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Heida A, Maal-Bared R, Veillette M, Duchaine C, Reynolds KA, Ashraf A, Ogunseye OO, Jung Y, Shulman L, Ikner L, Betancourt W, Hamilton KA, Wilson AM. Quantitative microbial risk assessment (QMRA) tool for modelling pathogen infection risk to wastewater treatment plant workers. WATER RESEARCH 2024; 260:121858. [PMID: 38936269 DOI: 10.1016/j.watres.2024.121858] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 05/25/2024] [Accepted: 05/29/2024] [Indexed: 06/29/2024]
Abstract
Wastewater treatment plants (WWTPs) provide vital services to the public by removing contaminants from wastewater prior to environmental discharge or reuse for beneficial purposes. WWTP workers occupationally exposed to wastewater can be at risk of respiratory or gastrointestinal diseases. The study objectives were to: (1) quantify pathogens and pathogen indicators in wastewater aerosols near different WWTP processes/unit operations, (2) develop a QMRA model for multi-pathogen and multi-exposure pathway risks, and (3) create a web-based application to perform and communicate risk calculations for wastewater workers. Case studies for seven different WWTP job tasks were performed investigating infection risk across nine different enteric and respiratory pathogens. It was observed that the ingestion risk among job tasks was highest for "walking the WWTP," which involved exposure from splashing, bioaerosols, and hand-to-mouth contact from touching contaminated surfaces. There was also a notable difference in exposure risk during peak (5:00am-9:00am) and non-peak hours (9:00am- 5:00am), with risks during the peak flow hours of the early morning assumed to be 5 times greater than non-peak hours. N95 respirator usage reduced median respiratory risks by 77 %. The developed tool performs multiple QMRA calculations to estimate WWTP workers' infection risks from accidental ingestion or inhalation of wastewater from multiple pathogens and exposure scenarios, which can inform risk management strategies to protect occupational health. However, more data are needed to reduce uncertainty in model estimates, including comparative data for pathogen concentrations in wastewater during peak and non-peak hours. QMRA tools will increase accessibility of risk models for utilization in decision-making.
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Affiliation(s)
- Ashley Heida
- School for Engineering of Matter, Transport and Energy, Arizona State University, 502 E Tyler Mall, Tempe, AZ 85287, USA; The Biodesign Institute Center for Environmental Health Engineering, Arizona State University, 1001 S. McAllister Ave, Tempe, AZ 85281, USA
| | - Rasha Maal-Bared
- Bellevue Research and Testing Laboratory, CDM Smith, 14432 SE Eastgate Way Suite 100, Bellevue, WA 98007, USA
| | - Marc Veillette
- Department of biochemistry, microbiology and bioinformatics, Université Laval, Canada Research Chair on Bioaerosols, Quebec City, Canada
| | - Caroline Duchaine
- Department of biochemistry, microbiology and bioinformatics, Université Laval, Canada Research Chair on Bioaerosols, Quebec City, Canada
| | - Kelly A Reynolds
- Department of Community, Environment, & Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Ahamed Ashraf
- Department of Community, Environment, & Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Olusola O Ogunseye
- Department of Community, Environment, & Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Yoonhee Jung
- Department of Community, Environment, & Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Lester Shulman
- Central Virology Laboratory, Sheba Medical Center, Tel Hashomer, Ramat Gan 52621, Israel; School of Public Health, Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Luisa Ikner
- Department of Environmental Science, College of Agricultre, Life & Environmental Sciences, University of Arizona, Tucson, AZ, USA
| | - Walter Betancourt
- Department of Environmental Science, College of Agricultre, Life & Environmental Sciences, University of Arizona, Tucson, AZ, USA
| | - Kerry A Hamilton
- The Biodesign Institute Center for Environmental Health Engineering, Arizona State University, 1001 S. McAllister Ave, Tempe, AZ 85281, USA; School of Sustainable Engineering and the Built Environment, Arizona State University, Tempe, AZ 85281, USA
| | - Amanda M Wilson
- Department of Community, Environment, & Policy, Mel and Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA.
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Lindsley WG, Blachere FM, Derk RC, Mnatsakanova A, Noti JD. Efficacy of powered air-purifying respirators (PAPRs) for source control of simulated respiratory aerosols. Am J Infect Control 2024:S0196-6553(24)00632-1. [PMID: 39116998 DOI: 10.1016/j.ajic.2024.07.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Revised: 07/26/2024] [Accepted: 07/27/2024] [Indexed: 08/10/2024]
Abstract
BACKGROUND Loose-fitting powered air-purifying respirators (PAPRs) are a popular alternative to the use of filtering facepiece respirators for health care workers. Although PAPRs protect the wearer from aerosol particles, their ability to block infectious aerosol particles exhaled by the wearer from being released into the environment (called source control) is unclear. METHODS The source control performance of 4 PAPRs with loose-fitting facepieces were tested using a manikin that exhales aerosol particles. The PAPRs were tested by themselves and in combination with a face-worn product intended to provide source control (either a surgical mask or an N95 filtering facepiece respirator). RESULTS Two PAPR facepieces with filtration panels significantly reduced the release of exhaled aerosols into the environment, while 3 facepieces without such panels did not. Wearing a surgical mask or respirator under the facepiece significantly improved the source control performance. CONCLUSIONS Most PAPR facepieces do not block aerosols exhaled by the wearer. Facepieces designed to filter exhaled particles can prevent aerosols from being released into the environment. Wearing a surgical mask or a filtering facepiece respirator under the facepiece can also provide source control, but PAPRs are not typically certified for use with masks and respirators.
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Affiliation(s)
- William G Lindsley
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV.
| | - Francoise M Blachere
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV
| | - Raymond C Derk
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV
| | - Anna Mnatsakanova
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV
| | - John D Noti
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Morgantown, WV
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3
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Bartsch SM, Weatherwax C, Leff B, Wasserman MR, Singh RD, Velmurugan K, John DC, Chin KL, O’Shea KJ, Gussin GM, Martinez MF, Heneghan JL, Scannell SA, Shah TD, Huang SS, Lee BY. Modeling Nursing Home Harms From COVID-19 Staff Furlough Policies. JAMA Netw Open 2024; 7:e2429613. [PMID: 39158906 PMCID: PMC11333984 DOI: 10.1001/jamanetworkopen.2024.29613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 06/28/2024] [Indexed: 08/20/2024] Open
Abstract
Importance Current guidance to furlough health care staff with mild COVID-19 illness may prevent the spread of COVID-19 but may worsen nursing home staffing shortages as well as health outcomes that are unrelated to COVID-19. Objective To compare COVID-19-related with non-COVID-19-related harms associated with allowing staff who are mildly ill with COVID-19 to work while masked. Design, Setting, and Participants This modeling study, conducted from November 2023 to June 2024, used an agent-based model representing a 100-bed nursing home and its residents, staff, and their interactions; care tasks; and resident and staff health outcomes to simulate the impact of different COVID-19 furlough policies over 1 postpandemic year. Exposures Simulating increasing proportions of staff who are mildly ill and are allowed to work while wearing N95 respirators under various vaccination coverage, SARS-CoV-2 transmissibility and severity, and masking adherence. Main Outcomes and Measures The main outcomes were staff and resident COVID-19 cases, staff furlough days, missed care tasks, nursing home resident hospitalizations (related and unrelated to COVID-19), deaths, and costs. Results In the absence of SARS-CoV-2 infection in the study's 100-bed agent-based model, nursing home understaffing resulted in an annual mean (SD) 93.7 (0.7) missed care tasks daily (22.1%), 38.0 (7.6) resident hospitalizations (5.2%), 4.6 (2.2) deaths (0.6%), and 39.7 (19.8) quality-adjusted life years lost from non-COVID-19-related harms, costing $1 071 950 ($217 200) from the Centers for Medicare & Medicaid Services (CMS) perspective and $1 112 800 ($225 450) from the societal perspective. Under the SARS-CoV-2 Omicron variant conditions from 2023 to 2024, furloughing all staff who tested positive for SARS-CoV-2 was associated with a mean (SD) 326.5 (69.1) annual furlough days and 649.5 (95% CI, 593.4-705.6) additional missed care tasks, resulting in 4.3 (95% CI, 2.9-5.9) non-COVID-19-related resident hospitalizations and 0.7 (95% CI, 0.2-1.1) deaths, costing an additional $247 090 (95% CI, $203 160-$291 020) from the CMS perspective and $405 250 (95% CI, $358 550-$451 950) from the societal perspective. Allowing 75% of staff who were mildly ill to work while masked was associated with 5 additional staff and 5 additional resident COVID-19 cases without added COVID-19-related hospitalizations but mitigated staffing shortages, with 475.9 additional care tasks being performed annually, 3.5 fewer non-COVID-19-related hospitalizations, and 0.4 fewer non-COVID-19-related deaths. Allowing staff who were mildly ill to work ultimately saved an annual mean $85 470 (95% CI, $41 210-$129 730) from the CMS perspective and $134 450 (95% CI, $86 370-$182 540) from the societal perspective. These results were robust to increased vaccination coverage, increased nursing home transmission, increased importation of COVID-19 from the community, and failure to mask while working ill. Conclusion and Relevance In this modeling study of staff COVID-19 furlough policies, allowing nursing home staff to work with mild COVID-19 illness was associated with fewer resident harms from staffing shortages and missed care tasks than harms from increased COVID-19 transmission, ultimately saving substantial direct medical and societal costs.
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Affiliation(s)
- Sarah M. Bartsch
- Center for Advanced Technology and Communication in Health, City University of New York Graduate School of Public Health and Health Policy, New York
- Public Health Informatics, Computational, and Operations Research, City University of New York Graduate School of Public Health and Health Policy, New York
- Artificial Intelligence, Modeling, and Informatics for Nutrition Guidance and Systems Center, City University of New York Graduate School of Public Health and Health Policy, New York
| | - Colleen Weatherwax
- Center for Advanced Technology and Communication in Health, City University of New York Graduate School of Public Health and Health Policy, New York
- Public Health Informatics, Computational, and Operations Research, City University of New York Graduate School of Public Health and Health Policy, New York
- Artificial Intelligence, Modeling, and Informatics for Nutrition Guidance and Systems Center, City University of New York Graduate School of Public Health and Health Policy, New York
| | - Bruce Leff
- Division of Geriatric Medicine and Gerontology, The Center for Transformative Geriatric Research, Johns Hopkins School of Medicine, Baltimore, Maryland
| | | | - Raveena D. Singh
- Division of Infectious Diseases, Department of Medicine, University of California Irvine School of Medicine, Irvine
| | - Kavya Velmurugan
- Center for Advanced Technology and Communication in Health, City University of New York Graduate School of Public Health and Health Policy, New York
- Public Health Informatics, Computational, and Operations Research, City University of New York Graduate School of Public Health and Health Policy, New York
- Artificial Intelligence, Modeling, and Informatics for Nutrition Guidance and Systems Center, City University of New York Graduate School of Public Health and Health Policy, New York
| | - Danielle C. John
- Center for Advanced Technology and Communication in Health, City University of New York Graduate School of Public Health and Health Policy, New York
- Public Health Informatics, Computational, and Operations Research, City University of New York Graduate School of Public Health and Health Policy, New York
- New York City Pandemic Response Institute, New York
| | - Kevin L. Chin
- Center for Advanced Technology and Communication in Health, City University of New York Graduate School of Public Health and Health Policy, New York
- Public Health Informatics, Computational, and Operations Research, City University of New York Graduate School of Public Health and Health Policy, New York
- Artificial Intelligence, Modeling, and Informatics for Nutrition Guidance and Systems Center, City University of New York Graduate School of Public Health and Health Policy, New York
| | - Kelly J. O’Shea
- Center for Advanced Technology and Communication in Health, City University of New York Graduate School of Public Health and Health Policy, New York
- Public Health Informatics, Computational, and Operations Research, City University of New York Graduate School of Public Health and Health Policy, New York
- Artificial Intelligence, Modeling, and Informatics for Nutrition Guidance and Systems Center, City University of New York Graduate School of Public Health and Health Policy, New York
| | - Gabrielle M. Gussin
- Division of Infectious Diseases, Department of Medicine, University of California Irvine School of Medicine, Irvine
| | - Marie F. Martinez
- Center for Advanced Technology and Communication in Health, City University of New York Graduate School of Public Health and Health Policy, New York
- Public Health Informatics, Computational, and Operations Research, City University of New York Graduate School of Public Health and Health Policy, New York
- Artificial Intelligence, Modeling, and Informatics for Nutrition Guidance and Systems Center, City University of New York Graduate School of Public Health and Health Policy, New York
| | - Jessie L. Heneghan
- Center for Advanced Technology and Communication in Health, City University of New York Graduate School of Public Health and Health Policy, New York
- Public Health Informatics, Computational, and Operations Research, City University of New York Graduate School of Public Health and Health Policy, New York
- Artificial Intelligence, Modeling, and Informatics for Nutrition Guidance and Systems Center, City University of New York Graduate School of Public Health and Health Policy, New York
| | - Sheryl A. Scannell
- Center for Advanced Technology and Communication in Health, City University of New York Graduate School of Public Health and Health Policy, New York
- Public Health Informatics, Computational, and Operations Research, City University of New York Graduate School of Public Health and Health Policy, New York
- Artificial Intelligence, Modeling, and Informatics for Nutrition Guidance and Systems Center, City University of New York Graduate School of Public Health and Health Policy, New York
| | - Tej D. Shah
- Center for Advanced Technology and Communication in Health, City University of New York Graduate School of Public Health and Health Policy, New York
- Public Health Informatics, Computational, and Operations Research, City University of New York Graduate School of Public Health and Health Policy, New York
- Artificial Intelligence, Modeling, and Informatics for Nutrition Guidance and Systems Center, City University of New York Graduate School of Public Health and Health Policy, New York
| | - Susan S. Huang
- Division of Infectious Diseases, Department of Medicine, University of California Irvine School of Medicine, Irvine
| | - Bruce Y. Lee
- Center for Advanced Technology and Communication in Health, City University of New York Graduate School of Public Health and Health Policy, New York
- Public Health Informatics, Computational, and Operations Research, City University of New York Graduate School of Public Health and Health Policy, New York
- Artificial Intelligence, Modeling, and Informatics for Nutrition Guidance and Systems Center, City University of New York Graduate School of Public Health and Health Policy, New York
- New York City Pandemic Response Institute, New York
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4
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Greenhalgh T, MacIntyre CR, Baker MG, Bhattacharjee S, Chughtai AA, Fisman D, Kunasekaran M, Kvalsvig A, Lupton D, Oliver M, Tawfiq E, Ungrin M, Vipond J. Masks and respirators for prevention of respiratory infections: a state of the science review. Clin Microbiol Rev 2024; 37:e0012423. [PMID: 38775460 PMCID: PMC11326136 DOI: 10.1128/cmr.00124-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2024] Open
Abstract
SUMMARYThis narrative review and meta-analysis summarizes a broad evidence base on the benefits-and also the practicalities, disbenefits, harms and personal, sociocultural and environmental impacts-of masks and masking. Our synthesis of evidence from over 100 published reviews and selected primary studies, including re-analyzing contested meta-analyses of key clinical trials, produced seven key findings. First, there is strong and consistent evidence for airborne transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and other respiratory pathogens. Second, masks are, if correctly and consistently worn, effective in reducing transmission of respiratory diseases and show a dose-response effect. Third, respirators are significantly more effective than medical or cloth masks. Fourth, mask mandates are, overall, effective in reducing community transmission of respiratory pathogens. Fifth, masks are important sociocultural symbols; non-adherence to masking is sometimes linked to political and ideological beliefs and to widely circulated mis- or disinformation. Sixth, while there is much evidence that masks are not generally harmful to the general population, masking may be relatively contraindicated in individuals with certain medical conditions, who may require exemption. Furthermore, certain groups (notably D/deaf people) are disadvantaged when others are masked. Finally, there are risks to the environment from single-use masks and respirators. We propose an agenda for future research, including improved characterization of the situations in which masking should be recommended or mandated; attention to comfort and acceptability; generalized and disability-focused communication support in settings where masks are worn; and development and testing of novel materials and designs for improved filtration, breathability, and environmental impact.
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Affiliation(s)
- Trisha Greenhalgh
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - C Raina MacIntyre
- Biosecurity Program, The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Michael G Baker
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Shovon Bhattacharjee
- Biosecurity Program, The Kirby Institute, University of New South Wales, Sydney, Australia
- School of Mechanical and Manufacturing Engineering, University of New South Wales, Sydney, Australia
| | - Abrar A Chughtai
- School of Population Health, University of New South Wales, Sydney, Australia
| | - David Fisman
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Mohana Kunasekaran
- Biosecurity Program, The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Amanda Kvalsvig
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Deborah Lupton
- Centre for Social Research in Health and Social Policy Research Centre, Faculty of Arts, Design and Architecture, University of New South Wales, Sydney, Australia
| | - Matt Oliver
- Professional Standards Advocate, Edmonton, Canada
| | - Essa Tawfiq
- Biosecurity Program, The Kirby Institute, University of New South Wales, Sydney, Australia
| | - Mark Ungrin
- Faculty of Veterinary Medicine; Department of Biomedical Engineering, Schulich School of Engineering; Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Joe Vipond
- Department of Emergency Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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5
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Lai J, Coleman KK, Tai SHS, German J, Hong F, Albert B, Esparza Y, Rastogi D, Srikakulapu A, Kalliomäki P, Schanz M, Smith AA, Sierra Maldonado I, Oertel M, Fadul N, Gold TL, McPhaul K, Ma T, Cowling BJ, Milton DK. Relative efficacy of masks and respirators as source control for viral aerosol shedding from people infected with SARS-CoV-2: a controlled human exhaled breath aerosol experimental study. EBioMedicine 2024; 104:105157. [PMID: 38821778 PMCID: PMC11245760 DOI: 10.1016/j.ebiom.2024.105157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Revised: 05/03/2024] [Accepted: 05/04/2024] [Indexed: 06/02/2024] Open
Abstract
BACKGROUND Tight-fitting masks and respirators, in manikin studies, improved aerosol source control compared to loose-fitting masks. Whether this translates to humans is not known. METHODS We compared efficacy of masks (cloth and surgical) and respirators (KN95 and N95) as source control for SARS-CoV-2 viral load in exhaled breath of volunteers with COVID-19 using a controlled human experimental study. Volunteers (N = 44, 43% female) provided paired unmasked and masked breath samples allowing computation of source-control factors. FINDINGS All masks and respirators significantly reduced exhaled viral load, without fit tests or training. A duckbill N95 reduced exhaled viral load by 98% (95% CI: 97%-99%), and significantly outperformed a KN95 (p < 0.001) as well as cloth and surgical masks. Cloth masks outperformed a surgical mask (p = 0.027) and the tested KN95 (p = 0.014). INTERPRETATION These results suggest that N95 respirators could be the standard of care in nursing homes and healthcare settings when respiratory viral infections are prevalent in the community and healthcare-associated transmission risk is elevated. FUNDING Defense Advanced Research Projects Agency, National Institute of Allergy and Infectious Diseases, Centers for Disease Control and Prevention, the Bill & Melinda Gates Foundation, and The Flu Lab.
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Affiliation(s)
- Jianyu Lai
- Maryland Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, MD, USA
| | - Kristen K Coleman
- Maryland Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, MD, USA
| | - S-H Sheldon Tai
- Maryland Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, MD, USA
| | - Jennifer German
- Maryland Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, MD, USA
| | - Filbert Hong
- Maryland Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, MD, USA
| | - Barbara Albert
- Maryland Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, MD, USA
| | - Yi Esparza
- Maryland Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, MD, USA
| | - Dewansh Rastogi
- Department of Chemical and Biomolecular Engineering, University of Maryland, College Park, MD, USA
| | - Aditya Srikakulapu
- Maryland Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, MD, USA
| | - Petri Kalliomäki
- Maryland Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, MD, USA
| | - Maria Schanz
- Maryland Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, MD, USA
| | - Alycia A Smith
- Maryland Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, MD, USA
| | - Isabel Sierra Maldonado
- Maryland Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, MD, USA
| | - Molly Oertel
- Maryland Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, MD, USA
| | - Naja Fadul
- Maryland Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, MD, USA
| | - T Louie Gold
- Maryland Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, MD, USA
| | - Kathleen McPhaul
- Maryland Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, MD, USA
| | - Tianzhou Ma
- Department of Epidemiology and Biostatistics, University of Maryland School of Public Health, College Park, MD, USA
| | - Benjamin J Cowling
- World Health Organization Collaborating Centre for Infectious Disease Epidemiology and Control, School of Public Health, The University of Hong Kong, Hong Kong Special Administrative Region, China
| | - Donald K Milton
- Maryland Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, MD, USA.
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6
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Bartsch SM, Weatherwax C, Wasserman MR, Chin KL, Martinez MF, Velmurugan K, Singh RD, John DC, Heneghan JL, Gussin GM, Scannell SA, Tsintsifas AC, O'Shea KJ, Dibbs AM, Leff B, Huang SS, Lee BY. How the Timing of Annual COVID-19 Vaccination of Nursing Home Residents and Staff Affects Its Value. J Am Med Dir Assoc 2024; 25:639-646.e5. [PMID: 38432644 PMCID: PMC10990766 DOI: 10.1016/j.jamda.2024.02.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Revised: 02/07/2024] [Accepted: 02/08/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVES To evaluate the epidemiologic, clinical, and economic value of an annual nursing home (NH) COVID-19 vaccine campaign and the impact of when vaccination starts. DESIGN Agent-based model representing a typical NH. SETTING AND PARTICIPANTS NH residents and staff. METHODS We used the model representing an NH with 100 residents, its staff, their interactions, COVID-19 spread, and its health and economic outcomes to evaluate the epidemiologic, clinical, and economic value of varying schedules of annual COVID-19 vaccine campaigns. RESULTS Across a range of scenarios with a 60% vaccine efficacy that wanes starting 4 months after protection onset, vaccination was cost saving or cost-effective when initiated in the late summer or early fall. Annual vaccination averted 102 to 105 COVID-19 cases when 30-day vaccination campaigns began between July and October (varying with vaccination start), decreasing to 97 and 85 cases when starting in November and December, respectively. Starting vaccination between July and December saved $3340 to $4363 and $64,375 to $77,548 from the Centers for Medicare & Medicaid Services and societal perspectives, respectively (varying with vaccination start). Vaccination's value did not change when varying the COVID-19 peak between December and February. The ideal vaccine campaign timing was not affected by reducing COVID-19 levels in the community, or varying transmission probability, preexisting immunity, or COVID-19 severity. However, if vaccine efficacy wanes more quickly (over 1 month), earlier vaccination in July resulted in more cases compared with vaccinating later in October. CONCLUSIONS AND IMPLICATIONS Annual vaccination of NH staff and residents averted the most cases when initiated in the late summer through early fall, at least 2 months before the COVID-19 winter peak but remained cost saving or cost-effective when it starts in the same month as the peak. This supports tethering COVID vaccination to seasonal influenza campaigns (typically in September-October) for providing protection against SARS-CoV-2 winter surges in NHs.
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Affiliation(s)
- Sarah M Bartsch
- Public Health Informatics, Computational, and Operations Research (PHICOR), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Center for Advanced Technology and Communication in Health (CATCH), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Artificial Intelligence, Modeling, and Informatics, for Nutrition Guidance and Systems (AIMINGS) Center, CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA
| | - Colleen Weatherwax
- Public Health Informatics, Computational, and Operations Research (PHICOR), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Center for Advanced Technology and Communication in Health (CATCH), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Artificial Intelligence, Modeling, and Informatics, for Nutrition Guidance and Systems (AIMINGS) Center, CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA
| | | | - Kevin L Chin
- Public Health Informatics, Computational, and Operations Research (PHICOR), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Center for Advanced Technology and Communication in Health (CATCH), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Artificial Intelligence, Modeling, and Informatics, for Nutrition Guidance and Systems (AIMINGS) Center, CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA
| | - Marie F Martinez
- Public Health Informatics, Computational, and Operations Research (PHICOR), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Center for Advanced Technology and Communication in Health (CATCH), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Artificial Intelligence, Modeling, and Informatics, for Nutrition Guidance and Systems (AIMINGS) Center, CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA
| | - Kavya Velmurugan
- Public Health Informatics, Computational, and Operations Research (PHICOR), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Center for Advanced Technology and Communication in Health (CATCH), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Artificial Intelligence, Modeling, and Informatics, for Nutrition Guidance and Systems (AIMINGS) Center, CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA
| | - Raveena D Singh
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Danielle C John
- Public Health Informatics, Computational, and Operations Research (PHICOR), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Center for Advanced Technology and Communication in Health (CATCH), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Pandemic Response Institute, New York City, NY, USA
| | - Jessie L Heneghan
- Public Health Informatics, Computational, and Operations Research (PHICOR), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Center for Advanced Technology and Communication in Health (CATCH), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Artificial Intelligence, Modeling, and Informatics, for Nutrition Guidance and Systems (AIMINGS) Center, CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA
| | - Gabrielle M Gussin
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Sheryl A Scannell
- Public Health Informatics, Computational, and Operations Research (PHICOR), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Center for Advanced Technology and Communication in Health (CATCH), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Artificial Intelligence, Modeling, and Informatics, for Nutrition Guidance and Systems (AIMINGS) Center, CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA
| | - Alexandra C Tsintsifas
- Public Health Informatics, Computational, and Operations Research (PHICOR), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Center for Advanced Technology and Communication in Health (CATCH), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Artificial Intelligence, Modeling, and Informatics, for Nutrition Guidance and Systems (AIMINGS) Center, CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA
| | - Kelly J O'Shea
- Public Health Informatics, Computational, and Operations Research (PHICOR), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Center for Advanced Technology and Communication in Health (CATCH), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Artificial Intelligence, Modeling, and Informatics, for Nutrition Guidance and Systems (AIMINGS) Center, CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA
| | - Alexis M Dibbs
- Public Health Informatics, Computational, and Operations Research (PHICOR), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Center for Advanced Technology and Communication in Health (CATCH), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Artificial Intelligence, Modeling, and Informatics, for Nutrition Guidance and Systems (AIMINGS) Center, CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA
| | - Bruce Leff
- Division of Geriatric Medicine, Center for Transformative Geriatric Research, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Susan S Huang
- Division of Infectious Diseases, University of California Irvine School of Medicine, Irvine, CA, USA
| | - Bruce Y Lee
- Public Health Informatics, Computational, and Operations Research (PHICOR), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Center for Advanced Technology and Communication in Health (CATCH), CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Artificial Intelligence, Modeling, and Informatics, for Nutrition Guidance and Systems (AIMINGS) Center, CUNY Graduate School of Public Health and Health Policy, New York City, NY, USA; Pandemic Response Institute, New York City, NY, USA.
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7
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Kahn D, Chen W, Linden Y, Corbeil KA, Lowry S, Higham CA, Mendez KS, Burch P, DiFondi T, Verhougstraete M, De Roos AJ, Haas CN, Gerba C, Hamilton KA. A microbial risk assessor's guide to Valley Fever (Coccidioides spp.): Case study and review of risk factors. THE SCIENCE OF THE TOTAL ENVIRONMENT 2024; 917:170141. [PMID: 38242485 PMCID: PMC10923130 DOI: 10.1016/j.scitotenv.2024.170141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Revised: 12/07/2023] [Accepted: 01/11/2024] [Indexed: 01/21/2024]
Abstract
Valley Fever is a respiratory disease caused by inhalation of arthroconidia, a type of spore produced by fungi within the genus Coccidioides spp. which are found in dry, hot ecosystems of the Western Hemisphere. A quantitative microbial risk assessment (QMRA) for the disease has not yet been performed due to a lack of dose-response models and a scarcity of quantitative occurrence data from environmental samples. A literature review was performed to gather data on experimental animal dosing studies, environmental occurrence, human disease outbreaks, and meteorological associations. As a result, a risk framework is presented with information for parameterizing QMRA models for Coccidioides spp., with eight new dose-response models proposed. A probabilistic QMRA was conducted for a Southwestern US agricultural case study, evaluating eight scenarios related to farming occupational exposures. Median daily workday risks for developing severe Valley Fever ranged from 2.53 × 10-7 (planting by hand while wearing an N95 facemask) to 1.33 × 10-3 (machine harvesting while not wearing a facemask). The literature review and QMRA synthesis confirmed that exposure to aerosolized arthroconidia has the potential to result in high attack rates but highlighted that the mechanistic relationships between environmental conditions and disease remain poorly understood. Recommendations for Valley Fever risk assessment research needs in order to reduce disease risks are discussed, including interventions for farmers.
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Affiliation(s)
- David Kahn
- Department of Civil Architectural and Environmental Engineering, Drexel University, Philadelphia, PA 19104, USA
| | - William Chen
- Department of Civil & Environmental Engineering & Earth Sciences, University of Notre Dame, Notre Dame, IN 46556, USA
| | - Yarrow Linden
- Department of Environmental Sciences and Engineering, Gillings School of Global Public Health, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA
| | - Karalee A Corbeil
- Department of Water Management and Hydrological Science, Texas A&M University, College Station, TX 79016, USA
| | - Sarah Lowry
- Department of Civil and Environmental Engineering, Stanford University, Stanford, CA 94305, USA
| | - Ciara A Higham
- Leeds Institute for Fluid Dynamics, University of Leeds, Woodhouse Lane, Leeds LS2 9JT, UK
| | - Karla S Mendez
- The University of Texas Health Science Center at Houston, School of Public Health, Houston, TX 77030, USA
| | - Paige Burch
- Seaford High School, 1575 Seamans Neck Rd, Seaford, NY 11783, USA
| | - Taylor DiFondi
- Seaford High School, 1575 Seamans Neck Rd, Seaford, NY 11783, USA
| | - Marc Verhougstraete
- University of Arizona, Mel and Enid Zuckerman College of Public Health, 1295 N. Marton Ave., Tucson, AZ 85724, USA
| | - Anneclaire J De Roos
- Department of Environmental and Occupational Health, Dornsife School of Public Health, Drexel University, Philadelphia, PA 19104, USA
| | - Charles N Haas
- Department of Civil Architectural and Environmental Engineering, Drexel University, Philadelphia, PA 19104, USA
| | - Charles Gerba
- University of Arizona, Mel and Enid Zuckerman College of Public Health, 1295 N. Marton Ave., Tucson, AZ 85724, USA
| | - Kerry A Hamilton
- The Biodesign Institute Center for Environmental Health Engineering, Arizona State University, 1001 S. McAllister Ave, Tempe, AZ 85281, USA; School of Sustainable Engineering and the Built Environment, Arizona State University, Tempe, AZ 85281, USA.
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8
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Yang W, Shaman J. Reconciling the efficacy and effectiveness of masking on epidemic outcomes. J R Soc Interface 2024; 21:20230666. [PMID: 38442856 PMCID: PMC10914508 DOI: 10.1098/rsif.2023.0666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2023] [Accepted: 02/07/2024] [Indexed: 03/07/2024] Open
Abstract
During the COVID-19 pandemic, mask wearing in public settings has been a key control measure. However, the reported effectiveness of masking has been much lower than laboratory measures of efficacy, leading to doubts on the utility of masking. Here, we develop an agent-based model that comprehensively accounts for individual masking behaviours and infectious disease dynamics, and test the impact of masking on epidemic outcomes. Using realistic inputs of mask efficacy and contact data at the individual level, the model reproduces the lower effectiveness as reported in randomized controlled trials. Model results demonstrate that transmission within households, where masks are rarely used, can substantially lower effectiveness, and reveal the interaction of nonlinear epidemic dynamics, control measures and potential measurement biases. Overall, model results show that, at the individual level, consistent masking can reduce the risk of first infection and, over time, reduce the frequency of repeated infection. At the population level, masking can provide direct protection to mask wearers, as well as indirect protection to non-wearers, collectively reducing epidemic intensity. These findings suggest it is prudent for individuals to use masks during an epidemic, and for policymakers to recognize the less-than-ideal effectiveness of masking when devising public health interventions.
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Affiliation(s)
- Wan Yang
- Department of Epidemiology, Mailman School of Public Health, Columbia University Medical Center, New York, NY, USA
- Herbert Irving Comprehensive Cancer Center, Columbia University Medical Center, New York, NY, USA
| | - Jeffrey Shaman
- Department of Environmental Health Sciences, Mailman School of Public Health, Columbia University Medical Center, New York, NY, USA
- Columbia Climate School, Columbia University, New York, NY, USA
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9
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Enright C, Gilbourne C, Kiersey R, Parlour R, Flanagan P, McGowan E, Boland M, Mulholland D. Efficacy of facemasks in preventing transmission of COVID-19 in non-healthcare settings: A scoping review. J Infect Prev 2024; 25:24-32. [PMID: 38362115 PMCID: PMC10866118 DOI: 10.1177/17571774231203387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Accepted: 08/14/2023] [Indexed: 02/17/2024] Open
Abstract
Background During the COVID-19 pandemic, an abundance of literature relating to the efficacy of face masks on reducing transmission of COVID-19 in non-healthcare settings emerged. Aim/objective The aim of this scoping review was to allow the identification of: types of evidence conducted in this area; knowledge gaps and common concepts relating to mask efficacy in non-healthcare settings. Methods A comprehensive literature search was conducted in PubMed, CINAHL, MEDLINE, Embase and the Irish Management Institute bibliographic database on December 15th, 2021. All types of face masks were included. Of 722 records, 16 were included after full text screening. Findings/results Themes from an adapted model of Howard et al. framework were used to group results and identify common concepts. The grouped thematic results were then applied to the socio-ecological model. This illustrated the multifactorial elements determining the efficacy of masks themselves while also illustrating how other factors such as individual behaviours, social interactions, settings and national policy can influence the degree of the protective effect. Discussion The findings from this scoping review indicate that an abundance of experimental literature is available indicating that masks are effective at preventing COVID-19 transmission but their degree of efficacy is impacted by external factors. This review highlights that the quality of the evidence available is low.
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10
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Pratt AA, Brown GD, Perencevich EN, Diekema DJ, Nonnenmann MW. Comparison of virus aerosol concentrations across a face shield worn on a healthcare personnel during a simulated patient cough. Infect Control Hosp Epidemiol 2024; 45:221-226. [PMID: 37609833 DOI: 10.1017/ice.2023.130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
BACKGROUND Patients diagnosed with coronavirus disease 2019 (COVID-19) aerosolize severe acute respiratory coronavirus virus 2 (SARS-CoV-2) via respiratory efforts, expose, and possibly infect healthcare personnel (HCP). To prevent transmission of SARS-CoV-2 HCP have been required to wear personal protective equipment (PPE) during patient care. Early in the COVID-19 pandemic, face shields were used as an approach to control HCP exposure to SARS-CoV-2, including eye protection. METHODS An MS2 bacteriophage was used as a surrogate for SARS-CoV-2 and was aerosolized using a coughing machine. A simulated HCP wearing a disposable plastic face shield was placed 0.41 m (16 inches) away from the coughing machine. The aerosolized virus was sampled using SKC biosamplers on the inside (near the mouth of the simulated HCP) and the outside of the face shield. The aerosolized virus collected by the SKC Biosampler was analyzed using a viability assay. Optical particle counters (OPCs) were placed next to the biosamplers to measure the particle concentration. RESULTS There was a statistically significant reduction (P < .0006) in viable virus concentration on the inside of the face shield compared to the outside of the face shield. The particle concentration was significantly lower on the inside of the face shield compared to the outside of the face shield for 12 of the 16 particle sizes measured (P < .05). CONCLUSIONS Reductions in virus and particle concentrations were observed on the inside of the face shield; however, viable virus was measured on the inside of the face shield, in the breathing zone of the HCP. Therefore, other exposure control methods need to be used to prevent transmission from virus aerosol.
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Affiliation(s)
- Alessandra A Pratt
- University of Iowa, Department of Occupational and Environmental Health, Iowa City, Iowa
- Iowa City Veterans Affairs Health Care System, Iowa City, Iowa
| | - Grant D Brown
- Department of Biostatistics, University of Iowa, Iowa City, Iowa
| | - Eli N Perencevich
- Iowa City Veterans Affairs Health Care System, Iowa City, Iowa
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa
| | - Daniel J Diekema
- Department of Internal Medicine, Carver College of Medicine, University of Iowa, Iowa City, Iowa
- Department of Medicine, Maine Medical Center, PortlandMaine
| | - Matthew W Nonnenmann
- Department of Environmental, Agricultural and Occupational Health, University of Nebraska Medical Center, Omaha, Nebraska
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11
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Haider CL, Park H, Hauswald A, Weisz N. Neural Speech Tracking Highlights the Importance of Visual Speech in Multi-speaker Situations. J Cogn Neurosci 2024; 36:128-142. [PMID: 37977156 DOI: 10.1162/jocn_a_02059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2023]
Abstract
Visual speech plays a powerful role in facilitating auditory speech processing and has been a publicly noticed topic with the wide usage of face masks during the COVID-19 pandemic. In a previous magnetoencephalography study, we showed that occluding the mouth area significantly impairs neural speech tracking. To rule out the possibility that this deterioration is because of degraded sound quality, in the present follow-up study, we presented participants with audiovisual (AV) and audio-only (A) speech. We further independently manipulated the trials by adding a face mask and a distractor speaker. Our results clearly show that face masks only affect speech tracking in AV conditions, not in A conditions. This shows that face masks indeed primarily impact speech processing by blocking visual speech and not by acoustic degradation. We can further highlight how the spectrogram, lip movements and lexical units are tracked on a sensor level. We can show visual benefits for tracking the spectrogram especially in the multi-speaker condition. While lip movements only show additional improvement and visual benefit over tracking of the spectrogram in clear speech conditions, lexical units (phonemes and word onsets) do not show visual enhancement at all. We hypothesize that in young normal hearing individuals, information from visual input is less used for specific feature extraction, but acts more as a general resource for guiding attention.
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Affiliation(s)
| | | | | | - Nathan Weisz
- Paris Lodron Universität Salzburg
- Paracelsus Medical University Salzburg
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12
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Myers WR, Yang W, Ryan KJ, Bergman MS, M Fisher E, Soo JC, Zhuang Z. Total outward leakage of half-mask respirators and surgical masks used for source control. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2023; 20:610-620. [PMID: 37682702 DOI: 10.1080/15459624.2023.2257254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Abstract
Both respirators and surgical masks (SM) are used as source control devices. During the COVID-19 pandemic, there was much interest in understanding the extent of particle total outward leakage (TOL) from these devices. The objective of this study was to quantify the TOL for five categories of devices: SMs, National Institute for Occupational Safety and Health (NIOSH) Approved N95 filtering facepiece respirators (FFRs) without exhalation valves, NIOSH Approved N95 FFRs with exhalation valves (N95 FFRV), NIOSH Approved elastomeric half-mask respirators (EHMRs) with exhalation valves, and NIOSH Approved EHMRs with an SM covering the exhalation valve (EHMRSM). A benchtop test system was designed to test two models of each device category. Each device was mounted on a headform at three faceseal levels (0% faceseal, 50% faceseal, and 100% faceseal). At each faceseal level, the TOL was assessed at three flow rates of minute ventilations of 17, 28, and 39 L/min. The experimental design was a split-split-plot configuration. Device type, faceseal level, flow rate, and the interaction of device type and faceseal level were found to have a significant effect (p - value < 0.05) on the TOL. This study found that the N95 FFRs without exhalation valves had the lowest mean TOL. The SMs had about three times higher TOL than the N95 FFRs without exhalation valves. The TOL of the N95 FFRV was comparable to that of the SM at 0% and 50% faceseal on average overall conditions, but the N95 FFRV had a significantly higher TOL than the SM at a 100% faceseal. The EHMRs had the highest TOL because of the exhalation valve. Using an SM to cover the exhalation valve did not improve the EHMRs' efficiency in mitigating the TOL. Caution should be exercised when using N95 FFRVs as a source control measure against respiratory activities with heavy work rates, such as performing CPR. Results of this study showed that reduced faceseal leakage for N95 FFRs and SMs improves source control.
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Affiliation(s)
- Warren R Myers
- Department of Industrial and Management Systems Engineering, West Virginia University, Morgantown, West Virginia
| | - Weihua Yang
- Department of Industrial and Management Systems Engineering, West Virginia University, Morgantown, West Virginia
| | - Kenneth J Ryan
- Department of Statistics, West Virginia University, Morgantown, West Virginia
| | - Michael S Bergman
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, National Personal Protective Technology Laboratory, Pittsburgh, Pennsylvania
| | - Edward M Fisher
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, National Personal Protective Technology Laboratory, Pittsburgh, Pennsylvania
| | - Jhy-Charm Soo
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, National Personal Protective Technology Laboratory, Pittsburgh, Pennsylvania
| | - Ziqing Zhuang
- Centers for Disease Control and Prevention, National Institute for Occupational Safety and Health, National Personal Protective Technology Laboratory, Pittsburgh, Pennsylvania
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13
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Integration von SARS-CoV-2 als Erreger von Infektionen in der endemischen Situation in die Empfehlungen der KRINKO „Infektionsprävention im Rahmen der Pflege und Behandlung von Patienten mit übertragbaren Krankheiten“. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2023; 66:1279-1301. [PMID: 37861707 DOI: 10.1007/s00103-023-03776-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
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14
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Fakherpour A, Jahangiri M, Jansz J. A systematic review of passing fit testing of the masks and respirators used during the COVID-19 pandemic: Part 1-quantitative fit test procedures. PLoS One 2023; 18:e0293129. [PMID: 37883443 PMCID: PMC10602271 DOI: 10.1371/journal.pone.0293129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 10/05/2023] [Indexed: 10/28/2023] Open
Abstract
BACKGROUND During respiratory infection pandemics, masks and respirators are highly sought after, especially for frontline healthcare workers and patients carrying respiratory viruses. The objective of this study was to systematically review fit test pass rates and identify factors influencing the fitting characteristics. METHODS Potentially relevant studies were identified using PubMed, Scopus, Web of Science, and Science Direct during the COVID-19 pandemic from February 5, 2020, to March 21, 2023. The search strategy using the following keywords was conducted: Quantitative Fit Test, Condensation Nuclei Counter, Controlled Negative Pressure, PortaCount, Sibata, Accufit, Fit, Seal, Mask, Respirator, Respiratory Protective Device, Respiratory Protective Equipment, Protective Device, Personal Protective Equipment, COVID-19, Coronavirus, and SARS-CoV-2. The quality of the included studies was also assessed using the Newcastle-Ottawa scale. RESULTS A total of 137 articles met the eligibility criteria. Fifty articles had a quality score of less than 7 (good quality). A total of 21 studies had a fit test pass rate of less than 50%. 26 studies on disposable respirators and 11 studies on reusable respirators had an FF of less than 50 and less than 200, respectively. The most influential factors include respirator brand/model, style, gender, ethnicity, facial dimensions, facial hair, age, reuse, extensive movement, seal check, comfort and usability assessment, and training. CONCLUSION 37.36% of the disposable respirator studies and 43% of the reusable respirator studies did not report fit test results. 67.86% of the disposable respirator studies had a fit test pass rate greater than 50%, and 35.84% of these studies had an FF greater than 100. Also, 85.71% of the reusable respirator studies had a fit test pass rate greater than 50%, and 52.77% of these studies had an FF greater than 1000. Overall, the fit test pass rate was relatively acceptable. Newly developed or modified respirators must undergo reliable testing to ensure the protection of HCWs. Subject and respirator characteristics should be considered when implementing fit testing protocols. An optimal fit test panel should be developed prior to respirator design, certification, procurement decisions, and selection procedures.
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Affiliation(s)
- Anahita Fakherpour
- Student Research Committee, Department of Occupational Health and Safety Engineering, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Mehdi Jahangiri
- Department of Occupational Health and Safety Engineering, Research Center for Health Sciences, School of Health, Shiraz University of Medical Sciences, Shiraz, Iran
| | - Janis Jansz
- School of Mines: Minerals, Energy and Chemical Engineering, Faculty of Science and Engineering, Curtin University, Perth, Australia
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15
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Jones RM, Snead R, Sarwer DB, Ibrahim JK. Mask Adherence and the Relationship Between Masking and Weather-Related Metrics. J Community Health 2023; 48:761-768. [PMID: 37097507 PMCID: PMC10126535 DOI: 10.1007/s10900-023-01219-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/01/2023] [Indexed: 04/26/2023]
Abstract
Little is known about adherence to COVID-19 masking mandates on college campuses or the relationship between weather-related variables and masking. This study aimed to (1) observe students' adherence to on-campus mask mandates and (2) estimate the effect of weather on mask-wearing. Temple University partnered in the Centers for Disease Control and Prevention's observational Mask Adherence Surveillance at Colleges and Universities Project. February-April 2021, weekly observations were completed at 12 on-campus locations to capture whether individuals wore masks, wore them correctly, and the type of mask worn. Fashion and university masks also were recorded. Weekly average temperature, humidity, and precipitation were calculated. Descriptive statistics were calculated for masking adherence overall, over time, and by location. Statistical significance was assessed between correct mask use and mask type and the linear relationships between weekly weather metrics and mask use. Overall, 3508 individuals were observed with 89.6% wearing masks. Of those, 89.4% correctly wore masks. Cloth (58.7%) and surgical masks (35.3%) were most commonly observed and 21.3% wore fashion masks. N95/KN95 masks were correctly worn in 98.3% of observations and surgical and cloth masks were correctly worn ~ 90% of the time. Weekly adherence varied over time and by campus location. Significant inverse linear relationships existed between weekly temperature (r = - 0.72; p < 0.05) and humidity (r = - 0.63; p ≤ 0.05) and masking. Mask adherence and correct use was high. Temperature and humidity inversely affected adherence. Adherence varied by on-campus location, which suggests the locations (e.g., academic buildings, recreational center) and possibly the characteristics of individuals who frequent certain areas impacted adherence.
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Affiliation(s)
- Resa M Jones
- Department of Epidemiology and Biostatistics, College of Public Health, Temple University, 1301 Cecil B. Moore Ave. Ritter Annex, 9thFloor, Philadelphia, PA, 19122, USA.
- Fox Chase Cancer Center, Temple University Health, Philadelphia, PA, USA.
| | - Ryan Snead
- Department of Epidemiology and Biostatistics, College of Public Health, Temple University, 1301 Cecil B. Moore Ave. Ritter Annex, 9thFloor, Philadelphia, PA, 19122, USA
| | - David B Sarwer
- Department of Social and Behavioral Sciences, College of Public Health, Temple University, Philadelphia, PA, USA
| | - Jennifer K Ibrahim
- Department of Health Services, Administration, and Policy, College of Public Health, Temple University, Philadelphia, PA, USA
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16
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Gurbaxani BM, Hill AN, Patel P. Unpacking Cochrane's Update on Masks and COVID-19. Am J Public Health 2023; 113:1074-1078. [PMID: 37672741 PMCID: PMC10484132 DOI: 10.2105/ajph.2023.307377] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/25/2023] [Indexed: 09/08/2023]
Affiliation(s)
- Brian M Gurbaxani
- Brian M. Gurbaxani and Pragna Patel are with the National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Brian M. Gurbaxani is also with the Departments of Electrical and Computer Engineering and Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta. Andrew N. Hill is with the Global Health Center, Division of Parasitic Diseases and Malaria, CDC, and the Department of Biostatistics and Bioinformatics Department, Rollins School of Public Health, Emory University, Atlanta, GA. Pragna Patel is also with the Department of Medicine, Emory University
| | - Andrew N Hill
- Brian M. Gurbaxani and Pragna Patel are with the National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Brian M. Gurbaxani is also with the Departments of Electrical and Computer Engineering and Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta. Andrew N. Hill is with the Global Health Center, Division of Parasitic Diseases and Malaria, CDC, and the Department of Biostatistics and Bioinformatics Department, Rollins School of Public Health, Emory University, Atlanta, GA. Pragna Patel is also with the Department of Medicine, Emory University
| | - Pragna Patel
- Brian M. Gurbaxani and Pragna Patel are with the National Center for Immunization and Respiratory Diseases, Centers for Disease Control and Prevention (CDC), Atlanta, GA. Brian M. Gurbaxani is also with the Departments of Electrical and Computer Engineering and Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta. Andrew N. Hill is with the Global Health Center, Division of Parasitic Diseases and Malaria, CDC, and the Department of Biostatistics and Bioinformatics Department, Rollins School of Public Health, Emory University, Atlanta, GA. Pragna Patel is also with the Department of Medicine, Emory University
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17
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Chen Y, Beattie H, Simpson A, Nicholls G, Sandys V, Keen C, Curran AD. A COVID-19 Outbreak in a Large Meat-Processing Plant in England: Transmission Risk Factors and Controls. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6806. [PMID: 37835076 PMCID: PMC10572747 DOI: 10.3390/ijerph20196806] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/21/2023] [Revised: 08/11/2023] [Accepted: 09/19/2023] [Indexed: 10/15/2023]
Abstract
The meat-processing industry had frequent COVID-19 outbreaks reported worldwide. In May 2021, a large meat-processing plant in the UK had an outbreak affecting 4.1% (63/1541) of workers. A rapid on-site investigation was conducted to understand the virus transmission risk factors and control measures. This included observational assessments of work activities, control measures, real-time environmental measurements and surface microbial sampling. The production night-shift attack rate (11.6%, 44/380) was nearly five times higher than the production day-shift (2.4%, 9/380). Shared work transport was provided to 150 staff per dayshift and 104 per nightshift. Production areas were noisy (≥80 dB(A)) and physical distancing was difficult to maintain. Face visors were mandatory, additional face coverings were required for some activities but not always worn. The refrigeration system continuously recirculated chilled air. In some areas, the mean temperature was as low as 4.5 °C and mean relative humidity (RH) was as high as 96%. The adequacy of ventilation in the production areas could not be assessed reliably using CO2, due to the use of CO2 in the packaging process. While there were challenges in the production areas, the observed COVID-19 control measures were generally implemented well in the non-production areas. Sixty surface samples from all areas were tested for SARS-CoV-2 RNA and 11.7% were positive. Multi-layered measures, informed by a workplace specific risk assessment, are required to prevent and control workplace outbreaks of COVID-19 or other similar respiratory infectious diseases.
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Affiliation(s)
- Yiqun Chen
- Science Division, Health and Safety Executive, Buxton SK17 9JN, UK
| | - Helen Beattie
- Science Division, Health and Safety Executive, Buxton SK17 9JN, UK
| | - Andrew Simpson
- Science Division, Health and Safety Executive, Buxton SK17 9JN, UK
| | - Gillian Nicholls
- Science Division, Health and Safety Executive, Buxton SK17 9JN, UK
| | - Vince Sandys
- Science Division, Health and Safety Executive, Buxton SK17 9JN, UK
| | - Chris Keen
- Science Division, Health and Safety Executive, Buxton SK17 9JN, UK
| | - Andrew D Curran
- Science Division, Health and Safety Executive, Buxton SK17 9JN, UK
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18
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Kriebel D. Advancing global public health with occupational epidemiology. Occup Environ Med 2023; 80:485-488. [PMID: 37567765 DOI: 10.1136/oemed-2023-108939] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2023] [Accepted: 07/18/2023] [Indexed: 08/13/2023]
Affiliation(s)
- David Kriebel
- Public Health, University of Massachusetts, Lowell, Massachusetts, USA
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19
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Bennett WD, Prince SE, Zeman KL, Chen H, Samet JM. A novel method for the quantitative assessment of the fitted containment efficiency of face coverings. Infect Control Hosp Epidemiol 2023; 44:1481-1484. [PMID: 36912322 PMCID: PMC10507493 DOI: 10.1017/ice.2022.316] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Revised: 12/05/2022] [Accepted: 12/06/2022] [Indexed: 03/14/2023]
Abstract
BACKGROUND Face masks reduce disease transmission by protecting the wearer from inhaled pathogens and reducing the emission of infectious aerosols. Although methods quantifying efficiency for wearer protection are established, current methods for assessing face mask containment efficiency rely on measurement of a low concentration of aerosols emitted from an infected or noninfected individual. METHODS A small port enabled the introduction of 0.05 µm sodium chloride particles at a constant rate behind the mask worn by a study participant. A condensation particle counter monitored ambient particle numbers 60 cm in front of the participant over 3-minute periods of rest, speaking, and coughing. The containment efficiency (%) for each mask and procedure was calculated as follows: 100 × (1 - average ambient concentration with face covering worn/average ambient concentration with a sham face covering in place). The protection efficiency (%) was also measured using previously published methods. The probability of transmission (%) from infected to uninfected (a function of both the containment efficiency and the protection efficiency) was calculated as follows: {1 - (containment efficiency/100)}×{1 - (protection efficiency/100)}×100. RESULTS The average containment efficiencies for each mask over all procedures and repeated measures were 94.6%, 60.9%, 38.8%, and 43.2%, respectively, for the N95 mask, the KN95 mask, the procedure face mask, and the gaiter. The corresponding protection efficiencies for each mask were 99.0%, 63.7%, 45.3%, and 24.2%, respectively. For example, the transmission probability for 1 infected and 1 uninfected individual in close proximity was ∼14.2% for KN95 masks, compared to 36%-39% when only 1 individual wore a KN95 mask. CONCLUSION Overall, we detected a good correlation between the protection and containment that a face covering afforded to a wearer.
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Affiliation(s)
- William D. Bennett
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Steven E. Prince
- Center for Public Health and Environmental Assessment, US Environmental Protection Agency, Research Triangle Park, North Carolina
| | - Kirby L. Zeman
- University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Hao Chen
- Oak Ridge Institute for Science Education, Oak Ridge, Tennessee
| | - James M. Samet
- Center for Public Health and Environmental Assessment, US Environmental Protection Agency, Research Triangle Park, North Carolina
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20
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Wilson AM, Ravi P, Pargas NT, Gerald LB, Lowe AA. School health systems under strain: an example of COVID-19 experiences & burnout among school health staff in Pima County, Arizona. BMC Public Health 2023; 23:1626. [PMID: 37626343 PMCID: PMC10463464 DOI: 10.1186/s12889-023-16532-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2023] [Accepted: 08/16/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND School health staff lead and provide a variety of care for children in schools. As school districts have navigated the COVID-19 pandemic, school health staff have faced unprecedented challenges in protecting the health of students and school staff. Our objective was to qualitatively characterize these pandemic challenges and experiences of school health staff in Pima County, Arizona to identify gaps in school health staff support for improving future emergency preparedness. METHODS We conducted two focus group discussions (FGDs) with 48 school health staff in Pima County, Arizona in two school districts using a discussion guide including ten open-ended questions. The FGDs were audio recorded and transcribed verbatim. We used the socioecological model (SEM) to organize the thematic analysis and generate codes and themes; data were analyzed using Atlas.ti software. FINDINGS The pandemic has significantly challenged school health staff with new pandemic-related job tasks: managing isolation, vaccination, and developing/implementing new and evolving COVID-19 guidelines. School health staff also reported increased stress related to interactions with parents and school administration as well as frustrations with rapid changes to guidance from the health department and policy makers. A common issue was not having enough staff or resources to complete regular job responsibilities, such as providing care for students with non-COVID-19 related health issues. CONCLUSIONS Increased workload for school health staff resulted in physical burnout, mental distress, and disruption of core functions with long term implications for children's health. These focus groups highlight the need for improved emergency preparedness in schools during pandemics or infectious disease outbreaks. These include basic infrastructure changes (e.g., personnel support from health departments for tasks such as contact tracing to enable school nurses to continue core functions), and increased funding to allow for hazard pay and more school health personnel during emergency situations. In addition, basic school health infrastructure is lacking, and we should include a licensed school health nurse in every school.
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Affiliation(s)
- Amanda M Wilson
- Department of Community, Environment & Policy, Mel & Enid Zuckerman College of Public Health, University of Arizona, 1295 N. Martin Ave. A233, Tucson, AZ, 85721, USA.
| | - Priyanka Ravi
- Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
| | - Nicole T Pargas
- Health Services Department, Marana Unified School District, Marana, AZ, USA
| | - Lynn B Gerald
- Office of Population Health Sciences in the Office of the Vice Chancellor for Health Affairs, University of Illinois Chicago, Chicago, IL, USA
| | - Ashley A Lowe
- Department of Health Promotion Sciences, Mel & Enid Zuckerman College of Public Health, University of Arizona, Tucson, AZ, USA
- Asthma & Airway Disease Research Center, University of Arizona Health Sciences, Tucson, AZ, USA
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21
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Cooper DK, Sobolik JS, Kovacevic J, Rock CM, Sajewski ET, Guest JL, Lopman BA, Jaykus LA, Leon JS. Combined Infection Control Interventions Protect Essential Food Workers from Occupational Exposures to SARS-CoV-2 in the Agricultural Environment. Appl Environ Microbiol 2023; 89:e0012823. [PMID: 37310232 PMCID: PMC10370312 DOI: 10.1128/aem.00128-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 05/22/2023] [Indexed: 06/14/2023] Open
Abstract
Essential food workers experience elevated risks of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection due to prolonged occupational exposures in food production and processing areas, shared transportation (car or bus), and employer-provided shared housing. Our goal was to quantify the daily cumulative risk of SARS-CoV-2 infection for healthy susceptible produce workers and to evaluate the relative reduction in risk attributable to food industry interventions and vaccination. We simulated daily SARS-CoV-2 exposures of indoor and outdoor produce workers through six linked quantitative microbial risk assessment (QMRA) model scenarios. For each scenario, the infectious viral dose emitted by a symptomatic worker was calculated across aerosol, droplet, and fomite-mediated transmission pathways. Standard industry interventions (2-m physical distancing, handwashing, surface disinfection, universal masking, ventilation) were simulated to assess relative risk reductions from baseline risk (no interventions, 1-m distance). Implementation of industry interventions reduced an indoor worker's relative infection risk by 98.0% (0.020; 95% uncertainty interval [UI], 0.005 to 0.104) from baseline risk (1.00; 95% UI, 0.995 to 1.00) and an outdoor worker's relative infection risk by 94.5% (0.027; 95% UI, 0.013 to 0.055) from baseline risk (0.487; 95% UI, 0.257 to 0.825). Integrating these interventions with two-dose mRNA vaccinations (86 to 99% efficacy), representing a worker's protective immunity to infection, reduced the relative infection risk from baseline for indoor workers by 99.9% (0.001; 95% UI, 0.0002 to 0.005) and outdoor workers by 99.6% (0.002; 95% UI, 0.0003 to 0.005). Consistent implementation of combined industry interventions, paired with vaccination, effectively mitigates the elevated risks from occupationally acquired SARS-CoV-2 infection faced by produce workers. IMPORTANCE This is the first study to estimate the daily risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection across a variety of indoor and outdoor environmental settings relevant to food workers (e.g., shared transportation [car or bus], enclosed produce processing facility and accompanying breakroom, outdoor produce harvesting field, shared housing facility) through a linked quantitative microbial risk assessment framework. Our model has demonstrated that the elevated daily SARS-CoV-2 infection risk experienced by indoor and outdoor produce workers can be reduced below 1% when vaccinations (optimal vaccine efficacy, 86 to 99%) are implemented with recommended infection control strategies (e.g., handwashing, surface disinfection, universal masking, physical distancing, and increased ventilation). Our novel findings provide scenario-specific infection risk estimates that can be utilized by food industry managers to target high-risk scenarios with effective infection mitigation strategies, which was informed through more realistic and context-driven modeling estimates of the infection risk faced by essential food workers daily. Bundled interventions, particularly if they include vaccination, yield significant reductions (>99%) in daily SARS-CoV-2 infection risk for essential food workers in enclosed and open-air environments.
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Affiliation(s)
- D. Kane Cooper
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Julia S. Sobolik
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Jovana Kovacevic
- Food Innovation Center, Oregon State University, Portland, Oregon, USA
| | - Channah M. Rock
- Department of Soil, Water and Environmental Science, University of Arizona, Tucson, Arizona, USA
| | | | - Jodie L. Guest
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Ben A. Lopman
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
| | - Lee-Ann Jaykus
- Food, Bioprocessing and Nutrition Sciences, North Carolina State University, Raleigh, North Carolina, USA
| | - Juan S. Leon
- Rollins School of Public Health, Emory University, Atlanta, Georgia, USA
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22
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Kim JE, Choi H, Lee M, Lee CH. The effect of shortening the quarantine period and lifting the indoor mask mandate on the spread of COVID-19: a mathematical modeling approach. Front Public Health 2023; 11:1166528. [PMID: 37546304 PMCID: PMC10401846 DOI: 10.3389/fpubh.2023.1166528] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Accepted: 07/06/2023] [Indexed: 08/08/2023] Open
Abstract
In this paper, we present a mathematical model to assess the impact of reducing the quarantine period and lifting the indoor mask mandate on the spread of Coronavirus Disease 2019 (COVID-19) in Korea. The model incorporates important epidemiological parameters, such as transmission rates and mortality rates, to simulate the transmission of the virus under different scenarios. Our findings reveal that the impact of mask wearing fades in the long term, which highlights the crucial role of quarantine in controlling the spread of the disease. In addition, balancing the confirmed cases and costs, the lifting of mandatory indoor mask wearing is cost-effective; however, maintaining the quarantine period remains essential. A relationship between the disease transmission rate and vaccine efficiency was also apparent, with higher transmission rates leading to a greater impact of the vaccine efficiency. Moreover, our findings indicate that a higher disease transmission rate exacerbates the consequences of early quarantine release.
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Affiliation(s)
- Jung Eun Kim
- Department of Mathematics and Computer Science, Korea Science Academy of KAIST, Busan, Republic of Korea
| | - Heejin Choi
- Department of Mathematical Sciences, Ulsan National Institute of Science and Technology, Ulsan, Republic of Korea
| | - Minji Lee
- Department of Mathematical Sciences, Ulsan National Institute of Science and Technology, Ulsan, Republic of Korea
| | - Chang Hyeong Lee
- Department of Mathematical Sciences, Ulsan National Institute of Science and Technology, Ulsan, Republic of Korea
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23
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Martín Sánchez FJ, Martínez-Sellés M, Molero García JM, Moreno Guillén S, Rodríguez-Artalejo FJ, Ruiz-Galiana J, Cantón R, De Lucas Ramos P, García-Botella A, García-Lledó A, Hernández-Sampelayo T, Gómez-Pavón J, González Del Castillo J, Martín-Delgado MC, Bouza E. Insights for COVID-19 in 2023. REVISTA ESPANOLA DE QUIMIOTERAPIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE QUIMIOTERAPIA 2023; 36:114-124. [PMID: 36510683 PMCID: PMC10066911 DOI: 10.37201/req/122.2022] [Citation(s) in RCA: 29] [Impact Index Per Article: 29.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Accepted: 11/30/2022] [Indexed: 12/15/2022]
Abstract
Predictions for a near end of the pandemic by the World Health Organization should be interpreted with caution. Current evidence indicates that the efficacy of a fourth dose of classical mRNA vaccines (BT162b2 or mRNA-1273) is low and short-lived in preventing SARS-CoV-2 infection in its predominant variant (Omicron). However, its efficacy is high against severe symptomatic infection, hospitalization and death. The new vaccines being introduced are bivalent and active against the Omicron variants. Potential new vaccines to be introduced in the coming year include a vaccine based on a recombinant protein that emulates the receptor binding domain of the Spike protein under development by the Spanish company Hipra, as well as vaccines for nasal or oral administration. Available information suggests that vaccines against COVID-19 can be administered in association with influenza vaccination without particular complications. New drugs against COVID-19, both antiviral and anti-inflammatory, are under investigation, but this does not seem to be the case with monoclonal antibodies. The indication to use masks in some circumstances will be maintained next year in view of the accumulation of scientific data on their efficacy. Finally, the long COVID or Post-COVID syndrome may continue to affect a very high proportion of patients who have had the disease, requiring combined diagnostic and therapeutic resources.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - E Bouza
- Servicio de Microbiología Clínica y Enfermedades Infecciosas del Hospital General Universitario Gregorio Marañón, Universidad Complutense. CIBERES. Ciber de Enfermedades Respiratorias. Madrid, Spain.
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24
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Martín Sánchez FJ, Martínez-Sellés M, Molero García JM, Moreno Guillén S, Rodríguez-Artalejo FJ, Ruiz-Galiana J, Cantón R, De Lucas Ramos P, García-Botella A, García-Lledó A, Hernández-Sampelayo T, Gómez-Pavón J, González Del Castillo J, Martín-Delgado MC, Bouza E. Insights for COVID-19 in 2023. REVISTA ESPANOLA DE QUIMIOTERAPIA : PUBLICACION OFICIAL DE LA SOCIEDAD ESPANOLA DE QUIMIOTERAPIA 2023. [PMID: 36510683 DOI: 10.3701/req/059.2022] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Predictions for a near end of the pandemic by the World Health Organization should be interpreted with caution. Current evidence indicates that the efficacy of a fourth dose of classical mRNA vaccines (BT162b2 or mRNA-1273) is low and short-lived in preventing SARS-CoV-2 infection in its predominant variant (Omicron). However, its efficacy is high against severe symptomatic infection, hospitalization and death. The new vaccines being introduced are bivalent and active against the Omicron variants. Potential new vaccines to be introduced in the coming year include a vaccine based on a recombinant protein that emulates the receptor binding domain of the Spike protein under development by the Spanish company Hipra, as well as vaccines for nasal or oral administration. Available information suggests that vaccines against COVID-19 can be administered in association with influenza vaccination without particular complications. New drugs against COVID-19, both antiviral and anti-inflammatory, are under investigation, but this does not seem to be the case with monoclonal antibodies. The indication to use masks in some circumstances will be maintained next year in view of the accumulation of scientific data on their efficacy. Finally, the long COVID or Post-COVID syndrome may continue to affect a very high proportion of patients who have had the disease, requiring combined diagnostic and therapeutic resources.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | - E Bouza
- Servicio de Microbiología Clínica y Enfermedades Infecciosas del Hospital General Universitario Gregorio Marañón, Universidad Complutense. CIBERES. Ciber de Enfermedades Respiratorias. Madrid, Spain.
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25
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Pratt A, Eckermann N, Venugopalan SR, Uribe LM, Barlow L, Nonnenmann M. Evaluation of aerosols in a simulated orthodontic debanding procedure. Sci Rep 2023; 13:4826. [PMID: 36964164 PMCID: PMC10036970 DOI: 10.1038/s41598-023-32082-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 03/22/2023] [Indexed: 03/26/2023] Open
Abstract
Dental practitioners may be at risk for exposure to severe acute respiratory syndrome corona virus 2 when performing aerosol generating procedures. Though recent evidence suggests that coronavirus may be transmitted through aerosol generating procedures, it is unknown whether common procedures performed in dental clinics generate aerosol. The aim of this study was to simultaneously quantify airborne concentrations of the bacteriophage MS2 near the oral cavity of a dental mannequin and behind personal protective equipment (i.e., face shield) of the practitioner during a simulated orthodontic debanding procedure. A deband was performed eight times on a dental mannequin. Optical particle counters and SKC Biosamplers were used to measure particle concentration and to collect virus aerosol generated during the procedure, both near the oral cavity and behind the orthodontists face shield. A plaque assay was used to determine the viable virus airborne concentration. When comparing the two measuring locations, near the oral cavity and behind the clinician's face shield, there was no statistically significant difference of virus concentrations or particle size distribution. This study suggests that debanding under these conditions generates live virus aerosol and a face shield does not provide increased protection from virus aerosol, but does provide some protection against splatter during the procedure.
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Affiliation(s)
- Alessandra Pratt
- Department of Occupational and Environmental Health, University of Iowa, Iowa City, IA, USA.
- Center for Access and Delivery Research and Evaluation, Iowa City VA Medical Center, Iowa City, IA, USA.
| | - Nile Eckermann
- Department of Orthodontics, University of Iowa, Iowa City, IA, USA
| | | | | | - Lauren Barlow
- Department of Occupational and Environmental Health, University of Iowa, Iowa City, IA, USA
| | - Matthew Nonnenmann
- Department of Environmental, Agricultural and Occupational Health, University of Nebraska Medical Center, Omaha, NE, USA
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26
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Chaudhary AS, Kiran B, Sivagami K, Govindarajan D, Chakraborty S. Thermal degradation model of used surgical masks based on machine learning methodology. J Taiwan Inst Chem Eng 2023; 144:104732. [PMID: 36817942 PMCID: PMC9922155 DOI: 10.1016/j.jtice.2023.104732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2022] [Revised: 01/19/2023] [Accepted: 02/02/2023] [Indexed: 02/13/2023]
Abstract
Background The COVID-19 pandemic has leveraged facial masks to be one of the most effective measures to prevent the spread of the virus, which thereby has exponentially increased the usage of facial masks that lead to medical waste mismanagements which pose a serious threat to life. Thermal degradation or pyrolysis is an effective treatment method for the used facial mask wastes and this study aims to investigate the thermal degradation of the same. Methods Predicted the TGA experimental curves of the mask components using a Machine Learning model known as Artificial Neural Network (ANN). Significant findings Three different parts of the mask namely- ribbon, body, and corner were separated and used for the analysis. The thermal degradation behavior is studied using Thermogravimetric Analysis (TGA) and this is crucial for determining the reactivity of the individual mask components as they are subjected to a range of temperatures. Using the curves obtained from TGA, kinetic parameters such as Activation energy (E) and Pre-exponential factor (A) were estimated using the Coats-Redfern model-fitting method. Using the determined kinetic parameters, thermodynamic quantities such as a change in Enthalpy (ΔH), Entropy (ΔS), and Gibbs-Free energy (ΔG) were also calculated. Since TGA is a costly and time-consuming process, this study attempted to predict the TGA experimental curves of the mask components using a Machine Learning model known as Artificial Neural Network (ANN). The dataset obtained at a heating rate of 10°C/min was used to train the 3 different neural networks corresponding to the mask components and it showed an excellent agreement with experimental data (R2 > 0.99). Through this study, a complex chemical process such as thermal degradation was modelled using Machine Learning based on available experimental parameters without delving into the intricacies and complexities of the process.
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Affiliation(s)
- Abhishek S Chaudhary
- Process Systems Engineering Laboratory, School of Chemical Engineering, Vellore Institute of Technology, Vellore, Tamil Nadu 632014,India
- Department of Chemical Engineering, Delft University of Technology, Netherlands
| | - Bandaru Kiran
- Process Systems Engineering Laboratory, School of Chemical Engineering, Vellore Institute of Technology, Vellore, Tamil Nadu 632014,India
| | - K Sivagami
- Process Systems Engineering Laboratory, School of Chemical Engineering, Vellore Institute of Technology, Vellore, Tamil Nadu 632014,India
| | - Dhivakar Govindarajan
- Department of Civil Engineering, Environmental and Water Resources Engineering, IIT Madras, Tamil Nadu, India
| | - Samarshi Chakraborty
- Colloids and Polymer Research Group, School of Chemical Engineering, Vellore Institute of Technology, Vellore, Tamil Nadu 632 014, India
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27
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Derk RC, Coyle JP, Lindsley WG, Blachere FM, Lemons AR, Service SK, Martin SB, Mead KR, Fotta SA, Reynolds JS, McKinney WG, Sinsel EW, Beezhold DH, Noti JD. Efficacy of Do-It-Yourself air filtration units in reducing exposure to simulated respiratory aerosols. BUILDING AND ENVIRONMENT 2023; 229:109920. [PMID: 36569517 PMCID: PMC9759459 DOI: 10.1016/j.buildenv.2022.109920] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 12/03/2022] [Accepted: 12/12/2022] [Indexed: 05/20/2023]
Abstract
Many respiratory diseases, including COVID-19, can be spread by aerosols expelled by infected people when they cough, talk, sing, or exhale. Exposure to these aerosols indoors can be reduced by portable air filtration units (air cleaners). Homemade or Do-It-Yourself (DIY) air filtration units are a popular alternative to commercially produced devices, but performance data is limited. Our study used a speaker-audience model to examine the efficacy of two popular types of DIY air filtration units, the Corsi-Rosenthal cube and a modified Ford air filtration unit, in reducing exposure to simulated respiratory aerosols within a mock classroom. Experiments were conducted using four breathing simulators at different locations in the room, one acting as the respiratory aerosol source and three as recipients. Optical particle spectrometers monitored simulated respiratory aerosol particles (0.3-3 μm) as they dispersed throughout the room. Using two DIY cubes (in the front and back of the room) increased the air change rate as much as 12.4 over room ventilation, depending on filter thickness and fan airflow. Using multiple linear regression, each unit increase of air change reduced exposure by 10%. Increasing the number of filters, filter thickness, and fan airflow significantly enhanced the air change rate, which resulted in exposure reductions of up to 73%. Our results show DIY air filtration units can be an effective means of reducing aerosol exposure. However, they also show performance of DIY units can vary considerably depending upon their design, construction, and positioning, and users should be mindful of these limitations.
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Affiliation(s)
- Raymond C Derk
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, 1000 Fredrick Lane, Morgantown, WV, 26508, USA
| | - Jayme P Coyle
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, 1000 Fredrick Lane, Morgantown, WV, 26508, USA
| | - William G Lindsley
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, 1000 Fredrick Lane, Morgantown, WV, 26508, USA
| | - Francoise M Blachere
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, 1000 Fredrick Lane, Morgantown, WV, 26508, USA
| | - Angela R Lemons
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, 1000 Fredrick Lane, Morgantown, WV, 26508, USA
| | - Samantha K Service
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, 1000 Fredrick Lane, Morgantown, WV, 26508, USA
| | - Stephen B Martin
- Respiratory Health Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, 1000 Fredrick Lane, Morgantown, WV, 26505, USA
| | - Kenneth R Mead
- Division of Field Studies and Engineering, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, Cincinnati, OH, 45226, USA
| | - Steven A Fotta
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, 1000 Fredrick Lane, Morgantown, WV, 26508, USA
| | - Jeffrey S Reynolds
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, 1000 Fredrick Lane, Morgantown, WV, 26508, USA
| | - Walter G McKinney
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, 1000 Fredrick Lane, Morgantown, WV, 26508, USA
| | - Erik W Sinsel
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, 1000 Fredrick Lane, Morgantown, WV, 26508, USA
| | - Donald H Beezhold
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, 1000 Fredrick Lane, Morgantown, WV, 26508, USA
| | - John D Noti
- Health Effects Laboratory Division, National Institute for Occupational Safety and Health, Centers for Disease Control and Prevention, 1000 Fredrick Lane, Morgantown, WV, 26508, USA
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28
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Ngonghala CN, Taboe HB, Safdar S, Gumel AB. Unraveling the dynamics of the Omicron and Delta variants of the 2019 coronavirus in the presence of vaccination, mask usage, and antiviral treatment. APPLIED MATHEMATICAL MODELLING 2023; 114:447-465. [PMID: 36281307 PMCID: PMC9581714 DOI: 10.1016/j.apm.2022.09.017] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Revised: 08/31/2022] [Accepted: 09/12/2022] [Indexed: 06/13/2023]
Abstract
The effectiveness of control interventions against COVID-19 is threatened by the emergence of SARS-CoV-2 variants of concern. We present a mathematical model for studying the transmission dynamics of two of these variants (Delta and Omicron) in the United States, in the presence of vaccination, treatment of individuals with clinical symptoms of the disease and the use of face masks. The model is parameterized and cross-validated using observed daily case data for COVID-19 in the United States for the period from November 2021 (when Omicron first emerged) to March 2022. Rigorous qualitative analysis of the model shows that the disease-free equilibrium of the model is locally-asymptotically stable when the control reproduction number of the model (denoted by R c ) is less than one. This equilibrium is shown to be globally-asymptotically stable for a special case of the model, where disease-induced mortality is negligible and both vaccine-derived immunity in fully-vaccinated individuals and natural immunity do not wane, when the associated reproduction number is less than one. The epidemiological implication of the latter result is that the combined vaccination-boosting strategy can lead to the elimination of the pandemic if its implementation can bring (and maintain) the associated reproduction number to a value less than one. An analytical expression for the vaccine-derived herd immunity threshold is derived. Using this expression, together with the baseline values of the parameters of the parameterized model, we showed that the vaccine-derived herd immunity can be achieved in the United States (so that the pandemic will be eliminated) if at least 68 % of the population is fully-vaccinated with two of the three vaccines approved for use in the United States (Pfizer or Moderna vaccine). Furthermore, this study showed (as of the time of writing in March 2022) that the control reproduction number of the Omicron variant was approximately 3.5 times that of the Delta variant (the reproduction of the latter is computed to be ≈ 0.2782 ), indicating that Delta had practically died out and that Omicron has competitively-excluded Delta (to become the predominant variant in the United States). Based on our analysis and parameterization at the time of writing of this paper (March 2022), our study suggests that SARS-CoV-2 elimination is feasible by June 2022 if the current baseline level of the coverage of fully-vaccinated individuals is increased by about 20 % . The prospect of pandemic elimination is significantly improved if vaccination is combined with a face mask strategy that prioritizes moderately effective and high-quality masks. Having a high percentage of the populace wearing the moderately-effective surgical mask is more beneficial to the community than having low percentage of the populace wearing the highly-effective N95 masks. We showed that waning natural and vaccine-derived immunity (if considered individually) offer marginal impact on disease burden, except for the case when they wane at a much faster rate (e.g., within three months), in comparison to the baseline (estimated to be within 9 months to a year). Treatment of symptomatic individuals has marginal effect in reducing daily cases of SARS-CoV-2, in comparison to the baseline, but it has significant impact in reducing daily hospitalizations. Furthermore, while treatment significantly reduces daily hospitalizations (and, consequently, deaths), the prospects of COVID-19 elimination in the United States are significantly enhanced if investments in control resources are focused on mask usage and vaccination rather than on treatment.
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Affiliation(s)
- Calistus N Ngonghala
- Department of Mathematics, University of Florida, Gainesville, FL 32611, USA
- Emerging Pathogens Institute, University of Florida, Gainesville, FL 32610, USA
| | - Hemaho B Taboe
- Department of Mathematics, University of Florida, Gainesville, FL 32611, USA
- Laboratoire de Biomathématiques et d'Estimations Forestières, University of Abomey-Calavi, Cotonou, Bénin
| | - Salman Safdar
- School of Mathematical and Statistical Sciences, Arizona State University, Tempe, AZ 85287, USA
| | - Abba B Gumel
- Department of Mathematics, University of Maryland, College Park, MD 20742, USA
- Department of Biology & Institute for Physical Science and Technology, University of Maryland, College Park, MD 20742, USA
- Department of Mathematics and Applied Mathematics, University of Pretoria, Pretoria 0002, South Africa
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Husain AA, Rai U, Sarkar AK, Chandrasekhar V, Hashmi MF. Out-of-Hospital Cardiac Arrest during the COVID-19 Pandemic: A Systematic Review. Healthcare (Basel) 2023; 11:189. [PMID: 36673557 PMCID: PMC9858873 DOI: 10.3390/healthcare11020189] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2022] [Revised: 12/23/2022] [Accepted: 01/03/2023] [Indexed: 01/11/2023] Open
Abstract
Objective: Out-of-hospital cardiac arrest (OHCA) is a prominent cause of death worldwide. As indicated by the high proportion of COVID-19 suspicion or diagnosis among patients who had OHCA, this issue could have resulted in multiple fatalities from coronavirus disease 2019 (COVID-19) occurring at home and being counted as OHCA. Methods: We used the MeSH term "heart arrest" as well as non-MeSH terms "out-of-hospital cardiac arrest, sudden cardiac death, OHCA, cardiac arrest, coronavirus pandemic, COVID-19, and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)." We conducted a literature search using these search keywords in the Science Direct and PubMed databases and Google Scholar until 25 April 2022. Results: A systematic review of observational studies revealed OHCA and mortality rates increased considerably during the COVID-19 pandemic compared to the same period of the previous year. A temporary two-fold rise in OHCA incidence was detected along with a drop in survival. During the pandemic, the community's response to OHCA changed, with fewer bystander cardiopulmonary resuscitations (CPRs), longer emergency medical service (EMS) response times, and worse OHCA survival rates. Conclusions: This study's limitations include a lack of a centralised data-gathering method and OHCA registry system. If the chain of survival is maintained and effective emergency ambulance services with a qualified emergency medical team are given, the outcome for OHCA survivors can be improved even more.
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Affiliation(s)
- Amreen Aijaz Husain
- School of Pharmaceutical and Population Health Informatics, DIT University, Dehradun 248009, India
| | - Uddipak Rai
- School of Pharmaceutical and Population Health Informatics, DIT University, Dehradun 248009, India
| | | | | | - Mohammad Farukh Hashmi
- Department of Electronics and Communication Engineering, National Institute of Technology, Warangal 506004, India
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Hunt MG, Chiarodit D, Tieu T, Baum J. Using core values and social influence to increase mask-wearing in non-compliant college students. Soc Sci Med 2022; 314:115446. [PMID: 36274455 DOI: 10.1016/j.socscimed.2022.115446] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 10/05/2022] [Accepted: 10/08/2022] [Indexed: 11/18/2022]
Abstract
Determining the best way to increase public health behaviors like mask-wearing in non-compliant individuals remains an important problem. In this two-part study, we examined the correlates of mask non-compliance in undergraduates at a selective East Coast university, and then developed an intervention designed to appeal to individuals with those traits. We found that being politically conservative and favoring the core values of respect for authority and in-group loyalty were associated with mask non-compliance. We then developed two novel public service announcement (PSA) videos. One featured peer campus leaders (e.g. the president of the College Republicans) to appeal to both social influence and the core values of authority and loyalty. The other featured national and local health care authorities. We found that (a) conservative students rated the two videos as equally authoritative, while liberal students rated the health authority PSA to be significantly more authoritative; (b) conservative participants significantly increased their self-reported mask-wearing rates compared to baseline, narrowing the gap in compliance substantially; and (c) the two PSAs were equally effective for conservative students at increasing mask-wearing. This study shows that public health interventions that target the values and beliefs associated with non-compliance may best influence behavior.
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Bahrami F, Batt T, Schudel S, Annaheim S, He W, Wang J, Rossi RM, Defraeye T. How long and effective does a mask protect you from an infected person who emits virus-laden particles: By implementing one-dimensional physics-based modeling. Front Public Health 2022; 10:991455. [PMID: 36311564 PMCID: PMC9614280 DOI: 10.3389/fpubh.2022.991455] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Accepted: 09/27/2022] [Indexed: 01/26/2023] Open
Abstract
SARS-CoV-2 spreads via droplets, aerosols, and smear infection. From the beginning of the COVID-19 pandemic, using a facemask in different locations was recommended to slow down the spread of the virus. To evaluate facemasks' performance, masks' filtration efficiency is tested for a range of particle sizes. Although such tests quantify the blockage of the mask for a range of particle sizes, the test does not quantify the cumulative amount of virus-laden particles inhaled or exhaled by its wearer. In this study, we quantify the accumulated viruses that the healthy person inhales as a function of time, activity level, type of mask, and room condition using a physics-based model. We considered different types of masks, such as surgical masks and filtering facepieces (FFPs), and different characteristics of public places such as office rooms, buses, trains, and airplanes. To do such quantification, we implemented a physics-based model of the mask. Our results confirm the importance of both people wearing a mask compared to when only one wears the mask. The protection time for light activity in an office room decreases from 7.8 to 1.4 h with surgical mask IIR. The protection time is further reduced by 85 and 99% if the infected person starts to cough or increases the activity level, respectively. Results show the leakage of the mask can considerably affect the performance of the mask. For the surgical mask, the apparent filtration efficiency reduces by 75% with such a leakage, which cannot provide sufficient protection despite the high filtration efficiency of the mask. The facemask model presented provides key input in order to evaluate the protection of masks for different conditions in public places. The physics-based model of the facemask is provided as an online application.
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Affiliation(s)
- Flora Bahrami
- Laboratory for Biomimetic Membranes and Textiles, Empa, Swiss Federal Laboratories for Materials Science and Technology, St. Gallen, Switzerland,ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Till Batt
- Laboratory for Biomimetic Membranes and Textiles, Empa, Swiss Federal Laboratories for Materials Science and Technology, St. Gallen, Switzerland
| | - Seraina Schudel
- Laboratory for Biomimetic Membranes and Textiles, Empa, Swiss Federal Laboratories for Materials Science and Technology, St. Gallen, Switzerland
| | - Simon Annaheim
- Laboratory for Biomimetic Membranes and Textiles, Empa, Swiss Federal Laboratories for Materials Science and Technology, St. Gallen, Switzerland
| | - Weidong He
- Institute of Environmental Engineering, ETH Zurich, Zürich, Switzerland,Laboratory for Advanced Analytical Technologies, Empa, Swiss Federal Laboratories for Materials Science and Technology, Dübendorf, Switzerland
| | - Jing Wang
- Institute of Environmental Engineering, ETH Zurich, Zürich, Switzerland,Laboratory for Advanced Analytical Technologies, Empa, Swiss Federal Laboratories for Materials Science and Technology, Dübendorf, Switzerland
| | - René M. Rossi
- Laboratory for Biomimetic Membranes and Textiles, Empa, Swiss Federal Laboratories for Materials Science and Technology, St. Gallen, Switzerland
| | - Thijs Defraeye
- Laboratory for Biomimetic Membranes and Textiles, Empa, Swiss Federal Laboratories for Materials Science and Technology, St. Gallen, Switzerland,*Correspondence: Thijs Defraeye
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Acuti Martellucci C, Flacco ME, Martellucci M, Violante FS, Manzoli L. Inhaled CO 2 Concentration While Wearing Face Masks: A Pilot Study Using Capnography. ENVIRONMENTAL HEALTH INSIGHTS 2022; 16:11786302221123573. [PMID: 36133777 PMCID: PMC9483963 DOI: 10.1177/11786302221123573] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Accepted: 08/10/2022] [Indexed: 05/21/2023]
Abstract
Background Face masks are recommended based on the assumption that they protect against SARS-CoV-2 transmission, however studies on their potential side effects are still lacking. We aimed to evaluate the inhaled air carbon dioxide (CO2) concentration, when wearing masks. Methods We measured end-tidal CO2 using professional side-stream capnography, with water-removing tubing, (1) without masks, (2) wearing a surgical mask, and (3) wearing a FFP2 respirator (for 5 minutes each while seated after 10 minutes of rest), in 146 healthy volunteers aged 10 to 90 years, from the general population of Ferrara, Italy. The inhaled air CO2 concentration was computed as: ([mask volume × end-tidal CO2] + [tidal volume - mask volume] × ambient air CO2)/tidal volume. Results With surgical masks, the mean CO2 concentration was 7091 ± 2491 ppm in children, 4835 ± 869 in adults, and 4379 ± 978 in the elderly. With FFP2 respirators, this concentration was 13 665 ± 3655 in children, 8502 ± 1859 in adults, and 9027 ± 1882 in the elderly. The proportion showing a CO2 concentration higher than the 5000 ppm (8-hour average) acceptable threshold for workers was 41.1% with surgical masks, and 99.3% with FFP2 respirators. Adjusting for age, gender, BMI, and smoking, the inhaled air CO2 concentration significantly increased with increasing respiratory rate (mean 10 837 ±3712 ppm among participants ⩾18 breaths/minute, with FFP2 respirators), and among the minors. Conclusion If these results are confirmed, the current guidelines on mask-wearing should be reevaluated.
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Affiliation(s)
| | - Maria Elena Flacco
- Department of Environmental and
Prevention Sciences, University of Ferrara, Ferrara, Italy
| | - Mosè Martellucci
- Department of Medicine and Surgery,
University of Perugia, Perugia, Italy
| | - Francesco Saverio Violante
- Occupational Health Unit, Sant’Orsola
Malpighi University Hospital, University of Bologna, Bologna, Italy
| | - Lamberto Manzoli
- Department of Medical and Surgical
Sciences, University of Bologna, Bologna, Italy
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Rosa N, Jordão M, Costa J, Gaspar A, Martinho N, Gameiro Lopes A, Panão M, Gameiro da Silva M. Experimental and numerical evaluation of a new visor concept with aerodynamic sealing to protect medical professionals from contaminated droplets and aerosols. INDOOR AIR 2022; 32:e13114. [PMID: 36168222 PMCID: PMC9538746 DOI: 10.1111/ina.13114] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/04/2022] [Revised: 07/25/2022] [Accepted: 08/31/2022] [Indexed: 06/16/2023]
Abstract
The fast spreading of the SARS-CoV-2 virus led to a significant increase in the demand for personal protective equipment (PPE). Healthcare professionals, mainly dentists, work near the patients, increasing their risk of infection. This paper investigates the effectiveness of an air-curtain sealing effect in a newly designed visor developed to reduce the risk of contracting a respiratory infection. This PPE was developed by computational fluid dynamics (CFD) modeling. CFD results show that the aerodynamic sealing in this PPE device effectively protects the user's face by 43% from a contaminated environment. The experiments considered two different tests: one using a tracer gas (CO2 ) to simulate a gaseous contaminant inside and outside the PPE face shield and a second test using smoke to simulate aerosol transport and evaluate the PPE efficiency. The particle concentration within the aerodynamically sealed PPE was evaluated and compared with the protection efficiency of other PPE. Results show similar protection levels for particles in the 1-5 μm range between the prototype and a KN95 respirator. The combined use of this novel PPE with aerodynamic sealing and a physical mask (KN95 or surgical) produced protection efficiency values within the range of 57%-70% for particles greater than 0.5 μm. This study reveals the potential of using an air curtain combined with a face shield to reduce the risks from contaminated environments.
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Affiliation(s)
- Nuno Rosa
- Univ CoimbraADAI, Department of Mechanical EngineeringCoimbraPortugal
| | - Mário Jordão
- Univ CoimbraADAI, Department of Mechanical EngineeringCoimbraPortugal
| | - José Costa
- Univ CoimbraADAI, Department of Mechanical EngineeringCoimbraPortugal
| | - Adélio Gaspar
- Univ CoimbraADAI, Department of Mechanical EngineeringCoimbraPortugal
| | - Nuno Martinho
- Univ CoimbraADAI, Department of Mechanical EngineeringCoimbraPortugal
- Polytechnic Institute of Leiria, Department of Mechanical EngineeringLeiriaPortugal
| | | | - Miguel Panão
- Univ CoimbraADAI, Department of Mechanical EngineeringCoimbraPortugal
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Huang W, Wang K, Hung CT, Chow KM, Tsang D, Lai RWM, Xu RH, Yeoh EK, Ho KF, Chen C. Evaluation of SARS-CoV-2 transmission in COVID-19 isolation wards: On-site sampling and numerical analysis. JOURNAL OF HAZARDOUS MATERIALS 2022; 436:129152. [PMID: 35739698 PMCID: PMC9106403 DOI: 10.1016/j.jhazmat.2022.129152] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2022] [Revised: 05/06/2022] [Accepted: 05/11/2022] [Indexed: 05/29/2023]
Abstract
Although airborne transmission has been considered as a possible route for the spread of SARS-CoV-2, the role that aerosols play in SARS-CoV-2 transmission is still controversial. This study evaluated the airborne transmission of SARS-CoV-2 in COVID-19 isolation wards at Prince of Wales Hospital in Hong Kong by both on-site sampling and numerical analysis. A total of 838 air samples and 1176 surface samples were collected, and SARS-CoV-2 RNA was detected using the RT-PCR method. Testing revealed that 2.3% of the air samples and 9.3% of the surface samples were positive, indicating that the isolation wards were contaminated with the virus. The dispersion and deposition of exhaled particles in the wards were calculated by computational fluid dynamics (CFD) simulations. The calculated accumulated number of particles collected at the air sampling points was closely correlated with the SARS-CoV-2 positive rates from the field sampling, which confirmed the possibility of airborne transmission. Furthermore, three potential intervention strategies, i.e., the use of curtains, ceiling-mounted air cleaners, and periodic ventilation, were numerically investigated to explore effective control measures in isolation wards. According to the results, the use of ceiling-mounted air cleaners is effective in reducing the airborne transmission of SARS-CoV-2 in such wards.
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Affiliation(s)
- Wenjie Huang
- Department of Mechanical and Automation Engineering, The Chinese University of Hong Kong, Shatin, N.T. 999077, Hong Kong, China
| | - Kailu Wang
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, N.T. 999077, Hong Kong, China; Centre for Health Systems and Policy Research, JCSPHPC, The Chinese University of Hong Kong, Shatin, N.T. 999077, Hong Kong, China
| | - Chi-Tim Hung
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, N.T. 999077, Hong Kong, China; Centre for Health Systems and Policy Research, JCSPHPC, The Chinese University of Hong Kong, Shatin, N.T. 999077, Hong Kong, China
| | - Kai-Ming Chow
- Department of Medicine and Therapeutics, Prince of Wales Hospital, Shatin, N.T. 999077, Hong Kong, China
| | - Dominic Tsang
- Public Health Laboratory Centre, Centre for Health Protection, Kowloon 999077, Hong Kong, China
| | - Raymond Wai-Man Lai
- Department of Microbiology, Prince of Wales Hospital, Shatin, N.T. 999077, Hong Kong, China
| | - Richard Huan Xu
- Department of Rehabilitation Science, Faculty of Health and Social Science, The Hong Kong Polytechnic University, Kowloon 999077, Hong Kong, China
| | - Eng-Kiong Yeoh
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, N.T. 999077, Hong Kong, China; Centre for Health Systems and Policy Research, JCSPHPC, The Chinese University of Hong Kong, Shatin, N.T. 999077, Hong Kong, China
| | - Kin-Fai Ho
- The Jockey Club School of Public Health and Primary Care, The Chinese University of Hong Kong, Shatin, N.T. 999077, Hong Kong, China.
| | - Chun Chen
- Department of Mechanical and Automation Engineering, The Chinese University of Hong Kong, Shatin, N.T. 999077, Hong Kong, China; Shenzhen Research Institute, The Chinese University of Hong Kong, Shenzhen 518057, China.
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Brainard J, Hall S, van der Es M, Sekoni A, Price A, Padoveze MC, Ogunsola FT, Nichiata LYI, Hornsey E, Crook B, Cirino F, Chu L, Hunter PR. A mixed methods study on effectiveness and appropriateness of face shield use as COVID-19 PPE in middle income countries. Am J Infect Control 2022; 50:878-884. [PMID: 35908826 PMCID: PMC9329084 DOI: 10.1016/j.ajic.2022.01.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2021] [Revised: 01/24/2022] [Accepted: 01/24/2022] [Indexed: 11/29/2022]
Abstract
Background Face shields were widely used in 2020-2021 as facial personal protective equipment (PPE). Laboratory evidence about how protective face shields might be and whether real world user priorities and usage habits conflicted with best practice for maximum possible protection was lacking – especially in limited resource settings. Methods Relative protective potential of 13 face shield designs were tested in a controlled laboratory setting. Community and health care workers were surveyed in middle income country cities (Brazil and Nigeria) about their preferences and perspectives on face shields as facial PPE. Priorities about facial PPE held by survey participants were compared with the implications of the laboratory-generated test results. Results No face shield tested totally eliminated exposure. Head orientation and design features influenced the level of protection. Over 600 individuals were interviewed in Brazil and Nigeria (including 240 health care workers) in March-April 2021. Respondents commented on what influenced their preferred forms of facial PPE, how they tended to clean face shields, and their priorities in choosing a face cover product. Surveyed health care workers commonly bought personal protection equipment for use at work. Conclusions All face shields provided some protection but none gave high levels of protection against external droplet contamination. Respondents wanted facial PPE that considered good communication, secure fixture, good visibility, comfort, fashion, and has validated protectiveness.
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Affiliation(s)
- Julii Brainard
- Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK.
| | - Samantha Hall
- UK Health and Safety Executive, Harpur Hill, Buxton, Derbyshire, UK
| | - Mike van der Es
- Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK
| | - Adekemi Sekoni
- College of Medicine, University of Lagos, Lagos, Nigeria
| | - Amy Price
- Stanford University School of Medicine, Stanford, CA
| | | | | | | | - Emilio Hornsey
- UK Public Health Rapid Support Team, UK Health Security Agency, and London School of Hygiene & Tropical Medicine, London, UK
| | - Brian Crook
- UK Health and Safety Executive, Harpur Hill, Buxton, Derbyshire, UK
| | - Ferla Cirino
- Diadema Municipal Health Department, Diadema, São Paulo, Brazil
| | - Larry Chu
- Stanford University School of Medicine, Stanford, CA
| | - Paul R Hunter
- Norwich Medical School, University of East Anglia, Norwich, Norfolk, UK
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Gedge DA, Chilcott RP, Williams J. Quantifying the Risk to Health Care Workers of Cough as an Aerosol Generating Event in an Ambulance Setting: A Research Report. Prehosp Disaster Med 2022; 37:515-519. [PMID: 35713106 PMCID: PMC9280060 DOI: 10.1017/s1049023x22000917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2022] [Revised: 04/12/2022] [Accepted: 04/30/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION AND OBJECTIVE United Kingdom Health Security Agency (UKHSA) guidance related to mask use for health care workers in a non-aerosol generating procedure (AGP) setting has remained as Level 2 water repellent paper mask (surgical mask) only. Energetic respiratory events, such as coughing, can generate vast numbers of droplets and aerosols. Coughing, considered to be a non-AGP event, frequently occurs in the relatively small, confined space of an ambulance (∼25 m3). The report seeks to explore whether existing research can provide an indication of the risk to ambulance staff, via aerosol transmission, of an acute respiratory infection (ARI) during a coughing event within the clinical setting of an ambulance. METHODS International bibliographic databases were searched (CINAHL Plus, SCOPUS, PubMed, and CENTRAL) using appropriate search strings and a combination of relevant medical subject headings with appropriate truncation. Methodological filters were not applied. Papers without an English language abstract were excluded from the review. Grey literature was sought by searching specialist databases OpenGrey and GreyNet, as well as key organizations' websites. The initial search identified 2,405 articles. Following screening, along with forward and backward citation of key papers identified within the literature search, 36 papers were deemed eligible for the scoping review. DISCUSSION Attempts to replicate a clinical environment to investigate the risk of transmission of airborne viruses to health care workers during a coughing event provided evidence for the generation of respirable aerosol particles and thus potential transmission of pathogens. In cases of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), potential to infect versus true airborne transmission is a debate that continues, but there is general consensus that a large variation of cough characteristics and aerosol generation amongst individuals exists. Studies widely endorsed face masks as a source control device, but there were conflicting views about the impact of mask leakage. CONCLUSION Further research is required to provide clarity of the risk to health care workers when caring for a coughing patient in the confined clinical ambulance setting and to provide an evidence base to assist in the determination of appropriate respiratory protective equipment (RPE).
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Affiliation(s)
- Dale A. Gedge
- University of Hertfordshire, School of Health and Social Work, Hatfield, Hertfordshire, United Kingdom
- Norfolk and Norwich University Hospital NHS Foundation Trust, Norwich, Norfolk, United Kingdom
| | - Robert P. Chilcott
- University of Hertfordshire, Toxicology Research Group, Hatfield, Hertfordshire, United Kingdom
| | - Julia Williams
- University of Hertfordshire, School of Health and Social Work, Hatfield, Hertfordshire, United Kingdom
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Niu Z, Scarciotti G. Ranking the effectiveness of non-pharmaceutical interventions to counter COVID-19 in UK universities with vaccinated population. Sci Rep 2022; 12:13039. [PMID: 35906452 PMCID: PMC9336164 DOI: 10.1038/s41598-022-16532-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Accepted: 07/12/2022] [Indexed: 11/16/2022] Open
Abstract
Several universities around the world have resumed in-person teaching after successful vaccination campaigns have covered 70/80% of the population. In this study, we combine a new compartmental model with an optimal control formulation to discover, among different non-pharmaceutical interventions, the best prevention strategy to maximize on-campus activities while keeping spread under control. Composed of two interconnected Susceptible-Exposed-Infected-Quarantined-Recovered (SEIQR) structures, the model enables staff-to-staff infections, student-to-staff cross infections, student-to-student infections, and environment-to-individual infections. Then, we model input variables representing the implementation of different non-pharmaceutical interventions and formulate and solve optimal control problems for four desired scenarios: minimum number of cases, minimum intervention, minimum non-quarantine intervention, and minimum quarantine intervention. Our results reveal the particular significance of mask wearing and social distancing in universities with vaccinated population (with proportions according to UK data). The study also reveals that quarantining infected students has a higher importance than quarantining staff. In contrast, other measures such as environmental disinfection seems to be less important.
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Affiliation(s)
- Zirui Niu
- EEE, Imperial College London, Exhibition Rd, South Kensington, London, SW7 2AZ, UK
| | - Giordano Scarciotti
- EEE, Imperial College London, Exhibition Rd, South Kensington, London, SW7 2AZ, UK.
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Hall S, Johnson P, Bailey C, Gould Z, White R, Crook B. Evaluation of Face Shields, Goggles, and Safety Glasses as a Virus Transmission Control Measure to Protect the Wearer Against Cough Droplets. Ann Work Expo Health 2022; 67:36-49. [PMID: 35853621 PMCID: PMC9384474 DOI: 10.1093/annweh/wxac047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2022] [Revised: 04/08/2022] [Accepted: 06/23/2022] [Indexed: 01/14/2023] Open
Abstract
Face shields (also referred to as visors), goggles and safety glasses have been worn during the COVID-19 pandemic as one measure to control transmission of the virus. However, their effectiveness in controlling facial exposure to cough droplets is not well established and standard tests for evaluating eye protection for this application are limited. A method was developed to evaluate face shields, goggles, and safety glasses as a control measure to protect the wearer against cough droplets. The method uses a semi-quantitative assessment of facial droplet deposition. A cough simulator was developed to generate droplets comparable to those from a human cough. The droplets consisted of a UV fluorescent marker (fluorescein) in water. Fourteen face shields, four pairs of goggles and one pair of safety glasses were evaluated by mounting them on two different sizes of breathing manikin head and challenging them with the simulated cough. The manikin head was positioned in seven orientations relative to the cough simulator to represent various potential occupational exposure scenarios, for example, a nurse standing over a patient. Droplet deposition in the eyes, nose and mouth regions were visualised following three 'coughs'. Face shields, goggles, and safety glasses reduced, but did not eliminate exposure to the wearer from droplets such as those produced by a human cough. The level of protection differed based on the design of the personal protective equipment and the relative orientation of the wearer to the cough. For example, face shields, and goggles offered the greatest protection when a cough challenge was face on or from above and the least protection when a cough challenge was from below. Face shields were also evaluated as source control to protect others from the wearer. Results suggested that if a coughing person wears a face shield, it can provide some protection from cough droplets to those standing directly in front of the wearer.
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Affiliation(s)
- Samantha Hall
- Author to whom correspondence should be addressed. Tel: +44-02030282185; e-mail:
| | - Paul Johnson
- Health and Safety Executive Science and Research Centre, Harpur Hill, Buxton, Derbyshire SK17 9JN, UK
| | - Claire Bailey
- Health and Safety Executive Science and Research Centre, Harpur Hill, Buxton, Derbyshire SK17 9JN, UK
| | - Zoe Gould
- Health and Safety Executive Science and Research Centre, Harpur Hill, Buxton, Derbyshire SK17 9JN, UK
| | - Robert White
- Health and Safety Executive Science and Research Centre, Harpur Hill, Buxton, Derbyshire SK17 9JN, UK
| | - Brian Crook
- Health and Safety Executive Science and Research Centre, Harpur Hill, Buxton, Derbyshire SK17 9JN, UK
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Sobolik JS, Sajewski ET, Jaykus LA, Cooper DK, Lopman BA, Kraay ANM, Ryan PB, Guest JL, Webb-Girard A, Leon JS. Decontamination of SARS-CoV-2 from cold-chain food packaging provides no marginal benefit in risk reduction to food workers. Food Control 2022; 136:108845. [PMID: 35075333 PMCID: PMC8770992 DOI: 10.1016/j.foodcont.2022.108845] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 01/13/2022] [Accepted: 01/17/2022] [Indexed: 01/20/2023]
Abstract
Countries continue to debate the need for decontamination of cold-chain food packaging to reduce possible severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) fomite transmission among frontline workers. While laboratory-based studies demonstrate persistence of SARS-CoV-2 on surfaces, the likelihood of fomite-mediated transmission under real-life conditions is uncertain. Using a quantitative microbial risk assessment model of a frozen food packaging facility, we simulated 1) SARS-CoV-2 fomite-mediated infection risks following worker exposure to contaminated plastic packaging; and 2) reductions in these risks from masking, handwashing, and vaccination. In a frozen food facility without interventions, SARS-CoV-2 infection risk to a susceptible worker from contact with contaminated packaging was 1.5 × 10-3 per 1h-period (5th - 95th percentile: 9.2 × 10-6, 1.2 × 10-2). Standard food industry infection control interventions, handwashing and masking, reduced risk (99.4%) to 8.5 × 10-6 risk per 1h-period (5th - 95th percentile: 2.8 × 10-8, 6.6 × 10-5). Vaccination of the susceptible worker (two doses Pfizer/Moderna, vaccine effectiveness: 86-99%) with handwashing and masking reduced risk to 5.2 × 10-7 risk per 1h-period (5th - 95th percentile: 1.8 × 10-9, 5.4 × 10-6). Simulating increased transmissibility of current and future variants (Delta, Omicron), (2-, 10-fold viral shedding) among a fully vaccinated workforce, handwashing and masking continued to mitigate risk (1.4 × 10-6 - 8.8 × 10-6 risk per 1h-period). Additional decontamination of frozen food plastic packaging reduced infection risks to 1.2 × 10-8 risk per 1h-period (5th - 95th percentile: 1.9 × 10-11, 9.5 × 10-8). Given that standard infection control interventions reduced risks well below 1 × 10-4 (World Health Organization water quality risk thresholds), additional packaging decontamination suggest no marginal benefit in risk reduction. Consequences of this decontamination may include increased chemical exposures to workers, food quality and hazard risks to consumers, and unnecessary added costs to governments and the global food industry.
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Affiliation(s)
- Julia S Sobolik
- Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | | | - Lee-Ann Jaykus
- Food, Bioprocessing and Nutrition Sciences, North Carolina State University, Raleigh, NC, 27695, USA
| | - D Kane Cooper
- Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Ben A Lopman
- Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Alicia N M Kraay
- Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - P Barry Ryan
- Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Jodie L Guest
- Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Amy Webb-Girard
- Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
| | - Juan S Leon
- Rollins School of Public Health, Emory University, Atlanta, GA, 30322, USA
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40
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Ayed IIA, Khalil R, Adam I, Al-Wutayd O. Face Mask Practice and Technique During the COVID-19 Pandemic: A Nonrepresentative Cross-Sectional Study in Sudan. Patient Prefer Adherence 2022; 16:1163-1176. [PMID: 35535254 PMCID: PMC9078352 DOI: 10.2147/ppa.s366099] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 04/12/2022] [Indexed: 11/23/2022] Open
Abstract
Background The World Health Organization issued guidelines for face mask use in community settings during the current COVID-19 pandemic. However, data are limited on public compliance with those guidelines in Sudan. Therefore, this study assessed face mask-wearing practice and technique during the COVID-19 pandemic among residents of Sudan. Methods A cross-sectional study was conducted from July to September 2021 among Sudanese aged ≥18 years. A web-based questionnaire was shared through different social media platforms. Personal characteristics, four knowledge-associated items, three attitude-associated items, one item concerning mask-wearing practice, and five items related to mask-wearing technique were determined. Univariate, bivariate, and multivariable analyses were performed using STATA v17. Results The survey included 1059 participants (48% males, 52% females) from different regions of Sudan. The overall mean ± SD was 3 ± 0.73 for knowledge of COVID-19 transmission; 2.3 ± 0.71 for attitude toward wearing face masks; 0.38 ± 0.49 for the practice of wearing a face mask; and 4.17 ± 0.97 for face mask-wearing technique. Approximately one-third (38%) of participants always wore a face mask during the pandemic, with age, sex, education level, family income, face mask attitude, occupation, and history of COVID-19 infection affecting the practice. All steps of face mask-wearing technique were performed by 46% of participants (59% performed hand hygiene before putting on a mask and 86% after removing it; 98% covered mouth and nose; 90% adjusted masks at the nose bridge, and 84% tied masks securely), and associated with age, occupation, family income, history of COVID-19 infection, and face-mask attitude. Conclusion Although knowledge and attitude were relatively good, the practice of wearing a face mask and using proper techniques among participants were low. To ensure optimal face mask use and proper mask-wearing techniques, educational intervention and establishing governmental regulations are highly recommended.
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Affiliation(s)
- Itimad I A Ayed
- Department of Basic Medical Sciences, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, Saudi Arabia
- Department of Pharmacology, Faculty of Medicine, International University of Africa, Khartoum, Sudan
| | - Rehana Khalil
- Department of Family and Community Medicine, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, Saudi Arabia
| | - Ishag Adam
- Department of Obstetrics and Gynecology, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, Kingdom of Saudi Arabia
| | - Osama Al-Wutayd
- Department of Family and Community Medicine, Unaizah College of Medicine and Medical Sciences, Qassim University, Unaizah, Saudi Arabia
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Styczynski A, Hemlock C, Hoque KI, Verma R, LeBoa C, Bhuiyan MOF, Nag A, Harun MGD, Amin MB, Andrews JR. Assessing impact of ventilation on airborne transmission of SARS-CoV-2: a cross-sectional analysis of naturally ventilated healthcare settings in Bangladesh. BMJ Open 2022; 12:e055206. [PMID: 35428628 PMCID: PMC9013789 DOI: 10.1136/bmjopen-2021-055206] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 03/18/2022] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES To evaluate the risk of exposure to SARS-CoV-2 in naturally ventilated hospital settings by measuring parameters of ventilation and comparing these findings with results of bioaerosol sampling. STUDY DESIGN Cross-sectional study. STUDY SETTING AND STUDY SAMPLE The study sample included nine hospitals in Dhaka, Bangladesh. Ventilation characteristics and air samples were collected from 86 healthcare spaces during October 2020 to February 2021. PRIMARY OUTCOME Risk of cumulative SARS-CoV-2 infection by type of healthcare area. SECONDARY OUTCOMES Ventilation rates by healthcare space; risk of airborne detection of SARS-CoV-2 across healthcare spaces; impact of room characteristics on absolute ventilation; SARS-CoV-2 detection by naturally ventilated versus mechanically ventilated spaces. RESULTS The majority (78.7%) of naturally ventilated patient care rooms had ventilation rates that fell short of the recommended ventilation rate of 60 L/s/p. Using a modified Wells-Riley equation and local COVID-19 case numbers, we found that over a 40-hour exposure period, outpatient departments posed the highest median risk for infection (7.7%). SARS-CoV-2 RNA was most frequently detected in air samples from non-COVID wards (50.0%) followed by outpatient departments (42.9%). Naturally ventilated spaces (22.6%) had higher rates of SARS-CoV-2 detection compared with mechanically ventilated spaces (8.3%), though the difference was not statistically significant (p=0.128). In multivariable linear regression with calculated elasticity, open door area and cross-ventilation were found to have a significant impact on ventilation. CONCLUSION Our findings provide evidence that naturally ventilated healthcare settings may pose a high risk for exposure to SARS-CoV-2, particularly among non-COVID-designated spaces, but improving parameters of ventilation can mitigate this risk.
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Affiliation(s)
- Ashley Styczynski
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Caitlin Hemlock
- Division of Epidemiology and Biostatistics, University of California Berkeley, Berkeley, California, USA
| | - Kazi Injamamul Hoque
- Laboratory Sciences and Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Renu Verma
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Chris LeBoa
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Md Omar Faruk Bhuiyan
- Laboratory Sciences and Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Auddithio Nag
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, USA
| | - Md Golam Dostogir Harun
- Laboratory Sciences and Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Mohammed Badrul Amin
- Laboratory Sciences and Services Division, International Centre for Diarrhoeal Disease Research, Bangladesh, Dhaka, Bangladesh
| | - Jason R Andrews
- Division of Infectious Diseases and Geographic Medicine, Stanford University School of Medicine, Stanford, California, USA
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Jensen A, Brown N, Kosacki N, Spacek S, Bradley A, Katz D, Jimenez JL, de Gouw J. Teaching Instrumental Analysis during the Pandemic: Application of Handheld CO 2 Monitors to Explore COVID-19 Transmission Risks. JOURNAL OF CHEMICAL EDUCATION 2022; 99:1794-1801. [PMID: 35431325 PMCID: PMC9003892 DOI: 10.1021/acs.jchemed.1c01154] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Revised: 02/09/2022] [Indexed: 06/14/2023]
Abstract
The COVID-19 pandemic has posed a challenge for maintaining an engaging learning environment while using remote laboratory formats. In this work, we describe a Student Choice Project (SCP) in an undergraduate instrumental analysis course that was adapted for remote learning without sacrificing research-based learning goals. We discuss the implementation and assessment of this SCP, selected student results, and student feedback. Students were provided handheld carbon dioxide monitors and charged with designing and implementing an investigation centered on COVID-19 airborne transmission. The real-time monitors provided experience with a new analytical tool that demanded considerations and analysis not common to other methods discussed in the course. Students were motivated by the ability to design their own projects and by the real-world implications of their findings. They performed well for all assessments, reported a positive experience, and recommended these monitors be added to the typical repertoire of instrumentation for the course.
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Affiliation(s)
- Andrew Jensen
- Department
of Chemistry and Cooperative Institute for Research in Environmental
Sciences, University of Colorado, Boulder, Colorado 80309, United States
| | - Niamh Brown
- Department
of Chemistry and Cooperative Institute for Research in Environmental
Sciences, University of Colorado, Boulder, Colorado 80309, United States
- Department
of Chemistry, Massachusetts Institute of
Technology, Cambridge, Massachusetts 02139, United States
| | - Nathalie Kosacki
- Department
of Chemistry and Cooperative Institute for Research in Environmental
Sciences, University of Colorado, Boulder, Colorado 80309, United States
| | - Sara Spacek
- Department
of Chemistry and Cooperative Institute for Research in Environmental
Sciences, University of Colorado, Boulder, Colorado 80309, United States
| | - Alexander Bradley
- Department
of Chemistry and Cooperative Institute for Research in Environmental
Sciences, University of Colorado, Boulder, Colorado 80309, United States
| | - Daniel Katz
- Department
of Chemistry and Cooperative Institute for Research in Environmental
Sciences, University of Colorado, Boulder, Colorado 80309, United States
| | - Jose L. Jimenez
- Department
of Chemistry and Cooperative Institute for Research in Environmental
Sciences, University of Colorado, Boulder, Colorado 80309, United States
| | - Joost de Gouw
- Department
of Chemistry and Cooperative Institute for Research in Environmental
Sciences, University of Colorado, Boulder, Colorado 80309, United States
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Bartsch SM, O'Shea KJ, Chin KL, Strych U, Ferguson MC, Bottazzi ME, Wedlock PT, Cox SN, Siegmund SS, Hotez PJ, Lee BY. Maintaining face mask use before and after achieving different COVID-19 vaccination coverage levels: a modelling study. Lancet Public Health 2022; 7:e356-e365. [PMID: 35276093 PMCID: PMC8903840 DOI: 10.1016/s2468-2667(22)00040-8] [Citation(s) in RCA: 29] [Impact Index Per Article: 14.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Accepted: 02/08/2022] [Indexed: 12/12/2022]
Abstract
BACKGROUND Face mask wearing has been an important part of the response to the COVID-19 pandemic. As vaccination coverage progresses in countries, relaxation of such practices is increasing. Subsequent COVID-19 surges have raised the questions of whether face masks should be encouraged or required and for how long. Here, we aim to assess the value of maintaining face masks use indoors according to different COVID-19 vaccination coverage levels in the USA. METHODS In this computational simulation-model study, we developed and used a Monte Carlo simulation model representing the US population and SARS-CoV-2 spread. Simulation experiments compared what would happen if face masks were used versus not used until given final vaccination coverages were achieved. Different scenarios varied the target vaccination coverage (70-90%), the date these coverages were achieved (Jan 1, 2022, to July 1, 2022), and the date the population discontinued wearing face masks. FINDINGS Simulation experiments revealed that maintaining face mask use (at the coverage seen in the USA from March, 2020, to July, 2020) until target vaccination coverages were achieved was cost-effective and in many cases cost saving from both the societal and third-party payer perspectives across nearly all scenarios explored. Face mask use was estimated to be cost-effective and usually cost saving when the cost of face masks per person per day was ≤US$1·25. In all scenarios, it was estimated to be cost-effective to maintain face mask use for about 2-10 weeks beyond the date that target vaccination coverage (70-90%) was achieved, with this added duration being longer when the target coverage was achieved during winter versus summer. Factors that might increase the transmissibility of the virus (eg, emergence of the delta [B.1.617.2] and omicron [B.1.1.529] variants), or decrease vaccine effectiveness (eg, waning immunity or escape variants), or increase social interactions among certain segments of the population, only increased the cost savings or cost-effectiveness provided by maintaining face mask use. INTERPRETATION Our study provides strong support for maintaining face mask use until and a short time after achieving various final vaccination coverage levels, given that maintaining face mask use can be not just cost-effective, but even cost saving. The emergence of the omicron variant and the prospect of future variants that might be more transmissible and reduce vaccine effectiveness only increases the value of face masks. FUNDING The Agency for Healthcare Research and Quality, the National Institute of General Medical Sciences, the National Science Foundation, the National Center for Advancing Translational Sciences, and the City University of New York.
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Affiliation(s)
- Sarah M Bartsch
- Center for Advanced Technology and Communication in Health, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA; Public Health Informatics, Computational, and Operations Research, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - Kelly J O'Shea
- Center for Advanced Technology and Communication in Health, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA; Public Health Informatics, Computational, and Operations Research, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - Kevin L Chin
- Center for Advanced Technology and Communication in Health, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA; Public Health Informatics, Computational, and Operations Research, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - Ulrich Strych
- National School of Tropical Medicine and Departments of Pediatrics and Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, USA
| | - Marie C Ferguson
- Center for Advanced Technology and Communication in Health, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA; Public Health Informatics, Computational, and Operations Research, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - Maria Elena Bottazzi
- National School of Tropical Medicine and Departments of Pediatrics and Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, USA
| | - Patrick T Wedlock
- Center for Advanced Technology and Communication in Health, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA; Public Health Informatics, Computational, and Operations Research, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - Sarah N Cox
- Center for Advanced Technology and Communication in Health, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA; Public Health Informatics, Computational, and Operations Research, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - Sheryl S Siegmund
- Center for Advanced Technology and Communication in Health, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA; Public Health Informatics, Computational, and Operations Research, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA
| | - Peter J Hotez
- National School of Tropical Medicine and Departments of Pediatrics and Molecular Virology and Microbiology, Baylor College of Medicine, Houston, TX, USA
| | - Bruce Y Lee
- Center for Advanced Technology and Communication in Health, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA; Public Health Informatics, Computational, and Operations Research, Graduate School of Public Health and Health Policy, City University of New York, New York, NY, USA.
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Rahman MZ, Hoque ME, Alam MR, Rouf MA, Khan SI, Xu H, Ramakrishna S. Face Masks to Combat Coronavirus (COVID-19)-Processing, Roles, Requirements, Efficacy, Risk and Sustainability. Polymers (Basel) 2022; 14:1296. [PMID: 35406172 PMCID: PMC9003287 DOI: 10.3390/polym14071296] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2022] [Revised: 02/26/2022] [Accepted: 03/14/2022] [Indexed: 02/04/2023] Open
Abstract
Increasingly prevalent respiratory infectious diseases (e.g., COVID-19) have posed severe threats to public health. Viruses including coronavirus, influenza, and so on can cause respiratory infections. A pandemic may potentially emerge owing to the worldwide spread of the virus through persistent human-to-human transmission. However, transmission pathways may vary; respiratory droplets or airborne virus-carrying particles can have a key role in transmitting infections to humans. In conjunction with social distancing, hand cleanliness, and other preventative measures, the use of face masks is considered to be another scientific approach to combat ubiquitous coronavirus. Different types of face masks are produced using a range of materials (e.g., polypropylene, polyacrylonitrile, polycarbonate, polyurethane, polystyrene, polyester and polyethylene) and manufacturing techniques (woven, knitted, and non-woven) that provide different levels of protection to the users. However, the efficacy and proper disposal/management of the used face masks, particularly the ones made of non-biodegradable polymers, pose great environmental concerns. This review compiles the recent advancements of face masks, covering their requirements, materials and techniques used, efficacy, challenges, risks, and sustainability towards further enhancement of the quality and performance of face masks.
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Affiliation(s)
- Md Zillur Rahman
- Department of Mechanical Engineering, Ahsanullah University of Science and Technology (AUST), Dhaka 1208, Bangladesh
| | - Md Enamul Hoque
- Department of Biomedical Engineering, Military Institute of Science and Technology (MIST), Dhaka 1216, Bangladesh;
| | - Md Rubel Alam
- Department of Knitwear Manufacturing and Technology, BGMEA University of Fashion and Technology (BUFT), Dhaka 1230, Bangladesh; (M.R.A.); (M.A.R.)
| | - Md Abdur Rouf
- Department of Knitwear Manufacturing and Technology, BGMEA University of Fashion and Technology (BUFT), Dhaka 1230, Bangladesh; (M.R.A.); (M.A.R.)
| | - Saiful Islam Khan
- Department of Biomedical Engineering, Military Institute of Science and Technology (MIST), Dhaka 1216, Bangladesh;
| | - Huaizhong Xu
- Department of Biobased Materials Science, Kyoto Institute of Technology (KIT), Matsugasaki Hashikamicho 1, Sakyoku, Kyoto 606-8585, Japan
| | - Seeram Ramakrishna
- Department of Mechanical Engineering, National University of Singapore (NUS), Singapore 117575, Singapore;
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Abstract
Eco-friendly face mask is necessity to reduce the aggravates the environment due to increased face masks waste during COVID-19 pandemic. The successful eco-friendly masks development influenced by understanding of user’s need and effectiveness of communications. The employed conjoint analysis obtained user mask preferences information to support effective communication strategies by business enterprises and policy makers on encouraging public to consume appropriate masks. The attribute importance followed from eco-friendly (32.1%), mask certification (26.5%), filtration efficiency (19.8%), price (13.9%), layers (5.6%), type of mask (1.5%), material (0.7%). The public expecting the mask with the ability to recycled and biodegradable, with certification, performance above 90% filtration efficiency, and affordable prices in the range of Rp.1.500-Rp.25.000. Also, 3-ply fabrics for the medical type and cotton material are generally preferred to polyester/polypropylene. The government needs to improve the effectiveness masks education, provide convenience process to masks certification by manufacturers, and provision of incentives to reduce masks production cost. Meanwhile, manufacturers ensure produce of the standard eco-friendly masks in affordable pricing. Furthermore, gender did not show significant effect on preferences, but varied with average expenditure.
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Woodfield MJ, Jones RM, Sleeth DK. Influence of face shields on exposures to respirable aerosol. JOURNAL OF OCCUPATIONAL AND ENVIRONMENTAL HYGIENE 2022; 19:139-144. [PMID: 34982641 DOI: 10.1080/15459624.2021.2023163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/14/2023]
Abstract
The objective of this study was to determine the influence of face shields on the concentration of respirable aerosols in the breathing zone of the wearer. The experimental approach involved the generation of poly-dispersed respirable test dust aerosol in a low-speed wind tunnel over 15 min, with a downstream breathing mannequin. Aerosol concentrations were measured in the breathing zone of the mannequin and at an upstream location using two laser spectrophotometers that measured particle number concentration over the range 0.25-31 µm. Three face shield designs were tested (A, B, and C) and were positioned on the mannequin operated at a high and low breathing rate. Efficiency-the reduction in aerosol concentration in the breathing zone-was calculated as a function of particle size and overall, for each face shield. Face shield A, a bucket hat with flexible shield, had the highest efficiency, approximately 95%, while more traditional face shield designs had efficiency 53-78%, depending on face shield and breathing rate. Efficiency varied by particle size, but the pattern differed among face shield designs. Face shields decreased the concentration of respirable aerosols in the breathing zone when aerosols were carried perpendicular to the face. Additional research is needed to understand the impact of face shield position relative to the source.
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Affiliation(s)
- Marion J Woodfield
- Department of Family and Preventive Medicine, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah
| | - Rachael M Jones
- Department of Family and Preventive Medicine, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah
| | - Darrah K Sleeth
- Department of Family and Preventive Medicine, Spencer Fox Eccles School of Medicine, University of Utah, Salt Lake City, Utah
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He Z, Gao Q, Henley A, Khatchadourian ZD, Somerville W, Wiseman M, Mongeau L, Tamimi F. Efficacy of Aerosol Reduction Measures for Dental Aerosol Generating Procedures. AEROSOL SCIENCE AND TECHNOLOGY : THE JOURNAL OF THE AMERICAN ASSOCIATION FOR AEROSOL RESEARCH 2022; 56:413-424. [PMID: 36311996 PMCID: PMC9616072 DOI: 10.1080/02786826.2022.2040729] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/09/2021] [Revised: 01/06/2022] [Accepted: 01/28/2022] [Indexed: 06/16/2023]
Abstract
Aerosol particles generated by dental procedures could facilitate the transmission of infectious diseases and contain carcinogen particles. Such particles can penetrate common surgical masks and reach the lungs, leading to increased risk for dental care professionals. However, the risk of inhaling contaminated aerosol and the effectiveness of aerosol reduction measures in dental offices remain unclear. The present study aimed to quantify aerosols produced by drilling and scaling procedures and to evaluate present recommendations for aerosol reduction. The concentration of aerosol particles released from the mock scaling and drilling procedures on dental mannequin were measured using a TSI Optical Particle Sizer (OPS 3330) during 15-min sessions carried out in a single-patient examination room. Using a drilling procedure as the aerosol source, the aerosol reduction performance of two types of high-volume evacuators (HVEs) and a commercial off-the-shelf air purifier was evaluated in a simulated clinical setting. Using either HVEs or the air purifier individually reduced the aerosol accumulated over the course of a 15-minutes drilling procedure at a reduction rate of 94.8 to 97.6%. Using both measures simultaneously raised the reduction rate to 99.6%. The results show that existing HVEs can effectively reduce aerosol concentration generated by a drilling procedure and can be further improved by using an air purifier. Following current regulatory guidelines can ensure a low risk of inhaling contaminated aerosol for dentists, assistants, and patients.
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Affiliation(s)
- Zixin He
- Department of Mechanical Engineering, McGill University, Montreal, Canada
| | - Qiman Gao
- Department of Mechanical Engineering, McGill University, Montreal, Canada
- Faculty of Dentistry, McGill University, Montreal, Canada
| | - Anna Henley
- Department of Mechanical Engineering, McGill University, Montreal, Canada
| | | | | | | | - Luc Mongeau
- Department of Mechanical Engineering, McGill University, Montreal, Canada
| | - Faleh Tamimi
- College of Dentistry, QU Health, Qatar University, Doha, Qatar
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48
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McNeill VF. Airborne Transmission of SARS-CoV-2: Evidence and Implications for Engineering Controls. Annu Rev Chem Biomol Eng 2022; 13:123-140. [PMID: 35300517 DOI: 10.1146/annurev-chembioeng-092220-111631] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Since late 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread globally, causing a pandemic (coronavirus disease 2019, or COVID-19) with dire consequences, including widespread death, long-term illness, and societal and economic disruption. Although initially uncertain, evidence is now overwhelming that SARS-CoV-2 is transmitted primarily through small respiratory droplets and aerosols emitted by infected individuals. As a result, many effective nonpharmaceutical interventions for slowing virus transmission operate by blocking, filtering, or diluting respiratory aerosol, particularly in indoor environments. In this review, we discuss the evidence for airborne transmission of SARS-CoV-2 and implications for engineering solutions to reduce transmission risk. Expected final online publication date for the Annual Review of Chemical and Biomolecular Engineering, Volume 13 is October 2022. Please see http://www.annualreviews.org/page/journal/pubdates for revised estimates.
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Affiliation(s)
- V Faye McNeill
- Department of Chemical Engineering and Department of Earth and Environmental Sciences, Columbia University, New York, NY, USA;
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49
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Klompas M, Karan A. Preventing SARS-CoV-2 Transmission in Health Care Settings in the Context of the Omicron Variant. JAMA 2022; 327:619-620. [PMID: 35072715 DOI: 10.1001/jama.2022.0262] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Affiliation(s)
- Michael Klompas
- Department of Population Medicine, Harvard Medical School and Harvard Pilgrim Health Care Institute, Boston, Massachusetts
- Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts
| | - Abraar Karan
- Division of Infectious Diseases and Geographic Medicine, Stanford University, Palo Alto, California
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50
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Klompas M, Rhee C, Baker MA. Universal Use of N95 Respirators in Healthcare Settings When Community Coronavirus Disease 2019 Rates Are High. Clin Infect Dis 2022; 74:529-531. [PMID: 34113977 PMCID: PMC8384408 DOI: 10.1093/cid/ciab539] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2021] [Indexed: 12/23/2022] Open
Abstract
The Centers for Disease Control and Prevention recommends N95 respirators for all providers who see patients with possible or confirmed coronavirus disease 2019 (COVID-19). We suggest that N95 respirators may be just as important for the care of patients without suspected COVID-19 when community incidence rates are high. This is because severe acute respiratory syndrome coronavirus 2 is most contagious before symptom onset. Ironically, by the time patients are sick enough to be admitted to the hospital with COVID-19, they tend to be less contagious. The greatest threat of transmission in healthcare facilities may therefore be patients and healthcare workers with early occult infection. N95 respirators' superior fit and filtration provide superior exposure protection for healthcare providers seeing patients with early undiagnosed infection and superior source control to protect patients from healthcare workers with early undiagnosed infection. The probability of occult infection in patients and healthcare workers is greatest when community incidence rates are high. Universal use of N95 respirators may help decrease nosocomial transmission at such times.
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Affiliation(s)
- Michael Klompas
- Department of Population Medicine, Harvard Medical School
and Harvard Pilgrim Health Care Institute, Boston,
Massachusetts, USA
- Department of Medicine, Brigham and Women’s
Hospital, Boston, Massachusetts, USA
| | - Chanu Rhee
- Department of Population Medicine, Harvard Medical School
and Harvard Pilgrim Health Care Institute, Boston,
Massachusetts, USA
- Department of Medicine, Brigham and Women’s
Hospital, Boston, Massachusetts, USA
| | - Meghan A Baker
- Department of Population Medicine, Harvard Medical School
and Harvard Pilgrim Health Care Institute, Boston,
Massachusetts, USA
- Department of Medicine, Brigham and Women’s
Hospital, Boston, Massachusetts, USA
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