Situation Report-73 HIGHLIGHTS • No new countries/territories/areas reported cases of COVID-19 in the past 24 hours. Region of the Americas 216 912 confirmed (28161) 4565 deaths (1165) African Region 4702 confirmed (629) 127 deaths (36) WHO RISK ASSESSMENT Global Level Very High SUBJECT IN FOCUS: The routes of transmission from COVID-19 patients As the COVID-19 outbreak continues to evolve, we are learning more about this new virus every day. Here we summarize what has been reported about transmission of the COVID-19 virus, and provide a brief overview of available evidence on transmission from symptomatic, pre-symptomatic and asymptomatic people infected with COVID-19. Symptomatic transmission By way of definition, a symptomatic COVID-19 case is a case who has developed signs and symptoms compatible with COVID-19 virus infection. Symptomatic transmission refers to transmission from a person while they are experiencing symptoms. Data from published epidemiology and virologic studies provide evidence that COVID-19 is primarily transmitted from symptomatic people to others who are in close contact through respiratory droplets, by direct contact with infected persons, or by contact with contaminated objects and surfaces. 1-7 This is supported by detailed experiences shared by technical partners via WHO global expert networks, and reports and presentations by Ministries of Health. Data from clinical and virologic studies that have collected repeated biological samples from confirmed patients provide evidence that shedding of the COVID-19 virus is highest in upper respiratory tract (nose and throat) early in the course of the disease. 8-11 That is, within the first 3 days from onset of symptoms. 10-11 Preliminary data suggests that people may be more contagious around the time of symptom onset as compared to later on in the disease.

While healthcare entities have integrated various forms of health information technology (HIT) into their systems due to claims of increased quality and decreased costs, as well as various incentives, there is little available information about which applications of HIT are actually the most beneficial and efficient. In this study, we aim to assist administrators in understanding the characteristics of top performing hospitals. We utilized data from the Health Information and Management Systems Society and the Center for Medicare and Medicaid to assess 1039 hospitals. Inputs considered were full time equivalents, hospital size, and technology inputs. Technology inputs included personal health records (PHR), electronic medical records (EMRs), computerized physician order entry systems (CPOEs), and electronic access to diagnostic results. Output variables were measures of quality, hospital readmission and mortality rate. The analysis was conducted in a two-stage methodology: Data Envelopment Analysis (DEA) and Automatic Interaction Detector Analysis (AID), decision tree regression (DTreg). Overall, we found that electronic access to diagnostic results systems was the most influential technological characteristics; however organizational characteristics were more important than technological inputs. Hospitals that had the highest levels of quality indicated no excess in the use of technology input, averaging one use of a technology component. This study indicates that prudent consideration of organizational characteristics and technology is needed before investing in innovative programs.

Objective To examine the results, level of evidence, and methodologic quality of original studies regarding surgical mask effectiveness in minimizing viral respiratory illness transmission, and, in particular, the performance of the N95 respirator versus surgical mask. Methods Meta‐analysis was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses (PRISMA) guidelines with use of PubMed, MEDLINE, and the Cochrane Library databases. Results Eight studies (9164 participants) were included after screening 153 articles. Analyses showed statistically significant differences between N95 respirator versus surgical mask use to prevent influenza‐like‐illness (risk ratio [RR] = 0.81, 95% confidence interval [CI] = 0.68–0.94, P < 0.05), non‐influenza respiratory viral infection (RR = 0.62, 95% CI = 0.52–0.74, P < 0.05), respiratory viral infection (RR = 0.73, 95% CI = 0.65–0.82, P < 0.05), severe acute respiratory syndrome coronavirus (SARS‐CoV) 1 and 2 virus infection (RR = 0.17, 95% CI = 0.06–0.49, P < 0.05), and laboratory‐confirmed respiratory viral infection (RR = 0.75, 95% CI = 0.66–0.84, P < 0.05). Analyses did not indicate statistically significant results against laboratory‐confirmed influenza (RR = 0.87, CI = 0.74–1.03, P > 0.05). Conclusions N95 respirator use was associated with fewer viral infectious episodes for healthcare workers compared with surgical masks. The N95 respirator was most effective in reducing the risk of a viral infection in the hospital setting from the SARS‐CoV 1 and 2 viruses compared to the other viruses included in this investigation. Methodologic quality, risk of biases, and small number of original studies indicate the necessity for further research to be performed, especially in front‐line healthcare delivery settings.

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