Review of indoor aerosol generation, transport, and control in the context of COVID‐19

Kohanski, Michael A.; Lo, L. James; Waring, Michael S.

doi:10.1002/alr.22661

Cited by 144 publications

(138 citation statements)

References 74 publications

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“…Early research findings suggest that SARS-Cov-2 may primarily spread through aerosol droplets [8]. which can be respired by asymptomatic/pre-symptomatic persons [9]; thus, indicators of latent infection are of crucial interest.…”

Section: Introductionmentioning

confidence: 99%

Reduced odor detection and hedonic changes in asymptomatic university students as SARS-CoV-2 emerged locally

Walsh‐Messinger

Kaouk

Manis

et al. 2020

Preprint

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Background Anosmia is a recognized symptom of COVID-19, but the relationship of SARS-CoV-2 exposure with olfactory dysfunction remains enigmatic. This report adds unique data from healthy students tested as the virus emerged locally. Methods Psychometrically validated measures assessed odor detection, identification and hedonics in healthy university students. Data from asymptomatic students (N=22), tested as SARS-CoV-2 unknowingly emerged locally, were compared to students tested just prior to local virus transmission (N=25), and our normative sample (N=272) tested over the previous 4 years. Results The exposed cohort demonstrated significantly reduced odor detection sensitivity compared to the students in the prior group (P=.01; d=0.77; CI 0.17, 1.36), with a distribution skewed towards less detection sensitivity (P=.03). Categorically, the exposed group was significantly more likely to have hyposmia (OR=7.7; CI, 3.1, 19.4), particularly the subset assessed in the final week before campus closure (OR=13.6; CI, 3.4, 35.7). The exposed group also rated odors as less unpleasant (P<.001, CLES=0.77, CI, 0.51, 1.56) and showed a similarly skewed distribution (P=.005). The groups had similar odor identification performance. Conclusion Psychometric measures of odor detection sensitivity and hedonics may detect early SARS-CoV-2 exposure in asymptomatic and pre-symptomatic persons with normal odor identification. Viral detection by nasal associated lymphoid tissue is known to trigger systemic immune effects, but its activation may also reduce smell sensitivity and shift perception of the environment towards unpleasant, increasing the social isolation that may mitigate viral infection or transmission. Regular testing of odor detection and hedonics may have value for identifying regional viral exposure.

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Section: Introductionmentioning

confidence: 99%

Reduced odor detection and hedonic changes in asymptomatic university students as SARS-CoV-2 emerged locally

Walsh‐Messinger

Kaouk

Manis

et al. 2020

Preprint

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“…This minireview covers mechanisms of aerosol emission, evolution and transport, together with some implications for SARS-CoV-2 transmission in non-clinical public buildings and transportation. Transmission in hospital settings, including generation of aerosols during clinical procedures involving COVID-19 patients, and fecal bioaerosols from toilets are excluded, having been reviewed elsewhere (21)(22)(23)(24).…”

Section: Introductionmentioning

confidence: 99%

Aerosol Transmission of SARS-CoV-2: Physical Principles and Implications

Jarvis

2020

Front. Public Health

127

116

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Evidence has emerged that SARS-CoV-2, the coronavirus that causes COVID-19, can be transmitted airborne in aerosol particles as well as in larger droplets or by surface deposits. This minireview outlines the underlying aerosol science, making links to aerosol research in other disciplines. SARS-CoV-2 is emitted in aerosol form during normal breathing by both asymptomatic and symptomatic people, remaining viable with a half-life of up to about an hour during which air movement can carry it considerable distances, although it simultaneously disperses. The proportion of the droplet size distribution within the aerosol range depends on the sites of origin within the respiratory tract and on whether the distribution is presented on a number or volume basis. Evaporation and fragmentation reduce the size of the droplets, whereas coalescence increases the mean droplet size. Aerosol particles containing SARS-CoV-2 can also coalesce with pollution particulates, and infection rates correlate with pollution. The operation of ventilation systems in public buildings and transportation can create infection hazards via aerosols, but provides opportunities for reducing the risk of transmission in ways as simple as switching from recirculated to outside air. There are also opportunities to inactivate SARS-CoV-2 in aerosol form with sunlight or UV lamps. The efficiency of masks for blocking aerosol transmission depends strongly on how well they fit. Research areas that urgently need further experimentation include the basis for variation in droplet size distribution and viral load, including droplets emitted by “superspreader” individuals; the evolution of droplet sizes after emission, their interaction with pollutant aerosols and their dispersal by turbulence, which gives a different basis for social distancing.

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“…The coronavirus disease 2019 (COVID-19) pandemic has substantial impact on operating room (OR) management for surgical procedures with aerosol production (e.g., navigational bronchoscopy) [ 1 , 2 ]. Previous OR management scientific studies provide guidance for mitigation of the effect on ambulatory surgery of asymptomatic patients testing false negative (i.e., with unrecognized COVID-19) [ [3] , [4] , [5] ].…”

Section: Introductionmentioning

confidence: 99%

Caseload is increased by resequencing cases before and on the day of surgery at ambulatory surgery centers where initial patient recovery is in operating rooms and cleanup times are longer than typical

Wang¹,

Dexter

Zenios³

2020

Journal of Clinical Anesthesia

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Study objective The coronavirus disease 2019 (COVID-19) pandemic impacts operating room (OR) management in regions with high prevalence (e.g., >1.0% of asymptomatic patients testing positive). Cases with aerosol producing procedures are isolated to a few ORs, initial phase I recovery of those patients is in the ORs, and multimodal environmental decontamination applied. We quantified the potential increase in productivity from also resequencing these cases among those 2 or 3 ORs. Design Computer simulation provided sample sizes requiring >100 years experimentally. Resequencing was limited to changes in the start times of surgeons' lists of cases. Setting Ambulatory surgery center or hospital outpatient department. Main results With case resequencing applied before and on the day of surgery, there were 5.6% and 5.5% more cases per OR per day for the 2 ORs and 3 ORs, respectively, both standard errors (SE) < 0.1%. Resequencing cases among ORs to start cases earlier permitted increases in the hours into which cases could be scheduled from 10.5 to 11.0 h, while assuring >90% probability of each OR finishing within the prespecified 12-h shift. Thus, the additional cases were all scheduled before the day of surgery. The greater allocated time also resulted in less overutilized time, a mean of 4.2 min per OR per day for 2 ORs (SE 0.5) and 6.3 min per OR per day for 3 ORs (SE 0.4). The benefit could be achieved while limiting application of resequencing to days when the OR with the fewest estimated hours of cases has ≤8 h. Conclusions Some ambulatory surgery ORs have unusually long OR times and/or room cleanup times (e.g., infection control efforts because of the pandemic). Resequencing cases before and on the day of surgery should be considered, because moving 1 or 2 cases occasionally has little to no cost with substantive benefit.

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Review of indoor aerosol generation, transport, and control in the context of COVID‐19

Abstract: are inventors on a pending patent for aerosol and droplet protective devices.

Cited by 144 publications

References 74 publications

Reduced odor detection and hedonic changes in asymptomatic university students as SARS-CoV-2 emerged locally

Reduced odor detection and hedonic changes in asymptomatic university students as SARS-CoV-2 emerged locally

Aerosol Transmission of SARS-CoV-2: Physical Principles and Implications

Caseload is increased by resequencing cases before and on the day of surgery at ambulatory surgery centers where initial patient recovery is in operating rooms and cleanup times are longer than typical

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