Determination of Length of Time for "Postaerosol Pause" for Patients Under Investigation or Positive for COVID-19

Optimal design of building openings to reduce the risk of indoor respiratory epidemic infections

The design of indoor airflow environments can significantly reduce the risk of respiratory epidemic infections indoors. Some studies have successfully developed theoretical models for calculating the effect of airflow fields on infection rates. However, up until now, studies have primarily focused on simulating and calculating the distribution of viral infection rates in current building scenarios. Due to the lack of a direct influence model for the design parameters and infection rate calculation, the present studies lack a quantitative analysis of the design parameters. This paper investigates the building openings design approach in a medium-sized kindergarten in Germany, intending to explore passive-based design solutions to improve the building's ability to prevent the virus' spread. We calculate the infection rate distribution in space by CFD combined with the Wells-Riley model. And then, use the Grasshopper platform to build an optimization model with the design parameters of building openings and infection rate values to discuss the relationship between geometric parameters and infection rate variation. The results show that the building openings' design parameters in transition spaces significantly affect the indoor infection rate under the condition that the input wind speed at the building openings is stable. We can see that optimizing building openings significantly reduces the average infection rate in space. The infection rate in the area with the largest decrease can be reduced by 18.41%. The distribution of infection rate in space is much more uniform, and the excess area is significantly reduced. This study has implications for future research and practice in designing public buildings under the influence of long-standing and cyclical outbreaks of epidemics.

International Survey of Operative Practices for Otologists and Neurotologists During the COVID-19 Crisis

OBJECTIVE

To investigate the influence of the COVID-19 pandemic on operative practices of otology and neurotology providers internationally.

STUDY DESIGN

Cross-sectional survey.

METHODS

A 78-question survey was distributed to otologists and neurotologists between May 12, 2020 and June 8, 2020 to assess the impact of the pandemic on surgical practices. Sections within the survey delineated time periods: prior to the crisis, onset of the crisis, during the crisis, postcrisis transition.

RESULTS

Of 396 survey respondents, 284 participants from 38 countries met inclusion criteria.Respondents were 16.9% female and 82.4% male, with a most common age range of 40 to 49 years (36.3%). 69.8% of participants had been in practice for over 10 years and most respondents worked in an academic medical center (79.2%). The average operative weekly caseload was 5.3 (SD 3.9) per surgeon prior to the crisis, 0.7 (SD 1.2) during the COVID-19 crisis, and 3.5 (SD 3.3) for those who had begun a postcrisis transition at the time of survey administration (p < 0.001). 71.5% of providers did not perform an elective otologic or neurotologic operative procedure during the initial crisis period. 49.8% reported modifying their surgical technique due to the COVID-19 pandemic. Use of powered air-purifying respirators and filtering facepiece 2 or 3 (FFP2/FFP3) respirators were in minimal supply for 66.9% and 62.3% of respondents, respectively.

CONCLUSION

The COVID-19 pandemic impacted the otology and neurotology community globally, resulting in significant changes in operative volume and case selection. Modification of surgical technique and shortages of personal protective equipment were frequently reported.

Operating room air delivery design to protect patient and surgical site results in particles released at surgical table having greater concentration along walls of the room than at the instrument tray

Background

During the coronavirus disease 2019 (COVID-19) pandemic, recommendations have included that personnel not involved in procedures releasing airborne contaminants reduce their exposure by moving >2 m away. We tested whether air particle concentrations in operating rooms (ORs) are greater in the periphery, downstream from the supply airflow.

Methods

We analyzed data from 15 mock surgical procedures performed in 3 ORs. Two ORs were modern, one with a single large diffuser system above the surgical table, and the other using a multiple diffuser array design. An air particle counting unit was located on the instrument table, another adjacent to an air return grille.

Results

Concentrations of air particles were greater at return grille than instrument table for the single large diffuser at 26 air exchanges per hour, and the multiple diffuser array at both 26 and 20 air exchanges per hour (all P ≤ .0044), including during electrocautery (all P ≤ .0072). The ratios of concentrations, return grille versus instrument table, were greater during electrocautery for 0.5 to 1.0-micron particles and 1.0 to 5.0-micron particles (both P < .0001).

Conclusions

Modern OR airflow systems are so effective at protecting the surgical field and team from airborne particles emitted during surgery that concentrations of particles released at the OR table are greater at the OR walls than near the center of the room.

Arrhythmias and COVID-19: A Review

Current understanding of the impact of coronavirus disease-2019 (COVID-19) on arrhythmias continues to evolve as new data emerge. Cardiac arrhythmias are more common in critically ill COVID-19 patients. The potential mechanisms that could result in arrhythmogenesis among COVID-19 patients include hypoxia caused by direct viral tissue involvement of lungs, myocarditis, abnormal host immune response, myocardial ischemia, myocardial strain, electrolyte derangements, intravascular volume imbalances, and drug sides effects. To manage these arrhythmias, it is imperative to increase the awareness of potential drug-drug interactions, to monitor QTc prolongation while receiving COVID therapy and provide special considerations for patients with inherited arrhythmia syndromes. It is also crucial to minimize exposure to COVID-19 infection by stratifying the need for intervention and using telemedicine. As COVID-19 infection continues to prevail with a potential for future surges, more data are required to better understand pathophysiology and to validate management strategies.