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Siebler L, Rathje T, Calandri M, Stergiaropoulos K, Donker T, Richter B, Spahn C, Nusseck M. A coupled experimental and statistical approach for an assessment of SARS-CoV-2 infection risk at indoor event locations. BMC Public Health 2023; 23:1394. [PMID: 37474924 PMCID: PMC10357618 DOI: 10.1186/s12889-023-16154-0] [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: 02/14/2023] [Accepted: 06/19/2023] [Indexed: 07/22/2023] Open
Abstract
Indoor event locations are particularly affected by the SARS-CoV-2 pandemic. At large venues, only incomplete risk assessments exist, whereby no suitable measures can be derived. In this study, a physical and data-driven statistical model for a comprehensive infection risk assessment has been developed. At venues displacement ventilation concepts are often implemented. Here simplified theoretical assumptions fail for the prediction of relevant airflows for airborne transmission processes. Thus, with locally resolving trace gas measurements infection risks are computed more detailed. Coupled with epidemiological data such as incidences, vaccination rates, test sensitivities, and audience characteristics such as masks and age distribution, predictions of new infections (mean), situational R-values (mean), and individual risks on- and off-seat can be achieved for the first time. Using the Stuttgart State Opera as an example, the functioning of the model and its plausibility are tested and a sensitivity analysis is performed with regard to masks and tests. Besides a reference scenario on 2022-11-29, a maximum safety scenario with an obligation of FFP2 masks and rapid antigen tests as well as a minimum safety scenario without masks and tests are investigated. For these scenarios the new infections (mean) are 10.6, 0.25 and 13.0, respectively. The situational R-values (mean) - number of new infections caused by a single infectious person in a certain situation - are 2.75, 0.32 and 3.39, respectively. Besides these results a clustered consideration divided by age, masks and whether infections occur on-seat or off-seat are presented. In conclusion this provides an instrument that can enable policymakers and operators to take appropriate measures to control pandemics despite ongoing mass gathering events.
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Affiliation(s)
- Lukas Siebler
- Institute for Building Energetics, Thermotechnology and Energy Storage (IGTE), University of Stuttgart, Pfaffenwaldring 35, Stuttgart, 70569, Baden-Württemberg, Germany.
| | - Torben Rathje
- Institute for Building Energetics, Thermotechnology and Energy Storage (IGTE), University of Stuttgart, Pfaffenwaldring 35, Stuttgart, 70569, Baden-Württemberg, Germany
| | - Maurizio Calandri
- Institute for Building Energetics, Thermotechnology and Energy Storage (IGTE), University of Stuttgart, Pfaffenwaldring 35, Stuttgart, 70569, Baden-Württemberg, Germany
| | - Konstantinos Stergiaropoulos
- Institute for Building Energetics, Thermotechnology and Energy Storage (IGTE), University of Stuttgart, Pfaffenwaldring 35, Stuttgart, 70569, Baden-Württemberg, Germany
| | - Tjibbe Donker
- Institute for Infection Prevention and Hospital Epidemiology, University Medical Center Freiburg, Breisacher Straße 115 B, Freiburg, 79106, Baden-Württemberg, Germany
| | - Bernhard Richter
- Freiburg Institute for Musicians' Medicine, University of Music Freiburg, University Medical Center Freiburg, Medical Faculty of the Albert-Ludwigs-University Freiburg, Freiburg Center for Research and Teaching in Music, Germany, Elsässer Straße 2m, Freiburg, 79110, Baden-Württemberg, Germany
| | - Claudia Spahn
- Freiburg Institute for Musicians' Medicine, University of Music Freiburg, University Medical Center Freiburg, Medical Faculty of the Albert-Ludwigs-University Freiburg, Freiburg Center for Research and Teaching in Music, Germany, Elsässer Straße 2m, Freiburg, 79110, Baden-Württemberg, Germany
| | - Manfred Nusseck
- Freiburg Institute for Musicians' Medicine, University of Music Freiburg, University Medical Center Freiburg, Medical Faculty of the Albert-Ludwigs-University Freiburg, Freiburg Center for Research and Teaching in Music, Germany, Elsässer Straße 2m, Freiburg, 79110, Baden-Württemberg, Germany
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Berghöfer A, Rotter G, Pankert J, Icke K, Roll S, King R, Willich SN. SARS-CoV-2 infections in professional orchestra and choir musicians-a prospective cohort study. Eur J Epidemiol 2022; 37:1061-1070. [PMID: 36173478 PMCID: PMC9519404 DOI: 10.1007/s10654-022-00917-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2022] [Accepted: 09/13/2022] [Indexed: 11/25/2022]
Abstract
During the COVID-19 pandemic, rehearsal and concert activities of professional orchestras and choirs were severely restricted based on the assumption of particularly high infection risks associated with wind instruments and singing. Therefore, our primary objective was to determine the incidence of SARS-CoV-2 infections in orchestra and choir musicians compared to controls. We also assessed influenza, flu, upper respiratory tract infections, and course of illness. Musicians from professional orchestras and choirs and controls from 23 institutions throughout Germany were included in a prospective cohort study. Data were collected from October 2020 to June 2021 by weekly online surveys. A mixed-effects cox proportional hazards model was used to assess the effect of exposure by professional activity on SARS-CoV-2 infection. In 1,097 participants (46.7 years (SD 10.3); 46.8% female; 705 orchestra, 154 choir, and 238 control subjects) 40 SARS-CoV-2 infections occurred. Cases per person-years were 0.06 in orchestras, 0.11 in choirs, and 0.03 in controls. Hazard ratios compared to controls were 1.74 (95% CI 0.58 to 5.25, p = 0.320) for orchestra musicians and 2.97 (0.87 to 10.28, p = 0.087) for choir singers. Infection source was suspected predominantly in private contexts. Disease courses were mild to moderate. Other respiratory infections were reported in 6.1% of study weeks in orchestras, 10.1% in choirs, and 8.0% in controls. Sick leave days of total study days were 0.5, 2.1 and 1.3%, respectively. This epidemiologic study during the pandemic in professional musicians indicates no increased risk of SARS-CoV-2 infections in orchestra musicians and a trend towards increased risk in choir singers compared to controls. However, the exact routes of infection could not be validated. If appropriate hygiene concepts are adhered to, safe orchestra and choir activity appears possible in pandemic times.
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Affiliation(s)
- Anne Berghöfer
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany.
| | - Gabriele Rotter
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Joachim Pankert
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Katja Icke
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Stephanie Roll
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Ryan King
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Stefan N Willich
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin Berlin, corporate member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
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Zhang X, Wu J, Smith LM, Li X, Yancey O, Franzblau A, Dvonch JT, Xi C, Neitzel RL. Monitoring SARS-CoV-2 in air and on surfaces and estimating infection risk in buildings and buses on a university campus. JOURNAL OF EXPOSURE SCIENCE & ENVIRONMENTAL EPIDEMIOLOGY 2022; 32:751-758. [PMID: 35477766 PMCID: PMC9045468 DOI: 10.1038/s41370-022-00442-9] [Citation(s) in RCA: 24] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 04/11/2022] [Accepted: 04/12/2022] [Indexed: 05/13/2023]
Abstract
BACKGROUND Evidence is needed on the presence of SARS-CoV-2 in various types of environmental samples and on the estimated transmission risks in non-healthcare settings on campus. OBJECTIVES The objective of this research was to collect data on SARS-CoV-2 viral load and to examine potential infection risks of people exposed to the virus in publicly accessible non-healthcare environments on a university campus. METHODS Air and surface samples were collected using wetted wall cyclone bioaerosol samplers and swab kits, respectively, in a longitudinal environmental surveillance program from August 2020 until April 2021 on the University of Michigan Ann Arbor campus. Quantitative rRT-PCR with primers and probes targeting gene N1 were used for SARS-CoV-2 RNA quantification. The RNA concentrations were used to estimate the probability of infection by quantitative microbial risk assessment modeling and Monte-Carlo simulation. RESULTS In total, 256 air samples and 517 surface samples were collected during the study period, among which positive rates were 1.6% and 1.4%, respectively. Point-biserial correlation showed that the total case number on campus was significantly higher in weeks with positive environmental samples than in non-positive weeks (p = 0.001). The estimated probability of infection was about 1 per 100 exposures to SARS-CoV-2-laden aerosols through inhalation and as high as 1 per 100,000 exposures from contacting contaminated surfaces in simulated scenarios. SIGNIFICANCE Viral shedding was demonstrated by the detection of viral RNA in multiple air and surface samples on a university campus. The low overall positivity rate indicated that the risk of exposure to SARS-CoV-2 at monitored locations was low. Risk modeling results suggest that inhalation is the predominant route of exposure compared to surface contact, which emphasizes the importance of protecting individuals from airborne transmission of SARS-CoV-2 and potentially other respiratory infectious diseases. IMPACT Given the reoccurring epidemics caused by highly infectious respiratory viruses in recent years, our manuscript reinforces the importance of monitoring environmental transmission by the simultaneous sampling and integration of multiple environmental surveillance matrices for modeling and risk assessment.
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Affiliation(s)
- Xin Zhang
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Jianfeng Wu
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Lauren M Smith
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Xin Li
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Olivia Yancey
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Alfred Franzblau
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - J Timothy Dvonch
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA
| | - Chuanwu Xi
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA.
| | - Richard L Neitzel
- Department of Environmental Health Sciences, University of Michigan School of Public Health, Ann Arbor, MI, USA.
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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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Gantner S, Echternach M, Veltrup R, Westphalen C, Köberlein MC, Kuranova L, Peters G, Jakubaß B, Benthaus T, Döllinger M, Kniesburges S. Impulse dispersion of aerosols during playing wind instruments. PLoS One 2022; 17:e0262994. [PMID: 35239657 PMCID: PMC8893631 DOI: 10.1371/journal.pone.0262994] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2021] [Accepted: 01/10/2022] [Indexed: 12/24/2022] Open
Abstract
Musical activities, especially singing and playing wind instruments, have been singled out as potentially high-risk activities for the transmission of SARS CoV-2, due to a higher rate of aerosol production and emission. Playing wind instruments can produce condensation, droplets of saliva, and aerosol particles, which hover and spread in the environmental air's convectional flows and which can be potentially infectious. The aim of this study is to investigate the primary impulse dispersion of aerosols that takes place during the playing of different wind instruments as compared to breathing and to speaking. Nine professional musicians (3 trumpeters, 3 flautists and 3 clarinetists) from the Bavarian Symphony Orchestra performed the main theme from the 4th movement of Ludwig van Beethoven's 9th symphony in different pitches and loudness. The inhaled air volume was marked with small aerosol particles produced using a commercial e-cigarette. The expelled aerosol cloud was recorded by cameras from different perspectives. Afterwards, the dimensions and dynamics of the aerosol cloud were measured by segmenting the video footage at every time point. Overall, the flutes produced the largest dispersion at the end of the task, reaching maximum forward distances of 1.88 m. An expulsion of aerosol was observed in different directions: upwards and downwards at the mouthpiece, at the end of the instrument, and along the flute at the key plane. In comparison, the maximum impulse dispersions generated by the trumpets and clarinets were lower in frontal and lateral direction (1.2 m and 1.0 m towards the front, respectively). Also, the expulsion to the sides was lower.
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Affiliation(s)
- Sophia Gantner
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology, University Hospital, LMU Munich, Munich, Germany
| | - Matthias Echternach
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology, University Hospital, LMU Munich, Munich, Germany
| | - Reinhard Veltrup
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology, Head & Neck Surgery, University Hospital Erlangen, Medical School, Friedrich-Alexander-University Erlangen-Nueremberg, Erlangen, Germany
| | - Caroline Westphalen
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology, University Hospital, LMU Munich, Munich, Germany
| | - Marie Christine Köberlein
- 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
| | - Gregor Peters
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology, Head & Neck Surgery, University Hospital Erlangen, Medical School, Friedrich-Alexander-University Erlangen-Nueremberg, Erlangen, Germany
| | - Bernhard Jakubaß
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology, Head & Neck Surgery, University Hospital Erlangen, Medical School, Friedrich-Alexander-University Erlangen-Nueremberg, Erlangen, Germany
| | - Tobias Benthaus
- Institute and Clinic for Occupational, Social and Environmental Medicine, University Hospital, LMU Munich, Munich, Germany
| | - Michael Döllinger
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology, Head & Neck Surgery, University Hospital Erlangen, Medical School, Friedrich-Alexander-University Erlangen-Nueremberg, Erlangen, Germany
| | - Stefan Kniesburges
- Division of Phoniatrics and Pediatric Audiology, Department of Otorhinolaryngology, Head & Neck Surgery, University Hospital Erlangen, Medical School, Friedrich-Alexander-University Erlangen-Nueremberg, Erlangen, Germany
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