Probable Evidence of Fecal Aerosol Transmission of SARS-CoV-2 in a High-Rise Building

Kang, Min; Wei, Jianjian; Yuan, Jun; Guo, Jianhui; Zhang, Yingtao; Hang, Jian; Qu, Yabin; Qian, Hua; Zhuang, Yuehong; Chen, Xuguang; Peng, Xin; Shi, Tao; Wang, Jun; Wu, Jie; Song, Tie; He, Jianfeng; Li, Yuguo; Zhong, Nanshan

doi:10.7326/m20-0928

Cited by 206 publications

(201 citation statements)

References 18 publications

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“…In theory, fecal transmission could occur through different routes, including contact (e.g., while changing incontinence briefs), short-range aerosolization (i.e., inhalation), or long-range aerosolization due to toilet flushing (156). The latter was well established in the SARS-CoV-1 Amoy Gardens outbreak and was recently considered the main mode of transmission in a SARS-CoV-2 outbreak involving a high-rise building in China, where the nine infected cases lived in three vertically aligned flats connected by drainage pipes in the master bathrooms (157).…”

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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“…Transmission occurs mainly through respiratory droplets and aerosols [4]. Transmission by other routes has not been convincingly demonstrated in contrast to SARS [5,6]. One factor for the high infectivity of SARS-CoV2 is its replication in the upper respiratory tract.…”

Section: Transmissionmentioning

confidence: 99%

Epidemiology of SARS-CoV-2

et al. 2020

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Purpose SARS-CoV-2 is a recently emerged ß-coronavirus. Here we present the current knowledge on its epidemiologic features. Methods Non-systematic review. Results SARS-CoV-2 replicates in the upper and lower respiratory tract. It is mainly transmitted by droplets and aerosols from asymptomatic and symptomatic infected subjects. The consensus estimate for the basis reproduction number (R0) is between 2 and 3, and the median incubation period is 5.7 (range 2–14) days. Similar to SARS and MERS, superspreading events have been reported, the dispersion parameter (kappa) is estimated at 0.1. Most infections are uncomplicated, and 5–10% of patients are hospitalized, mainly due to pneumonia with severe inflammation. Complications are respiratory and multiorgan failure; risk factors for complicated disease are higher age, hypertension, diabetes, chronic cardiovascular, chronic pulmonary disease and immunodeficiency. Nosocomial and infections in medical personnel have been reported. Drastic reductions of social contacts have been implemented in many countries with outbreaks of SARS-CoV-2, leading to rapid reductions. Most interventions have used bundles, but which of the measures have been more or less effective is still unknown. The current estimate for the infection’s fatality rate is 0.5–1%. Using current models of age-dependent infection fatality rates, upper and lower limits for the attack rate in Germany can be estimated between 0.4 and 1.6%, lower than in most European countries. Conclusions Despite a rapid worldwide spread, attack rates have been low in most regions, demonstrating the efficacy of control measures.

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“…According to the Centers for Disease Control and Prevention (CDC) of the United States, transmission of the virus is primarily accomplished through direct contact or respiratory droplets [ 6 ] in a proximity and time-dependent manner, often requiring close contact within 6 feet over a period of 15 minutes or longer [ 7 ]. However, the possibility for airborne transmission under certain circumstances has recently been demonstrated [ [8] , [9] , [10] , [11] ], including prolonged exposure in an enclosed space without proper air handling [ [12] , [13] , [14] ]. The virus rapidly spread across the globe through travelers and the number of world-wide cases has now exceeded 72 million with over one million deaths as of December 14, 2020 [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

COVID-19 vaccines: The status and perspectives in delivery points of view

Chung

Thone

Kwon

2021

Advanced Drug Delivery Reviews

277

235

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Due to the high prevalence and long incubation periods often without symptoms, the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has infected millions of individuals globally, causing the coronavirus disease 2019 (COVID-19) pandemic. Even with the recent approval of the anti-viral drug, remdesivir, and Emergency Use Authorization of monoclonal antibodies against S protein, bamlanivimab and casirimab/imdevimab, efficient and safe COVID-19 vaccines are still desperately demanded not only to prevent its spread but also to restore social and economic activities via generating mass immunization. Recent Emergency Use Authorization of Pfizer and BioNTech’s mRNA vaccine may provide a pathway forward, but monitoring of long-term immunity is still required, and diverse candidates are still under development. As the knowledge of SARS-CoV-2 pathogenesis and interactions with the immune system continues to evolve, a variety of drug candidates are under investigation and in clinical trials. Potential vaccines and therapeutics against COVID-19 include repurposed drugs, monoclonal antibodies, antiviral and antigenic proteins, peptides, and genetically engineered viruses. This paper reviews virology and immunology of SARS-CoV-2, alternative therapies for COVID-19 to vaccination, principles and design considerations in COVID-19 vaccine development, and the promises and roles of vaccine carriers in addressing the unique immunopathological challenges presented by the disease.

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Probable Evidence of Fecal Aerosol Transmission of SARS-CoV-2 in a High-Rise Building

Cited by 206 publications

References 18 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

Epidemiology of SARS-CoV-2

COVID-19 vaccines: The status and perspectives in delivery points of view

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