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1.
Cities ; : 103139, 2021 Feb 11.
Article in English | MEDLINE | ID: covidwho-1077828

ABSTRACT

COVID-19 threatens the world. Social distancing is a significant factor in determining the spread of this disease, and social distancing is strongly affected by the local travel behaviour of people in large cities. In this study, we analysed the changes in the local travel behaviour of various population groups in Hong Kong, between 1 January and 31 March 2020, by using second-by-second smartcard data obtained from the Mass Transit Railway Corporation (MTRC) system. Due to the pandemic, local travel volume decreased by 43%, 49% and 59% during weekdays, Saturdays and Sundays, respectively. The local travel volumes of adults, children, students and senior citizens decreased by 42%, 86%, 73% and 48%, respectively. The local travel behaviour changes for adults and seniors between non-pandemic and pandemic times were greater than those between weekdays and weekends. The opposite was true for children and students. During the pandemic, the daily commute flow decreased by 42%. Local trips to shopping areas, amusement areas and borders decreased by 42%, 81% and 99%, respectively. The effective reproduction number (R t ) of COVID-19 had the strongest association with daily population use of the MTR 7-8 days earlier.

3.
Clin Infect Dis ; 2020 Dec 04.
Article in English | MEDLINE | ID: covidwho-960504

ABSTRACT

BACKGROUND: COVID-19 continues to threaten human life worldwide. We explored how human behaviours have been influenced by the COVID-19 pandemic in Hong Kong, and how the transmission of other respiratory diseases (e.g. influenza) has been influenced by human behaviour. METHODS: We focused on the spread of COVID-19 and influenza infections based on reported COVID-19 cases and influenza surveillance data, and investigated the changes in human behaviour due to COVID-19 based on mass transit railway data and the data from a telephone survey. We did the simulation based on SEIR model to assess the risk reduction of influenza transmission caused by the changes in human behaviour. RESULTS: During the COVID-19 pandemic, the number of passengers fell by 52.0% compared with the same period in 2019. Residents spent 32.2% more time at home. Each person on average came into close contact with 17.6 and 7.1 people per day during the normal and pandemic periods, respectively. Students, workers, and older people reduced their daily number of close contacts by 83.0%, 48.1%, and 40.3%, respectively. The close contact rates in residences, workplaces, places of study, restaurants, shopping centres, markets, and public transport decreased by 8.3%, 30.8%, 66.0%, 38.5%, 48.6%, 41.0%, and 36.1%, respectively. Based on the simulation, these changes in human behaviours reduced the effective reproduction number of influenza by 63.1%. CONCLUSIONS: Human behaviours were significantly influenced by the COVID-19 pandemic in Hong Kong. Close contact control contributed more than 47% to the reduction in infection risk of COVID-19.

4.
J Virol Methods ; : 114036, 2020 Dec 04.
Article in English | MEDLINE | ID: covidwho-957273

ABSTRACT

The coronavirus disease 2019 (COVID-19) pandemic, caused by infection with a novel coronavirus (severe acute respiratory syndrome coronavirus 2, SARS-CoV-2), has led to escalating morbidity and mortality in all nations and cities. SARS-CoV-2 lies within the same coronavirus family as SARS-CoV (2003) and MERS-CoV (2012), though there are genetic and epidemiological differences between the viruses, as well as different clinical presentations in the patients. Despite this, Hong Kong has so far managed to control the pandemic very successfully. Here we offer a Hong Kong perspective on different aspects of the pandemic virus (SARS-CoV-2) and the disease : public health (diagnosis and control), food safety (reducing transmission in the workplace) and animal vectors (controlling potential reservoirs of the virus and their movements).

5.
Indoor Air ; 2020 Oct 31.
Article in English | MEDLINE | ID: covidwho-901068

ABSTRACT

It is essential to understand where and how severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is transmitted. Case reports were extracted from the local Municipal Health Commissions of 320 prefectural municipalities in China (not including Hubei Province). We identified all outbreaks involving three or more cases and reviewed the major characteristics of the enclosed spaces in which the outbreaks were reported and their associated indoor environmental aspects. Three hundred and eighteen outbreaks with three or more cases were identified, comprising a total of 1245 confirmed cases in 120 prefectural cities. Among the identified outbreaks, 53.8% involved three cases, 26.4% involved four cases, and only 1.6% involved ten or more cases. Home-based outbreaks were the dominant category (254 of 318 outbreaks; 79.9%), followed by transport-based outbreaks (108; 34.0%), and many outbreaks occurred in more than one category of venue. All identified outbreaks of three or more cases occurred in indoor environments, which confirm that sharing indoor spaces with one or more infected persons is a major SARS-CoV-2 infection risk.

6.
Clin Infect Dis ; 2020 Oct 20.
Article in English | MEDLINE | ID: covidwho-880792

ABSTRACT

BACKGROUND: Non-pharmaceutical interventions (NPIs) against Coronavirus Disease 2019 (COVID-19) are vital to reducing the transmission risks. However, the relative efficiency of social distancing against COVID-19 remains controversial, since social distancing and isolation/quarantine were implemented almost at the same time in China. METHODS: In this study, surveillance data of COVID-19 and seasonal influenza in the year 2018-2020 were used to quantify the relative efficiency of NPIs against COVID-19 in China, since isolation/quarantine was not used for the influenza epidemics. Given that the relative age-dependent susceptibility to influenza and COVID-19 may vary, an age-structured Susceptible-Infected-Recovered model was built to explore the efficiency of social distancing against COVID-19 under different population susceptibility scenarios. RESULTS: The mean effective reproductive number, Rt, of COVID-19 before NPIs was 2.12 (95% confidential interval (CI): 2.02-2.21). By March 11, 2020, the overall reduction in Rt of COVID-19 was 66.1% (95% CI: 60.1%-71.2%). In the epidemiological year 2019/20, influenza transmissibility reduced by 34.6% (95% CI: 31.3%-38.2%) compared with that in the epidemiological year 2018/19. Under the observed contact patterns changes in China, social distancing had similar efficiency against COVID-19 in three different scenarios. By assuming same efficiency of social distancing against seasonal influenza and COVID-19 transmission, isolation/quarantine and social distancing could lead to a 48.1% (95% CI: 35.4%-58.1%) and 34.6% (95% CI: 31.3%-38.2%) reduction of the transmissibility of COVID-19. CONCLUSIONS: Though isolation/quarantine is more effective than social distancing, given that typical basic reproductive number of COVID-19 is 2-3, isolation/quarantine alone could not contain the COVID-19 pandemic effectively in China.

7.
Preprint | SSRN | ID: ppcovidwho-971

ABSTRACT

Background: To date, the Coronavirus Disease 2019 (COVID-19) pandemic had been successful under control in China However, the necessity of some non-pharmaceuti

8.
Ann Intern Med ; 2020 Sep 01.
Article in English | MEDLINE | ID: covidwho-738264

ABSTRACT

BACKGROUND: The role of fecal aerosols in the transmission of severe acute respiratory syndrome coronavirus 2 has been suspected. OBJECTIVE: To investigate the temporal and spatial distributions of 3 infected families in a high-rise apartment building and examine the associated environment variables to verify the role of fecal aerosols. DESIGN: Epidemiologic survey and quantitative reverse transcriptase polymerase chain reaction analyses on throat swabs from the participants; 237 surface and air samples from 11 of the 83 flats in the building, public areas, and building drainage systems; and tracer gas released into bathrooms as a surrogate for virus-laden aerosols in the drainage system. SETTING: A high-rise apartment building in Guangzhou, China. PARTICIPANTS: 9 infected patients, 193 other residents of the building, and 24 members of the building's management staff. MEASUREMENTS: Locations of infected flats and positive environmental samples, and spread of virus-laden aerosols. RESULTS: 9 infected patients in 3 families were identified. The first family had a history of travel to the coronavirus disease 2019 (COVID-19) epicenter Wuhan, whereas the other 2 families had no travel history and a later onset of symptoms. No evidence was found for transmission via the elevator or elsewhere. The families lived in 3 vertically aligned flats connected by drainage pipes in the master bathrooms. Both the observed infections and the locations of positive environmental samples are consistent with the vertical spread of virus-laden aerosols via these stacks and vents. LIMITATION: Inability to determine whether the water seals were dried out in the flats of the infected families. CONCLUSION: On the basis of circumstantial evidence, fecal aerosol transmission may have caused the community outbreak of COVID-19 in this high-rise building. PRIMARY FUNDING SOURCE: Key-Area Research and Development Program of Guangdong Province and the Research Grants Council of Hong Kong.

9.
Sci Total Environ ; 753: 141710, 2021 Jan 20.
Article in English | MEDLINE | ID: covidwho-713250

ABSTRACT

Respiratory and fecal aerosols play confirmed and suspected roles, respectively, in transmitting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). An extensive environmental sampling campaign of both toilet and non-toilet environments was performed in a dedicated hospital building for patients with coronavirus disease 2019 (COVID-19), and the associated environmental factors were analyzed. In total, 107 surface samples, 46 air samples, two exhaled condensate samples, and two expired air samples were collected within and beyond four three-bed isolation rooms. The data of the COVID-19 patients were collected. The building environmental design and the cleaning routines were reviewed. Field measurements of airflow and CO2 concentrations were conducted. The 107 surface samples comprised 37 from toilets, 34 from other surfaces in isolation rooms, and 36 from other surfaces outside the isolation rooms in the hospital. Four of these samples were positive, namely two ward door handles, one bathroom toilet seat cover, and one bathroom door handle. Three were weakly positive, namely one bathroom toilet seat, one bathroom washbasin tap lever, and one bathroom ceiling exhaust louver. Of the 46 air samples, one collected from a corridor was weakly positive. The two exhaled condensate samples and the two expired air samples were negative. The fecal-derived aerosols in patients' toilets contained most of the detected SARS-CoV-2 in the hospital, highlighting the importance of surface and hand hygiene for intervention.


Subject(s)
Bathroom Equipment , Coronavirus Infections , Pandemics , Pneumonia, Viral , Severe Acute Respiratory Syndrome , Betacoronavirus , Hospitals , Humans
10.
Build Environ ; 180: 107106, 2020 Aug.
Article in English | MEDLINE | ID: covidwho-625254

ABSTRACT

By March 31, 2020, COVID-19 had spread to more than 200 countries. Over 750,000 confirmed cases were reported, leading to more than 36,000 deaths. In this study, we analysed the efficiency of various intervention strategies to prevent infection by the virus, SARS-CoV-2, using an agent-based SEIIR model, in the fully urbanised city of Shenzhen, Guangdong Province, China. Shortening the duration from symptom onset to hospital admission, quarantining recent arrivals from Hubei Province, and letting symptomatic individuals stay at home were found to be the three most important interventions to reduce the risk of infection in Shenzhen. The ideal time window for a mandatory quarantine of arrivals from Hubei Province was between 10 January and January 17, 2020, while the ideal time window for local intervention strategies was between 15 and 22 January. The risk of infection could have been reduced by 50% if all symptomatic individuals had immediately gone to hospital for isolation, and by 35% if a 14-day quarantine for arrivals from Hubei Province had been introduced one week earlier. Intervention strategies implemented in Shenzhen were effective, and the spread of infection would be controlled even if the initial basic reproduction number had doubled. Our results may be useful for other cities when choosing their intervention strategies to prevent outbreaks of COVID-19.

11.
Aerosol Sci. Technol. ; 8(54): 869-879, 20200802.
Article in English | ELSEVIER | ID: covidwho-597617

ABSTRACT

Respiratory droplets are bioaerosols that originate from the respiratory tract. Knowing their deposition characteristics during exhalation would facilitate the understanding of the source of large respiratory droplets and their importance in the spread of respiratory infectious diseases. In this study, computational fluid dynamics is used to simulate the motion and deposition of droplets released from either trachea or bronchi in a realistic reconstruction of the human respiratory tract. Influences of airflow structures and locations of droplet generation on droplet deposition are studied, and droplets with diameters between 1 and 50 µm are examined. The deposition of droplets is found to be influenced mainly by the droplet diameter and the flow rate of exhalation. The number of droplets released from the trachea or bronchi that can escape into the environment decreases as the flow rate increases. When the flow rate is low (10 L/min), the critical diameter of droplets generated in the lower respiratory system that can escape into the air is approximately 12 µm, but this diameter is approximately 5 µm when the flow rate is medium (30 to 60 L/min) or large (90 L/min). The larynx is the dominant site of deposition for droplets smaller than the critical diameter, while trachea and bronchus are more important locations that account for the deposition of larger droplets. This study indicates that the lower respiratory tract is an important source of fine droplets (<5 µm) in indoor environments, and larger droplets probably originate from the upper respiratory tract, which needs further investigation. Copyright © 2020 American Association for Aerosol Research.

12.
Int J Environ Res Public Health ; 17(11)2020 06 03.
Article in English | MEDLINE | ID: covidwho-541301

ABSTRACT

The world has been suffering from the COVID-19 pandemic since late 2019. In this study, we compared various types of infection locations in which COVID-19 cases clustered, based on the data from three adjacent provinces in Northeast China. The collected data include all officially reported cases in this area until 8 March 2020. We explored the associations between the cases and the frequency of infection locations. The COVID-19 epidemic situation was worse in Heilongjiang Province than in Liaoning and Jilin Provinces. Most clustered cases occurred in individual families and/or between relatives. The transmission in public venues served as a hub for transmitting the disease to other families and results in new clusters. The public transport spread the infection over long distances by transporting infected individuals, and most infections did not seem to occur within vehicles. This field study shows the effect of indoor environments on SARS-CoV-2 transmission and our data may be useful in developing guidance for future disease prevention and control.


Subject(s)
Coronavirus Infections/epidemiology , Coronavirus Infections/transmission , Pandemics/statistics & numerical data , Pneumonia, Viral/epidemiology , Pneumonia, Viral/transmission , Public Facilities , Workplace , Betacoronavirus/isolation & purification , China/epidemiology , Cluster Analysis , Coronavirus Infections/virology , Humans , Pneumonia, Viral/virology
13.
Environ Int ; 142: 105832, 2020 09.
Article in English | MEDLINE | ID: covidwho-381748

ABSTRACT

During the rapid rise in COVID-19 illnesses and deaths globally, and notwithstanding recommended precautions, questions are voiced about routes of transmission for this pandemic disease. Inhaling small airborne droplets is probable as a third route of infection, in addition to more widely recognized transmission via larger respiratory droplets and direct contact with infected people or contaminated surfaces. While uncertainties remain regarding the relative contributions of the different transmission pathways, we argue that existing evidence is sufficiently strong to warrant engineering controls targeting airborne transmission as part of an overall strategy to limit infection risk indoors. Appropriate building engineering controls include sufficient and effective ventilation, possibly enhanced by particle filtration and air disinfection, avoiding air recirculation and avoiding overcrowding. Often, such measures can be easily implemented and without much cost, but if only they are recognised as significant in contributing to infection control goals. We believe that the use of engineering controls in public buildings, including hospitals, shops, offices, schools, kindergartens, libraries, restaurants, cruise ships, elevators, conference rooms or public transport, in parallel with effective application of other controls (including isolation and quarantine, social distancing and hand hygiene), would be an additional important measure globally to reduce the likelihood of transmission and thereby protect healthcare workers, patients and the general public.


Subject(s)
Air Microbiology , Coronavirus Infections/prevention & control , Coronavirus Infections/transmission , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Pneumonia, Viral/transmission , Aerosols , Betacoronavirus , Crowding , Disinfection/instrumentation , Filtration , Humans , Inhalation Exposure , Ventilation
14.
Clin Infect Dis ; 70(5): 850-858, 2020 Feb 14.
Article in English | MEDLINE | ID: covidwho-326398

ABSTRACT

BACKGROUND: Respiratory virus-laden particles are commonly detected in the exhaled breath of symptomatic patients or in air sampled from healthcare settings. However, the temporal relationship of detecting virus-laden particles at nonhealthcare locations vs surveillance data obtained by conventional means has not been fully assessed. METHODS: From October 2016 to June 2018, air was sampled weekly from a university campus in Hong Kong. Viral genomes were detected and quantified by real-time reverse-transcription polymerase chain reaction. Logistic regression models were fitted to examine the adjusted odds ratios (aORs) of ecological and environmental factors associated with the detection of virus-laden airborne particles. RESULTS: Influenza A (16.9% [117/694]) and influenza B (4.5% [31/694]) viruses were detected at higher frequencies in air than rhinovirus (2.2% [6/270]), respiratory syncytial virus (0.4% [1/270]), or human coronaviruses (0% [0/270]). Multivariate analyses showed that increased crowdedness (aOR, 2.3 [95% confidence interval {CI}, 1.5-3.8]; P < .001) and higher indoor temperature (aOR, 1.2 [95% CI, 1.1-1.3]; P < .001) were associated with detection of influenza airborne particles, but absolute humidity was not (aOR, 0.9 [95% CI, .7-1.1]; P = .213). Higher copies of influenza viral genome were detected from airborne particles >4 µm in spring and <1 µm in autumn. Influenza A(H3N2) and influenza B viruses that caused epidemics during the study period were detected in air prior to observing increased influenza activities in the community. CONCLUSIONS: Air sampling as a surveillance tool for monitoring influenza activity at public locations may provide early detection signals on influenza viruses that circulate in the community.

15.
Nat Med ; 26(5): 676-680, 2020 05.
Article in English | MEDLINE | ID: covidwho-203367

ABSTRACT

We identified seasonal human coronaviruses, influenza viruses and rhinoviruses in exhaled breath and coughs of children and adults with acute respiratory illness. Surgical face masks significantly reduced detection of influenza virus RNA in respiratory droplets and coronavirus RNA in aerosols, with a trend toward reduced detection of coronavirus RNA in respiratory droplets. Our results indicate that surgical face masks could prevent transmission of human coronaviruses and influenza viruses from symptomatic individuals.


Subject(s)
Coronavirus Infections/transmission , Masks/virology , Pneumonia, Viral/transmission , Respiratory Tract Infections/transmission , Aerosols/isolation & purification , Coronavirus Infections/prevention & control , Coronavirus Infections/virology , Exhalation/physiology , Humans , Orthomyxoviridae/isolation & purification , Orthomyxoviridae/pathogenicity , Pandemics/prevention & control , Pneumonia, Viral/prevention & control , Pneumonia, Viral/virology , RNA, Viral/isolation & purification , Respiratory Tract Infections/pathology , Respiratory Tract Infections/virology , Virus Shedding
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