Coronavirus Disease 2019 Patients in Earlier Stages Exhaled Millions of Severe Acute Respiratory Syndrome Coronavirus 2 Per Hour

Ma, Jingjiao; Xiao, Qin; Chen, Haoxuan; Li, Xinyue; Zhang, Zheng; Wang, Haibin; Sun, Lingli; Zhang, Lu; Guo, Jiazhen; Morawska, Lidia; Grinshpun, Sergey A.; Biswas, Pratim; Flagan, Richard C.; Yao, Maosheng

doi:10.1093/cid/ciaa1283

Cited by 240 publications

(240 citation statements)

References 11 publications

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“…Endoscopic studies also found RNA in the esophagi, stomachs, duodena, and recta of patients with severe gastrointestinal symptoms (151). Finally, two studies showed the toilet was among the most contaminated areas in indoor settings (152,153): interestingly, the patient who's toilet air sample was positive had a negative exhaled breath sample, warranting the consideration that detectable airborne SARS-CoV-2 could originate from fecal rather than respiratory aerosols. As with air, a limited number of studies have been able to culture infectious viruses from stools (154,155), supporting infectivity.…”

Section: How Do We Explain That Sars-cov-2 Spreads So Easily?mentioning

confidence: 99%

SARS-CoV-2 and Health Care Worker Protection in Low-Risk Settings: a Review of Modes of Transmission and a Novel Airborne Model Involving Inhalable Particles

Zhang

Duchaine

2020

Clin Microbiol Rev

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SUMMARY Since the beginning of the COVID-19 pandemic, there has been intense debate over SARS-CoV-2’s mode of transmission and appropriate personal protective equipment for health care workers in low-risk settings. The objective of this review is to identify and appraise the available evidence (clinical trials and laboratory studies on masks and respirators, epidemiological studies, and air sampling studies), clarify key concepts and necessary conditions for airborne transmission, and shed light on knowledge gaps in the field. We find that, except for aerosol-generating procedures, the overall data in support of airborne transmission—taken in its traditional definition (long-distance and respirable aerosols)—are weak, based predominantly on indirect and experimental rather than clinical or epidemiological evidence. Consequently, we propose a revised and broader definition of “airborne,” going beyond the current droplet and aerosol dichotomy and involving short-range inhalable particles, supported by data targeting the nose as the main viral receptor site. This new model better explains clinical observations, especially in the context of close and prolonged contacts between health care workers and patients, and reconciles seemingly contradictory data in the SARS-CoV-2 literature. The model also carries important implications for personal protective equipment and environmental controls, such as ventilation, in health care settings. However, further studies, especially clinical trials, are needed to complete the picture.

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Section: How Do We Explain That Sars-cov-2 Spreads So Easily?mentioning

confidence: 99%

SARS-CoV-2 and Health Care Worker Protection in Low-Risk Settings: a Review of Modes of Transmission and a Novel Airborne Model Involving Inhalable Particles

Zhang

Duchaine

2020

Clin Microbiol Rev

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“…A single SARS-CoV-2-infected person talking normally can exhale millions of SARS CoV-2 viral genome equivalents every hour [ 29 ]. Like SARS-CoV, spread of SARS-CoV-2 from inadequate sewage systems is another potential, albeit uncommon, route of airborne transmission [ 30–32 ].…”

Section: Epidemiologymentioning

confidence: 99%

COVID-19—Lessons Learned and Questions Remaining

Fang

Benson

Rı́o

et al. 2020

Clinical Infectious Diseases

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“…By the nature of clinical and surgical practice, ophthalmologists may be at risk of exposure to SARS‐CoV‐2 5,19,24,28 . However, while both microdroplets and exhaled aerosol have been identified as potential routes for SARS‐CoV‐2 transmission, the risk of viable viral contamination via ocular fluid, through the generation of microdroplets and aerosol during phacoemulsification surgery, appears to be low but is still under investigation 4,23,25,26,29 …”

Section: Discussionmentioning

confidence: 99%

Microdroplet and spatter contamination during phacoemulsification cataract surgery in the era of COVID‐19

McGhee

Dean

Freundlich

et al. 2020

Clinical Exper Ophthalmology

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Importance Determine phacoemulsification cataract surgery risk in a Covid‐19 era. Background SARS‐CoV‐2 (Covid‐19) transmission via microdroplet and aerosol generating procedures present a risk to medical professionals. As the most common elective surgical procedure performed globally; determining contamination risk from phacoemulsification cataract surgery may guide personal protection equipment use. Design Pilot study involving phacoemulsification cataract surgery on enucleated porcine eyes by experienced ophthalmologists in an ophthalmic operating theatre. Participants Two ophthalmic surgical teams. Methods Standardised phacoemulsification of porcine eyes by two ophthalmologists accompanied by an assistant. Fluorescein incorporated into phacoemulsification irrigation fluid identifying microdroplets and spatter. Contamination documented using a single‐lens reflex camera with a 532 nm narrow bandpass (fluorescein) filter, in‐conjunction with a wide‐field blue light and flat horizontal laser beam (wavelength 532 nm). Quantitative image analysis using Image‐J software. Main Outcome Measures Microdroplet and spatter contamination from cataract phacoemulsification. Results With phacoemulsification instruments fully within the eye, spatter contamination was limited to <10 cm. Insertion and removal of the phacoemulsification needle and bimanual irrigation/aspiration, with irrigation active generated spatter on the surgeons' gloves and gown extending to >16 cm below the neckline in surgeon 1 and > 5.5 cm below the neckline of surgeon 2. A small tear in the phacoemulsification irrigation sleeve, presented a worse‐case scenario the greatest spatter. No contamination above the surgeons' neckline nor contamination of assistant occurred. Conclusions and Relevance Cataract phacoemulsification generates microdroplets and spatter. Until further studies on SARS‐CoV‐2 transmission via microdroplets or aerosolisation of ocular fluid are reported, this pilot study only supports standard personal protective equipment.

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Coronavirus Disease 2019 Patients in Earlier Stages Exhaled Millions of Severe Acute Respiratory Syndrome Coronavirus 2 Per Hour

Cited by 240 publications

References 11 publications

SARS-CoV-2 and Health Care Worker Protection in Low-Risk Settings: a Review of Modes of Transmission and a Novel Airborne Model Involving Inhalable Particles

SARS-CoV-2 and Health Care Worker Protection in Low-Risk Settings: a Review of Modes of Transmission and a Novel Airborne Model Involving Inhalable Particles

COVID-19—Lessons Learned and Questions Remaining

Microdroplet and spatter contamination during phacoemulsification cataract surgery in the era of COVID‐19

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