Fomite Transmission Follows Invasion Ecology Principles.

The invasion ecology principles illustrated in many ecosystems have not yet been explored in the context of fomite transmission. We hypothesized that invaders in fomite transmission are trackable, are neutrally distributed between hands and environmental surfaces, and exhibit a proximity effect. To test this hypothesis, a surrogate invader, Lactobacillus delbrueckii subsp. bulgaricus, was spread by a root carrier in an office housing more than 20 participants undertaking normal activities, and the microbiotas on skin and environmental surfaces were analyzed before and after invasion. First, we found that the invader was trackable. Its identity and emission source could be determined using microbial-interaction networks, and the root carrier could be identified using a rank analysis. Without prior information, L. bulgaricus could be identified as the invader emitted from a source that exclusively contained the invader, and the probable root carrier could be located. In addition to the single-taxon invasion by L. bulgaricus, multiple-taxon invasion was observed, as genera from sputum/saliva exhibited co-occurrence relationships on skin and environmental surfaces. Second, the invader had a below-neutral distribution in a neutral community model, suggesting that hands accrued heavier invader contamination than environmental surfaces. Third, a proximity effect was observed on a surface touch network. Invader contamination on surfaces decreased with increasing geodesic distance from the hands of the carrier, indicating that the carrier's touching behaviors were the main driver of fomite transmission. Taken together, these results demonstrate the invasion ecology principles in fomite transmission and provide a general basis for the management of ecological fomite transmission. IMPORTANCE Fomite transmission contributes to the spread of many infectious diseases. However, pathogens in fomite transmission typically are either investigated individually without considering the context of native microbiotas or investigated in a nondiscriminatory way from the dispersal of microbiotas. In this study, we adopted an invasion ecology framework in which we considered pathogens as invaders, the surface environment as an ecosystem, and human behaviors as the driver of microbial dispersal. With this approach, we assessed the ability of quantitative ecological theories to track and forecast pathogen movements in fomite transmission. By uncovering the relationships between the invader and native microbiotas and between human behaviors and invader/microbiota dispersal, we demonstrated that fomite transmission follows idiosyncratic invasion ecology principles. Our findings suggest that attempts to manage fomite transmission for public health purposes should focus on the microbial communities and anthropogenic factors involved, in addition to the pathogens.

High attack rate in a Tong Lau house outbreak of COVID-19 with subdivided units in Hong Kong.

Poor housing conditions are known to be associated with infectious diseases such as high Coronavirus disease 2019 (COVID-19) incidences. Transmission causes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in poor housing conditions can be complex. An understanding of the exact mechanism of transmission can help to pinpoint contributing environmental issues. Here, we investigated a Hong Kong COVID-19 outbreak in early 2021 in four traditional Tong Lau houses with subdivided units. There are more than 80 subdivided units of less than 20 m2 floor area each on average. With a total of 34 confirmed COVID-19 cases, the outbreak had an attack rate of 25.4%, being one of the highest attack rates observed in Hong Kong, and ranked among the highest attack rates in reported outbreaks internationally. Tracer gas leakage and decay measurements were performed in the drainage system and in the subdivided units to determine the transport of infectious aerosols by the owner-modified sophisticated wastewater drainage pipe networks and the poor ventilation conditions in some subdivided units. The results show that the outbreak was probably due to multiple transmission routes, i.e. by the drainage pipe spread of stack aerosols, which is enhanced by poor ventilation in the subdivided units.

Modelling the thermal microenvironment of footwear subjected to forced ventilation.

In this paper, we develop a mathematical model of the thermal microenvironment in footwear that considers forced ventilation of the footwear cavity. The developed model was validated using a newly developed thermal foot-manikin system and the results show that the model effectively predicts the total dry thermal insulation of footwear under various dynamic conditions. The footwear cavity model is then integrated with a thermoregulation model, and the integrated model effectively predicts changes in foot skin temperature resulting from forced ventilation (0-90 L/min). At an air temperature of 26.4 °C and a foot thermal comfort temperature of 32.2 °C, the required minimum ventilation rate was found to be 5.4-24.6 L/min, which corresponds to a total static thermal insulation of footwear of 0.10-0.20 m2·K·W-1. This indicates that ventilation can adequately control the thermal microenvironment of the footwear cavity, thereby maintaining foot thermal comfort. Practitioner summary: An adverse footwear thermal microenvironment results in foot thermal discomfort and foot hygiene problems. We hypothesise that forced ventilation may enable thermal control of footwear microenvironments. A mathematical model was developed which can determine the forced ventilation rate required in a given type of footwear to create foot thermal comfort.

Aerosol transmission of SARS-CoV-2 due to the chimney effect in two high-rise housing drainage stacks.

Stack aerosols are generated within vertical building drainage stacks during the discharge of wastewater containing feces and exhaled mucus from toilets and washbasins. Fifteen stack aerosol-related outbreaks of coronavirus disease 2019 (COVID-19) in high-rise buildings have been observed in Hong Kong and Guangzhou. Currently, we investigated two such outbreaks of COVID-19 in Hong Kong, identified the probable role of chimney effect-induced airflow in a building drainage system in the spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). We injected tracer gas (SF6) into the drainage stacks via the water closet of the index case and monitored tracer gas concentrations in the bathrooms and along the facades of infected and non-infected flats and in roof vents. The air temperature, humidity, and pressure in vertical stacks were also monitored. The measured tracer gas distribution agreed with the observed distribution of the infected cases. Phylogenetic analysis of the SARS-CoV-2 genome sequences demonstrated clonal spread from a point source in cases along the same vertical column. The stack air pressure and temperature distributions suggested that stack aerosols can spread to indoors through pipe leaks which provide direct evidence for the long-range aerosol transmission of SARS-CoV-2 through drainage pipes via the chimney effect.

Footwear microclimate and its effects on the microbial community of the plantar skin.

The association between the footwear microclimate and microbial community on the foot plantar skin was investigated by experiments with three participants. Novel methods were developed for measuring in-shoe temperature and humidity at five footwear regions, as well as the overall ventilation rate inside the footwear. Three types of footwear were tested including casual shoes, running shoes, and perforated shoes for pairwise comparison of footwear microclimate and corresponding microbial community on the skin. The major findings are as follows: (1) footwear types make a significant difference to in-shoe temperature at the instep region with the casual shoes sustaining the warmest of all types; (2) significant differences were observed in local internal absolute humidity between footwear types, with the casual shoes sustaining the highest level of humidity at most regions; (3) the perforated shoes provided the highest ventilation rate, followed by running and casual shoes, and the faster the gait, the larger the discrepancy in ventilation rate between footwear types; (4) the casual shoes seemed to provide the most favorable internal environment for bacterial growth at the distal plantar skin; and (5) the bacterial growth at the distal plantar skin showed a positive linear correlation with the in-shoe temperature and absolute humidity, and a negative linear correlation with the ventilation rate. The ventilation rate seemed to be a more reliable indicator of the bacterial growth. Above all, we can conclude that footwear microclimate varies in footwear types, which makes contributions to the bacterial growth on the foot plantar skin.

Surface touch network structure determines bacterial contamination spread on surfaces and occupant exposure.

Fomites are known to spread infectious diseases, but their role in determining transmission risk remains unclear. The association of surface touch networks (STNs), proposed to explain this risk, with real-life surface contamination has not yet been demonstrated. To construct STNs, we collected surface touch data from 23 to 26 scholars through 2 independent experiments conducted in office spaces for 13 h each. In parallel, a tracer bacterium (Lactobacillus bulgaricus) was spread by a designated carrier in each experiment during normal activities; the subsequent extent of surface contamination was assessed using qPCR. The touch data were also analyzed using an agent-based model that predicted the observed contamination. Touching public (door handles) and hidden public (desks, chair seatbacks) surfaces that connected occupants, sparse hand-to-hand contact, and active carriers contributed significantly to contamination spread, which was also correlated with the size of the social group containing carriers. The natural and unsupervised experiments reflected realistic exposure levels of mouths (1-10 ppm of total contamination spread by one root carrier), nostrils (~1 ppm), and eyes (~0.1 ppm). We conclude that the contamination degree of known and hidden public surfaces can indicate fomite exposure risk. The social group effect could trigger superspreading events through fomite transmission.

Lack of cross-transmission of SARS-CoV-2 between passenger's cabins on the Diamond Princess cruise ship.

An outbreak of COVID-19 occurred on the Diamond Princess cruise ship in January and February 2020 in Japan. We analysed information on the cases of infection to infer whether airborne transmission of SARS-CoV-2, the causative agent of COVID-19, had occurred between cabins. We infer from our analysis that most infections in passengers started on 28 January and were completed by 6 February, except in those who shared a cabin with another infected passenger. The distribution of the infected cabins was random, and no spatial cluster of the infected can be identified. We infer that the ship's central air-conditioning system for passenger's cabins did not play a role in SARS-CoV-2 transmission, i.e. airborne transmission did not occur between cabins during the outbreak, suggesting that the sufficient ventilation was provided. We also infer that the ship's cabin drainage system did not play a role. Most transmission appears to have occurred in the public areas of the cruise ship, likely due to crowding and insufficient ventilation in some of these areas.

Toilets dominate environmental detection of severe acute respiratory syndrome coronavirus 2 in a hospital.

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.

Indoor transmission of SARS-CoV-2.

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.

Infection Spread and High-Resolution Detection of Close Contact Behaviors.

Knowledge of human behaviors is important for improving indoor-environment design, building-energy efficiency, and productivity, and for studies of infection spread. However, such data are lacking. In this study, we designed a device for detecting and recording, second by second, the 3D indoor positioning and head and body motions of each graduate student in an office. From more than 400 person hours of data. Students spent 92.2%, 4.1%, 2.9%, and 0.8% of their time in their own office cubicles, other office cubicles, aisles, and areas near public facilities, respectively. They spent 9.7% of time in close contact, and each student averagely had 4.0 close contacts/h. Students spent long time on close contact in the office which may lead to high infection risk. The average interpersonal distance during close contact was 0.81 m. When sitting, students preferred small relative face orientation angle. Pairs of standing students preferred a face-to-face orientation during close contact which means this pattern had a lower infection risk via close contact. Probability of close contact decreased exponentially with the increasing distance between two students' cubicles. Data on human behaviour during close contact is helpful for infection risk analysis and infection control and prevention.