Transmission of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) From Asymptomatic and Presymptomatic Individuals in Healthcare Settings Despite Medical Masks and Eye Protection

Klompas, Michael; Baker, Meghan A; Griesbach, Diane; Tucker, Robert; Gallagher, Glen R.; Lang, Andrew S.; Fink, Timelia; Cumming, Melissa; Smole, Sandra; Madoff, Lawrence C.; Rhee, Chanu

doi:10.1093/cid/ciab218

Cited by 51 publications

(54 citation statements)

References 4 publications

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“…The problem is that the evidence is heterogeneous and hindered by suboptimal PPE adherence and underpowered study designs. The need for higher-rated PPE should be calibrated to the degree of risk [298]. As many HCWs in clinical care (and potentially other essential workers) are at the highest risk for exposure due to proximity, duration, and infectiousness of patients [267], access to fit-tested FFRs is indicated for their safety.…”

Section: Epidemiological Evidencementioning

confidence: 99%

“…As many HCWs in clinical care (and potentially other essential workers) are at the highest risk for exposure due to proximity, duration, and infectiousness of patients [267], access to fit-tested FFRs is indicated for their safety. Medical masks reduce but do not eliminate aerosol exposure and therefore may offer incomplete protection for frontline HCWs and other HCWs that engage in near-range, face-to-face, sustained encounters with patients with known or suspected COVID-19, untested individuals, and/or individuals that are unable to wear masks [298,299]. The value of FFRs outside of these circumstances is likely marginal but more research is needed [298].…”

Section: Epidemiological Evidencementioning

confidence: 99%

“…Medical masks reduce but do not eliminate aerosol exposure and therefore may offer incomplete protection for frontline HCWs and other HCWs that engage in near-range, face-to-face, sustained encounters with patients with known or suspected COVID-19, untested individuals, and/or individuals that are unable to wear masks [298,299]. The value of FFRs outside of these circumstances is likely marginal but more research is needed [298]. Third, community-based reports generally support the effectiveness of the existing TBPs (if consistently and adequately instituted) [300][301][302][303][304][305][306][307][308][309].…”

Section: Epidemiological Evidencementioning

confidence: 99%

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COVID-19 false dichotomies and a comprehensive review of the evidence regarding public health, COVID-19 symptomatology, SARS-CoV-2 transmission, mask wearing, and reinfection

et al. 2021

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Scientists across disciplines, policymakers, and journalists have voiced frustration at the unprecedented polarization and misinformation around coronavirus disease 2019 (COVID-19) pandemic. Several false dichotomies have been used to polarize debates while oversimplifying complex issues. In this comprehensive narrative review, we deconstruct six common COVID-19 false dichotomies, address the evidence on these topics, identify insights relevant to effective pandemic responses, and highlight knowledge gaps and uncertainties. The topics of this review are: 1) Health and lives vs. economy and livelihoods, 2) Indefinite lockdown vs. unlimited reopening, 3) Symptomatic vs. asymptomatic severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, 4) Droplet vs. aerosol transmission of SARS-CoV-2, 5) Masks for all vs. no masking, and 6) SARS-CoV-2 reinfection vs. no reinfection. We discuss the importance of multidisciplinary integration (health, social, and physical sciences), multilayered approaches to reducing risk (“Emmentaler cheese model”), harm reduction, smart masking, relaxation of interventions, and context-sensitive policymaking for COVID-19 response plans. We also address the challenges in understanding the broad clinical presentation of COVID-19, SARS-CoV-2 transmission, and SARS-CoV-2 reinfection. These key issues of science and public health policy have been presented as false dichotomies during the pandemic. However, they are hardly binary, simple, or uniform, and therefore should not be framed as polar extremes. We urge a nuanced understanding of the science and caution against black-or-white messaging, all-or-nothing guidance, and one-size-fits-all approaches. There is a need for meaningful public health communication and science-informed policies that recognize shades of gray, uncertainties, local context, and social determinants of health.

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Section: Epidemiological Evidencementioning

confidence: 99%

Section: Epidemiological Evidencementioning

confidence: 99%

Section: Epidemiological Evidencementioning

confidence: 99%

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COVID-19 false dichotomies and a comprehensive review of the evidence regarding public health, COVID-19 symptomatology, SARS-CoV-2 transmission, mask wearing, and reinfection

et al. 2021

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“…In some cases, staff-to-patient and staff-to-staff transmissions have led to large clusters ( 6 ). Universal masking diminishes this risk, but perfect adherence is not realistic and surgical masks are not perfectly protective; nosocomial transmission despite masks has been well documented ( 7 ). Vaccines, by contrast, provide constant protection without requiring reminders, persuasion, mask-fitting aids, or behavioral changes.…”

Section: Nosocomial Transmission Of Sars-cov-2 Is Commonmentioning

confidence: 99%

The Case for Mandating COVID-19 Vaccines for Health Care Workers

Pearson

Morris

2021

Ann Intern Med

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“…Faecal aerosols produced by toilet flushing were thought to be responsible, 11 reminiscent of the Amoy Gardens SARS outbreak in Hong Kong in 2003. There have also been several documented outbreaks in health care settings which were not only highly suggestive of airborne transmission but also demonstrated that physical distancing and the use of surgical masks is not always sufficient to prevent infection 12-15 . In contrast, a study of health care workers from Finland found that none of those using FFP2/3 respirators became infected 15…”

mentioning

confidence: 99%