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Mimura K, Oka H, Sawano M. A perspective on hospital-acquired (nosocomial) infection control of COVID-19: usefulness of spatial separation between wards and airborne isolation unit. J Breath Res 2021; 15. [PMID: 34293732 DOI: 10.1088/1752-7163/ac1721] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 07/22/2021] [Indexed: 01/12/2023]
Abstract
The coronavirus disease 2019 (COVID-19) pandemic has imposed a considerable burden on hospitals and healthcare workers (HCWs) worldwide, increasing the risk of outbreaks and nosocomial transmission to 'non-COVID-19' patients, who represent the highest-risk population in terms of mortality, and HCWs. Since HCWs are at the interface between hospitals on the one hand and the community on the other, they are potential reservoirs, carriers, or victims of severe acute respiratory syndrome coronavirus 2 cross-transmission. In addition, there has been a paradigm shift in the management of viral respiratory outbreaks, such as the widespread testing of patients and HCWs, including asymptomatic individuals. In hospitals, there is a risk of aerosol transmission in poorly ventilated spaces, and when performing aerosol-producing procedures, it is imperative to take measures against aerosol transmission. In particular, spatial separation of the inpatient ward for non-COVID-19 patients from that designated for patients with suspected or confirmed COVID-19 as well as negative-pressure isolation on the floor of the ward, using an airborne infection isolation device could help prevent nosocomial infection.
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Affiliation(s)
- Kazuyuki Mimura
- Department of General Internal Medicine, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Hideaki Oka
- Department of General Internal Medicine, Saitama Medical Center, Saitama Medical University, Saitama, Japan
| | - Makoto Sawano
- Center for Advanced Emergency Medicine and Critical Care, Saitama Medical Center, Saitama Medical University, Saitama, Japan
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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] [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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Lai A, Chang ML, O'Donnell RP, Zhou C, Sumner JA, Hsiai TK. Association of COVID-19 transmission with high levels of ambient pollutants: Initiation and impact of the inflammatory response on cardiopulmonary disease. THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 779:146464. [PMID: 33961545 PMCID: PMC7960028 DOI: 10.1016/j.scitotenv.2021.146464] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2020] [Revised: 03/10/2021] [Accepted: 03/10/2021] [Indexed: 05/14/2023]
Abstract
Ambient air pollution contributes to 7 million premature deaths annually. Concurrently, the ongoing coronavirus disease 2019 (COVID-19) pandemic, complicated with S-protein mutations and other variants, caused by the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has resulted in over 2.5 million deaths globally. Chronic air pollution-mediated cardiopulmonary diseases have been associated with an increased incidence of hospitalization and mechanical ventilation following COVID-19 transmission. While the underlying mechanisms responsible for this association remain elusive, air pollutant-induced vascular oxidative stress and inflammatory responses have been implicated in amplifying COVID-19-mediated cytokine release and vascular thrombosis. In addition, prolonged exposure to certain types of particulate matter (PM2.5, d < 2.5 μm) has also been correlated with increased lung epithelial and vascular endothelial expression of the angiotensin-converting enzyme-2 (ACE2) receptors to which the SARS-CoV-2 spike glycoproteins (S) bind for fusion and internalization into host cells. Emerging literature has linked high rates of SARS-CoV-2 infection to regions with elevated levels of PM2.5, suggesting that COVID-19 lockdowns have been implicated in regional reductions in air pollutant-mediated cardiopulmonary effects. Taken together, an increased incidence of SARS-CoV-2-mediated cardiopulmonary diseases seems to overlap with highly polluted regions. To this end, we will review the redox-active components of air pollutants, the pathophysiology of SARS-CoV-2 transmission, and the key oxidative mechanisms and ACE2 overexpression underlying air pollution-exacerbated SARS-CoV-2 transmission.
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Affiliation(s)
- Angela Lai
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, CA, United States of America
| | - Megan L Chang
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, CA, United States of America
| | - Ryan P O'Donnell
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, CA, United States of America
| | - Changcheng Zhou
- Division of Biomedical Sciences, School of Medicine, University of California, Riverside, CA, United States of America
| | - Jennifer A Sumner
- Department of Psychology, College of Life Sciences, University of California, Los Angeles, United States of America
| | - Tzung K Hsiai
- Division of Cardiology, Department of Medicine, David Geffen School of Medicine at University of California, Los Angeles, CA, United States of America; Department of Medicine, Greater Los Angeles VA Healthcare System, Los Angeles, CA, United States of America; Department of Bioengineering, Henry Samueli School of Engineering & Applied Science, University of California, Los Angeles, CA, United States of America.
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54
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Rufaida, Mahmood T, Kedwai I, Ahsan F, Shamim A, Shariq M, Parveen S. A dossier on COVID-19 chronicle. J Basic Clin Physiol Pharmacol 2021; 33:45-54. [PMID: 34280963 DOI: 10.1515/jbcpp-2020-0511] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Accepted: 06/28/2021] [Indexed: 01/08/2023]
Abstract
The dissemination of the 2019 novel coronavirus (2019-nCoV) is presenting the planet with a new health emergency response or threat to health. The virus emerged in bats and was disseminated to humans in December 2019 via still unknown intermediate species in Wuhan, China. It is disseminated by inhalation or breaks out with infected droplets and the incubation period is between 2 and 14 days. The symptoms usually include high body temperature, cough, sore throat, dyspnea, low energy or tiredness, and weakness. The condition is moderate in most people; but in the elderly and those with comorbidities, it advances to pneumonia, acute respiratory distress syndrome (ARDS), and multiple organ failure. Popular research work includes normal/low WBC with upraised C-reactive protein (CRP). Treatment is generally supportive and requires home seclusion of suspected persons and rigorous infection control methods at hospitals. The Covid-19 has lower fatality than SARS and MERS. Among the proposed therapeutic regimen, hydroxychloroquine, chloroquine, remdisevir, azithromycin, toclizumab, and cromostat mesylate have shown promising results, and the limited benefit was seen with lopinavir-ritonavir treatment in hospitalized adult patients with severe COVID-19. Early development of the SARS-CoV-2 vaccine started based on the full-length genome analysis of severe acute respiratory syndrome coronavirus. Several subunit vaccines, peptides, nucleic acids, plant-derived, and recombinant vaccines are under pipeline. Research work, development of new medicines and vaccines, and efforts to reduce disease morbidity and mortality must be encouraged to improve our position in the fight against this disease and to protect human life.
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Affiliation(s)
- Rufaida
- Department of Pharmacology, Faculty of Pharmacy, Integral University, Lucknow (U.P.), India
| | - Tarique Mahmood
- Department of Pharmacology, Faculty of Pharmacy, Integral University, Lucknow (U.P.), India
| | - Ismail Kedwai
- Department of Pharmacology, School of Pharmaceutical Education and Research, Jamia Hamdard, New Delhi, India
| | - Farogh Ahsan
- Department of Pharmacology, Faculty of Pharmacy, Integral University, Lucknow (U.P.), India
| | - Arshiya Shamim
- Department of Pharmacology, Faculty of Pharmacy, Integral University, Lucknow (U.P.), India
| | - Mohammad Shariq
- Department of Pharmacology, Faculty of Pharmacy, Integral University, Lucknow (U.P.), India
| | - Saba Parveen
- Department of Pharmacology, Faculty of Pharmacy, Integral University, Lucknow (U.P.), India
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Modeling Aerial Transmission of Pathogens (Including the SARS-CoV-2 Virus) through Aerosol Emissions from E-Cigarettes. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11146355] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
We examine the plausibility of aerial transmission of pathogens (including the SARS-CoV-2 virus) through respiratory droplets that might be carried by exhaled e-cigarette aerosol (ECA). Given the lack of empiric evidence on this phenomenon, we consider available evidence on cigarette smoking and respiratory droplet emission from mouth breathing through a mouthpiece as convenient proxies to infer the capacity of vaping to transport pathogens in respiratory droplets. Since both exhaled droplets and ECA droplets are within the Stokes regime, the ECA flow acts effectively as a visual tracer of the expiratory flow. To infer quantitatively the direct exposure distance, we consider a model that approximates exhaled ECA flow as an axially symmetric intermittent steady starting jet evolving into an unstable puff, an evolution that we corroborate by comparison with photographs and videos of actual vapers. On the grounds of all this theoretical modeling, we estimate for low-intensity vaping (practiced by 80–90% of vapers) the emission of 6–210 (median 39.9, median deviation 67.3) respiratory submicron droplets per puff and a horizontal distance spread of 1–2 m, with intense vaping possibly emitting up to 1000 droplets per puff in the submicron range with a distance spread over 2 m. The optical visibility of the ECA flow has important safety implications, as bystanders become instinctively aware of the scope and distance of possible direct contagion through the vaping jet.
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Dbouk T, Aranda-García S, Barcala-Furelos R, Rodríguez-Núñez A, Drikakis D. Airborne infection risk during open-air cardiopulmonary resuscitation. Emerg Med J 2021; 38:673-678. [PMID: 34187880 DOI: 10.1136/emermed-2021-211209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Accepted: 06/13/2021] [Indexed: 11/03/2022]
Abstract
AIM Cardiopulmonary resuscitation (CPR) is an emergency procedure where interpersonal distance cannot be maintained. There are and will always be outbreaks of infection from airborne diseases. Our objective was to assess the potential risk of airborne virus transmission during CPR in open-air conditions. METHODS We performed advanced high-fidelity three-dimensional modelling and simulations to predict airborne transmission during out-of-hospital hands-only CPR. The computational model considers complex fluid dynamics and heat transfer phenomena such as aerosol evaporation, breakup, coalescence, turbulence, and local interactions between the aerosol and the surrounding fluid. Furthermore, we incorporated the effects of the wind speed/direction, the air temperature and relative humidity on the transport of contaminated saliva particles emitted from a victim during a resuscitation process based on an Airborne Infection Risk (AIR) Index. RESULTS The results reveal low-risk conditions that include wind direction and high relative humidity and temperature. High-risk situations include wind directed to the rescuer, low humidity and temperature. Combinations of other conditions have an intermediate AIR Index and risk for the rescue team. CONCLUSIONS The fluid dynamics, simulation-based AIR Index provides a classification of the risk of contagion by victim's aerosol in the case of hands-only CPR considering environmental factors such as wind speed and direction, relative humidity and temperature. Therefore, we recommend that rescuers perform a quick assessment of their airborne infectious risk before starting CPR in the open air and positioning themselves to avoid wind directed to their faces.
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Affiliation(s)
| | - Silvia Aranda-García
- GRAFIS Research Group, National Institute of Physical Education of Catalonia, Barcelona University, Barcelona, Spain
| | - Roberto Barcala-Furelos
- REMOSS Research Group, University of Vigo, Faculty of Education and Sport Sciences, Pontevedra, Spain.,CLINURSID Research Group, University of Santiago de Compostela School of Nursing, Santiago de Compostela, Spain
| | - Antonio Rodríguez-Núñez
- CLINURSID Research Group, University of Santiago de Compostela School of Nursing, Santiago de Compostela, Spain.,Intermediate and Palliative Care Section, Santiago de Compostela's University Hospital, Santiago de Compostela, Spain
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Use of portable air cleaners to reduce aerosol transmission on a hospital coronavirus disease 2019 (COVID-19) ward. Infect Control Hosp Epidemiol 2021; 43:987-992. [PMID: 34266516 PMCID: PMC8314194 DOI: 10.1017/ice.2021.284] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Objective: To study the airflow, transmission, and clearance of aerosols in the clinical spaces of a hospital ward that had been used to care for patients with coronavirus disease 2019 (COVID-19) and to examine the impact of portable air cleaners on aerosol clearance. Design: Observational study. Setting: A single ward of a tertiary-care public hospital in Melbourne, Australia. Intervention: Glycerin-based aerosol was used as a surrogate for respiratory aerosols. The transmission of aerosols from a single patient room into corridors and a nurses’ station in the ward was measured. The rate of clearance of aerosols was measured over time from the patient room, nurses’ station and ward corridors with and without air cleaners [ie, portable high-efficiency particulate air (HEPA) filters]. Results: Aerosols rapidly travelled from the patient room into other parts of the ward. Air cleaners were effective in increasing the clearance of aerosols from the air in clinical spaces and reducing their spread to other areas. With 2 small domestic air cleaners in a single patient room of a hospital ward, 99% of aerosols could be cleared within 5.5 minutes. Conclusions: Air cleaners may be useful in clinical spaces to help reduce the risk of acquisition of respiratory viruses that are transmitted via aerosols. They are easy to deploy and are likely to be cost-effective in a variety of healthcare settings.
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Alwazzan RA, Baseer MA, ALMugeiren OM, Ingle NA. Dental Professional's Knowledge, Preventive Awareness and Attitude Towards COVID-19 in Saudi Arabia: A Cross-Sectional Survey. Risk Manag Healthc Policy 2021; 14:2277-2288. [PMID: 34104018 PMCID: PMC8179811 DOI: 10.2147/rmhp.s303858] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 05/09/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Given the COVID-19 pandemic, it is necessary to assess the dentist's knowledge, preventive awareness, and attitude towards COVID-19 in Saudi Arabia. This study aimed to assess dental professionals' knowledge, preventive awareness, and attitude towards dental care during the COVID-19 pandemic in Saudi Arabia. STUDY SUBJECTS AND METHODS The study participants consisted of dental professionals working in government, private and academic sectors in Saudi Arabia. An online questionnaire (Whatsapp and Twitter) was sent to dental professionals in July 2020. The questionnaire consisted of questions on dental professional's demographic variables, their knowledge of the incubation period, the symptoms, mode of transmission, preventive awareness of COVID-19, and their attitude toward treating patients with COVID-19. Mann-Whitney U and Kruskal-Wallis tests were applied to compare mean ranks and a p<0.05 is considered statistically significant. RESULTS This study included a total of 356 dental professionals (dentists and dental students) aged 22-60 years (mean±SD, 32.14±7.48 years). Majority of the participants were graduates/general practitioners (GP) 145 (40.7%), followed by post graduate (PG) student 108 (30.3%), undergraduate students 23 (6.5%) and specialist 80 (22.5%). Dental professionals showed a high level (>90% correct responses) of knowledge of COVID-19 except for the infection among comorbid patients 283 (79.5%) and incubation period of COVID-19, 164 (46.1%). An overall high knowledge of COVID-19 (87.26%), preventive awareness (88.64%) and a positive attitude (65.26%) towards dental care were observed among the study participants. The mean knowledge ranks differed significantly in different genders (p=0.029) and marital status (p=0.023), whereas preventive awareness differed significantly across various qualifications (p=0.004). The mean attitude rank was significantly higher among Saudi (182.29) compared to non-Saudi (141.36) study participants (p=0.025). CONCLUSION The dental professionals participated in this study demonstrated adequate knowledge of symptoms, preventive awareness, and a positive attitude towards dental care of the COVID-19 infected patients.
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Affiliation(s)
- Rayyan Abdallah Alwazzan
- Department of Preventive Dentistry, College of Dentistry, Riyadh Elm University, Riyadh, Saudi Arabia
| | - Mohammad A Baseer
- Department of Preventive Dentistry, College of Dentistry, Riyadh Elm University, Riyadh, Saudi Arabia
| | | | - Navin Anand Ingle
- Department of Preventive Dentistry, College of Dentistry, Riyadh Elm University, Riyadh, Saudi Arabia
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Khosronejad A, Kang S, Wermelinger F, Koumoutsakos P, Sotiropoulos F. A computational study of expiratory particle transport and vortex dynamics during breathing with and without face masks. PHYSICS OF FLUIDS (WOODBURY, N.Y. : 1994) 2021; 33:066605. [PMID: 34149276 PMCID: PMC8188648 DOI: 10.1063/5.0054204] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Accepted: 05/05/2021] [Indexed: 05/18/2023]
Abstract
We present high-fidelity numerical simulations of expiratory biosol transport during normal breathing under indoor, stagnant air conditions with and without a facile mask. We investigate mask efficacy to suppress the spread of saliva particles that is underpinnings existing social distancing recommendations. The present simulations incorporate the effect of human anatomy and consider a spectrum of saliva particulate sizes that range from 0.1 to 10 μm while also accounting for their evaporation. The simulations elucidate the vorticity dynamics of human breathing and show that without a facile mask, saliva particulates could travel over 2.2 m away from the person. However, a non-medical grade face mask can drastically reduce saliva particulate propagation to 0.72 m away from the person. This study provides new quantitative evidence that facile masks can successfully suppress the spreading of saliva particulates due to normal breathing in indoor environments.
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Affiliation(s)
- Ali Khosronejad
- Department of Civil Engineering, Stony Brook University, Stony Brook, New York 11794, USA
| | - Seokkoo Kang
- Department of Civil and Environmental Engineering, Hanyang University, Seoul 04763, South Korea
| | - Fabian Wermelinger
- Computational Science and Engineering Laboratory, ETH Zurich, Zurich CH-8092, Switzerland
| | - Petros Koumoutsakos
- Institute for Applied Computational Science, Harvard University, Cambridge, Massachusetts 02138, USA
| | - Fotis Sotiropoulos
- Department of Civil Engineering, Stony Brook University, Stony Brook, New York 11794, USA
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Pandey LK, Singh VV, Sharma PK, Meher D, Biswas U, Sathe M, Ganesan K, Thakare VB, Agarwal K. Screening of core filter layer for the development of respiratory mask to combat COVID-19. Sci Rep 2021; 11:10187. [PMID: 33986353 PMCID: PMC8119445 DOI: 10.1038/s41598-021-89503-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2021] [Accepted: 04/28/2021] [Indexed: 12/04/2022] Open
Abstract
The severe outbreak of respiratory coronavirus disease 2019 has increased the significant demand of respiratory mask and its use become ubiquitous worldwide to control this unprecedented respiratory pandemic. The performance of a respiratory mask depends on the efficiency of the filter layer which is mostly made of polypropylene melt blown non-woven (PP-MB-NW). So far, very limited characterization data are available for the PPE-MB-NW in terms to achieve desired particulate filtration efficiency (PFE) against 0.3 µm size, which are imperative in order to facilitate the right selection of PP-MB-NW fabric for the development of mask. In present study, eight different kinds of PP-MB-NW fabrics (Sample A-H) of varied structural morphology are chosen. The different PP-MB-NW were characterized for its pore size and distribution by mercury porosimeter and BET surface area analyzer was explored first time to understand the importance of blind pore in PFE. The PP-MB-NW samples were characterized using scanning electron microscopy so as to know the surface morphology. The filtration efficiency, pressure drop and breathing resistance of various PP-MB-NW fabric samples are investigated in single and double layers combination against the particle size of 0.3, 0.5 and 1 µm. The samples which are having low pore dia, high solid fraction volume, and low air permeability has high filtration efficiency (> 90%) against 0.3 µm particle with high pressure drop (16.3-21.3 mm WC) and breathing resistance (1.42-1.92 mbar) when compared to rest of the samples. This study will pave the way for the judicial selection of right kind of filter layer i.e., PP-MB-NW fabric for the development of mask and it will be greatly helpful in manufacturing of mask in this present pandemic with desired PFE indicating considerable promise for defense against respiratory pandemic.
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Affiliation(s)
- Lokesh K Pandey
- Defence Research and Development Establishment, DRDO, Jhansi Road, Gwalior, 474002, India
| | - Virendra V Singh
- Defence Research and Development Establishment, DRDO, Jhansi Road, Gwalior, 474002, India.
| | - Pushpendra K Sharma
- Defence Research and Development Establishment, DRDO, Jhansi Road, Gwalior, 474002, India
| | - Damayanti Meher
- Defence Research and Development Establishment, DRDO, Jhansi Road, Gwalior, 474002, India
| | - Utpal Biswas
- Defence Research and Development Establishment, DRDO, Jhansi Road, Gwalior, 474002, India
| | - Manisha Sathe
- Defence Research and Development Establishment, DRDO, Jhansi Road, Gwalior, 474002, India
| | - Kumaran Ganesan
- Defence Research and Development Establishment, DRDO, Jhansi Road, Gwalior, 474002, India
| | - Vikas B Thakare
- Defence Research and Development Establishment, DRDO, Jhansi Road, Gwalior, 474002, India
| | - Kavita Agarwal
- Defence Materials and Stores Research and Development Establishment, Kanpur, 208013, India
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A prospective clinical evaluation of a patient isolation hood during the COVID-19 pandemic. Aust Crit Care 2021; 35:28-33. [PMID: 34144863 PMCID: PMC8112290 DOI: 10.1016/j.aucc.2021.05.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Revised: 03/20/2021] [Accepted: 05/01/2021] [Indexed: 01/01/2023] Open
Abstract
Background Healthcare workers (HCWs) have frequently become infected with severe acute respiratory syndrome coronavirus 2 whilst treating patients with coronavirus disease 2019 (COVID-19). A variety of novel devices have been proposed to reduce COVID-19 cross-contamination. Objectives The aim of the study was (i) to test whether patients and HCWs thought that a novel patient isolation hood was safe and comfortable and (ii) to obtain COVID-19 infection data of hospital HCWs. Methods This is a prospective cohort study of 20 patients, entailing HCW/patient questionnaires and safety aspects of prototype isolation hoods. COVID-19 data of HCWs were prospectively collected. Assessment of the hood's safety and practicality and adverse event reporting was carried out. Outcome measures The outcome measures are as follows: questionnaire responses, adverse event reporting, rates of infections in HCWs during the study period (20/6/2020 to 21/7/2020), and COVID-19 infections in HCWs reported until the last recorded diagnosis of COVID-19 in HCWs (20/6/2020 to 27/9/2020). Results Of the 64 eligible individual HCW surveys, 60 surveys were overall favourable (>75% questions answered in favour of the isolation hood). HCWs were unanimous in perceiving the hood as safe (60/60), preferring its use (56/56), and understanding its potential COVID-19 cross-contamination minimisation (60/60). All eight patients who completed the questionnaire thought the isolation hood helped prevent COVID-19 cross infection and was safe and comfortable. There were no reported patient safety adverse events. The COVID-19 attack rate from 20/6/2020 to 27/9/2020 among registered nurses was as follows: intensive care units (ICUs), 2.2% (3/138); geriatric wards, 13.2% (26/197); and COVID-19 wards, 18.3% (32/175). The COVID-19 attack rate among medical staff was as follows: junior staff, 2.1% (24/932); senior staff, 0.7% (4/607); aged care/rehabilitation, 6.7% (2/30); and all ICU medical staff, 8.6% (3/35). Conclusions The isolation hood was preferred to standard care by HCWs and well tolerated by patients, and after the study, isolation hoods became part of standard ICU therapy. There was an association between being an ICU nurse and a low COVID-19 infection rate (no causality implied). ICU HCWs feel safer when treating patients with COVID-19 using an isolation hood.
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Lieber C, Melekidis S, Koch R, Bauer HJ. Insights into the evaporation characteristics of saliva droplets and aerosols: Levitation experiments and numerical modeling. JOURNAL OF AEROSOL SCIENCE 2021; 154:105760. [PMID: 33518792 PMCID: PMC7826107 DOI: 10.1016/j.jaerosci.2021.105760] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2020] [Revised: 01/12/2021] [Accepted: 01/13/2021] [Indexed: 05/04/2023]
Abstract
Understanding the transmission phenomena of SARS-CoV-2 by virus-laden droplets and aerosols is of paramount importance for controlling the current COVID-19 pandemic. Detailed information about the lifetime and kinematics of airborne droplets of different size is relevant in order to evaluate hygiene measures like wearing masks but also social distancing and ventilation concepts for indoor environments. However, the evaporation process of expiratory droplets and aerosols is not fully understood. Consequently, the main objective of this study is to present evaporation characteristics of saliva droplets. An acoustic levitator is utilized in conjunction with microscopic imaging for recording the temporal evolution of the evaporation of saliva droplets under well-defined ambient conditions. Following the evaporation of the water content, a saliva droplet reaches a final size, which remains stable in the timescale of hours. By investigating numerous droplets of different size, it was found that the final droplet diameter correlates well to 20 % of the initial diameter. This correlation is independent of the ambient conditions for a temperature range from 20 °C to 29 °C and a relative humidity from 6 % to up to 65 %. The experimentally obtained evaporation characteristics are implemented into a numerical model, which is based on one-dimensional droplet kinematics and a rapid mixing evaporation model. By taking into account the evaporation-falling curve as presented by Wells, the significance of the experimental results for predicting the lifetime of saliva droplets and aerosols is demonstrated. The numerical predictions may be used to determine the impact of the droplet size and the ambient conditions on the transmission risks of infectious diseases like COVID-19.
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Affiliation(s)
- Christian Lieber
- Karlsruhe Institute of Technology, Institute of Thermal Turbomachinery, Straße am Forum 6, 76131 Karlsruhe, Germany
| | - Stefanos Melekidis
- Karlsruhe Institute of Technology, Institute of Thermal Turbomachinery, Straße am Forum 6, 76131 Karlsruhe, Germany
| | - Rainer Koch
- Karlsruhe Institute of Technology, Institute of Thermal Turbomachinery, Straße am Forum 6, 76131 Karlsruhe, Germany
| | - Hans-Jörg Bauer
- Karlsruhe Institute of Technology, Institute of Thermal Turbomachinery, Straße am Forum 6, 76131 Karlsruhe, Germany
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Atnafie SA, Anteneh DA, Yimenu DK, Kifle ZD. Assessment of exposure risks to COVID-19 among frontline health care workers in Amhara Region, Ethiopia: A cross-sectional survey. PLoS One 2021; 16:e0251000. [PMID: 33914826 PMCID: PMC8084207 DOI: 10.1371/journal.pone.0251000] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Accepted: 04/16/2021] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The burden to fight with Corona Virus Disease-19 (COVID-19) pandemic has lied to frontline health care workers that are putting themselves at a higher risk in the battle against the disease. This study aimed to assess the exposure health risks of COVID-19 among frontline healthcare workers in the Amhara region, Ethiopia. METHOD A web-based cross-sectional study was conducted on public health workers from May to August 2020. Data were collected using a structured questionnaire via email and telegram services. Both descriptive statistics and bivariate followed by multivariable logistic regression analyses were conducted to identify distribution patterns and factors associated with exposure risks to COVID-19. Odds ratio with 95% Confidence Interval (CI), and a P-value of <0.05 was used to determine statistical significance. RESULT A total of 418 health care workers participated in the study with a response rate of 99.1%. The majority of the study participants 310(74.2%), were males, and 163(39%) were nurses/ midwives respectively. More than half of the respondents 237(56.7%), had reported that they didn`t have face-to-face contact with a confirmed COVID-19 patient. Among the respondents, 173(41.4%), 147(35.2%), 63(15.1%), and 65(15.6%) of the health professionals had always used gloves, medical masks, face shield, or goggles/protective glasses, and disposable gown, respectively. In this study, age between 25-34 years (AOR = 0.20), age between 35-44 years (AOR = 0.13), family size of >6 (AOR = 3.77), work experience of 21-30 years (AOR = 0.01), and good handwashing habit (AOR = 0.44) were the protective factors against COVID-19. On the other hand, perception of non-exposure to COVD 19 (AOR = 9.56), and poor habit of decontamination of high touch areas (AOR = 2.52) were the risk factors associated with confirmed COVID 19 cases among health care workers. CONCLUSION Poor adherence to personal protective equipment use and aseptic practices during and after health care interactions with patients were identified. Strategies should be implemented to institute effective and sustainable infection control measures that protect the health care workers from COVID-19 infection.
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Affiliation(s)
- Seyfe Asrade Atnafie
- Department of Pharmacology, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Demssie Ayalew Anteneh
- Department of Hospital Clinical Pharmacy, College of Medicine and Health Science, University of Gondar, Gondar, Ethiopia
| | - Dawit Kumilachew Yimenu
- Department of Pharmaceutics and Social Pharmacy, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Zemene Demelash Kifle
- Department of Pharmacology, School of Pharmacy, College of Medicine and Health Sciences, University of Gondar, Gondar, Ethiopia
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64
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Wynn M. Understanding the principles of infection prevention and control. Nurs Stand 2021; 36:61-66. [PMID: 33899381 DOI: 10.7748/ns.2021.e11729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/10/2021] [Indexed: 11/09/2022]
Abstract
Nurses have a crucial role in infection prevention and control. The coronavirus disease 2019 (COVID-19) pandemic has emphasised the importance of controlling the spread of infections, while reinforcing the challenges involved in the care of patients who already have an infection. This article discusses important elements of theory and practice related to infection prevention and control. The author also explores various areas that have come to prominence as a result of the COVID-19 pandemic, including measures such as risk assessment, the use of personal protective equipment, the role of surveillance, and outbreak management.
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Affiliation(s)
- Matthew Wynn
- adult nursing, University of Salford, Salford, England
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65
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Nohara A, Tada H, Ogura M, Okazaki S, Ono K, Shimano H, Daida H, Dobashi K, Hayashi T, Hori M, Matsuki K, Minamino T, Yokoyama S, Harada-Shiba M. Homozygous Familial Hypercholesterolemia. J Atheroscler Thromb 2021; 28:665-678. [PMID: 33867421 PMCID: PMC8265428 DOI: 10.5551/jat.rv17050] [Citation(s) in RCA: 56] [Impact Index Per Article: 18.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Familial hypercholesterolemia (FH) is an inherited disorder with retarded clearance of plasma LDL caused by mutations of the genes involved in the LDL receptor-mediated pathway and most of them exhibit autosomal dominant inheritance. Homozygotes of FH (HoFH) may have plasma LDL-C levels, which are at least twice as high as those of heterozygous FH (HeFH) and therefore four times higher than normal levels. Prevalence of HoFH had been estimated as 1 in 1,000,000 before but more recent genetic analysis surveys predict 1 in 170,000 to 300,000. Since LDL receptor activity is severely impaired, HoFH patients do not or very poorly respond to medications to enhance activity, such as statins, and have a poorer prognosis compared to HeFH. HoFH should therefore be clinically distinguished from HeFH. Thorough family studies and genetic analysis are recommended for their accurate diagnosis. Fatal cardiovascular complications could develop even in the first decade of life for HoFH, so aggressive lipid-lowering therapy should be initiated as early as possible. Direct removal of plasma LDL by lipoprotein apheresis has been the principal measure for these patients. However, this treatment alone may not achieve stable LDL-C target levels and combination with drugs should be considered. The lipid-lowering effects of statins and PCSK9 inhibitors substantially vary depending on the remaining LDL receptor activity of individual patients. On the other hand, the action an MTP inhibitor is independent of LDL receptor activity, and it is effective in most HoFH cases. This review summarizes the key clinical issues of HoFH as well as insurance coverage available under the Japanese public healthcare system.
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Affiliation(s)
- Atsushi Nohara
- Department of Clinical Genetics, Ishikawa Prefectural Central Hospital
| | - Hayato Tada
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences
| | - Masatsune Ogura
- Department of Molecular Innovation in Lipidology, National Cerebral and Cardiovascular Center Research Institute
| | - Sachiko Okazaki
- Division for Health Service Promotion, The University of Tokyo
| | - Koh Ono
- Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine
| | - Hitoshi Shimano
- Department of Internal Medicine (Endocrinology and Metabolism), Faculty of Medicine University of Tsukuba
| | - Hiroyuki Daida
- Faculty of Health Science, Juntendo University, Juntendo University Graduate School of Medicine
| | - Kazushige Dobashi
- Department of Pediatrics, School of Medicine, University of Yamanashi
| | - Toshio Hayashi
- School of Health Sciences, Nagoya University Graduate School of Medicine
| | - Mika Hori
- Department of Endocrinology, Research Institute of Environmental Medicine, Nagoya University
| | - Kota Matsuki
- Department of Endocrinology and Metabolism, Hirosaki University Graduate School of Medicine
| | - Tetsuo Minamino
- Department of Cardiorenal and Cerebrovascular Medicine, Faculty of Medicine, Kagawa University
| | | | - Mariko Harada-Shiba
- Department of Molecular Pathogenesis, National Cerebral and Cardiovascular Center Research Institute
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Heneghan CJ, Spencer EA, Brassey J, Plüddemann A, Onakpoya IJ, Evans DH, Conly JM, Jefferson T. SARS-CoV-2 and the role of airborne transmission: a systematic review. F1000Res 2021. [DOI: 10.12688/f1000research.52091.1] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
Background: Airborne transmission is the spread of an infectious agent caused by the dissemination of droplet nuclei (aerosols) that remain infectious when suspended in the air. We carried out a systematic review to identify, appraise and summarise the evidence from studies of the role of airborne transmission of SARS-CoV-2. Methods: We searched LitCovid, MedRxiv, Google Scholar and the WHO Covid-19 database from 1 February to 20 December 2020 and included studies on airborne transmission. Data were dual extracted and we assessed quality using a modified QUADAS 2 risk of bias tool. Results: We included 67 primary studies and 22 reviews on airborne SARS-CoV-2. Of the 67 primary studies, 53 (79%) reported data on RT-PCR air samples, 12 report cycle threshold values and 18 copies per sample volume. All primary studies were observational and of low quality. The research often lacked standard methods, standard sampling sizes and reporting items. We found 36 descriptions of different air samplers deployed. Of the 42 studies conducted in-hospital that reported binary RT-PCR tests, 24 (57%) reported positive results for SARs-CoV-2 (142 positives out of 1,403 samples: average 10.1%, range 0% to 100%). There was no pattern between the type of hospital setting (ICU versus non-ICU) and RT-PCR positivity. Seventeen studies reported potential air transmission in the outdoors or in the community. Seven performed RT-PCR sampling, of which two studies report weak positive RNA samples for 2 or more genes (5 of 125 samples positive: average 4.0%). Ten studies attempted viral culture with no serial passage for viral culture. Conclusion: SARS-CoV-2 RNA is detected intermittently in the air in various settings. Standardized guidelines for conducting and reporting research on airborne transmission are needed. The lack of recoverable viral culture samples of SARS-CoV-2 prevents firm conclusions over airborne transmission.
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O'Brien TP, Pelletier J. Topical Ocular Povidone-Iodine as an Adjunctive Preventative Practice in the Era of COVID-19. Asia Pac J Ophthalmol (Phila) 2021; 10:142-145. [PMID: 33793439 PMCID: PMC8016473 DOI: 10.1097/apo.0000000000000353] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 11/08/2020] [Indexed: 12/24/2022] Open
Abstract
ABSTRACT Ophthalmologists and patients have an inherent increased risk for transmission of SARS-CoV-2. The human ocular surface expresses receptors and enzymes facilitating transmission of SARS-CoV-2. Personal protective equipment alone provides incomplete protection. Adjunctive topical ocular, nasal, and oral antisepsis with povidone iodine bolsters personal protective equipment in prevention of provider-patient transmission of SARS-CoV-2 in ophthalmology.
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Affiliation(s)
- Terrence P O'Brien
- Department of Ophthalmology, Bascom Palmer Eye Institute, University of Miami Miller School of Medicine, Miami, FL
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68
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Hamilton GS. Aerosol-generating procedures in the COVID era. Respirology 2021; 26:416-418. [PMID: 33660369 PMCID: PMC8014278 DOI: 10.1111/resp.14031] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 02/19/2021] [Indexed: 12/29/2022]
Affiliation(s)
- Garun S Hamilton
- Monash Lung, Sleep, Allergy and Immunology, Monash Health, Melbourne, VIC, Australia.,School of Clinical Sciences, Monash University, Melbourne, VIC, Australia
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69
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Zhang X, Wang J, Wang C, Lian Z, Shi Y, Ren Y, Yan Y. Thermophoretic collection of virus-laden (SARS-CoV-2) aerosols. BIOMICROFLUIDICS 2021; 15:024101. [PMID: 33763159 PMCID: PMC7955857 DOI: 10.1063/5.0039247] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Revised: 03/29/2021] [Accepted: 02/16/2021] [Indexed: 06/12/2023]
Abstract
Detecting the existence of SARS-CoV-2 in the indoor atmosphere is a practical solution to track the prevalence and prevent the spread of the virus. In this work, a thermophoretic approach is presented to collect the novel coronavirus-laden aerosols from the air and accumulate to high concentrations adequate for the sensitivity of viral RNA detection. Among the factors, the density and particle size have negligible effects on particle trajectory, while the vertical coordinates of particles increase with the rise in heating source temperature. When the heating temperature is higher than 355 K , all of the particles exit the channel from one outlet; thus, the collecting and accumulating of virus-laden aerosols can be realized. This study provides a potential approach to accelerate the detection of SARS-CoV-2 and avoid a false negative in the following RNA test.
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Affiliation(s)
| | | | - Chengbo Wang
- Department of Electrical and Electronic Engineering, University of Nottingham Ningbo China, Ningbo 315100, China
| | - Zheng Lian
- HiFiBio (Hangzhou) Co., Ltd., Hangzhou 311215, China
| | | | - Yong Ren
- Author to whom correspondence should be addressed:
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Danesh-Meyer HV, McGhee CNJ. Implications of COVID-19 for Ophthalmologists. Am J Ophthalmol 2021; 223:108-118. [PMID: 32976847 PMCID: PMC7506460 DOI: 10.1016/j.ajo.2020.09.027] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Revised: 08/13/2020] [Accepted: 09/15/2020] [Indexed: 01/08/2023]
Abstract
PURPOSE To describe and explain the implications of coronavirus disease 2019 (COVID-19) for ophthalmologists considering the rapid developments in our understanding of the virology, transmission, and ocular involvement. DESIGN Evidence-based perspective. METHODS Review and synthesis of pertinent literature. RESULTS Retrospective studies highlight that <1% of patients display COVID-19-related conjunctivitis. However, prospective studies suggest the rate is higher (~6%). Viral RNA has been identified in tears and conjunctival secretions in patients with active conjunctivitis as well as asymptomatic cases. Overall, conjunctival swabs are positive in 2.5%. Samples taken earlier in the disease course are more likely to demonstrate positive virus. Viral transmission through ocular tissues has not been substantiated. Ophthalmologists are in the high-risk category for COVID-19 infection for several reasons: high-volume clinics, close proximity with patients, equipment-intense clinics, and direct contact with patients' conjunctival mucosal surfaces. COVID-19 is predominantly contracted through direct or airborne transmission by inhalation of respiratory droplets. Evidence that aerosol transmission occurs is increasing in particularly prolonged exposure to high concentrations in a relatively closed environment. Based on the current evidence, ophthalmologists should consider measures that include social distancing, wearing masks, sterilization techniques, and managing clinic volumes. CONCLUSIONS A major challenge to containing COVID-19 is that many infected people are asymptomatic. Droplet spread, contaminated environmental surfaces, and shared medical devices are areas that require management by ophthalmologists. More studies are required to explore the role of the conjunctiva and ocular tissues in the transmission of disease.
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Affiliation(s)
| | - Charles N J McGhee
- Department of Ophthalmology, University of Auckland, Auckland, New Zealand
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71
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Lubrano R, Bloise S, Testa A, Marcellino A, Dilillo A, Mallardo S, Isoldi S, Martucci V, Sanseviero M, Del Giudice E, Malvaso C, Iorfida D, Ventriglia F. Assessment of Respiratory Function in Infants and Young Children Wearing Face Masks During the COVID-19 Pandemic. JAMA Netw Open 2021; 4:e210414. [PMID: 33651109 PMCID: PMC7926283 DOI: 10.1001/jamanetworkopen.2021.0414] [Citation(s) in RCA: 37] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
IMPORTANCE Face masks have been associated with effective prevention of diffusion of viruses via droplets. However, the use of face masks among children, especially those aged younger than 3 years, is debated, and the US Centers for Disease Control and American Academy of Physicians recommend the use of face mask only among individuals aged 3 years or older. OBJECTIVE To examine whether the use of surgical facial masks among children is associated with episodes of oxygen desaturation or respiratory distress. DESIGN, SETTING, AND PARTICIPANTS This cohort study was conducted from May through June 2020 in a secondary-level hospital pediatric unit in Italy. Included participants were 47 healthy children divided by age (ie, group A, aged ≤24 months, and group B, aged >24 months to ≤144 months). Data were analyzed from May through June 2020. INTERVENTIONS All participants were monitored every 15 minutes for changes in respiratory parameters for the first 30 minutes while not wearing a surgical face mask and for the next 30 minutes while wearing a face mask. Children aged 24 months and older then participated in a walking test for 12 minutes. MAIN OUTCOMES AND MEASURES Changes in respiratory parameters during the use of surgical masks were evaluated. RESULTS Among 47 children, 22 children (46.8%) were aged 24 months or younger (ie, group A), with 11 boys (50.0%) and median (interquartile range [IQR]) age 12.5 (10.0-17.5) months, and 25 children (53.2%) were aged older than 24 months to 144 months or younger, with 13 boys (52.0%) and median (IQR) age 100.0 (72.0-120.0) months. During the first 60 minutes of evaluation in the 2 groups, there was no significant change in group A in median (IQR) partial pressure of end-tidal carbon dioxide (Petco2; 33.0 [32.0-34.0] mm Hg; P for Kruskal Wallis = .59), oxygen saturation (Sao2; 98.0% [97.0%-99.0%]; P for Kruskal Wallis = .61), pulse rate (PR; 130.0 [115.0-140.0] pulsations/min; P for Kruskal Wallis = .99), or respiratory rate (RR; 30.0 [28.0-33.0] breaths/min; P for Kruskal Wallis = .69) or for group B in median (IQR) Petco2 (36.0 [34.0-38.0] mm Hg; P for Kruskal Wallis = .97), Sao2 (98.0% [97.0%-98.0%]; P for Kruskal Wallis = .52), PR (96.0 [84.0-104.5] pulsations/min; P for Kruskal Wallis test = .48), or RR (22.0 [20.0-25.0] breaths/min; P for Kruskal Wallis = .55). After the group B walking test, compared with before the walking test, there was a significant increase in median (IQR) PR (96.0 [84.0-104.5] pulsations/min vs 105.0 [100.0-115.0] pulsations/min; P < .02) and RR (22.0 [20.0-25.0] breaths/min vs 26.0 [24.0-29.0] breaths/min; P < .05). CONCLUSIONS AND RELEVANCE This cohort study among infants and young children in Italy found that the use of facial masks was not associated with significant changes in Sao2 or Petco2, including among children aged 24 months and younger.
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Affiliation(s)
- Riccardo Lubrano
- Pediatric and Neonatology Unit, Maternal and Child Department, Sapienza University of Rome, Polo Pontino, Rome Italy
| | - Silvia Bloise
- Pediatric and Neonatology Unit, Maternal and Child Department, Sapienza University of Rome, Polo Pontino, Rome Italy
| | - Alessia Testa
- Pediatric and Neonatology Unit, Maternal and Child Department, Sapienza University of Rome, Polo Pontino, Rome Italy
| | - Alessia Marcellino
- Pediatric and Neonatology Unit, Maternal and Child Department, Sapienza University of Rome, Polo Pontino, Rome Italy
| | - Anna Dilillo
- Pediatric and Neonatology Unit, Maternal and Child Department, Sapienza University of Rome, Polo Pontino, Rome Italy
| | - Saverio Mallardo
- Pediatric and Neonatology Unit, Maternal and Child Department, Sapienza University of Rome, Polo Pontino, Rome Italy
| | - Sara Isoldi
- Pediatric and Neonatology Unit, Maternal and Child Department, Sapienza University of Rome, Polo Pontino, Rome Italy
| | - Vanessa Martucci
- Pediatric and Neonatology Unit, Maternal and Child Department, Sapienza University of Rome, Polo Pontino, Rome Italy
| | - Maria Sanseviero
- Pediatric and Neonatology Unit, Maternal and Child Department, Sapienza University of Rome, Polo Pontino, Rome Italy
| | - Emanuela Del Giudice
- Pediatric and Neonatology Unit, Maternal and Child Department, Sapienza University of Rome, Polo Pontino, Rome Italy
| | - Concetta Malvaso
- Pediatric and Neonatology Unit, Maternal and Child Department, Sapienza University of Rome, Polo Pontino, Rome Italy
| | - Donatella Iorfida
- Pediatric and Neonatology Unit, Maternal and Child Department, Sapienza University of Rome, Polo Pontino, Rome Italy
| | - Flavia Ventriglia
- Pediatric and Neonatology Unit, Maternal and Child Department, Sapienza University of Rome, Polo Pontino, Rome Italy
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Mortazavi H, Beni HM, Aghaei F, Sajadian SH. SARS-CoV-2 droplet deposition path and its effects on the human upper airway in the oral inhalation. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2021; 200:105843. [PMID: 33223278 PMCID: PMC7666874 DOI: 10.1016/j.cmpb.2020.105843] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/08/2020] [Accepted: 11/11/2020] [Indexed: 05/07/2023]
Abstract
BACKGROUND AND OBJECTIVE It is crucial to study the uptake of viral droplets in the human respiratory system to control, prevent, and treat diseases. METHODS In this study, a well-verified real anatomical model was used; the passage of air in the human upper respiratory system computed using high-quality Computer Tomography (CT) images. Then, the airflow field, along with the coronavirus micro-droplets injection, was examined in this realistic model using the Fluid-Structure Interaction (FSI) method. The Discrete Phase Model (DPM) was used to solve the field, and with the help of it, the accurate assessment of the temporal and spatial motion of the deposition in the virus-impregnated droplets was obtained in vitro in the upper respiratory system. RESULTS The results show that the amount of deposited micro-droplets in the nasal cavity area is meager at the inhalation only through the oral. However, it has the most residence time in this area. The most and least droplet absorption occurred in the oral cavity and larynx-trachea, respectively. Deposition efficiency is about 100% in 30 L/min flow rate and 10 μm diameter; in other words, no droplet enters the lungs. This study's other achievements include the relatively inverse relationship between droplets deposition efficiency in some parts of the upper airway, which have the most deformation in the tract. CONCLUSIONS Utilization of a realistic model with accurate and precise computational analysis can end speculation about the deposition zone, accumulation, and the effects of the COVID-19 virus on the upper respiratory tract. On the other hand, recognizing the virus-containing droplet location can ease understanding the areas where the virus can first infect in the upper respiratory tract.
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Affiliation(s)
- Hamed Mortazavi
- Department of Biomedical Engineering, Arsanjan Branch, Islamic Azad University, Arsanjan, Iran
| | | | - Fatemeh Aghaei
- Department of Immunology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Seyed Hossein Sajadian
- Department of Biomedical Engineering, Arsanjan Branch, Islamic Azad University, Arsanjan, Iran
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Mortazavy Beni H, Mortazavi H, Aghaei F, Kamalipour S. Experimental tracking and numerical mapping of novel coronavirus micro-droplet deposition through nasal inhalation in the human respiratory system. Biomech Model Mechanobiol 2021; 20:1087-1100. [PMID: 33646442 PMCID: PMC7919632 DOI: 10.1007/s10237-021-01434-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2020] [Accepted: 02/10/2021] [Indexed: 01/15/2023]
Abstract
It is essential to study the viral droplet’s uptake in the human respiratory system to better control, prevent, and treat diseases. Micro-droplets can easily pass through ordinary respiratory masks. Therefore, the SARS-COV-2 transmit easily in conversation with a regular mask with 'silent spreaders' in the most physiological way of breathing through the nose, indoor and at rest condition. The results showed that the amount of deposited micro-droplets in the olfactory epithelium area is low. Also, due to receptors and long droplet residence time in this region, the possibility of absorption increases in the cribriform plate. This phenomenon eventually could lead to brain lesion damage and, in some cases, leads to stroke. In all inlet flow rates lower than 30 L/min inlet boundary conditions, the average percentage of viral contamination for upper respiratory tract is always less than 50% and more than 50% for the lungs. At 6L/min and 15L/min flow rates, the average percentage of lung contamination increases to more than 87%, which due to the presence of the Coronavirus receptor in the lungs, the involvement of the lungs increases significantly. This study's other achievements include the inverse relationship between droplets deposition efficiency in some parts of the upper airway, which have the most deformation in the tract. Also, the increased deformities per minute applied to the trachea and nasal cavity, which is 1.5 times more than usual, could lead to chest and head bothers.
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Affiliation(s)
| | - Hamed Mortazavi
- Department of Biomedical Engineering, Arsanjan Branch, Islamic Azad University, Arsanjan, Iran
| | - Fatemeh Aghaei
- Department of Immunology, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Sanam Kamalipour
- Department of Biomedical Engineering, Arsanjan Branch, Islamic Azad University, Arsanjan, Iran
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Komperda J, Peyvan A, Li D, Kashir B, Yarin AL, Megaridis CM, Mirbod P, Paprotny I, Cooper LF, Rowan S, Stanford C, Mashayek F. Computer simulation of the SARS-CoV-2 contamination risk in a large dental clinic. PHYSICS OF FLUIDS (WOODBURY, N.Y. : 1994) 2021; 33:033328. [PMID: 33897241 PMCID: PMC8060974 DOI: 10.1063/5.0043934] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 02/16/2021] [Indexed: 05/18/2023]
Abstract
COVID-19, caused by the SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) virus, has been rapidly spreading worldwide since December 2019, causing a public health crisis. Recent studies showed SARS-CoV-2's ability to infect humans via airborne routes. These motivated the study of aerosol and airborne droplet transmission in a variety of settings. This study performs a large-scale numerical simulation of a real-world dentistry clinic that contains aerosol-generating procedures. The simulation tracks the dispersion of evaporating droplets emitted during ultrasonic dental scaling procedures. The simulation considers 25 patient treatment cubicles in an open plan dentistry clinic. The droplets are modeled as having a volatile (evaporating) and nonvolatile fraction composed of virions, saliva, and impurities from the irrigant water supply. The simulated clinic's boundary and flow conditions are validated against experimental measurements of the real clinic. The results evaluate the behavior of large droplets and aerosols. We investigate droplet residence time and travel distance for different droplet diameters, surface contamination due to droplet settling and deposition, airborne aerosol mass concentration, and the quantity of droplets that escape through ventilation. The simulation results raise concerns due to the aerosols' long residence times (averaging up to 7.31 min) and travel distances (averaging up to 24.45 m) that exceed social distancing guidelines. Finally, the results show that contamination extends beyond the immediate patient treatment areas, requiring additional surface disinfection in the clinic. The results presented in this research may be used to establish safer dental clinic operating procedures, especially if paired with future supplementary material concerning the aerosol viral load generated by ultrasonic scaling and the viral load thresholds required to infect humans.
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Affiliation(s)
- Jonathan Komperda
- Department of Mechanical and Industrial Engineering, University of Illinois at Chicago, Chicago, Illinois 60607, USA
| | - Ahmad Peyvan
- Department of Mechanical and Industrial Engineering, University of Illinois at Chicago, Chicago, Illinois 60607, USA
| | - Dongru Li
- Department of Mechanical and Industrial Engineering, University of Illinois at Chicago, Chicago, Illinois 60607, USA
| | - Babak Kashir
- Department of Mechanical and Industrial Engineering, University of Illinois at Chicago, Chicago, Illinois 60607, USA
| | - Alexander L. Yarin
- Department of Mechanical and Industrial Engineering, University of Illinois at Chicago, Chicago, Illinois 60607, USA
| | - Constantine M. Megaridis
- Department of Mechanical and Industrial Engineering, University of Illinois at Chicago, Chicago, Illinois 60607, USA
| | - Parisa Mirbod
- Department of Mechanical and Industrial Engineering, University of Illinois at Chicago, Chicago, Illinois 60607, USA
| | - Igor Paprotny
- Department of Electrical and Computer Engineering, University of Illinois at Chicago, Chicago, Illinois 60607, USA
| | - Lyndon F. Cooper
- College of Dentistry, University of Illinois at Chicago, Chicago, Illinois 60612, USA
| | - Susan Rowan
- College of Dentistry, University of Illinois at Chicago, Chicago, Illinois 60612, USA
| | - Clark Stanford
- College of Dentistry, University of Illinois at Chicago, Chicago, Illinois 60612, USA
| | - Farzad Mashayek
- Department of Mechanical and Industrial Engineering, University of Illinois at Chicago, Chicago, Illinois 60607, USA
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75
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Splatters and Aerosols Contamination in Dental Aerosol Generating Procedures. APPLIED SCIENCES-BASEL 2021. [DOI: 10.3390/app11041914] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Dental aerosol-generating procedures produce a large amount of splatters and aerosols that create a major concern for airborne disease transmission, such as COVID-19. This study established a method to visualise splatter and aerosol contamination by common dental instrumentation, namely ultrasonic scaling, air-water spray, high-speed and low-speed handpieces. Mock dental procedures were performed on a mannequin model, containing teeth in a typodont and a phantom head, using irrigation water containing fluorescein dye as a tracer. Filter papers were placed in 10 different locations to collect splatters and aerosols, at distances ranging from 20 to 120 cm from the source. All four types of dental equipment produced contamination from splatters and aerosols. At 120 cm away from the source, the high-speed handpiece generated the greatest amount and size (656 ± 551 μm) of splatter particles, while the triplex syringe generated the largest amount of aerosols (particle size: 1.73 ± 2.23 μm). Of note, the low-speed handpiece produced the least amount and size (260 ± 142 μm) of splatter particles and the least amount of aerosols (particle size: 4.47 ± 5.92 μm) at 120 cm. All four dental AGPs produce contamination from droplets and aerosols, with different patterns of distribution. This simple model provides a method to test various preventive strategies to reduce risks from splatter and aerosols.
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76
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Tada H, Takamura M, Kawashiri MA. Familial Hypercholesterolemia: A Narrative Review on Diagnosis and Management Strategies for Children and Adolescents. Vasc Health Risk Manag 2021; 17:59-67. [PMID: 33628029 PMCID: PMC7898200 DOI: 10.2147/vhrm.s266249] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2020] [Accepted: 01/28/2021] [Indexed: 12/20/2022] Open
Abstract
Familial hypercholesterolemia (FH) is a relatively common inherited disorder caused by deleterious mutation(s) in the low-density lipoprotein (LDL) receptor or its associated genes. Given its nature as a heritable disease, any useful screening scheme, including universal, and cascade screening, allows for the early identification of patients with FH. Another important aspect to note is that early diagnosis associated with appropriate treatment can promote better prognosis. However, most clinical diagnostic criteria for adults have adopted clinical elements, such as physical xanthomas and family history, both of which are usually obscure and/or difficult to obtain in children and adolescents. Moreover, LDL cholesterol levels fluctuating considerably during adolescence, hindering the timely diagnosis of FH. In addition, recent advancements in human genetics have revealed several types of FH, including conventional monogenic FH, polygenic FH caused by common single nucleotide variations (SNV) accumulation associated with elevated LDL cholesterol, and oligogenic FH with multiple deleterious genetic variations leading to substantially elevated LDL cholesterol. The aforementioned findings collectively suggest the need for amassing information related to genetics and imaging, in addition to classical clinical elements, for the accurate diagnosis of FH in this era of personalized medicine. The current narrative review summarizes the current status of the clinical and genetic diagnosis of FH in children and adolescents, as well as provide useful management strategies for FH in children and adolescents based on currently available clinical evidence.
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Affiliation(s)
- Hayato Tada
- Department of Cardiology, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - Masayuki Takamura
- Department of Cardiology, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
| | - Masa-Aki Kawashiri
- Department of Cardiology, Kanazawa University Graduate School of Medicine, Kanazawa, Japan
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77
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Sussman RA, Golberstein E, Polosa R. Aerial Transmission of the SARS-CoV-2 Virus through Environmental E-Cigarette Aerosols: Implications for Public Policies. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:1437. [PMID: 33546515 PMCID: PMC7913611 DOI: 10.3390/ijerph18041437] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 01/27/2021] [Accepted: 01/29/2021] [Indexed: 12/15/2022]
Abstract
We discuss the implications of possible contagion of COVID-19 through e-cigarette aerosol (ECA) for prevention and mitigation strategies during the current pandemic. This is a relevant issue when millions of vapers (and smokers) must remain under indoor confinement and/or share public outdoor spaces with non-users. The fact that the respiratory flow associated with vaping is visible (as opposed to other respiratory activities) clearly delineates a safety distance of 1-2 m along the exhaled jet to prevent direct exposure. Vaping is a relatively infrequent and intermittent respiratory activity for which we infer a mean emission rate of 79.82 droplets per puff (6-200, standard deviation 74.66) comparable to mouth breathing, it adds into shared indoor spaces (home and restaurant scenarios) a 1% extra risk of indirect COVID-19 contagion with respect to a "control case" of existing unavoidable risk from continuous breathing. As a comparative reference, this added relative risk increases to 44-176% for speaking 6-24 min per hour and 260% for coughing every 2 min. Mechanical ventilation decreases absolute emission levels but keeps the same relative risks. As long as direct exposure to the visible exhaled jet is avoided, wearing of face masks effectively protects bystanders and keeps risk estimates very low. As a consequence, protection from possible COVID-19 contagion through vaping emissions does not require extra interventions besides the standard recommendations to the general population: keeping a social separation distance of 2 m and wearing of face masks.
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Affiliation(s)
- Roberto A. Sussman
- Institute of Nuclear Sciences, National Autonomous University of Mexico, 04510 Mexico City, Mexico
| | | | - Riccardo Polosa
- Center of Excellence for the Acceleration of Harm Reduction (CoEHAR), University of Catania, 95123 Catania, Italy;
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78
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Rando HM, MacLean AL, Lee AJ, Lordan R, Ray S, Bansal V, Skelly AN, Sell E, Dziak JJ, Shinholster L, McGowan LD, Guebila MB, Wellhausen N, Knyazev S, Boca SM, Capone S, Qi Y, Park Y, Sun Y, Mai D, Boerckel JD, Brueffer C, Byrd JB, Kamil JP, Wang J, Velazquez R, Szeto GL, Barton JP, Goel RR, Mangul S, Lubiana T, Gitter A, Greene CS. Pathogenesis, Symptomatology, and Transmission of SARS-CoV-2 through Analysis of Viral Genomics and Structure. ARXIV 2021:arXiv:2102.01521v4. [PMID: 33594340 PMCID: PMC7885912] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Revised: 12/03/2021] [Indexed: 12/02/2022]
Abstract
The novel coronavirus SARS-CoV-2, which emerged in late 2019, has since spread around the world and infected hundreds of millions of people with coronavirus disease 2019 (COVID-19). While this viral species was unknown prior to January 2020, its similarity to other coronaviruses that infect humans has allowed for rapid insight into the mechanisms that it uses to infect human hosts, as well as the ways in which the human immune system can respond. Here, we contextualize SARS-CoV-2 among other coronaviruses and identify what is known and what can be inferred about its behavior once inside a human host. Because the genomic content of coronaviruses, which specifies the virus's structure, is highly conserved, early genomic analysis provided a significant head start in predicting viral pathogenesis and in understanding potential differences among variants. The pathogenesis of the virus offers insights into symptomatology, transmission, and individual susceptibility. Additionally, prior research into interactions between the human immune system and coronaviruses has identified how these viruses can evade the immune system's protective mechanisms. We also explore systems-level research into the regulatory and proteomic effects of SARS-CoV-2 infection and the immune response. Understanding the structure and behavior of the virus serves to contextualize the many facets of the COVID-19 pandemic and can influence efforts to control the virus and treat the disease.
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Affiliation(s)
- Halie M Rando
- Department of Systems Pharmacology and Translational Therapeutics, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America; Department of Biochemistry and Molecular Genetics, University of Colorado School of Medicine, Aurora, Colorado, United States of America; Center for Health AI, University of Colorado School of Medicine, Aurora, Colorado, United States of America · Funded by the Gordon and Betty Moore Foundation (GBMF 4552); the National Human Genome Research Institute (R01 HG010067)
| | - Adam L MacLean
- Department of Quantitative and Computational Biology, University of Southern California, Los Angeles, California, United States of America
| | - Alexandra J Lee
- Department of Systems Pharmacology and Translational Therapeutics, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America · Funded by the Gordon and Betty Moore Foundation (GBMF 4552)
| | - Ronan Lordan
- Institute for Translational Medicine and Therapeutics, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA 19104-5158, USA
| | - Sandipan Ray
- Department of Biotechnology, Indian Institute of Technology Hyderabad, Kandi, Sangareddy 502285, Telangana, India
| | - Vikas Bansal
- Biomedical Data Science and Machine Learning Group, German Center for Neurodegenerative Diseases, Tübingen 72076, Germany
| | - Ashwin N Skelly
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America; Institute for Immunology, University of Pennsylvania Perelman School of Medicine, Philadelphia, United States of America · Funded by NIH Medical Scientist Training Program T32 GM07170
| | - Elizabeth Sell
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - John J Dziak
- Edna Bennett Pierce Prevention Research Center, The Pennsylvania State University, University Park, PA, United States of America
| | - Lamonica Shinholster
- Mercer University, Macon, GA, United States of America · Funded by the Center for Global Genomics and Health Equity at the University of Pennsylvania
| | - Lucy D'Agostino McGowan
- Department of Mathematics and Statistics, Wake Forest University, Winston-Salem, North Carolina, United States of America
| | - Marouen Ben Guebila
- Department of Biostatistics, Harvard School of Public Health, Boston, Massachusetts, United States of America
| | - Nils Wellhausen
- Department of Systems Pharmacology and Translational Therapeutics, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | - Sergey Knyazev
- Georgia State University, Atlanta, GA, United States of America
| | - Simina M Boca
- Innovation Center for Biomedical Informatics, Georgetown University Medical Center, Washington, District of Columbia, United States of America
| | - Stephen Capone
- St. George's University School of Medicine, St. George's, Grenada
| | - Yanjun Qi
- Department of Computer Science, University of Virginia, Charlottesville, VA, United States of America
| | - YoSon Park
- Department of Systems Pharmacology and Translational Therapeutics, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America · Funded by NHGRI R01 HG10067
| | - Yuchen Sun
- Department of Computer Science, University of Virginia, Charlottesville, VA, United States of America
| | - David Mai
- Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, USA
| | - Joel D Boerckel
- Department of Orthopaedic Surgery, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA, United States of America; Department of Bioengineering, University of Pennsylvania, Philadelphia, PA, United States of America
| | | | - James Brian Byrd
- University of Michigan School of Medicine, Ann Arbor, Michigan, United States of America · Funded by NIH K23HL128909; FastGrants
| | - Jeremy P Kamil
- Department of Microbiology and Immunology, Louisiana State University Health Sciences Center Shreveport, Shreveport, Louisiana, USA
| | - Jinhui Wang
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America
| | | | - Gregory L Szeto
- Allen Institute for Immunology, Seattle, WA, United States of America
| | - John P Barton
- Department of Physics and Astronomy, University of California-Riverside, Riverside, California, United States of America
| | - Rishi Raj Goel
- Institute for Immunology, University of Pennsylvania, Philadelphia, PA, United States of America
| | - Serghei Mangul
- Department of Clinical Pharmacy, School of Pharmacy, University of Southern California, Los Angeles, CA, United States of America
| | - Tiago Lubiana
- Department of Clinical and Toxicological Analyses, School of Pharmaceutical Sciences, University of São Paulo, São Paulo, Brazil
| | - Anthony Gitter
- Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison, Madison, Wisconsin, United States of America; Morgridge Institute for Research, Madison, Wisconsin, United States of America · Funded by John W. and Jeanne M. Rowe Center for Research in Virology
| | - Casey S Greene
- Department of Systems Pharmacology and Translational Therapeutics, University of Pennsylvania, Philadelphia, Pennsylvania, United States of America; Childhood Cancer Data Lab, Alex's Lemonade Stand Foundation, Philadelphia, Pennsylvania, United States of America; Department of Biochemistry and Molecular Genetics, University of Colorado School of Medicine, Aurora, Colorado, United States of America; Center for Health AI, University of Colorado School of Medicine, Aurora, Colorado, United States of America · Funded by the Gordon and Betty Moore Foundation (GBMF 4552); the National Human Genome Research Institute (R01 HG010067)
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79
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Liao M, Liu H, Wang X, Hu X, Huang Y, Liu X, Brenan K, Mecha J, Nirmalan M, Lu JR. A technical review of face mask wearing in preventing respiratory COVID-19 transmission. Curr Opin Colloid Interface Sci 2021; 52:101417. [PMID: 33642918 PMCID: PMC7902177 DOI: 10.1016/j.cocis.2021.101417] [Citation(s) in RCA: 86] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Since the outbreak of the COVID-19 pandemic, most countries have recommended their citizens to adopt social distance, hand hygiene, and face mask wearing. However, wearing face masks has not been well adopted by many citizens. While the reasons are complex, there is a general perception that the evidence to support face mask wearing is lacking, especially for the general public in a community setting. Face mask wearing can block or filter airborne virus-carrying particles through the working of colloid and interface science. This paper assesses current knowledge behind the design and functioning of face masks by reviewing the selection of materials, mask specifications, relevant laboratory tests, and respiratory virus transmission trials, with an overview of future development of reusable masks for the general public. This review highlights the effectiveness of face mask wearing in the prevention of COVID-19 infection.
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Affiliation(s)
- Mingrui Liao
- Biological Physics Group, Department of Physics and Astronomy, School of Natural Sciences, The University of Manchester, Oxford Road, Manchester M13 9PL, UK
| | - Huayang Liu
- Biological Physics Group, Department of Physics and Astronomy, School of Natural Sciences, The University of Manchester, Oxford Road, Manchester M13 9PL, UK
| | - Xi Wang
- Textile Technology Group, Department of Materials, School of Natural Sciences, The University of Manchester, Oxford Road, Manchester M13 9PL, UK
| | - Xuzhi Hu
- Biological Physics Group, Department of Physics and Astronomy, School of Natural Sciences, The University of Manchester, Oxford Road, Manchester M13 9PL, UK
| | - Yuhao Huang
- Textile Technology Group, Department of Materials, School of Natural Sciences, The University of Manchester, Oxford Road, Manchester M13 9PL, UK
| | - Xuqing Liu
- Textile Technology Group, Department of Materials, School of Natural Sciences, The University of Manchester, Oxford Road, Manchester M13 9PL, UK
| | - Keith Brenan
- Division of Cancer Studies, School of Biological Sciences, The University of Manchester, Oxford Road, Manchester M13 9PL, UK
| | - Jared Mecha
- School of Medicine, University of Nairobi, Nairobi, Kenya
| | - Mahesan Nirmalan
- Division of Medical Education,School of Medical Sciences, The University of Manchester, Oxford Road, Manchester M13 9PL, UK
| | - Jian Ren Lu
- Biological Physics Group, Department of Physics and Astronomy, School of Natural Sciences, The University of Manchester, Oxford Road, Manchester M13 9PL, UK
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80
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Kamar A, Khalil A, Nemer G. The Digenic Causality in Familial Hypercholesterolemia: Revising the Genotype-Phenotype Correlations of the Disease. Front Genet 2021; 11:572045. [PMID: 33519890 PMCID: PMC7844333 DOI: 10.3389/fgene.2020.572045] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Accepted: 12/01/2020] [Indexed: 12/20/2022] Open
Abstract
Genetically inherited defects in lipoprotein metabolism affect more than 10 million individuals around the globe with preponderance in some parts where consanguinity played a major role in establishing founder mutations. Mutations in four genes have been so far linked to the dominant and recessive form of the disease. Those players encode major proteins implicated in cholesterol regulation, namely, the low-density lipoprotein receptor (LDLR) and its associate protein 1 (LDLRAP1), the proprotein convertase substilin/kexin type 9 (PCSK9), and the apolipoprotein B (APOB). Single mutations or compound mutations in one of these genes are enough to account for a spectrum of mild to severe phenotypes. However, recently several reports have identified digenic mutations in familial cases that do not necessarily reflect a much severe phenotype. Yet, data in the literature supporting this notion are still lacking. Herein, we review all the reported cases of digenic mutations focusing on the biological impact of gene dosage and the potential protective effects of single-nucleotide polymorphisms linked to hypolipidemia. We also highlight the difficulty of establishing phenotype-genotype correlations in digenic familial hypercholesterolemia cases due to the complexity and heterogeneity of the phenotypes and the still faulty in silico pathogenicity scoring system. We finally emphasize the importance of having a whole exome/genome sequencing approach for all familial cases of familial hyperlipidemia to better understand the genetic and clinical course of the disease.
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Affiliation(s)
- Amina Kamar
- Department of Biology, American University of Beirut, Beirut, Lebanon
| | - Athar Khalil
- Department of Biochemistry and Molecular Genetics, American University of Beirut, Beirut, Lebanon
| | - Georges Nemer
- Department of Biochemistry and Molecular Genetics, American University of Beirut, Beirut, Lebanon
- Division of Genomics and Translational Biomedicine, College of Health and Life Sciences, Hamad Bin Khalifa University, Doha, Qatar
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81
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Li Y. Basic routes of transmission of respiratory pathogens-A new proposal for transmission categorization based on respiratory spray, inhalation, and touch. INDOOR AIR 2021; 31:3-6. [PMID: 33474779 PMCID: PMC8013452 DOI: 10.1111/ina.12786] [Citation(s) in RCA: 30] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2020] [Revised: 11/26/2020] [Accepted: 12/15/2020] [Indexed: 05/05/2023]
Affiliation(s)
- Yuguo Li
- University of Hong KongHong KongHong Kong
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82
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Jacob S, Nithianandam S, Rastogi S, Sakhuja S, Sri Laxma Alankar SN. Handling and treatment strategies of biomedical wastes and biosolids contaminated with SARS-CoV-2 in waste environment. ENVIRONMENTAL AND HEALTH MANAGEMENT OF NOVEL CORONAVIRUS DISEASE (COVID-19 ) 2021. [PMCID: PMC8237404 DOI: 10.1016/b978-0-323-85780-2.00012-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
The biomedical waste (BW) generated by hospitals and other health care facilities such as quarantine homes and isolation wards are exponentially increasing amid the COVID-19 pandemic. This has evoked a major challenge for governments worldwide to cope with the increasing demands of waste disposal with limited facilities. Each and every hospital has its own way of managing the waste generated, however, due to the COVID-19 pandemic, there is an intense pressure on health care workers to employ speedy and effective management techniques for the disposal of highly contagious SARS-CoV-2-contaminated BW. The study of survival rates of SARS-CoV-2 on various surfaces such as plastics (2–3 days), clothes (7 days), and wood (<24 h) has helped to deploy various disinfection processes such as treatment of contaminated surfaces with 70% ethanol and 0.05% sodium hypochlorite. Additionally, various effective waste processing procedures such as incineration and autoclaving for the disposal of infected masks, personal protective equipment (PPE) kits, towels, and tissues have been recommended. This chapter is focused on the detailed discussion on the characteristics and classification of wastes generated from health care sectors and management strategies with an emphasis on COVID-19.
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83
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Liu T, Guo Y, Hao X, Wang M, He S, Lin Z, Zhou R. Evaluation of an innovative pediatric isolation (PI) bed using fluid dynamics simulation and aerosol isolation efficacy. BUILDING SIMULATION 2021; 14:1543-1552. [PMID: 33686353 PMCID: PMC7929910 DOI: 10.1007/s12273-021-0761-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 12/11/2020] [Accepted: 12/21/2020] [Indexed: 05/05/2023]
Abstract
Airborne transmission is an important mechanism of spread for both viruses and bacteria in hospitals, with nosocomial infections putting a great burden on public health. In this study, we designed and manufactured a bed for pediatric clinic consultation rooms providing air isolation to protect patients and medical personnel from pathogen transmission. The pediatric isolation bed has several primary efficiency filters and a high-efficiency particulate air filter in the bedside unit. The air circulation between inlet and outlet forms negative pressure to remove the patient's exhaled air timeously and effectively. A computational fluid dynamics model was used to calculate the speed of the airflow and the angle of sampler. Following this, we conducted purification experiments using cigarette smoke, Staphylococcus albus (S. albus) and human adenovirus type 5 (HAdV-5) to demonstrate the isolation efficacy. The results showed that the patient's head should be placed as close to the air inlet hood as possible, and an air intake wind speed of 0.86 m/s was effective. The isolation efficacy of the pediatric isolation bed was demonstrated by computational fluid dynamics technology. The isolation efficiency against cigarette smoke exceeded 91.8%, and against S. albus was greater than 99.8%, while the isolation efficiency against HAdV-5 was 100%. The pediatric isolation bed could be used where isolation wards are unavailable, such as in intensive care units and primary clinical settings, to control hospital acquired infections.
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Affiliation(s)
- Tiantian Liu
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, Guangdong, 510310 China
| | - Yubing Guo
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Xiaotang Hao
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, Guangdong, 510310 China
| | - Mei Wang
- School of Public Health, Guangdong Pharmaceutical University, Guangzhou, Guangdong, 510310 China
| | - Shicong He
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Zhengshi Lin
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
| | - Rong Zhou
- State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, First Affiliated Hospital of Guangzhou Medical University, Guangzhou Medical University, Guangzhou, China
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84
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Ascione F, De Masi RF, Mastellone M, Vanoli GP. The design of safe classrooms of educational buildings for facing contagions and transmission of diseases: A novel approach combining audits, calibrated energy models, building performance (BPS) and computational fluid dynamic (CFD) simulations. ENERGY AND BUILDINGS 2021; 230:110533. [PMID: 33052169 PMCID: PMC7543903 DOI: 10.1016/j.enbuild.2020.110533] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 09/28/2020] [Accepted: 10/03/2020] [Indexed: 05/05/2023]
Abstract
The proposed investigation is aimed at providing useful suggestions and guidelines for the renovation of educational buildings, in order to do University classrooms safe and sustainable indoor places, with respect to the 2020 SARS-CoV-2 global pandemic. Classrooms and common spaces have to be thought again, for a new "in-presence" life, after the recent worldwide emergency following the spring 2020 pandemic diffusion of COVID-19. In this paper, starting from a real case study, and thus the architectural and technological refurbishment of an Italian University building (Campobasso, South Italy, cold climate), with the aims of improving the classrooms' quality and safety, a comprehensive approach for the retrofit design is proposed. By taking into account the necessary come back to classrooms starting, hopefully, from the next months (Autumn 2020), experimental studies (monitoring and investigations of the current energy performances) are followed by the coupling of different numerical methods of investigations, and thus building performance simulations, under transient conditions of heat transfer, and computational fluid dynamics studies, to evidence criticalities and potentialities to designers involved in the re-thinking of indoor spaces hosting multiple persons, with quite high occupancy patterns. Both energy impacts, in terms of monthly and annual increase of energy demands due to higher mechanical ventilation, and indoor distribution of microclimatic parameters (i.e., temperature, airspeed, age of air) are here investigated, by proposing new scenarios and evidencing the usefulness of HVAC systems, equipment (e.g., sensible heat recovery, without flows' contamination) and suitability of some strategies for the air distribution systems (ceiling squared and linear slot diffusers) compared to traditional ones.
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Affiliation(s)
- Fabrizio Ascione
- Università degli Studi di Napoli Federico II, Department of Industrial Engineering, Piazzale Tecchio 80, 80125 Napoli, Italy
| | - Rosa Francesca De Masi
- Università degli Studi del Sannio, Department of Engineering, Piazza Roma 21, 82100 Benevento, Italy
| | - Margherita Mastellone
- Università degli Studi di Napoli Federico II, Department of Industrial Engineering, Piazzale Tecchio 80, 80125 Napoli, Italy
| | - Giuseppe Peter Vanoli
- Università degli Studi del Molise, Department of Medicine and Health Sciences Vincenzo Tiberio, Via Gazzani 47, 86100 Campobasso, Italy
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85
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Guidelines for infection control and prevention in anaesthesia in South Africa. SOUTHERN AFRICAN JOURNAL OF ANAESTHESIA AND ANALGESIA 2021. [DOI: 10.36303/sajaa.2021.27.4.s1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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86
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A review of deciphering the successes and learning from the failures in preventive and health policies to stop the COVID-19 pandemic. ENVIRONMENTAL AND HEALTH MANAGEMENT OF NOVEL CORONAVIRUS DISEASE (COVID-19 ) 2021. [PMCID: PMC8237401 DOI: 10.1016/b978-0-323-85780-2.00003-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Since the onset of the COVID-19 pandemic, some countries have had successful experiences as well as failures. Countries have taken significant and different approaches to reducing the spread of COVID-19. This chapter states the soft method and herd immunity policy of some European countries (e.g., Sweden) in the early days of the epidemic, which failed. Most countries (e.g., Italy) that enacted a mandatory lockdown during the epidemic soon realized that this trend should not continue for longer periods because of side effects, namely social and economic troubles. Some other countries (e.g., Germany) imposed a social distancing of two meters in public places, which have been effective in reducing infection. Nowadays, reports indicate that some Asian countries have had more success than most European and American countries in taking containment measures. Hong Kong and Singapore are among the most successful countries in the world since the beginning of the pandemic, while the United States and Brazil are among the countries that have handled the development of the pandemic worst. Wearing a face mask in combination with social distancing is effective around 50% of the time. However, a complete combination of the following contention policies must be carried out by all countries, always considering the political, social, and above all, economic characteristics of each of them: (1) use face masks in public places, (2) keep suitable physical distancing, (3) extremely thorough hand hygiene, and (4) isolate all infected people. This should also include improving the ventilation in enclosed environments, designing safe routes in public and particular business locations, together with cleaning and disinfection activities.
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87
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Abstract
Human respiratory virus infections lead to a spectrum of respiratory symptoms and disease severity, contributing to substantial morbidity, mortality and economic losses worldwide, as seen in the COVID-19 pandemic. Belonging to diverse families, respiratory viruses differ in how easy they spread (transmissibility) and the mechanism (modes) of transmission. Transmissibility as estimated by the basic reproduction number (R0) or secondary attack rate is heterogeneous for the same virus. Respiratory viruses can be transmitted via four major modes of transmission: direct (physical) contact, indirect contact (fomite), (large) droplets and (fine) aerosols. We know little about the relative contribution of each mode to the transmission of a particular virus in different settings, and how its variation affects transmissibility and transmission dynamics. Discussion on the particle size threshold between droplets and aerosols and the importance of aerosol transmission for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and influenza virus is ongoing. Mechanistic evidence supports the efficacies of non-pharmaceutical interventions with regard to virus reduction; however, more data are needed on their effectiveness in reducing transmission. Understanding the relative contribution of different modes to transmission is crucial to inform the effectiveness of non-pharmaceutical interventions in the population. Intervening against multiple modes of transmission should be more effective than acting on a single mode.
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Affiliation(s)
- Nancy H. L. Leung
- grid.194645.b0000000121742757WHO Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong Special Administrative Region, China
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Zhang R, Xu Q, Bai S, Hai J, Cheng L, Xu G, Qin Y. Enhancing the filtration efficiency and wearing time of disposable surgical masks using TENG technology. NANO ENERGY 2021; 79:105434. [PMID: 33042770 PMCID: PMC7534667 DOI: 10.1016/j.nanoen.2020.105434] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/18/2020] [Revised: 09/23/2020] [Accepted: 09/24/2020] [Indexed: 05/17/2023]
Abstract
The COVID-19 pandemic has caused an unprecedented human and health crisis. And the shortage of protective equipment, especially the personal protective disposable surgical masks, has been a great challenge. Here, we developed an effective and simple scheme to prolong the lifetime of disposable surgical masks without changing their current structure, which is beneficial to solve the shortage of personal masks. After electrifying the meltblown PP filter by the new-developed single-electrode-based sliding triboelectric nanogenerator (TENG) charge replenishment (NGCR) technology, the processed filter is bipolar charged and has a filtration efficiency beyond 95% for the particulate matter (PM) ranging from PM0.3 to PM10.0. Further, we demonstrate the 80 °C dry heating is an effective decontamination method. This method is compatible with single-electrode-based sliding TENG charge replenishment technology. The 80 °C dry heating and the NGCR technology can make up an effective regeneration procedure for the mask. Even after ten cycles of simulated 4 h wearing process and such regeneration procedure, the filtration efficiency of the disposable surgical masks PM0.3 is still higher than 95%.
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Affiliation(s)
- Ruichao Zhang
- Insitute of Nanoscience and Nanotechnology, School of Physical Science and Technology, Lanzhou University, Lanzhou 730000, China
| | - Qi Xu
- School of Advanced Materials and Nanotechnology, Xidian University, Xi'an 710071, China
| | - Suo Bai
- Insitute of Nanoscience and Nanotechnology, School of Physical Science and Technology, Lanzhou University, Lanzhou 730000, China
| | - Jun Hai
- State Key Laboratory of Applied Organic Chemistry Lanzhou University and Key Laboratory of Nonferrous Metal Chemistry and Resources Utilization of Gansu Province, Lanzhou University, Lanzhou 730000, China
| | - Li Cheng
- Insitute of Nanoscience and Nanotechnology, School of Physical Science and Technology, Lanzhou University, Lanzhou 730000, China
| | - Guoqiang Xu
- State Key Laboratory of Applied Organic Chemistry Lanzhou University and Key Laboratory of Nonferrous Metal Chemistry and Resources Utilization of Gansu Province, Lanzhou University, Lanzhou 730000, China
| | - Yong Qin
- Insitute of Nanoscience and Nanotechnology, School of Physical Science and Technology, Lanzhou University, Lanzhou 730000, China
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89
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Zia H, Singh R, Seth M, Ahmed A, Azim A. Engineering Solutions for Preventing Airborne Transmission in Hospitals with Resource Limitation and Demand Surge. Indian J Crit Care Med 2021; 25:453-460. [PMID: 34045813 PMCID: PMC8138644 DOI: 10.5005/jp-journals-10071-23792] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Among the various strategies for the prevention of airborne transmission, engineering measures are placed high in the hierarchy of control. Modern hospitals in high-income countries have mechanical systems of building ventilation also called HVAC (heating, ventilation, and air-conditioning) but installation and maintenance of such systems is a challenging and resource-intensive task. Even when the state-of-the-art technology was used to build airborne infection isolation rooms (AIIRs), recommended standards were often not met in field studies. The current coronavirus disease-2019 pandemic has highlighted the need to find cost-effective and less resource-intensive engineering solutions. Moreover, there is a need for the involvement of interdisciplinary teams to find innovative infection control solutions and doctors are frequently lacking in their understanding of building ventilation-related problems as well as their possible solutions. The current article describes building ventilation strategies (natural ventilation and hybrid ventilation) for hospitals where HVAC systems are either lacking or do not meet the recommended standards. Other measures like the use of portable air cleaning technologies and temporary negative-pressure rooms can be used as supplementary strategies in situations of demand surge. It can be easily understood that thermal comfort is compromised in buildings that are not mechanically fitted with HVAC systems, therefore the given building ventilation strategies are more helpful when climatic conditions are moderate or other measures are combined to maintain thermal comfort.
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Affiliation(s)
- Hina Zia
- Department of Architecture, Jamia Millia Islamia (Central University), New Delhi, India
| | - Ritu Singh
- Department of Trauma and Emergency, Indira Gandhi Institute of Medical Sciences, Patna, Bihar, India
| | - Manu Seth
- Department of Critical Care Medicine and Anesthesiology, Nishat Hospital and Research Centre, Lucknow, Uttar Pradesh, India
| | - Armin Ahmed
- Department of Critical Care Medicine, King George Medical University, Lucknow, Uttar Pradesh, India
| | - Afzal Azim
- Department of Critical Care Medicine, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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90
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Tosta E. Transmission of severe acute respiratory syndrome coronavirus 2 through asymptomatic carriers and aerosols: A major public health challenge. Rev Soc Bras Med Trop 2020; 53:e20200669. [PMID: 33331612 PMCID: PMC7747819 DOI: 10.1590/0037-8682-0669-2020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Accepted: 11/18/2020] [Indexed: 02/08/2023] Open
Abstract
In the absence of vaccines and effective antiviral drugs, control of the spread of coronavirus disease (Covid-19) relies mainly on the adequacy of public health resources and policies. Hence, failure to establish and implement scientifically reliable control measures may have a significant effect on the incidence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, severity of the disease, and death toll. The average number of secondary transmissions from an infected person, or reproduction numbers (R0 and R), and the points at which the collective immunity begins to reduce the transmission of the infection, or herd immunity thresholds, are important epidemiological tools used in strategies of Covid-19 control, suppression, and mitigation. However, SARS-CoV-2 transmission through asymptomatic carriers and, possibly, aerosols, has been ignored, and this may affect the effectiveness of Covid-19 control strategies. Therefore, consideration of the two possible ways of transmission would substantially increase the values of reproduction numbers, but if estimates of the contingent of the population naturally resistant to the virus, plus those with pre-existing cross-immunity to SARS-CoV-2 were considered, the evaluation of herd immunity thresholds should reach their real and achievable levels.
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Affiliation(s)
- Eduardo Tosta
- Professor emérito, Faculdade de Medicina, Universidade de
Brasília, Brasília, DF, Brasil
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91
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Shah N, Kalwar MS, Soomro BA. Early COVID-19 outbreak, individuals’ mask attitudes and purchase intentions: a cohesive care. JOURNAL OF SCIENCE AND TECHNOLOGY POLICY MANAGEMENT 2020. [DOI: 10.1108/jstpm-05-2020-0082] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Purpose
This study aims to explore individuals’ attitudes and intentions towards mask purchase in Pakistan at an initial outbreak of COVID-19.
Design/methodology/approach
The study is quantitatively based on the cross-sectional data. The data are collected through a survey questionnaire. Convenience sampling strategy is used to target the individuals of Pakistan. At the first, 650 questionnaires were distributed. In return, the authors received 321 raw samples with the response rate of 53.5%. Finally, 316 useful samples are proceeded to infer the final results.
Findings
The structural equation model’s results demonstrate a positive and significant effect of fear of complication of COVID-19, knowledge about COVID-19 and health consciousness on attitudes towards the mask. Further, attitudes towards mask are found to be the robust analyst of mask purchase intention.
Research limitations/implications
The study used cross-sectional data through a single source of data collection. The findings of the survey are on the sample size of 316.
Practical implications
The study would help policymakers to formulate the strategies to make aware individuals regarding their health and COVID-19 issues. The study would provide the guidelines to the government agents of Pakistan to combat with COVID-19 through the purchase of mask. The shopkeepers would be aware to observe the intentions and attitudes of consumers towards mask.
Originality/value
The outcomes of this study offer a shred of empirical evidence for attitudes and intentions regarding the purchase of mask, particularly for developing country settings.
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92
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Nestor CC, Wang S, Irwin MG. Are tracheal intubation and extubation aerosol-generating procedures? Anaesthesia 2020; 76:151-155. [PMID: 33274761 PMCID: PMC7753480 DOI: 10.1111/anae.15328] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/02/2020] [Indexed: 02/05/2023]
Affiliation(s)
- C C Nestor
- Department of Anaesthesiology, University of Hong Kong, Queen Mary Hospital, Hong Kong
| | - S Wang
- Department of Mechanical Engineering, City University of Hong Kong, Hong Kong
| | - M G Irwin
- Department of Anaesthesiology, University of Hong Kong, Queen Mary Hospital, Hong Kong
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93
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Birgand G, Peiffer-Smadja N, Fournier S, Kerneis S, Lescure FX, Lucet JC. Assessment of Air Contamination by SARS-CoV-2 in Hospital Settings. JAMA Netw Open 2020. [PMID: 33355679 DOI: 10.1001/jamaetworkopen.2020.33232] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Abstract
IMPORTANCE Controversy remains regarding the transmission routes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). OBJECTIVE To review current evidence on air contamination with SARS-CoV-2 in hospital settings and the factors associated with contamination, including viral load and particle size. EVIDENCE REVIEW The MEDLINE, Embase, and Web of Science databases were systematically queried for original English-language articles detailing SARS-CoV-2 air contamination in hospital settings between January 1 and October 27, 2020. This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. The positivity rate of SARS-CoV-2 viral RNA and culture were described and compared according to the setting, clinical context, air ventilation system, and distance from patients. The SARS-CoV-2 RNA concentrations in copies per meter cubed of air were pooled, and their distribution was described by hospital areas. Particle sizes and SARS-CoV-2 RNA concentrations in copies or median tissue culture infectious dose (TCID50) per meter cubed were analyzed after categorization as less than 1 μm, from 1 to 4 μm, and greater than 4 μm. FINDINGS Among 2284 records identified, 24 cross-sectional observational studies were included in the review. Overall, 82 of 471 air samples (17.4%) from close patient environments were positive for SARS-CoV-2 RNA, with a significantly higher positivity rate in intensive care unit settings (intensive care unit, 27 of 107 [25.2%] vs non-intensive care unit, 39 of 364 [10.7%]; P < .001). There was no difference according to the distance from patients (≤1 m, 3 of 118 [2.5%] vs >1-5 m, 13 of 236 [5.5%]; P = .22). The positivity rate was 5 of 21 air samples (23.8%) in toilets, 20 of 242 (8.3%) in clinical areas, 15 of 122 (12.3%) in staff areas, and 14 of 42 (33.3%) in public areas. A total of 81 viral cultures were performed across 5 studies, and 7 (8.6%) from 2 studies were positive, all from close patient environments. The median (interquartile range) SARS-CoV-2 RNA concentrations varied from 1.0 × 103 copies/m3 (0.4 × 103 to 3.1 × 103 copies/m3) in clinical areas to 9.7 × 103 copies/m3 (5.1 × 103 to 14.3 × 103 copies/m3) in the air of toilets or bathrooms. Protective equipment removal and patient rooms had high concentrations per titer of SARS-CoV-2 (varying from 0.9 × 103 to 40 × 103 copies/m3 and 3.8 × 103 to 7.2 × 103 TCID50/m3), with aerosol size distributions that showed peaks in the region of particle size less than 1 μm; staff offices had peaks in the region of particle size greater than 4 μm. CONCLUSIONS AND RELEVANCE In this systematic review, the air close to and distant from patients with coronavirus disease 2019 was frequently contaminated with SARS-CoV-2 RNA; however, few of these samples contained viable viruses. High viral loads found in toilets and bathrooms, staff areas, and public hallways suggest that these areas should be carefully considered.
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Affiliation(s)
- Gabriel Birgand
- National Institute of Health Research Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance, Imperial College London, London, United Kingdom
- Centre Hospitalo-Universitaire de Nantes, Nantes, France
| | - Nathan Peiffer-Smadja
- National Institute of Health Research Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance, Imperial College London, London, United Kingdom
- INSERM, IAME, UMR 1137, Paris, France
- Assistance Publique-Hôpitaux de Paris, Hôpital Bichat-Claude Bernard, Infectious Diseases Unit, Paris, Paris, France
- Equipe Operationnelle d'Hygiène, Siège Assistance Publique-Hôpitaux de Paris, Paris, France
- Universitaire Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Sandra Fournier
- Central Infection Control Team, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - Solen Kerneis
- Equipe Mobile d'Infectiologie, Hôpital Cochin, Assistance Publique-Hôpitaux de Paris, Paris, France
- Equipe de Prévention du Risque Infectieux, Hôpital Bichat, Assistance Publique-Hôpitaux de Paris, Paris, France
| | - François-Xavier Lescure
- INSERM, IAME, UMR 1137, Paris, France
- Assistance Publique-Hôpitaux de Paris, Hôpital Bichat-Claude Bernard, Infectious Diseases Unit, Paris, Paris, France
- Equipe Operationnelle d'Hygiène, Siège Assistance Publique-Hôpitaux de Paris, Paris, France
- Universitaire Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Jean-Christophe Lucet
- INSERM, IAME, UMR 1137, Paris, France
- Equipe Operationnelle d'Hygiène, Siège Assistance Publique-Hôpitaux de Paris, Paris, France
- Assistance Publique-Hôpitaux de Paris, Hôpital Bichat-Claude Bernard, Infection Control Unit, Paris, France
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94
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Birgand G, Peiffer-Smadja N, Fournier S, Kerneis S, Lescure FX, Lucet JC. Assessment of Air Contamination by SARS-CoV-2 in Hospital Settings. JAMA Netw Open 2020; 3:e2033232. [PMID: 33355679 PMCID: PMC7758808 DOI: 10.1001/jamanetworkopen.2020.33232] [Citation(s) in RCA: 54] [Impact Index Per Article: 13.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
IMPORTANCE Controversy remains regarding the transmission routes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). OBJECTIVE To review current evidence on air contamination with SARS-CoV-2 in hospital settings and the factors associated with contamination, including viral load and particle size. EVIDENCE REVIEW The MEDLINE, Embase, and Web of Science databases were systematically queried for original English-language articles detailing SARS-CoV-2 air contamination in hospital settings between January 1 and October 27, 2020. This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. The positivity rate of SARS-CoV-2 viral RNA and culture were described and compared according to the setting, clinical context, air ventilation system, and distance from patients. The SARS-CoV-2 RNA concentrations in copies per meter cubed of air were pooled, and their distribution was described by hospital areas. Particle sizes and SARS-CoV-2 RNA concentrations in copies or median tissue culture infectious dose (TCID50) per meter cubed were analyzed after categorization as less than 1 μm, from 1 to 4 μm, and greater than 4 μm. FINDINGS Among 2284 records identified, 24 cross-sectional observational studies were included in the review. Overall, 82 of 471 air samples (17.4%) from close patient environments were positive for SARS-CoV-2 RNA, with a significantly higher positivity rate in intensive care unit settings (intensive care unit, 27 of 107 [25.2%] vs non-intensive care unit, 39 of 364 [10.7%]; P < .001). There was no difference according to the distance from patients (≤1 m, 3 of 118 [2.5%] vs >1-5 m, 13 of 236 [5.5%]; P = .22). The positivity rate was 5 of 21 air samples (23.8%) in toilets, 20 of 242 (8.3%) in clinical areas, 15 of 122 (12.3%) in staff areas, and 14 of 42 (33.3%) in public areas. A total of 81 viral cultures were performed across 5 studies, and 7 (8.6%) from 2 studies were positive, all from close patient environments. The median (interquartile range) SARS-CoV-2 RNA concentrations varied from 1.0 × 103 copies/m3 (0.4 × 103 to 3.1 × 103 copies/m3) in clinical areas to 9.7 × 103 copies/m3 (5.1 × 103 to 14.3 × 103 copies/m3) in the air of toilets or bathrooms. Protective equipment removal and patient rooms had high concentrations per titer of SARS-CoV-2 (varying from 0.9 × 103 to 40 × 103 copies/m3 and 3.8 × 103 to 7.2 × 103 TCID50/m3), with aerosol size distributions that showed peaks in the region of particle size less than 1 μm; staff offices had peaks in the region of particle size greater than 4 μm. CONCLUSIONS AND RELEVANCE In this systematic review, the air close to and distant from patients with coronavirus disease 2019 was frequently contaminated with SARS-CoV-2 RNA; however, few of these samples contained viable viruses. High viral loads found in toilets and bathrooms, staff areas, and public hallways suggest that these areas should be carefully considered.
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Affiliation(s)
- Gabriel Birgand
- National Institute of Health Research Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance, Imperial College London, London, United Kingdom
- Centre Hospitalo-Universitaire de Nantes, Nantes, France
| | - Nathan Peiffer-Smadja
- National Institute of Health Research Health Protection Research Unit in Healthcare Associated Infection and Antimicrobial Resistance, Imperial College London, London, United Kingdom
- INSERM, IAME, UMR 1137, Paris, France
- Assistance Publique–Hôpitaux de Paris, Hôpital Bichat–Claude Bernard, Infectious Diseases Unit, Paris, Paris, France
- Equipe Operationnelle d'Hygiène, Siège Assistance Publique–Hôpitaux de Paris, Paris, France
- Universitaire Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Sandra Fournier
- Central Infection Control Team, Assistance Publique–Hôpitaux de Paris, Paris, France
| | - Solen Kerneis
- Equipe Mobile d’Infectiologie, Hôpital Cochin, Assistance Publique–Hôpitaux de Paris, Paris, France
- Equipe de Prévention du Risque Infectieux, Hôpital Bichat, Assistance Publique–Hôpitaux de Paris, Paris, France
| | - François-Xavier Lescure
- INSERM, IAME, UMR 1137, Paris, France
- Assistance Publique–Hôpitaux de Paris, Hôpital Bichat–Claude Bernard, Infectious Diseases Unit, Paris, Paris, France
- Equipe Operationnelle d'Hygiène, Siège Assistance Publique–Hôpitaux de Paris, Paris, France
- Universitaire Paris Diderot, Sorbonne Paris Cité, Paris, France
| | - Jean-Christophe Lucet
- INSERM, IAME, UMR 1137, Paris, France
- Equipe Operationnelle d'Hygiène, Siège Assistance Publique–Hôpitaux de Paris, Paris, France
- Assistance Publique–Hôpitaux de Paris, Hôpital Bichat–Claude Bernard, Infection Control Unit, Paris, France
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95
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Liu J, Kang X, Liu X, Yue P, Sun J, Lu C. Simultaneous removal of bioaerosols, odors and volatile organic compounds from a wastewater treatment plant by a full-scale integrated reactor. PROCESS SAFETY AND ENVIRONMENTAL PROTECTION : TRANSACTIONS OF THE INSTITUTION OF CHEMICAL ENGINEERS, PART B 2020; 144:2-14. [PMID: 32834560 PMCID: PMC7341965 DOI: 10.1016/j.psep.2020.07.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 06/02/2020] [Accepted: 07/02/2020] [Indexed: 05/03/2023]
Abstract
Biological control of odors and bioaerosols in wastewater treatment plants (WWTPs) have gained more attention in recent years. The simultaneous removal of odors, volatile organic compounds (VOCs) and bioaerosols in each unit of a full-scale integrated-reactor (FIR) in a sludge dewatering room was investigated. The average removal efficiencies (REs) of odors, VOCs and bioaerosols were recorded as 98.5 %, 94.7 % and 86.4 %, respectively, at an inlet flow rate of 5760 m3/h. The RE of each unit decreased, and the activated carbon adsorption zone (AZ) played a more important role as the inlet flow rate increased. The REs of hydrophilic compounds were higher than those of hydrophobic compounds. For bioaerosols, roughly 35 % of airborne heterotrophic bacteria (HB) was removed in the low-pH zone (LPZ) while over 30 % of total fungi (TF) was removed in the neutral-pH zone (NPZ). Most bioaerosols removed by the biofilter (BF) had a particle size larger than 4.7 μm while bioaerosols with small particle size were apt to be adsorbed by AZ. The microbial community in the BF changed significantly at different units. Health risks were found to be associated with H2S rather than with bioaerosols at the FIR outlet.
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Affiliation(s)
- Jianwei Liu
- Beijing Engineering Research Center of Sustainable Urban Sewage System Construction and Risk Control, Beijing University of Civil Engineering and Architecture, Beijing 100044, China
- School of Environment and Energy Engineering, Beijing University of Civil Engineering and Architecture, Beijing 100044, China
| | - Xinyue Kang
- Beijing Engineering Research Center of Sustainable Urban Sewage System Construction and Risk Control, Beijing University of Civil Engineering and Architecture, Beijing 100044, China
- School of Environment and Energy Engineering, Beijing University of Civil Engineering and Architecture, Beijing 100044, China
| | - Xueli Liu
- Beijing Engineering Research Center of Sustainable Urban Sewage System Construction and Risk Control, Beijing University of Civil Engineering and Architecture, Beijing 100044, China
- School of Environment and Energy Engineering, Beijing University of Civil Engineering and Architecture, Beijing 100044, China
| | - Peng Yue
- Beijing Engineering Research Center of Sustainable Urban Sewage System Construction and Risk Control, Beijing University of Civil Engineering and Architecture, Beijing 100044, China
- School of Environment and Energy Engineering, Beijing University of Civil Engineering and Architecture, Beijing 100044, China
| | - Jianbin Sun
- Beijing Engineering Research Center of Sustainable Urban Sewage System Construction and Risk Control, Beijing University of Civil Engineering and Architecture, Beijing 100044, China
- School of Environment and Energy Engineering, Beijing University of Civil Engineering and Architecture, Beijing 100044, China
| | - Chen Lu
- Beijing Engineering Research Center of Sustainable Urban Sewage System Construction and Risk Control, Beijing University of Civil Engineering and Architecture, Beijing 100044, China
- School of Environment and Energy Engineering, Beijing University of Civil Engineering and Architecture, Beijing 100044, China
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96
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Hemida MG, Ba Abduallah MM. The SARS-CoV-2 outbreak from a one health perspective. One Health 2020; 10:100127. [PMID: 32292814 PMCID: PMC7102578 DOI: 10.1016/j.onehlt.2020.100127] [Citation(s) in RCA: 40] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2020] [Revised: 03/12/2020] [Accepted: 03/14/2020] [Indexed: 01/04/2023] Open
Abstract
The severe acute respiratory syndrome cornavirus (SARS-CoV-2) is a new human coronavirus candidate recently detected in China that is now reported in people on inhabited continents. The virus shares a high level of identity with some bat coronaviruses and is recognised as a potentially zoonotic virus. We are utilizing the One Health concept to understand the emergence of the virus, as well as to point to some possible control strategies that might reduce the spread of the virus across the globe; thus, containment of such virus would be possible.
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Affiliation(s)
- Maged Gomaa Hemida
- Department of Microbiology, College of Veterinary Medicine, King Faisal University, Saudi Arabia
- Department of Virology, Faculty of Veterinary Medicine, Kafrelsheikh University, Egypt
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97
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Tada H, Takamura M, Kawashiri MA. Targeted Panel Sequencing will Boost Detection of Genetic Backgrounds of Familial Hypercholesterolemia in the World's Most Populous Country. J Atheroscler Thromb 2020; 27:1261-1263. [PMID: 32801290 PMCID: PMC7840167 DOI: 10.5551/jat.ed139] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Affiliation(s)
- Hayato Tada
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences
| | - Masayuki Takamura
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences
| | - Masa-Aki Kawashiri
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences
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98
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Transmission and prevention of SARS-CoV-2. Biochem Soc Trans 2020; 48:2307-2316. [PMID: 33084885 DOI: 10.1042/bst20200693] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 09/21/2020] [Accepted: 09/23/2020] [Indexed: 12/14/2022]
Abstract
The coronavirus disease 2019 (COVID-19), caused by a novel virus of the β-coronavirus genus (SARS-CoV-2), has been spreading globally. As of July 2020, there have been more than 17 million cases worldwide. Determining multiple transmission routes of SARS-CoV-2 is critical to improving safety practices for the public and stemming the spread of SARS-CoV-2 effectively. This article mainly focuses on published studies on the transmission routes of SARS-CoV-2 including contact transmission, droplet transmission, aerosol transmission and fecal-oral transmission, as well as related research approaches, such as epidemiological investigations, environmental sampling in hospitals and laboratories and animal models. We also provide four specific recommendations for the prevention and control of SARS-CoV-2 that may help reduce the risk of SARS-CoV-2 infection under different environmental conditions. First, social distancing, rational use of face masks and respirators, eye protection, and hand disinfection for medical staff and the general public deserve further attention and promotion. Second, aerodynamic characteristics, such as size distribution, release regularity, aerosol diffusion, survival and decline, infectious dose and spread distance, still require further investigation in order to identify the transmissibility of COVID-19. Third, background monitoring of the distribution of pathogenic microorganisms and environmental disinfection in crowded public places, such as railway stations, schools, hospitals and other densely populated areas, can give early warning of outbreaks and curb the transmission routes of SARS-CoV-2 in those high-risk areas. Forth, establishing novel predictive models can help us to not only assess transmission and impacts in communities, but also better implement corresponding emergency response measures.
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99
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Tada H, Shibayama J, Nishikawa T, Okada H, Nomura A, Usui S, Sakata K, Hashiba A, Inazu A, Takamura M, Kawashiri MA. Prevalence, self-awareness, and LDL cholesterol levels among patients highly suspected as familial hypercholesterolemia in a Japanese community. Pract Lab Med 2020; 22:e00181. [PMID: 33134467 PMCID: PMC7585140 DOI: 10.1016/j.plabm.2020.e00181] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2020] [Accepted: 10/15/2020] [Indexed: 11/30/2022] Open
Abstract
Backgrounds The prevalence of familial hypercholesterolemia (FH) among Japanese populations is still unclear. In addition, no prior data exist regarding the self-awareness. Accordingly, we aimed to investigate the prevalence, self-awareness, and LDL-C of patients with highly suspected as FH using data obtained in a community-based medical checkups. Methods This study included 52,276 subjects (18,588 men, 35.6%) aged ≥40 years who underwent the Japanese specific health checkup in Kanazawa City during 2018. We assessed the self-awareness of dyslipidemia (and the age) as well as the prevalence of patients with highly suspected as FH whose naïve LDL-C levels were ≥250 mg/dl. Naïve LDL-C levels were estimated by the adjustment (LDL-C/0.7) for those on lipid-lowering medication. We divided subjects into 3 groups based on their naïve LDL cholesterol level (≥250 mg/dl, 140–249, and ≤139 mg/dl). Results We identified 262 (0.5%) individuals highly suspected as FH whose naïve LDL-C levels were ≥250 mg/dl. Most of them (234 among 262, 89%) were under lipid-lowering medication; however, the self-awareness as dyslipidemia was not quite high (200 among 262, 76%), and their mean LDL-C level under lipid-lowering medication was 203 ± 35 mg/dl. Interestingly, the age of acknowledgement of dyslipidemia among the patients with highly suspected as FH was significantly younger than those in other categories (58 vs. 60/62 yrs, respectively, p < 0.05 for both). Conclusions The prevalence of patients highly suspected as FH was around 1 in 200, and their self-awareness as well as control were not still good enough among Japanese general populations.
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Affiliation(s)
- Hayato Tada
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Junichi Shibayama
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Tetsuo Nishikawa
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Hirofumi Okada
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Akihiro Nomura
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Soichiro Usui
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Kenji Sakata
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | | | - Akihiro Inazu
- Department of Laboratory Science, Molecular Biochemistry and Molecular Biology, Graduate School of Medical Science, Kanazawa University, Kanazawa, Japan
| | - Masayuki Takamura
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
| | - Masa-Aki Kawashiri
- Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences, Kanazawa, Japan
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Host-to-host airborne transmission as a multiphase flow problem for science-based social distance guidelines. INTERNATIONAL JOURNAL OF MULTIPHASE FLOW 2020; 132. [PMCID: PMC7471834 DOI: 10.1016/j.ijmultiphaseflow.2020.103439] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/09/2023]
Abstract
The COVID-19 pandemic has strikingly demonstrated how important it is to develop fundamental knowledge related to the generation, transport and inhalation of pathogen-laden droplets and their subsequent possible fate as airborne particles, or aerosols, in the context of human to human transmission. It is also increasingly clear that airborne transmission is an important contributor to rapid spreading of the disease. In this paper, we discuss the processes of droplet generation by exhalation, their potential transformation into airborne particles by evaporation, transport over long distances by the exhaled puff and by ambient air turbulence, and their final inhalation by the receiving host as interconnected multiphase flow processes. A simple model for the time evolution of droplet/aerosol concentration is presented based on a theoretical analysis of the relevant physical processes. The modeling framework along with detailed experiments and simulations can be used to study a wide variety of scenarios involving breathing, talking, coughing and sneezing and in a number of environmental conditions, as humid or dry atmosphere, confined or open environment. Although a number of questions remain open on the physics of evaporation and coupling with persistence of the virus, it is clear that with a more reliable understanding of the underlying flow physics of virus transmission one can set the foundation for an improved methodology in designing case-specific social distancing and infection control guidelines.
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