Low rate of severe acute respiratory syndrome coronavirus 2 spread among health-care personnel using ordinary personal protection equipment in a medium-incidence setting

Durante‐Mangoni, Emanuele; Andini, Roberto; Bertolino, Lorenzo; Mele, Ferruccio; Bernardo, Mariano; Grimaldi, Maria Chiara; Cuomo, Nunzia; Tiberio, Claudia; Falco, Erasmo; Spirito, Antimo Di; Raffone, Marcello; Russo, Mariaconcetta; Atripaldi, Luigi; Zampino, Rosa

doi:10.1016/j.cmi.2020.04.042

Cited by 18 publications

(14 citation statements)

References 2 publications

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“…Furthermore, a COVID-19 patient who stayed 35 h in an open cubicle of a general ward, coughed frequently, and received high-flow oxygen at 8 liters/min, did not infect any of the 71 staff members and 49 patients, of which 7 and 10, respectively, had close contacts wearing either N95s or masks (44). Finally, strict contact and droplet precautions, as well as the use of masks rather than respirators, completely prevented nosocomial transmission from three community-infected HCWs to coworkers and patients in an Italian hospital (45).…”

Section: Trials Comparing Masks and Respirators In Health Care Settingsmentioning

confidence: 92%

“…The vast majority of epidemiological studies that analyze SARS-CoV-2 outbreak patterns (case identification, contact tracing, epidemiological curves, and basic reproduction number or R0 estimates), undertaken in a variety of contexts, including health care facilities (41)(42)(43)(44)(45), homes (56), churches (57), fitness facilities (58), call centers (59), airplanes (60), and company conferences and tour groups (61), are in agreement: contact and droplets were the probable modes of transmission. Rather than long-range propagation and frequent mass outbreaks typical of airborne patterns, the distribution of infected individuals was strongly correlated with close encounters and secondary attack rates were estimated be very low, around 5% (62).…”

Section: Epidemiological Studies On Transmissionmentioning

confidence: 99%

“…Beyond the alarming statistics, several success stories around the world prove that much can be achieved quickly and efficiently with basic yet effective practices (45,(176)(177)(178), without the need to resort to elaborate theories or equipment.…”

Section: In the Face Of Uncertainty Should We Apply The Precautionarmentioning

confidence: 99%

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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: Trials Comparing Masks and Respirators In Health Care Settingsmentioning

confidence: 92%

Section: Epidemiological Studies On Transmissionmentioning

confidence: 99%

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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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“…Studies have shown that no nosocomial transmission occurred when appropriate PPE was worn. 50,51 More specifically, face masks, physical distancing (greater than 1 m) and eye protection have been shown to significantly reduce COVID-19 infection rates. 52,53 Therefore, patients should be required to wear a mask to appointments.…”

Section: The Risk and Implications For Primary Carementioning

confidence: 99%

SARS-CoV-2 and the nose: Risks and implications for primary care

Campbell¹

2020

Aust J Gen Pract

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Raewyn G Campbell Background General practitioners (GPs) have some of the highest rates of mortality from COVID-19 among healthcare workers. SARS-CoV-2 has unique properties that place GPs at particular risk. Objective The aim of this article is to discuss the nose-related features of SARS-CoV-2 that place GPs at risk, and to make recommendations pertinent to the safety and protection of primary healthcare physicians. Discussion The highest viral load of SARS-CoV-2 is in the nose and nasopharynx. It is often highest early in the illness, before the development of symptoms. Further, SARS-CoV-2 replicates and continues to shed in the nasopharynx long after the virus is no longer detectable in the lower respiratory tract. This places any physician performing examinations on, or procedures involving, the upper respiratory tract at risk for contracting COVID-19. New-onset hyposmia and dysgeusia are indicators for COVID-19 and should be included in screening protocols. FRONTLINE HEALTHCARE WORKERS have a threefold greater risk of becoming infected with SARS-CoV-2 than the general community. 1 In fact, many healthcare workers have died from COVID-19, the disease caused by SARS-CoV-2. 2 Initially, the highest incidence of nosocomial infection was in otolaryngologists in China. 3 However, more recent data suggest the majority of physician deaths have been general practitioners (GPs) and emergency physicians (42.5%), with only 4% of deaths occurring in ear, nose and throat (ENT) surgeons. 2 This is most likely due to the sheer volume of patients with COVID-19 seen by these specialties, as well as limited personal protective equipment (PPE). This article focuses on the unique features of SARS-CoV-2 that place any healthcare provider performing a procedure involving the upper respiratory tract (URT) at risk. Recommendations will also be made, focusing on protecting the primary healthcare physician working in the COVID-19 era.

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“… 1 Studies of previous SARS viruses has shown that tracheal intubation is one of the highest risk procedures. 2 COVID-19 patients frequently present in respiratory distress and often require emergent airway interventions, leading to high risk for exposure to droplet and airborne secretions to healthcare personnel performing pre-oxygenation, induction, and intubation.…”

Section: Introductionmentioning

confidence: 99%