Susceptibility of SARS-CoV-2 to UV irradiation

Fast inactivation of SARS-CoV-2 by UV-C and ozone exposure on different materials

The extremely rapid spread of the SARS-CoV-2 has already resulted in more than 1 million reported deaths of coronavirus disease 2019 (COVID-19). The ability of infectious particles to persist on environmental surfaces is potentially considered a factor for viral spreading. Therefore, limiting viral diffusion in public environments should be achieved with correct disinfection of objects, tissues, and clothes. This study proves how two widespread disinfection systems, short-wavelength ultraviolet light (UV-C) and ozone (O3), are active in vitro on different commonly used materials. The development of devices equipped with UV-C, or ozone generators, may prevent the virus from spreading in public places.

Extreme Exposure to Filtered Far-UVC: A Case Study†

Far-UVC devices are being commercially sold as "safe for humans" for the inactivation of SARS-CoV-2, without supporting human safety data. We felt there was a need for rapid proof-of-concept human self-exposure, to inform future controlled research and promote informed discussion. A Fitzpatrick Skin Type II individual exposed their inner forearms to large radiant exposures from a filtered Krypton-Chloride (KrCl) far-UVC system (SafeZoneUVC, Ushio Inc., Tokyo, Japan) with peak emission at 222 nm. No visible skin changes were observed at 1500 mJ cm^-2 ; whereas, skin yellowing that appeared immediately and resolved within 24 h occurred with a 6000 mJ cm^-2 exposure. No erythema was observed at any time point with exposures up to 18 000 mJ cm^-2 . These results combined with Monte Carlo Radiative Transfer computer modeling suggest that filtering longer ultraviolet wavelengths is critical for the human skin safety of far-UVC devices. This work also contributes to growing arguments for the exploration of exposure limit expansion, which would subsequently enable faster inactivation of viruses.

SARS-CoV-2: Outline, Prevention, and Decontamination

The new coronavirus began to spread around the world in late 2019. Initially, it was found only in China, but in the following days there were reported cases of infections in other countries. Subsequently, based on taxonomy, phylogeny, and accepted practice, the virus was officially designated as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). As a result of the rapid spread of SARS-CoV-2 in different countries around the world, on March 11, 2020, the World Health Organization (WHO) announced a status change in the disease caused by this coronavirus-from an epidemic to a pandemic disease. Although the world is taking unprecedented efforts to control the spread of SARS-CoV-2, the number of confirmed cases is rising. Therefore, effective preventive measures are needed in order to limit the spread of illness. The prevention measures are mainly based on information on the virus transmission routes, its environmental stability, and persistence on commonly touched surfaces. Social distancing, mask usage, and good hygiene practice are the most important recommendations for general public. Healthcare professionals who are directly involved in SARS-CoV-2 patients care are more exposed to virus infection and additional protection measures are necessary, including protective suits, aprons, face shields, goggles, and gloves. Due to the stability of SARS-CoV-2 on different surfaces, such as glass, paper, or wood, proper disinfection is crucial. Several studies have shown that despite the virus's stability, it is sensitive to various disinfectants, such as ethanol, isopropanol, sodium hypochlorite, or hydrogen peroxide. These findings underline the importance of having comprehensive knowledge about SARS-CoV-2 and multidirectional strategies in order to limit the spread of the virus. This review is a summary of the most important information about SARS-CoV-2, such as its stability on different surfaces, protection strategies, and decontamination options.

Classical and alternative disinfection strategies to control the COVID-19 virus in healthcare facilities: a review

The coronavirus disease COVID-19 has spread throughout the world and has been declared as a pandemic by the World Health Organization on March 11th, 2020. The COVID-19 is caused by the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). One possible mode of virus transmission is through surfaces in the healthcare settings. This paper reviews currently used disinfection strategies to control SARS-CoV-2 at the healthcare facilities. Chemical disinfectants include hypochlorite, peroxymonosulfate, alcohols, quaternary ammonium compounds, and hydrogen peroxide. Advanced strategies include no-touch techniques such as engineered antimicrobial surfaces and automated room disinfection systems using hydrogen peroxide vapor or ultraviolet light.

Effect of intermittent irradiation and fluence-response of 222 nm ultraviolet light on SARS-CoV-2 contamination

BACKGROUND

The effectiveness of 222 nm ultraviolet (UV) C light for disinfecting surfaces contaminated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been reported. The aim of this study was to evaluate the effect of the intermittent irradiation of 222 nm UVC on SARS-CoV-2 and the fluence-dependent effect of 222 nm UVC irradiation on SARS-CoV-2 inactivation.

METHODS

We experimented with 5 min continuous and intermittent irradiation for 0.1, 0.05, 0.013, and 0.003 mW/cm² of 222 nm UVC to evaluate the differences in the effect of the continuous and intermittent irradiation of 222 nm UVC on SARS-CoV-2 inactivation. For intermittent irradiation, we followed the on-off irradiation cycles with every 10-s irradiation followed by a 380-s interval. Thereafter, we evaluated the effects of 0.1, 0.013, and 0.003 mW/cm² 222 nm UVC irradiation on SARS-CoV-2 contamination at UV fluences of 1, 2, and 3 mJ/cm² at each irradiance.

RESULTS

At each irradiance, no significant difference was observed in the log reduction of SARS-CoV-2 between continuous and intermittent irradiation. At each UV fluence, no significant difference was observed in the log reduction of SARS-CoV-2 among the three different irradiance levels.

CONCLUSION

There was no significant difference between continuous and intermittent irradiation with 222 nm UVC with regards to SARS-CoV-2 inactivation. Moreover, 222 nm UVC inactivates SARS-CoV-2 in a fluence-dependent manner. The efficacy of 222-nm UVC irradiation in reducing the contamination of SARS-CoV-2 needs to be further evaluated in a real-world setting.

Inactivation of SARS-CoV-2 virus in saliva using a guanidium based transport medium suitable for RT-PCR diagnostic assays

BACKGROUND

Upper respiratory samples used to test for SARS-CoV-2 virus may be infectious and present a hazard during transport and testing. A buffer with the ability to inactivate SARS-CoV-2 at the time of sample collection could simplify and expand testing for COVID-19 to non-conventional settings.

METHODS

We evaluated a guanidium thiocyanate-based buffer, eNAT™ (Copan) as a possible transport and inactivation medium for downstream RT-PCR testing to detect SARS-CoV-2. Inactivation of SARS-CoV-2 USA-WA1/2020 in eNAT and in diluted saliva was studied at different incubation times. The stability of viral RNA in eNAT was also evaluated for up to 7 days at room temperature (28°C), refrigerated conditions (4°C) and at 35°C.

RESULTS

SARS-COV-2 virus spiked directly in eNAT could be inactivated at >5.6 log 10 PFU/ml within a minute of incubation. When saliva was diluted 1:1 in eNAT, no cytopathic effect (CPE) on vero-E6 cell lines was observed, although SARS-CoV-2 RNA could be detected even after 30 min incubation and after two cell culture passages. A 1:2 (saliva:eNAT) dilution abrogated both CPE and detectable viral RNA after as little as 5 min incubation in eNAT. SARS-CoV-2 RNA from virus spiked at 5X the limit of detection remained positive up to 7 days of incubation in all tested conditions.

CONCLUSION

eNAT and similar guanidinium thiocyanate-based media may be of value for transport, preservation, and processing of clinical samples for RT-PCR based SARS-CoV-2 detection.

Unlocking the surge in demand for personal and protective equipment (PPE) and improvised face coverings arising from coronavirus disease (COVID-19) pandemic - Implications for efficacy, re-use and sustainable waste management

Currently, there is no effective vaccine for tackling the ongoing COVID-19 pandemic caused by SARS-CoV-2 with the occurrence of repeat waves of infection frequently stretching hospital resources beyond capacity. Disease countermeasures rely upon preventing person-to-person transmission of SARS-CoV2 so as to protect front-line healthcare workers (HCWs). COVID-19 brings enormous challenges in terms of sustaining the supply chain for single-use-plastic personal and protective equipment (PPE). Post-COVID-19, the changes in medical practice will drive high demand for PPE. Important countermeasures for preventing COVID-19 transmission include mitigating potential high risk aerosol transmission in healthcare setting using medical PPE (such as filtering facepiece respirators (FFRs)) and the appropriate use of face coverings by the general public that carries a lower transmission risk. PPE reuse is a potential short term solution during COVID-19 pandemic where there is increased evidence for effective deployment of reprocessing methods such as vaporized hydrogen peroxide (30 to 35% VH2O2) used alone or combined with ozone, ultraviolet light at 254 nm (2000 mJ/cm²) and moist heat (60 °C at high humidity for 60 min). Barriers to PPE reuse include potentially trust and acceptance by HCWs. Efficacy of face coverings are influenced by the appropriate wearing to cover the nose and mouth, type of material used, number of layers, duration of wearing, and potentially superior use of ties over ear loops. Insertion of a nose clip into cloth coverings may help with maintaining fit. Use of 60 °C for 60 min (such as, use of domestic washing machine and spin dryer) has been advocated for face covering decontamination. Risk of virus infiltration in improvised face coverings is potentially increased by duration of wearing due to humidity, liquid diffusion and virus retention. Future sustained use of PPE will be influenced by the availability of recyclable PPE and by innovative biomedical waste management.

The virus removal in UV irradiation, ozonation and chlorination

The COVID-19 pandemic draws much attention to virus inactivation since the SARS-CoV-2 was detected in miscellaneous environments and the wastewater can be a potential transmitting pathway. UV irradiation, ozonation and chlorination are widely used disinfection processes in water treatment. In this review, the mechanisms and applications of three disinfection processes are introduced, and their inactivation effects on virus as well as other microorganisms are compared and discussed. The resistance of viruses to UV irradiation is generally stronger than that of bacteria. 4-log inactivation of bacteria can be easily obtained within a UV dose of 10 ​mJ/cm². However, the doses to reach the same virus removal rate vary greatly from 10 to 140 ​mJ/cm². The coronaviruses have even stronger UV resistance. Comparatively, ozonation and chlorination are effective methods to inactivate viruses, and the CT values of 4-log removal for most viruses concerned are lower than 1 ​mg·min/L and 10 ​mg·min/L, respectively. Protozoa, fungal spores and bacterial spores are more resistant to disinfection. Temperature, pH, organic matters, turbidity and other parameters all have influences on the disinfection. With a 10 ​°C decrease in temperature, the CT value required for certain removal rates doubles. Generally low pH promotes disinfection and high pH is against it. In drinking water and wastewater treatment process, the resistance properties of microorganisms and other influence parameters should be taken into consideration when choosing disinfection technologies.

Cellular Immunity in COVID-19 Convalescents with PCR-Confirmed Infection but with Undetectable SARS-CoV-2–Specific IgG

We investigated immune responses against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) among a group of convalescent, potential blood donors in Germany who had PCR-confirmed SARS-CoV-2 infection. Sixty days after onset of symptoms, 13/78 (17%) study participants had borderline or negative results to an ELISA detecting IgG against the S1 protein of SARS-CoV-2. We analyzed participants with PCR-confirmed infection who had strong antibody responses (ratio >3) as positive controls and participants without symptoms of SARS-CoV-2 infection and without household contact with infected patients as negative controls. Using interferon-γ ELISpot, we observed that 78% of PCR-positive volunteers with undetectable antibodies showed T cell immunity against SARS-CoV-2. We observed a similar frequency (80%) of T-cell immunity in convalescent donors with strong antibody responses but did not detect immunity in negative controls. We concluded that, in convalescent patients with undetectable SARS-CoV-2 IgG, immunity may be mediated through T cells.

Efficacy of Generalized Face Masking Mandates

This commentary discusses if targeted uses of face masks may provide better results than generalized face masks mandates to limit the spread of Covid-19. The study is based on a literature review, as well as the analysis of cases and fatalities of different countries adopting different mask mandates. Before the Covid-19 emergency, the literature was consistently against generalized masking for cold and flu viruses. The latest literature for Covid-19 infection is opposite mostly supportive for generalized masking, even if contrarian works exist. The Covid-19 recommendations are not based on randomized controlled trials of healthy individuals wearing or not masks, differentiating in between closed or open spaces. Countries that did not mandate face masks have not performed worse for the number of cases and fatalities than countries that adopted generalized face masking policies during the Covid-19 emergency. Face masks help against Covid-19 infection but also have downfalls. Their benefits are overestimated, while their risks are underestimated. Masks can block the larger droplets exhaled by an infected wearer, protecting the healthy from viral exposure, but their ability to filter out viruses is variable and generally poor especially in reused cloth masks worn by the public. New surgical masks should be used in crowded spaces especially indoors, preferring distancing without masks outdoor. There are serious unintended consequences from wearing face masks improperly and for too long that must be accounted for. There could be more advantages from targeted rather than generalized uses of only surgical face masks.

Methods to disinfect and decontaminate SARS-CoV-2: a systematic review of in vitro studies

BACKGROUND

Cleaning is a major control component for outbreaks of infection. However, for the SARS-CoV-2 pandemic, there is limited specific guidance regarding the proper disinfection methods that should be used.

METHODS

We conducted a systematic review of the literature on cleaning, disinfection or decontamination methods in the prevention of SARS-CoV-2.

RESULTS

A total of 27 studies were included, reporting a variety of methods with which the effectiveness of interventions were assessed. Virus was inoculated onto different types of material including masks, nasopharyngeal swabs, serum, laboratory plates and simulated saliva, tears or nasal fluid and then interventions were applied in an attempt to eliminate the virus including chemical, ultraviolet (UV) light irradiation, and heat and humidity. At body temperature (37°C) there is evidence that the virus will not be detectable after 2 days but this can be reduced to non-detection at 30 min at 56°C, 15 min at 65°C and 2 min at 98°C. Different experimental methods testing UV light have shown that it can inactivate the virus. Light of 254-365 nm has been used, including simulated sunlight. Many chemical agents including bleach, hand sanitiser, hand wash, soap, ethanol, isopropanol, guandinium thiocynate/t-octylphenoxypolyethoxyethanol, formaldehyde, povidone-iodine, 0.05% chlorhexidine, 0.1% benzalkonium chloride, acidic electrolysed water, Clyraguard copper iodine complex and hydrogen peroxide vapour have been shown to disinfect SARS-CoV-2.

CONCLUSIONS

Heating, UV light irradiation and chemicals can be used to inactivate SARS-CoV-2 but there is insufficient evidence to support one measure over others in clinical practice.

Rapid and complete inactivation of SARS-CoV-2 by ultraviolet-C irradiation

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic has devastated global public health systems and economies, with over 52 million people infected, millions of jobs and businesses lost, and more than 1 million deaths recorded to date. Contact with surfaces contaminated with droplets generated by infected persons through exhaling, talking, coughing and sneezing is a major driver of SARS-CoV-2 transmission, with the virus being able to survive on surfaces for extended periods of time. To interrupt these chains of transmission, there is an urgent need for devices that can be deployed to inactivate the virus on both recently and existing contaminated surfaces. Here, we describe the inactivation of SARS-CoV-2 in both wet and dry format using radiation generated by a commercially available Signify ultraviolet (UV)-C light source at 254 nm. We show that for contaminated surfaces, only seconds of exposure is required for complete inactivation, allowing for easy implementation in decontamination workflows.

Evaluation of a portable Ultraviolet C (UV-C) device for hospital surface decontamination

Background

Surface decontamination of hospital environments is essential to ensure the safety of health professionals and patients. This process is usually performed through active chemicals substances with high toxicity, and new decontamination technologies that do not leave residues have been currently used, such as UV-C light. Thus, the objective of the present study is to evaluate the effectiveness of a portable UV-C light device on the viability of standard pathogenic strains and other microorganisms isolated from different surfaces of a public health hospital.

Methods

In vitro decontamination was performed by applying Biosept Home© UV-C to Staphylococcus aureus, Staphylococcus epidermidis, Escherichia coli, Pseudomonas aeruginosa, Salmonella enterica and Candida albicans. In real conditions, the application was made on different surfaces of a hospital. The device used in the experiment haa a 254 nm UV-C light and a radiation intensity of 45.6 mW/cm² over a distance of 1 cm from the surfaces. The light dose was 0.912 J/cm² for 20 s of application in both conditions (in vitro and hospital).

Results

After in vitro decontamination with UV-C light no bacterial growth was observed, demonstrating 100 % of bacterial inactivation under the conditions tested. Additionally, there was a reduction of approximately 4 logs for the yeast C. albicans. In all hospital surfaces, the number of colonies of microorganisms was significantly reduced after the procedure.

Conclusion

The results suggest that Biosept Home© UV-C is efficient and constitutes a promosing intervention for disinfection protocols in hospitals and clinics.

Investigating the Potential for Ultraviolet Light to Modulate Morbidity and Mortality From COVID-19: A Narrative Review and Update

During the COVID-19 (coronavirus disease of 2019) pandemic, researchers have been seeking low-cost and accessible means of providing protection from its harms, particularly for at-risk individuals such as those with cardiovascular disease, diabetes and obesity. One possible way is via safe sun exposure, and/or dietary supplementation with induced beneficial mediators (e.g., vitamin D). In this narrative review, we provide rationale and updated evidence on the potential benefits and harms of sun exposure and ultraviolet (UV) light that may impact COVID-19. We review recent studies that provide new evidence for any benefits (or otherwise) of UV light, sun exposure, and the induced mediators, vitamin D and nitric oxide, and their potential to modulate morbidity and mortality induced by infection with SARS-CoV-2 (severe acute respiratory disease coronavirus-2). We identified substantial interest in this research area, with many commentaries and reviews already published; however, most of these have focused on vitamin D, with less consideration of UV light (or sun exposure) or other mediators such as nitric oxide. Data collected to-date suggest that ambient levels of both UVA and UVB may be beneficial for reducing severity or mortality due to COVID-19, with some inconsistent findings. Currently unresolved are the nature of the associations between blood 25-hydroxyvitamin D and COVID-19 measures, with more prospective data needed that better consider lifestyle factors, such as physical activity and personal sun exposure levels. Another short-coming has been a lack of measurement of sun exposure, and its potential to influence COVID-19 outcomes. We also discuss possible mechanisms by which sun exposure, UV light and induced mediators could affect COVID-19 morbidity and mortality, by focusing on likely effects on viral pathogenesis, immunity and inflammation, and potential cardiometabolic protective mechanisms. Finally, we explore potential issues including the impacts of exposure to high dose UV radiation on COVID-19 and vaccination, and effective and safe doses for vitamin D supplementation.

Navigating the risks of flying during COVID-19: a review for safe air travel

RATIONALE FOR REVIEW

With air travel restarting, there has been much discourse about the safety of flying during the pandemic. In travel medicine, risk assessment includes estimating baseline risk to the traveller, recognizing factors that may modify that risk, considering the role of interventions to decrease that risk and accounting for a traveller's perception and tolerance of risk. The goals of this review are to identify the in-flight transmission risks of commercial air travel, provide recommendations about the risks of flying during the pandemic and propose strategies to mitigate the spread of COVID-19.

KEY FINDINGS

The airline industry has taken a layered approach to increase passenger safety through effective onboard ventilation, extended ventilation at the gate, boarding and deplaning strategies, improved aircraft disinfection and pre-flight screening such as temperature checks and COVID-19 testing. Proximity to an index case may contribute to the risk of transmission more than the seat type or location. The use of face masks has significantly reduced onboard transmission, and mandatory in-flight mask-wearing policies are being enforced. Innovations such as digital health passports may help standardize screening entry requirements at airports and borders, allowing for a safer return to travel.

RECOMMENDATIONS

In-flight transmission of SARS-CoV-2 is a real risk, which may be minimized by combining mitigation strategies and infection prevention measures including mandatory masking onboard, minimizing unmasked time while eating, turning on gasper airflow in-flight, frequent hand sanitizing, disinfecting high touch surfaces, promoting distancing while boarding and deplaning, limiting onboard passenger movement, implementing effective pre-flight screening measures and enhancing contact tracing capability. Assessing risk is a cornerstone of travel medicine. It is important to evaluate the multiple factors contributing to the cumulative risk of an individual traveller during the COVID-19 pandemic and to employ a multi-pronged approach to reduce that risk.

Physicochemical susceptibility of SARS-CoV-2 to disinfection and physical approach of prophylaxis

The transmission control of the newly emerged severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the most effective strategy by the absence of its specified vaccine or drug. Although the aerosol mediated transmission of SARS-CoV-2 has been confirmed, the physicochemical treatment of the biotic and abiotic objects is still the most promising approach in its infection control. The front line of the most effective disinfecting compounds on SARS-CoV-2 implies to be sodium hypochlorite, ethanol, hydrogen peroxide, quaternary ammonium compounds, and phenolic compounds, respectively. However, widely used compounds of alkyldimethylbenzylammonium chloride (benzalkonium chloride) biguanides (chlorhexidine) have not shown the multitude load reduction in less than 10 minutes. The susceptibility of SARS-CoV-2 to physical treatment follows the pattern of heat, acidity, and UV radiation. Rather all of the mentioned physical or chemical treatments, target the envelope proteins of the coronavirus mainly by impairing its entry to host cells. The anti-SARS-CoV-2 activity of combinatorial physicochemical treatments or evaluation of new chemical entities or physical treatments such as microwave irradiation still needs to be explored. Therefore, the development of a reliable decontamination protocol for SARS-CoV-2 demands revealing its stability pattern study vs a spectrum of single and combinatorial physicochemical parameters.

Infectivity of SARS-CoV-2 and Other Coronaviruses on Dry Surfaces: Potential for Indirect Transmission

The unwavering spread of COVID-19 has taken the world by storm. Preventive measures like social distancing and mask usage have been taken all around the globe but still, as of September 2020, the number of cases continues to rise in many countries. Evidently, these measures are insufficient. Although decreases in population density and surges in the public's usage of personal protective equipment can mitigate direct transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), indirect transmission of the virus is still probable. By summarizing the current state of knowledge on the stability of coronaviruses on dry materials, this review uncovers the high potential for SARS-CoV-2 transmission through contaminated surfaces (i.e., fomites) and prompts future research. Fully contextualized data on coronavirus persistence are presented. The methods and limitations to testing the stability of coronaviruses are explored, and the SARS-CoV-2 representativeness of different coronaviruses is analyzed. The factors which dictate the persistence of coronaviruses on surfaces (media, environmental conditions, and material-type) are investigated, and the review is concluded by encouraging material innovation to combat the current pandemic. To summarize, SARS-CoV-2 remains viable on the timescale of days on hard surfaces under ambient indoor conditions. Similarly, the virus is stable on human skin, signifying the necessity of hand hygiene amidst the current pandemic. There is an inverse relationship between SARS-CoV-2 surface persistence and temperature/humidity, and the virus is well suited to air-conditioned environments (room temperature, ~ 40% relative humidity). Sunlight may rapidly inactivate the virus, suggesting that indirect transmission predominantly occurs indoors. The development of antiviral materials and surface coatings would be an extremely effective method to mitigate the spread of COVID-19. To obtain applicable data on the persistence of coronaviruses and the efficiency of virucidal materials, future researchers should understand the common experimental limitations outlined in this review and plan their studies accordingly.

Cellular Immunity in COVID-19 Convalescents with PCR-Confirmed Infection but with Undetectable SARS-CoV-2-Specific IgG

We investigated immune responses against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) among a group of convalescent, potential blood donors in Germany who had PCR-confirmed SARS-CoV-2 infection. Sixty days after onset of symptoms, 13/78 (17%) study participants had borderline or negative results to an ELISA detecting IgG against the S1 protein of SARS-CoV-2. We analyzed participants with PCR-confirmed infection who had strong antibody responses (ratio >3) as positive controls and participants without symptoms of SARS-CoV-2 infection and without household contact with infected patients as negative controls. Using interferon-γ ELISpot, we observed that 78% of PCR-positive volunteers with undetectable antibodies showed T cell immunity against SARS-CoV-2. We observed a similar frequency (80%) of T-cell immunity in convalescent donors with strong antibody responses but did not detect immunity in negative controls. We concluded that, in convalescent patients with undetectable SARS-CoV-2 IgG, immunity may be mediated through T cells.

AAID White Paper: Management of the Dental Implant Patient During the COVID-19 Pandemic and Beyond

The scientific community's understanding of how the SARS-CoV-2 virus is transmitted and how to best mitigate its spread is improving daily. To help protect patients from acquiring COVID-19 from a dental office nosocomial infection, many state or local governments have classified dental treatments as "nonessential" and have paused routine dental care. Dentists have been instructed to perform only procedures designated as emergencies. Unfortunately, there is not a good understanding of what a dental emergency is among governmental leaders. What a government agency may perceive as an elective procedure may be seen as "essential" by the dental clinician responsible for maintaining the oral health of the patient. Each dental specialty understands the effects delayed care has on a patient's oral and systemic health. Dentistry has made extensive progress in improving oral health through prevention of the dental emergency. The dental profession must work together to prevent the reversal of the progress dentistry and patients have made. This American Academy of Implant Dentistry (AAID) White Paper discusses what COVID-19 is and how it impacts dental treatments, presents guidelines for dentistry in general and for dental implant related treatments, specifically. Recommendations for implant dentistry include the following: (1) what constitutes a dental implant related emergency, (2) how patients should be screened and triaged, (3) what personal protective equipment is necessary, (4) how operatories should be equipped, (5) what equipment should be used, and (6) what, when, and how procedures can be performed. This paper is intended to provide guidance for the dental implant practice so patients and dental health care providers can be safe, and offices can remain open and viable during the pandemic.

COVID-19 Pandemic and Its Impact on Neurosurgery Practice in Malaysia: Academic Insights, Clinical Experience and Protocols from March till August 2020

The newly discovered coronavirus disease 2019 (COVID-19) is an infectious disease introduced to humans for the first time. Following the pandemic of COVID-19, there is a major shift of practices among surgical departments in response to an unprecedented surge in reducing the transmission of disease. With pooling and outsourcing of more health care workers to emergency rooms, public health care services and medical services, further in-hospital resources are prioritised to those in need. It is imperative to balance the requirements of caring for COVID-19 patients with imminent risk of delay to others who need care. As Malaysia now approaches the recovery phase following the pandemic, the crisis impacted significantly on neurosurgical services throughout the country. Various emergency measures taken at the height of the crisis may remain as the new normal in the provision of neurosurgical services and practices in Malaysia. The crisis has certainly put a strain on the effective delivery of services and as we approach the recovery era, what may have been a strain may prove to be a silver lining in neurosurgical services in Malaysia. The following details are various measures put in place as the new operational protocols for neurosurgical services in Malaysia.

Rapid Review of SARS-CoV-1 and SARS-CoV-2 Viability, Susceptibility to Treatment, and the Disinfection and Reuse of PPE, Particularly Filtering Facepiece Respirators

In the COVID-19 pandemic caused by SARS-CoV-2, hospitals are often stretched beyond capacity. There are widespread reports of dwindling supplies of personal protective equipment (PPE), particularly N95-type filtering facepiece respirators (FFRs), which are paramount to protect frontline medical/nursing staff, and to minimize further spread of the virus. We carried out a rapid review to summarize the existing literature on the viability of SARS-CoV-2, the efficacy of key potential disinfection procedures against the virus (specifically ultraviolet light and heat), and the impact of these procedures on FFR performance, material integrity, and/or fit. In light of the recent discovery of SARS-CoV-2 and limited associated research, our review also focused on the closely related SARS-CoV-1. We propose a possible whole-of-PPE disinfection solution for potential reuse that could be rapidly instituted in many health care settings, without significant investments in equipment.