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Berthelot S, Longtin Y, Margni M, Guertin JR, LeBlanc A, Marx T, Mangou K, Bluteau A, Mantovani D, Mikhaylin S, Bergeron F, Dancause V, Desjardins A, Lahrichi N, Martin D, Sossa CJ, Lachapelle P, Genest I, Schaal S, Gignac A, Tremblay S, Hufty É, Bélanger L, Beatty E. Postpandemic Evaluation of the Eco-Efficiency of Personal Protective Equipment Against COVID-19 in Emergency Departments: Proposal for a Mixed Methods Study. JMIR Res Protoc 2023; 12:e50682. [PMID: 38060296 PMCID: PMC10739239 DOI: 10.2196/50682] [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: 07/09/2023] [Accepted: 07/21/2023] [Indexed: 12/08/2023] Open
Abstract
BACKGROUND The COVID-19 pandemic has had a profound impact on emergency department (ED) care in Canada and around the world. To prevent transmission of COVID-19, personal protective equipment (PPE) was required for all ED care providers in contact with suspected cases. With mass vaccination and improvements in several infection prevention components, our hypothesis is that the risks of transmission of COVID-19 will be significantly reduced and that current PPE use will have economic and ecological consequences that exceed its anticipated benefits. Evidence is needed to evaluate PPE use so that recommendations can ensure the clinical, economic, and environmental efficiency (ie, eco-efficiency) of its use. OBJECTIVE To support the development of recommendations for the eco-efficient use of PPE, our research objectives are to (1) estimate the clinical effectiveness (reduced transmission, hospitalizations, mortality, and work absenteeism) of PPE against COVID-19 for health care workers; (2) estimate the financial cost of using PPE in the ED for the management of suspected or confirmed COVID-19 patients; and (3) estimate the ecological footprint of PPE use against COVID-19 in the ED. METHODS We will conduct a mixed method study to evaluate the eco-efficiency of PPE use in the 5 EDs of the CHU de Québec-Université Laval (Québec, Canada). To achieve our goals, the project will include four phases: systematic review of the literature to assess the clinical effectiveness of PPE (objective 1; phase 1); cost estimation of PPE use in the ED using a time-driven activity-based costing method (objective 2; phase 2); ecological footprint estimation of PPE use using a life cycle assessment approach (objective 3; phase 3); and cost-consequence analysis and focus groups (integration of objectives 1 to 3; phase 4). RESULTS The first 3 phases have started. The results of these phases will be available in 2023. Phase 4 will begin in 2023 and results will be available in 2024. CONCLUSIONS While the benefits of PPE use are likely to diminish as health care workers' immunity increases, it is important to assess its economic and ecological impacts to develop recommendations to guide its eco-efficient use. TRIAL REGISTRATION PROSPERO CRD42022302598; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=302598. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID) DERR1-10.2196/50682.
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Affiliation(s)
- Simon Berthelot
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche, CHU de Québec-Université Laval, Québec, QC, Canada
- Département de médecine de famille et de médecine d'urgence, Faculté de médecine, Université Laval, Québec, QC, Canada
| | | | - Manuele Margni
- Ecole Polytechnique, Université de Montréal, Montréal, QC, Canada
| | - Jason Robert Guertin
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche, CHU de Québec-Université Laval, Québec, QC, Canada
- Département de médecine sociale et préventive, Faculté de médecine, Université Laval, Québec, QC, Canada
| | - Annie LeBlanc
- Département de médecine de famille et de médecine d'urgence, Faculté de médecine, Université Laval, Québec, QC, Canada
| | - Tania Marx
- Services des urgences, Centre hospitalier universitaire de Besançon, Besançon, France
| | - Khadidiatou Mangou
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche, CHU de Québec-Université Laval, Québec, QC, Canada
| | - Ariane Bluteau
- Axe Santé des populations et pratiques optimales en santé, Centre de recherche, CHU de Québec-Université Laval, Québec, QC, Canada
| | - Diego Mantovani
- Axe Médecine régénératrice, Centre de recherche, CHU de Québec-Université Laval, Québec, QC, Canada
| | - Sergey Mikhaylin
- EcoFoodLab, Département des sciences de aliments, Institut sur la Nutrition et les Aliments Fonctionnels, Université Laval, Québec, QC, Canada
| | | | | | | | - Nadia Lahrichi
- Ecole Polytechnique, Université de Montréal, Montréal, QC, Canada
| | - Danielle Martin
- Fashion Design and Creative Direction, Toronto Metropolitan University, Toronto, ON, Canada
| | | | | | | | | | - Anne Gignac
- CHU de Québec-Université Laval, Québec, QC, Canada
| | | | - Éric Hufty
- CHU de Québec-Université Laval, Québec, QC, Canada
| | | | - Erica Beatty
- Département de médecine d'urgence, Hôpital Montfort, Ottawa, ON, Canada
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Ijaz MK, Sattar SA, Nims RW, Boone SA, McKinney J, Gerba CP. Environmental dissemination of respiratory viruses: dynamic interdependencies of respiratory droplets, aerosols, aerial particulates, environmental surfaces, and contribution of viral re-aerosolization. PeerJ 2023; 11:e16420. [PMID: 38025703 PMCID: PMC10680453 DOI: 10.7717/peerj.16420] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 10/17/2023] [Indexed: 12/01/2023] Open
Abstract
During the recent pandemic of COVID-19 (SARS-CoV-2), influential public health agencies such as the World Health Organization (WHO) and the U.S. Centers for Disease Control and Prevention (CDC) have favored the view that SARS CoV-2 spreads predominantly via droplets. Many experts in aerobiology have openly opposed that stance, forcing a vigorous debate on the topic. In this review, we discuss the various proposed modes of viral transmission, stressing the interdependencies between droplet, aerosol, and fomite spread. Relative humidity and temperature prevailing determine the rates at which respiratory aerosols and droplets emitted from an expiratory event (sneezing, coughing, etc.) evaporate to form smaller droplets or aerosols, or experience hygroscopic growth. Gravitational settling of droplets may result in contamination of environmental surfaces (fomites). Depending upon human, animal and mechanical activities in the occupied space indoors, viruses deposited on environmental surfaces may be re-aerosolized (re-suspended) to contribute to aerosols, and can be conveyed on aerial particulate matter such as dust and allergens. The transmission of respiratory viruses may then best be viewed as resulting from dynamic virus spread from infected individuals to susceptible individuals by various physical states of active respiratory emissions, instead of the current paradigm that emphasizes separate dissemination by respiratory droplets, aerosols or by contaminated fomites. To achieve the optimum outcome in terms of risk mitigation and infection prevention and control (IPAC) during seasonal infection peaks, outbreaks, and pandemics, this holistic view emphasizes the importance of dealing with all interdependent transmission modalities, rather than focusing on one modality.
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Affiliation(s)
- M. Khalid Ijaz
- Global Research & Development for Lysol and Dettol, Reckitt Benckiser LLC, Montvale, NJ, United States of America
| | - Syed A. Sattar
- Department of Biochemistry, Microbiology & Immunology, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Stephanie A. Boone
- Water & Energy Sustainable Technology Center, University of Arizona, Tucson, AZ, United States of America
| | - Julie McKinney
- Global Research & Development for Lysol and Dettol, Reckitt Benckiser LLC, Montvale, NJ, United States of America
| | - Charles P. Gerba
- Water & Energy Sustainable Technology Center, University of Arizona, Tucson, AZ, United States of America
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3
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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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Saccente-Kennedy B, Szczepanska A, Harrison J, Archer J, Watson NA, Orton CM, Costello D, Calder JD, Shah PL, Reid JP, Bzdek BR, Epstein R. Mitigation of Respirable Aerosol Particles from Speech and Language Therapy Exercises. J Voice 2023:S0892-1997(23)00124-8. [PMID: 37248120 DOI: 10.1016/j.jvoice.2023.04.001] [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: 03/16/2023] [Accepted: 04/05/2023] [Indexed: 05/31/2023]
Abstract
INTRODUCTION Phonation and speech are known sources of respirable aerosol in humans. Voice assessment and treatment manipulate all the subsystems of voice production, and previous work (Saccente-Kennedy et al., 2022) has demonstrated such activities can generate >10 times more aerosol than conversational speech and 30 times more aerosol than breathing. Aspects of voice therapy may therefore be considered aerosol generating procedures and pose a greater risk of potential airborne pathogen (eg, SARS-CoV-2) transmission than typical speech. Effective mitigation measures may be required to ensure safe service delivery for therapist and patient. OBJECTIVE To assess the effectiveness of mitigation measures in reducing detectable respirable aerosol produced by voice assessment/therapy. METHODS We recruited 15 healthy participants (8 cis-males, 7 cis-females), 9 of whom were voice-specialist speech-language pathologists. Optical Particle Sizers (OPS) (Model 3330, TSI) were used to measure the number concentration of respirable aerosol particles (0.3 µm-10 µm) generated during a selection of voice assessment/therapy tasks, both with and without mitigation measures in place. Measurements were performed in a laminar flow operating theatre, with near-zero background aerosol concentration, allowing us to quantify the number concentration of respiratory aerosol particles produced. Mitigation measures included the wearing of Type IIR fluid resistant surgical masks, wrapping the same masks around the end of straws, and the use of heat and moisture exchange microbiological filters (HMEFs) for a water resistance therapy (WRT) task. RESULTS All unmitigated therapy tasks produced more aerosol than unmasked breathing or speaking. Mitigation strategies reduced detectable aerosol from all tasks to a level significantly below, or no different to, that of unmasked breathing. Pooled filtration efficiencies determined that Type IIR surgical masks reduced detectable aerosol by 90%. Surgical masks wrapped around straws reduced detectable aerosol by 96%. HMEF filters were 100% effective in mitigating the aerosol from WRT, the exercise that generated more aerosol than any other task in the unmitigated condition. CONCLUSIONS Voice therapy and assessment causes the release of significant quantities of respirable aerosol. However, simple mitigation strategies can reduce emitted aerosol concentrations to levels comparable to unmasked breathing.
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Affiliation(s)
- Brian Saccente-Kennedy
- Department of Speech and Language Therapy (ENT), Royal National Ear, Nose and Throat and Eastman Dental Hospitals, University College London Hospitals NHS Foundation Trust, London, United Kingdom
| | - Alicja Szczepanska
- School of Chemistry, University of Bristol, Cantock's Close, Bristol, United Kingdom
| | - Joshua Harrison
- School of Chemistry, University of Bristol, Cantock's Close, Bristol, United Kingdom
| | - Justice Archer
- School of Chemistry, University of Bristol, Cantock's Close, Bristol, United Kingdom
| | - Natalie A Watson
- Department of Ear, Nose and Throat Surgery, Guy's and St Thomas' NHS Foundation Trust, London, United Kingdom
| | - Christopher M Orton
- Department of Respiratory Medicine, Royal Brompton Hospital, London, United Kingdom; Department of Respiratory Medicine, Chelsea and Westminster Hospital, London, United Kingdom; National Heart and Lung Institute, Guy Scadding Building, Imperial College London, London, United Kingdom
| | - Declan Costello
- Ear, Nose and Throat Department, Wexham Park Hospital, United Kingdom
| | - James D Calder
- Department of Bioengineering, Imperial College London, United Kingdom; Fortius Clinic, Fitzhardinge St, London, United Kingdom
| | - Pallav L Shah
- Department of Respiratory Medicine, Royal Brompton Hospital, London, United Kingdom; Department of Respiratory Medicine, Chelsea and Westminster Hospital, London, United Kingdom; National Heart and Lung Institute, Guy Scadding Building, Imperial College London, London, United Kingdom
| | - Jonathan P Reid
- School of Chemistry, University of Bristol, Cantock's Close, Bristol, United Kingdom
| | - Bryan R Bzdek
- School of Chemistry, University of Bristol, Cantock's Close, Bristol, United Kingdom
| | - Ruth Epstein
- Department of Speech and Language Therapy (ENT), Royal National Ear, Nose and Throat and Eastman Dental Hospitals, University College London Hospitals NHS Foundation Trust, London, United Kingdom.
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de Rooij MM, Sikkema RS, Bouwknegt M, de Geus Y, Stanoeva KR, Nieuwenweg S, van Dam AS, Raben C, Dohmen W, Heederik D, Reusken C, Meijer A, Koopmans MP, Franz E, Smit LA. A Comprehensive Sampling Study on SARS-CoV-2 Contamination of Air and Surfaces in a Large Meat Processing Plant Experiencing COVID-19 Clusters in June 2020. J Occup Environ Med 2023; 65:e227-e233. [PMID: 36640441 PMCID: PMC10090283 DOI: 10.1097/jom.0000000000002785] [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: 01/15/2023]
Abstract
OBJECTIVE We aimed to assess SARS-CoV-2 contamination of air and surfaces to gain insight into potential occupational exposure in a large meat processing plant experiencing COVID-19 clusters. Methods: Oro-nasopharyngeal SARS-CoV-2 screening was performed in 76 workers. Environmental samples ( n = 275) including air, ventilation systems, sewage, and swabs of high-touch surfaces and workers' hands were tested for SARS-CoV-2 RNA by real-time quantitative polymerase chain reaction. Results: Twenty-seven (35.5%) of the (predominantly asymptomatic) workers tested positive with modest to low viral loads (cycle threshold ≥ 29.7). Six of 203 surface swabs, 1 of 12 personal air samples, and one of four sewage samples tested positive; other samples tested negative. Conclusions: Although one third of workers tested positive, environmental contamination was limited. Widespread SARS-CoV-2 transmission via air and surfaces was considered unlikely within this plant at the time of investigation while strict COVID-19 control measures were already implemented.
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6
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Jonker L, Linde KJ, de Hoog MLA, Sprado R, Huisman RC, Molenkamp R, Oude Munnink BB, Dohmen W, Heederik DJJ, Eggink D, Welkers MRA, Vennema H, Fraaij PLA, Koopmans MPG, Wouters IM, Bruijning-Verhagen PCJL. SARS-CoV-2 outbreaks in secondary school settings in the Netherlands during fall 2020; silent circulation. BMC Infect Dis 2022; 22:960. [PMID: 36572861 PMCID: PMC9791966 DOI: 10.1186/s12879-022-07904-3] [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: 05/30/2022] [Accepted: 11/29/2022] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND In fall 2020 when schools in the Netherlands operated under a limited set of COVID-19 measures, we conducted outbreaks studies in four secondary schools to gain insight in the level of school transmission and the role of SARS-CoV-2 transmission via air and surfaces. METHODS Outbreak studies were performed between 11 November and 15 December 2020 when the wild-type variant of SARS-CoV-2 was dominant. Clusters of SARS-CoV-2 infections within schools were identified through a prospective school surveillance study. All school contacts of cluster cases, irrespective of symptoms, were invited for PCR testing twice within 48 h and 4-7 days later. Combined NTS and saliva samples were collected at each time point along with data on recent exposure and symptoms. Surface and active air samples were collected in the school environment. All samples were PCR-tested and sequenced when possible. RESULTS Out of 263 sampled school contacts, 24 tested SARS-CoV-2 positive (secondary attack rate 9.1%), of which 62% remained asymptomatic and 42% had a weakly positive test result. Phylogenetic analysis on 12 subjects from 2 schools indicated a cluster of 8 and 2 secondary cases, respectively, but also other distinct strains within outbreaks. Of 51 collected air and 53 surface samples, none were SARS-CoV-2 positive. CONCLUSION Our study confirmed within school SARS-CoV-2 transmission and substantial silent circulation, but also multiple introductions in some cases. Absence of air or surface contamination suggests environmental contamination is not widespread during school outbreaks.
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Affiliation(s)
- Lotte Jonker
- grid.7692.a0000000090126352Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht University, Universiteitsweg 100, 3584 CG Utrecht, The Netherlands
| | - Kimberly J. Linde
- grid.5477.10000000120346234Institute for Risk Assessment Sciences, Utrecht University, Yalelaan 2, 3584 CM Utrecht, The Netherlands
| | - Marieke L. A. de Hoog
- grid.7692.a0000000090126352Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht University, Universiteitsweg 100, 3584 CG Utrecht, The Netherlands
| | - Robin Sprado
- grid.7692.a0000000090126352Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht University, Universiteitsweg 100, 3584 CG Utrecht, The Netherlands
| | - Robin C. Huisman
- grid.5645.2000000040459992XDepartment of Viroscience, Erasmus Medical Center, Dr. Molewaterplein 50, 3015 GD Rotterdam, The Netherlands
| | - Richard Molenkamp
- grid.5645.2000000040459992XDepartment of Viroscience, Erasmus Medical Center, Dr. Molewaterplein 50, 3015 GD Rotterdam, The Netherlands
| | - Bas B. Oude Munnink
- grid.5645.2000000040459992XDepartment of Viroscience, Erasmus Medical Center, Dr. Molewaterplein 50, 3015 GD Rotterdam, The Netherlands
| | - Wietske Dohmen
- grid.5477.10000000120346234Institute for Risk Assessment Sciences, Utrecht University, Yalelaan 2, 3584 CM Utrecht, The Netherlands
| | - Dick J. J. Heederik
- grid.5477.10000000120346234Institute for Risk Assessment Sciences, Utrecht University, Yalelaan 2, 3584 CM Utrecht, The Netherlands
| | - Dirk Eggink
- grid.31147.300000 0001 2208 0118Center for Infectious Disease Control, National Institute for Public Health and the Environment, Antonie Van Leeuwenhoeklaan 9, 3721 MA Bilthoven, The Netherlands
| | - Matthijs R. A. Welkers
- grid.31147.300000 0001 2208 0118Center for Infectious Disease Control, National Institute for Public Health and the Environment, Antonie Van Leeuwenhoeklaan 9, 3721 MA Bilthoven, The Netherlands ,grid.509540.d0000 0004 6880 3010Department of Medical Microbiology & Infection Prevention, Amsterdam University Medical Center, Meibergdreef 9, 1105AZ Amsterdam, The Netherlands
| | - Harry Vennema
- grid.31147.300000 0001 2208 0118Center for Infectious Disease Control, National Institute for Public Health and the Environment, Antonie Van Leeuwenhoeklaan 9, 3721 MA Bilthoven, The Netherlands
| | - Pieter L. A. Fraaij
- grid.5645.2000000040459992XDepartment of Viroscience, Erasmus Medical Center, Dr. Molewaterplein 50, 3015 GD Rotterdam, The Netherlands ,grid.416135.40000 0004 0649 0805Department of Pediatrics, Subdivision Infectious Diseases and Immunology, Erasmus Medical Center-Sophia Children’s Hospital, Wytemaweg 80, 3015 CN Rotterdam, The Netherlands
| | - Marion P. G. Koopmans
- grid.5645.2000000040459992XDepartment of Viroscience, Erasmus Medical Center, Dr. Molewaterplein 50, 3015 GD Rotterdam, The Netherlands
| | - Inge M. Wouters
- grid.5477.10000000120346234Institute for Risk Assessment Sciences, Utrecht University, Yalelaan 2, 3584 CM Utrecht, The Netherlands
| | - Patricia C. J. L. Bruijning-Verhagen
- grid.7692.a0000000090126352Julius Center for Health Sciences and Primary Care, UMC Utrecht, Utrecht University, Universiteitsweg 100, 3584 CG Utrecht, The Netherlands
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Valenzuela-Fernández A, Cabrera-Rodriguez R, Ciuffreda L, Perez-Yanes S, Estevez-Herrera J, González-Montelongo R, Alcoba-Florez J, Trujillo-González R, García-Martínez de Artola D, Gil-Campesino H, Díez-Gil O, Lorenzo-Salazar JM, Flores C, Garcia-Luis J. Nanomaterials to combat SARS-CoV-2: Strategies to prevent, diagnose and treat COVID-19. Front Bioeng Biotechnol 2022; 10:1052436. [PMID: 36507266 PMCID: PMC9732709 DOI: 10.3389/fbioe.2022.1052436] [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: 09/23/2022] [Accepted: 11/09/2022] [Indexed: 11/26/2022] Open
Abstract
The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and the associated coronavirus disease 2019 (COVID-19), which severely affect the respiratory system and several organs and tissues, and may lead to death, have shown how science can respond when challenged by a global emergency, offering as a response a myriad of rapid technological developments. Development of vaccines at lightning speed is one of them. SARS-CoV-2 outbreaks have stressed healthcare systems, questioning patients care by using standard non-adapted therapies and diagnostic tools. In this scenario, nanotechnology has offered new tools, techniques and opportunities for prevention, for rapid, accurate and sensitive diagnosis and treatment of COVID-19. In this review, we focus on the nanotechnological applications and nano-based materials (i.e., personal protective equipment) to combat SARS-CoV-2 transmission, infection, organ damage and for the development of new tools for virosurveillance, diagnose and immune protection by mRNA and other nano-based vaccines. All the nano-based developed tools have allowed a historical, unprecedented, real time epidemiological surveillance and diagnosis of SARS-CoV-2 infection, at community and international levels. The nano-based technology has help to predict and detect how this Sarbecovirus is mutating and the severity of the associated COVID-19 disease, thereby assisting the administration and public health services to make decisions and measures for preparedness against the emerging variants of SARS-CoV-2 and severe or lethal COVID-19.
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Affiliation(s)
- Agustín Valenzuela-Fernández
- Laboratorio de Inmunología Celular y Viral, Unidad de Farmacología, Sección de Medicina, Facultad de Ciencias de la Salud, Universidad de La Laguna, San Cristóbal de La Laguna, Spain
| | - Romina Cabrera-Rodriguez
- Laboratorio de Inmunología Celular y Viral, Unidad de Farmacología, Sección de Medicina, Facultad de Ciencias de la Salud, Universidad de La Laguna, San Cristóbal de La Laguna, Spain
| | - Laura Ciuffreda
- Research Unit, Hospital Universitario N. S. de Candelaria, Santa Cruz de Tenerife, Spain
| | - Silvia Perez-Yanes
- Laboratorio de Inmunología Celular y Viral, Unidad de Farmacología, Sección de Medicina, Facultad de Ciencias de la Salud, Universidad de La Laguna, San Cristóbal de La Laguna, Spain
| | - Judith Estevez-Herrera
- Laboratorio de Inmunología Celular y Viral, Unidad de Farmacología, Sección de Medicina, Facultad de Ciencias de la Salud, Universidad de La Laguna, San Cristóbal de La Laguna, Spain
| | | | - Julia Alcoba-Florez
- Servicio de Microbiología, Hospital Universitario N. S. de Candelaria, Santa Cruz de Tenerife, Spain
| | - Rodrigo Trujillo-González
- Laboratorio de Inmunología Celular y Viral, Unidad de Farmacología, Sección de Medicina, Facultad de Ciencias de la Salud, Universidad de La Laguna, San Cristóbal de La Laguna, Spain
- Departamento de Análisis Matemático, Facultad de Ciencias, Universidad de La Laguna, Santa Cruz de Tenerife, Spain
| | | | - Helena Gil-Campesino
- Servicio de Microbiología, Hospital Universitario N. S. de Candelaria, Santa Cruz de Tenerife, Spain
| | - Oscar Díez-Gil
- Servicio de Microbiología, Hospital Universitario N. S. de Candelaria, Santa Cruz de Tenerife, Spain
| | - José M. Lorenzo-Salazar
- Genomics Division, Instituto Tecnológico y de Energías Renovables, Santa Cruz de Tenerife, Spain
| | - Carlos Flores
- Research Unit, Hospital Universitario N. S. de Candelaria, Santa Cruz de Tenerife, Spain
- Genomics Division, Instituto Tecnológico y de Energías Renovables, Santa Cruz de Tenerife, Spain
- CIBER de Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, Spain
- Faculty of Health Sciences, University of Fernando Pessoa Canarias, Las Palmas de Gran Canaria, Spain
| | - Jonay Garcia-Luis
- Laboratorio de Inmunología Celular y Viral, Unidad de Farmacología, Sección de Medicina, Facultad de Ciencias de la Salud, Universidad de La Laguna, San Cristóbal de La Laguna, Spain
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Karakoç A, Miettinen A, Sözümert E, Evans L, Yiğitler H, Bostanci B, Taciroğlu E, Jäntti R. Microstructural evaluation and recommendations for face masks in community use to reduce the transmission of respiratory infectious diseases. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 226:107154. [PMID: 36182670 PMCID: PMC9519173 DOI: 10.1016/j.cmpb.2022.107154] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 09/12/2022] [Accepted: 09/21/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND AND OBJECTIVE Recommendations for the use of face masks to prevent and protect against the aerosols (≤5µm) and respiratory droplet particles (≥5µm), which can carry and transmit respiratory infections including severe acute respiratory syndrome coronavirus (SARS-CoV-2), have been in effect since the early stages of the coronavirus disease 2019 (COVID-19). The particle filtration efficiency (PFE) and air permeability are the most crucial factors affecting the level of pathogen transmission and breathability, i.e. wearer comfort, which should be investigated in detail. METHODS In this context, this article presents a novel assessment framework for face masks combining X-ray microtomography and computational fluid dynamics simulations. In consideration to their widespread public use, two types of face masks were assessed: (I) two layer non-woven face masks and (II) the surgical masks (made out of a melt-blown fabric layer covered with two non-woven fabric layers). RESULTS The results demonstrate that the surgical masks provide PFEs over 75% for particles with diameter over 0.1µm while two layer face masks are found out to have insufficient PFEs, even for the particles with diameter over 2µm (corresponding PFE is computed as 47.2%). Thus, existence of both the non-woven fabric layers for mechanical filtration and insertion of melt-blown fabric layer(s) for electrostatic filtration in the face masks were found to be highly critical to prevent the airborne pathogen transmission. CONCLUSIONS The present framework would assist in computational assessment of commonly used face mask types based on their microstructural characteristics including fiber diameter, orientation distributions and fiber network density. Therefore, it would be also possible to provide new yet feasible design routes for face masks to ensure reliable personal protection and optimal breathability.
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Affiliation(s)
- Alp Karakoç
- Aalto University, Department of Communications and Networking, Espoo, Finland.
| | - Arttu Miettinen
- Department of Physics, University of Jyväskylä, Jyväskylä, Finland
| | | | - Llion Evans
- College of Engineering, Swansea University, UK
| | - Hüseyin Yiğitler
- Aalto University, Department of Communications and Networking, Espoo, Finland
| | - Başak Bostanci
- Institute Medicana Hospital Istanbul, Ophthalmology Department, İstanbul, Turkey
| | - Ertuğrul Taciroğlu
- University of California Los Angeles, Dept. of Civil & Environmental Engineering, USA
| | - Riku Jäntti
- Aalto University, Department of Communications and Networking, Espoo, Finland
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COVID-19 clusters in a teaching hospital during the second wave of the SARS-CoV-2 pandemic in France: a descriptive study and lessons learned for waves to come. Am J Infect Control 2022; 50:1060-1063. [PMID: 35760144 PMCID: PMC9233875 DOI: 10.1016/j.ajic.2022.06.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 06/16/2022] [Accepted: 06/20/2022] [Indexed: 12/02/2022]
Abstract
A total of 92 coronavirus disease 2019 clusters involving 1,156 individuals (729 patients and 427 healthcare workers) occurred in Lyon University Hospital between September 1, 2020 and March 31, 2021, mostly on medical and geriatric wards. The number of clusters was closely correlated to the trend in coronavirus disease 2019 community incidence over time; in-hospital clusters did not persist when community incidence decreased. Recommended preventive measures were not fully applicable due to specific ward-associated determinants and patient characteristics.
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10
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Bartelt L, van Duin D. An overview of COVID-19 in solid organ transplantation. Clin Microbiol Infect 2022; 28:779-784. [PMID: 35189336 PMCID: PMC8855607 DOI: 10.1016/j.cmi.2022.02.005] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 02/02/2022] [Accepted: 02/03/2022] [Indexed: 12/14/2022]
Abstract
BACKGROUND The COVID-19 pandemic has influenced the field of solid organ transplantation (SOT) in many ways. COVID-19 has led to programmatic impacts and changes in donor and recipient selection. Several studies have evaluated the course, optimal treatment, and prevention of COVID-19 in SOT recipients. OBJECTIVES To review the literature on COVID-19 in SOT recipients. SOURCES PubMed, Web of Science, and Google Scholar were searched. The search was restricted to articles published between January 1, 2019 and December 1, 2021. CONTENT The COVID-19 pandemic initially led to a decreased volume of solid organ transplants. However, transplant volumes at most centres have rebounded. Donor selection remains an incompletely defined issue. Several reports suggest that donor-derived SARS-CoV-2 infections occur only in lung transplant recipients and that other organs from SARS-CoV-2 PCR-positive donors could potentially be safely used. However, these data are limited to case series. Transplantation for end-stage lung disease after COVID-19 infection is increasingly common and has been performed with acceptable outcomes. In acute COVID-19 in a transplant candidate, transplantation should be delayed when feasible. After adjustment, mortality after COVID-19 appear similar in SOT recipients compared to the general population, with notable increased use of antiviral and anti-inflammatory treatment options. Prevention of COVID-19 is key in SOT recipients. Vaccination of SOT recipients and anyone who is in contact with SOT recipients is one of the cornerstones of prevention. Nonpharmacological interventions such as face coverings, hand hygiene, and physical distancing remain ever important as well. IMPLICATIONS The COVID-19 pandemic continues to have an important impact on SOT candidates and recipients. Prevention of infection is the most important measure and requires careful attention to approaches to vaccination and messaging of the ongoing need for face coverings, physical distancing, and hand hygiene.
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Affiliation(s)
- Luther Bartelt
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, North Carolina, USA; Department of Microbiology and Immunology, University of North Carolina at Chapel Hill, North Carolina, USA
| | - David van Duin
- Division of Infectious Diseases, Department of Medicine, University of North Carolina at Chapel Hill, North Carolina, USA.
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11
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Treneman-Evans G, Ali B, Denison-Day J, Clegg T, Yardley L, Denford S, Essery R. The Rapid Adaptation and Optimisation of a Digital Behaviour-Change Intervention to Reduce the Spread of COVID-19 in Schools. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:6731. [PMID: 35682312 PMCID: PMC9180389 DOI: 10.3390/ijerph19116731] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Revised: 05/24/2022] [Accepted: 05/28/2022] [Indexed: 02/04/2023]
Abstract
The rapid transmission of COVID-19 in school communities has been a major concern. To ensure that mitigation systems were in place and support was available, a digital intervention to encourage and facilitate infection-control behaviours was rapidly adapted and optimised for implementation as a whole-school intervention. Using the person-based approach, 'Germ Defence' was iteratively adapted, guided by relevant literature, co-production with Patient and Public Involvement representatives, and think-aloud interviews with forty-five school students, staff, and parents. Suggested infection-control behaviours deemed feasible and acceptable by the majority of participants included handwashing/hand-sanitising and wearing a face covering in certain contexts, such as crowded public spaces. Promoting a sense of collective responsibility was reported to increase motivation for the adoption of these behaviours. However, acceptability and willingness to implement recommended behaviours seemed to be influenced by participants' perceptions of risk. Barriers to the implementation of recommended behaviours in school and at home primarily related to childcare needs and physical space. We conclude that it was possible to rapidly adapt Germ Defence to provide an acceptable resource to help mitigate against infection transmission within and from school settings. Adapted content was considered acceptable, persuasive, and accessible.
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Affiliation(s)
- Georgia Treneman-Evans
- Bristol Medical School, University of Bristol, Bristol BS8 1QU, UK; (J.D.-D.); (T.C.); (L.Y.); (S.D.); (R.E.)
| | - Becky Ali
- Bristol Medical School, University of Bristol, Bristol BS8 1QU, UK; (J.D.-D.); (T.C.); (L.Y.); (S.D.); (R.E.)
| | - James Denison-Day
- Bristol Medical School, University of Bristol, Bristol BS8 1QU, UK; (J.D.-D.); (T.C.); (L.Y.); (S.D.); (R.E.)
- Primary Care Research Centre, University of Southampton, Southampton SO16 5ST, UK
| | - Tara Clegg
- Bristol Medical School, University of Bristol, Bristol BS8 1QU, UK; (J.D.-D.); (T.C.); (L.Y.); (S.D.); (R.E.)
| | - Lucy Yardley
- Bristol Medical School, University of Bristol, Bristol BS8 1QU, UK; (J.D.-D.); (T.C.); (L.Y.); (S.D.); (R.E.)
- Primary Care Research Centre, University of Southampton, Southampton SO16 5ST, UK
| | - Sarah Denford
- Bristol Medical School, University of Bristol, Bristol BS8 1QU, UK; (J.D.-D.); (T.C.); (L.Y.); (S.D.); (R.E.)
| | - Rosie Essery
- Bristol Medical School, University of Bristol, Bristol BS8 1QU, UK; (J.D.-D.); (T.C.); (L.Y.); (S.D.); (R.E.)
- Primary Care Research Centre, University of Southampton, Southampton SO16 5ST, UK
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12
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Schoen CN, Morgan E, Leftwich HK, Rogers C, Soorneedi A, Suther C, Moore MD. Failure to Detect SARS-CoV-2 RNA in the Air During Active Labor in Mothers Who Recently Tested Positive. Front Public Health 2022; 10:881613. [PMID: 35570919 PMCID: PMC9093214 DOI: 10.3389/fpubh.2022.881613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 03/31/2022] [Indexed: 12/03/2022] Open
Abstract
The risk of potential SARS-CoV-2 transmission by infected mothers during labor and delivery has not been investigated in-depth. This work collected air samples close to (respiratory droplets) and more distant from (aerosol generation) unvaccinated patients who had previously tested positive for SARS-CoV-2 during labor within 5 days of a positive test. All but one of the patients wore masks during the delivery, and delivery was carried out in either birthing or negative pressure isolation rooms. Our work failed to detect SARS-CoV-2 RNA in any air samples for all of the six patients who gave birth vaginally, despite validation of the limit of detection of the samplers. In sum, this brief report provides initial evidence that the risk of airborne transmission of SARS-CoV-2 during labor may be mitigated by the use of masks and high ventilation rates common in many modern U.S. medical facilities; however more work is needed to fully evaluate the risk of SARS-CoV-2 transmission during labor and maternal pushing.
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Affiliation(s)
- Corina N Schoen
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Massachusetts Medical School-Baystate, Springfield, MA, United States
| | - Elizabeth Morgan
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, University of Massachusetts Medical School-Baystate, Springfield, MA, United States
| | - Heidi K Leftwich
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, University of Massachusetts Chan Medical School/UMASS Memorial Health, Worcester, MA, United States
| | - Christine Rogers
- Department of Environmental Health Sciences, School of Public Health & Health Sciences, University of Massachusetts-Amherst, Amherst, MA, United States
| | - Anand Soorneedi
- Department of Food Science, University of Massachusetts-Amherst, Amherst, MA, United States
| | - Cassandra Suther
- Department of Food Science, University of Massachusetts-Amherst, Amherst, MA, United States
| | - Matthew D Moore
- Department of Food Science, University of Massachusetts-Amherst, Amherst, MA, United States
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13
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Stettler MEJ, Nishida RT, de Oliveira PM, Mesquita LCC, Johnson TJ, Galea ER, Grandison A, Ewer J, Carruthers D, Sykes D, Kumar P, Avital E, Obeysekara AIB, Doorly D, Hardalupas Y, Green DC, Coldrick S, Parker S, Boies AM. Source terms for benchmarking models of SARS-CoV-2 transmission via aerosols and droplets. ROYAL SOCIETY OPEN SCIENCE 2022. [PMID: 35592762 DOI: 10.6084/m9.figshare.c.5958950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
There is ongoing and rapid advancement in approaches to modelling the fate of exhaled particles in different environments relevant to disease transmission. It is important that models are verified by comparison with each other using a common set of input parameters to ensure that model differences can be interpreted in terms of model physics rather than unspecified differences in model input parameters. In this paper, we define parameters necessary for such benchmarking of models of airborne particles exhaled by humans and transported in the environment during breathing and speaking.
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Affiliation(s)
- Marc E J Stettler
- Department of Civil and Environmental Engineering, Imperial College London, London SW7 2AZ, UK
| | - Robert T Nishida
- Department of Mechanical Engineering, University of Alberta, Edmonton, Alberta, Canada T6G 2G8
| | | | - Léo C C Mesquita
- Department of Engineering, University of Cambridge, Cambridge CB2 1PZ, UK
| | - Tyler J Johnson
- Department of Engineering, University of Cambridge, Cambridge CB2 1PZ, UK
| | - Edwin R Galea
- Fire Safety Engineering Group, University of Greenwich, London SE10 9LS, UK
| | - Angus Grandison
- Fire Safety Engineering Group, University of Greenwich, London SE10 9LS, UK
| | - John Ewer
- Fire Safety Engineering Group, University of Greenwich, London SE10 9LS, UK
| | - David Carruthers
- Cambridge Environmental Research Consultants Ltd, 3 Kings Parade, Cambridge CB2 1SJ, UK
| | | | - Prashant Kumar
- Global Centre for Clean Air Research (GCARE), Department of Civil and Environmental Engineering, Faculty of Engineering and Physical Sciences, University of Surrey, Guildford GU2 7XH, UK
| | - Eldad Avital
- School of Engineering and Materials Science, Queen Mary University of London, London E1 4NS, UK
| | - Asiri I B Obeysekara
- Applied Modelling and Computation Group, Department of Earth Science and Engineering, Imperial College London, London SW7 2AZ, UK
| | - Denis Doorly
- Department of Aeronautics, Imperial College London, London SW7 2AZ, UK
| | - Yannis Hardalupas
- Department of Mechanical Engineering, Imperial College London, London SW7 2AZ, UK
| | - David C Green
- MRC Centre for Environment and Health, Environmental Research Group, Imperial College London, Michael Uren Biomedical Engineering Hub, London, W12 OBZ, UK
- NIHR HPRU in Environmental Exposures and Health, Imperial College London, Michael Uren Biomedical Engineering Hub, London, W12 OBZ, UK
| | - Simon Coldrick
- Health and Safety Executive, Harpur Hill, Buxton, Derbyshire SK17 9JN UK
| | - Simon Parker
- Defence Science and Technology Laboratory, Porton Down, Salisbury SP4 0JQ, UK
| | - Adam M Boies
- Department of Engineering, University of Cambridge, Cambridge CB2 1PZ, UK
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14
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Stettler MEJ, Nishida RT, de Oliveira PM, Mesquita LCC, Johnson TJ, Galea ER, Grandison A, Ewer J, Carruthers D, Sykes D, Kumar P, Avital E, Obeysekara AIB, Doorly D, Hardalupas Y, Green DC, Coldrick S, Parker S, Boies AM. Source terms for benchmarking models of SARS-CoV-2 transmission via aerosols and droplets. ROYAL SOCIETY OPEN SCIENCE 2022; 9:212022. [PMID: 35592762 PMCID: PMC9066307 DOI: 10.1098/rsos.212022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2021] [Accepted: 04/13/2022] [Indexed: 05/03/2023]
Abstract
There is ongoing and rapid advancement in approaches to modelling the fate of exhaled particles in different environments relevant to disease transmission. It is important that models are verified by comparison with each other using a common set of input parameters to ensure that model differences can be interpreted in terms of model physics rather than unspecified differences in model input parameters. In this paper, we define parameters necessary for such benchmarking of models of airborne particles exhaled by humans and transported in the environment during breathing and speaking.
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Affiliation(s)
- Marc E. J. Stettler
- Department of Civil and Environmental Engineering, Imperial College London, London SW7 2AZ, UK
| | - Robert T. Nishida
- Department of Mechanical Engineering, University of Alberta, Edmonton, Alberta, Canada T6G 2G8
| | | | - Léo C. C. Mesquita
- Department of Engineering, University of Cambridge, Cambridge CB2 1PZ, UK
| | - Tyler J. Johnson
- Department of Engineering, University of Cambridge, Cambridge CB2 1PZ, UK
| | - Edwin R. Galea
- Fire Safety Engineering Group, University of Greenwich, London SE10 9LS, UK
| | - Angus Grandison
- Fire Safety Engineering Group, University of Greenwich, London SE10 9LS, UK
| | - John Ewer
- Fire Safety Engineering Group, University of Greenwich, London SE10 9LS, UK
| | - David Carruthers
- Cambridge Environmental Research Consultants Ltd, 3 Kings Parade, Cambridge CB2 1SJ, UK
| | | | - Prashant Kumar
- Global Centre for Clean Air Research (GCARE), Department of Civil and Environmental Engineering, Faculty of Engineering and Physical Sciences, University of Surrey, Guildford GU2 7XH, UK
| | - Eldad Avital
- School of Engineering and Materials Science, Queen Mary University of London, London E1 4NS, UK
| | - Asiri I. B. Obeysekara
- Applied Modelling and Computation Group, Department of Earth Science and Engineering, Imperial College London, London SW7 2AZ, UK
| | - Denis Doorly
- Department of Aeronautics, Imperial College London, London SW7 2AZ, UK
| | - Yannis Hardalupas
- Department of Mechanical Engineering, Imperial College London, London SW7 2AZ, UK
| | - David C. Green
- MRC Centre for Environment and Health, Environmental Research Group, Imperial College London, Michael Uren Biomedical Engineering Hub, London, W12 OBZ, UK
- NIHR HPRU in Environmental Exposures and Health, Imperial College London, Michael Uren Biomedical Engineering Hub, London, W12 OBZ, UK
| | - Simon Coldrick
- Health and Safety Executive, Harpur Hill, Buxton, Derbyshire SK17 9JN UK
| | - Simon Parker
- Defence Science and Technology Laboratory, Porton Down, Salisbury SP4 0JQ, UK
| | - Adam M. Boies
- Department of Engineering, University of Cambridge, Cambridge CB2 1PZ, UK
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15
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Abstract
The ongoing coronavirus disease 2019 (COVID-19) pandemic, caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has led to a global public health disaster. The current gold standard for the diagnosis of infected patients is real-time reverse transcription-quantitative PCR (RT-qPCR). As effective as this method may be, it is subject to false-negative and -positive results, affecting its precision, especially for the detection of low viral loads in samples. In contrast, digital PCR (dPCR), the third generation of PCR, has been shown to be more effective than the gold standard, RT-qPCR, in detecting low viral loads in samples. In this review article, we selected publications to show the broad-spectrum applications of dPCR, including the development of assays and reference standards, environmental monitoring, mutation detection, and clinical diagnosis of SARS-CoV-2, while comparing it analytically to the gold standard, RT-qPCR. In summary, it is evident that the specificity, sensitivity, reproducibility, and detection limits of RT-dPCR are generally unaffected by common factors that may affect RT-qPCR. As this is the first time that dPCR is being tested in an outbreak of such a magnitude, knowledge of its applications will help chart a course for future diagnosis and monitoring of infectious disease outbreaks.
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16
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Viral load of SARS-CoV-2 in droplets and bioaerosols directly captured during breathing, speaking and coughing. Sci Rep 2022; 12:3484. [PMID: 35241703 PMCID: PMC8894466 DOI: 10.1038/s41598-022-07301-5] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 02/16/2022] [Indexed: 02/08/2023] Open
Abstract
Determining the viral load and infectivity of SARS-CoV-2 in macroscopic respiratory droplets, bioaerosols, and other bodily fluids and secretions is important for identifying transmission modes, assessing risks and informing public health guidelines. Here we show that viral load of SARS-CoV-2 Ribonucleic Acid (RNA) in participants’ naso-pharyngeal (NP) swabs positively correlated with RNA viral load they emitted in both droplets >10 \documentclass[12pt]{minimal}
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\begin{document}$$\upmu \hbox {m}$$\end{document}μm and bioaerosols <10 \documentclass[12pt]{minimal}
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\begin{document}$$\upmu \hbox {m}$$\end{document}μm directly captured during the combined expiratory activities of breathing, speaking and coughing using a standardized protocol, although the NP swabs had \documentclass[12pt]{minimal}
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\begin{document}$$\approx$$\end{document}≈ 10\documentclass[12pt]{minimal}
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\begin{document}$$^3\times$$\end{document}3× more RNA on average. By identifying highly-infectious individuals (maximum of 18,000 PFU/mL in NP), we retrieved higher numbers of SARS-CoV-2 RNA gene copies in bioaerosol samples (maximum of 4.8\documentclass[12pt]{minimal}
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\begin{document}$${\times }10^{5}$$\end{document}×105 gene copies/mL and minimum cycle threshold of 26.2) relative to other studies. However, all attempts to identify infectious virus in size-segregated droplets and bioaerosols were negative by plaque assay (0 of 58). This outcome is partly attributed to the insufficient amount of viral material in each sample (as indicated by SARS-CoV-2 gene copies) or may indicate no infectious virus was present in such samples, although other possible factors are identified.
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17
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de Rooij MMT, Hakze-Van der Honing RW, Hulst MM, Harders F, Engelsma M, van de Hoef W, Meliefste K, Nieuwenweg S, Oude Munnink BB, van Schothorst I, Sikkema RS, van der Spek AN, Spierenburg M, Spithoven J, Bouwstra R, Molenaar RJ, Koopmans M, Stegeman A, van der Poel WHM, Smit LAM. Occupational and environmental exposure to SARS-CoV-2 in and around infected mink farms. Occup Environ Med 2021; 78:893-899. [PMID: 34330815 DOI: 10.1101/2021.01.06.20248760] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 06/29/2021] [Indexed: 05/19/2023]
Abstract
OBJECTIVE Unprecedented SARS-CoV-2 infections in farmed minks raised immediate concerns regarding transmission to humans and initiated intensive environmental investigations to assess occupational and environmental exposure. METHODS Air sampling was performed at infected Dutch mink farms, at farm premises and at nearby residential sites. A range of other environmental samples were collected from minks' housing units, including bedding materials. SARS-CoV-2 RNA was analysed in all samples by quantitative PCR. RESULTS Inside the farms, considerable levels of SARS-CoV-2 RNA were found in airborne dust, especially in personal inhalable dust samples (approximately 1000-10 000 copies/m3). Most of the settling dust samples tested positive for SARS-CoV-2 RNA (82%, 75 of 92). SARS-CoV-2 RNA was not detected in outdoor air samples, except for those collected near the entrance of the most recently infected farm. Many samples of minks' housing units and surfaces contained SARS-CoV-2 RNA. CONCLUSIONS Infected mink farms can be highly contaminated with SARS-CoV-2 RNA. This warns of occupational exposure, which was substantiated by considerable SARS-CoV-2 RNA concentrations in personal air samples. Dispersion of SARS-CoV-2 to outdoor air was found to be limited and SARS-CoV-2 RNA was not detected in air samples collected beyond farm premises, implying a negligible risk of environmental exposure to nearby communities. Our occupational and environmental risk assessment is in line with whole genome sequencing analyses showing mink-to-human transmission among farm workers, but no indications of direct zoonotic transmission events to nearby communities.
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Affiliation(s)
- Myrna M T de Rooij
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | | | - Marcel M Hulst
- Wageningen Bioveterinary Research, Lelystad, The Netherlands
| | - Frank Harders
- Wageningen Bioveterinary Research, Lelystad, The Netherlands
| | - Marc Engelsma
- Wageningen Bioveterinary Research, Lelystad, The Netherlands
| | - Wouter van de Hoef
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Kees Meliefste
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Sigrid Nieuwenweg
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | | | | | - Reina S Sikkema
- Department of Viroscience, Erasmus MC, Rotterdam, The Netherlands
| | - Arco N van der Spek
- Netherlands Food and Consumer Product Safety Authority, Utrecht, The Netherlands
| | - Marcel Spierenburg
- Netherlands Food and Consumer Product Safety Authority, Utrecht, The Netherlands
| | - Jack Spithoven
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | | | | | - Marion Koopmans
- Department of Viroscience, Erasmus MC, Rotterdam, The Netherlands
| | - Arjan Stegeman
- Farm Animal Health, Utrecht University, Utrecht, The Netherlands
| | | | - Lidwien A M Smit
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
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18
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de Rooij MMT, Hakze-Van der Honing RW, Hulst MM, Harders F, Engelsma M, van de Hoef W, Meliefste K, Nieuwenweg S, Oude Munnink BB, van Schothorst I, Sikkema RS, van der Spek AN, Spierenburg M, Spithoven J, Bouwstra R, Molenaar RJ, Koopmans M, Stegeman A, van der Poel WHM, Smit LAM. Occupational and environmental exposure to SARS-CoV-2 in and around infected mink farms. Occup Environ Med 2021; 78:893-899. [PMID: 34330815 PMCID: PMC8327637 DOI: 10.1136/oemed-2021-107443] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2021] [Accepted: 06/29/2021] [Indexed: 12/24/2022]
Abstract
OBJECTIVE Unprecedented SARS-CoV-2 infections in farmed minks raised immediate concerns regarding transmission to humans and initiated intensive environmental investigations to assess occupational and environmental exposure. METHODS Air sampling was performed at infected Dutch mink farms, at farm premises and at nearby residential sites. A range of other environmental samples were collected from minks' housing units, including bedding materials. SARS-CoV-2 RNA was analysed in all samples by quantitative PCR. RESULTS Inside the farms, considerable levels of SARS-CoV-2 RNA were found in airborne dust, especially in personal inhalable dust samples (approximately 1000-10 000 copies/m3). Most of the settling dust samples tested positive for SARS-CoV-2 RNA (82%, 75 of 92). SARS-CoV-2 RNA was not detected in outdoor air samples, except for those collected near the entrance of the most recently infected farm. Many samples of minks' housing units and surfaces contained SARS-CoV-2 RNA. CONCLUSIONS Infected mink farms can be highly contaminated with SARS-CoV-2 RNA. This warns of occupational exposure, which was substantiated by considerable SARS-CoV-2 RNA concentrations in personal air samples. Dispersion of SARS-CoV-2 to outdoor air was found to be limited and SARS-CoV-2 RNA was not detected in air samples collected beyond farm premises, implying a negligible risk of environmental exposure to nearby communities. Our occupational and environmental risk assessment is in line with whole genome sequencing analyses showing mink-to-human transmission among farm workers, but no indications of direct zoonotic transmission events to nearby communities.
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Affiliation(s)
- Myrna M T de Rooij
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | | | - Marcel M Hulst
- Wageningen Bioveterinary Research, Lelystad, The Netherlands
| | - Frank Harders
- Wageningen Bioveterinary Research, Lelystad, The Netherlands
| | - Marc Engelsma
- Wageningen Bioveterinary Research, Lelystad, The Netherlands
| | - Wouter van de Hoef
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Kees Meliefste
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | - Sigrid Nieuwenweg
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | | | | | - Reina S Sikkema
- Department of Viroscience, Erasmus MC, Rotterdam, The Netherlands
| | - Arco N van der Spek
- Netherlands Food and Consumer Product Safety Authority, Utrecht, The Netherlands
| | - Marcel Spierenburg
- Netherlands Food and Consumer Product Safety Authority, Utrecht, The Netherlands
| | - Jack Spithoven
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
| | | | | | - Marion Koopmans
- Department of Viroscience, Erasmus MC, Rotterdam, The Netherlands
| | - Arjan Stegeman
- Farm Animal Health, Utrecht University, Utrecht, The Netherlands
| | | | - Lidwien A M Smit
- Institute for Risk Assessment Sciences, Utrecht University, Utrecht, The Netherlands
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19
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Kim DY, Shinde SK, Lone S, Palem RR, Ghodake GS. COVID-19 Pandemic: Public Health Risk Assessment and Risk Mitigation Strategies. J Pers Med 2021; 11:1243. [PMID: 34945715 PMCID: PMC8707584 DOI: 10.3390/jpm11121243] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 11/17/2021] [Accepted: 11/22/2021] [Indexed: 12/17/2022] Open
Abstract
A newly emerged respiratory viral disease called severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is also known as pandemic coronavirus disease (COVID-19). This pandemic has resulted an unprecedented global health crisis and devastating impact on several sectors of human lives and economies. Fortunately, the average case fatality ratio for SARS-CoV-2 is below 2%, much lower than that estimated for MERS (34%) and SARS (11%). However, COVID-19 has a much higher transmissibility rate, as evident from the constant increase in the count of infections worldwide. This article explores the reasons behind how COVID-19 was able to cause a global pandemic crisis. The current outbreak scenario and causes of rapid global spread are examined using recent developments in the literature, epidemiological features relevant to public health awareness, and critical perspective of risk assessment and mitigation strategies. Effective pandemic risk mitigation measures have been established and amended against COVID-19 diseases, but there is still much scope for upgrading execution and coordination among authorities in terms of organizational leadership's commitment and diverse range of safety measures, including administrative control measures, engineering control measures, and personal protective equipment (PPE). The significance of containment interventions against the COVID-19 pandemic is now well established; however, there is a need for its effective execution across the globe, and for the improvement of the performance of risk mitigation practices and suppression of future pandemic crises.
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Affiliation(s)
- Dae-Young Kim
- Department of Biological and Environmental Science, Dongguk University-Seoul, 32 Dongguk-ro, Ilsandong-gu, Goyang-si 10326, Gyeonggi-do, Korea; (D.-Y.K.); (S.K.S.)
| | - Surendra Krushna Shinde
- Department of Biological and Environmental Science, Dongguk University-Seoul, 32 Dongguk-ro, Ilsandong-gu, Goyang-si 10326, Gyeonggi-do, Korea; (D.-Y.K.); (S.K.S.)
| | - Saifullah Lone
- Interdisciplinary Division for Renewable Energy and Advanced Materials (iDREAM), National Institute of Technology (NIT), Srinagar 190006, India;
| | - Ramasubba Reddy Palem
- Department of Medical Biotechnology, Dongguk University-Seoul, 32 Dongguk-ro, Ilsandong-gu, Goyang-si 10326, Gyeonggi-do, Korea;
| | - Gajanan Sampatrao Ghodake
- Department of Biological and Environmental Science, Dongguk University-Seoul, 32 Dongguk-ro, Ilsandong-gu, Goyang-si 10326, Gyeonggi-do, Korea; (D.-Y.K.); (S.K.S.)
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20
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Halperin DT, Hearst N, Hodgins S, Bailey RC, Klausner JD, Jackson H, Wamai RG, Ladapo JA, Over M, Baral S, Escandón K, Gandhi M. Revisiting COVID-19 policies: 10 evidence-based recommendations for where to go from here. BMC Public Health 2021; 21:2084. [PMID: 34774012 PMCID: PMC8590121 DOI: 10.1186/s12889-021-12082-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Accepted: 10/22/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Strategies to control coronavirus 2019 disease (COVID-19) have often been based on preliminary and limited data and have tended to be slow to evolve as new evidence emerges. Yet knowledge about COVID-19 has grown exponentially, and the expanding rollout of vaccines presents further opportunity to reassess the response to the pandemic more broadly. MAIN TEXT We review the latest evidence concerning 10 key COVID-19 policy and strategic areas, specifically addressing: 1) the expansion of equitable vaccine distribution, 2) the need to ease restrictions as hospitalization and mortality rates eventually fall, 3) the advantages of emphasizing educational and harm reduction approaches over coercive and punitive measures, 4) the need to encourage outdoor activities, 5) the imperative to reopen schools, 6) the far-reaching and long-term economic and psychosocial consequences of sustained lockdowns, 7) the excessive focus on surface disinfection and other ineffective measures, 8) the importance of reassessing testing policies and practices, 9) the need for increasing access to outpatient therapies and prophylactics, and 10) the necessity to better prepare for future pandemics. CONCLUSIONS While remarkably effective vaccines have engendered great hope, some widely held assumptions underlying current policy approaches call for an evidence-based reassessment. COVID-19 will require ongoing mitigation for the foreseeable future as it transforms from a pandemic into an endemic infection, but maintaining a constant state of emergency is not viable. A more realistic public health approach is to adjust current mitigation goals to be more data-driven and to minimize unintended harms associated with unfocused or ineffective control efforts. Based on the latest evidence, we therefore present recommendations for refining 10 key policy areas, and for applying lessons learned from COVID-19 to prevent and prepare for future pandemics.
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Affiliation(s)
- Daniel T Halperin
- Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC, USA
| | - Norman Hearst
- Department of Family and Community Medicine, School of Medicine, University of California, San Francisco, CA, USA
| | - Stephen Hodgins
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Robert C Bailey
- School of Public Health, University of Illinois, Chicago, IL, USA
| | - Jeffrey D Klausner
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | | | - Richard G Wamai
- Integrated Initiative for Global Health, Northeastern University, Boston, MA, USA
- School of Public Health, University of Nairobi, Nairobi, Kenya
| | - Joseph A Ladapo
- Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine, University of California, Los Angeles, CA, USA
| | - Mead Over
- Center for Global Development, Washington, D.C, USA
| | - Stefan Baral
- Department of Epidemiology, Johns Hopkins School of Public Health, Baltimore, MD, USA
| | - Kevin Escandón
- School of Medicine, Universidad del Valle, Cali, Colombia.
- Department of Microbiology, Universidad del Valle, Grupo de Investigación en Virus Emergentes VIREM, Cali, Colombia.
| | - Monica Gandhi
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California, San Francisco, CA, USA
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21
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Locke L, Dada O, Shedd JS. Aerosol Transmission of Infectious Disease and the Efficacy of Personal Protective Equipment (PPE): A Systematic Review. J Occup Environ Med 2021; 63:e783-e791. [PMID: 34419986 PMCID: PMC8562920 DOI: 10.1097/jom.0000000000002366] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Health care professionals and governmental agencies are in consensus regarding contact and droplet transmission of infectious diseases. However, personal protective equipment (PPE) efficacy is not considered for aerosol or airborne transmission of infectious diseases. This review discusses the inhalation of virus-laden aerosols as a viable mechanism of transmission of various respiratory infectious diseases and PPE efficacy. METHODS The Preferred Reporting Items for Systematic reviews, and Meta-Analysis (PRISMA) guidelines was used. RESULTS The transmission of infectious disease is of concern for all respirable diseases discussed (SARS-CoV-1, SARS-CoV-2, MERS, influenza, and tuberculosis), and the effectiveness of facemasks is dependent on the efficiency of the filter, fit, and proper use. CONCLUSION PPE should be the last resort in preventing the spread of infectious disease and should only be used for protection and not to control the transmission.
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Affiliation(s)
- Laramie Locke
- Department of Occupational Safety and Health, Murray State University, Kentucky (Mr Locke, Dr Dada); Eastman Chemical Company, Tennessee (Mr Locke); and Department of Environmental Health Sciences, University of Alabama at Birmingham, Birmingham, Alabama (Mr Shedd)
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22
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Dancer SJ, Li Y, Hart A, Tang JW, Jones DL. What is the risk of acquiring SARS-CoV-2 from the use of public toilets? THE SCIENCE OF THE TOTAL ENVIRONMENT 2021; 792:148341. [PMID: 34146809 PMCID: PMC8192832 DOI: 10.1016/j.scitotenv.2021.148341] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/26/2021] [Revised: 06/04/2021] [Accepted: 06/05/2021] [Indexed: 05/18/2023]
Abstract
Public toilets and bathrooms may act as a contact hub point where community transmission of SARS-CoV-2 occurs between users. The mechanism of spread would arise through three mechanisms: inhalation of faecal and/or urinary aerosol from an individual shedding SARS-CoV-2; airborne transmission of respiratory aerosols between users face-to-face or during short periods after use; or from fomite transmission via frequent touch sites such as door handles, sink taps, lota or toilet roll dispenser. In this respect toilets could present a risk comparable with other high throughput enclosed spaces such as public transport and food retail outlets. They are often compact, inadequately ventilated, heavily used and subject to maintenance and cleaning issues. Factors such as these would compound the risks generated by toilet users incubating or symptomatic with SARS-CoV-2. Furthermore, toilets are important public infrastructure since they are vital for the maintenance of accessible, sustainable and comfortable urban spaces. Given the lack of studies on transmission through use of public toilets, comprehensive risk assessment relies upon the compilation of evidence gathered from parallel studies, including work performed in hospitals and prior work on related viruses. This narrative review examines the evidence suggestive of transmission risk through use of public toilets and concludes that such a risk cannot be lightly disregarded. A range of mitigating actions are suggested for both users of public toilets and those that are responsible for their design, maintenance and management.
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Affiliation(s)
- Stephanie J Dancer
- Department of Microbiology, Hairmyres Hospital, NHS, Lanarkshire G75 8RG, Scotland, UK; School of Applied Sciences, Edinburgh Napier University, Edinburgh EH14 1DJ, Scotland, UK.
| | - Yuguo Li
- Department of Mechanical Engineering, University of Hong Kong, Hong Kong, China
| | - Alwyn Hart
- Environment Agency, Research Assessment & Evaluation, Streetsbrook Road, Solihull B91 1QT, West Midlands, England, UK
| | - Julian W Tang
- Respiratory Sciences, University of Leicester, Leicester LE1 7RH, England, UK
| | - Davey L Jones
- Environment Centre Wales, Bangor University, Deiniol Road, Bangor, Gwynedd LL57 2UW, Wales, UK; UWA School of Agriculture and Environment, University of Western Australia, Perth, WA 6009, Australia
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23
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Wilson J, Carson G, Fitzgerald S, Llewelyn MJ, Jenkins D, Parker S, Boies A, Thomas J, Sutcliffe K, Sowden AJ, O'Mara-Eves A, Stansfield C, Harriss E, Reilly J. Are medical procedures that induce coughing or involve respiratory suctioning associated with increased generation of aerosols and risk of SARS-CoV-2 infection? A rapid systematic review. J Hosp Infect 2021; 116:37-46. [PMID: 34245806 PMCID: PMC8264274 DOI: 10.1016/j.jhin.2021.06.011] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2021] [Revised: 06/28/2021] [Accepted: 06/30/2021] [Indexed: 12/14/2022]
Abstract
BACKGROUND The risk of transmission of SARS-CoV-2 from aerosols generated by medical procedures is a cause for concern. AIM To evaluate the evidence for aerosol production and transmission of respiratory infection associated with procedures that involve airway suctioning or induce coughing/sneezing. METHODS The review was informed by PRISMA guidelines. Searches were conducted in PubMed for studies published between January 1st, 2003 and October 6th, 2020. Included studies examined whether nasogastric tube insertion, lung function tests, nasendoscopy, dysphagia assessment, or suctioning for airway clearance result in aerosol generation or transmission of SARS-CoV-2, SARS-CoV, MERS, or influenza. Risk of bias assessment focused on robustness of measurement, control for confounding, and applicability to clinical practice. FINDINGS Eighteen primary studies and two systematic reviews were included. Three epidemiological studies found no association between nasogastric tube insertion and acquisition of respiratory infections. One simulation study found low/very low production of aerosols associated with pulmonary lung function tests. Seven simulation studies of endoscopic sinus surgery suggested significant increases in aerosols but findings were inconsistent; two clinical studies found airborne particles associated with the use of microdebriders/drills. Some simulation studies did not use robust measures to detect particles and are difficult to equate to clinical conditions. CONCLUSION There was an absence of evidence to suggest that the procedures included in the review were associated with an increased risk of transmission of respiratory infection. In order to better target precautions to mitigate risk, more research is required to determine the characteristics of medical procedures and patients that increase the risk of transmission of SARS-CoV-2.
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Affiliation(s)
- J Wilson
- Richard Wells Research Centre, University of West London, London, UK.
| | - G Carson
- Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - S Fitzgerald
- Department of Engineering, University of Cambridge, Cambridge, UK
| | - M J Llewelyn
- Brighton and Sussex Medical School, University of Sussex, Brighton, UK
| | - D Jenkins
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - S Parker
- Defence Science and Technology Laboratory, Porton Down, Salisbury, UK
| | - A Boies
- Department of Engineering, University of Cambridge, Cambridge, UK
| | - J Thomas
- EPPI-Centre, Social Research Institute, UCL Institute of Education, University College London, London, UK
| | - K Sutcliffe
- EPPI-Centre, Social Research Institute, UCL Institute of Education, University College London, London, UK
| | - A J Sowden
- Centre for Reviews and Dissemination, University of York, York, UK
| | - A O'Mara-Eves
- EPPI-Centre, Social Research Institute, UCL Institute of Education, University College London, London, UK
| | - C Stansfield
- EPPI-Centre, Social Research Institute, UCL Institute of Education, University College London, London, UK
| | - E Harriss
- Bodleian Health Care Libraries, John Radcliffe Hospital, Oxford, UK
| | - J Reilly
- Research Centre for Health (ReaCH), Glasgow Caledonian University, Glasgow, UK
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24
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Robles-Romero JM, Conde-Guillén G, Safont-Montes JC, García-Padilla FM, Romero-Martín M. Behaviour of aerosols and their role in the transmission of SARS-CoV-2; a scoping review. Rev Med Virol 2021; 32:e2297. [PMID: 34595799 PMCID: PMC8646542 DOI: 10.1002/rmv.2297] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2021] [Revised: 09/03/2021] [Accepted: 09/07/2021] [Indexed: 12/23/2022]
Abstract
Covid‐19 has triggered an unprecedented global health crisis. The highly contagious nature and airborne transmission route of SARS‐CoV‐2 virus requires extraordinary measures for its containment. It is necessary to know the behaviour of aerosols carrying the virus to avoid this contagion. This paper describes the behaviour of aerosols and their role in the transmission of SARS‐CoV‐2 according to published models using a scoping review based on the PubMed, Scopus, and WOS databases. From an initial 530 references, 9 papers were selected after applying defined inclusion criteria. The results reinforce the airborne transmission route as a means of contagion of the virus and recommend the use of face masks, extending social distance to more than 2 metres, and natural ventilation of enclosed spaces as preventive measures. These results contribute to a better understanding of SARS‐CoV‐2 and help design effective strategies to prevent its spread.
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25
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Lepore E, Aguilera Benito P, Piña Ramírez C, Viccione G. Indoors ventilation in times of confinement by SARS-CoV-2 epidemic: A comparative approach between Spain and Italy. SUSTAINABLE CITIES AND SOCIETY 2021; 72:103051. [PMID: 34099968 PMCID: PMC8172273 DOI: 10.1016/j.scs.2021.103051] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Revised: 05/06/2021] [Accepted: 05/24/2021] [Indexed: 05/07/2023]
Abstract
With the arrival of the SARS-CoV-2 coronavirus, the scientific academia, as well as policymakers, are striving to conceive solutions as an attempt to contain the spreading of contagion. Among the adopted measures, severe lockdown restrictions were issued to avoid the diffusion of the virus in an uncontrolled way through public spaces. It can be deduced from recent literature that the primary route of transmission is via aerosols, produced mainly in poorly ventilated interior areas where infected people spend a lot of time with other people. Concerning contagion rates, accumulated incidence or number of hospitalizations due to COVID-19, Spain, and Italy have reached very high levels. In this framework, a regression analysis to assess the feasibility of the indoor ventilation measures established in Spain and Italy, with respect to the European framework, is here presented. To this aim, ten cases of housing typology were and analyzed. The results show that the measures established in the applicable regulations to prevent and control the risk of contagion by aerosols are not adequate to guarantee a healthy environment indoors. The current Italian guidelines are more restrictive than in Spain, yet the ventilation levels are still insufficient in times of pandemic.
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Key Words
- ACH, air changes per hour
- CO, Carbon Monoxide
- CO2, carbon dioxide
- COVID-19
- COVID-19, Coronavirus disease 2019
- CTE, Technical Building Code, Spain
- EN, European Standards
- F, Statistical test F (Ronald Fisher)
- HS, basic documenton salubrity
- IAQ, indoor air quality
- IEQ, Indoor Environmental Quality
- IEQcat, Indoor Environmental Quality category for design
- Indoor air quality
- Italy
- NOX, oxides of nitrogen
- O3, ozone
- OMS (WHO), World Health Organization
- PM, Particulate Matter
- Qop, specific external air flow per person
- SARS-CoV-2, severe acute respiratory syndrome Coronavirus 2
- SIMA, Italian Society of Environmental Medicine
- SO2, sulfur dioxide
- Spain
- UNE, Spanish Association for Standardisation
- UNESCO, United Nations Educational, Scientific and Cultural Organization
- UNI, Italian national unification body
- Ventilation
- ns, crowding index per unit area
- p, significance value
- ppm, parts per million
- qB, ventilation rate for building materials
- qp, ventilation rate for people
- qv, minimum flow for housing
- ΔCO2, difference in CO2 concentration
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Affiliation(s)
- Ester Lepore
- University of Salerno, Deparment of Civil Engineering, Fisciano, Italy
| | - Patricia Aguilera Benito
- Polytechnic University of Madrid, Higher Technical School of Building, Department of Building Technology, Spain
| | - Carolina Piña Ramírez
- Polytechnic University of Madrid, Higher Technical School of Building, Department of Architectural Construction and its Control, Spain
| | - Giacomo Viccione
- University of Salerno, Deparment of Civil Engineering, Fisciano, Italy
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26
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Zupin L, Fontana F, Gratton R, Milani M, Clemente L, Pascolo L, Ruscio M, Crovella S. SARS-CoV-2 Short-Time Infection Produces Relevant Cytopathic Effects in Vero E6 Cell Line. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18179020. [PMID: 34501610 PMCID: PMC8431154 DOI: 10.3390/ijerph18179020] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 08/18/2021] [Accepted: 08/25/2021] [Indexed: 01/04/2023]
Abstract
Severe acute respiratory syndrome coronavirus type 2 (SARS-CoV-2) is mainly transmitted through respiratory droplets from positive subjects to susceptible hosts or by direct contact with an infected individual. Our study focuses on the in vitro minimal time of viral absorption as well as the minimal quantity of virus able to establish a persistent infection in Vero E6 cells. We observed that 1 min of in vitro virus exposure is sufficient to generate a cytopathic effect in cells after 7 days of infection, even at a multiplicity of infection (MOI) value of 0.01. Being aware that our findings have been obtained using an in vitro cellular model, we demonstrated that short-time exposures and low viral concentrations are able to cause infection, thus opening questions about the risk of SARS-CoV-2 transmissibility even following short contact times.
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Affiliation(s)
- Luisa Zupin
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, 34137 Trieste, Italy; (R.G.); (L.P.)
- Correspondence: ; Tel.: +39-040-3785422
| | - Francesco Fontana
- Division of Laboratory Medicine, University Hospital Giuliano Isontina (ASUGI), 34129 Trieste, Italy; (F.F.); (L.C.); (M.R.)
| | - Rossella Gratton
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, 34137 Trieste, Italy; (R.G.); (L.P.)
| | - Margherita Milani
- Department of Medicine, Surgery and Health Sciences, University of Trieste, 34149 Trieste, Italy;
| | - Libera Clemente
- Division of Laboratory Medicine, University Hospital Giuliano Isontina (ASUGI), 34129 Trieste, Italy; (F.F.); (L.C.); (M.R.)
| | - Lorella Pascolo
- Institute for Maternal and Child Health IRCCS Burlo Garofolo, 34137 Trieste, Italy; (R.G.); (L.P.)
| | - Maurizio Ruscio
- Division of Laboratory Medicine, University Hospital Giuliano Isontina (ASUGI), 34129 Trieste, Italy; (F.F.); (L.C.); (M.R.)
| | - Sergio Crovella
- Department of Biological and Environmental Sciences, College of Arts and Sciences, University of Qatar, Doha 2713, Qatar;
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Escandón K, Rasmussen AL, Bogoch II, Murray EJ, Escandón K, Popescu SV, Kindrachuk J. COVID-19 false dichotomies and a comprehensive review of the evidence regarding public health, COVID-19 symptomatology, SARS-CoV-2 transmission, mask wearing, and reinfection. BMC Infect Dis 2021; 21:710. [PMID: 34315427 PMCID: PMC8314268 DOI: 10.1186/s12879-021-06357-4] [Citation(s) in RCA: 81] [Impact Index Per Article: 27.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 06/24/2021] [Indexed: 02/07/2023] Open
Abstract
Scientists across disciplines, policymakers, and journalists have voiced frustration at the unprecedented polarization and misinformation around coronavirus disease 2019 (COVID-19) pandemic. Several false dichotomies have been used to polarize debates while oversimplifying complex issues. In this comprehensive narrative review, we deconstruct six common COVID-19 false dichotomies, address the evidence on these topics, identify insights relevant to effective pandemic responses, and highlight knowledge gaps and uncertainties. The topics of this review are: 1) Health and lives vs. economy and livelihoods, 2) Indefinite lockdown vs. unlimited reopening, 3) Symptomatic vs. asymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, 4) Droplet vs. aerosol transmission of SARS-CoV-2, 5) Masks for all vs. no masking, and 6) SARS-CoV-2 reinfection vs. no reinfection. We discuss the importance of multidisciplinary integration (health, social, and physical sciences), multilayered approaches to reducing risk ("Emmentaler cheese model"), harm reduction, smart masking, relaxation of interventions, and context-sensitive policymaking for COVID-19 response plans. We also address the challenges in understanding the broad clinical presentation of COVID-19, SARS-CoV-2 transmission, and SARS-CoV-2 reinfection. These key issues of science and public health policy have been presented as false dichotomies during the pandemic. However, they are hardly binary, simple, or uniform, and therefore should not be framed as polar extremes. We urge a nuanced understanding of the science and caution against black-or-white messaging, all-or-nothing guidance, and one-size-fits-all approaches. There is a need for meaningful public health communication and science-informed policies that recognize shades of gray, uncertainties, local context, and social determinants of health.
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Affiliation(s)
- Kevin Escandón
- School of Medicine, Universidad del Valle, Cali, Colombia.
| | - Angela L Rasmussen
- Vaccine and Infectious Disease Organization, University of Saskatchewan, Saskatoon, Canada
- Georgetown Center for Global Health Science and Security, Georgetown University, Washington, DC, USA
| | - Isaac I Bogoch
- Division of Infectious Diseases, University of Toronto, Toronto General Hospital, Toronto, Canada
| | - Eleanor J Murray
- Department of Epidemiology, Boston University School of Public Health, Boston, USA
| | - Karina Escandón
- Department of Anthropology, Universidad Nacional de Colombia, Bogotá, Colombia
| | - Saskia V Popescu
- Georgetown Center for Global Health Science and Security, Georgetown University, Washington, DC, USA
- Schar School of Policy and Government, George Mason University, Fairfax, VA, USA
| | - Jason Kindrachuk
- Vaccine and Infectious Disease Organization, University of Saskatchewan, Saskatoon, Canada
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Canada
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28
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Barbieri P, Zupin L, Licen S, Torboli V, Semeraro S, Cozzutto S, Palmisani J, Di Gilio A, de Gennaro G, Fontana F, Omiciuolo C, Pallavicini A, Ruscio M, Crovella S. Molecular detection of SARS-CoV-2 from indoor air samples in environmental monitoring needs adequate temporal coverage and infectivity assessment. ENVIRONMENTAL RESEARCH 2021; 198:111200. [PMID: 33901446 PMCID: PMC8065246 DOI: 10.1016/j.envres.2021.111200] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2021] [Revised: 04/03/2021] [Accepted: 04/09/2021] [Indexed: 05/18/2023]
Abstract
The relevance of airborne exposure to SARS-CoV-2 in indoor environments is a matter of research and debate, with special importance for healthcare low-risk settings. Experimental approaches to the bioaerosol sampling are neither standardized nor optimized yet, leading in some cases to limited representativity of the temporal and spatial variability of viral presence in aerosols. Airborne viral viability moreover needs to be assessed. A study has been conducted collecting five 24-h PM10 samples in a COVID-19 geriatric ward in late June 2020, and detecting E and RdRp genes by RT-qPCR with a Ct between 36 and 39. The viral RNA detection at Ct = 36 was related to the maximal numerosity of infected patients hosted in the ward. Lacking a direct infectivity assessment for the collected samples an experimental model has been defined, by seeding twelve nasopharyngeal swab extracts from COVID-19 positive patients on Vero E6 cells; only the four extracts with a viral load above E+10 viral copies (approximately Ct<24) have been able to establish a persistent infection in vitro. Therefore, the cytopathic effect, a key feature of residual infectivity, could be considered unlikely for the environmental PM10 samples showing amplification of viral RNA at Ct = 36 or higher. A standardization of airborne SARS-CoV-2 long-term monitoring and of environmental infectivity assessment is urgently needed.
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Affiliation(s)
- Pierluigi Barbieri
- Dept. of Chemical and Pharmaceutical Sciences, University of Trieste, Via L. Giorgieri 1, 34127, Trieste, Italy; INSTM National Interuniversity Consortium of Materials Science and Technology, Via G. Giusti, 9 50121, Firenze, Italy.
| | - Luisa Zupin
- Institute for Maternal and Child Health, IRCCS Burlo Garofolo, Via Dell'Istria 65/1, 34137, Trieste, Italy.
| | - Sabina Licen
- Dept. of Chemical and Pharmaceutical Sciences, University of Trieste, Via L. Giorgieri 1, 34127, Trieste, Italy; INSTM National Interuniversity Consortium of Materials Science and Technology, Via G. Giusti, 9 50121, Firenze, Italy.
| | - Valentina Torboli
- Dept. of Life Sciences, University of Trieste, Via L. Giorgieri 8, 34127, Trieste, Italy.
| | - Sabrina Semeraro
- INSTM National Interuniversity Consortium of Materials Science and Technology, Via G. Giusti, 9 50121, Firenze, Italy.
| | - Sergio Cozzutto
- ARCO Solutions Srl, C/o BIC Incubatori FVG S.p.A. Via Flavia 23/1, 34148, Trieste, Italy.
| | - Jolanda Palmisani
- Dept. of Biology, University of Bari "Aldo Moro", Via Via E. Orabona, 4 70124, Bari, Italy.
| | - Alessia Di Gilio
- Dept. of Biology, University of Bari "Aldo Moro", Via Via E. Orabona, 4 70124, Bari, Italy.
| | - Gianluigi de Gennaro
- Dept. of Biology, University of Bari "Aldo Moro", Via Via E. Orabona, 4 70124, Bari, Italy.
| | - Francesco Fontana
- Azienda Sanitaria Universitaria Giuliano Isontina - Ospedale San Polo Via Luigi Galvani 1, 34074, Monfalcone (GO), Italy.
| | - Cinzia Omiciuolo
- Azienda Sanitaria Universitaria Giuliano Isontina - Ospedale Maggiore Piazza Dell'Ospitale 1, 34129, Trieste (TS), Italy.
| | - Alberto Pallavicini
- Dept. of Life Sciences, University of Trieste, Via L. Giorgieri 8, 34127, Trieste, Italy.
| | - Maurizio Ruscio
- Azienda Sanitaria Universitaria Giuliano Isontina - Ospedale Maggiore Piazza Dell'Ospitale 1, 34129, Trieste (TS), Italy.
| | - Sergio Crovella
- Department of Biological and Environmental Sciences, College of Arts and Sciences, University of Qatar, Doha, 2713, Qatar.
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29
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Patel DR, Field CJ, Septer KM, Sim DG, Jones MJ, Heinly TA, Vanderford TH, McGraw EA, Sutton TC. Transmission and Protection against Reinfection in the Ferret Model with the SARS-CoV-2 USA-WA1/2020 Reference Isolate. J Virol 2021; 95:e0223220. [PMID: 33827954 PMCID: PMC8315962 DOI: 10.1128/jvi.02232-20] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Accepted: 04/02/2021] [Indexed: 01/10/2023] Open
Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has initiated a global pandemic, and several vaccines have now received emergency use authorization. Using the reference strain SARS-CoV-2 USA-WA1/2020, we evaluated modes of transmission and the ability of prior infection or vaccine-induced immunity to protect against infection in ferrets. Ferrets were semipermissive to infection with the USA-WA1/2020 isolate. When transmission was assessed via the detection of viral RNA (vRNA) at multiple time points, direct contact transmission was efficient to 3/3 and 3/4 contact animals in 2 respective studies, while respiratory droplet transmission was poor to only 1/4 contact animals. To determine if previously infected ferrets were protected against reinfection, ferrets were rechallenged 28 or 56 days postinfection. Following viral challenge, no infectious virus was recovered in nasal wash samples. In addition, levels of vRNA in the nasal wash were several orders of magnitude lower than during primary infection, and vRNA was rapidly cleared. To determine if intramuscular vaccination protected ferrets, ferrets were vaccinated using a prime-boost strategy with the S protein receptor-binding domain formulated with an oil-in-water adjuvant. Upon viral challenge, none of the mock or vaccinated animals were protected against infection, and there were no significant differences in vRNA or infectious virus titers in the nasal wash. Combined, these studies demonstrate direct contact is the predominant mode of transmission of the USA-WA1/2020 isolate in ferrets and that immunity to SARS-CoV-2 is maintained for at least 56 days. Our studies also indicate protection of the upper respiratory tract against SARS-CoV-2 will require vaccine strategies that mimic natural infection or induce site-specific immunity. IMPORTANCE The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) USA-WA1/2020 strain is a CDC reference strain used by multiple research laboratories. Here, we show that the predominant mode of transmission of this isolate in ferrets is by direct contact. We further demonstrate ferrets are protected against reinfection for at least 56 days even when levels of neutralizing antibodies are low or undetectable. Last, we show that when ferrets were vaccinated by the intramuscular route to induce antibodies against SARS-CoV-2, ferrets remain susceptible to infection of the upper respiratory tract. Collectively, these studies suggest that protection of the upper respiratory tract will require vaccine approaches that mimic natural infection.
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Affiliation(s)
- Devanshi R. Patel
- Department of Veterinary and Biomedical Science, The Pennsylvania State University, University Park, Pennsylvania, USA
- The Huck Institutes of Life Sciences, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Cassandra J. Field
- Department of Veterinary and Biomedical Science, The Pennsylvania State University, University Park, Pennsylvania, USA
- The Huck Institutes of Life Sciences, The Pennsylvania State University, University Park, Pennsylvania, USA
- Emory-UGA Center of Excellence of Influenza Research and Surveillance (CEIRS), University Park, Pennsylvania, USA
| | - Kayla M. Septer
- Department of Veterinary and Biomedical Science, The Pennsylvania State University, University Park, Pennsylvania, USA
- The Huck Institutes of Life Sciences, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Derek G. Sim
- The Huck Institutes of Life Sciences, The Pennsylvania State University, University Park, Pennsylvania, USA
- Department of Biology, The Huck Institutes of Life Sciences, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Matthew J. Jones
- The Huck Institutes of Life Sciences, The Pennsylvania State University, University Park, Pennsylvania, USA
- Department of Biology, The Huck Institutes of Life Sciences, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Talia A. Heinly
- Department of Veterinary and Biomedical Science, The Pennsylvania State University, University Park, Pennsylvania, USA
- The Huck Institutes of Life Sciences, The Pennsylvania State University, University Park, Pennsylvania, USA
- Emory-UGA Center of Excellence of Influenza Research and Surveillance (CEIRS), University Park, Pennsylvania, USA
| | - Thomas H. Vanderford
- Division of Microbiology and Immunology, Yerkes National Primate Research Center, Emory University, Atlanta, Georgia, USA
| | - Elizabeth A. McGraw
- The Huck Institutes of Life Sciences, The Pennsylvania State University, University Park, Pennsylvania, USA
- Department of Entomology, The Pennsylvania State University, University Park, Pennsylvania, USA
| | - Troy C. Sutton
- Department of Veterinary and Biomedical Science, The Pennsylvania State University, University Park, Pennsylvania, USA
- The Huck Institutes of Life Sciences, The Pennsylvania State University, University Park, Pennsylvania, USA
- Emory-UGA Center of Excellence of Influenza Research and Surveillance (CEIRS), University Park, Pennsylvania, USA
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30
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Positive no-touch surfaces and undetectable SARS-CoV-2 aerosols in long-term care facilities: An attempt to understand the contributing factors and the importance of timing in air sampling campaigns. Am J Infect Control 2021; 49:701-706. [PMID: 33587983 PMCID: PMC7879049 DOI: 10.1016/j.ajic.2021.02.004] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2020] [Revised: 02/03/2021] [Accepted: 02/09/2021] [Indexed: 01/06/2023]
Abstract
BACKGROUND Long-term care facilities (LTCF) are environments particularly favorable to coronavirus disease (SARS-CoV-2) pandemic outbreaks, due to the at-risk population they welcome and the close proximity of residents. Yet, the transmission dynamics of the disease in these establishments remain unclear. METHODS Air and no-touch surfaces of 31 rooms from 7 LTCFs were sampled and SARS-CoV-2 was quantified by real-time reverse transcription polymerase chain reaction (RT-qPCR). RESULTS Air samples were negative but viral genomes were recovered from 20 of 62 surface samples at concentrations ranging from 13 to 36,612 genomes/surface. Virus isolation (culture) from surface samples (n = 7) was negative. CONCLUSIONS The presence of viral RNA on no-touch surfaces is evidence of viral dissemination through air, but the lack of airborne viral particles in air samples suggests that they were not aerosolized in a significant manner during air sampling sessions. The air samples were collected 8 to 30 days after the residents' symptom onset, which could indicate that viruses are aerosolized early in the infection process. Additional research is needed to evaluate viral viability conservation and the potential role of direct contact and aerosols in SARS-CoV-2 transmission in these institutions.
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31
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Archambault AS, Zaid Y, Rakotoarivelo V, Turcotte C, Doré É, Dubuc I, Martin C, Flamand O, Amar Y, Cheikh A, Fares H, El Hassani A, Tijani Y, Côté A, Laviolette M, Boilard É, Flamand L, Flamand N. High levels of eicosanoids and docosanoids in the lungs of intubated COVID-19 patients. FASEB J 2021; 35:e21666. [PMID: 34033145 PMCID: PMC8206770 DOI: 10.1096/fj.202100540r] [Citation(s) in RCA: 89] [Impact Index Per Article: 29.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/29/2021] [Accepted: 04/30/2021] [Indexed: 12/13/2022]
Abstract
Severe acute respiratory syndrome coronavirus 2 is responsible for coronavirus disease 2019 (COVID-19). While COVID-19 is often benign, a subset of patients develops severe multilobar pneumonia that can progress to an acute respiratory distress syndrome. There is no cure for severe COVID-19 and few treatments significantly improved clinical outcome. Dexamethasone and possibly aspirin, which directly/indirectly target the biosynthesis/effects of numerous lipid mediators are among those options. Our objective was to define if severe COVID-19 patients were characterized by increased bioactive lipids modulating lung inflammation. A targeted lipidomic analysis of bronchoalveolar lavages (BALs) by tandem mass spectrometry was done on 25 healthy controls and 33 COVID-19 patients requiring mechanical ventilation. BALs from severe COVID-19 patients were characterized by increased fatty acids and inflammatory lipid mediators. There was a predominance of thromboxane and prostaglandins. Leukotrienes were also increased, notably LTB4 , LTE4 , and eoxin E4 . Monohydroxylated 15-lipoxygenase metabolites derived from linoleate, arachidonate, eicosapentaenoate, and docosahexaenoate were also increased. Finally yet importantly, specialized pro-resolving mediators, notably lipoxin A4 and the D-series resolvins, were also increased, underscoring that the lipid mediator storm occurring in severe COVID-19 involves pro- and anti-inflammatory lipids. Our data unmask the lipid mediator storm occurring in the lungs of patients afflicted with severe COVID-19. We discuss which clinically available drugs could be helpful at modulating the lipidome we observed in the hope of minimizing the deleterious effects of pro-inflammatory lipids and enhancing the effects of anti-inflammatory and/or pro-resolving lipid mediators.
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Affiliation(s)
- Anne-Sophie Archambault
- Centre de Recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Faculté de médecine, Département de médecine, Université Laval, Québec, QC, Canada.,Canada Excellence Research Chair in the Microbiome-Endocannabinoidome Axis in Metabolic Health, Université Laval, Québec, QC, Canada
| | - Younes Zaid
- Biology Department, Faculty of Sciences, Mohammed V University, Rabat, Morocco.,Cheikh Zaïd Hospital, Abulcasis University of Health Sciences, Rabat, Morocco
| | - Volatiana Rakotoarivelo
- Centre de Recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Faculté de médecine, Département de médecine, Université Laval, Québec, QC, Canada.,Canada Excellence Research Chair in the Microbiome-Endocannabinoidome Axis in Metabolic Health, Université Laval, Québec, QC, Canada
| | - Caroline Turcotte
- Centre de Recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Faculté de médecine, Département de médecine, Université Laval, Québec, QC, Canada.,Canada Excellence Research Chair in the Microbiome-Endocannabinoidome Axis in Metabolic Health, Université Laval, Québec, QC, Canada
| | - Étienne Doré
- Centre de Recherche du Centre Hospitalier, Universitaire de Québec-Université Laval, Québec, QC, Canada.,Centre de Recherche Arthrite, Université Laval, Québec, QC, Canada
| | - Isabelle Dubuc
- Centre de Recherche du Centre Hospitalier, Universitaire de Québec-Université Laval, Québec, QC, Canada
| | - Cyril Martin
- Centre de Recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Faculté de médecine, Département de médecine, Université Laval, Québec, QC, Canada.,Canada Excellence Research Chair in the Microbiome-Endocannabinoidome Axis in Metabolic Health, Université Laval, Québec, QC, Canada
| | - Olivier Flamand
- Centre de Recherche du Centre Hospitalier, Universitaire de Québec-Université Laval, Québec, QC, Canada
| | - Youssef Amar
- Moroccan Foundation for Advanced Science, Innovation & Research (MAScIR), Rabat, Morocco
| | - Amine Cheikh
- Cheikh Zaïd Hospital, Abulcasis University of Health Sciences, Rabat, Morocco
| | - Hakima Fares
- Cheikh Zaïd Hospital, Abulcasis University of Health Sciences, Rabat, Morocco
| | - Amine El Hassani
- Cheikh Zaïd Hospital, Abulcasis University of Health Sciences, Rabat, Morocco
| | - Youssef Tijani
- Faculty of Medicine, Mohammed VI University of Health Sciences, Casablanca, Morocco
| | - Andréanne Côté
- Centre de Recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Faculté de médecine, Département de médecine, Université Laval, Québec, QC, Canada
| | - Michel Laviolette
- Centre de Recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Faculté de médecine, Département de médecine, Université Laval, Québec, QC, Canada
| | - Éric Boilard
- Centre de Recherche du Centre Hospitalier, Universitaire de Québec-Université Laval, Québec, QC, Canada.,Centre de Recherche Arthrite, Université Laval, Québec, QC, Canada.,Département de Microbiologie-Infectiologie et d'immunologie, Université Laval, Québec, QC, Canada
| | - Louis Flamand
- Centre de Recherche du Centre Hospitalier, Universitaire de Québec-Université Laval, Québec, QC, Canada.,Département de Microbiologie-Infectiologie et d'immunologie, Université Laval, Québec, QC, Canada
| | - Nicolas Flamand
- Centre de Recherche de l'Institut universitaire de cardiologie et de pneumologie de Québec, Faculté de médecine, Département de médecine, Université Laval, Québec, QC, Canada.,Canada Excellence Research Chair in the Microbiome-Endocannabinoidome Axis in Metabolic Health, Université Laval, Québec, QC, Canada
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32
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SARS-CoV-2 aerosol generation during respiratory equipment reprocessing. Antimicrob Resist Infect Control 2021; 10:82. [PMID: 34044893 PMCID: PMC8156569 DOI: 10.1186/s13756-021-00955-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 05/17/2021] [Indexed: 11/10/2022] Open
Abstract
Aerosolization may occur during reprocessing of medical devices. With the current coronavirus disease 2019 pandemic, it is important to understand the necessity of using respirators in the cleaning area of the sterile processing department. To evaluate the presence of severe acute respiratory syndrome coronavirus (SARS-CoV-2) in the air of the sterile processing department during the reprocessing of contaminated medical devices. Air and surface samples were collected from the sterile processing department of two teaching tertiary hospitals during the reprocessing of respiratory equipment used in patients diagnosed with coronavirus disease 2019 and from intensive care units during treatment of these patients. SARS-CoV-2 was detected only in 1 air sample before the beginning of decontamination process. Viable severe acute respiratory syndrome coronavirus 2 RNA was not detected in any sample collected from around symptomatic patients or in sterile processing department samples. The cleaning of respiratory equipment does not cause aerosolization of SARS-CoV-2. We believe that the use of medical masks is sufficient while reprocessing medical devices during the coronavirus disease 2019 pandemic.
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33
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Dubey A, Kotnala G, Mandal TK, Sonkar SC, Singh VK, Guru SA, Bansal A, Irungbam M, Husain F, Goswami B, Kotnala RK, Saxena S, Sharma SK, Saxena KN, Sharma C, Kumar S, Aswal DK, Manchanda V, Koner BC. Evidence of the presence of SARS-CoV-2 virus in atmospheric air and surfaces of a dedicated COVID hospital. J Med Virol 2021; 93:5339-5349. [PMID: 33913527 PMCID: PMC8242543 DOI: 10.1002/jmv.27029] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 03/11/2021] [Accepted: 04/11/2021] [Indexed: 12/23/2022]
Abstract
The present study was conducted from July 1, 2020 to September 25, 2020 in a dedicated coronavirus disease 2019 (COVID‐19) hospital in Delhi, India to provide evidence for the presence of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) virus in atmospheric air and surfaces of the hospital wards. Swabs from hospital surfaces (patient's bed, ward floor, and nursing stations area) and suspended particulate matter in ambient air were collected by a portable air sampler from the medicine ward, intensive care unit, and emergency ward admitting COVID‐19 patients. By performing reverse‐transcriptase polymerase chain reaction (RT‐PCR) for E‐gene and RdRp gene, SARS‐CoV‐2 virus was detected from hospital surfaces and particulate matters from the ambient air of various wards collected at 1 and 3‐m distance from active COVID‐19 patients. The presence of the virus in the air beyond a 1‐m distance from the patients and surfaces of the hospital indicates that the SARS‐CoV‐2 virus has the potential to be transmitted by airborne and surface routes from COVID‐19 patients to health‐care workers working in COVID‐19 dedicated hospital. This warrants that precautions against airborne and surface transmission of COVID‐19 in the community should be taken when markets, industries, educational institutions, and so on, reopen for normal activities.
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Affiliation(s)
- Abhishek Dubey
- Department of Biochemistry, Maulana Azad Medical College & Associated Hospital, New Delhi, India
| | - Garima Kotnala
- Environmental Sciences and Biomedical Metrology Division, CSIR-National Physical Laboratory, New Delhi, India
| | - Tuhin K Mandal
- Environmental Sciences and Biomedical Metrology Division, CSIR-National Physical Laboratory, New Delhi, India
| | - Subash C Sonkar
- Multidisciplinary Research Unit, Maulana Azad Medical College & Associated Hospital, New Delhi, India
| | - Vijay K Singh
- Department of Biochemistry, Maulana Azad Medical College & Associated Hospital, New Delhi, India
| | - Sameer A Guru
- Multidisciplinary Research Unit, Maulana Azad Medical College & Associated Hospital, New Delhi, India
| | - Aastha Bansal
- Department of Biochemistry, Maulana Azad Medical College & Associated Hospital, New Delhi, India
| | - Monica Irungbam
- Department of Biochemistry, Maulana Azad Medical College & Associated Hospital, New Delhi, India
| | - Farah Husain
- Department of Anesthesia, Lok Nayak Hospital, New Delhi, India
| | - Binita Goswami
- Department of Biochemistry, Maulana Azad Medical College & Associated Hospital, New Delhi, India.,Multidisciplinary Research Unit, Maulana Azad Medical College & Associated Hospital, New Delhi, India
| | - Ravindra K Kotnala
- Environmental Sciences and Biomedical Metrology Division, CSIR-National Physical Laboratory, New Delhi, India
| | - Sonal Saxena
- Department of Microbiology, Maulana Azad Medical College & Associated Hospital, New Delhi, India
| | - Sudhir K Sharma
- Environmental Sciences and Biomedical Metrology Division, CSIR-National Physical Laboratory, New Delhi, India
| | - Kirti N Saxena
- Department of Anesthesia, Maulana Azad Medical College & Associated Hospital, New Delhi, India
| | - Chhemendra Sharma
- Environmental Sciences and Biomedical Metrology Division, CSIR-National Physical Laboratory, New Delhi, India
| | - Suresh Kumar
- Department of Medicine, Maulana Azad Medical College & Associated Hospital, New Delhi, India
| | - Dinesh K Aswal
- Environmental Sciences and Biomedical Metrology Division, CSIR-National Physical Laboratory, New Delhi, India
| | - Vikas Manchanda
- Department of Microbiology, Maulana Azad Medical College & Associated Hospital, New Delhi, India
| | - Bidhan C Koner
- Department of Biochemistry, Maulana Azad Medical College & Associated Hospital, New Delhi, India.,Multidisciplinary Research Unit, Maulana Azad Medical College & Associated Hospital, New Delhi, India
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34
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Onakpoya IJ, Heneghan CJ, Spencer EA, Brassey J, Plüddemann A, Evans DH, Conly JM, Jefferson T. SARS-CoV-2 and the role of close contact in transmission: a systematic review. F1000Res 2021; 10:280. [PMID: 36398277 PMCID: PMC9636487 DOI: 10.12688/f1000research.52439.1] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/10/2022] [Indexed: 12/01/2023] Open
Abstract
Background: SARS-CoV-2 transmission has been reported to be associated with close contact with infected individuals. However, the mechanistic pathway for transmission in close contact settings is unclear. Our objective was to identify, appraise and summarise the evidence from studies assessing the role of close contact in SARS-CoV-2 transmission. Methods: This review is part of an Open Evidence Review on Transmission Dynamics of SARS-CoV-2. We conduct ongoing searches using WHO Covid-19 Database, LitCovid, medRxiv, PubMed and Google Scholar; assess study quality based on the QUADAS-2 criteria and report important findings on an ongoing basis. Results: We included 278 studies: 258 primary studies and 20 systematic reviews. The settings for primary studies were predominantly in home/quarantine facilities (39.5%) and acute care hospitals (12%). The overall reporting quality of the studies was low-to-moderate. There was significant heterogeneity in design and methodology. The frequency of attack rates (PCR testing) varied between 2.1-75%; attack rates were highest in prison and wedding venues, and in households. The frequency of secondary attack rates was 0.3-100% with rates highest in home/quarantine settings. Three studies showed no transmission if the index case was a recurrent infection. Viral culture was performed in four studies of which three found replication-competent virus; culture results were negative where index cases had recurrent infections. Eighteen studies performed genomic sequencing with phylogenetic analysis - the completeness of genomic similarity ranged from 77-100%. Findings from systematic reviews showed that children were significantly less likely to transmit SARS-CoV-2 and household contact was associated with a significantly increased risk of infection. Conclusions: The evidence from published studies demonstrates that SARS-CoV-2 can be transmitted in close contact settings. The risk of transmission is greater in household contacts. There was a wide variation in methodology. Standardized guidelines for reporting transmission in close contact settings should be developed.
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Affiliation(s)
- Igho J. Onakpoya
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
- Department for Continuing Education, University of Oxford, Rewley house, Wellington Square, Oxford, OX1 2JA, UK
| | - Carl J. Heneghan
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - Elizabeth A. Spencer
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | | | - Annette Plüddemann
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
| | - David H. Evans
- Department of Medical Microbiology & Immunology,Li Ka Shing Institute of Virology, University of Alberta, Edmonton, AB, T6G 2R3, Canada
| | - John M. Conly
- University of Calgary and Alberta Health Services,, University of Calgary, Calgary, AB, T2N 4Z6, Canada
| | - Tom Jefferson
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, OX2 6GG, UK
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35
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Inglis R, Barros L, Checkley W, Cizmeci EA, Lelei-Mailu F, Pattnaik R, Papali A, Schultz MJ, Ferreira JC. Pragmatic Recommendations for Safety while Caring for Hospitalized Patients with COVID-19 in Low- and Middle-Income Countries. Am J Trop Med Hyg 2020; 104:12-24. [PMID: 33355072 PMCID: PMC7957241 DOI: 10.4269/ajtmh.20-1128] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Accepted: 12/06/2020] [Indexed: 11/07/2022] Open
Abstract
Infection prevention and control measures to control the spread of COVID-19 are challenging to implement in many low- and middle-income countries (LMICs). This is compounded by the fact that most recommendations are based on evidence that mainly originates in high-income countries. There are often availability, affordability, and feasibility barriers to applying such recommendations in LMICs, and therefore, there is a need for developing recommendations that are achievable in LMICs. We used a modified version of the GRADE method to select important questions, searched the literature for relevant evidence, and formulated pragmatic recommendations for safety while caring for patients with COVID-19 in LMICs. We selected five questions related to safety, covering minimal requirements for personal protective equipment (PPE), recommendations for extended use and reuse of PPE, restriction on the number of times healthcare workers enter patients' rooms, hand hygiene, and environmental ventilation. We formulated 21 recommendations that are feasible and affordable in LMICs.
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Affiliation(s)
- Rebecca Inglis
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Mahosot Hospital, Vientiane, Lao People’s Democratic Republic
| | - Lia Barros
- Division of Cardiology, University of Washington, Seattle, Washington
| | - William Checkley
- Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
- Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, Maryland
| | - Elif A. Cizmeci
- Interdepartmental Division of Critical Care Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
| | - Faith Lelei-Mailu
- Department of Quality Health and Safety, AIC Kijabe Hospital, Kijabe, Kenya
| | | | - Alfred Papali
- Division of Pulmonary and Critical Care Medicine, Atrium Health, Charlotte, North Carolina
| | - Marcus J. Schultz
- Department of Intensive Care, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Department of Clinical Tropical Medicine, Mahidol University, Bangkok, Thailand
- Mahidol–Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand
| | - Juliana C. Ferreira
- Divisao de Pneumologia, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
| | - for the COVID-LMIC Task Force and the Mahidol-Oxford Research Unit (MORU)
- Lao-Oxford-Mahosot Hospital-Wellcome Trust Research Unit (LOMWRU), Mahosot Hospital, Vientiane, Lao People’s Democratic Republic
- Division of Cardiology, University of Washington, Seattle, Washington
- Division of Pulmonary and Critical Care, Department of Medicine, School of Medicine, Johns Hopkins University, Baltimore, Maryland
- Center for Global Non-Communicable Disease Research and Training, School of Medicine, Johns Hopkins University, Baltimore, Maryland
- Interdepartmental Division of Critical Care Medicine, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Canada
- Department of Quality Health and Safety, AIC Kijabe Hospital, Kijabe, Kenya
- Division of Critical Care Medicine, Ispat General Hospital, Rourkela, India
- Division of Pulmonary and Critical Care Medicine, Atrium Health, Charlotte, North Carolina
- Department of Intensive Care, Amsterdam University Medical Centers, Amsterdam, The Netherlands
- Department of Clinical Tropical Medicine, Mahidol University, Bangkok, Thailand
- Mahidol–Oxford Tropical Medicine Research Unit (MORU), Mahidol University, Bangkok, Thailand
- Divisao de Pneumologia, Instituto do Coracao, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, Sao Paulo, Brazil
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