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Rhee C, Klompas M, Pak TR, Köhler JR. In Support of Universal Admission Testing for SARS-CoV-2 During Significant Community Transmission. Clin Infect Dis 2024; 78:439-444. [PMID: 37463411 DOI: 10.1093/cid/ciad424] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2023] [Revised: 06/27/2023] [Accepted: 07/13/2023] [Indexed: 07/20/2023] Open
Abstract
Many hospitals have stopped or are considering stopping universal admission testing for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We discuss reasons why admission testing should still be part of a layered system to prevent hospital-acquired SARS-CoV-2 infections during times of significant community transmission. These include the morbidity of SARS-CoV-2 in vulnerable patients, the predominant contribution of presymptomatic and asymptomatic people to transmission, the high rate of transmission between patients in shared rooms, and data suggesting surveillance testing is associated with fewer nosocomial infections. Preferences of diverse patient populations, particularly the hardest-hit communities, should be surveyed and used to inform prevention measures. Hospitals' ethical responsibility to protect patients from serious infections should predominate over concerns about costs, labor, and inconvenience. We call for more rigorous data on the incidence and morbidity of nosocomial SARS-CoV-2 infections and more research to help determine when to start, stop, and restart universal admission testing and other prevention measures.
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Affiliation(s)
- Chanu Rhee
- Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Healthcare Institute, Boston, Massachusetts, USA
- Division of Infectious Diseases, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Michael Klompas
- Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Healthcare Institute, Boston, Massachusetts, USA
- Division of Infectious Diseases, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Theodore R Pak
- Department of Population Medicine, Harvard Medical School/Harvard Pilgrim Healthcare Institute, Boston, Massachusetts, USA
- Division of Infectious Diseases, Department of Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Julia R Köhler
- Division of Infectious Diseases, Department of Pediatrics, Boston Children's Hospital, Boston, Massachusetts, USA
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Uno S, Goto R, Honda K, Uchida S, Uwamino Y, Namkoong H, Yoshifuji A, Mikita K, Takano Y, Matsumoto M, Kitagawa Y, Hasegawa N. Cost-Effectiveness of Universal Asymptomatic Preoperative SARS-CoV-2 Polymerase Chain Reaction Screening: A Cost-Utility Analysis. Clin Infect Dis 2024; 78:57-64. [PMID: 37556365 PMCID: PMC10810706 DOI: 10.1093/cid/ciad463] [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: 06/01/2023] [Revised: 07/31/2023] [Accepted: 08/04/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND An early report has shown the clinical benefit of the asymptomatic preoperative severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) screening test, and some clinical guidelines recommended this test. However, the cost-effectiveness of asymptomatic screening was not evaluated. We aimed to investigate the cost-effectiveness of universal preoperative screening of asymptomatic patients for SARS-CoV-2 using polymerase chain reaction (PCR) testing. METHODS We evaluated the cost-effectiveness of asymptomatic screening using a decision tree model from a payer perspective, assuming that the test-positive rate was 0.07% and the screening cost was 8500 Japanese yen (JPY) (approximately 7601 US dollars [USD]). The input parameter was derived from the available evidence reported in the literature. A willingness-to-pay threshold was set at 5 000 000 JPY/quality-adjusted life-year (QALY). RESULTS The incremental cost of 1 death averted was 74 469 236 JPY (approximately 566 048 USD) and 291 123 368 JPY/QALY (approximately 2 212 856 USD/QALY), which was above the 5 000 000 JPY/QALY willingness-to-pay threshold. The incremental cost-effectiveness ratio fell below 5 000 000 JPY/QALY only when the test-positive rate exceeded 0.739%. However, when the probability of developing a postoperative pulmonary complication among SARS-CoV-2-positive patients was below 0.22, asymptomatic screening was never cost-effective, regardless of how high the test-positive rate became. CONCLUSIONS Asymptomatic preoperative universal SARS-CoV-2 PCR screening is not cost-effective in the base case analysis. The cost-effectiveness mainly depends on the test-positive rate, the frequency of postoperative pulmonary complications, and the screening costs; however, no matter how high the test-positive rate, the cost-effectiveness is poor if the probability of developing postoperative pulmonary complications among patients positive for SARS-CoV-2 is sufficiently reduced.
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Affiliation(s)
- Shunsuke Uno
- Department of Infectious Diseases, Keio University School of Medicine, Tokyo, Japan
- Health Technology Assessment Unit, Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan
| | - Rei Goto
- Health Technology Assessment Unit, Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan
- Graduate School of Business Administration, Keio University, Kanagawa, Japan
- Graduate School of Health Management, Keio University, Kanagawa, Japan
| | - Kimiko Honda
- Health Technology Assessment Unit, Department of Preventive Medicine and Public Health, Keio University School of Medicine, Tokyo, Japan
- Graduate School of Health Management, Keio University, Kanagawa, Japan
- Center of Health Economics and Health Technology Assessment, Keio University Global Research Institute, Tokyo, Japan
| | - Sho Uchida
- Department of Infectious Diseases, Keio University School of Medicine, Tokyo, Japan
| | - Yoshifumi Uwamino
- Department of Laboratory Medicine, Keio University School of Medicine, Tokyo, Japan
| | - Ho Namkoong
- Department of Infectious Diseases, Keio University School of Medicine, Tokyo, Japan
| | - Ayumi Yoshifuji
- Department of Infectious Diseases, Keio University School of Medicine, Tokyo, Japan
| | - Kei Mikita
- Department of Infectious Diseases, Keio University School of Medicine, Tokyo, Japan
| | - Yaoko Takano
- Division of Infectious Diseases and Infection Control, Keio University Hospital, Tokyo, Japan
| | - Morio Matsumoto
- Department of Orthopedics, Keio University School of Medicine, Tokyo, Japan
| | - Yuko Kitagawa
- Department of Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Naoki Hasegawa
- Department of Infectious Diseases, Keio University School of Medicine, Tokyo, Japan
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Ehrenzeller S, Chen T, Vaidya V, Rhee C, Baker MA, Klompas M. Impact of SARS-CoV-2 Prevention Measures on Non-SARS-CoV-2 Hospital-Onset Respiratory Viral Infections: An Incidence Trend Analysis From 2015-2023. Clin Infect Dis 2023; 77:1696-1699. [PMID: 37531616 DOI: 10.1093/cid/ciad451] [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: 05/18/2023] [Revised: 07/12/2023] [Accepted: 07/31/2023] [Indexed: 08/04/2023] Open
Abstract
We reviewed hospital-onset respiratory viral infections, 2015-2023, in one hospital to determine whether Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) transmission prevention measures prevented non-SARS-CoV-2 respiratory viral infections. Masking, employee symptom attestations, and screening patients and visitors for symptoms were associated with a 44%-53% reduction in hospital-onset influenza and respiratory syncytial virus (RSV), accounting for changes in community incidence.
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Affiliation(s)
- Selina Ehrenzeller
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
- Department of Quality and Safety, Brigham and Women's Hospital, Boston, Massachusetts, USA
- Division of Infectious Diseases and Hospital Epidemiology, University Hospital Basel, University of Basel, Basel, Switzerland
| | - Tom Chen
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
| | - Vineeta Vaidya
- Department of Quality and Safety, 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 Quality and Safety, 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 Quality and Safety, Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Michael Klompas
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts, USA
- Department of Quality and Safety, Brigham and Women's Hospital, Boston, Massachusetts, USA
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4
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Hare D, Dembicka KM, Brennan C, Campbell C, Sutton-Fitzpatrick U, Stapleton PJ, De Gascun CF, Dunne CP. Whole-genome sequencing to investigate transmission of SARS-CoV-2 in the acute healthcare setting: a systematic review. J Hosp Infect 2023; 140:139-155. [PMID: 37562592 DOI: 10.1016/j.jhin.2023.08.002] [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: 05/30/2023] [Revised: 07/03/2023] [Accepted: 08/04/2023] [Indexed: 08/12/2023]
Abstract
BACKGROUND Whole-genome sequencing (WGS) has been used widely to elucidate transmission of SARS-CoV-2 in acute healthcare settings, and to guide infection, prevention, and control (IPC) responses. AIM To systematically appraise available literature, published between January 1st, 2020 and June 30th, 2022, describing the implementation of WGS in acute healthcare settings to characterize nosocomial SARS-CoV-2 transmission. METHODS Searches of the PubMed, Embase, Ovid MEDLINE, EBSCO MEDLINE, and Cochrane Library databases identified studies in English reporting the use of WGS to investigate SARS-CoV-2 transmission in acute healthcare environments. Publications involved data collected up to December 31st, 2021, and findings were reported in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. FINDINGS In all, 3088 non-duplicate records were retrieved; 97 met inclusion criteria, involving 62 outbreak analyses and 35 genomic surveillance studies. No publications from low-income countries were identified. In 87/97 (90%), WGS supported hypotheses for nosocomial transmission, while in 46 out of 97 (47%) suspected transmission events were excluded. An IPC intervention was attributed to the use of WGS in 18 out of 97 (18%); however, only three (3%) studies reported turnaround times ≤7 days facilitating near real-time IPC action, and none reported an impact on the incidence of nosocomial COVID-19 attributable to WGS. CONCLUSION WGS can elucidate transmission of SARS-CoV-2 in acute healthcare settings to enhance epidemiological investigations. However, evidence was not identified to support sequencing as an intervention to reduce the incidence of SARS-CoV-2 in hospital or to alter the trajectory of active outbreaks.
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Affiliation(s)
- D Hare
- UCD National Virus Reference Laboratory, University College Dublin, Ireland; School of Medicine, University of Limerick, Limerick, Ireland.
| | - K M Dembicka
- School of Medicine, University of Limerick, Limerick, Ireland
| | - C Brennan
- UCD National Virus Reference Laboratory, University College Dublin, Ireland
| | - C Campbell
- UCD National Virus Reference Laboratory, University College Dublin, Ireland
| | | | | | - C F De Gascun
- UCD National Virus Reference Laboratory, University College Dublin, Ireland
| | - C P Dunne
- School of Medicine, University of Limerick, Limerick, Ireland; Centre for Interventions in Infection, Inflammation & Immunity (4i), University of Limerick, Limerick, Ireland
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Marco L, Cambien G, Garcia M, Broutin L, Cateau E, Lariviere A, Castel O, Thevenot S, Bousseau A. [Respiratory infections: Additional transmission-based precautions in healthcare facilities]. Rev Mal Respir 2023; 40:572-603. [PMID: 37365075 DOI: 10.1016/j.rmr.2023.05.001] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 05/04/2023] [Indexed: 06/28/2023]
Abstract
INTRODUCTION In health care, measures against cross-transmission of microorganisms are codified by standard precautions, and if necessary, they are supplemented by additional precautions. STATE OF THE ART Several factors impact transmission of microorganisms via the respiratory route: size and quantity of the emitted particles, environmental conditions, nature and pathogenicity of the microorganisms, and degree of host receptivity. While some microorganisms necessitate additional airborne or droplet precautions, others do not. PROSPECTS For most microorganisms, transmission patterns are well-understood and transmission-based precautions are well-established. For others, measures to prevent cross-transmission in healthcare facilities remain under discussion. CONCLUSIONS Standard precautions are essential to the prevention of microorganism transmission. Understanding of the modalities of microorganism transmission is essential to implementation of additional transmission-based precautions, particularly in view of opting for appropriate respiratory protection.
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Affiliation(s)
- L Marco
- Unité d'hygiène hospitalière, département des agents infectieux, pôle BIOSPHARM, CHU de Poitiers, 86021 Poitiers, France
| | - G Cambien
- Unité d'hygiène hospitalière, département des agents infectieux, pôle BIOSPHARM, CHU de Poitiers, 86021 Poitiers, France; Inserm CIC 1402, université de Poitiers, CHU de Poitiers, 86021 Poitiers, France
| | - M Garcia
- Département des agents infectieux, laboratoire de virologie et mycobactériologie, pôle BIOSPHARM, CHU de Poitiers, 86021 Poitiers, France; Laboratoire inflammation, tissus épithéliaux et cytokines, EA 4331, université de Poitiers, 86021 Poitiers, France
| | - L Broutin
- Département des agents infectieux, laboratoire de bactériologie, pôle BIOSPHARM, CHU de Poitiers, 86021 Poitiers, France
| | - E Cateau
- Laboratoire écologie et biologie des interactions, UMR CNRS 7267, université de Poitiers, 86021 Poitiers, France; Département des agents infectieux, laboratoire de parasitologie et mycologie médicale, pôle BIOSPHARM, CHU de Poitiers, 86021 Poitiers, France
| | - A Lariviere
- Département des agents infectieux, laboratoire de virologie et mycobactériologie, pôle BIOSPHARM, CHU de Poitiers, 86021 Poitiers, France
| | - O Castel
- Unité d'hygiène hospitalière, département des agents infectieux, pôle BIOSPHARM, CHU de Poitiers, 86021 Poitiers, France
| | - S Thevenot
- Unité d'hygiène hospitalière, département des agents infectieux, pôle BIOSPHARM, CHU de Poitiers, 86021 Poitiers, France; Inserm CIC 1402, université de Poitiers, CHU de Poitiers, 86021 Poitiers, France
| | - A Bousseau
- Unité d'hygiène hospitalière, département des agents infectieux, pôle BIOSPHARM, CHU de Poitiers, 86021 Poitiers, France.
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Affiliation(s)
- Tara N Palmore
- George Washington University School of Medicine and Health Sciences, Washington, DC (T.N.P.)
| | - David K Henderson
- Clinical Center, National Institutes of Health, Bethesda, Maryland (D.K.H.)
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Jones LD, Chan ER, Cadnum JL, Redmond SN, Navas ME, Zabarsky TF, Eckstein EC, Kovach JD, Linger M, Zimmerman PA, Donskey CJ. Investigation of a cluster of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in a hospital administration building. Infect Control Hosp Epidemiol 2023; 44:277-83. [PMID: 35189996 DOI: 10.1017/ice.2022.45] [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: 12/12/2022]
Abstract
OBJECTIVE To investigate a cluster of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections in employees working on 1 floor of a hospital administration building. METHODS Contact tracing was performed to identify potential exposures and all employees were tested for SARS-CoV-2. Whole-genome sequencing was performed to determine the relatedness of SARS-CoV-2 samples from infected personnel and from control cases in the healthcare system with coronavirus disease 2019 (COVID-19) during the same period. Carbon dioxide levels were measured during a workday to assess adequacy of ventilation; readings >800 parts per million (ppm) were considered an indication of suboptimal ventilation. To assess the potential for airborne transmission, DNA-barcoded aerosols were released, and real-time polymerase chain reaction was used to quantify particles recovered from air samples in multiple locations. RESULTS Between December 22, 2020, and January 8, 2021, 17 coworkers tested positive for SARS-CoV-2, including 13 symptomatic and 4 asymptomatic individuals. Of the 5 cluster SARS-CoV-2 samples sequenced, 3 were genetically related, but these employees denied higher-risk contacts with one another. None of the sequences from the cluster were genetically related to the 17 control sequences of SARS-CoV-2. Carbon dioxide levels increased during a workday but never exceeded 800 ppm. DNA-barcoded aerosol particles were dispersed from the sites of release to locations throughout the floor; 20% of air samples had >1 log10 particles. CONCLUSIONS In a hospital administration building outbreak, sequencing of SARS-CoV-2 confirmed transmission among coworkers. Transmission occurred despite the absence of higher-risk exposures and in a setting with adequate ventilation based on monitoring of carbon dioxide levels.
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Talbot TR, Hayden MK, Yokoe DS, Malani AN, Amer HA, Kalu IC, Logan LK, Moehring RW, Munoz-Price S, Palmore TN, Weber DJ, Wright SB; SHEA Board of Trustees. Asymptomatic screening for severe acute respiratory coronavirus virus 2 (SARS-CoV-2) as an infection prevention measure in healthcare facilities: Challenges and considerations. Infect Control Hosp Epidemiol 2023; 44:2-7. [PMID: 36539917 DOI: 10.1017/ice.2022.295] [Citation(s) in RCA: 24] [Impact Index Per Article: 24.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Testing of asymptomatic patients for severe acute respiratory coronavirus virus 2 (SARS-CoV-2) (ie, "asymptomatic screening) to attempt to reduce the risk of nosocomial transmission has been extensive and resource intensive, and such testing is of unclear benefit when added to other layers of infection prevention mitigation controls. In addition, the logistic challenges and costs related to screening program implementation, data noting the lack of substantial aerosol generation with elective controlled intubation, extubation, and other procedures, and the adverse patient and facility consequences of asymptomatic screening call into question the utility of this infection prevention intervention. Consequently, the Society for Healthcare Epidemiology of America (SHEA) recommends against routine universal use of asymptomatic screening for SARS-CoV-2 in healthcare facilities. Specifically, preprocedure asymptomatic screening is unlikely to provide incremental benefit in preventing SARS-CoV-2 transmission in the procedural and perioperative environment when other infection prevention strategies are in place, and it should not be considered a requirement for all patients. Admission screening may be beneficial during times of increased virus transmission in some settings where other layers of controls are limited (eg, behavioral health, congregate care, or shared patient rooms), but widespread routine use of admission asymptomatic screening is not recommended over strengthening other infection prevention controls. In this commentary, we outline the challenges surrounding the use of asymptomatic screening, including logistics and costs of implementing a screening program, and adverse patient and facility consequences. We review data pertaining to the lack of substantial aerosol generation during elective controlled intubation, extubation, and other procedures, and we provide guidance for when asymptomatic screening for SARS-CoV-2 may be considered in a limited scope.
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Ganly KH, Bowyer JC, Bird PW, Willford NJ, Shaw J, Odedra M, Osborn G, Everett T, Warner M, Horne S, Dinn M, McMurray CL, Holmes CW, Koo SSF, Tang JWT. Prospective Surveillance of Respiratory Infections in British Antarctic Survey Bases During the COVID-19 Pandemic. J Infect Dis 2022; 226:2105-2112. [PMID: 36214778 PMCID: PMC9619699 DOI: 10.1093/infdis/jiac412] [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: 05/10/2022] [Revised: 09/30/2022] [Accepted: 10/06/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The British Antarctic bases offer a semiclosed environment for assessing the transmission and persistence of seasonal respiratory viruses. METHODS Weekly swabbing was performed for respiratory pathogen surveillance (including SARS-CoV-2), at 2 British Antarctic Survey bases, during 2020: King Edward Point (KEP, 30 June to 29 September, 9 participants, 124 swabs) and Rothera (9 May to 6 June, 27 participants, 127 swabs). Symptom questionnaires were collected for any newly symptomatic cases that presented during this weekly swabbing period. RESULTS At KEP, swabs tested positive for non-SARS-CoV-2 seasonal coronavirus (2), adenovirus (1), parainfluenza 3 (1), and respiratory syncytial virus B (1). At Rothera, swabs tested positive for non-SARS-CoV-2 seasonal coronavirus (3), adenovirus (2), parainfluenza 4 (1), and human metapneumovirus (1). All bacterial agents identified were considered to be colonizers and not pathogenic. CONCLUSIONS At KEP, the timeline indicated that the parainfluenza 3 and adenovirus infections could have been linked to some of the symptomatic cases that presented. For the other viruses, the only other possible sources were the visiting ship crew members. At Rothera, the single symptomatic case presented too early for this to be linked to the subsequent viral detections, and the only other possible source could have been a single nonparticipating staff member.
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Affiliation(s)
- Katharine H Ganly
- Emergency Department, British Antarctic Survey Medical Unit, University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom
| | - James C Bowyer
- Emergency Department, British Antarctic Survey Medical Unit, University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom
| | - Paul W Bird
- Clinical Microbiology, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Nicholas J Willford
- Clinical Microbiology, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Jessica Shaw
- Clinical Microbiology, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Mina Odedra
- Clinical Microbiology, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Georgia Osborn
- Clinical Microbiology, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Tom Everett
- Emergency Department, British Antarctic Survey Medical Unit, University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom
| | - Matthew Warner
- Emergency Department, British Antarctic Survey Medical Unit, University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom
| | - Simon Horne
- Emergency Department, British Antarctic Survey Medical Unit, University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom
| | - Michael Dinn
- Emergency Department, British Antarctic Survey Medical Unit, University Hospitals Plymouth NHS Trust, Plymouth, United Kingdom
| | - Claire L McMurray
- Clinical Microbiology, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Christopher W Holmes
- Clinical Microbiology, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Sharon S F Koo
- Clinical Microbiology, University Hospitals of Leicester NHS Trust, Leicester, United Kingdom
| | - Julian Wei-Tze Tang
- Correspondence: J. W.-T. Tang, MBChB, MA, PhD, MRCP, Clinical Microbiology, 5/F Sandringham Building, Leicester Royal Infirmary, Infirmary Square, Leicester LE1 5WW, UK (; )
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Jimenez JL, Marr LC, Randall K, Ewing ET, Tufekci Z, Greenhalgh T, Tellier R, Tang JW, Li Y, Morawska L, Mesiano‐Crookston J, Fisman D, Hegarty O, Dancer SJ, Bluyssen PM, Buonanno G, Loomans MGLC, Bahnfleth WP, Yao M, Sekhar C, Wargocki P, Melikov AK, Prather KA. What were the historical reasons for the resistance to recognizing airborne transmission during the COVID-19 pandemic? Indoor Air 2022; 32:e13070. [PMID: 36040283 PMCID: PMC9538841 DOI: 10.1111/ina.13070] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 05/25/2022] [Accepted: 05/30/2022] [Indexed: 05/05/2023]
Abstract
The question of whether SARS-CoV-2 is mainly transmitted by droplets or aerosols has been highly controversial. We sought to explain this controversy through a historical analysis of transmission research in other diseases. For most of human history, the dominant paradigm was that many diseases were carried by the air, often over long distances and in a phantasmagorical way. This miasmatic paradigm was challenged in the mid to late 19th century with the rise of germ theory, and as diseases such as cholera, puerperal fever, and malaria were found to actually transmit in other ways. Motivated by his views on the importance of contact/droplet infection, and the resistance he encountered from the remaining influence of miasma theory, prominent public health official Charles Chapin in 1910 helped initiate a successful paradigm shift, deeming airborne transmission most unlikely. This new paradigm became dominant. However, the lack of understanding of aerosols led to systematic errors in the interpretation of research evidence on transmission pathways. For the next five decades, airborne transmission was considered of negligible or minor importance for all major respiratory diseases, until a demonstration of airborne transmission of tuberculosis (which had been mistakenly thought to be transmitted by droplets) in 1962. The contact/droplet paradigm remained dominant, and only a few diseases were widely accepted as airborne before COVID-19: those that were clearly transmitted to people not in the same room. The acceleration of interdisciplinary research inspired by the COVID-19 pandemic has shown that airborne transmission is a major mode of transmission for this disease, and is likely to be significant for many respiratory infectious diseases.
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Affiliation(s)
- Jose L. Jimenez
- Department of Chemistry and Cooperative Institute for Research in Environmental SciencesUniversity of ColoradoBoulderColoradoUSA
| | - Linsey C. Marr
- Department of Civil and Environmental EngineeringVirginia TechBlacksburgVirginiaUSA
| | | | | | - Zeynep Tufekci
- School of JournalismColumbia UniversityNew YorkNew YorkUSA
| | - Trish Greenhalgh
- Department of Primary Care Health SciencesMedical Sciences DivisionUniversity of OxfordOxfordUK
| | | | - Julian W. Tang
- Department of Respiratory SciencesUniversity of LeicesterLeicesterUK
| | - Yuguo Li
- Department of Mechanical EngineeringUniversity of Hong KongHong KongChina
| | - Lidia Morawska
- International Laboratory for Air Quality and HeathQueensland University of TechnologyBrisbaneQueenslandAustralia
| | | | - David Fisman
- Dalla Lana School of Public HealthUniversity of TorontoTorontoOntarioCanada
| | - Orla Hegarty
- School of Architecture, Planning & Environmental PolicyUniversity College DublinDublinIreland
| | - Stephanie J. Dancer
- Department of MicrobiologyHairmyres Hospital, Glasgow, and Edinburgh Napier UniversityGlasgowUK
| | - Philomena M. Bluyssen
- Faculty of Architecture and the Built EnvironmentDelft University of TechnologyDelftThe Netherlands
| | - Giorgio Buonanno
- Department of Civil and Mechanical EngineeringUniversity of Cassino and Southern LazioCassinoItaly
| | - Marcel G. L. C. Loomans
- Department of the Built EnvironmentEindhoven University of Technology (TU/e)EindhovenThe Netherlands
| | - William P. Bahnfleth
- Department of Architectural EngineeringThe Pennsylvania State UniversityUniversity ParkPennsylvaniaUSA
| | - Maosheng Yao
- College of Environmental Sciences and EngineeringPeking UniversityBeijingChina
| | - Chandra Sekhar
- Department of the Built EnvironmentNational University of SingaporeSingaporeSingapore
| | - Pawel Wargocki
- Department of Civil EngineeringTechnical University of DenmarkLyngbyDenmark
| | - Arsen K. Melikov
- Department of Civil EngineeringTechnical University of DenmarkLyngbyDenmark
| | - Kimberly A. Prather
- Scripps Institution of OceanographyUniversity of California San DiegoLa JollaCaliforniaUSA
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11
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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.
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12
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Jefferson T, Spencer EA, Onakpoya IJ, Plu Ddemann A, Conly JM, Heneghan CJ. Transmission of Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV-2) from pre and asymptomatic infected individuals: a systematic review update. Clin Microbiol Infect 2022; 28:1511-1512. [PMID: 35777603 PMCID: PMC9238017 DOI: 10.1016/j.cmi.2022.06.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 06/14/2022] [Accepted: 06/14/2022] [Indexed: 11/29/2022]
Affiliation(s)
- Tom Jefferson
- Department for Continuing Education, University of Oxford, UK.
| | - Elizabeth A Spencer
- Centre for Evidence Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - Igho J Onakpoya
- Department for Continuing Education, University of Oxford, UK
| | - Annette Plu Ddemann
- Centre for Evidence Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
| | - John M Conly
- Departments of Medicine, Microbiology, Immunology & Infectious Diseases, and Pathology & Laboratory Medicine, Synder Institute for Chronic Diseases and O'Brien Institute for Public Health, Cumming School of Medicine, University of Calgary and Alberta Health Services, Calgary, Canada
| | - Carl J Heneghan
- Centre for Evidence Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, UK
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13
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Rhee C, Baker MA, Klompas M. Survey of coronavirus disease 2019 (COVID-19) infection control policies at leading US academic hospitals in the context of the initial pandemic surge of the severe acute respiratory coronavirus virus 2 (SARS-CoV-2) omicron variant. Infect Control Hosp Epidemiol 2022;:1-7. [PMID: 35705223 DOI: 10.1017/ice.2022.155] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
OBJECTIVE To assess coronavirus disease 2019 (COVID-19) infection policies at leading US medical centers in the context of the initial wave of the severe acute respiratory coronavirus virus 2 (SARS-CoV-2) omicron variant. DESIGN Electronic survey study eliciting hospital policies on masking, personal protective equipment, cohorting, airborne-infection isolation rooms (AIIRs), portable HEPA filters, and patient and employee testing. SETTING AND PARTICIPANTS "Hospital epidemiologists from U.S. News top 20 hospitals and 10 hospitals in the CDC Prevention Epicenters program." As it is currently written, it implies all 30 hospitals are from the CDC Prevention Epicenters program, but that only applies to 10 hospitals. Alternatively, we could just say "Hospital epidemiologists from 30 leading US hospitals." METHODS Survey results were reported using descriptive statistics. RESULTS Of 30 hospital epidemiologists surveyed, 23 (77%) completed the survey between February 15 and March 3, 2022. Among the responding hospitals, 18 (78%) used medical masks for universal masking and 5 (22%) used N95 respirators. 16 hospitals (70%) required universal eye protection. 22 hospitals (96%) used N95s for routine COVID-19 care and 1 (4%) reserved N95s for aerosol-generating procedures. 2 responding hospitals (9%) utilized dedicated COVID-19 wards; 8 (35%) used mixed COVID-19 and non-COVID-19 units; and 13 (57%) used both dedicated and mixed units. 4 hospitals (17%) used AIIRs for all COVID-19 patients, 10 (43%) prioritized AIIRs for aerosol-generating procedures, 3 (13%) used alternate risk-stratification criteria (not based on aerosol-generating procedures), and 6 (26%) did not routinely use AIIRs. 9 hospitals (39%) did not use portable HEPA filters, but 14 (61%) used them for various indications, most commonly as substitutes for AIIRs when unavailable or for specific high-risk areas or situations. 21 hospitals (91%) tested asymptomatic patients on admission, but postadmission testing strategies and preferred specimen sites varied substantially. 5 hospitals (22%) required regular testing of unvaccinated employees and 1 hospital (4%) reported mandatory weekly testing even for vaccinated employees during the SARS-CoV-2 omicron surge. CONCLUSIONS COVID-19 infection control practices in leading hospitals vary substantially. Clearer public health guidance and transparency around hospital policies may facilitate more consistent national standards.
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14
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Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) delta variant transmits much more rapidly than prior SARS-CoV-2 viruses. The primary mode of transmission is via short range aerosols that are emitted from the respiratory tract of an index case. There is marked heterogeneity in the spread of this virus, with 10% to 20% of index cases contributing to 80% of secondary cases, while most index cases have no subsequent transmissions. Vaccination, ventilation, masking, eye protection, and rapid case identification with contact tracing and isolation can all decrease the transmission of this virus.
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Affiliation(s)
- Eric A Meyerowitz
- Montefiore Medical Center, 111 East 210th Street, Bronx, NY 10467, USA.
| | - Aaron Richterman
- Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104, USA
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15
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Cadnum JL, Jencson AL, Alhmidi H, Zabarsky TF, Donskey CJ. Airflow Patterns in Double-Occupancy Patient Rooms May Contribute to Roommate-to-Roommate Transmission of Severe Acute Respiratory Syndrome Coronavirus 2. Clin Infect Dis 2022; 75:2128-2134. [PMID: 35476020 PMCID: PMC9129113 DOI: 10.1093/cid/ciac334] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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: 02/18/2022] [Revised: 04/15/2022] [Accepted: 04/25/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND Hospitalized patients are at risk to acquire severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from roommates with unrecognized coronavirus disease 2019 (COVID-19). We hypothesized that airflow patterns might contribute to SARS-CoV-2 transmission in double-occupancy patient rooms. METHODS A device emitting condensed moisture was used to identify airflow patterns in double-occupancy patient rooms. Simulations were conducted to assess transfer of fluorescent microspheres, 5% sodium chloride aerosol, and aerosolized bacteriophage MS2 between patient beds 3 meters apart and to assess the effectiveness of privacy curtains and portable air cleaners in reducing transfer. RESULTS Air flowed from inlet vents in the center of the room to an outlet vent near the door, resulting in air currents flowing toward the bed adjacent to the outlet vent. Fluorescent microspheres (212-250-µm diameter), 5% sodium chloride aerosol, and aerosolized bacteriophage MS2 released from the inner bed were carried on air currents toward the bed adjacent to the outlet vent. Closing curtains between the patient beds reduced transfer of each of the particles. Operation of a portable air cleaner reduced aerosol transfer to the bed adjacent to the outlet vent but did not offer a benefit over closing the curtains alone, and in some situations, resulted in an increase in aerosol exposure. CONCLUSIONS Airflow patterns in double-occupancy patient rooms may contribute to risk for transmission of SARS-CoV-2 between roommates. Keeping curtains closed between beds may be beneficial in reducing risk.
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Affiliation(s)
- Jennifer L. Cadnum
- Research Service, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA
| | - Annette L. Jencson
- Research Service, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA
| | - Heba Alhmidi
- Research Service, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA
| | - Trina F. Zabarsky
- Infection Control Department, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA
| | - Curtis J. Donskey
- Geriatric Research, Education, and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA,Case Western Reserve University School of Medicine, Cleveland, Ohio, USA,Corresponding author: Curtis J. Donskey, Infectious Diseases Section 1110W, Louis Stokes Cleveland VA Medical Center, 10701 East Boulevard, Cleveland, Ohio 44106, USA;
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16
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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.
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Affiliation(s)
- Raymond Tellier
- Department of Medicine, McGill University, Montreal, Quebec, Canada
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17
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Klompas M, Baker M, Rhee C. COVID-19's Challenges to Infection Control Dogma Regarding Respiratory Virus Transmission. Clin Infect Dis 2022; 75:e102-e104. [PMID: 35271714 DOI: 10.1093/cid/ciac204] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2022] [Indexed: 12/29/2022] Open
Affiliation(s)
- Michael Klompas
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA.,Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Meghan Baker
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA.,Department of Medicine, Brigham and Women's Hospital, Boston, MA
| | - Chanu Rhee
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, MA.,Department of Medicine, Brigham and Women's Hospital, Boston, MA
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18
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Leonardi AJ, Mishra AK. A Sanitation Argument for Clean Indoor Air: Meeting a Requisite for Safe Public Spaces. Front Public Health 2022; 10:805780. [PMID: 35237550 PMCID: PMC8883285 DOI: 10.3389/fpubh.2022.805780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Accepted: 01/06/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Asit Kumar Mishra
- MaREI Centre, Ryan Institute & School of Engineering, College of Science and Engineering, National University of Ireland Galway, Galway, Ireland
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19
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Doos D, Barach P, Sarmiento E, Ahmed R. Reuse of Personal Protective Equipment: Results of a Human Factors Study Using Fluorescence to Identify Self-Contamination During Donning and Doffing. J Emerg Med 2022; 62:337-341. [PMID: 35131132 PMCID: PMC8814906 DOI: 10.1016/j.jemermed.2021.12.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 09/02/2021] [Revised: 12/14/2021] [Accepted: 12/23/2021] [Indexed: 11/19/2022]
Abstract
BACKGROUND At least 115,000 health and care workers (HCWs) are estimated to have lost their lives to COVID-19, according to the the chief of the World Health Organization (WHO). Personal protective equipment (PPE) is the first line of defense for HCWs against infectious diseases. At the height of the pandemic, PPE supplies became scarce, necessitating reuse, which increased the occupational COVID-19 risks to HCWs. Currently, there are few robust studies addressing PPE reuse and practice variability, leaving HCWs vulnerable to accidental contamination and harm. OBJECTIVE The objective of this study was to assess potential HCW contamination during PPE donning, doffing, and reuse. METHODS The study included 28 active acute care physicians, nurses, and nurse practitioners that evaluated 5 simulated patients with COVID-like symptoms while donning and doffing PPE between each patient encounter. An N95 mask was contaminated with a transparent fluorescent gel applied to the outside of the N95 mask to simulate contamination that might occur during reuse. Participants were evaluated after PPE doffing for each encounter using a black light to assess for face and body contamination. RESULTS All participants had multiple sites of contamination, predominantly on their head and neck. None of the participants were able to don and doff PPE without contaminating themselves during five consecutive simulation cycles. CONCLUSIONS The current Centers for Disease Control and Prevention PPE guidelines for donning and doffing fall short in protecting HCWs. They do not adequately protect HCWs from contamination. There is an urgent need for PPE and workflow redesign.
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Affiliation(s)
- Devin Doos
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana,Reprint Address: Devin Doos, MD, Department of Emergency Medicine, Indiana University School of Medicine, 720 Eskenazi Avenue, FT 3, Indianapolis, IN 46202
| | - Paul Barach
- Jefferson College of Population Health, Thomas Jefferson University, Philadelphia, Pennsylvania,University of Queensland, Brisbane, Queensland, Australia
| | - Elisa Sarmiento
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana
| | - Rami Ahmed
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana
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20
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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.
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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
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21
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Affiliation(s)
- Michael Klompas
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Abraar Karan
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Palo Alto, California
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22
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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.
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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
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23
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Klompas M. New Insights into the Prevention of Hospital-Acquired Pneumonia/Ventilator-Associated Pneumonia Caused by Viruses. Semin Respir Crit Care Med 2022; 43:295-303. [PMID: 35042261 DOI: 10.1055/s-0041-1740582] [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] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
A fifth or more of hospital-acquired pneumonias may be attributable to respiratory viruses. The SARS-CoV-2 pandemic has clearly demonstrated the potential morbidity and mortality of respiratory viruses and the constant threat of nosocomial transmission and hospital-based clusters. Data from before the pandemic suggest the same can be true of influenza, respiratory syncytial virus, and other respiratory viruses. The pandemic has also helped clarify the primary mechanisms and risk factors for viral transmission. Respiratory viruses are primarily transmitted by respiratory aerosols that are routinely emitted when people exhale, talk, and cough. Labored breathing and coughing increase aerosol generation to a much greater extent than intubation, extubation, positive pressure ventilation, and other so-called aerosol-generating procedures. Transmission risk is proportional to the amount of viral exposure. Most transmissions take place over short distances because respiratory emissions are densest immediately adjacent to the source but then rapidly dilute and diffuse with distance leading to less viral exposure. The primary risk factors for transmission then are high viral loads, proximity, sustained exposure, and poor ventilation as these all increase net viral exposure. Poor ventilation increases the risk of long-distance transmission by allowing aerosol-borne viruses to accumulate over time leading to higher levels of exposure throughout an enclosed space. Surgical and procedural masks reduce viral exposure but do not eradicate it and thus lower but do not eliminate transmission risk. Most hospital-based clusters have been attributed to delayed diagnoses, transmission between roommates, and staff-to-patient infections. Strategies to prevent nosocomial respiratory viral infections include testing all patients upon admission, preventing healthcare providers from working while sick, assuring adequate ventilation, universal masking, and vaccinating both patients and healthcare workers.
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Affiliation(s)
- Michael Klompas
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Healthcare Institute, Boston, Massachusetts.,Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
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24
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Birgand G, Kerneis S, Lucet J. Modes de transmission du SARS-CoV-2 : que sait-on actuellement ? M�decine et Maladies Infectieuses Formation 2022. [DOI: 10.1016/j.mmifmc.2021.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Des progrès remarquables ont été obtenus dans notre compréhension de la transmission du SARS-CoV-2 et la réduction de sa propagation. La prise en compte du risque majeur des formes asymptomatiques par le port universel du masque est une de ces avancées. Les données épidémiologiques (taux d'attaque et R0) ainsi que l'accumulation de données en contexte clinique suggèrent une similitude de transmission du SARS-CoV-2 avec celle des autres virus respiratoires comme la grippe ou le SARS-CoV-1, un mode de transmission principal direct de personne à personne, à courte distance par les gouttelettes. La transmission aéroportée est possible mais rare, et ne semble se produire que dans des circonstances opportunistes, notamment lors de procédures médicales sur la sphère respiratoire de patients infectés, ou dans des conditions d'excrétion virale élevée en zone confinée mal ventilée. L'hygiène des mains et le port du masque sont les deux armes essentielles de prévention dans le contexte de la COVID-19.
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25
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Tang JW, Tellier R, Li Y. Hypothesis: All respiratory viruses (including SARS-CoV-2) are aerosol-transmitted. Indoor Air 2022; 32:e12937. [PMID: 35104003 DOI: 10.1111/ina.12937] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [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: 07/17/2021] [Accepted: 09/22/2021] [Indexed: 06/14/2023]
Abstract
The potential role of aerosol transmission for seasonal respiratory viruses has been dramatically highlighted during the ongoing COVID-19 pandemic. It is now evident that short-range (conversational) and long-range aerosol transmission plays at least some part in how all these respiratory viruses are transmitted between people. This article highlights and discusses various studies that form the basis for this hypothesis.
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Affiliation(s)
- Julian W Tang
- Clinical Microbiology, Leicester Royal Infirmary, Leicester, UK
- Respiratory Sciences, University of Leicester, Leicester, UK
| | - Raymond Tellier
- Department of Medicine, McGill University, Montreal, Quebec, Canada
| | - Yuguo Li
- Department of Mechanical Engineering, The University of Hong Kong, Pokfulam, Hong Kong, China
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26
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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.
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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
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27
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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
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28
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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.
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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
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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.
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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
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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.
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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
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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.
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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.)
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Williams VR, Maze Dit Mieusement L, Tomiczek N, Chan AK, Salt N, Leis JA. Risk of SARS-CoV-2 transmission from universally masked healthcare workers to patients or residents: A prospective cohort study. Am J Infect Control 2021; 49:1429-31. [PMID: 34455030 DOI: 10.1016/j.ajic.2021.08.024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 08/20/2021] [Accepted: 08/21/2021] [Indexed: 11/26/2022]
Abstract
In a multifacility prospective cohort study, we identified 116 acute care, 26 long-term care, and 67 rehabilitation patients who received direct care from a universally masked healthcare worker while communicable with COVID-19. Among 133(64%) patients with at least 14-day follow-up, 3 (2.3%, 95% CI, 0.77-6.4) became positive for SARS-CoV-2. Universal masking, embedded with other infection control practices, is associated with low risk of transmission of SARS-CoV-2 from healthcare workers to patients and residents.
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Klompas M, Rhee C. Aerosol Generation During Exercise: Implications for Preventing Viral Transmission In and Out of the Exercise Laboratory. Chest 2021; 160:1174-1176. [PMID: 34625166 PMCID: PMC8490916 DOI: 10.1016/j.chest.2021.05.065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [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: 05/25/2021] [Accepted: 05/25/2021] [Indexed: 12/14/2022] Open
Affiliation(s)
- Michael Klompas
- Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston, MA; Department of Medicine, Brigham and Women's Hospital, Boston, MA.
| | - Chanu Rhee
- Department of Population Medicine, Harvard Medical School, and Harvard Pilgrim Health Care Institute, Boston, MA; Department of Medicine, Brigham and Women's Hospital, Boston, MA
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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.
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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
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von Huth S, Lillevang ST, Røge BT, Madsen JS, Mogensen CB, Coia JE, Möller S, Justesen US, Johansen IS. SARS-CoV-2 seroprevalence among 7950 healthcare workers in the Region of Southern Denmark. Int J Infect Dis 2021; 112:96-102. [PMID: 34534698 PMCID: PMC8440007 DOI: 10.1016/j.ijid.2021.09.023] [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] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Revised: 09/06/2021] [Accepted: 09/13/2021] [Indexed: 01/09/2023] Open
Abstract
OBJECTIVE Healthcare workers (HCWs) carry a pronounced risk of acquiring severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. The aim of this study was to determine the seroprevalence and potential risk factors of SARS-CoV-2 infection among HCWs in the Region of Southern Denmark after the first pandemic wave in the spring of 2020. METHODS This was an observational study conducted between May and June 2020. SARS-CoV-2 IgG and IgM antibodies were measured in plasma. Participants were asked to complete a questionnaire consisting of demographic information, risk factors, and COVID-19-related symptoms. RESULTS A total of 7950 HCWs participated. The seroprevalence of SARS-CoV-2 antibodies was 2.1% (95% confidence interval (CI) 1.8-2.4%). Seropositive participants were significantly older (mean age 48.9 years vs 46.7 years in seronegative participants, P = 0.022) and a higher percentage had experienced at least one symptom of COVID-19 (P < 0.001). The seroprevalence was significantly higher among HCWs working on dedicated COVID-19 wards (3.5%; OR 2.02, 95% CI 1.44-2.84). Seroprevalence was significantly related to 11-50 close physical contacts per day outside work (OR 1.54, 95% CI 1.07-2.22). CONCLUSIONS The prevalence of SARS-CoV-2 antibodies was low in HCWs. However, the occupational risk of contracting the infection was found to be higher for those working on dedicated COVID-19 wards. Further, the results imply that attention should be paid to occupational risk factors in planning pandemic preparedness.
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Affiliation(s)
- Sebastian von Huth
- Department of Infectious Diseases, Odense University Hospital, J. B. Winsløws Vej 4, Indgang 18 Penthouse 2. sal, DK-5000 Odense C, Denmark; Research Unit of Infectious Diseases, University of Southern Denmark, J. B. Winsløws Vej 4, Indgang 18 Penthouse 2. sal, DK-5000 Odense C, Denmark; Department of Internal Medicine, Lillebælt Hospital, Kolding, Sygehusvej 24, DK-6000 Kolding, Denmark.
| | - Søren Thue Lillevang
- Department of Clinical Immunology, Odense University Hospital, J. B. Winsløws Vej 4, DK-5000 Odense C, Denmark.
| | - Birgit Thorup Røge
- Department of Internal Medicine, Lillebælt Hospital, Kolding, Sygehusvej 24, DK-6000 Kolding, Denmark.
| | - Jonna Skov Madsen
- Department of Biochemistry and Immunology, Lillebælt Hospital, Vejle, Beriderbakken 4, DK-7100 Vejle, Denmark; Department of Regional Health Research IRS, University of Southern Denmark, J. B. Winsløws Vej 19, 3, DK-5000 Odense C, Denmark.
| | - Christian Backer Mogensen
- Department of Regional Health Research IRS, University of Southern Denmark, J. B. Winsløws Vej 19, 3, DK-5000 Odense C, Denmark; Department of Emergency Medicine, Hospital Sønderjylland, Kresten Philipsens Vej 15, DK-6200 Aabenraa, Denmark.
| | - John Eugenio Coia
- Department of Regional Health Research IRS, University of Southern Denmark, J. B. Winsløws Vej 19, 3, DK-5000 Odense C, Denmark; Department of Clinical Microbiology, Hospital South West Jutland, Finsensgade 35, Bygning F, 1, sal, DK-6700 Esbjerg, Denmark.
| | - Sören Möller
- Department of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 19, 3, DK-5000 Odense C, Denmark; OPEN - Open Patient Data Explorative Network, Odense University Hospital, J. B. Winsløws Vej 4, DK-5000 Odense C, Denmark.
| | - Ulrik Stenz Justesen
- Department of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 19, 3, DK-5000 Odense C, Denmark; Department of Clinical Microbiology, Odense University Hospital, J. B. Winsløws Vej 21, 2, DK-5000 Odense C, Denmark.
| | - Isik Somuncu Johansen
- Department of Infectious Diseases, Odense University Hospital, J. B. Winsløws Vej 4, Indgang 18 Penthouse 2. sal, DK-5000 Odense C, Denmark; Research Unit of Infectious Diseases, University of Southern Denmark, J. B. Winsløws Vej 4, Indgang 18 Penthouse 2. sal, DK-5000 Odense C, Denmark; Department of Clinical Research, University of Southern Denmark, J. B. Winsløws Vej 19, 3, DK-5000 Odense C, Denmark.
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Abstract
Not all health care workers have been vaccinated against COVID-19, and their reasons are multiple and varied. Some additional health care workers might decide to be vaccinated if the argument for vaccination were sufficiently clear. This article attempts to provide that clarity.
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Affiliation(s)
- Michael Klompas
- Harvard Medical School, Harvard Pilgrim Health Care Institute, and Brigham and Women's Hospital, Boston, Massachusetts (M.K.)
| | - Madelyn Pearson
- Brigham and Women's Hospital, Boston, Massachusetts (M.P., C.M.)
| | - Charles Morris
- Brigham and Women's Hospital, Boston, Massachusetts (M.P., C.M.)
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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.
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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
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38
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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.
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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
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Jinadatha C, Jones LD, Choi H, Chatterjee P, Hwang M, Redmond SN, Navas ME, Zabarsky TF, Bhullar D, Cadnum JL, Donskey CJ. Transmission of SARS-CoV-2 in Inpatient and Outpatient Settings in a Veterans Affairs Health Care System. Open Forum Infect Dis 2021; 8:ofab328. [PMID: 34426792 PMCID: PMC8344547 DOI: 10.1093/ofid/ofab328] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2021] [Accepted: 06/18/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Health care personnel and patients are at risk to acquire severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in health care settings, including in outpatient clinics and ancillary care areas. METHODS Between May 1, 2020, and January 31, 2021, we identified clusters of 3 or more coronavirus disease 2019 (COVID-19) cases in which nosocomial transmission was suspected in a Veterans Affairs health care system. Asymptomatic employees and patients were tested for SARS-CoV-2 if they were identified as being at risk through contact tracing investigations; for 7 clusters, all personnel and/or patients in a shared work area were tested regardless of exposure history. Whole-genome sequencing was performed to determine the relatedness of SARS-CoV-2 samples from the clusters and from control employees and patients. RESULTS Of 14 clusters investigated, 7 occurred in community-based outpatient clinics, 1 in the emergency department, 3 in ancillary care areas, and 3 on hospital medical/surgical wards that did not provide care for patients with known COVID-19 infection. Eighty-one of 82 (99%) symptomatic COVID-19 cases and 31 of 35 (89%) asymptomatic cases occurred in health care personnel. Sequencing analysis provided support for several transmission events between coworkers and in 2 cases supported transmission from health care personnel to patients. There were no documented transmissions from patients to personnel. CONCLUSIONS Clusters of COVID-19 with nosocomial transmission predominantly involved health care personnel and often occurred in outpatient clinics and ancillary care areas. There is a need for improved measures to prevent transmission of SARS-CoV-2 by health care personnel in inpatient and outpatient settings.
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Affiliation(s)
- Chetan Jinadatha
- Medical Service, Central Texas Veterans Healthcare System, Temple, Texas, USA
- College of Medicine, Texas A&M University, Bryan, Texas, USA
| | - Lucas D Jones
- Department of Molecular Biology and Microbiology, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Hosoon Choi
- Research Service, Central Texas Veterans Healthcare System, Temple, Texas, USA
| | - Piyali Chatterjee
- Research Service, Central Texas Veterans Healthcare System, Temple, Texas, USA
| | - Munok Hwang
- Research Service, Central Texas Veterans Healthcare System, Temple, Texas, USA
| | - Sarah N Redmond
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Maria E Navas
- Pathology and Laboratory Medicine Service, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA
| | - Trina F Zabarsky
- Infection Control Department, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA
| | - Davinder Bhullar
- Personnel Health Department, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA
| | - Jennifer L Cadnum
- Research Service, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA
| | - Curtis J Donskey
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
- Geriatric Research, Education, and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA
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Escandón K, Rasmussen AL, Bogoch II, Murray EJ, Escandón K, Popescu SV, Kindrachuk J. COVID-19 false dichotomies and a comprehensive review of the evidence regarding public health, COVID-19 symptomatology, SARS-CoV-2 transmission, mask wearing, and reinfection. BMC Infect Dis 2021; 21:710. [PMID: 34315427 PMCID: PMC8314268 DOI: 10.1186/s12879-021-06357-4] [Citation(s) in RCA: 81] [Impact Index Per Article: 27.0] [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: 12/01/2020] [Accepted: 06/24/2021] [Indexed: 02/07/2023] Open
Abstract
Scientists across disciplines, policymakers, and journalists have voiced frustration at the unprecedented polarization and misinformation around coronavirus disease 2019 (COVID-19) pandemic. Several false dichotomies have been used to polarize debates while oversimplifying complex issues. In this comprehensive narrative review, we deconstruct six common COVID-19 false dichotomies, address the evidence on these topics, identify insights relevant to effective pandemic responses, and highlight knowledge gaps and uncertainties. The topics of this review are: 1) Health and lives vs. economy and livelihoods, 2) Indefinite lockdown vs. unlimited reopening, 3) Symptomatic vs. asymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, 4) Droplet vs. aerosol transmission of SARS-CoV-2, 5) Masks for all vs. no masking, and 6) SARS-CoV-2 reinfection vs. no reinfection. We discuss the importance of multidisciplinary integration (health, social, and physical sciences), multilayered approaches to reducing risk ("Emmentaler cheese model"), harm reduction, smart masking, relaxation of interventions, and context-sensitive policymaking for COVID-19 response plans. We also address the challenges in understanding the broad clinical presentation of COVID-19, SARS-CoV-2 transmission, and SARS-CoV-2 reinfection. These key issues of science and public health policy have been presented as false dichotomies during the pandemic. However, they are hardly binary, simple, or uniform, and therefore should not be framed as polar extremes. We urge a nuanced understanding of the science and caution against black-or-white messaging, all-or-nothing guidance, and one-size-fits-all approaches. There is a need for meaningful public health communication and science-informed policies that recognize shades of gray, uncertainties, local context, and social determinants of health.
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Affiliation(s)
- Kevin Escandón
- School of Medicine, Universidad del Valle, Cali, Colombia.
| | - Angela L Rasmussen
- Vaccine and Infectious Disease Organization, University of Saskatchewan, Saskatoon, Canada
- Georgetown Center for Global Health Science and Security, Georgetown University, Washington, DC, USA
| | - Isaac I Bogoch
- Division of Infectious Diseases, University of Toronto, Toronto General Hospital, Toronto, Canada
| | - Eleanor J Murray
- Department of Epidemiology, Boston University School of Public Health, Boston, USA
| | - Karina Escandón
- Department of Anthropology, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Saskia V Popescu
- Georgetown Center for Global Health Science and Security, Georgetown University, Washington, DC, USA
- Schar School of Policy and Government, George Mason University, Fairfax, VA, USA
| | - Jason Kindrachuk
- Vaccine and Infectious Disease Organization, University of Saskatchewan, Saskatoon, Canada
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
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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
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Kurosu H, Watanabe K, Kurosawa K, Nakashita M, Kasamatsu A, Nakamura H, Yamagishi T, Mitsuhashi Y, Yano K, Hachiya Y, Odani T, Amishima M, Nekomiya Y, Matsui T, Yamada M, Kamiyama K, Kikuchi T, Takadate K, Watanabe C, Furusawa Y, Kase K, Hyodo Y, Suzuki H, Matsunaga T, Hori H, Kanoh M, Miyake Y, Yamada M, Kobayashi Y, Sugai M, Suzuki M, Sunagawa T. Possible contact transmission of SARS-CoV-2 in healthcare settings in Japan, 2020-2021. Infect Control Hosp Epidemiol 2021;:1-12. [PMID: 34039453 DOI: 10.1017/ice.2021.254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
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Andujar Vazquez GM, Morely J, Boucher HW, Doron SI. Coronavirus disease 2019 (COVID-19) vaccinations and preservation of the healthcare workforce. Infect Control Hosp Epidemiol 2021;:1-2. [PMID: 34016205 DOI: 10.1017/ice.2021.238] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022]
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Jones LD, Chan ER, Zabarsky TF, Cadnum JL, Navas ME, Redmond SN, Kovach JD, Linger M, Rutala WA, Zimmerman PA, Donskey CJ. Transmission of SARS-CoV-2 on a Patient Transport Van. Clin Infect Dis 2021; 74:339-342. [PMID: 33893474 PMCID: PMC8135457 DOI: 10.1093/cid/ciab347] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [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: 03/18/2021] [Indexed: 01/09/2023] Open
Abstract
We report 2 episodes of potential SARS-CoV-2 transmission from infected van drivers to passengers despite masking and physical distancing. Whole genome sequencing confirmed relatedness of driver and passenger SARS-CoV-2. With the heater operating, fluorescent microspheres were transported by airflow >3 meters from the front to the back of the van.
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Affiliation(s)
- Lucas D Jones
- Department of Molecular Biology and Microbiology, Case Western Reserve University School of Medicine, Cleveland Ohio, USA
| | - Ernest R Chan
- Cleveland Institute for Computational Biology, Case Western Reserve University, Cleveland, Ohio, USA
| | - Trina F Zabarsky
- Infection Control Department, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA
| | - Jennifer L Cadnum
- Research Service, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA
| | - Maria E Navas
- Pathology and Laboratory Medicine Service, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA
| | - Sarah N Redmond
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA
| | - Jeffrey D Kovach
- The Center for Global Health & Diseases, Case Western Reserve University, Cleveland, Ohio, USA
| | - Marlin Linger
- The Center for Global Health & Diseases, Case Western Reserve University, Cleveland, Ohio, USA
| | - William A Rutala
- Division of Infectious Diseases, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Peter A Zimmerman
- The Center for Global Health & Diseases, Case Western Reserve University, Cleveland, Ohio, USA
| | - Curtis J Donskey
- Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.,Geriatric Research, Education, and Clinical Center, Louis Stokes Cleveland VA Medical Center, Cleveland, Ohio, USA
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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.
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