d_e, about 30% of d_o) is approximately proportional to the second power of the particle diameter, taking only a few milliseconds for a 1 μm droplet but hundreds of milliseconds for a 10 μm droplet; in other words, the viruses carried by the large droplets can be preserved as much as possible. Finally, the infectious droplet nuclei maybe inhaled by the susceptible population through different and random contact routes, and the droplet nuclei with larger d_e decompose more easily into tiny particles on account of the accelerated collision in a complex airway, which can be deposited in the higher risk alveolar region. During disease transmission, the infectious droplet particle size varies widely, and the transmission risk varies significantly at different time nodes; therefore, the fuzzy term "aerosol" is not conducive to analyzing disease exposure risk. Recommendations for epidemic prevention and control strategies are: 1) Large droplets are the main conflict in disease transmission; thus, even if they are blocked by a homemade mask initially, it significantly contains the epidemic. 2) The early phase of contact, such as close-contact and short-range transmission, has the highest infection risk; therefore, social distancing can effectively keep the susceptible population from inhaling active viruses. 3) The risk of the fomite route depends on the time in contact with infectious viruses; thus, it is important to promote good health habits (including frequent hand washing, no-eye rubbing, coughing etiquette, normalization of surface cleaning), although blind and excessive disinfection measures are not advisable. 4) Compared with the large droplets, the small droplets have larger numbers but carry fewer viruses and are more prone to die through evaporation.

Impact of intervention methods on COVID-19 transmission in Shenzhen

By March 31, 2020, COVID-19 had spread to more than 200 countries. Over 750,000 confirmed cases were reported, leading to more than 36,000 deaths. In this study, we analysed the efficiency of various intervention strategies to prevent infection by the virus, SARS-CoV-2, using an agent-based SEIIR model, in the fully urbanised city of Shenzhen, Guangdong Province, China. Shortening the duration from symptom onset to hospital admission, quarantining recent arrivals from Hubei Province, and letting symptomatic individuals stay at home were found to be the three most important interventions to reduce the risk of infection in Shenzhen. The ideal time window for a mandatory quarantine of arrivals from Hubei Province was between 10 January and January 17, 2020, while the ideal time window for local intervention strategies was between 15 and 22 January. The risk of infection could have been reduced by 50% if all symptomatic individuals had immediately gone to hospital for isolation, and by 35% if a 14-day quarantine for arrivals from Hubei Province had been introduced one week earlier. Intervention strategies implemented in Shenzhen were effective, and the spread of infection would be controlled even if the initial basic reproduction number had doubled. Our results may be useful for other cities when choosing their intervention strategies to prevent outbreaks of COVID-19.

Most self-touches are with the nondominant hand

Self-touch may promote the transfer of microorganisms between body parts or surfaces to mucosa. In overt videography of a post-graduate office, students spent 9% of their time touching their own hair, face, neck, and shoulders (HFNS). These data were collected from 274,000 s of surveillance video in a Chinese graduate student office. The non-dominant hand contributed to 66.1% of HFNS-touches. Most importantly, mucous membranes were touched, on average, 34.3 (SE = 2.4) times per hour, which the non-dominant hand contributed to 240% more than the dominant hand. Gender had no significant effect on touch frequency, but a significant effect on duration per touch. The duration per touch on the HFNS was fitted with a log–log linear distribution. Touch behaviour analysis included surface combinations and a probability matrix for sequential touches of 20 sub-surfaces. These findings may partly explain the observed variation in the literature regarding the microbiome community distribution on human skin, supporting the importance of indirect contact transmission route in some respiratory disease transmission and providing data for risk analysis of infection spread and control.

[3H-estradiol binding to cytosol receptors of the rat olfactory epithelium]

Two types of cytosol receptors of 3H-estradiol with high affinity and limited quantity of binding sites (KDI = 1-2 nM, BmaxI = 8 fmoles/mg protein; KDII = 10 nM, BmaxII = 8 fmoles/mg protein) were determined in the rat olfactory tissue. The amount of high affinity receptors of type I does not change with maturation of the rats, and has no sex difference. The role of estradiol receptors in the olfactory tissue of the rats is discussed.