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2.
JMIR Public Health Surveill ; 7(4): e20699, 2021 04 21.
Article in English | MEDLINE | ID: covidwho-2141282

ABSTRACT

BACKGROUND: Daily new COVID-19 cases from January to April 2020 demonstrate varying patterns of SARS-CoV-2 transmission across different geographical regions. Constant infection rates were observed in some countries, whereas China and South Korea had a very low number of daily new cases. In fact, China and South Korea successfully and quickly flattened their COVID-19 curve. To understand why this was the case, this paper investigated possible aerosol-forming patterns in the atmosphere and their relationship to the policy measures adopted by select countries. OBJECTIVE: The main research objective was to compare the outcomes of policies adopted by countries between January and April 2020. Policies included physical distancing measures that in some cases were associated with mask use and city disinfection. We investigated whether the type of social distancing framework adopted by some countries (ie, without mask use and city disinfection) led to the continual dissemination of SARS-CoV-2 (daily new cases) in the community during the study period. METHODS: We examined the policies used as a preventive framework for virus community transmission in some countries and compared them to the policies adopted by China and South Korea. Countries that used a policy of social distancing by 1-2 m were divided into two groups. The first group consisted of countries that implemented social distancing (1-2 m) only, and the second comprised China and South Korea, which implemented distancing with additional transmission/isolation measures using masks and city disinfection. Global daily case maps from Johns Hopkins University were used to provide time-series data for the analysis. RESULTS: The results showed that virus transmission was reduced due to policies affecting SARS-CoV-2 propagation over time. Remarkably, China and South Korea obtained substantially better results than other countries at the beginning of the epidemic due to their adoption of social distancing (1-2 m) with the additional use of masks and sanitization (city disinfection). These measures proved to be effective due to the atmosphere carrier potential of SARS-CoV-2 transmission. CONCLUSIONS: Our findings confirm that social distancing by 1-2 m with mask use and city disinfection yields positive outcomes. These strategies should be incorporated into prevention and control policies and be adopted both globally and by individuals as a method to fight the COVID-19 pandemic.


Subject(s)
Air Microbiology , COVID-19/prevention & control , COVID-19/transmission , Policy , COVID-19/epidemiology , China/epidemiology , Cities/epidemiology , Disinfection , Global Health , Humans , Masks , Physical Distancing , Policy Making , Republic of Korea/epidemiology , SARS-CoV-2
4.
Infect Control Hosp Epidemiol ; 41(11): 1258-1265, 2020 11.
Article in English | MEDLINE | ID: covidwho-2096345

ABSTRACT

BACKGROUND: The role of severe respiratory coronavirus virus 2 (SARS-CoV-2)-laden aerosols in the transmission of coronavirus disease 2019 (COVID-19) remains uncertain. Discordant findings of SARS-CoV-2 RNA in air samples were noted in early reports. METHODS: Sampling of air close to 6 asymptomatic and symptomatic COVID-19 patients with and without surgical masks was performed with sampling devices using sterile gelatin filters. Frequently touched environmental surfaces near 21 patients were swabbed before daily environmental disinfection. The correlation between the viral loads of patients' clinical samples and environmental samples was analyzed. RESULTS: All air samples were negative for SARS-CoV-2 RNA in the 6 patients singly isolated inside airborne infection isolation rooms (AIIRs) with 12 air changes per hour. Of 377 environmental samples near 21 patients, 19 (5.0%) were positive by reverse-transcription polymerase chain reaction (RT-PCR) assay, with a median viral load of 9.2 × 102 copies/mL (range, 1.1 × 102 to 9.4 × 104 copies/mL). The contamination rate was highest on patients' mobile phones (6 of 77, 7.8%), followed by bed rails (4 of 74, 5.4%) and toilet door handles (4 of 76, 5.3%). We detected a significant correlation between viral load ranges in clinical samples and positivity rate of environmental samples (P < .001). CONCLUSION: SARS-CoV-2 RNA was not detectable by air samplers, which suggests that the airborne route is not the predominant mode of transmission of SARS-CoV-2. Wearing a surgical mask, appropriate hand hygiene, and thorough environmental disinfection are sufficient infection control measures for COVID-19 patients isolated singly in AIIRs. However, this conclusion may not apply during aerosol-generating procedures or in cohort wards with large numbers of COVID-19 patients.


Subject(s)
Air Microbiology , Betacoronavirus/isolation & purification , Coronavirus Infections/transmission , Fomites/virology , Infection Control/methods , Patients' Rooms , Pneumonia, Viral/transmission , Adolescent , Adult , Aerosols , COVID-19 , Coronavirus Infections/diagnosis , Coronavirus Infections/prevention & control , Female , Hospitalization , Humans , Male , Middle Aged , Pandemics/prevention & control , Pneumonia, Viral/diagnosis , Pneumonia, Viral/prevention & control , SARS-CoV-2 , Viral Load
5.
Sensors (Basel) ; 22(17)2022 Aug 31.
Article in English | MEDLINE | ID: covidwho-2006171

ABSTRACT

Several pathogens that spread through the air are highly contagious, and related infectious diseases are more easily transmitted through airborne transmission under indoor conditions, as observed during the COVID-19 pandemic. Indoor air contaminated by microorganisms, including viruses, bacteria, and fungi, or by derived pathogenic substances, can endanger human health. Thus, identifying and analyzing the potential pathogens residing in the air are crucial to preventing disease and maintaining indoor air quality. Here, we applied deep learning technology to analyze and predict the toxicity of bacteria in indoor air. We trained the ProtBert model on toxic bacterial and virulence factor proteins and applied them to predict the potential toxicity of some bacterial species by analyzing their protein sequences. The results reflect the results of the in vitro analysis of their toxicity in human cells. The in silico-based simulation and the obtained results demonstrated that it is plausible to find possible toxic sequences in unknown protein sequences.


Subject(s)
Air Pollution, Indoor , COVID-19 , Air Microbiology , Air Pollution, Indoor/analysis , Bacteria , Fungi , Humans , Pandemics , Reproducibility of Results
6.
Ecotoxicol Environ Saf ; 241: 113740, 2022 Aug.
Article in English | MEDLINE | ID: covidwho-1944829

ABSTRACT

Air and surface contamination of the SARS-CoV-2 have been reported by multiple studies. However, the evidence is limited for the change of environmental contamination of this virus in the surrounding of patients with COVID-19 at different time points during the course of disease and under different conditions of the patients. Therefore, this study aims to understand the risk factors associated with the appearance of SARS-CoV-2 through the period when the patients were staying in the isolation wards. In this study, COVID-19 patients admitted to the isolation wards were followed up for up to 10 days for daily collection of air and surface samples in their surroundings. The positivity rate of the environmental samples at different locations was plotted, and multiple multi-level mixed-effect logistic regressions were used to examine the association between the positivity of environmental samples and their daily health conditions and environmental factors. It found 6.6 % of surface samples (133/2031 samples) and 2.1 % of air samples (22/1075 samples) were positive, and the positivity rate reached to peak during 2-3 days after admission to the ward. The virus was more likely to present at bedrail, patients' personal items and medical equipment, while less likely to be detected in the air outside the range of 2 m from the patients. It also revealed that higher positivity rate is associated with lower environmental temperature, fever and cough at the day of sampling, lower Ct values of latest test for respiratory tract samples, and pre-existing respiratory or cardiovascular conditions. The finding can be used to guide the hospital infection control strategies by identifying high-risk areas and patients. Extra personal hygiene precautions and equipment for continuously environmental disinfection can be used for these high-risk areas and patients to reduce the risk of hospital infection.


Subject(s)
COVID-19 , Cross Infection , Air Microbiology , COVID-19/epidemiology , COVID-19/prevention & control , Cross Infection/prevention & control , Disinfection , Environment , Equipment Contamination , Hospitals , Humans , Infection Control , SARS-CoV-2
7.
Int J Environ Res Public Health ; 19(10)2022 05 16.
Article in English | MEDLINE | ID: covidwho-1855636

ABSTRACT

The coronavirus disease pandemic has afforded dental professionals an opportunity to reconsider infection control during treatment. We investigated the efficacy of combining extraoral high-volume evacuators (eHVEs) with preprocedural mouth rinsing in reducing aerosol contamination by ultrasonic scalers. A double-masked, two-group, crossover randomized clinical trial was conducted over eight weeks. A total of 10 healthy subjects were divided into two groups; they received 0.5% povidone-iodine (PI), essential oil (EO), or water as preprocedural rinse. Aerosols produced during ultrasonic scaling were collected from the chest area (PC), dentist's mask, dentist's chest area (DC), bracket table, and assistant's area. Bacterial contamination was assessed using colony counting and adenosine triphosphate assays. With the eHVE 10 cm away from the mouth, bacterial contamination by aerosols was negligible. With the eHVE 20 cm away, more dental aerosols containing bacteria were detected at the DC and PC. Mouth rinsing decreased viable bacterial count by 31-38% (PI) and 22-33% (EO), compared with no rinsing. The eHVE prevents bacterial contamination when close to the patient's mouth. Preprocedural mouth rinsing can reduce bacterial contamination where the eHVE is positioned away from the mouth, depending on the procedure. Combining an eHVE with preprocedural mouth rinsing can reduce bacterial contamination in dental offices.


Subject(s)
Anti-Infective Agents, Local , Mouthwashes , Aerosols , Air Microbiology , Anti-Infective Agents, Local/therapeutic use , Bacteria , Humans , Mouthwashes/therapeutic use , Ultrasonics
8.
BMJ ; 377: o976, 2022 04 13.
Article in English | MEDLINE | ID: covidwho-1788946
9.
Int J Environ Res Public Health ; 19(6)2022 03 16.
Article in English | MEDLINE | ID: covidwho-1760587

ABSTRACT

Indoor air quality in hospital operating rooms is of great concern for the prevention of surgical site infections (SSI). A wide range of relevant medical and engineering literature has shown that the reduction in air contamination can be achieved by introducing a more efficient set of controls of HVAC systems and exploiting alarms and monitoring systems that allow having a clear report of the internal air status level. In this paper, an operating room air quality monitoring system based on a fuzzy decision support system has been proposed in order to help hospital staff responsible to guarantee a safe environment. The goal of the work is to reduce the airborne contamination in order to optimize the surgical environment, thus preventing the occurrence of SSI and reducing the related mortality rate. The advantage of FIS is that the evaluation of the air quality is based on easy-to-find input data established on the best combination of parameters and level of alert. Compared to other literature works, the proposed approach based on the FIS has been designed to take into account also the movement of clinicians in the operating room in order to monitor unauthorized paths. The test of the proposed strategy has been executed by exploiting data collected by ad-hoc sensors placed inside a real operating block during the experimental activities of the "Bacterial Infections Post Surgery" Project (BIPS). Results show that the system is capable to return risk values with extreme precision.


Subject(s)
Air Pollution, Indoor , Operating Rooms , Air Conditioning , Air Microbiology , Air Pollution, Indoor/analysis , Air Pollution, Indoor/prevention & control , Humans , Surgical Wound Infection/prevention & control
10.
J Infect Dis ; 225(5): 768-776, 2022 03 02.
Article in English | MEDLINE | ID: covidwho-1722480

ABSTRACT

BACKGROUND: We determined the burden of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in air and on surfaces in rooms of patients hospitalized with coronavirus disease 2019 (COVID-19) and investigated patient characteristics associated with SARS-CoV-2 environmental contamination. METHODS: Nasopharyngeal swabs, surface, and air samples were collected from the rooms of 78 inpatients with COVID-19 at 6 acute care hospitals in Toronto from March to May 2020. Samples were tested for SARS-CoV-2 ribonucleic acid (RNA), cultured to determine potential infectivity, and whole viral genomes were sequenced. Association between patient factors and detection of SARS-CoV-2 RNA in surface samples were investigated. RESULTS: Severe acute respiratory syndrome coronavirus 2 RNA was detected from surfaces (125 of 474 samples; 42 of 78 patients) and air (3 of 146 samples; 3 of 45 patients); 17% (6 of 36) of surface samples from 3 patients yielded viable virus. Viral sequences from nasopharyngeal and surface samples clustered by patient. Multivariable analysis indicated hypoxia at admission, polymerase chain reaction-positive nasopharyngeal swab (cycle threshold of ≤30) on or after surface sampling date, higher Charlson comorbidity score, and shorter time from onset of illness to sampling date were significantly associated with detection of SARS-CoV-2 RNA in surface samples. CONCLUSIONS: The infrequent recovery of infectious SARS-CoV-2 virus from the environment suggests that the risk to healthcare workers from air and near-patient surfaces in acute care hospital wards is likely limited.


Subject(s)
COVID-19 , Nasopharynx/virology , SARS-CoV-2/isolation & purification , Adult , Aged , Air Microbiology , COVID-19/epidemiology , COVID-19/prevention & control , COVID-19/transmission , COVID-19 Nucleic Acid Testing , Canada/epidemiology , Environmental Exposure , Health Personnel , Humans , Inpatients , Middle Aged , Pandemics/prevention & control , SARS-CoV-2/genetics
11.
Indoor Air ; 32(2): e13000, 2022 02.
Article in English | MEDLINE | ID: covidwho-1714194

ABSTRACT

The ability to model the dispersion of pathogens in exhaled breath is important for characterizing transmission of the SARS-CoV-2 virus and other respiratory pathogens. A Computational Fluid Dynamics (CFD) model of droplet and aerosol emission during exhalations has been developed and for the first time compared directly with experimental data for the dispersion of respiratory and oral bacteria from ten subjects coughing, speaking, and singing in a small unventilated room. The modeled exhalations consist of a warm, humid, gaseous carrier flow and droplets represented by a discrete Lagrangian particle phase which incorporates saliva composition. The simulations and experiments both showed greater deposition of bacteria within 1 m of the subject, and the potential for a substantial number of bacteria to remain airborne, with no clear difference in airborne concentration of small bioaerosols (<10 µm diameter) between 1 and 2 m. The agreement between the model and the experimental data for bacterial deposition directly in front of the subjects was encouraging given the uncertainties in model input parameters and the inherent variability within and between subjects. The ability to predict airborne microbial dispersion and deposition gives confidence in the ability to model the consequences of an exhalation and hence the airborne transmission of respiratory pathogens such as SARS-CoV-2.


Subject(s)
Air Microbiology , Air Pollution, Indoor , COVID-19 , Respiratory Aerosols and Droplets/virology , COVID-19/transmission , Cough , Humans , SARS-CoV-2
12.
Indoor Air ; 32(2): e12989, 2022 02.
Article in English | MEDLINE | ID: covidwho-1714193

ABSTRACT

To optimize strategies for curbing the transmission of airborne pathogens, the efficacy of three key controls-face masks, ventilation, and physical distancing-must be well understood. In this study, we used the Quadrature-based model of Respiratory Aerosol and Droplets to quantify the reduction in exposure to airborne pathogens from various combinations of controls. For each combination of controls, we simulated thousands of scenarios that represent the tremendous variability in factors governing airborne transmission and the efficacy of mitigation strategies. While the efficacy of any individual control was highly variable among scenarios, combining universal mask-wearing with distancing of 1 m or more reduced the median exposure by more than 99% relative to a close, unmasked conversation, with further reductions if ventilation is also enhanced. The large reductions in exposure to airborne pathogens translated to large reductions in the risk of initial infection in a new host. These findings suggest that layering controls is highly effective for reducing transmission of airborne pathogens and will be critical for curbing outbreaks of novel viruses in the future.


Subject(s)
Air Microbiology , Air Pollution, Indoor , COVID-19 , Aerosols , Air Pollution, Indoor/prevention & control , COVID-19/prevention & control , Humans , SARS-CoV-2 , Ventilation
13.
Indoor Air ; 32(2): e12988, 2022 02.
Article in English | MEDLINE | ID: covidwho-1714192

ABSTRACT

Oxygen therapy is an essential treatment for patients with coronavirus disease 2019, although there is a risk of aerosolization of additional viral droplets occurring during this treatment that poses a danger to healthcare professionals. High-flow oxygen through nasal cannula (HFNC) is a vital treatment bridging low-flow oxygen therapy with tracheal intubation. Although many barrier devices (including devices without negative pressure in the barrier) have been reported in the literature, few barrier devices are suitable for HFNC and aerosol infection control procedures during HFNC have not yet been established. Hence, we built a single cough simulator model to examine the effectiveness of three protective measures (a semi-closed barrier device, a personalized exhaust, and surgical masks) administered in isolation as well as in combination using particle counter measurements and laser sheet visualization. We found that the addition of a personalized exhaust to a semi-closed barrier device reduced aerosol leakage during HFNC without negative pressure. This novel combination may thus reduce aerosol exposure during oxygen therapy, enhance the protection of healthcare workers, and likely reduce nosocomial infection risk.


Subject(s)
Air Microbiology , Air Pollution, Indoor , COVID-19 , Respiratory Aerosols and Droplets , Cough , Humans , SARS-CoV-2
15.
Eur Rev Med Pharmacol Sci ; 26(3): 1020-1027, 2022 02.
Article in English | MEDLINE | ID: covidwho-1699173

ABSTRACT

OBJECTIVE: Microorganisms present a global public health problem and are the leading cause of hospital-acquired infections. Therefore, it is essential to study the prevalence of microorganisms in hospital environments. The conclusion from such a study can contribute to identify the areas most likely to be contaminated in a hospital and appropriate measures that can decrease the exposure risk. MATERIALS AND METHODS: The prevalence of microorganisms in hospital air was examined in different departments by obtaining air samples with an impactor before and during the SARS-CoV-2 pandemic. A total of 2145 microorganisms were identified, and the corresponding data were jointly analyzed by area, sampling period, and concentration. RESULTS: The most frequently detected microorganisms in hospital air were Staphylococcus, Micrococcus, Neisseria, and fungi, and the more polluted departments were the hemodialysis department, respiratory department, treatment room, and toilet. Significant differences were found between the concentration of bacteria and fungi before and during the pandemic, which could be related to multiple environmental conditions. Furthermore, SARS-CoV-2 was negative in all the air samples. CONCLUSIONS: Overall, this study confirmed the existence and dynamic characteristics of airborne microorganisms in a hospital. The results contribute to the adaptation of specific measures which can decrease the exposure risk of patients, visitors, and staff.


Subject(s)
Air Microbiology , Bacteria/isolation & purification , Fungi/isolation & purification , Hospitals , Air Pollution, Indoor , Bacteria/classification , Environmental Monitoring , Epidemiological Monitoring , Fungi/classification , Hospital Departments , Pandemics , SARS-CoV-2
16.
Indoor Air ; 32(2): e12998, 2022 02.
Article in English | MEDLINE | ID: covidwho-1691553

ABSTRACT

Classrooms are often under-ventilated, posing risks for airborne disease transmission as schools have reopened amidst the COVID-19 pandemic. While technical solutions to ensure adequate air exchange are crucial, this research focuses on teachers' perceptions and practices that may also have important implications for achieving a safe classroom environment. We report on a (pre-pandemic) survey of 84 teachers across 11 California schools, exploring their perceptions of environmental quality in relation to monitored indoor environmental quality (IEQ) data from their classrooms. Teachers were not educated regarding mechanical ventilation. Errors in HVAC system installation and programming contributed to misunderstandings (because mechanical ventilation was often not performing as it should) and even occasionally made it possible for teachers to turn off the HVAC fan (to reduce noise). Teachers did not accurately perceive (in)sufficient ventilation; in fact, those in classrooms with poorer ventilation were more satisfied with IEQ, likely due to more temperature fluctuations when ventilation rates were higher combined with occupants' tendency to conflate perceptions of air quality and temperature. We conclude that classroom CO2  monitoring and teacher education are vital to ensure that teachers feel safe in the classroom and empowered to protect the health of themselves and their students.


Subject(s)
Air Microbiology , Air Pollution, Indoor , COVID-19 , Schools , Ventilation , COVID-19/epidemiology , California/epidemiology , Humans , Pandemics , SARS-CoV-2
17.
Indoor Air ; 32(2): e13001, 2022 02.
Article in English | MEDLINE | ID: covidwho-1685323

ABSTRACT

Since the beginning of the pandemic, the transmission modes of SARS-CoV-2-particularly the role of aerosol transmission-have been much debated. Accumulating evidence suggests that SARS-CoV-2 can be transmitted by aerosols, and not only via larger respiratory droplets. In this study, we quantified SARS-CoV-2 in air surrounding 14 test subjects in a controlled setting. All subjects had SARS-CoV-2 infection confirmed by a recent positive PCR test and had mild symptoms when included in the study. RT-PCR and cell culture analyses were performed on air samples collected at distances of one, two, and four meters from test subjects. Oronasopharyngeal samples were taken from consenting test subjects and analyzed by RT-PCR. Additionally, total aerosol particles were quantified during air sampling trials. Air viral concentrations at one-meter distance were significantly correlated with both viral loads in the upper airways, mild coughing, and fever. One sample collected at four-meter distance was RT-PCR positive. No samples were successfully cultured. The results reported here have potential application for SARS-CoV-2 detection and monitoring schemes, and for increasing our understanding of SARS-CoV-2 transmission dynamics. Practical implications. In this study, quantification of SARS-CoV-2 in air was performed around infected persons with mild symptoms. Such persons may go longer before they are diagnosed and may thus be a disproportionately important epidemiological group. By correlating viral concentrations in air with behavior and symptoms, we identify potential risk factors for viral dissemination in indoor environments. We also show that quantification of total aerosol particles is not a useful strategy for monitoring SARS-CoV-2 in indoor environments.


Subject(s)
Air Microbiology , Air Pollution, Indoor , COVID-19 , SARS-CoV-2/isolation & purification , Aerosols , COVID-19/virology , Humans , Pandemics
19.
Int J Environ Res Public Health ; 19(3)2022 01 21.
Article in English | MEDLINE | ID: covidwho-1650893

ABSTRACT

Interrupting the transmission of airborne (<≈5 µm) respiratory pathogens indoors is not a new challenge, but it has attracted unprecedented interest due to the COVID-19 pandemic during 2020-2021. However, bacterial respiratory pathogens with known or potential airborne transmission account for an appreciable proportion of the communicable disease burden globally. We aimed to systematically review quantitative, laboratory-based studies of air disinfection techniques for airborne respiratory bacteria. Three databases (PubMed, Web of Science, Scopus) were searched, following PRISMA guidelines. A total of 9596 articles were identified, of which 517 were assessed in detail and of which 26 met the inclusion and quality assessment criteria. Seven air disinfection techniques, including UV-C light, filtration, and face masks, among others, were applied to 13 different bacterial pathogens. More than 80% of studies suggested that air disinfection techniques were more effective at inactivating or killing bacteria than the comparator or baseline condition. However, it was not possible to compare these techniques because of methodological heterogeneity and the relatively small number of the studies. Laboratory studies are useful for demonstrating proof-of-concept and performance under controlled conditions. However, the generalisability of their findings to person-to-person transmission in real-world settings is unclear for most of the pathogens and techniques we assessed.


Subject(s)
Air Pollution, Indoor , COVID-19 , Air Microbiology , Bacteria , Disinfection , Humans , Pandemics , SARS-CoV-2
20.
Indoor Air ; 32(2): e12976, 2022 02.
Article in English | MEDLINE | ID: covidwho-1669148

ABSTRACT

We propose the Transmission of Virus in Carriages (TVC) model, a computational model which simulates the potential exposure to SARS-CoV-2 for passengers traveling in a subway rail system train. This model considers exposure through three different routes: fomites via contact with contaminated surfaces; close-range exposure, which accounts for aerosol and droplet transmission within 2 m of the infectious source; and airborne exposure via small aerosols which does not rely on being within 2 m distance from the infectious source. Simulations are based on typical subway parameters and the aim of the study is to consider the relative effect of environmental and behavioral factors including prevalence of the virus in the population, number of people traveling, ventilation rate, and mask wearing as well as the effect of model assumptions such as emission rates. Results simulate generally low exposures in most of the scenarios considered, especially under low virus prevalence. Social distancing through reduced loading and high mask-wearing adherence is predicted to have a noticeable effect on reducing exposure through all routes. The highest predicted doses happen through close-range exposure, while the fomite route cannot be neglected; exposure through both routes relies on infrequent events involving relatively few individuals. Simulated exposure through the airborne route is more homogeneous across passengers, but is generally lower due to the typically short duration of the trips, mask wearing, and the high ventilation rate within the carriage. The infection risk resulting from exposure is challenging to estimate as it will be influenced by factors such as virus variant and vaccination rates.


Subject(s)
Air Pollution, Indoor , COVID-19 , Railroads , Aerosols , Air Microbiology , COVID-19/transmission , Fomites/virology , Humans , SARS-CoV-2
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