A position statement and practical guide to the use of particulate filtering facepiece respirators (N95, FFP2, or equivalent) for South African health workers exposed to respiratory pathogens including Mycobacterium tuberculosis and SARS-CoV-2.

SUMMARY: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is transmitted mainly by aerosol in particles <10 µm that can remain suspended for hours before being inhaled. Because particulate filtering facepiece respirators ('respirators'; e.g. N95 masks) are more effective than surgical masks against bio-aerosols, many international organisations now recommend that health workers (HWs) wear a respirator when caring for individuals who may have COVID-19. In South Africa (SA), however, surgical masks are still recommended for the routine care of individuals with possible or confirmed COVID-19, with respirators reserved for so-called aerosol-generating procedures. In contrast, SA guidelines do recommend respirators for routine care of individuals with possible or confirmed tuberculosis (TB), which is also transmitted via aerosol. In health facilities in SA, distinguishing between TB and COVID-19 is challenging without examination and investigation, both of which may expose HWs to potentially infectious individuals. Symptom-based triage has limited utility in defining risk. Indeed, significant proportions of individuals with COVID-19 and/or pulmonary TB may not have symptoms and/or test negative. The prevalence of undiagnosed respiratory disease is therefore likely significant in many general clinical areas (e.g. waiting areas). Moreover, a proportion of HWs are HIV-positive and are at increased risk of severe COVID-19 and death. RECOMMENDATIONS: Sustained improvements in infection prevention and control (IPC) require reorganisation of systems to prioritise HW and patient safety. While this will take time, it is unacceptable to leave HWs exposed until such changes are made. We propose that the SA health system adopts a target of 'zero harm', aiming to eliminate transmission of respiratory pathogens to all individuals in every healthcare setting. Accordingly, we recommend: the use of respirators by all staff (clinical and non-clinical) during activities that involve contact or sharing air in indoor spaces with individuals who: (i) have not yet been clinically evaluated; or (ii) are thought or known to have TB and/or COVID-19 or other potentially harmful respiratory infections;the use of respirators that meet national and international manufacturing standards;evaluation of all respirators, at the least, by qualitative fit testing; andthe use of respirators as part of a 'package of care' in line with international IPC recommendations. We recognise that this will be challenging, not least due to global and national shortages of personal protective equipment (PPE). SA national policy around respiratory protective equipment enables a robust framework for manufacture and quality control and has been supported by local manufacturers and the Department of Trade, Industry and Competition. Respirator manufacturers should explore adaptations to improve comfort and reduce barriers to communication. Structural changes are needed urgently to improve the safety of health facilities: persistent advocacy and research around potential systems change remain essential.

Diagnosis of COVID-19: Considerations, controversies and challenges.

Coronavirus disease 2019 (COVID-19) due to a novel virus, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is a global pandemic that has resulted in over 1.5 million confirmed cases and close to 100 000 deaths. In the majority of symptomatic cases, COVID-19 results in a mild disease predominantly characterised by upper respiratory tract symptoms. Reverse transcription polymerase chain reaction (RT-PCR) using a nasopharyngeal sample is the mainstay of diagnosis, but there is an ~30% false negative rate early in the disease and in patients with mild disease, and therefore repeat testing may be required. RT-PCR positivity can persist for several days after resolution of symptoms. IgM and IgG antibody responses become positive several days after the onset of symptoms, and robust antibody responses are detectable in the second week of illness. Antibody-based immunoassays have a limited role in the diagnosis of early symptomatic disease. However, their incremental benefit over RT-PCR in the first 2 weeks of illness is currently being clarified in ongoing studies. Such assays may be useful for surveillance purposes. However, their role in potentially selecting individuals who may benefit from vaccination, or as a biomarker identifying persons who could be redeployed into essential employment roles, is being investigated. Rapid antibody-based immunoassays that detect viral antigen in nasopharyngeal samples are being developed and evaluated.

Approaches to laboratory testing for COVID-19

Virologists working in large diagnostic laboratories in South Africa give insights into testing in a pandemic. As the Covid-19 pandemic unfolds, several factors have come to the fore as particularly relevant. Rather than give an overview of current testing guidelines and practices which are prone to change over time, and in any case, for which good reviews are available, the study instead wants to list some of the pertinent issues encountered in South Africa, the African country first and so far worst hit by the pandemic, and some proposed solutions. Clear and up-to-date guidance is needed and must be followed by all role players, including different spheres of government. In South Africa for example, some official governmental recommendations have not been aligned with national Department of Health guidance, and for example, required negative PCR test results before an individual who had Covid-19 was allowed back to their workplace. Such unnecessary requirements serve no purpose but increase the burden on laboratories and interfere with testing of clinically and epidemiologically relevant samples. As the SARS-CoV-2 pandemic spreads, laboratory staff will become infected, too;their infection risk is not exposure to specimens (provided some simple precautions are being followed) but instead to the community and also colleagues. Therefore, the same rules will have to be followed as in all workplaces, including universal wearing of non-medical (cloth) masks, physical distancing, improved hand hygiene, regular cleaning and disinfection of surfaces, etc.

Opportunities for Transdisciplinary Science to Mitigate Biosecurity Risks From the Intersectionality of Illegal Wildlife Trade With Emerging Zoonotic Pathogens

Existing collaborations among public health practitioners, veterinarians, and ecologists do not sufficiently consider illegal wildlife trade in their surveillance, biosafety, and security (SB&S) efforts even though the risks to health and biodiversity from these threats are significant. We highlight multiple cases to illustrate the risks posed by existing gaps in understanding the intersectionality of the illegal wildlife trade and zoonotic disease transmission. We argue for more integrative science in support of decision-making using the One Health approach. Opportunities abound to apply transdisciplinary science to sustainable wildlife trade policy and programming, such as combining on-the-ground monitoring of health, environmental, and social conditions with an understanding of the operational and spatial dynamics of illicit wildlife trade. We advocate for (1) a surveillance sample management system for enhanced diagnostic efficiency in collaboration with diverse and local partners that can help establish new or link existing surveillance networks, outbreak analysis, and risk mitigation strategies;(2) novel analytical tools and decision support models that can enhance self-directed local livelihoods by addressing monitoring, detection, prevention, interdiction, and remediation;(3) enhanced capacity to promote joint SB&S efforts that can encourage improved human and animal health, timely reporting, emerging disease detection, and outbreak response;and, (4) enhanced monitoring of illicit wildlife trade and supply chains across the heterogeneous context within which they occur. By integrating more diverse scientific disciplines, and their respective scientists with indigenous people and local community insight and risk assessment data, we can help promote a more sustainable and equitable wildlife trade. © Copyright © 2021 Aguirre, Gore, Kammer-Kerwick, Curtin, Heyns, Preiser and Shelley.

SARS

Severe acute respiratory syndrome (SARS) emerged in southern China in late 2002. It first spread within Guangdong Province and then to other parts of China. Via air travelers, it quickly reached various countries around the globe, causing several major hospital outbreaks.Within weeks, the causative agent, a previously unknown coronavirus (SARS-CoV), was identified, thanks to an unprecedented international effort led by the World Health Organization (WHO). Its origin was quickly traced to wild animals traded locally for culinary purposes. Masked palm civet and some other species seem to have acted as intermediate hosts. Since then, SARS-like coronaviruses were found in different bat species in China and elsewhere, and bats are now regarded as the wildlife reservoir for SARS-CoV.Fortunately, the SARS outbreak could be contained within months. Until July 2003, it had caused 8096 cases, with 774 deaths. Once adequate measures such as isolating patients and quarantining their contacts were strictly adhered to, further transmission between human beings could be interrupted.SARS is an example of how rapidly an infectious agent can spread in the modern world. At the same time, it should serve as a showcase of how international cooperation and modern science can help to combat the spread of infectious diseases. FAU - Berger, A.

The role of serological testing in the SARS-CoV-2 outbreak.

Antibody tests for the novel coronavirus, SARS-CoV2, have been developed both as rapid diagnostic assays and for high-throughput formal serology platforms. Although these tests may be a useful adjunct to a diagnostic strategy, they have a number of limitations. Because of the antibody and viral dynamics of the coronavirus, their sensitivity can be variable, especially at early time points after symptom onset. Additional data are required on the performance of the tests in the South African population, especially with regard to development and persistence of antibody responses and whether antibodies are protective against reinfection. These tests may, however, be useful in guiding the public health response, providing data for research (including seroprevalence surveys and vaccine initiatives) and development of therapeutic strategies.