Systematic Review of the Key Factors Influencing the Indoor Airborne Spread of SARS-CoV-2.

The COVID-19 pandemic due to the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has been plaguing the world since late 2019/early 2020 and has changed the way we function as a society, halting both economic and social activities worldwide. Classrooms, offices, restaurants, public transport, and other enclosed spaces that typically gather large groups of people indoors, and are considered focal points for the spread of the virus. For society to be able to go "back to normal", it is crucial to keep these places open and functioning. An understanding of the transmission modes occurring in these contexts is essential to set up effective infection control strategies. This understanding was made using a systematic review, according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses statement (PRISMA) 2020 guidelines. We analyze the different parameters influencing airborne transmission indoors, the mathematical models proposed to understand it, and discuss how we can act on these parameters. Methods to judge infection risks through the analysis of the indoor air quality are described. Various mitigation measures are listed, and their efficiency, feasibility, and acceptability are ranked by a panel of experts in the field. Thus, effective ventilation procedures controlled by CO2-monitoring, continued mask wearing, and a strategic control of room occupancy, among other measures, are put forth to enable a safe return to these essential places.

Compliance with Barrier Gestures during COVID-19 Pandemic as a Function of the Context: A Longitudinal Observational Survey at the University of Liège.

During the COVID-19 pandemic, barrier gestures such as mask wearing, physical distancing, greetings without contact, one-way circulation flow, and hand sanitization were major strategies to prevent the spread of SARS-CoV-2, but they were only useful if consistently applied. This survey was a follow-up of the first survey performed in 2020 at the University of Liège. We aim to evaluate the compliance with these gestures on campuses and examine differences in the extent of the compliance observed in different educational activities and contexts. During 3.5 months, the counting of compliant and non-compliant behaviors was performed each week in randomly selected rooms. Using data collected during both surveys (2020 and 2021), binomial negative regression models of compliance depending on periods (teaching periods and exam sessions), type of rooms, and campuses were conducted to evaluate prevalence ratios of compliance. The percentage of compliance in this second survey was the highest for mask wearing and physical distancing during educational activities (90% and 88%, respectively) and lowest for physical distancing outside educational activities and hand sanitization (45% and 52%, respectively). Multivariate analyses revealed that the compliance with most gestures was significantly higher in teaching rooms than in hallways and restaurants and during exam sessions. The compliance with physical distancing was significantly higher (from 66%) in auditoriums, where students had to remain seated, than during practical works that allowed or required free movement. Therefore, the compliance with barrier gestures was associated with contextual settings, which should be considered when communicating and managing barrier gestures. Further studies should specify and confirm the determining contextual characteristics regarding the compliance with barrier gestures in times of pandemic.

The First Random Observational Survey of Barrier Gestures against COVID-19.

In the context of COVID-19 in Belgium, face-to-face teaching activities were allowed in Belgian universities at the beginning of the 2020-2021 academic year. Nevertheless, several control measures were established to control COVID-19 transmission on the campuses. To ensure compliance with these measures, a random observational survey, based on five barrier gestures, was implemented at the University of Liege (greetings without contact, hand sanitisation, following a one-way traffic flow, wearing a mask and physical distancing). Each barrier gesture was weighted, based on experts' elicitation, and a scoring system was developed. The results were presented as a diagram (to identify the margin of improvement for each barrier gesture) and a risk management barometer. In total, 526 h of observations were performed. The study revealed that some possible improvements could be made in the management of facilities, in terms of room allocation, the functionality of hydro-alcoholic gel dispensers, floor markings and one-way traffic flow. Compliance with the barrier gestures reached an overall weighted score of 68.2 (between 0 and 100). Three barrier gestures presented a lower implementation rate and should be addressed: the use of hydro-alcoholic gel (particularly when exiting buildings), compliance with the traffic flow and the maintenance of a 1.5 m physical distance outside of the auditoriums. The methodology and tool developed in the present study can easily be applied to other settings. They were proven to be useful in managing COVID-19, as the barometer that was developed and the outcomes of this survey enabled an improved risk assessment on campuses, and identified the critical points to be addressed in any further public health communication or education messages.