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Kulmala I, Taipale A, Sanmark E, Lastovets N, Sormunen P, Nuorti P, Saari S, Luoto A, Säämänen A. Estimated relative potential for airborne SARS-CoV-2 transmission in a day care centre. Heliyon 2024; 10:e30724. [PMID: 38756615 PMCID: PMC11096945 DOI: 10.1016/j.heliyon.2024.e30724] [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: 08/20/2023] [Revised: 05/01/2024] [Accepted: 05/02/2024] [Indexed: 05/18/2024] Open
Abstract
We estimated the hourly probability of airborne severe acute respiratory coronavirus 2 (SARS-CoV-2) transmission and further the estimated number of persons at transmission risk in a day care centre by calculating the inhaled dose for airborne pathogens based on their concentration, exposure time and activity. Information about the occupancy and activity of the rooms was collected from day care centre personnel and building characteristics were obtained from the design values. The generation rate of pathogens was calculated as a product of viral load of the respiratory fluids and the emission of the exhaled airborne particles, considering the prevalence of the disease and the activity of the individuals. A well-mixed model was used in the estimation of the concentration of pathogens in the air. The Wells-Riley model was used for infection probability. The approach presented in this study was utilised in the identification of hot spots and critical events in the day care centre. Large variation in the infection probabilities and estimated number of persons at transmission risk was observed when modelling a normal day at the centre. The estimated hourly infection probabilities between the worst hour in the worst room and the best hour in the best room varied in the ratio of 100:1. Similarly, the number of persons at transmission risk between the worst and best cases varied in the ratio 1000:1. Although there are uncertainties in the input values affecting the absolute risk estimates the model proved to be useful in ranking and identifying the hot spots and events in the building and implementing effective control measures.
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Affiliation(s)
- Ilpo Kulmala
- VTT Smart Energy and Built Environment, Visiokatu 4, PO Box 1300, FI-33101, Tampere, Finland
| | - Aimo Taipale
- VTT Smart Energy and Built Environment, Visiokatu 4, PO Box 1300, FI-33101, Tampere, Finland
| | - Enni Sanmark
- Helsinki University Hospital, Department of Otorhinolaryngology and Phoniatrics – Head and Neck Surgery, Helsinki, Finland
- University of Helsinki, Helsinki, Finland
| | - Natalia Lastovets
- Tampere University, Faculty of Built Environment, Civil Engineering Unit, Korkeakoulunkatu 5D, FI-33720, Tampere, Finland
| | - Piia Sormunen
- Tampere University, Faculty of Built Environment, Civil Engineering Unit, Korkeakoulunkatu 5D, FI-33720, Tampere, Finland
| | - Pekka Nuorti
- Tampere University, Faculty of Social Sciences, Health Sciences Unit, Arvo Ylpön Katu 34, 33520, Tampere, Finland
| | - Sampo Saari
- Tampere University of Applied Sciences, Kuntokatu 3, 33520, Tampere, Finland
| | - Anni Luoto
- Granlund Oy, Malminkaari 21, 00700, Helsinki, Finland
| | - Arto Säämänen
- VTT Smart Energy and Built Environment, Visiokatu 4, PO Box 1300, FI-33101, Tampere, Finland
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Hermann LA, Tur B, Köberlein MC, Gantner S, Westphalen C, Benthaus T, Döllinger M, Kniesburges S, Echternach M. Aerosol Dispersion During Different Phonatory Tasks in Amateur Singers. J Voice 2024; 38:731-740. [PMID: 34963518 DOI: 10.1016/j.jvoice.2021.11.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 11/18/2021] [Accepted: 11/18/2021] [Indexed: 11/28/2022]
Abstract
INTRODUCTION Due to increased aerosol generation during singing, choir rehearsals were widely prohibited in the course of the CoVID-19 pandemic. Most studies on aerosol generation and dispersion focus on professional singers. However, it has not been clarified if these data are also representative for amateur singers. METHODS Nine non-professional singers (four male, five female) were asked to perform five tasks; speaking (T+), singing a text softly (MT-) and loudly (MT+), singing on the vowel [ə] (M+) and singing with a N95 mask (MT+N95). Before performing the tasks, the singers were asked to inhale 0.5 L vapor produced by an e-cigarette consisting of the basic liquid. The spread of the exhaled vapor was recorded in all three dimensions by high-definition cameras and the impulse dispersion was detected as a function of time. RESULTS Regarding the median dispersion to the front, all tasks showed comparable distances from 0.69 m to 0.82 m at the end of the tasks. However, the maximum aerosol dispersion showed a larger variety among different subjects or tasks, respectively. Especially in the M+ task a maximum distance of 1.96 m to the front was reached by a single subject. Although singing with a N95 mask resulted in a slightly increased median dispersion to the front, the maximum dispersion was decreased from 1.47 m (MT+) to 1.04 m (MT+N95). CONCLUSION The maximum dispersion distance to the front of 1.96 m at the end of the M+ task and 1.47 m at the end of the MT+ task showed higher values in comparison to professional singers. Differences in phonation, articulation and mouth opening could lead to greater impulse dispersion. Singing in loud phonation with a N95 mask reduced the maximum impulse dispersion to the front to 1.04 m. Taking all results into consideration, a slightly larger safety distance should be necessary for non-professional singers.
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Affiliation(s)
- Laila Ava Hermann
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology, Munich University Hospital (LMU), Munich, Germany
| | - Bogac Tur
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology, Head & Neck Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Marie Christine Köberlein
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology, Munich University Hospital (LMU), Munich, Germany
| | - Sophia Gantner
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology, Munich University Hospital (LMU), Munich, Germany
| | - Caroline Westphalen
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology, Munich University Hospital (LMU), Munich, Germany
| | - Tobias Benthaus
- Institute and Clinic for Occupational, Social and Environmental Medicine, Munich University Hospital (LMU), Munich, Germany
| | - Michael Döllinger
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology, Head & Neck Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Stefan Kniesburges
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology, Head & Neck Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Matthias Echternach
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology, Munich University Hospital (LMU), Munich, Germany.
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Caracci E, Stabile L, Ferro AR, Morawska L, Buonanno G. Respiratory particle emission rates from children during speaking. Sci Rep 2023; 13:18294. [PMID: 37880507 PMCID: PMC10600129 DOI: 10.1038/s41598-023-45615-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2023] [Accepted: 10/21/2023] [Indexed: 10/27/2023] Open
Abstract
The number of respiratory particles emitted during different respiratory activities is one of the main parameters affecting the airborne transmission of respiratory pathogens. Information on respiratory particle emission rates is mostly available for adults (few studies have investigated adolescents and children) and generally involves a limited number of subjects. In the present paper we attempted to reduce this knowledge gap by conducting an extensive experimental campaign to measure the emission of respiratory particles of more than 400 children aged 6 to 12 years while they pronounced a phonetically balanced word list at two different voice intensity levels ("speaking" and "loudly speaking"). Respiratory particle concentrations, particle distributions, and exhaled air flow rates were measured to estimate the respiratory particle emission rate. Sound pressure levels were also simultaneously measured. We found out that median respiratory particle emission rates for speaking and loudly speaking were 26 particles s-1 (range 7.1-93 particles s-1) and 41 particles s-1 (range 10-146 particles s-1), respectively. Children sex was significant for emission rates, with higher emission rates for males during both speaking and loudly speaking. No effect of age on the emission rates was identified. Concerning particle size distributions, for both respiratory activities, a main mode at approximately 0.6 µm and a second minor mode at < 2 µm were observed, and no differences were found between males and females. This information provides important input parameters in predictive models adopted to estimate the transmission risk of airborne pathogens in indoor spaces.
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Affiliation(s)
- Elisa Caracci
- Department of Civil and Mechanical Engineering, University of Cassino and Southern Lazio, Cassino, FR, Italy
| | - Luca Stabile
- Department of Civil and Mechanical Engineering, University of Cassino and Southern Lazio, Cassino, FR, Italy.
| | - Andrea R Ferro
- Department of Civil and Environmental Engineering, Clarkson University, Potsdam, NY, USA
| | - Lidia Morawska
- International Laboratory for Air Quality and Health, Queensland University of Technology, Brisbane, QLD, Australia
| | - Giorgio Buonanno
- Department of Civil and Mechanical Engineering, University of Cassino and Southern Lazio, Cassino, FR, Italy
- International Laboratory for Air Quality and Health, Queensland University of Technology, Brisbane, QLD, Australia
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Sánchez-Fernández A, Coll-Aliaga E, Lerma-Arce V, Lorenzo-Sáez E. Evaluation of Different Natural Ventilation Strategies by Monitoring the Indoor Air Quality Using CO 2 Sensors. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:6757. [PMID: 37754617 PMCID: PMC10531387 DOI: 10.3390/ijerph20186757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Revised: 09/06/2023] [Accepted: 09/07/2023] [Indexed: 09/28/2023]
Abstract
Indoor air quality is a characteristic that depends on air pollutants inside a building and that can be affected by different ventilation strategies. There is strong evidence linking poor indoor air quality (IAQ) and harmful health effects, especially on vulnerable collectives, such as children in schools. Due to this concern, this work aims to provide guidance on the design of highly efficient ventilation strategies to improve the air quality of schools' classrooms. For this, IAQ monitoring has been carried out in eight educational in real conditions centres using CO2 concentration as an IAQ indicator. Variables such as the presence of students and their number, activity developed in the classroom and ventilation strategy used together with break time duration have been also recorded to analyse their influence on CO2 concentration levels. Concluding results have allowed us to determine the maximum number of students allowed in a closed room to maintain CO2 levels at normal concentrations and the time needed to reduce these CO2 levels depending on the ventilation strategy adopted. Moreover, it has been discussed how surrounding school conditions (pollution or noise) and the building isolation are impacting the final IAQ in the classrooms studied.
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Affiliation(s)
| | | | - Victoria Lerma-Arce
- ITACA Research Institute, Universitat Politècnica de València, Camí de Vera s/n, 46022 Valencia, Spain
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5
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van Mersbergen M, Marchetta J, Foti D, Pillow E, Dasgupta A, Cain C, Morvant S. Comparison of Aerosol Emissions during Specific Speech Tasks. J Voice 2023:S0892-1997(23)00156-X. [PMID: 37423794 DOI: 10.1016/j.jvoice.2023.05.004] [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: 03/11/2023] [Revised: 05/09/2023] [Accepted: 05/09/2023] [Indexed: 07/11/2023]
Abstract
OBJECTIVES/HYPOTHESIS Recent investigations into the behavior of aerosolized emissions from the oral cavity have shown that particulate emissions do indeed occur during speech. To date, there is little information about the relative contribution of different speech sounds in producing particle emissions in a free field. This study compares airborne aerosol generation in participants producing isolated speech sounds: fricative consonants, plosive consonants, and vowel sounds. STUDY DESIGN Prospective, reversal experimental design, where each participant served as their own control and all participants were exposed to all stimuli. METHODS While participants produced isolated speech tasks, a planar beam of laser light, a high-speed camera, and image software calculated the number of particulates detected over time. This study compared airborne aerosols emitted by human participants at a distance of 2.54 cm between the laser sheet and the mouth. RESULTS Statistically significant increases in particulate count over ambient dust distribution for all speech sounds. When collapsed across loudness levels, emitted particles in vowel sounds were statistically greater than consonants, suggesting that mouth opening, as opposed to the place of vocal tract constriction or manner of sound production, might also be influential in the degree to which particulates become aerosolized during speech. CONCLUSIONS The results of this research will inform boundary conditions for computational models of aerosolized particulates during speech.
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Affiliation(s)
- Miriam van Mersbergen
- School of Communication Sciences and Disorders, University of Memphis, Memphis, Tennessee; Department of Otolaryngology, Head and Neck Surgery, University of Tennessee Health Sciences Center, Memphis, Tennessee; Institute for Intelligent Systems, University of Memphis, Tennessee.
| | - Jeffrey Marchetta
- Department of Mechanical Engineering, University of Memphis, Memphis, Tennessee
| | - Daniel Foti
- Department of Mechanical Engineering, University of Memphis, Memphis, Tennessee
| | - Eric Pillow
- Department of Mechanical Engineering, University of Memphis, Memphis, Tennessee
| | - Apratim Dasgupta
- Department of Mechanical Engineering, University of Memphis, Memphis, Tennessee
| | - Chandler Cain
- Department of Mechanical Engineering, University of Memphis, Memphis, Tennessee
| | - Stephen Morvant
- Department of Otolaryngology, Head and Neck Surgery, University of Tennessee Health Sciences Center, Memphis, Tennessee
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6
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Sanmark E, Oksanen LAH, Rantanen N, Lahelma M, Anttila VJ, Lehtonen L, Hyvärinen A, Geneid A. Aerosol generation during coughing: an observational study. J Laryngol Otol 2023; 137:442-447. [PMID: 35543098 PMCID: PMC10040286 DOI: 10.1017/s0022215122001165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Coronavirus disease 2019 has highlighted the lack of knowledge on aerosol exposure during respiratory activity and aerosol-generating procedures. This study sought to determine the aerosol concentrations generated by coughing to better understand, and to set a standard for studying, aerosols generated in medical procedures. METHODS Aerosol exposure during coughing was measured in 37 healthy volunteers in the operating theatre with an optical particle sizer, from 40 cm, 70 cm and 100 cm distances. RESULTS Altogether, 306 volitional and 15 involuntary coughs were measured. No differences between groups were observed. CONCLUSION Many medical procedures are expected to generate aerosols; it is unclear whether they are higher risk than normal respiratory activity. The measured aerosol exposure can be used to determine the risk for significant aerosol generation during medical procedures. Considerable variation of aerosol generation during cough was observed between individuals, but whether cough was volitional or involuntary made no difference to aerosol production.
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Affiliation(s)
- E Sanmark
- Facultie of Medicine, University of Helsinki, Helsinki, Finland
- Department of Otorhinolaryngology and Phoniatrics - Head and Neck Surgery, Helsinki University Hospital, Helsinki, Finland
| | - L A H Oksanen
- Facultie of Medicine, University of Helsinki, Helsinki, Finland
- Department of Otorhinolaryngology and Phoniatrics - Head and Neck Surgery, Helsinki University Hospital, Helsinki, Finland
| | - N Rantanen
- Facultie of Medicine, University of Helsinki, Helsinki, Finland
- Department of Otorhinolaryngology and Phoniatrics - Head and Neck Surgery, Helsinki University Hospital, Helsinki, Finland
| | - M Lahelma
- Facultie of Medicine, University of Helsinki, Helsinki, Finland
- Department of Otorhinolaryngology and Phoniatrics - Head and Neck Surgery, Helsinki University Hospital, Helsinki, Finland
- Faculties of Science, Mathematics and Statistics, University of Helsinki, Helsinki, Finland
| | - V-J Anttila
- Facultie of Medicine, University of Helsinki, Helsinki, Finland
- HUS Inflammation Center, Helsinki University Hospital, Helsinki, Finland
| | - L Lehtonen
- Facultie of Medicine, University of Helsinki, Helsinki, Finland
- HUS Diagnostic Center, HUSLAB, Helsinki University Hospital, Helsinki, Finland
| | - A Hyvärinen
- Finnish Meteorological Institute, Helsinki, Finland
| | - A Geneid
- Facultie of Medicine, University of Helsinki, Helsinki, Finland
- Department of Otorhinolaryngology and Phoniatrics - Head and Neck Surgery, Helsinki University Hospital, Helsinki, Finland
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7
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Abstract
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection remains asymptomatic in 33% to 90% of older adults depending on their immune status from prior infection, vaccination, and circulating strain. Older adults symptomatic with SARS-CoV-2 often both present atypically, such as with a blunted fever response, and develop more severe disease. Early and late reports showed that older adults have increased severity of coronavirus disease 2019 (COVID-19) with higher case fatality rates and higher intensive care needs compared with younger adults. Infection and vaccine-induced antibody response and long-term effects of COVID-19 also differ in older adults.
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8
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Jendrossek SN, Jurk LA, Remmers K, Cetin YE, Sunder W, Kriegel M, Gastmeier P. The Influence of Ventilation Measures on the Airborne Risk of Infection in Schools: A Scoping Review. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3746. [PMID: 36834438 PMCID: PMC9961295 DOI: 10.3390/ijerph20043746] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 02/15/2023] [Accepted: 02/17/2023] [Indexed: 06/18/2023]
Abstract
OBJECTIVES To review the risk of airborne infections in schools and evaluate the effect of intervention measures reported in field studies. BACKGROUND Schools are part of a country's critical infrastructure. Good infection prevention measures are essential for reducing the risk of infection in schools as much as possible, since these are places where many individuals spend a great deal of time together every weekday in a small area where airborne pathogens can spread quickly. Appropriate ventilation can reduce the indoor concentration of airborne pathogens and reduce the risk of infection. METHODS A systematic search of the literature was conducted in the databases Embase, MEDLINE, and ScienceDirect using keywords such as school, classroom, ventilation, carbon dioxide (CO2) concentration, SARS-CoV-2, and airborne transmission. The primary endpoint of the studies selected was the risk of airborne infection or CO2 concentration as a surrogate parameter. Studies were grouped according to the study type. RESULTS We identified 30 studies that met the inclusion criteria, six of them intervention studies. When specific ventilation strategies were lacking in schools being investigated, CO2 concentrations were often above the recommended maximum values. Improving ventilation lowered the CO2 concentration, resulting in a lower risk of airborne infections. CONCLUSIONS The ventilation in many schools is not adequate to guarantee good indoor air quality. Ventilation is an important measure for reducing the risk of airborne infections in schools. The most important effect is to reduce the time of residence of pathogens in the classrooms.
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Affiliation(s)
- Sandra N. Jendrossek
- Institute of Hygiene and Environmental Medicine, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 12203 Berlin, Germany
| | - Lukas A. Jurk
- Institute of Industrial Building and Construction Design, Technical University Carolo Wilhelmina, 38106 Braunschweig, Germany
| | - Kirsten Remmers
- Institute of Industrial Building and Construction Design, Technical University Carolo Wilhelmina, 38106 Braunschweig, Germany
| | - Yunus E. Cetin
- Hermann-Rietschel-Institut, Technical University of Berlin, 10623 Berlin, Germany
| | - Wolfgang Sunder
- Institute of Industrial Building and Construction Design, Technical University Carolo Wilhelmina, 38106 Braunschweig, Germany
| | - Martin Kriegel
- Hermann-Rietschel-Institut, Technical University of Berlin, 10623 Berlin, Germany
| | - Petra Gastmeier
- Institute of Hygiene and Environmental Medicine, Charité—Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 12203 Berlin, Germany
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9
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Lanier WA, Palmer DK, Willmore DK, Oakeson KF, Young EL, Nolen LD. Investigation of SARS-CoV-2 Transmission in The Tabernacle Choir at Temple Square in the Context of Prevention Protocols, Utah, September-November 2021. Public Health Rep 2023:333549231152198. [PMID: 36734220 PMCID: PMC9899664 DOI: 10.1177/00333549231152198] [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] [Indexed: 02/04/2023] Open
Abstract
Group singing and playing of wind instruments increase COVID-19 transmission risk. After a pause during the initial period of the COVID-19 pandemic, The Tabernacle Choir at Temple Square organization (hereinafter, Choir) resumed musical events in September 2021 with prevention protocols, including required vaccination and pre-event rapid antigen testing. We investigated potential SARS-CoV-2 transmission at Choir events during September 21-November 7, 2021. We interviewed COVID-19-positive members (hereinafter, case-members) and identified members exposed when a case-member attended a Choir event during his or her infectious period. We compared whole genome sequencing results to assess the genetic relatedness of available SARS-CoV-2 specimens obtained from case-members. We identified 30 case-members through pre-event testing (n = 10), self-reported positive test results (n = 18), and a review of Utah's disease surveillance system (n = 2). All 30 case-members reported symptoms; 21 (70%) were women and 23 (77%) received a positive test result by nucleic acid amplification test. No hospitalizations or deaths were reported. We identified 176 test-eligible exposed members from 14 instances of case-members attending events during their infectious periods. All were tested at least once 2 to 14 days after exposure: 74 (42%) by rapid antigen test only (all negative) and 102 (58%) by nucleic acid amplification test (4 positive, 97 negative, and 1 equivocal). Among viral sequences available from 15 case-members, the smallest single-nucleotide polymorphism distance between 2 sequences was 2, and the next-smallest distance was 10. The lack of disease detected in most exposed members suggests that minimal, if any, transmission occurred at Choir events. When community COVID-19 incidence is high, prevention protocols might help limit SARS-CoV-2 transmission during group musical activities.
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Affiliation(s)
- William A. Lanier
- Utah Department of Health and Human
Services, Salt Lake City, UT, USA,Career Epidemiology Field Officer
Program, Division of State and Local Readiness, Center for Preparedness and
Response, Centers for Disease Control and Prevention, Atlanta, GA, USA,US Public Health Service, Rockville,
MD, USA,The Tabernacle Choir at Temple Square,
Salt Lake City, UT, USA,William A. Lanier, DVM, MPH, Utah
Department of Health and Human Services, 288 N 1460 W, Salt Lake City, UT 84116,
USA.
| | - David K. Palmer
- The Tabernacle Choir at Temple Square,
Salt Lake City, UT, USA
| | - D. Keith Willmore
- The Tabernacle Choir at Temple Square,
Salt Lake City, UT, USA,Brigham Young University Health Center,
Provo, UT, USA
| | - Kelly F. Oakeson
- Utah Department of Health and Human
Services, Salt Lake City, UT, USA
| | - Erin L. Young
- Utah Department of Health and Human
Services, Salt Lake City, UT, USA
| | - Leisha D. Nolen
- Utah Department of Health and Human
Services, Salt Lake City, UT, USA
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10
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Schuchmann P, Scheuch G, Naumann R, Keute M, Lücke T, Zielen S, Brinkmann F. Exhaled aerosols among PCR-confirmed SARS-CoV-2-infected children. Front Pediatr 2023; 11:1156366. [PMID: 37152322 PMCID: PMC10160682 DOI: 10.3389/fped.2023.1156366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Accepted: 04/03/2023] [Indexed: 05/09/2023] Open
Abstract
Background Available data on aerosol emissions among children and adolescents during spontaneous breathing are limited. Our aim was to gain insight into the role of children in the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and whether aerosol measurements among children can be used to help detect so-called superspreaders-infected individuals with extremely high numbers of exhaled aerosol particles. Methods In this prospective study, the aerosol concentrations of SARS-CoV-2 PCR-positive and SARS-CoV-2 PCR-negative children and adolescents (2-17 years) were investigated. All subjects were asked about their current health status and medical history. The exhaled aerosol particle counts of PCR-negative and PCR-positive subjects were measured using the Resp-Aer-Meter (Palas GmbH, Karlsruhe, Germany) and compared using linear regression. Results A total of 250 children and adolescents were included in this study, 105 of whom were SARS-CoV-2 positive and 145 of whom were SARS-CoV-2 negative. The median age in both groups was 9 years (IQR 7-11 years). A total of 124 (49.6%) participants were female, and 126 (50.4%) participants were male. A total of 81.9% of the SARS-CoV-2-positive group had symptoms of viral infection. The median particle count of all individuals was 79.55 particles/liter (IQR 44.55-141.15). There was a tendency for older children to exhale more particles (1-5 years: 79.54 p/L; 6-11 years: 77.96 p/L; 12-17 years: 98.63 p/L). SARS-CoV-2 PCR status was not a bivariate predictor (t = 0.82, p = 0.415) of exhaled aerosol particle count; however, SARS-CoV-2 status was shown to be a significant predictor in a multiple regression model together with age, body mass index (BMI), COVID-19 vaccination, and past SARS-CoV-2 infection (t = 2.81, p = 0.005). COVID-19 vaccination status was a highly significant predictor of exhaled aerosol particles (p < .001). Conclusion During SARS-CoV-2 infection, children and adolescents did not have elevated aerosol levels. In addition, no superspreaders were found.
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Affiliation(s)
- Pia Schuchmann
- Department of Children and Adolescents, University Children’s Hospital, Ruhr University of Bochum, Bochum, Germany
- Pediatric Practice (Dr. Voigt, Dr. Heier), Stadtbergen, Germany
- Correspondence: Pia Schuchmann
| | - Gerhard Scheuch
- GS Bio-Inhalation GmbH, Headquarters & Logistics, Gemuenden, Germany
| | | | - Marius Keute
- Independent Statistical Consultant, Warendorf, Germany
| | - Thomas Lücke
- Department of Children and Adolescents, University Children’s Hospital, Ruhr University of Bochum, Bochum, Germany
| | - Stefan Zielen
- Department for Children and Adolescents, Allergology, Pulmonology and Cystic Fibrosis, University Hospital, Goethe University, Frankfurt, Germany
| | - Folke Brinkmann
- Department of Pediatric Pneumology, University Children's Hospital, Ruhr University of Bochum, Bochum, Germany
- Department of Pediatric Pneumology and Allergology, University Children’s Hospital Schleswig-Holstein, Lübeck, Germany
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11
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Viala R, Creton M, Jousserand M, Soubrié T, Néchab J, Crenn V, Léglise J. Experimental and numerical investigation on aerosols emission in musical practice and efficiency of reduction means. JOURNAL OF AEROSOL SCIENCE 2022; 166:106051. [PMID: 36061037 PMCID: PMC9420034 DOI: 10.1016/j.jaerosci.2022.106051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 06/27/2022] [Accepted: 07/10/2022] [Indexed: 06/07/2023]
Abstract
Early in the CoViD-19 pandemic, musical practices, especially singing and playing wind instruments, have been pointed out as having a high risk disease transmission due to aerosol production. However, characterization of these emission sources was not consolidated. This study focuses on the generation of aerosols and potential reduction in the context of playing wind instruments and singing. Aerosol concentration reduction means are evaluated using aerosol measurements in clean room and Computational Fluid Dynamics. Measurements at the bell of a clarinet and in front of singers are performed with or without a protection (bell cover for clarinet and surgical mask for singers). Numerical results on clarinet suggest that most of the supermicron ( ≥ 1 μ m ) particles are trapped on the walls of the instruments, which act as a filter, depending on toneholes configurations (closed or opened) changing the frequency of sound produced. Experimental results are consistent since almost only submicron particles contribute to the measured number concentration during playing clarinet. First of all, the high inter and intra-individuals variability is highlighted, with high coefficients of variation. This study highlights the impact of fingerings on the generated particles and the efficiency of protections such as bell cover (from 3 to 100 times), depending on the played note and players. Results for singers show that surgical masks significantly reduce the aerosol concentration (from 8 to 170 times) in front of the mouth. The evolution of aerosol concentration is also correlated with sound intensity.
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Affiliation(s)
- Romain Viala
- Institut Technologique Européen des Métiers de la Musique, ITEMM, 71 Avenue Olivier Messiaen, 72000, Le Mans, France
- Laboratoire d'Acoustique de l'Université du Mans - LAUM CNRS 6613 - Le Mans Université, Avenue Olivier Messiaen, 72085 Le Mans Cedex 09, France
| | - Milena Creton
- Buffet Crampon, 5 rue Maurice Berteaux, 78711 Mantes-La-Ville, France
| | | | - Tristan Soubrié
- ANDHEO, Centre ONERA, 29 Avenue de la Division Leclerc, 92322 Châtillon, France
| | - Julien Néchab
- ANDHEO, Centre ONERA, 29 Avenue de la Division Leclerc, 92322 Châtillon, France
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12
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Jantunen MJ. Pandemic management requires exposure science. ENVIRONMENT INTERNATIONAL 2022; 169:107470. [PMID: 36028335 PMCID: PMC9392555 DOI: 10.1016/j.envint.2022.107470] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 08/10/2022] [Accepted: 08/11/2022] [Indexed: 06/15/2023]
Abstract
COVID-19 was first detected in Wuhan, China, on 8.12.2019, and WHO announced it a pandemic on 11.3.2020. No vaccines or medical cures against COVID-19 were available in the first corona year. Instead, different combinations of generic non-pharmaceutical interventions - to slow down the spread of infections via exposure restrictions to 'flatten the curve' so that it would not overburden the health care systems, or to suppress the virus to extinction - were applied with varying levels of strictness, duration and success in the Pacific and North Atlantic regions. Due to an old misconception, almost all public health authorities dismissed the possibility that the virus would be transmitted via air. Opportunities to reduce the inhalation exposure - such as wearing effective FFP2/N95 respirators, improving ventilation and indoor air cleaning - were missed, and instead, hands were washed and surfaces disinfected. The fact that aerosols were acknowledged as the main route of COVID-19 transmission in 2021 opened avenues for more efficient and socially less disruptive exposure and risk reduction policies that are discussed and evaluated here, demonstrating that indoor air and exposure sciences are crucial for successful management of pandemics. To effectively apply environmental and personal exposure mitigation measures, exposure science needs to target the human-to-human exposure pathways of the virus.
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13
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Oksanen LAH, Virtanen J, Sanmark E, Rantanen N, Venkat V, Sofieva S, Aaltonen K, Kivistö I, Svirskaite J, Pérez AD, Kuula J, Levanov L, Hyvärinen A, Maunula L, Atanasova NS, Laitinen S, Anttila V, Lehtonen L, Lappalainen M, Geneid A, Sironen T. SARS-CoV-2 indoor environment contamination with epidemiological and experimental investigations. INDOOR AIR 2022; 32:e13118. [PMID: 36305066 PMCID: PMC9828560 DOI: 10.1111/ina.13118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/14/2022] [Revised: 08/25/2022] [Accepted: 09/06/2022] [Indexed: 05/02/2023]
Abstract
SARS-CoV-2 has been detected both in air and on surfaces, but questions remain about the patient-specific and environmental factors affecting virus transmission. Additionally, more detailed information on viral sampling of the air is needed. This prospective cohort study (N = 56) presents results from 258 air and 252 surface samples from the surroundings of 23 hospitalized and eight home-treated COVID-19 index patients between July 2020 and March 2021 and compares the results between the measured environments and patient factors. Additionally, epidemiological and experimental investigations were performed. The proportions of qRT-PCR-positive air (10.7% hospital/17.6% homes) and surface samples (8.8%/12.9%) showed statistical similarity in hospital and homes. Significant SARS-CoV-2 air contamination was observed in a large (655.25 m3 ) mechanically ventilated (1.67 air changes per hour, 32.4-421 L/s/patient) patient hall even with only two patients present. All positive air samples were obtained in the absence of aerosol-generating procedures. In four cases, positive environmental samples were detected after the patients had developed a neutralizing IgG response. SARS-CoV-2 RNA was detected in the following particle sizes: 0.65-4.7 μm, 7.0-12.0 μm, >10 μm, and <100 μm. Appropriate infection control against airborne and surface transmission routes is needed in both environments, even after antibody production has begun.
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Affiliation(s)
- Lotta‐Maria A. H. Oksanen
- Faculty of MedicineUniversity of HelsinkiHelsinkiFinland
- Department of Otorhinolaryngology and Phoniatrics – Head and Neck SurgeryHelsinki University HospitalHelsinkiFinland
| | - Jenni Virtanen
- Faculty of MedicineUniversity of HelsinkiHelsinkiFinland
- Faculty of Veterinary MedicineUniversity of HelsinkiHelsinkiFinland
| | - Enni Sanmark
- Faculty of MedicineUniversity of HelsinkiHelsinkiFinland
- Department of Otorhinolaryngology and Phoniatrics – Head and Neck SurgeryHelsinki University HospitalHelsinkiFinland
| | - Noora Rantanen
- Faculty of MedicineUniversity of HelsinkiHelsinkiFinland
- Department of Otorhinolaryngology and Phoniatrics – Head and Neck SurgeryHelsinki University HospitalHelsinkiFinland
| | - Vinaya Venkat
- Faculty of MedicineUniversity of HelsinkiHelsinkiFinland
- Faculty of Veterinary MedicineUniversity of HelsinkiHelsinkiFinland
| | - Svetlana Sofieva
- Faculty of Biological and Environmental SciencesUniversity of HelsinkiHelsinkiFinland
- Finnish Meteorological InstituteHelsinkiFinland
| | - Kirsi Aaltonen
- Faculty of MedicineUniversity of HelsinkiHelsinkiFinland
- Faculty of Veterinary MedicineUniversity of HelsinkiHelsinkiFinland
| | - Ilkka Kivistö
- Faculty of MedicineUniversity of HelsinkiHelsinkiFinland
- Faculty of Veterinary MedicineUniversity of HelsinkiHelsinkiFinland
| | - Julija Svirskaite
- Faculty of Biological and Environmental SciencesUniversity of HelsinkiHelsinkiFinland
| | | | - Joel Kuula
- Finnish Meteorological InstituteHelsinkiFinland
| | - Lev Levanov
- Faculty of MedicineUniversity of HelsinkiHelsinkiFinland
| | | | - Leena Maunula
- Faculty of Veterinary MedicineUniversity of HelsinkiHelsinkiFinland
| | - Nina S. Atanasova
- Faculty of Biological and Environmental SciencesUniversity of HelsinkiHelsinkiFinland
- Finnish Meteorological InstituteHelsinkiFinland
| | | | - Veli‐Jukka Anttila
- Faculty of MedicineUniversity of HelsinkiHelsinkiFinland
- HUS Inflammation CenterHelsinki University HospitalHelsinkiFinland
| | - Lasse Lehtonen
- Faculty of MedicineUniversity of HelsinkiHelsinkiFinland
- HUS Diagnostic Center, HUSLABHelsinki University HospitalHelsinkiFinland
| | - Maija Lappalainen
- Faculty of MedicineUniversity of HelsinkiHelsinkiFinland
- HUS Diagnostic Center, HUSLABHelsinki University HospitalHelsinkiFinland
| | - Ahmed Geneid
- Faculty of MedicineUniversity of HelsinkiHelsinkiFinland
- Department of Otorhinolaryngology and Phoniatrics – Head and Neck SurgeryHelsinki University HospitalHelsinkiFinland
| | - Tarja Sironen
- Faculty of MedicineUniversity of HelsinkiHelsinkiFinland
- Faculty of Veterinary MedicineUniversity of HelsinkiHelsinkiFinland
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14
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Kniesburges S, Schlegel P, Peters G, Westphalen C, Jakubaß B, Veltrup R, Kist AM, Döllinger M, Gantner S, Kuranova L, Benthaus T, Semmler M, Echternach M. Effects of surgical masks on aerosol dispersion in professional singing. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2022; 32:727-734. [PMID: 34611302 PMCID: PMC8491963 DOI: 10.1038/s41370-021-00385-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Revised: 09/09/2021] [Accepted: 09/10/2021] [Indexed: 05/02/2023]
Abstract
BACKGROUND In the CoVID-19 pandemic, singing came into focus as a high-risk activity for the infection with airborne viruses and was therefore forbidden by many governmental administrations. OBJECTIVE The aim of this study is to investigate the effectiveness of surgical masks regarding the spatial and temporal dispersion of aerosol and droplets during professional singing. METHODS Ten professional singers performed a passage of the Ludwig van Beethoven's "Ode of Joy" in two experimental setups-each with and without surgical masks. First, they sang with previously inhaled vapor of e-cigarettes. The emitted cloud was recorded by three cameras to measure its dispersion dynamics. Secondly, the naturally expelled larger droplets were illuminated by a laser light sheet and recorded by a high-speed camera. RESULTS The exhaled vapor aerosols were decelerated and deflected by the mask and stayed in the singer's near-field around and above their heads. In contrast, without mask, the aerosols spread widely reaching distances up to 1.3 m. The larger droplets were reduced by up to 86% with a surgical mask worn. SIGNIFICANCE The study shows that surgical masks display an effective tool to reduce the range of aerosol dispersion during singing. In combination with an appropriate aeration strategy for aerosol removal, choir singers could be positioned in a more compact assembly without contaminating neighboring singers all singers.
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Affiliation(s)
- Stefan Kniesburges
- Division of Phoniatrics and Pediatric Audiology at the Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany.
| | - Patrick Schlegel
- Department of Head and Neck Surgery, David Geffen School of Medicine at the University of California Los Angeles, Los Angeles, CA, USA
| | - Gregor Peters
- Division of Phoniatrics and Pediatric Audiology at the Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Caroline Westphalen
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology, University Hospital, LMU Munich, Munich, Germany
| | - Bernhard Jakubaß
- Division of Phoniatrics and Pediatric Audiology at the Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Reinhard Veltrup
- Division of Phoniatrics and Pediatric Audiology at the Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Andreas M Kist
- Department of Artificial Intelligence in Biomedical Engineering, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Michael Döllinger
- Division of Phoniatrics and Pediatric Audiology at the Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Sophia Gantner
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology, University Hospital, LMU Munich, Munich, Germany
| | - Liudmila Kuranova
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology, University Hospital, LMU Munich, Munich, Germany
| | - Tobias Benthaus
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Marion Semmler
- Division of Phoniatrics and Pediatric Audiology at the Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital Erlangen, Friedrich-Alexander-University Erlangen-Nürnberg, Erlangen, Germany
| | - Matthias Echternach
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology, University Hospital, LMU Munich, Munich, Germany
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15
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Ahmed T, Rawat MS, Ferro AR, Mofakham AA, Helenbrook BT, Ahmadi G, Senarathna D, Mondal S, Brown D, Erath BD. Characterizing respiratory aerosol emissions during sustained phonation. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2022; 32:689-696. [PMID: 35351959 PMCID: PMC8963400 DOI: 10.1038/s41370-022-00430-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Revised: 03/11/2022] [Accepted: 03/15/2022] [Indexed: 06/10/2023]
Abstract
OBJECTIVE To elucidate the role of phonation frequency (i.e., pitch) and intensity of speech on respiratory aerosol emissions during sustained phonations. METHODS Respiratory aerosol emissions are measured in 40 (24 males and 16 females) healthy, non-trained singers phonating the phoneme /a/ at seven specific frequencies at varying vocal intensity levels. RESULTS Increasing frequency of phonation was positively correlated with particle production (r = 0.28, p < 0.001). Particle production rate was also positively correlated (r = 0.37, p < 0.001) with the vocal intensity of phonation, confirming previously reported findings. The primary mode (particle diameter ~0.6 μm) and width of the particle number size distribution were independent of frequency and vocal intensity. Regression models of the particle production rate using frequency, vocal intensity, and the individual subject as predictor variables only produced goodness of fit of adjusted R2 = 40% (p < 0.001). Finally, it is proposed that superemitters be defined as statistical outliers, which resulted in the identification of one superemitter in the sample of 40 participants. SIGNIFICANCE The results suggest there remain unexplored effects (e.g., biomechanical, environmental, behavioral, etc.) that contribute to the high variability in respiratory particle production rates, which ranged from 0.2 particles/s to 142 particles/s across all trials. This is evidenced as well by changes in the distribution of participant particle production that transitions to a more bimodal distribution (second mode at particle diameter ~2 μm) at higher frequencies and vocal intensity levels.
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Affiliation(s)
- Tanvir Ahmed
- Department of Mechanical and Aerospace Engineering, Clarkson University, Potsdam, NY, 13699, USA
| | - Mahender Singh Rawat
- Department of Civil and Environmental Engineering, Clarkson University, Potsdam, NY, 13699, USA
| | - Andrea R Ferro
- Department of Civil and Environmental Engineering, Clarkson University, Potsdam, NY, 13699, USA
| | - Amir A Mofakham
- Department of Mechanical and Aerospace Engineering, Clarkson University, Potsdam, NY, 13699, USA
| | - Brian T Helenbrook
- Department of Mechanical and Aerospace Engineering, Clarkson University, Potsdam, NY, 13699, USA
| | - Goodarz Ahmadi
- Department of Mechanical and Aerospace Engineering, Clarkson University, Potsdam, NY, 13699, USA
| | | | - Sumona Mondal
- Department of Mathematics, Clarkson University, Potsdam, NY, 13699, USA
| | - Deborah Brown
- Joint Educational Programs, Trudeau Institute, Saranac Lake, NY, 12983, USA
| | - Byron D Erath
- Department of Mechanical and Aerospace Engineering, Clarkson University, Potsdam, NY, 13699, USA.
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16
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Aerosol emissions from wind instruments: effects of performer age, sex, sound pressure level, and bell covers. Sci Rep 2022; 12:11303. [PMID: 35788635 PMCID: PMC9252563 DOI: 10.1038/s41598-022-15530-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Accepted: 06/24/2022] [Indexed: 12/30/2022] Open
Abstract
Aerosol emissions from wind instruments are a suspected route of transmission for airborne infectious diseases, such as SARS-CoV-2. We evaluated aerosol number emissions (from 0.25 to 35.15 μm) from 81 volunteer performers of both sexes and varied age (12 to 63 years) while playing wind instruments (bassoon, clarinet, flute, French horn, oboe, piccolo, saxophone, trombone, trumpet, and tuba) or singing. Measured emissions spanned more than two orders of magnitude, ranging in rate from < 8 to 1,815 particles s-1, with brass instruments, on average, producing 191% (95% CI 81-367%) more aerosol than woodwinds. Being male was associated with a 70% increase in emissions (vs. female; 95% CI 9-166%). Each 1 dBA increase in sound pressure level was associated with a 28% increase (95% CI 10-40%) in emissions from brass instruments; sound pressure level was not associated with woodwind emissions. Age was not a significant predictor of emissions. The use of bell covers reduced aerosol emissions from three brass instruments tested (trombone, tuba, and trumpet), with average reductions ranging from 53 to 73%, but not for the two woodwind instruments tested (oboe and clarinet). Results from this work can facilitate infectious disease risk management for the performing arts.
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17
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Wang L, Lin T, Da Costa H, Zhu S, Stockman T, Kumar A, Weaver J, Spede M, Milton DK, Hertzberg J, Toohey DW, Vance ME, Miller SL, Srebric J. Characterization of aerosol plumes from singing and playing wind instruments associated with the risk of airborne virus transmission. INDOOR AIR 2022; 32:e13064. [PMID: 35762243 PMCID: PMC9328346 DOI: 10.1111/ina.13064] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Revised: 04/25/2022] [Accepted: 05/23/2022] [Indexed: 06/15/2023]
Abstract
The exhalation of aerosols during musical performances or rehearsals posed a risk of airborne virus transmission in the COVID-19 pandemic. Previous research studied aerosol plumes by only focusing on one risk factor, either the source strength or convective transport capability. Furthermore, the source strength was characterized by the aerosol concentration and ignored the airflow rate needed for risk analysis in actual musical performances. This study characterizes aerosol plumes that account for both the source strength and convective transport capability by conducting experiments with 18 human subjects. The source strength was characterized by the source aerosol emission rate, defined as the source aerosol concentration multiplied by the source airflow rate (brass 383 particle/s, singing 408 particle/s, and woodwind 480 particle/s). The convective transport capability was characterized by the plume influence distance, defined as the sum of the horizontal jet length and horizontal instrument length (brass 0.6 m, singing 0.6 m and woodwind 0.8 m). Results indicate that woodwind instruments produced the highest risk with approximately 20% higher source aerosol emission rates and 30% higher plume influence distances compared with the average of the same risk indicators for singing and brass instruments. Interestingly, the clarinet performance produced moderate source aerosol concentrations at the instrument's bell, but had the highest source aerosol emission rates due to high source airflow rates. Flute performance generated plumes with the lowest source aerosol emission rates but the highest plume influence distances due to the highest source airflow rate. Notably, these comprehensive results show that the source airflow is a critical component of the risk of airborne disease transmission. The effectiveness of masking and bell covering in reducing aerosol transmission is due to the mitigation of both source aerosol concentrations and plume influence distances. This study also found a musician who generated approximately five times more source aerosol concentrations than those of the other musicians who played the same instrument. Despite voice and brass instruments producing measurably lower average risk, it is possible to have an individual musician produce aerosol plumes with high source strength, resulting in enhanced transmission risk; however, our sample size was too small to make generalizable conclusions regarding the broad musician population.
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Affiliation(s)
- Lingzhe Wang
- Department of Mechanical EngineeringUniversity of MarylandCollege ParkMarylandUSA
| | - Tong Lin
- Department of Mechanical EngineeringUniversity of MarylandCollege ParkMarylandUSA
| | - Hevander Da Costa
- Department of Mechanical EngineeringUniversity of MarylandCollege ParkMarylandUSA
| | - Shengwei Zhu
- Department of Mechanical EngineeringUniversity of MarylandCollege ParkMarylandUSA
| | - Tehya Stockman
- Department of Civil, Environmental, and Architectural EngineeringUniversity of Colorado BoulderBoulderColoradoUSA
| | - Abhishek Kumar
- Department of Mechanical EngineeringUniversity of Colorado BoulderBoulderColoradoUSA
| | - James Weaver
- National Federation of State High School AssociationsIndianapolisIndianaUSA
| | - Mark Spede
- Department of Performing ArtsClemson UniversityClemsonSouth CarolinaUSA
| | - Donald K. Milton
- Maryland Institute for Applied Environmental Health, School of Public HealthUniversity of MarylandCollege ParkMarylandUSA
| | - Jean Hertzberg
- Department of Mechanical EngineeringUniversity of Colorado BoulderBoulderColoradoUSA
| | - Darin W. Toohey
- Department of Atmospheric and Oceanic SciencesUniversity of Colorado BoulderBoulderColoradoUSA
| | - Marina E. Vance
- Department of Mechanical EngineeringUniversity of Colorado BoulderBoulderColoradoUSA
| | - Shelly L. Miller
- Department of Mechanical EngineeringUniversity of Colorado BoulderBoulderColoradoUSA
| | - Jelena Srebric
- Department of Mechanical EngineeringUniversity of MarylandCollege ParkMarylandUSA
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18
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Firle C, Steinmetz A, Stier O, Stengel D, Ekkernkamp A. Aerosol emission from playing wind instruments and related COVID-19 infection risk during music performance. Sci Rep 2022; 12:8598. [PMID: 35597808 PMCID: PMC9124212 DOI: 10.1038/s41598-022-12529-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 04/29/2022] [Indexed: 12/29/2022] Open
Abstract
The pandemic of COVID-19 led to restrictions in all kinds of music activities. Airborne transmission of SARS-CoV-2 requires risk assessment of wind instrument playing in various situations. Previous studies focused on short-range transmission, whereas long-range transmission risk has not been assessed. The latter requires knowledge of aerosol emission rates from wind instrument playing. We measured aerosol concentrations in a hermetically closed chamber of 20 m3 in an operating theatre as resulting from 20 min standardized wind instrument playing (19 flute, 11 oboe, 1 clarinet, 1 trumpet players). We calculated aerosol emission rates showing uniform distribution for both instrument groups. Aerosol emission from wind instrument playing ranged from 11 ± 288 particles/second (P/s) up to 2535 ± 195 P/s, expectation value ± uncertainty standard deviation. The analysis of aerosol particle size distributions shows that 70–80% of emitted particles had a size of 0.25–0.8 µm and thus are alveolar. Masking the bell with a surgical mask did not reduce aerosol emission. Aerosol emission rates were higher from wind instrument playing than from speaking or breathing. Differences between instrumental groups could not be found but high interindividual variance, as expressed by uniform distribution of aerosol emission rates. Our findings indicate that aerosol emission depends on physiological factors and playing techniques rather than on the type of instrument, in contrast to some previous studies. Based on our results, we present transmission risk calculations for long-range transmission of COVID-19 for three typical woodwind playing situations.
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Affiliation(s)
- Carl Firle
- GP Practice, Dr. Claudia-Isabella Wildfeuer, 10715, Berlin, Germany.
| | - Anke Steinmetz
- Physical and Rehabilitation Medicine, Department of Trauma, Reconstructive Surgery and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, Germany
| | | | - Dirk Stengel
- BG Kliniken-Klinikverbund Der Gesetzlichen Unfallversicherung gGmbH, Berlin, Germany.,BG Klinikum Unfallkrankenhaus Berlin gGmbH, Berlin, Germany
| | - Axel Ekkernkamp
- Physical and Rehabilitation Medicine, Department of Trauma, Reconstructive Surgery and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, Germany.,Department of Trauma, Reconstructive Surgery, and Rehabilitation Medicine, University Medicine Greifswald, Greifswald, Germany.,BG Klinikum Unfallkrankenhaus Berlin gGmbH, Berlin, Germany
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Alsved M, Nygren D, Thuresson S, Medstrand P, Fraenkel CJ, Löndahl J. SARS-CoV-2 in exhaled aerosol particles from covid-19 cases and its association to household transmission. Clin Infect Dis 2022; 75:e50-e56. [PMID: 35271734 PMCID: PMC8992237 DOI: 10.1093/cid/ciac202] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2022] [Indexed: 12/29/2022] Open
Abstract
Background Coronavirus disease 2019 (COVID-19) transmission via exhaled aerosol particles has been considered an important route for the spread of infection, especially during super-spreading events involving loud talking or singing. However, no study has previously linked measurements of viral aerosol emissions to transmission rates. Methods During February–March 2021, COVID-19 cases that were close to symptom onset were visited with a mobile laboratory for collection of exhaled aerosol particles during breathing, talking, and singing, respectively, and of nasopharyngeal and saliva samples. Aerosol samples were collected using a BioSpot-VIVAS and a NIOSH bc-251 2-stage cyclone, and all samples were analyzed by RT-qPCR for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) RNA detection. We compared transmission rates between households with aerosol-positive and aerosol-negative index cases. Results SARS-CoV-2 RNA was detected in at least 1 aerosol sample from 19 of 38 (50%) included cases. The odds ratio (OR) of finding positive aerosol samples decreased with each day from symptom onset (OR 0.55, 95 confidence interval [CI] .30–1.0, P = .049). The highest number of positive aerosol samples were from singing, 16 (42%), followed by talking, 11 (30%), and the least from breathing, 3 (8%). Index cases were identified for 13 households with 31 exposed contacts. Higher transmission rates were observed in households with aerosol-positive index cases, 10/16 infected (63%), compared to households with aerosol-negative index cases, 4/15 infected (27%) (χ2 test, P = .045). Conclusions COVID-19 cases were more likely to exhale SARS-CoV-2-containing aerosol particles close to symptom onset and during singing or talking as compared to breathing. This study supports that individuals with SARS-CoV-2 in exhaled aerosols are more likely to transmit COVID-19.
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Affiliation(s)
- Malin Alsved
- Division of Ergonomics and Aerosol Technology, Department of Design Sciences, Lund University, Lund, Sweden
| | - David Nygren
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Sara Thuresson
- Division of Ergonomics and Aerosol Technology, Department of Design Sciences, Lund University, Lund, Sweden
| | - Patrik Medstrand
- Department of Translational Medicine, Lund University, Lund, Sweden
| | - Carl Johan Fraenkel
- Division of Infection Medicine, Department of Clinical Sciences, Lund University, Lund, Sweden
- Department of Infection Control, Region Skåne, Lund, Sweden
| | - Jakob Löndahl
- Division of Ergonomics and Aerosol Technology, Department of Design Sciences, Lund University, Lund, Sweden
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20
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Fleischer M, Schumann L, Hartmann A, Walker RS, Ifrim L, von Zadow D, Lüske J, Seybold J, Kriegel M, Mürbe D. Pre-adolescent children exhibit lower aerosol particle volume emissions than adults for breathing, speaking, singing and shouting. J R Soc Interface 2022; 19:20210833. [PMID: 35193389 PMCID: PMC8864358 DOI: 10.1098/rsif.2021.0833] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Speaking and singing are activities linked to increased aerosol particle emissions from the respiratory system, dependent on the utilized vocal intensity. As a result, these activities have experienced considerable restrictions in enclosed spaces since the onset of the COVID-19 pandemic due to the risk of infection from the SARS-CoV-2 virus, transmitted by virus-carrying aerosols. These constraints have affected public education and extracurricular activities for children as well, from in-person music instruction to children’s choirs. However, existing risk assessments for children have been based on emission measurements of adults. To address this, we measured the particle emission rates of 15 pre-adolescent children, all eight to ten years old, with a laser particle counter for the test conditions: breathing at rest, speaking, singing and shouting. Compared with values taken from 15 adults, emission rates for breathing, speaking and singing were significantly lower for children. Particle emission rates were reduced by a factor of 4.3 across all conditions, whereas emitted particle volume rates were reduced by a factor of 4.8. These data can supplement SARS-CoV-2 risk management scenarios for various school and extracurricular settings.
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Affiliation(s)
- Mario Fleischer
- Department of Audiology and Phoniatrics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Lukas Schumann
- Technische Universität Berlin, Hermann-Rietschel-Institut, 10587 Berlin, Germany
| | - Anne Hartmann
- Technische Universität Berlin, Hermann-Rietschel-Institut, 10587 Berlin, Germany
| | - Reuben Scott Walker
- Department of Audiology and Phoniatrics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Liliana Ifrim
- Department of Audiology and Phoniatrics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Dorothea von Zadow
- Department of Audiology and Phoniatrics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Jonas Lüske
- Department of Audiology and Phoniatrics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Joachim Seybold
- Vorstand Krankenversorgung, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
| | - Martin Kriegel
- Technische Universität Berlin, Hermann-Rietschel-Institut, 10587 Berlin, Germany
| | - Dirk Mürbe
- Department of Audiology and Phoniatrics, Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, 10117 Berlin, Germany
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21
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Archer J, McCarthy LP, Symons HE, Watson NA, Orton CM, Browne WJ, Harrison J, Moseley B, Philip KEJ, Calder JD, Shah PL, Bzdek BR, Costello D, Reid JP. Comparing aerosol number and mass exhalation rates from children and adults during breathing, speaking and singing. Interface Focus 2022; 12:20210078. [PMID: 35261733 PMCID: PMC8831083 DOI: 10.1098/rsfs.2021.0078] [Citation(s) in RCA: 18] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Accepted: 01/04/2022] [Indexed: 12/14/2022] Open
Abstract
Aerosol particles of respirable size are exhaled when individuals breathe, speak and sing and can transmit respiratory pathogens between infected and susceptible individuals. The COVID-19 pandemic has brought into focus the need to improve the quantification of the particle number and mass exhalation rates as one route to provide estimates of viral shedding and the potential risk of transmission of viruses. Most previous studies have reported the number and mass concentrations of aerosol particles in an exhaled plume. We provide a robust assessment of the absolute particle number and mass exhalation rates from measurements of minute ventilation using a non-invasive Vyntus Hans Rudolf mask kit with straps housing a rotating vane spirometer along with measurements of the exhaled particle number concentrations and size distributions. Specifically, we report comparisons of the number and mass exhalation rates for children (12–14 years old) and adults (19–72 years old) when breathing, speaking and singing, which indicate that child and adult cohorts generate similar amounts of aerosol when performing the same activity. Mass exhalation rates are typically 0.002–0.02 ng s
−1
from breathing, 0.07–0.2 ng s
−1
from speaking (at 70–80 dBA) and 0.1–0.7 ng s
−1
from singing (at 70–80 dBA). The aerosol exhalation rate increases with increasing sound volume for both children and adults when both speaking and singing.
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Affiliation(s)
| | | | | | - Natalie A. Watson
- Department of Ear, Nose and Throat Surgery, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Christopher M. Orton
- Department of Respiratory Medicine, Royal Brompton Hospital, London, UK
- Department of Respiratory Medicine, Chelsea and Westminster Hospital, London, UK
- National Heart and Lung Institute, Imperial College London, Guy Scadding Building, London, UK
| | | | | | - Benjamin Moseley
- Department of Respiratory Medicine, Chelsea and Westminster Hospital, London, UK
| | - Keir E. J. Philip
- Department of Respiratory Medicine, Royal Brompton Hospital, London, UK
- National Heart and Lung Institute, Imperial College London, Guy Scadding Building, London, UK
| | - James D. Calder
- Department of Bioengineering, Imperial College London, London, UK
- Fortius Clinic, Fitzhardinge Street, London, UK
| | - Pallav L. Shah
- Department of Respiratory Medicine, Royal Brompton Hospital, London, UK
- Department of Respiratory Medicine, Chelsea and Westminster Hospital, London, UK
- National Heart and Lung Institute, Imperial College London, Guy Scadding Building, London, UK
| | | | - Declan Costello
- Ear, Nose and Throat Department, Wexham Park Hospital, Slough, UK
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22
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Dessilly G, Pâques AT, Vandenbroucke AT, Hazée P, Gaume A, Gindro K, Schnée S, Lakaye F, Kabamba-Mukadi B. In vitro evaluation of virucidal activity of disodium citrate perhydrate (2SCP) disinfectant against SARS-CoV-2 virus. J Glob Antimicrob Resist 2022; 28:158-160. [PMID: 35038615 PMCID: PMC8759099 DOI: 10.1016/j.jgar.2022.01.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2021] [Revised: 10/27/2021] [Accepted: 01/09/2022] [Indexed: 11/13/2022] Open
Affiliation(s)
| | | | | | | | - Alain Gaume
- Agroscope, Plant Protection Department, Nyon, Switzerland
| | - Katia Gindro
- Agroscope, Plant Protection Department, Nyon, Switzerland
| | - Sylvain Schnée
- Agroscope, Plant Protection Department, Nyon, Switzerland
| | | | - Benoît Kabamba-Mukadi
- Medical Microbiology Unit (MBLG), Brussels, Belgium; Cliniques Universitaires Saint-Luc, Clinical Laboratory Department, Brussels, Belgium
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23
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Baumgarte S, Hartkopf F, Hölzer M, von Kleist M, Neitz S, Kriegel M, Bollongino K. Investigation of a Limited but Explosive COVID-19 Outbreak in a German Secondary School. Viruses 2022; 14:v14010087. [PMID: 35062291 PMCID: PMC8780098 DOI: 10.3390/v14010087] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2021] [Revised: 12/24/2021] [Accepted: 12/27/2021] [Indexed: 12/22/2022] Open
Abstract
The role of schools as a source of infection and driver in the coronavirus-pandemic has been controversial and is still not completely clarified. To prevent harm and disadvantages for children and adolescents, but also adults, detailed data on school outbreaks is needed, especially when talking about open schools employing evidence-based safety concepts. Here, we investigated the first significant COVID-19 school outbreak in Hamburg, Germany, after the re-opening of schools in 2020. Using clinical, laboratory, and contact data and spatial measures for epidemiological and environmental studies combined with whole-genome sequencing (WGS) analysis, we examined the causes and the course of the secondary school outbreak. The potential index case was identified by epidemiological tracking and the lessons in classrooms with presumably high virus spreading rates and further infection chains in the setting. Sequence analysis of samples detected one sample of a different virus lineage and 25 virus genomes with almost identical sequences, of which 21 showed 100% similarity. Most infections occurred in connection with two lesson units of the primary case. Likely, 31 students (12–14 years old), two staff members, and three family members were infected in the school or the typical household. Sequence analysis revealed an outbreak cluster with a single source that was epidemiologically identified as a member of the educational staff. In lesson units, two superspreading events of varying degrees with airborne transmission took place. These were influenced by several parameters including the exposure times, the use of respiratory masks while speaking and spatial or structural conditions at that time.
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Affiliation(s)
- Sigrid Baumgarte
- Infection Protection, Local Health Authority Hamburg-Nord, 20249 Hamburg, Germany; (S.N.); (K.B.)
- Correspondence:
| | - Felix Hartkopf
- Methodology and Research Infrastructure, Genome Sequencing and Genomic Epidemiology, Robert Koch Institute, 13353 Berlin, Germany;
| | - Martin Hölzer
- Methodology and Research Infrastructure, Bioinformatics, Robert Koch Institute, 13353 Berlin, Germany;
| | - Max von Kleist
- Systems Medicine of Infectious Disease, Robert Koch Institute, 13353 Berlin, Germany;
| | - Sabine Neitz
- Infection Protection, Local Health Authority Hamburg-Nord, 20249 Hamburg, Germany; (S.N.); (K.B.)
| | - Martin Kriegel
- Herrmann Rietschel-Institute, Technical University of Berlin, 10587 Berlin, Germany;
| | - Kirsten Bollongino
- Infection Protection, Local Health Authority Hamburg-Nord, 20249 Hamburg, Germany; (S.N.); (K.B.)
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24
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Gutmann D, Donath H, Herrlich L, Lehmkühler T, Landeis A, Ume ER, Hutter M, Goßmann AK, Weis F, Weiß M, Rabenau HF, Zielen S. Exhaled Aerosols in SARS-CoV-2 Polymerase Chain Reaction-Positive Children and Age-Matched-Negative Controls. Front Pediatr 2022; 10:941785. [PMID: 35923787 PMCID: PMC9339682 DOI: 10.3389/fped.2022.941785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2022] [Accepted: 06/14/2022] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND Children and adolescents seem to be less affected by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) disease in terms of severity, especially until the increasing spread of the omicron variant in December 2021. Anatomical structures and lower number of exhaled aerosols may in part explain this phenomenon. In a cohort of healthy and SARS-CoV-2 infected children, we compared exhaled particle counts to gain further insights about the spreading of SARS-CoV-2. MATERIALS AND METHODS In this single-center prospective observational trial, a total of 162 children and adolescents (age 6-17 years), of whom 39 were polymerase chain reaction (PCR)-positive for SARS-CoV-2 and 123 PCR-negative, were included. The 39 PCR-positive children were compared to 39 PCR-negative age-matched controls. The data of all PCR-negative children were analyzed to determine baseline exhaled particle counts in children. In addition, medical and clinical history was obtained and spirometry was measured. RESULTS Baseline exhaled particle counts were low in healthy children. Exhaled particle counts were significantly increased in SARS-CoV-2 PCR-positive children (median 355.0/L; range 81-6955/L), compared to age-matched -negative children (median 157.0/L; range 1-533/L; p < 0.001). CONCLUSION SARS-CoV-2 PCR-positive children exhaled significantly higher levels of aerosols than healthy children. Overall children had low levels of exhaled particle counts, possibly indicating that children are not the major driver of the SARS-CoV-2 pandemic. TRIAL REGISTRATION [ClinicalTrials.gov], Identifier [NCT04739020].
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Affiliation(s)
- Desiree Gutmann
- Division of Allergology, Pulmonology and Cystic Fibrosis, Department for Children and Adolescents, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Helena Donath
- Division of Allergology, Pulmonology and Cystic Fibrosis, Department for Children and Adolescents, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Laura Herrlich
- Division of Allergology, Pulmonology and Cystic Fibrosis, Department for Children and Adolescents, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Timon Lehmkühler
- Division of Allergology, Pulmonology and Cystic Fibrosis, Department for Children and Adolescents, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Anton Landeis
- Division of Allergology, Pulmonology and Cystic Fibrosis, Department for Children and Adolescents, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Emily R Ume
- Division of Allergology, Pulmonology and Cystic Fibrosis, Department for Children and Adolescents, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Martin Hutter
- Division of Allergology, Pulmonology and Cystic Fibrosis, Department for Children and Adolescents, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | | | - Frederik Weis
- Palas GmbH, Partikel- und Lasermesstechnik, Karlsruhe, Germany
| | - Maximilian Weiß
- Palas GmbH, Partikel- und Lasermesstechnik, Karlsruhe, Germany
| | - Holger F Rabenau
- Institute for Medical Virology, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
| | - Stefan Zielen
- Division of Allergology, Pulmonology and Cystic Fibrosis, Department for Children and Adolescents, University Hospital Frankfurt, Goethe University, Frankfurt, Germany
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25
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Ribaric NL, Vincent C, Jonitz G, Hellinger A, Ribaric G. Hidden hazards of SARS-CoV-2 transmission in hospitals: A systematic review. INDOOR AIR 2022; 32:e12968. [PMID: 34862811 DOI: 10.1111/ina.12968] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/09/2021] [Revised: 09/17/2021] [Accepted: 11/19/2021] [Indexed: 05/04/2023]
Abstract
Despite their considerable prevalence, dynamics of hospital-associated COVID-19 are still not well understood. We assessed the nature and extent of air- and surface-borne SARS-CoV-2 contamination in hospitals to identify hazards of viral dispersal and enable more precise targeting of infection prevention and control. PubMed, ScienceDirect, Web of Science, Medrxiv, and Biorxiv were searched for relevant articles until June 1, 2021. In total, 51 observational cross-sectional studies comprising 6258 samples were included. SARS-CoV-2 RNA was detected in one in six air and surface samples throughout the hospital and up to 7.62 m away from the nearest patients. The highest detection rates and viral concentrations were reported from patient areas. The most frequently and heavily contaminated types of surfaces comprised air outlets and hospital floors. Viable virus was recovered from the air and fomites. Among size-fractionated air samples, only fine aerosols contained viable virus. Aerosol-generating procedures significantly increased (ORair = 2.56 (1.46-4.51); ORsurface = 1.95 (1.27-2.99)), whereas patient masking significantly decreased air- and surface-borne SARS-CoV-2 contamination (ORair = 0.41 (0.25-0.70); ORsurface = 0.45 (0.34-0.61)). The nature and extent of hospital contamination indicate that SARS-CoV-2 is likely dispersed conjointly through several transmission routes, including short- and long-range aerosol, droplet, and fomite transmission.
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Affiliation(s)
- Noach Leon Ribaric
- Faculty of Medicine, University Medical Center Hamburg-Eppendorf, University of Hamburg, Hamburg, Germany
| | - Charles Vincent
- Department of Experimental Psychology, University of Oxford, Oxford, UK
| | - Günther Jonitz
- German Medical Association, Berlin, Germany
- State Chamber of Physicians Berlin, Berlin, Germany
| | - Achim Hellinger
- Department of General, Visceral, Endocrine and Oncologic Surgery, Fulda Hospital, University Medicine Marburg Campus Fulda, Fulda, Germany
| | - Goran Ribaric
- Johnson & Johnson Institute, Norderstedt, Germany
- MedTech Europe, Antimicrobial Resistance (AMR) and Healthcare Associated Infections (HAI) Sector Group, Brussels, Belgium
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26
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Kriegel M, Hartmann A, Buchholz U, Seifried J, Baumgarte S, Gastmeier P. SARS-CoV-2 Aerosol Transmission Indoors: A Closer Look at Viral Load, Infectivity, the Effectiveness of Preventive Measures and a Simple Approach for Practical Recommendations. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:220. [PMID: 35010484 PMCID: PMC8750733 DOI: 10.3390/ijerph19010220] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Revised: 12/15/2021] [Accepted: 12/16/2021] [Indexed: 12/12/2022]
Abstract
There is uncertainty about the viral loads of infectious individuals required to transmit COVID-19 via aerosol. In addition, there is a lack of both quantification of the influencing parameters on airborne transmission and simple-to-use models for assessing the risk of infection in practice, which furthermore quantify the influence of non-medical preventive measures. In this study, a dose-response model was adopted to analyze 25 documented outbreaks at infection rates of 4-100%. We show that infection was only possible if the viral load was higher than 108 viral copies/mL. Based on mathematical simplifications of our approach to predict the probable situational attack rate (PARs) of a group of persons in a room, and valid assumptions, we provide simplified equations to calculate, among others, the maximum possible number of persons and the person-related virus-free air supply flow necessary to keep the number of newly infected persons to less than one. A comparison of different preventive measures revealed that testing contributes the most to the joint protective effect, besides wearing masks and increasing ventilation. In addition, we conclude that absolute volume flow rate or person-related volume flow rate are more intuitive parameters for evaluating ventilation for infection prevention than air exchange rate.
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Affiliation(s)
- Martin Kriegel
- Hermann-Rietschel-Institut, Technical University of Berlin, 10623 Berlin, Germany;
| | - Anne Hartmann
- Hermann-Rietschel-Institut, Technical University of Berlin, 10623 Berlin, Germany;
| | - Udo Buchholz
- Department for Infectious Disease Epidemiology, Robert Koch Institute, 13353 Berlin, Germany; (U.B.); (J.S.)
| | - Janna Seifried
- Department for Infectious Disease Epidemiology, Robert Koch Institute, 13353 Berlin, Germany; (U.B.); (J.S.)
| | | | - Petra Gastmeier
- Institute for Hygiene and Environmental Medicine, Charité-University Medicine Berlin, 12203 Berlin, Germany;
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27
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Shrestha P, DeGraw JW, Zhang M, Liu X. Multizonal modeling of SARS-CoV-2 aerosol dispersion in a virtual office building. BUILDING AND ENVIRONMENT 2021; 206:108347. [PMID: 34566243 PMCID: PMC8451446 DOI: 10.1016/j.buildenv.2021.108347] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/28/2021] [Revised: 08/28/2021] [Accepted: 09/12/2021] [Indexed: 05/25/2023]
Abstract
The dispersion of indoor airborne contaminants across different zones within a mechanically ventilated building is a complex phenomenon driven by multiple factors. In this study, we modeled the indoor dispersion of airborne SARS-CoV-2 aerosols within a US Department of Energy detailed medium office prototype building using CONTAM software. The aim of this study is to improve our understanding about how different parts of a building can experience varying concentrations of the airborne viruses under different circumstances of release and mitigation strategies. Results indicate that unventilated stairwells can have significantly higher concentrations of airborne viruses. The mitigation strategies of morning and evening flushing of conditioned zones were not found to be very effective. Instead, a constant high percentage of outdoor air in the supply mix, and the use of masks, portable HEPA air cleaners, MERV 13 or higher HVAC air filters, and ultraviolet germicidal irradiation disinfection were effective strategies to prevent airborne viral contamination in the majority of the simulated office building.
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Affiliation(s)
- Prateek Shrestha
- Integrated Building Performance Group, Oak Ridge National Laboratory, Oak Ridge, TN, USA
| | - Jason W DeGraw
- Integrated Building Performance Group, Oak Ridge National Laboratory, Oak Ridge, TN, USA
| | - Mingkan Zhang
- Multifunctional Equipment Integration Group, Oak Ridge National Laboratory, Oak Ridge, TN, USA
| | - Xiaobing Liu
- Building Equipment Research Group, Oak Ridge National Laboratory, Oak Ridge, TN, USA
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28
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Freeman AL, Parker S, Noakes C, Fitzgerald S, Smyth A, Macbeth R, Spiegelhalter D, Rutter H. Expert elicitation on the relative importance of possible SARS-CoV-2 transmission routes and the effectiveness of mitigations. BMJ Open 2021; 11:e050869. [PMID: 34853105 PMCID: PMC8637346 DOI: 10.1136/bmjopen-2021-050869] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Accepted: 10/26/2021] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES To help people make decisions about the most effective mitigation measures against SARS-CoV-2 transmission in different scenarios, the likelihoods of transmission by different routes need to be quantified to some degree (however uncertain). These likelihoods need to be communicated in an appropriate way to illustrate the relative importance of different routes in different scenarios, the likely effectiveness of different mitigation measures along those routes, and the level of uncertainty in those estimates. In this study, a pragmatic expert elicitation was undertaken to supply the underlying quantitative values to produce such a communication tool. PARTICIPANTS Twenty-seven individual experts from five countries and many scientific disciplines provided estimates. OUTCOME MEASURES Estimates of transmission parameters, assessments of the quality of the evidence, references to relevant literature, rationales for their estimates and sources of uncertainty. RESULTS AND CONCLUSION The participants' responses showed that there is still considerable disagreement among experts about the relative importance of different transmission pathways and the effectiveness of different mitigation measures due to a lack of empirical evidence. Despite these disagreements, when pooled, the majority views on each parameter formed an internally consistent set of estimates (for example, that transmission was more likely indoors than outdoors, and at closer range), which formed the basis of a visualisation to help individuals and organisations understand the factors that influence transmission and the potential benefits of different mitigation measures.
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Affiliation(s)
- Alexandra Lj Freeman
- Winton Centre for Risk & Evidence Communication, University of Cambridge, Cambridge, UK
| | - Simon Parker
- Defence Science and Technology Laboratory, Salisbury, UK
| | | | - Shaun Fitzgerald
- Centre for Climate Repair at Cambridge, University of Cambridge, Cambridge, UK
| | | | | | - David Spiegelhalter
- Winton Centre for Risk & Evidence Communication, University of Cambridge, Cambridge, UK
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29
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Becher L, Gena AW, Alsaad H, Richter B, Spahn C, Voelker C. The spread of breathing air from wind instruments and singers using schlieren techniques. INDOOR AIR 2021; 31:1798-1814. [PMID: 34121229 DOI: 10.1111/ina.12869] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/24/2020] [Revised: 04/28/2021] [Accepted: 05/23/2021] [Indexed: 06/12/2023]
Abstract
The spread of breathing air when playing wind instruments and singing was investigated and visualized using two methods: (1) schlieren imaging with a schlieren mirror and (2) background-oriented schlieren (BOS). These methods visualize airflow by visualizing density gradients in transparent media. The playing of professional woodwind and brass instrument players, as well as professional classical trained singers were investigated to estimate the spread distances of the breathing air. For a better comparison and consistent measurement series, a single high note, a single low note, and an extract of a musical piece were investigated. Additionally, anemometry was used to determine the velocity of the spreading breathing air and the extent to which it was quantifiable. The results showed that the ejected airflow from the examined instruments and singers did not exceed a spreading range of 1.2 m into the room. However, differences in the various instruments have to be considered to assess properly the spread of the breathing air. The findings discussed below help to estimate the risk of cross-infection for wind instrument players and singers and to develop efficacious safety precautions, which is essential during critical health periods such as the current COVID-19 pandemic.
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Affiliation(s)
- Lia Becher
- Department of Building Physics, Bauhaus-University Weimar, Weimar, Germany
| | - Amayu W Gena
- Department of Building Physics, Bauhaus-University Weimar, Weimar, Germany
| | - Hayder Alsaad
- Department of Building Physics, Bauhaus-University Weimar, Weimar, Germany
| | - Bernhard Richter
- Freiburg Institute for Musicians' Medicine, Medical Faculty University Freiburg and Freiburg University of Music, Freiburg, Germany
| | - Claudia Spahn
- Freiburg Institute for Musicians' Medicine, Medical Faculty University Freiburg and Freiburg University of Music, Freiburg, Germany
| | - Conrad Voelker
- Department of Building Physics, Bauhaus-University Weimar, Weimar, Germany
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30
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Quantitative modeling of the impact of facemasks and associated leakage on the airborne transmission of SARS-CoV-2. Sci Rep 2021; 11:19403. [PMID: 34593891 PMCID: PMC8484595 DOI: 10.1038/s41598-021-98895-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2021] [Accepted: 09/16/2021] [Indexed: 12/28/2022] Open
Abstract
The ongoing worldwide outbreak of COVID-19 has set personal protective equipment in the spotlight. A significant number of countries impose the use of facemasks in public spaces and encourage it in the private sphere. Even in countries where relatively high vaccination rates are achieved at present, breakthrough infections have been frequently reported and usage of facemasks in certain settings has been recommended again. Alternative solutions, including community masks fabricated using various materials, such as cotton or jersey, have emerged alongside facemasks following long-established standards (e.g., EN 149, EN 14683). In the present work, we present a computational model to calculate the ability of different types of facemasks to reduce the exposure to virus-laden respiratory particles, with a focus on the relative importance of the filtration properties and the fitting on the wearer’s face. The model considers the facemask and the associated leakage, the transport of respiratory particles and their accumulation around the emitter, as well as the fraction of the inhaled particles deposited in the respiratory system. Different levels of leakages are considered to represent the diversity of fittings likely to be found among a population of non-trained users. The leakage prevails over the filtration performance of a facemask in determining the exposure level, and the ability of a face protection to limit leakages needs to be taken into account to accurately estimate the provided protection. Filtering facepieces (FFP) provide a better protection efficiency than surgical and community masks due to their higher filtration efficiency and their ability to provide a better fit and thus reduce the leakages. However, an improperly-fitted FFP mask loses a critical fraction of its protection efficiency, which may drop below the protection level provided by properly-worn surgical and community masks.
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31
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Barros MT, Veletić M, Kanada M, Pierobon M, Vainio S, Balasingham I, Balasubramaniam S. Molecular Communications in Viral Infections Research: Modeling, Experimental Data, and Future Directions. IEEE TRANSACTIONS ON MOLECULAR, BIOLOGICAL, AND MULTI-SCALE COMMUNICATIONS 2021; 7:121-141. [PMID: 35782714 PMCID: PMC8544950 DOI: 10.1109/tmbmc.2021.3071780] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/05/2020] [Revised: 03/09/2021] [Accepted: 03/15/2021] [Indexed: 12/22/2022]
Abstract
Hundreds of millions of people worldwide are affected by viral infections each year, and yet, several of them neither have vaccines nor effective treatment during and post-infection. This challenge has been highlighted by the COVID-19 pandemic, showing how viruses can quickly spread and impact society as a whole. Novel interdisciplinary techniques must emerge to provide forward-looking strategies to combat viral infections, as well as possible future pandemics. In the past decade, an interdisciplinary area involving bioengineering, nanotechnology and information and communication technology (ICT) has been developed, known as Molecular Communications. This new emerging area uses elements of classical communication systems to molecular signalling and communication found inside and outside biological systems, characterizing the signalling processes between cells and viruses. In this paper, we provide an extensive and detailed discussion on how molecular communications can be integrated into the viral infectious diseases research, and how possible treatment and vaccines can be developed considering molecules as information carriers. We provide a literature review on molecular communications models for viral infection (intra-body and extra-body), a deep analysis on their effects on immune response, how experimental can be used by the molecular communications community, as well as open issues and future directions.
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Affiliation(s)
- Michael Taynnan Barros
- CBIG/BioMediTechTampere University33014TampereFinland
- School of Computer Science and Electronic EngineeringUniversity of EssexColchesterCO4 3SQU.K.
| | - Mladen Veletić
- Intervention CentreOslo University Hospital0424OsloNorway
- Department of Electronic SystemsNorwegian University of Science and Technology7491TrondheimNorway
| | - Masamitsu Kanada
- Department of Pharmacology and ToxicologyInstitute for Quantitative Health Science and Engineering, Michigan State UniversityEast LansingMI48824USA
| | - Massimiliano Pierobon
- Department of Computer Science and EngineeringUniversity of Nebraska–LincolnLincolnNE68588USA
| | - Seppo Vainio
- InfoTech OuluKvantum Institute, Faculty of Biochemistry and Molecular Medicine, Laboratory of Developmental Biology, Oulu University90570OuluFinland
| | - Ilangko Balasingham
- Intervention CentreOslo University Hospital0424OsloNorway
- Department of Electronic SystemsNorwegian University of Science and Technology7491TrondheimNorway
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32
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Aerosol emission in professional singing of classical music. Sci Rep 2021; 11:14861. [PMID: 34290265 PMCID: PMC8295351 DOI: 10.1038/s41598-021-93281-x] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2020] [Accepted: 06/23/2021] [Indexed: 02/08/2023] Open
Abstract
In this study, emission rates of aerosols emitted by professional singers were measured with a laser particle counter under cleanroom conditions. The emission rates during singing varied between 753 and 6093 particles/sec with a median of 1537 particles/sec. Emission rates for singing were compared with data for breathing and speaking. Significantly higher emission rates were found for singing. The emission enhancements between singing and speaking were between 4.0 and 99.5 with a median of 17.4, largely due to higher sound pressure levels when singing. Further, significant effects of vocal loudness were found, whereas there were no significant differences between the investigated voice classifications. The present study supports the efforts to improve the risk management in cases of possible aerogenic virus transmission, especially for choir singing.
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33
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Use of portable air cleaners to reduce aerosol transmission on a hospital coronavirus disease 2019 (COVID-19) ward. Infect Control Hosp Epidemiol 2021; 43:987-992. [PMID: 34266516 PMCID: PMC8314194 DOI: 10.1017/ice.2021.284] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
Objective: To study the airflow, transmission, and clearance of aerosols in the clinical spaces of a hospital ward that had been used to care for patients with coronavirus disease 2019 (COVID-19) and to examine the impact of portable air cleaners on aerosol clearance. Design: Observational study. Setting: A single ward of a tertiary-care public hospital in Melbourne, Australia. Intervention: Glycerin-based aerosol was used as a surrogate for respiratory aerosols. The transmission of aerosols from a single patient room into corridors and a nurses’ station in the ward was measured. The rate of clearance of aerosols was measured over time from the patient room, nurses’ station and ward corridors with and without air cleaners [ie, portable high-efficiency particulate air (HEPA) filters]. Results: Aerosols rapidly travelled from the patient room into other parts of the ward. Air cleaners were effective in increasing the clearance of aerosols from the air in clinical spaces and reducing their spread to other areas. With 2 small domestic air cleaners in a single patient room of a hospital ward, 99% of aerosols could be cleared within 5.5 minutes. Conclusions: Air cleaners may be useful in clinical spaces to help reduce the risk of acquisition of respiratory viruses that are transmitted via aerosols. They are easy to deploy and are likely to be cost-effective in a variety of healthcare settings.
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Rezaei M, Netz RR. Airborne virus transmission via respiratory droplets: Effects of droplet evaporation and sedimentation. Curr Opin Colloid Interface Sci 2021; 55:101471. [PMID: 34093064 PMCID: PMC8164513 DOI: 10.1016/j.cocis.2021.101471] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Airborne transmission is considered as an important route for the spread of infectious diseases, such as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), and is primarily determined by the droplet sedimentation time, that is, the time droplets spend in air before reaching the ground. Evaporation increases the sedimentation time by reducing the droplet mass. In fact, small droplets can, depending on their solute content, almost completely evaporate during their descent to the ground and remain airborne as so-called droplet nuclei for a long time. Considering that viruses possibly remain infectious in aerosols for hours, droplet nuclei formation can substantially increase the infectious viral air load. Accordingly, the physical-chemical factors that control droplet evaporation and sedimentation times and play important roles in determining the infection risk from airborne respiratory droplets are reviewed in this article.
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Affiliation(s)
- Majid Rezaei
- Fachbereich Physik, Freie Universität Berlin, Berlin, 14195, Germany
| | - Roland R Netz
- Fachbereich Physik, Freie Universität Berlin, Berlin, 14195, Germany
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Spahn C, Hipp AM, Schubert B, Axt MR, Stratmann M, Schmölder C, Richter B. Airflow and Air Velocity Measurements While Playing Wind Instruments, with Respect to Risk Assessment of a SARS-CoV-2 Infection. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:5413. [PMID: 34069419 PMCID: PMC8159134 DOI: 10.3390/ijerph18105413] [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] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 05/07/2021] [Accepted: 05/10/2021] [Indexed: 11/17/2022]
Abstract
Due to airborne transmission of the coronavirus, the question arose as to how high the risk of spreading infectious particles can be while playing a wind instrument. To examine this question and to help clarify the possible risk, we analyzed 14 wind instruments, first qualitatively by making airflows visible while playing, and second quantitatively by measuring air velocity at three distances (1, 1.5, 2 m) in the direction of the instruments' bells. Measurements took place with wind instrumentalists of the Bamberg Symphony in their concert hall. Our findings highlight that while playing, no airflows escaping from any of the wind instruments-from the bell with brass instruments or from the mouthpiece, keyholes or bell with woodwinds-were measurable beyond a distance of 1.5 m, regardless of volume, pitch or what was played. With that, air velocity while playing corresponded to the usual value of 1 m/s in hall-like rooms. For air-jet woodwinds, alto flute and piccolo, significant air movements were seen close to the mouthpiece, which escaped directly into the room.
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Affiliation(s)
- Claudia Spahn
- Freiburg Institute of Musicians’ Medicine, University Medical Center Freiburg, University of Music Freiburg, Medical Faculty of the Albert-Ludwigs-University Freiburg, 79110 Freiburg i.Br., Germany; (C.S.); (B.R.)
| | - Anna Maria Hipp
- Freiburg Institute of Musicians’ Medicine, University Medical Center Freiburg, University of Music Freiburg, Medical Faculty of the Albert-Ludwigs-University Freiburg, 79110 Freiburg i.Br., Germany; (C.S.); (B.R.)
| | - Bernd Schubert
- Tintschl BioEnergie und Strömungstechnik AG, Tintschl Unternehmensgruppe, 91058 Erlangen, Germany;
| | - Marcus Rudolf Axt
- Bamberg Symphony, Bavarian State Philharmonic Orchestra, 96047 Bamberg, Germany; (M.R.A.); (M.S.); (C.S.)
| | - Markus Stratmann
- Bamberg Symphony, Bavarian State Philharmonic Orchestra, 96047 Bamberg, Germany; (M.R.A.); (M.S.); (C.S.)
| | - Christian Schmölder
- Bamberg Symphony, Bavarian State Philharmonic Orchestra, 96047 Bamberg, Germany; (M.R.A.); (M.S.); (C.S.)
| | - Bernhard Richter
- Freiburg Institute of Musicians’ Medicine, University Medical Center Freiburg, University of Music Freiburg, Medical Faculty of the Albert-Ludwigs-University Freiburg, 79110 Freiburg i.Br., Germany; (C.S.); (B.R.)
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Schade W, Reimer V, Seipenbusch M, Willer U. Experimental Investigation of Aerosol and CO 2 Dispersion for Evaluation of COVID-19 Infection Risk in a Concert Hall. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:3037. [PMID: 33809493 PMCID: PMC8002200 DOI: 10.3390/ijerph18063037] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Revised: 03/11/2021] [Accepted: 03/13/2021] [Indexed: 12/12/2022]
Abstract
The dispersion of small aerosols in a concert hall is experimentally studied for estimating the risk of infection with SARS-CoV-2 during a concert. A mannequin was modified to emit an air stream containing aerosols and CO2. The aerosols have a size distribution with a peak diameter (δ) close to 0.3 µm and a horizontal initial particle velocity (vp,x) of 2.4 m/s. The CO2-concentration (c) emitted simultaneously is 7500 ppm. It is investigated, if the spatial dissipation of aerosols and CO2 can be correlated. This would allow the use of technically easier CO2 measurements to monitor compliance with aerosol concentration limits. Both aerosol and CO2 concentrations are mapped by different sensors placed around the mannequin. As a result, no significant enrichment of aerosols and CO2 was obtained outside a radius of 1.5 m when the fresh air ventilation in the concert hall has a steady vertical flow with a velocity of vg,z=0.05 m/s and the installed ventilation system was operating at an air change rate per hour (ACH) of 3, corresponding to an air exchange rate of 51,000 m3/h. A Pearson correlation coefficient of 0.77 was obtained for CO2 and aerosol concentrations measured simultaneously at different positions within the concert hall.
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Affiliation(s)
- Wolfgang Schade
- Fraunhofer Heinrich Hertz Institute, 38640 Goslar, Germany;
- IEPT, Clausthal University of Technology, 38678 Clausthal, Germany;
| | - Vladislav Reimer
- Fraunhofer Heinrich Hertz Institute, 38640 Goslar, Germany;
- IEPT, Clausthal University of Technology, 38678 Clausthal, Germany;
| | | | - Ulrike Willer
- IEPT, Clausthal University of Technology, 38678 Clausthal, Germany;
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Schwarz S, Jenetzky E, Krafft H, Maurer T, Martin D. [Corona child studies "Co-Ki": first results of a Germany-wide register on mouth and nose covering (mask) in children]. Monatsschr Kinderheilkd 2021; 169:353-365. [PMID: 33642617 PMCID: PMC7898258 DOI: 10.1007/s00112-021-01133-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Accepted: 12/31/2020] [Indexed: 12/28/2022]
Abstract
BACKGROUND Narratives about complaints in children and adolescents caused by wearing a mask are accumulating. There is, to date, no registry for side effects of masks. METHODS In the context of the www.co-ki.de multi-study complex, an online registry has been set up where parents, doctors, pedagogues and others can enter their observations. On 20 October 2020, 363 doctors were asked to make entries and to make parents and teachers aware of the registry. RESULTS By 26 October 2020, a total of 20,353 people had taken part in the survey. The group of parents alone entered data on a total of 25,930 children. The average reported wearing time of masks was 270 min per day. Of the respondents 68% reported that children complained about impairments caused by wearing the mask. Side effects included irritability (60%), headache (53%), difficulty concentrating (50%), less happiness (49%), reluctance to go to school/kindergarten (44%), malaise (42%) impaired learning (38%) and drowsiness/fatigue (37%). DISCUSSION This world's first registry for recording the effects of wearing masks in children is dedicated to a new research question. A bias with respect to the preferential documentation of particularly severely affected children or persons who are fundamentally critical of protective measures cannot be ruled out.The frequency of use and the spectrum of symptoms registered indicate the importance of the topic and call for representative surveys, randomized controlled trials with various masks and a renewed risk-benefit assessment of mask obligation in the vulnerable group of children.
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Affiliation(s)
- Silke Schwarz
- Fakultät für Gesundheit/Department für Humanmedizin, Universität Witten/Herdecke, Witten/Herdecke, Deutschland
| | - Ekkehart Jenetzky
- Fakultät für Gesundheit/Department für Humanmedizin, Universität Witten/Herdecke, Witten/Herdecke, Deutschland
- Klinik und Poliklinik für Kinder- und Jugendpsychiatrie und -psychotherapie, Universitätsmedizin Mainz, Mainz, Deutschland
| | - Hanno Krafft
- Fakultät für Gesundheit/Department für Humanmedizin, Universität Witten/Herdecke, Witten/Herdecke, Deutschland
| | - Tobias Maurer
- Fakultät für Gesundheit/Department für Humanmedizin, Universität Witten/Herdecke, Witten/Herdecke, Deutschland
| | - David Martin
- Fakultät für Gesundheit/Department für Humanmedizin, Universität Witten/Herdecke, Witten/Herdecke, Deutschland
- Universitätsklinik für Kinder- und Jugendmedizin, Universität Tübingen, Tübingen, Deutschland
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[What role do children in school and kindergarten settings play in transmitting SARS-CoV-2? An evidence-based perspective]. Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz 2021; 64:1492-1499. [PMID: 34792612 PMCID: PMC8600106 DOI: 10.1007/s00103-021-03454-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2021] [Accepted: 10/22/2021] [Indexed: 01/09/2023]
Abstract
Are children and adolescents relevant disease vectors when it comes to the transmission of SARS-CoV-2? Moreover, do they play a role as relevant disease vectors in a school or kindergarten setting? These questions could not be sufficiently answered at the beginning of the pandemic. Consequently, schools and childcare facilities were closed to stop the spread of SARS-CoV‑2. Over the past few months, researchers have gained a more detailed understanding of the overall pandemic situation. The SARS-CoV‑2 infection rate in children below 10 years of age in 2020 has been substantially lower than in adults. In addition, it showed that children had a milder course of disease.Although a majority of the analyses performed in schools and childcare facilities revealed that the virus is transmitted in these facilities, these transmissions did not, however, have a considerable influence on the overall rate of new infections. Despite these findings, German politicians continue to advocate for the closure of childcare facilities, including schools, to fight the pandemic, whereas many specialist societies such as the German Society for Pediatric Infectious Diseases (DGPI) have emphasized that such closures should be the measure of last resort in combating the pandemic. The same message is also conveyed by a German evidence-based S3 guideline established by an interdisciplinary expert group that had already put forward clear recommendations for high incidences in the general population at the beginning of February 2021, indicating that school closures were only required in exceptional cases.In this article, we would like to outline the situation based on the currently available data, try to predict the future, and discuss the circumstances necessary to realize normal classroom teaching without accepting the risk of an uncontrolled spread of SARS-CoV‑2.
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