Paired Nasopharyngeal and Deep Lung Testing for Severe Acute Respiratory Syndrome Coronavirus-2 Reveals a Viral Gradient in Critically Ill Patients

Hamed, Islam; Shaban, Nesreen; Nassar, Marwan; Cayir, Dilek; Love, Sam; Curran, Martin D.; Webb, Stephen T.; Yang, Huina; Watson, Katherine M.; Rostron, Anthony J.; Navapurkar, Vilas; Mahroof, Razeen; Morris, Andrew Conway

doi:10.1016/j.chest.2020.10.017

Cited by 13 publications

(12 citation statements)

References 7 publications

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“…These include a later stage of disease during which viral replication is less pronounced 24 , higher viral loads in the lower rather than upper respiratory tract in critically ill patients 25 and use of respiratory devices, which reduce aerosol generation 20 . The reduction in microbial bioaerosols found in ICU during the week of the air filtration system provides confidence that the device was similarly effective to that used on the ward, despite the infrequent detection of SARS-CoV-2.…”

Section: Discussionmentioning

confidence: 99%

The removal of airborne SARS-CoV-2 and other microbial bioaerosols by air filtration on COVID-19 surge units

Morris

Sharrocks

Bousfield

et al. 2021

Preprint

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Background The COVID-19 pandemic has overwhelmed the respiratory isolation capacity in hospitals; many wards lacking high-frequency air changes have been repurposed for managing patients infected with SARS-CoV-2 requiring either standard or intensive care. Hospital-acquired COVID-19 is a recognised problem amongst both patients and staff, with growing evidence for the relevance of airborne transmission. This study examined the effect of air filtration and ultra-violet (UV) light sterilisation on detectable airborne SARS-CoV-2 and other microbial bioaerosols. Methods We conducted a crossover study of portable air filtration and sterilisation devices in a repurposed surge COVID ward and surge ICU. National Institute for Occupational Safety and Health (NIOSH) cyclonic aerosol samplers and PCR assays were used to detect the presence of airborne SARS-CoV-2 and other microbial bioaerosol with and without air/UV filtration. Results Airborne SARS-CoV-2 was detected in the ward on all five days before activation of air/UV filtration, but on none of the five days when the air/UV filter was operational; SARS-CoV-2 was again detected on four out of five days when the filter was off. Airborne SARS-CoV-2 was infrequently detected in the ICU. Filtration significantly reduced the burden of other microbial bioaerosols in both the ward (48 pathogens detected before filtration, two after, p=0.05) and the ICU (45 pathogens detected before filtration, five after p=0.05). Conclusions These data demonstrate the feasibility of removing SARS-CoV-2 from the air of repurposed surge wards and suggest that air filtration devices may help reduce the risk of hospital-acquired SARS-CoV-2.

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Section: Discussionmentioning

confidence: 99%

The removal of airborne SARS-CoV-2 and other microbial bioaerosols by air filtration on COVID-19 surge units

Morris

Sharrocks

Bousfield

et al. 2021

Preprint

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“…[11]. However, ACE2 receptors are also found throughout the respiratory tree including on the alveolar epithelial cells, and therefore inhalation of smaller infectious aerosol particles <5 µm that can travel deeper into the lungs may also contribute to the burden of disease [12, 13].…”

Section: Introductionmentioning

confidence: 99%

Impact of supplementary air filtration on airborne particulate matter in a UK hospital ward

D¹,

Butler

Peters

et al. 2022

Preprint

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Background During the COVID-19 pandemic, aerosol spread of SARS-CoV-2 has been a major problem in healthcare facilities, resulting in increased use of supplementary HEPA filtration to mitigate transmission. We report here a natural experiment that occurred when an air filtration unit (AFU) on an inpatient ward for older people was accidentally switched off. Aim To assess aerosol transport within the ward and determine whether the AFU reduced particulate matter (PM) levels in the air. Methods Time-series PM, CO2, temperature and humidity data (at 1 minute intervals) was collected from multiple sensors around the ward over two days in August 2021. During this period, the AFU was accidentally switched off for approximately 7 hours, allowing the impact of the intervention on particulates (PM1-PM10) to be assessed using a Mann-Whitney test. Pearson correlation analysis of the PM and CO2 signals was also undertaken to evaluate the movement of airborne particulates around the ward. Findings The AFU greatly reduced PM counts of all sizes throughout the ward space (p<0.001 for all sensors), with PM signals positively correlated with indoor CO2 levels (r = 0.343-0.817; all p<0.001). Aerosol particle counts tended to rise and fall simultaneously throughout the ward space when the AFU was off, with PM signals from multiple locations highly correlated (e.g. r = 0.343-0.868 (all p<0.001) for PM1). Conclusion Aerosols freely migrated between the various sub-compartments of the ward, suggesting that social distancing measures alone cannot prevent nosocomial transmission of SARS-CoV-2. The AFU greatly reduced PM levels throughout the ward space.

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“…Severe COVID-19 patients with a high dosage of CQ treatment even had a high rate of fatality, resulting in the early termination of the relevant studies [ 25 ]. SARS-COV-2 PCR tests showed that most severe COVID-19 patients had higher positive rates for samples from deep lung [ 30 ]. Recently, CQ and HCQ have been found to be unable to block the SARS-COV-2 infection in human lung cells [ 26 ], showing that CQ and HCQ have no ability to prevent SARS-CoV-2 from affecting the lungs of severe COVID-19 patients.…”

Section: Discussionmentioning

confidence: 99%

Chloroquine and Hydroxychloroquine: Efficacy in the Treatment of the COVID-19

Wang²,

Tsai

et al. 2021

Pathogens

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Chloroquine (CQ) and its derivative, hydroxychloroquine (HCQ), have attracted wide attention for treating coronavirus disease 2019 (COVID-19). However, conflicting outcomes have been found in COVID-19 clinical trials after treatment with CQ or HCQ. To date, it remains uncertain whether CQ and HCQ are beneficial antiviral drugs for combating COVID-19. We performed a systematic review to depict the efficacy of CQ or HCQ for the treatment of COVID-19. The guidelines of PRISMA were used to conduct this systematic review. We searched through articles from PubMed, Web of Science and other sources that were published from 1 January 2020 to 31 October 2020. The search terms included combinations of human COVID-19, CQ, and HCQ. Eleven qualitative articles comprising of four clinical trials and seven observation studies were utilized in our systematic review. The analysis shows that CQ and HCQ do not have efficacy in treatment of patients with severe COVID-19. In addition, CQ and HCQ have caused life-threatening adverse reactions which included cardiac arrest, electrocardiogram modification, and QTc prolongation, particularly during the treatment of patients with severe COVID-19. Our systematic review suggested that CQ and HCQ are not beneficial antiviral drugs for curing patients with severe COVID-19. The treatment effect of CQ and HCQ is not only null but also causes serious side effects, which may cause potential cardiotoxicity in severe COVID-19 patients.

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Paired Nasopharyngeal and Deep Lung Testing for Severe Acute Respiratory Syndrome Coronavirus-2 Reveals a Viral Gradient in Critically Ill Patients

Cited by 13 publications

References 7 publications

The removal of airborne SARS-CoV-2 and other microbial bioaerosols by air filtration on COVID-19 surge units

The removal of airborne SARS-CoV-2 and other microbial bioaerosols by air filtration on COVID-19 surge units

Impact of supplementary air filtration on airborne particulate matter in a UK hospital ward

Chloroquine and Hydroxychloroquine: Efficacy in the Treatment of the COVID-19

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