Viable SARS-CoV-2 in the air of a hospital room with COVID-19 patients

Aerosol Generation During Peak Flow Testing: Clinical Implications for COVID-19

BACKGROUND

Peak flow testing is a common procedure performed in ambulatory care. There are currently no data regarding aerosol generation during this procedure. Given the ongoing debate regarding the potential for aerosol transmission of SARS-CoV-2, we aimed to quantify and characterize aerosol generation during peak flow testing.

METHODS

Five healthy volunteers performed peak flow maneuvers in a particle-free laboratory space. Two devices continuously sampled the ambient air during the procedure. One device can detect ultrafine particles 0.02-1 μm in diameter, while the second device can detect particles 0.3, 0.5, 1.0, 2.0, 5.0, and 10 μm in diameter. Five different peak flow meters were compared to ambient baseline during masked and unmasked tidal breathing.

RESULTS

Ultrafine particles (0.02-1 μm) were generated during peak flow measurement. There was no significant difference in ultrafine particle mean concentration between peak flow meters (P = .23): Respironics (1.25 ± 0.47 particles/mL), Philips (3.06 ± 1.22), Clement Clarke (3.55 ± 1.22 particles/mL), Respironics Low Range (3.50 ± 1.52 particles/mL), and Monaghan (3.78 ± 1.31 particles/mL). Ultrafine particle mean concentration with peak flow testing was significantly higher than masked (0.22 ± 0.29 particles/mL) and unmasked tidal breathing (0.15 ± 0.18 particles/mL, P = .01), but the ultrafine particle concentrations were small compared to ambient particle concentrations in a pulmonary function testing room (89.9 ± 8.95 particles/mL).

CONCLUSIONS

In this study, aerosol generation was present during peak flow testing, but concentrations were small compared to the background particle concentration in the ambient clinical environment. Surgical masks and eye protection are likely sufficient infection control measures during peak expiratory flow testing in asymptomatic patients with well controlled respiratory symptoms, but COVID-19 testing remains prudent in patients with acute respiratory symptoms prior to evaluation and peak expiratory flow assessment while the community prevalence of SARS-CoV-2 cases remains high.

SARS-CoV-2: a systematic review of indoor air sampling for virus detection

In a post-pandemic scenario, indoor air monitoring may be required seeking to safeguard public health, and therefore well-defined methods, protocols, and equipment play an important role. Considering the COVID-19 pandemic, this manuscript presents a literature review on indoor air sampling methods to detect viruses, especially SARS-CoV-2. The review was conducted using the following online databases: Web of Science, Science Direct, and PubMed, and the Boolean operators "AND" and "OR" to combine the following keywords: air sampler, coronavirus, COVID-19, indoor, and SARS-CoV-2. This review included 25 published papers reporting sampling and detection methods for SARS-CoV-2 in indoor environments. Most of the papers focused on sampling and analysis of viruses in aerosols present in contaminated areas and potential transmission to adjacent areas. Negative results were found in 10 studies, while 15 papers showed positive results in at least one sample. Overall, papers report several sampling devices and methods for SARS-CoV-2 detection, using different approaches for distance, height from the floor, flow rates, and sampled air volumes. Regarding the efficacy of each mechanism as measured by the percentage of investigations with positive samples, the literature review indicates that solid impactors are more effective than liquid impactors, or filters, and the combination of various methods may be recommended. As a final remark, determining the sampling method is not a trivial task, as the samplers and the environment influence the presence and viability of viruses in the samples, and thus a case-by-case assessment is required for the selection of sampling systems.

A perspective on hospital-acquired (nosocomial) infection control of COVID-19: usefulness of spatial separation between wards and airborne isolation unit

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.

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

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.

Perspective of the Relationship between the Susceptibility to Initial SARS-CoV-2 Infectivity and Optimal Nasal Conditioning of Inhaled Air

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), as with the influenza virus, has been shown to spread more rapidly during winter. Severe coronavirus disease 2019 (COVID-19), which can follow SARS-CoV-2 infection, disproportionately affects older persons and males as well as people living in temperate zone countries with a tropical ancestry. Recent evidence on the importance of adequately warming and humidifying (conditioning) inhaled air in the nasal cavity for reducing SARS-CoV-2 infectivity in the upper respiratory tract (URT) is discussed, with particular reference to: (i) the relevance of air-borne SARS-CoV-2 transmission, (ii) the nasal epithelium as the initial site of SARS-CoV-2 infection, (iii) the roles of type 1 and 3 interferons for preventing viral infection of URT epithelial cells, (iv) weaker innate immune responses to respiratory viral infections in URT epithelial cells at suboptimal temperature and humidity, and (v) early innate immune responses in the URT for limiting and eliminating SARS-CoV-2 infections. The available data are consistent with optimal nasal air conditioning reducing SARS-CoV-2 infectivity of the URT and, as a consequence, severe COVID-19. Further studies on SARS-CoV-2 infection rates and viral loads in the nasal cavity and nasopharynx in relation to inhaled air temperature, humidity, age, gender, and genetic background are needed in this context. Face masks used for reducing air-borne virus transmission can also promote better nasal air conditioning in cold weather. Masks can, thereby, minimise SARS-CoV-2 infectivity and are particularly relevant for protecting more vulnerable persons from severe COVID-19.

Aerosol emission in professional singing of classical music

In this study, emission rates of aerosols emitted by professional singers were measured with a laser particle counter under cleanroom conditions. The emission rates during singing varied between 753 and 6093 particles/sec with a median of 1537 particles/sec. Emission rates for singing were compared with data for breathing and speaking. Significantly higher emission rates were found for singing. The emission enhancements between singing and speaking were between 4.0 and 99.5 with a median of 17.4, largely due to higher sound pressure levels when singing. Further, significant effects of vocal loudness were found, whereas there were no significant differences between the investigated voice classifications. The present study supports the efforts to improve the risk management in cases of possible aerogenic virus transmission, especially for choir singing.

[COVID-19: acceptance and compliance of PPE (personal protective equipment) and rules for hygiene and reducing contacts in German emergency medical services-a nationwide survey]

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has also significantly burdened and challenged the German emergency medical services (EMS). In this regard, the personal protective equipment (PPE) and rules like wear a mask, stay 6 feet away from others, avoid crowds and poorly ventilated spaces, wash your hands often (called AHA‑L rules in Germany) play an important role in reducing the spread of COVID-19 infections.

OBJECTIVE

The aim of this study is to evaluate the acceptance and compliance of PPE and protective measures among rescue service personnel in Germany during pandemic periods.

METHOD

More than 270 medical directors of EMS were contacted. They were asked to forward a web-based online survey to the rescue stations. Participants were asked about acceptance and compliance in everyday life, in the rescue station, during missions without COVID-19, during missions with COVID-19.

RESULTS

There were n = 1295 participants. Overall acceptance and compliance of PPE and protective measures is high. The lowest acceptance and compliance is found in the questions acceptance (mean = 4.16; ±1.01) and compliance (mean = 4.26; ±0.89) in the rescue station.

CONCLUSION

We recommend targeted training regarding PPE in pandemics and the provision of appropriate premises for conflict-free compliance with AHA‑L rules.

Ozone inactivation of airborne influenza and lack of resistance of respiratory syncytial virus to aerosolization and sampling processes

Influenza and RSV are human viruses responsible for outbreaks in hospitals, long-term care facilities and nursing homes. The present study assessed an air treatment using ozone at two relative humidity conditions (RHs) in order to reduce the infectivity of airborne influenza. Bovine pulmonary surfactant (BPS) and synthetic tracheal mucus (STM) were used as aerosols protectants to better reflect the human aerosol composition. Residual ozone concentration inside the aerosol chamber was also measured. RSV's sensitivity resulted in testing its resistance to aerosolization and sampling processes instead of ozone exposure. The results showed that without supplement and with STM, a reduction in influenza A infectivity of four orders of magnitude was obtained with an exposure to 1.70 ± 0.19 ppm of ozone at 76% RH for 80 min. Consequently, ozone could be considered as a virucidal disinfectant for airborne influenza A. RSV did not withstand the aerosolization and sampling processes required for the use of the experimental setup. Therefore, ozone exposure could not be performed for this virus. Nonetheless, this study provides great insight for the efficacy of ozone as an air treatment for the control of nosocomial influenza A outbreaks.

Prevalence, environmental fate, treatment strategies, and future challenges for wastewater contaminated with SARS-CoV-2

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been detected in untreated and treated wastewater and studies have shown that the concentration of SARS-CoV-2 is proportional to the prevalence of the coronavirus disease 2019 (COVID-19) in communities. This article presents a literature review of the prevalence of SARS-CoV-2 in wastewater, its environmental fate, recommended treatment strategies for contaminated wastewater, and treatment challenges to be faced in the future. The environmental fate of SARS-CoV-2 in wastewater is not straightforward because it can be a source of infection when present in the treated wastewater depending on the permeability of the wastewater treatment plant containment area, and can also leach into aquifers, which may serve as drinking water supplies. Secondly, there are different practices that can mitigate the SARS-CoV-2 infection rate from infected feces and urine. The World Health Organization has recommended the use of ultraviolet radiation (UV), disinfection, and filtration for wastewater contaminated with SARS-CoV-2, processes also common in wastewater treatment facilities. This article discusses these strategies referencing studies performed with surrogate viruses and shows that SARS-CoV-2 treatment can be complicated due to the interference from other aqueous chemical and physical factors. Considering that COVID-19 is not the first and certainly not the last pandemic, it is imperative to develop an effective multitreatment strategy for wastewater contaminated with contagious viruses and, preferably, those that are compatible with current wastewater treatment methods.

Aerosol Dynamics Model for Estimating the Risk from Short-Range Airborne Transmission and Inhalation of Expiratory Droplets of SARS-CoV-2

The highly infectious SARS-CoV-2 novel coronavirus has resulted in a global pandemic. More than a hundred million people are already impacted, with infected numbers expected to go up. Coughing, sneezing, and even talking emit respiratory droplets which can carry infectious viruses. It is important to understand how the exhaled particles move through air to an exposed person to better predict the airborne transmission impacts of SARS-CoV-2. There are many studies conducted on the airborne spread of viruses causing diseases such as SARS and measles; however, there are very limited studies that couple the transport characteristics with the aerosol dynamics of the droplets. In this study, a comprehensive model for simultaneous droplet evaporation and transport due to diffusion, convection, and gravitational settling is developed to determine the near spatial and temporal concentration of the viable virus exhaled by the infected individual. The exposure to the viable virus is estimated by calculating the respiratory deposition, and the risk of infection is determined using a dose-response model. The developed model is used to quantify the risk of short-range airborne transmission of SARS-CoV-2 from inhalation of virus-laden droplets when an infected individual is directly in front of the person exposed and the surrounding air is stagnant. The effect of different parameters, such as viral load, infectivity factor, emission sources, physical separation, exposure time, ambient air velocity, dilution, and mask usage, is determined on the risk of exposure.

Molecular detection of SARS-CoV-2 from indoor air samples in environmental monitoring needs adequate temporal coverage and infectivity assessment

The relevance of airborne exposure to SARS-CoV-2 in indoor environments is a matter of research and debate, with special importance for healthcare low-risk settings. Experimental approaches to the bioaerosol sampling are neither standardized nor optimized yet, leading in some cases to limited representativity of the temporal and spatial variability of viral presence in aerosols. Airborne viral viability moreover needs to be assessed. A study has been conducted collecting five 24-h PM10 samples in a COVID-19 geriatric ward in late June 2020, and detecting E and RdRp genes by RT-qPCR with a Ct between 36 and 39. The viral RNA detection at Ct = 36 was related to the maximal numerosity of infected patients hosted in the ward. Lacking a direct infectivity assessment for the collected samples an experimental model has been defined, by seeding twelve nasopharyngeal swab extracts from COVID-19 positive patients on Vero E6 cells; only the four extracts with a viral load above E+10 viral copies (approximately Ct<24) have been able to establish a persistent infection in vitro. Therefore, the cytopathic effect, a key feature of residual infectivity, could be considered unlikely for the environmental PM₁₀ samples showing amplification of viral RNA at Ct = 36 or higher. A standardization of airborne SARS-CoV-2 long-term monitoring and of environmental infectivity assessment is urgently needed.

Experimental investigation of indoor aerosol dispersion and accumulation in the context of COVID-19: Effects of masks and ventilation

The ongoing COVID-19 pandemic has highlighted the importance of aerosol dispersion in disease transmission in indoor environments. The present study experimentally investigates the dispersion and build-up of an exhaled aerosol modeled with polydisperse microscopic particles (approximately 1 μm mean diameter) by a seated manikin in a relatively large indoor environment. The aims are to offer quantitative insight into the effect of common face masks and ventilation/air purification, and to provide relevant experimental metrics for modeling and risk assessment. Measurements demonstrate that all tested masks provide protection in the immediate vicinity of the host primarily through the redirection and reduction of expiratory momentum. However, leakages are observed to result in notable decreases in mask efficiency relative to the ideal filtration efficiency of the mask material, even in the case of high-efficiency masks, such as the R95 or KN95. Tests conducted in the far field ( 2   m distance from the subject) capture significant aerosol build-up in the indoor space over a long duration ( 10   h ). A quantitative measure of apparent exhalation filtration efficiency is provided based on experimental data assimilation to a simplified model. The results demonstrate that the apparent exhalation filtration efficiency is significantly lower than the ideal filtration efficiency of the mask material. Nevertheless, high-efficiency masks, such as the KN95, still offer substantially higher apparent filtration efficiencies (60% and 46% for R95 and KN95 masks, respectively) than the more commonly used cloth (10%) and surgical masks (12%), and therefore are still the recommended choice in mitigating airborne disease transmission indoors. The results also suggest that, while higher ventilation capacities are required to fully mitigate aerosol build-up, even relatively low air-change rates ( 2   h - 1 ) lead to lower aerosol build-up compared to the best performing mask in an unventilated space.

SARS-CoV-2 detection and genomic sequencing from hospital surface samples collected at UC Davis

RATIONALE

There is little doubt that aerosols play a major role in the transmission of SARS-CoV-2. The significance of the presence and infectivity of this virus on environmental surfaces, especially in a hospital setting, remains less clear.

OBJECTIVES

We aimed to analyze surface swabs for SARS-CoV-2 RNA and infectivity, and to determine their suitability for sequence analysis.

METHODS

Samples were collected during two waves of COVID-19 at the University of California, Davis Medical Center, in COVID-19 patient serving and staff congregation areas. qRT-PCR positive samples were investigated in Vero cell cultures for cytopathic effects and phylogenetically assessed by whole genome sequencing.

MEASUREMENTS AND MAIN RESULTS

Improved cleaning and patient management practices between April and August 2020 were associated with a substantial reduction of SARS-CoV-2 qRT-PCR positivity (from 11% to 2%) in hospital surface samples. Even though we recovered near-complete genome sequences in some, none of the positive samples (11 of 224 total) caused cytopathic effects in cultured cells suggesting this nucleic acid was either not associated with intact virions, or they were present in insufficient numbers for infectivity. Phylogenetic analysis suggested that the SARS-CoV-2 genomes of the positive samples were derived from hospitalized patients. Genomic sequences isolated from qRT-PCR negative samples indicate a superior sensitivity of viral detection by sequencing.

CONCLUSIONS

This study confirms the low likelihood that SARS-CoV-2 contamination on hospital surfaces contains infectious virus, disputing the importance of fomites in COVID-19 transmission. Ours is the first report on recovering near-complete SARS-CoV-2 genome sequences directly from environmental surface swabs.

Use of portable air cleaners to reduce aerosol transmission on a hospital coronavirus disease 2019 (COVID-19) ward

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.

[The effect of mobile air filter systems on aerosol concentrations in large volume scenarios against the background of the risk of infection of COVID-19. Can classroom teaching be resumed?]

BACKGROUND

As a consequence of the corona pandemic, universities nationwide had stopped classroom teaching by the start of the summer semester 2020. As part of the second lockdown, in many states schools and day care centers were also closed or reduced to a minimum. In this context the effect of room air filters has already been discussed multiple times; however, mobile devices for air filtration are currently not recommended by the German Federal Environment Agency. The following investigation shows the real effects of mobile air filters on aerosol concentrations when used in lecture theaters, canteens or school learning centers.

METHODS

The effects of a mobile air purifier (DEMA-airtech, Stuttgart, Germany) were measured in three large rooms (a lecture theater, a company canteen and a learning center of a grammar school). Aerosol and carbon dioxide concentrations were determined with devices from the company Palas (Karlsruhe, Germany).

RESULTS

All three scenarios showed a relevant and permanent decrease in aerosol concentrations through the use of air filters. The effect partly even surpassed the effectiveness of simple ventilation by opening the windows.

CONCLUSION

In addition to social distancing and wearing highly efficient face masks, the use air filters is recommended. This measure could enable classroom teaching to be resumed.

COVID-19 in the Clinic: Aerosol Containment Mask for Endoscopic Otolaryngologic Clinic Procedures

Objective

To create an aerosol containment mask (ACM) that contains aerosols during common otolaryngologic endoscopic procedures while protecting patients from environmental aerosols.

Study Design

Bench testing.

Setting

Mannequin testing.

Methods

The mask was designed in SolidWorks and 3-dimensional printed. Mannequins were fitted with a nebulizer to generate aerosols. Commercial particle counters were used to measure mask performance.

Results

The ACM has 2 ports on either side for instruments and endoscopes, a port for a filter, and a port that can evacuate aerosols contained within the mask via a standard suction pump. The mask contained aerosols on a mannequin with and without facial hair when the suction was set to 18.5 L/min. Other types of masks demonstrated substantial aerosol leakage under similar conditions. In a subsequent experiment, the ACM contained aerosols generated by a nebulizer up to the saturation of the particle detector without measurable leakage with or without suction.

Conclusion

The ACM will accommodate rigid and flexible endoscopes plus instruments and prevent leakage of patient-generated aerosols, thus avoiding contamination of the room and protecting health care workers from airborne contagions.

Level of evidence

2.

A critical review on SARS-CoV-2 infectivity in water and wastewater. What do we know?

The COVID-19 outbreak circulating the world is far from being controlled, and possible contamination routes are still being studied. There are no confirmed cases yet, but little is known about the infection possibility via contact with sewage or contaminated water as well as with aerosols generated during the pumping and treatment of these aqueous matrices. Therefore, this article presents a literature review on the detection of SARS-CoV-2 in human excreta and its pathways through the sewer system and wastewater treatment plants until it reaches the water bodies, highlighting their occurrence and infectivity in sewage and natural water. Research lines are still indicated, which we believe are important for improving the detection, quantification, and mainly the infectivity analyzes of SARS-CoV-2 and other enveloped viruses in sewage and natural water. In fact, up till now, no case of transmission via contact with sewage or contaminated water has been reported and the few studies conducted with these aqueous matrices have not detected infectious viruses. On the other hand, studies are showing that SARS-CoV-2 can remain viable, i.e., infectious, for up to 4.3 and 6 days in sewage and water, respectively, and that other species of coronavirus may remain viable in these aqueous matrices for more than one year, depending on the sample conditions. These are strong pieces of evidence that the contamination mediated by contact with sewage or contaminated water cannot be ruled out, even because other more resistant and infectious mutations of SARS-CoV-2 may appear.

Centrifugal isolation of SARS-CoV-2: numerical simulation for purification of hospitals' air

Coronavirus and its spread all over the world have been the most challenging crisis in 2020. Hospitals are categorized among the most vulnerable centers due to their presumably highest traffic of this virus. In this study, centrifugal isolation of coronavirus is successfully deployed for purifying hospitals’ air using air conditioners and ducts, suggesting an efficient setup. Numerical simulations have been used to testify the proposed setup due to the complexities of using experimental investigation such as high cost and clinical hazards of the airborne SARS-CoV-2 in the air. Results show that a 20-cm pipe with an inlet velocity of 4 m/s constitutes the best choice for the separation and purification of air from the virus. The proposed scalable method also efficiently separates larger particles, but it can separate smaller particles too. Numerical results also suggest installing the air purifying system on the floor of the hospitals’ room for maximum efficiency.

Modeling of aerosol transmission of airborne pathogens in ICU rooms of COVID-19 patients with acute respiratory failure

The COVID-19 pandemic has generated many concerns about cross-contamination risks, particularly in hospital settings and Intensive Care Units (ICU). Virus-laden aerosols produced by infected patients can propagate throughout ventilated rooms and put medical personnel entering them at risk. Experimental results found with a schlieren optical method have shown that the air flows generated by a cough and normal breathing were modified by the oxygenation technique used, especially when using High Flow Nasal Canulae, increasing the shedding of potentially infectious airborne particles. This study also uses a 3D Computational Fluid Dynamics model based on a Lattice Boltzmann Method to simulate the air flows as well as the movement of numerous airborne particles produced by a patient's cough within an ICU room under negative pressure. The effects of different mitigation scenarii on the amount of aerosols potentially containing SARS-CoV-2 that are extracted through the ventilation system are investigated. Numerical results indicate that adequate bed orientation and additional air treatment unit positioning can increase by 40% the number of particles extracted and decrease by 25% the amount of particles deposited on surfaces 45s after shedding. This approach could help lay the grounds for a more comprehensive way to tackle contamination risks in hospitals, as the model can be seen as a proof of concept and be adapted to any room configuration.

SARS-CoV-2 in hospital indoor environments is predominantly non-infectious

Background

The ongoing SARS-CoV-2 pandemic has spread rapidly worldwide and disease prevention is more important than ever. In the absence of a vaccine, knowledge of the transmission routes and risk areas of infection remain the most important existing tools to prevent further spread.

Methods

Here we investigated the presence of the SARS-CoV-2 virus in the hospital environment at the Uppsala University Hospital Infectious Disease ward by RT-qPCR and determined the infectivity of the detected virus in vitro on Vero E6 cells.

Results

SARS-CoV-2 RNA was detected in several areas, although attempts to infect Vero E6 cells with positive samples were unsuccessful. However, RNase A treatment of positive samples prior to RNA extraction did not degrade viral RNA, indicating the presence of SARS-CoV-2 nucleocapsids or complete virus particles protecting the RNA as opposed to free viral RNA.

Conclusion

Our results show that even in places where a moderate concentration (Ct values between 30 and 38) of SARS-CoV-2 RNA was found; no infectious virus could be detected. This suggests that the SARS-CoV-2 virus in the hospital environment subsides in two states; as infectious and as non-infectious. Future work should investigate the reasons for the non-infectivity of SARS-CoV-2 virions.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12985-021-01556-6.

Detection of Environmental Spread of SARS-CoV-2 and Associated Patient Characteristics

Understanding transmission of severe acute respiratory syndrome coronavirus 2 informs infection prevention practices. Air sampling devices were placed in patient hospital rooms for consecutive collections with and without masks. With patient mask use, no virus was detected in the room. High viral load and fewer days from symptom onset were associated with viral particulate dispersion.

Aerosol transmission of SARS-CoV-2 by children and adults during the COVID-19 pandemic

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) can be transmitted via respiratory droplets, aerosols, and to a lesser extent, fomites. Defining the factors driving infectivity and transmission is critical for infection control and containment of this pandemic. We outline the major methods of transmission of SARS-CoV-2, focusing on aerosol transmission. We review principles of aerosol science and discuss their implications for mitigating the spread of SARS-CoV-2 among children and adults.

An investigation for airflow and deposition of PM2.5 contaminated with SAR-CoV-2 virus in healthy and diseased human airway

This study is motivated by the amplified transmission rates of the SAR-CoV-2 virus in areas with high concentrations of fine particulates (PM_2.5) as reported in northern Italy and Mexico. To develop a deeper understanding of the contribution of PM_2.5 in the propagation of the SAR-CoV-2 virus in the population, the deposition patterns and efficiencies (DEs) of PM_2.5 laced with the virus in healthy and asthmatic airways are studied. Physiologically correct 3-D models for generations 10-12 of the human airways are applied to carry out a numerical analysis of two-phase flow for full breathing cycles. Two concentrations of PM_2.5 are applied for the simulation, i.e., 30 μg⋅m^-3 and 80 μg⋅m^-3 for three breathing statuses, i.e., rest, light exercise, and moderate activity. All the PM_2.5 injected into the control volume is assumed to be 100% contaminated with the SAR-CoV-2 virus. Skewed air-flow phenomena at the bifurcations are proportional to the Reynolds number at the inlet, and their intensity in the asthmatic airway exceeded that of the healthy one. Upon exhalation, two peak air-flow vectors from daughter branches combine to form one big vector in the parent generation. Asthmatic airway models has higher deposition efficiencies (DEs) for contaminated PM_2.5 as compared to the healthy one. Higher DEs arise in the asthmatic airway model due to complex secondary flows which increase the impaction of contaminated PM_2.5 on airways' walls.

Exhaled SARS-CoV-2 quantified by face-mask sampling in hospitalised patients with COVID-19

BACKGROUND

Human to human transmission of SARS-CoV-2 is driven by the respiratory route but little is known about the pattern and quantity of virus output from exhaled breath. We have previously shown that face-mask sampling (FMS) can detect exhaled tubercle bacilli and have adapted its use to quantify exhaled SARS-CoV-2 RNA in patients admitted to hospital with Coronavirus Disease-2019 (COVID-19).

METHODS

Between May and December 2020, we took two concomitant FMS and nasopharyngeal samples (NPS) over two days, starting within 24 h of a routine virus positive NPS in patients hospitalised with COVID-19, at University Hospitals of Leicester NHS Trust, UK. Participants were asked to wear a modified duckbilled facemask for 30 min, followed by a nasopharyngeal swab. Demographic, clinical, and radiological data, as well as International Severe Acute Respiratory and emerging Infections Consortium (ISARIC) mortality and deterioration scores were obtained. Exposed masks were processed by removal, dissolution and analysis of sampling matrix strips fixed within the mask by RT-qPCR. Viral genome copy numbers were determined and results classified as Negative; Low: ≤999 copies; Medium: 1000-99,999 copies and High ≥ 100,000 copies per strip for FMS or per 100 µl for NPS.

RESULTS

102 FMS and NPS were collected from 66 routinely positive patients; median age: 61 (IQR 49 - 77), of which FMS was positive in 38% of individuals and concomitant NPS was positive in 50%. Positive FMS viral loads varied over five orders of magnitude (<10-3.3 x 106 genome copies/strip); 21 (32%) patients were asymptomatic at the time of sampling. High FMS viral load was associated with respiratory symptoms at time of sampling and shorter interval between sampling and symptom onset (FMS High: median (IQR) 2 days (2-3) vs FMS Negative: 7 days (7-10), p = 0.002). On multivariable linear regression analysis, higher FMS viral loads were associated with higher ISARIC mortality (Medium FMS vs Negative FMS gave an adjusted coefficient of 15.7, 95% CI 3.7-27.7, p = 0.01) and deterioration scores (High FMS vs Negative FMS gave an adjusted coefficient of 37.6, 95% CI 14.0 to 61.3, p = 0.002), while NPS viral loads showed no significant association.

CONCLUSION

We demonstrate a simple and effective method for detecting and quantifying exhaled SARS-CoV-2 in hospitalised patients with COVID-19. Higher FMS viral loads were more likely to be associated with developing severe disease compared to NPS viral loads. Similar to NPS, FMS viral load was highest in early disease and in those with active respiratory symptoms, highlighting the potential role of FMS in understanding infectivity.

Aerosolized SARS-CoV-2 exposure assessment: dispersion modeling with AERMOD

COVID-19 is now a pandemic and the knowledge gap on SARS-CoV-2, i.e., the COVID-19 disease agent, dispersion persists. The US Centers for Disease Control and Prevention suggests fomites may not be the main route through which the novel coronavirus spreads. Supporting the same view, the latest the World Health Organization report recommends wearing masks for every individual in public, highlighting the transmission through the air. In the current study AERMOD, one of the most validated and tested models suggested by the USEPA, is used to model SARS-CoV-2-laden PM10 in a hypothetical outdoor environment. Multiple scenarios including particle size, wind speed, source height variations as well as and combined scenarios were modeled to estimated how exposure risk changes with the above-mentioned variables. The results reveal that wind speed majorly narrows infectious plume rather than transferring the peak concentration. The particle size variation indicated that small particles, i.e.,0.01 - 2.5 μm, could reach more than 9 m away from the source in concentration range of 10 - 20 (μg/m 3). On the other hand, source height contributes to peak plume shift rather than dispersing the infected particles. This idea was further studies by using combined scenarios which indicated height difference can impact peak plume displacement rather than wind speed. In the worst-case scenario, the results indicate that the virus-laden particles can travel outdoors more than 8 m away from an infected source. The video output of the model results clearly shows the dynamic of viral peak shifts in several scenarios. The results also indicate that in specific conditions the airborne SARS-CoV-2 can be transported to 9 m away from the source. These findings can be useful for individuals as well as decision-makers to mitigated exposure risk in real-world conditions.

Supplementary Information

The online version contains supplementary material available at 10.1007/s40201-020-00602-9.

SARS-CoV-2 aerosol generation during respiratory equipment reprocessing

Aerosolization may occur during reprocessing of medical devices. With the current coronavirus disease 2019 pandemic, it is important to understand the necessity of using respirators in the cleaning area of the sterile processing department. To evaluate the presence of severe acute respiratory syndrome coronavirus (SARS-CoV-2) in the air of the sterile processing department during the reprocessing of contaminated medical devices. Air and surface samples were collected from the sterile processing department of two teaching tertiary hospitals during the reprocessing of respiratory equipment used in patients diagnosed with coronavirus disease 2019 and from intensive care units during treatment of these patients. SARS-CoV-2 was detected only in 1 air sample before the beginning of decontamination process. Viable severe acute respiratory syndrome coronavirus 2 RNA was not detected in any sample collected from around symptomatic patients or in sterile processing department samples. The cleaning of respiratory equipment does not cause aerosolization of SARS-CoV-2. We believe that the use of medical masks is sufficient while reprocessing medical devices during the coronavirus disease 2019 pandemic.

Exhaled CO2 as a COVID-19 Infection Risk Proxy for Different Indoor Environments and Activities

CO2 is co-exhaled with aerosols containing SARS-CoV-2 by COVID-19-infected people and can be used as a proxy of SARS-CoV-2 concentrations indoors. Indoor CO2 measurements by low-cost sensors hold promise for mass monitoring of indoor aerosol transmission risk for COVID-19 and other respiratory diseases. We derive analytical expressions of CO2-based risk proxies and apply them to various typical indoor environments. The relative infection risk in a given environment scales with excess CO2 level, and thus, keeping CO2 as low as feasible in a space allows optimization of the protection provided by ventilation. We show that the CO2 level corresponding to a given absolute infection risk varies by >2 orders of magnitude for different environments and activities. Although large uncertainties, mainly from virus exhalation rates, are still associated with infection risk estimates, our study provides more specific and practical recommendations for low-cost CO2-based indoor infection risk monitoring.

Airborne transmission of COVID-19 and mitigation using box fan air cleaners in a poorly ventilated classroom

Many indoor places, including aged classrooms and offices, prisons, homeless shelters, etc., are poorly ventilated but resource-limited to afford expensive ventilation upgrades or commercial air purification systems, raising concerns on the safety of opening activities in these places in the era of the COVID-19 pandemic. To address this challenge, using computational fluid dynamics, we conducted a systematic investigation of airborne transmission in a classroom equipped with a single horizontal unit ventilator (HUV) and evaluate the performance of a low-cost box fan air cleaner for risk mitigation. Our study shows that placing box fan air cleaners in the classroom results in a substantial reduction of airborne transmission risk across the entire space. The air cleaner can achieve optimal performance when placed near the asymptomatic patient. However, without knowing the location of the patient, the performance of the cleaner is optimal near the HUV with the air flowing downwards. In addition, we find that it is more efficient in reducing aerosol concentration and spread in the classroom by adding air cleaners in comparison with raising the flow rate of HUV alone. The number and placement of air cleaners need to be adjusted to maintain their efficacy for larger classrooms and to account for the thermal gradient associated with a human thermal plume and hot ventilation air during cold seasons. Overall, our study shows that box fan air cleaners can serve as an effective low-cost alternative for mitigating airborne transmission risks in poorly ventilated spaces.

Airborne transmission of SARS-CoV-2 via aerosols

A key consideration in the Covid-19 pandemic is the dominant modes of transmission of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. The objective of this review was to synthesise the evidence for the potential airborne transmission of SARS-CoV-2 via aerosols. Systematic literature searches were conducted in PubMed, Embase, Europe PMC and National Health Service UK evidence up to 27 July 2020. A protocol was published and Cochrane guidance for rapid review methodology was adhered to throughout. Twenty-eight studies were identified. Seven out of eight epidemiological studies suggest aerosol transmission may occur, with enclosed environments and poor ventilation noted as possible contextual factors. Ten of the 16 air sampling studies detected SARS-CoV-2 ribonucleic acid; however, only three of these studies attempted to culture the virus with one being successful in a limited number of samples. Two of four virological studies using artificially generated aerosols indicated that SARS-CoV-2 is viable in aerosols. The results of this review indicate there is inconclusive evidence regarding the viability and infectivity of SARS-CoV-2 in aerosols. Epidemiological studies suggest possible transmission, with contextual factors noted. Viral particles have been detected in air sampling studies with some evidence of clinical infectivity, and virological studies indicate these particles may represent live virus, adding further plausibility. However, there is uncertainty as to the nature and impact of aerosol transmission of SARS-CoV-2, and its relative contribution to the Covid-19 pandemic compared with other modes of transmission.

A guideline to limit indoor airborne transmission of COVID-19

The current revival of the American economy is being predicated on social distancing, specifically the Six-Foot Rule, a guideline that offers little protection from pathogen-bearing aerosol droplets sufficiently small to be continuously mixed through an indoor space. The importance of airborne transmission of COVID-19 is now widely recognized. While tools for risk assessment have recently been developed, no safety guideline has been proposed to protect against it. We here build on models of airborne disease transmission in order to derive an indoor safety guideline that would impose an upper bound on the "cumulative exposure time," the product of the number of occupants and their time in an enclosed space. We demonstrate how this bound depends on the rates of ventilation and air filtration, dimensions of the room, breathing rate, respiratory activity and face mask use of its occupants, and infectiousness of the respiratory aerosols. By synthesizing available data from the best-characterized indoor spreading events with respiratory drop size distributions, we estimate an infectious dose on the order of 10 aerosol-borne virions. The new virus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) is thus inferred to be an order of magnitude more infectious than its forerunner (SARS-CoV), consistent with the pandemic status achieved by COVID-19. Case studies are presented for classrooms and nursing homes, and a spreadsheet and online app are provided to facilitate use of our guideline. Implications for contact tracing and quarantining are considered, and appropriate caveats enumerated. Particular consideration is given to respiratory jets, which may substantially elevate risk when face masks are not worn.

A guideline to limit indoor airborne transmission of COVID-19

The current revival of the American economy is being predicated on social distancing, specifically the Six-Foot Rule, a guideline that offers little protection from pathogen-bearing aerosol droplets sufficiently small to be continuously mixed through an indoor space. The importance of airborne transmission of COVID-19 is now widely recognized. While tools for risk assessment have recently been developed, no safety guideline has been proposed to protect against it. We here build on models of airborne disease transmission in order to derive an indoor safety guideline that would impose an upper bound on the "cumulative exposure time," the product of the number of occupants and their time in an enclosed space. We demonstrate how this bound depends on the rates of ventilation and air filtration, dimensions of the room, breathing rate, respiratory activity and face mask use of its occupants, and infectiousness of the respiratory aerosols. By synthesizing available data from the best-characterized indoor spreading events with respiratory drop size distributions, we estimate an infectious dose on the order of 10 aerosol-borne virions. The new virus (severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2]) is thus inferred to be an order of magnitude more infectious than its forerunner (SARS-CoV), consistent with the pandemic status achieved by COVID-19. Case studies are presented for classrooms and nursing homes, and a spreadsheet and online app are provided to facilitate use of our guideline. Implications for contact tracing and quarantining are considered, and appropriate caveats enumerated. Particular consideration is given to respiratory jets, which may substantially elevate risk when face masks are not worn.

Isolation of SARS-CoV-2 from the air in a car driven by a COVID patient with mild illness

Objective

To determine if viable virus could be isolated from the air within a car driven by a patient infected with SARS-CoV-2, and to assess the size range of the infectious particles.

Methods

We used a Sioutas personal cascade impactor sampler (PCIS) to screen for SARS-CoV-2 in a car driven by a COVID-19 patient. The patient, who had only mild illness without fever or cough and was not wearing a mask, drove the car for 15 min with the air conditioning turned on and windows closed. The PCIS was clipped to the sun-visor above the front passenger seat and was retrieved from the car two hours after completion of the drive.

Results

SARS-CoV-2 was detectable at all PCIS stages by PCR and was cultured from the section of the sampler collecting particles in the 0.25–0.50 μm size range.

Conclusions

Our data highlight the potential risk of SARS-CoV-2 transmission by minimally symptomatic persons in the closed space inside of a car and suggest that a substantial component of that risk is via aerosolized virus.

Integration of sample preparation with RNA-Amplification in a hand-held device for airborne virus detection

Aerosol transmission is one of the three major transmission routes of respiratory viruses. However, the dynamics and significance of the aerosol transmission route are not well understood, partially due to the lack of rapid and efficient tools for on-the-spot detection of airborne viruses. We report a hand-held device that integrates a 3D-printed sample preparation unit with a laminated paper-based RNA amplification unit. The sample preparation unit features an innovative reagent delivery scheme based on a ball-based valve capable of storing and delivering reagents through the rotation of the unit without manual pipetting, while the paper-based unit enables RNA enrichment and reverse transcription loop-mediated isothermal amplification (RT-LAMP). We have determined the detection limit of the integrated sample-preparation/amplification device (SPAD) at 1 TCID₅₀ H1N1 influenza viruses in 140 μL aqueous sample. Further, we integrated SPAD with a previously reported viable virus aerosol sampler (VIVAS), a water-vapor-based condensational growth system capable of collecting aerosolized virus particles (Pan et al., 2016) [1]. Using the combined VIVAS-SPAD platform, we have demonstrated the collection/detection of lab-generated, airborne H1N1 influenza viruses in 65 min, suggesting that the platform has a potential for detecting and monitoring airborne virus transmission during outbreaks. The effective sampling and rapid detection of airborne viruses by the sample-to-answer platform will also help us better understand the dynamics and significance of aerosol transmission of infectious disease.

Integrative overview of antibodies against SARS-CoV-2 and their possible applications in COVID-19 prophylaxis and treatment

SARS-CoV-2 is a novel β-coronavirus that caused the COVID-19 pandemic disease, which spread rapidly, infecting more than 134 million people, and killing almost 2.9 million thus far. Based on the urgent need for therapeutic and prophylactic strategies, the identification and characterization of antibodies has been accelerated, since they have been fundamental in treating other viral diseases. Here, we summarized in an integrative manner the present understanding of the immune response and physiopathology caused by SARS-CoV-2, including the activation of the humoral immune response in SARS-CoV-2 infection and therefore, the synthesis of antibodies. Furthermore, we also discussed about the antibodies that can be generated in COVID-19 convalescent sera and their associated clinical studies, including a detailed characterization of a variety of human antibodies and identification of antibodies from other sources, which have powerful neutralizing capacities. Accordingly, the development of effective treatments to mitigate COVID-19 is expected. Finally, we reviewed the challenges faced in producing potential therapeutic antibodies and nanobodies by cell factories at an industrial level while ensuring their quality, efficacy, and safety.

The Promise and Pitfalls of Environmental DNA and RNA Approaches for the Monitoring of Human and Animal Pathogens from Aquatic Sources

Novel forensics-inspired molecular approaches have revolutionized species detection in the wild and are particularly useful for tracing endangered or invasive species. These new environmental DNA or RNA (eDNA or eRNA)–based techniques are now being applied to human and animal pathogen surveillance, particularly in aquatic environments. They allow better disease monitoring (presence or absence and geographical spread) and understanding of pathogen occurrence and transmission, benefitting species conservation and, more recently, our understanding of the COVID-19 global human pandemic. In the present article, we summarize the benefits of eDNA-based monitoring, highlighted by two case studies: The first is a fibropapillomatosis tumor-associated herpesvirus (chelonid herpesvirus 5) driving a sea turtle panzootic, and the second relates to eRNA-based detection of the SARS-CoV-2 coronavirus driving the COVID-19 human pandemic. The limitations of eDNA- or eRNA-based approaches are also summarized, and future directions and recommendations of the field are discussed. Continuous eDNA- or eRNA-based monitoring programs can potentially improve human and animal health by predicting disease outbreaks in advance, facilitating proactive rather than reactive responses.

SARS-CoV-2 Positivity on or After 9 Days Among Quarantined Student Contacts of Confirmed Cases

This study describes coronavirus test positivity rates among elementary, middle, and high school student contacts of confirmed COVID-19 cases in a Florida county where schools required a negative test on day 9 before return to school on day 10.

Heterogeneity in transmissibility and shedding SARS-CoV-2 via droplets and aerosols

Background

Which virological factors mediate overdispersion in the transmissibility of emerging viruses remains a long-standing question in infectious disease epidemiology.

Methods

Here, we use systematic review to develop a comprehensive dataset of respiratory viral loads (rVLs) of SARS-CoV-2, SARS-CoV-1 and influenza A(H1N1)pdm09. We then comparatively meta-analyze the data and model individual infectiousness by shedding viable virus via respiratory droplets and aerosols.

Results

The analyses indicate heterogeneity in rVL as an intrinsic virological factor facilitating greater overdispersion for SARS-CoV-2 in the COVID-19 pandemic than A(H1N1)pdm09 in the 2009 influenza pandemic. For COVID-19, case heterogeneity remains broad throughout the infectious period, including for pediatric and asymptomatic infections. Hence, many COVID-19 cases inherently present minimal transmission risk, whereas highly infectious individuals shed tens to thousands of SARS-CoV-2 virions/min via droplets and aerosols while breathing, talking and singing. Coughing increases the contagiousness, especially in close contact, of symptomatic cases relative to asymptomatic ones. Infectiousness tends to be elevated between 1 and 5 days post-symptom onset.

Conclusions

Intrinsic case variation in rVL facilitates overdispersion in the transmissibility of emerging respiratory viruses. Our findings present considerations for disease control in the COVID-19 pandemic as well as future outbreaks of novel viruses.

Funding

Natural Sciences and Engineering Research Council of Canada (NSERC) Discovery Grant program, NSERC Senior Industrial Research Chair program and the Toronto COVID-19 Action Fund.

Nosocomial outbreak of COVID-19 by possible airborne transmission leading to a superspreading event

Background

Nosocomial outbreaks with superspreading of COVID-19 due to a possible airborne transmission has not been reported.

Methods

Epidemiological analysis, environmental samplings, and whole genome sequencing (WGS) were performed for a hospital outbreak.

Results

A superspreading event involving 12 patients and 9 healthcare workers (HCWs) occurred within 4 days in 3 of 6 cubicles at an old-fashioned general ward with no air exhaust built within the cubicles. The environmental contamination by SARS-CoV-2 RNA was significantly higher in air grilles (>2m from patients’ head and not reachable by hands) than high-touch clinical surfaces (36.4%, 8/22 vs 3.4%, 1/29, p=0.003). Six (66.7%) of 9 contaminated air exhaust grilles were located outside patient cubicle. The clinical attack rate of patients was significantly higher than HCWs (15.4%, 12/78 exposed-patients vs 4.6%, 9/195 exposed-HCWs, p=0.005). Moreover, clinical attack rate of ward-based HCWs was significantly higher than non-ward-based HCWs (8.1%, 7/68 vs 1.8%, 2/109, p=0.045). The episodes (mean ± S.D) of patient-care duty assignment in the cubicles was significantly higher among infected ward-based HCWs than non-infected ward-based HCWs (6.0±2.4 vs 3.0±2.9, p=0.012) during the outbreak period. The outbreak strains belong to SARS-CoV-2 lineage, B.1.36.27 (GISAID Clade GH) with the unique S-T470N mutation on WGS.

Conclusion

This nosocomial point source superspreading due to possible airborne transmission demonstrated the need for stringent SARS-CoV-2 screening at admission to healthcare facilities and better architectural design of the ventilation system to prevent such outbreaks. Portable high-efficiency particulate filters were installed in each cubicle to improve ventilation before resumption of clinical service.

Aerosol Transmission of Coronavirus and Influenza Virus of Animal Origin

Coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has caused great harm to global public health, resulting in a large number of infections among the population. However, the epidemiology of coronavirus has not been fully understood, especially the mechanism of aerosol transmission. Many respiratory viruses can spread via contact and droplet transmission, but increasing epidemiological data have shown that viral aerosol is an essential transmission route of coronavirus and influenza virus due to its ability to spread rapidly and high infectiousness. Aerosols have the characteristics of small particle size, long-time suspension and long-distance transmission, and easy access to the deep respiratory tract, leading to a high infection risk and posing a great threat to public health. In this review, the characteristics of viral aerosol generation, transmission, and infection as well as the current advances in the aerosol transmission of zoonotic coronavirus and influenza virus are summarized. The aim of the review is to strengthen the understanding of viral aerosol transmission and provide a scientific basis for the prevention and control of these diseases.

From impossible to possible: the lessons from the control of recent COVID-19 outbreaks in China

The COVID-19 pandemic has catastrophically impacted the world. Before the success in vaccination, this virus shows no sign of stop spreading. Nearly all the countries have implemented stringent approaches to slow down the transmission of the virus, but the virus still caused over 2 million deaths and the number is increasing. Therefore, preventing the virus spreading is still necessary to protect most people, especially the ones with pre-conditions. Mainland China has successfully eradicated the COVID-19 virus infection in Wuhan in 2020. After that, several small-scale outbreaks occurred in many cities in China, but none of these COVID-19 virus infections caused the widespread. In this review, we would like to give a detailed presentation of the approaches that were implemented by the China government to suppress the virus spreading by considering the unique characteristics of this virus and the paths of the virus transmission. Both the pros and cons of these strategies will also be analyzed. The experiences and lessons learned during the virus-fighting in China, expectedly, will be a useful source of reference for other regions in overcoming the threat caused by the COVID-19 virus.

Airborne spread of infectious SARS-CoV-2: Moving forward using lessons from SARS-CoV and MERS-CoV

BACKGROUND

Although an increasing body of data reports the detection of SARS-CoV-2 RNA in air, this does not correlate to the presence of infectious viruses, thus not evaluating the risk for airborne COVID-19. Hence there is a marked knowledge gap that requires urgent attention. Therefore, in this systematic review, viability/stability of airborne SARS-CoV-2, SARS-CoV and MERS-CoV viruses is discussed.

METHODS

A systematic literature review was performed on PubMed/MEDLINE, Web of Science and Scopus to assess the stability and viability of SARS-CoV, MERS-CoV and SARS-CoV-2 on air samples.

RESULTS AND DISCUSSION

The initial search identified 27 articles. Following screening of titles and abstracts and removing duplicates, 11 articles were considered relevant. Temperatures ranging from 20 °C to 25 °C and relative humidity ranging from 40% to 50% were reported to have a protective effect on viral viability for airborne SARS-CoV and MERS-CoV. As no data is yet available on the conditions influencing viability for airborne SARS-CoV-2, and given the genetic similarity to SARS-CoV and MERS-CoV, one could extrapolate that the same conditions would apply. Nonetheless, the effect of these conditions seems to be residual considering the increasing number of cases in the south of USA, Brazil and India, where high temperatures and humidities have been observed.

CONCLUSION

Higher temperatures and high relative humidity can have a modest effect on SARS-CoV-2 viability in the environment, as reported in previous studies to this date. However, these studies are experimental, and do not support the fact that the virus has efficiently spread in the tropical regions of the globe, with other transmission routes such as the contact and droplet ones probably being responsible for the majority of cases reported in these regions, along with other factors such as human mobility patterns and contact rates. Further studies are needed to investigate the extent of aerosol transmission of SARS-CoV-2 as this would have important implications for public health and infection-control policies.

Greater than 3-Log Reduction in Viable Coronavirus Aerosol Concentration in Ducted Ultraviolet-C (UV-C) Systems

Control technologies to inactivate airborne viruses effectively are needed during the ongoing SARS-CoV-2 pandemic, and to guard against airborne transmitted diseases. We demonstrate that sealed UV-C flow reactors operating with fluences near 253 ± 1 nm of 13.9-49.6 mJ cm-2 efficiently inactivate coronaviruses in an aerosol. For measurements, porcine respiratory coronavirus (PRCV) was nebulized in a custom-built, 3.86 m wind tunnel housed in a biosafety level class II facility. The single pass log10 reduction of active coronavirus was in excess of 2.2 at a flow rate of 2439 L min-1 (13.9 mJ cm-2) and in excess of 3.7 (99.98% removal efficiency) at 684 L min-1 (49.6 mJ cm-2). Because virus titers resulting from sampling downstream of the UV-C reactor were below the limit of detection, the true log reduction is likely even higher than measured. Comparison of virus titration results to reverse transcriptase quantitative PCR and measurement of fluorescein concentrations (doped into the nebulized aerosol) reveals that the reduction in viable PRCV is primarily due to UV-C based inactivation, as opposed to physical collection of virus. The results confirm that UV-C flow reactors can efficiently inactivate coronaviruses through incorporation into HVAC ducts or recirculating air purifiers.

The stability of an isolate of the SARS-CoV-2 B.1.1.7 lineage in aerosols is similar to three earlier isolates

Background

Our laboratory previously examined the influence of environmental conditions on the stability of an early isolate of SARS-CoV-2 (hCoV-19/USA/WA-1/2020) in aerosols generated from culture medium or simulated saliva. However, genetic differences have emerged among SARS-CoV-2 lineages, and it is possible that these differences may affect environmental stability and the potential for aerosol transmission.

Methods

The influence of temperature, relative humidity, and simulated sunlight on the decay of four SARS-CoV-2 isolates in aerosols, including one belonging to the recently emerged B.1.1.7 lineage, were compared in a rotating drum chamber. Aerosols were generated from simulated respiratory tract lining fluid to represent aerosols originating from the deep lung.

Results

No differences in the stability of the isolates were observed in the absence of simulated sunlight at either 20°C or 40°C. However, a small but statistically significant difference in the stability was observed between some isolates in simulated sunlight at 20°C and 20% relative humidity. .

Conclusions

The stability of SARS-CoV-2 in aerosols does not vary greatly among currently circulating lineages, including B.1.1.7, suggesting that the increased transmissibility associated with recent SARS-CoV-2 lineages is not due to enhanced survival in the environment.

Estimating aerosol transmission risk of SARS-CoV-2 in New York City public schools during reopening

The objective of this study was to estimate the risk of SARS-CoV-2 transmission among students and teachers in New York City public schools, the largest school system in the US. Classroom measurements conducted from December 2017 to September 2018 were used to estimate risk of SARS-CoV-2 transmission using a modified Wells-Riley equation under a steady-state conditions and varying exposure scenarios (infectious student versus teacher, susceptible student versus teacher, with and without masks). We then used multivariable linear regression with GEE to identify school and classroom factors that impact transmission risk. Overall, 101 classrooms in 19 schools were assessed, 86 during the heating season, 69 during cooling season, and 54 during both. The mean probability of transmission was generally low but varied by scenario (range: 0.0015-0.81). Transmission rates were higher during the heating season (beta=0.108, p=0.010), in schools in higher income neighborhoods (>80K versus 20K-40K beta=0.196, p<0.001) and newer buildings (<50 years beta=0.237, p=<0.001; 50-99 years beta=0.230, p=0.013 versus 100+ years) and lower in schools with mechanical ventilation (beta=0.141, p=0.057). Surprisingly, schools located in older buildings and lower-income neighborhoods had lower transmission probabilities, likely due to the greater outdoor airflow associated with an older, non-renovated buildings that allow air to leak in (i.e. drafty buildings). Despite the generally low risk of school-based transmission found in this study, with SARS-CoV-2 prevalence rising in New York City this risk will increase and additional mitigation steps should be implemented in schools now.