On-site analysis of COVID-19 on the surfaces in wards

Indirect Virus Transmission via Fomites Can Counteract Lock-Down Effectiveness

The spread of severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) has raised major health policy questions. Direct transmission via respiratory droplets seems to be the dominant route of its transmission. However, indirect transmission via shared contact of contaminated objects may also occur. The contribution of each transmission route to epidemic spread might change during lock-down scenarios. Here, we simulate viral spread of an abstract epidemic considering both routes of transmission by use of a stochastic, agent-based SEIR model. We show that efficient contact tracing (CT) at a high level of incidence can stabilize daily cases independently of the transmission route long before effects of herd immunity become relevant. CT efficacy depends on the fraction of cases that do not show symptoms. Combining CT with lock-down scenarios that reduce agent mobility lowers the incidence for exclusive direct transmission scenarios and can even eradicate the epidemic. However, even for small fractions of indirect transmission, such lockdowns can impede CT efficacy and increase case numbers. These counterproductive effects can be reduced by applying measures that favor distancing over reduced mobility. In summary, we show that the efficacy of lock-downs depends on the transmission route. Our results point to the particular importance of hygiene measures during mobility lock-downs.

SARS-CoV-2 indoor environment contamination with epidemiological and experimental investigations

SARS-CoV-2 has been detected both in air and on surfaces, but questions remain about the patient-specific and environmental factors affecting virus transmission. Additionally, more detailed information on viral sampling of the air is needed. This prospective cohort study (N = 56) presents results from 258 air and 252 surface samples from the surroundings of 23 hospitalized and eight home-treated COVID-19 index patients between July 2020 and March 2021 and compares the results between the measured environments and patient factors. Additionally, epidemiological and experimental investigations were performed. The proportions of qRT-PCR-positive air (10.7% hospital/17.6% homes) and surface samples (8.8%/12.9%) showed statistical similarity in hospital and homes. Significant SARS-CoV-2 air contamination was observed in a large (655.25 m³ ) mechanically ventilated (1.67 air changes per hour, 32.4-421 L/s/patient) patient hall even with only two patients present. All positive air samples were obtained in the absence of aerosol-generating procedures. In four cases, positive environmental samples were detected after the patients had developed a neutralizing IgG response. SARS-CoV-2 RNA was detected in the following particle sizes: 0.65-4.7 μm, 7.0-12.0 μm, >10 μm, and <100 μm. Appropriate infection control against airborne and surface transmission routes is needed in both environments, even after antibody production has begun.

Hundreds-Dollar-Level Multiplex Integrated RT-qPCR Quantitative System for Field Detection

The COVID-19 pandemic poses a threat to global health. Due to its high sensitivity, specificity, and stability, real-time fluorescence quantitative (real-time PCR) detection has become the most extensively used approach for diagnosing SARS-CoV-2 pneumonia. According to a report from the World Health Organization, emerging and underdeveloped nations lack nucleic acid detection kits and polymerase chain reaction (PCR) instruments for molecular biological detection. In addition, sending samples to a laboratory for testing may result in considerable delays between sampling and diagnosis, which is not favorable to the timely prevention and control of new crown outbreaks. Concurrently, there is an urgent demand for accurate PCR devices that do not require a laboratory setting, are more portable, and are capable of completing testing on-site. Hence, we report on HDLRT-qPCR, a new, low-cost, multiplexed real-time fluorescence detection apparatus that we have developed for on-site testing investigations of diverse diseases in developing nations. This apparatus can complete on-site testing rapidly and sensitively. The entire cost of this instrument does not exceed USD 760. In order to demonstrate the applicability of our PCR instrument, we conducted testing that revealed that we achieved gradient amplification and melting curves comparable to those of commercially available equipment. Good consistency characterized the testing outcomes. The successful detection of target genes demonstrates the reliability of our inexpensive PCR diagnostic technique. With this apparatus, there is no need to transport samples to a central laboratory; instead, we conduct testing at the sampling site. This saves time on transportation, substantially accelerates overall testing speed, and provides results within 40 min.

Mechanical Wiping Increases the Efficacy of Liquid Disinfectants on SARS-CoV-2

High-touch environmental surfaces are acknowledged as potential sources of pathogen transmission, particularly in health care settings where infectious agents may be readily abundant. Methods of disinfecting these surfaces often include direct application of a chemical disinfectant or simply wiping the surface with a disinfectant pre-soaked wipe (DPW). In this study, we examine the ability of four disinfectants, ethanol (EtOH), sodium hypochlorite (NaOCl), chlorine dioxide (ClO2), and potassium monopersulfate (KMPS), to inactivate SARS-CoV-2 on a hard, non-porous surface, assessing the effects of concentration and contact time. The efficacy of DPWs to decontaminate carriers spiked with SARS-CoV-2, as well as the transferability of the virus from used DPWs to clean surfaces, is also assessed. Stainless steel carriers inoculated with approximately 6 logs of SARS-CoV-2 prepared in a soil load were disinfected within 5 min through exposure to 66.5% EtOH, 0.5% NaOCl, and 1% KMPS. The addition of mechanical wiping using DPWs impregnated with these biocides rendered the virus inactive almost immediately, with no viral transfer from the used DPW to adjacent surfaces. Carriers treated with 100 ppm of ClO2 showed a significant amount of viable virus remaining after 10 min of biocide exposure, while the virus was only completely inactivated after 10 min of treatment with 500 ppm of ClO2. Wiping SARS-CoV-2-spiked carriers with DPWs containing either concentration of ClO2 for 5 s left significant amounts of viable virus on the carriers. Furthermore, higher titers of infectious virus retained on the ClO2-infused DPWs were transferred to uninoculated carriers immediately after wiping. Overall, 66.5% EtOH, 0.5% NaOCl, and 1% KMPS appear to be highly effective biocidal agents against SARS-CoV-2, while ClO2 formulations are much less efficacious.

How surface and fomite infection affect contagion dynamics: a study with self-propelled particles

Self-propelled particles have been a tool of choice for many studies for understanding spatial interaction of people and propagation of infectious diseases. Other than the direct contagion process through face-to-face contacts with an infected agent, in some diseases, like COVID-19, the disease can spread by indirect ways, through contaminated object surfaces and puff-clouds created by the infected individual. However, this dual spreading process and the impact of these indirect infections in the entire dynamics are not properly explored. In this work, we consider epidemic spreading in an artificial society, with realistic parameters and movements of people, along with the possibilities of indirect exposure through contaminated surfaces and puff-clouds. This particular simulation based infectious disease dynamics is associated with the movements of some self-propelled free agents executing random motion which is investigated in conjunction with the rules of a realistic contagion process. With mathematical formulation and extensive computational studies, we have accommodated the indirect infection possibilities into the dynamics by incorporating an infectious 'tail' with the infected individuals. Analytical expressions of survival distance and infection probability of individuals have been explicitly calculated and reported. Results of precise and comparative simulation study have revealed the seriousness of indirect infections in connection with several dynamical parameters. Using this framework, interpretation of multiple waves in local as well as global scenarios have been established for COVID-19 infection statistics. Furthermore, the importance of indirect infections are also pointed out through data fitting, showing that ignoring this component might cause a misinterpretation of the dynamical parameters, like, imposed restrictions.

Transmission of COVID-19 and other infectious diseases in public washrooms: A systematic review

BACKGROUND

The risk of infectious disease transmission in public washrooms causes concern particularly in the context of the COVID-19 pandemic. This systematic review aims to assess the risk of transmission of viral or bacterial infections through inhalation, surface contact, and faecal-oral routes in public washrooms in healthcare and non-healthcare environments.

METHODS

We systematically reviewed environmental sampling, laboratory, and epidemiological studies on viral and bacterial infection transmission in washrooms using PubMed and Scopus. The review focused on indoor, publicly accessible washrooms.

RESULTS

Thirty-eight studies from 13 countries were identified, including 14 studies carried out in healthcare settings, 10 in laboratories or experimental chambers, and 14 studies in restaurants, workplaces, commercial and academic environments. Thirty-three studies involved surface sampling, 15 air sampling, 8 water sampling, and 5 studies were risk assessments or outbreak investigations. Infectious disease transmission was studied in relation with: (a) toilets with flushing mechanisms; (b) hand drying systems; and (c) water taps, sinks and drains. A wide range of enteric, skin and soil bacteria and enteric and respiratory viruses were identified in public washrooms, potentially posing a risk of infection transmission. Studies on COVID-19 transmission only examined washroom contamination in healthcare settings.

CONCLUSION

Open-lid toilet flushing, ineffective handwashing or hand drying, substandard or infrequent surface cleaning, blocked drains, and uncovered rubbish bins can result in widespread bacterial and/or viral contamination in washrooms. However, only a few cases of infectious diseases mostly related to faecal-oral transmission originating from washrooms in restaurants were reported. Although there is a risk of microbial aerosolisation from toilet flushing and the use of hand drying systems, we found no evidence of airborne transmission of enteric or respiratory pathogens, including COVID-19, in public washrooms. Appropriate hand hygiene, surface cleaning and disinfection, and washroom maintenance and ventilation are likely to minimise the risk of infectious disease transmission.

Generative design of 3D printed hands-free door handles for reduction of contagion risk in public buildings

During the emergency caused by COVID 19 evidence has been provided about the risk of easily getting the virus by touching contaminated surfaces and then by touching eyes, mouth, or nose with infected hands. In view of the restarting of daily activities in presence, it is paramount to put in place any strategy that, in addition to social distancing, is capable to positively impact on the safety levels in public buildings by reducing such risk. The main aim of this paper is to conceive a design methodology, based on a digital, flawless, and sustainable procedure, for producing human-building interfacing solutions that allow anybody to interact in a safer and more comfortable way. Such solutions are focused on the adaptation of existing buildings features and are thought to be an alternative to sensor based touchless technology when this is not applicable due to economic or time constraints. The process is based on the integration of digital technologies such as 3D Scanning, Generative Design and Additive Manufacturing and is optimised to be intuitive and to be adaptive, hence, to be replicable on different kinds of surfaces. The design concept is finalised to generate automatically different products that meet geometry fitting requirements and therefore adapt to the specific geometries of existing handles. A specific case on Hands Free Door Handles is presented and the results of manufacturing and preliminary validation process are provided and discussed.

Environmental contamination with SARS-CoV-2 in nursing homes

BACKGROUND

SARS-CoV-2 outbreaks in nursing homes (NHs) have been devastating and have led to the creation of coronavirus disease 2019 (COVID-19) units within NHs to care for affected patients. Frequency and persistence of SARS-CoV-2 environmental contamination in these units have not been studied.

METHODS

A prospective cohort study was conducted between October 2020 and January 2021 in four Michigan NHs. Swabs from high-touch surfaces in COVID-19-infected patient rooms were obtained at enrollment and follow-up. Demographic and clinical data were collected from clinical records. Primary outcome of interest was the probability of SARS-CoV-2 RNA detection from specific environmental surfaces in COVID-19 patient rooms. We used multivariable logistic regression to assess patient risk factors for SARS-CoV-2 contamination. Pairwise Phi coefficients were calculated to measure correlation of site-specific environmental detection upon enrollment and during follow-up.

RESULTS

One hundred and four patients with COVID-19 were enrolled (61.5% >80 years; 67.3% female; 89.4% non-Hispanic White; 51% short stay) and followed up for 241 visits. The study population had significant disabilities in activities of daily living (ADL; 81.7% dependent in four or more ADLs) and comorbidities, including dementia (55.8%), diabetes (40.4%), and heart failure (32.7%). Over the 3-month study period, 2087 swab specimens were collected (1896 COVID-19 patient rooms, 191 common areas). SARS-CoV-2 positivity was 28.4% (538/1896 swabs) on patient room surfaces and 3.7% (7/191 swabs) on common area surfaces. Nearly 90% (93/104) of patients had SARS-CoV-2 contamination in their room at least once. Environmental contamination upon enrollment correlated with contamination of the same site during follow-up. Functional independence increased the odds of proximate contamination.

CONCLUSIONS

Environmental detection of viral RNA from surfaces in the rooms of COVID-19 patients is nearly universal and persistent; more investigation is needed to determine the implications of this for infectiousness. Patients with greater independence are more likely than fully dependent patients to contaminate their immediate environment.

The SARS-CoV-2 (COVID-19) pandemic in hospital: An insight into environmental surfaces contamination, disinfectants' efficiency, and estimation of plastic waste production

The current COVID-19 pandemic that is caused by SARS-CoV-2 has led all the people around the globe to implement preventive measures such as environmental cleaning using alcohol-based materials, and social distancing in order to prevent and minimize viral transmission via fomites. The role of environmental surface contamination in viral transmission in within hospital wards is still debatable, especially considering the spread of new variants of the virus in the world. The present comprehensive study aims to investigate environmental surface contamination in different wards of a hospital as well as the efficacy of two common disinfectants for virus inactivation, and tries to produce an estimate of plastic residue pollution as an environmental side effect of the pandemic. With regard to environmental surface contamination, 76 samples were taken from different wards of the hospital, from which 40 were positive. These samples were taken from contaminated environmental surfaces such as patient bed handles, the nursing station, toilet door handles, cell phones, patient toilet sinks, toilet bowls, and patient's pillows, which are regularly-touched surfaces and can pose a high risk for transmission of the virus. The number of positive samples also reveals that SARS-CoV-2 can survive on inanimate surfaces after disinfection by ethanol 70 % and sodium hypochlorite (0.001 %). The results correspond to the time that the VOC 202012/01 (lineage B.1.1.7) had emerged in the hospital and this should be considered that this variant could possibly have different traits, characteristics, and level of persistence in the environment. The plastic waste as an environmental side effect of the pandemic was also investigated and it was confirmed that the amount of plastic residue for a single (RT) PCR confirmatory test for COVID-19 diagnosis is 821.778 g of plastic residue/test. As a result, it is recommended that for improving plastic waste management programs, considering challenges such as minimizing plastic waste pollution, optimization of gas control technologies in incinerators, process redesign, reduction of single-use plastics and PPE, etc. Is of utmost importance.

What is the risk of acquiring SARS-CoV-2 from the use of public toilets?

Public toilets and bathrooms may act as a contact hub point where community transmission of SARS-CoV-2 occurs between users. The mechanism of spread would arise through three mechanisms: inhalation of faecal and/or urinary aerosol from an individual shedding SARS-CoV-2; airborne transmission of respiratory aerosols between users face-to-face or during short periods after use; or from fomite transmission via frequent touch sites such as door handles, sink taps, lota or toilet roll dispenser. In this respect toilets could present a risk comparable with other high throughput enclosed spaces such as public transport and food retail outlets. They are often compact, inadequately ventilated, heavily used and subject to maintenance and cleaning issues. Factors such as these would compound the risks generated by toilet users incubating or symptomatic with SARS-CoV-2. Furthermore, toilets are important public infrastructure since they are vital for the maintenance of accessible, sustainable and comfortable urban spaces. Given the lack of studies on transmission through use of public toilets, comprehensive risk assessment relies upon the compilation of evidence gathered from parallel studies, including work performed in hospitals and prior work on related viruses. This narrative review examines the evidence suggestive of transmission risk through use of public toilets and concludes that such a risk cannot be lightly disregarded. A range of mitigating actions are suggested for both users of public toilets and those that are responsible for their design, maintenance and management.

Wastewater monitoring, surveillance and epidemiology: a review of terminology for a common understanding

Response to the COVID-19 (coronavirus disease 2019) pandemic saw an unprecedented uptake in bottom-up efforts to incorporate community wastewater testing to inform public health. While not a new strategy, various specialized scientific advancements were achieved to establish links between wastewater concentrations of SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) and public health outcomes. Maximizing public health benefit requires collaboration among a broad range of disciplinary experts, each bringing their own historical context to the central goal of protecting human health. One challenge has been a lack of shared terminology. Standardized terminology would provide common ground for this rapidly growing field. Based on the review herein, we recommend categorical usage of the term 'wastewater-based epidemiology' to describe the science of relating microbes, chemicals or other analytes in wastewater to public health. We further recommend the term 'wastewater surveillance' to describe continuous monitoring of health outcomes (either microbes or chemicals) via wastewater. We suggest that 'wastewater tracking' and 'wastewater tracing' be used in more narrow ways, specifically when trying to find the source of a health risk. Finally, we suggest that the phrase 'wastewater monitoring' be abandoned, except in rare circumstances when ensuring wastewater discharge is safe from a public health perspective.

Investigation of SARS CoV-2 virus in environmental surface

The prevalent respiratory viruses such as SARS-CoV-2 probably persist for a long time on fomites and environmental surfaces. Some recent studies have detected SARS-CoV-2 RNA on the surface of cell phones, door handles and other items in the inhabited sites of confirmed cases. For the aim of this study, a total of 50 environmental surface samples of SARS-CoV-2 was collected from Imam Khomeini Hospital in Ardabil. Forty-one environmental surface samples were proved negative for SARS-CoV-2 RNA while nine surface samples were positive. Our findings regarding surfaces contaminated with the virus are consistent with the results of recent similar researches as it was revealed that a number of different samples taken from hospital surfaces such as handles, cupboards, light switches, and door handles were positive for the presence of SARS-Cov-2.

Monitoring COVID-19 Transmission Risks by Quantitative Real-Time PCR Tracing of Droplets in Hospital and Living Environments

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) environmental contamination occurs through droplets and biological fluids released in the surroundings from patients or asymptomatic carriers. Surfaces and objects contaminated by saliva or nose secretions represent a risk for indirect transmission of coronavirus disease 2019 (COVID-19). We assayed surfaces from hospital and living spaces to identify the presence of viral RNA and the spread of fomites in the environment. Anthropic contamination by droplets and biological fluids was monitored by detecting the microbiota signature using multiplex quantitative real-time PCR (qPCR) on selected species and massive sequencing on 16S amplicons. A total of 92 samples (flocked swabs) were collected from critical areas during the pandemic, including indoor (three hospitals and three public buildings) and outdoor surfaces exposed to anthropic contamination (handles and handrails, playgrounds). Traces of biological fluids were frequently detected in spaces open to the public and on objects that are touched with the hands (>80%). However, viral RNA was not detected in hospital wards or other indoor and outdoor surfaces either in the air system of a COVID hospital but only in the surroundings of an infected patient, in consistent association with droplet traces and fomites. Handled objects accumulated the highest level of multiple contaminations by saliva, nose secretions, and fecal traces, further supporting the priority role of handwashing in prevention. In conclusion, anthropic contamination by droplets and biological fluids is widespread in spaces open to the public and can be traced by qPCR. Monitoring fomites can support evaluation of indirect transmission risks for coronavirus or other flu-like viruses in the environment.IMPORTANCE Several studies have evaluated the presence of SARS-CoV-2 in the environment. Saliva and nasopharyngeal droplets can land on objects and surfaces, creating fomites. A suitable indicator would allow the detection of droplets or biofluids carrying the virus. Therefore, we searched for viral RNA and droplets and fomites on at risk surfaces. We monitored by qPCR or next generation sequencing (NGS) droplets through their microbiota. Although the study was performed during the pandemic, SARS-CoV-2 was not significantly found on surfaces, with the only exception of environmental areas near infectious patients. Conversely, anthropic contamination was frequent, suggesting a role for biofluids as putative markers of indirect transmission and risk assessment. Moreover, all SARS-CoV-2-contaminated surfaces showed droplets' microbiota. Fomite monitoring by qPCR may have an impact on public health strategies, supporting prevention of indirect transmission similarly to what is done for other communicable diseases (e.g., influenza and influenza-like infections).