Viable SARS-CoV-2 in the air of a hospital room with COVID-19 patients

Lednicky, John A.; Lauzardo, Michael; Fan, Z. Hugh; Jutla, Antarpreet; Tilly, Trevor B.; Gangwar, Mayank; Usmani, Moiz; Shankar, Sripriya Nannu; Mohamed, Karim; Eiguren-Fernandez, Arantzazu; Stephenson, Caroline J.; Alam, Md. Mahbubul; Elbadry, Maha A.; Loeb, Julia C.; Subramaniam, Kuttichantran; Waltzek, Thomas B.; Cherabuddi, Kartikeya; Morris, J. Glenn; Wu, Chang‐Yu

doi:10.1016/j.ijid.2020.09.025

Cited by 555 publications

(526 citation statements)

References 33 publications

(46 reference statements)

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“…Of the 24 included studies, all were cross-sectional observational studies. Ten studies (41.7%) were from China, [9][10][11]15,[18][19][20]22,25,29 and the remaining were from the United States (4 [16.7%]), 12,13,26,30 Hong Kong (2 [8.3%]), 14,21 Korea (2 [8.3%]), 24,27 Singapore (2 [8.3%]), 3,16 Iran (2 [8.3%]), 8,28 the United Kingdom (1 [4.2%]), 19 and Italy (1 [4.2%]). 23 Of all included articles and studies, 20…”

Section: Characteristics Of Included Articles and Studiesmentioning

confidence: 99%

“…(83.3%) 3,[8][9][10][11][14][15][16][17][20][21][22][23][24][25][26][27][28][29][30] were published in peer-reviewed journals, and 4 (16.7%) 12,13,17,18 were posted on preprint servers.…”

Section: Characteristics Of Included Articles and Studiesmentioning

confidence: 99%

“…The viral culture was planned in the methods of 6 studies (20.8%) 12,13,17,26,27,30 but performed in 5 (12.5%) of them. 12,13,17,26,30 The remaining did not perform viral culture due to negative RT-PCR results. Three studies (12.5%) 9,13,16 assessed the particle size in parallel to RNA concentration or viral titer.…”

Section: Characteristics Of Included Articles and Studiesmentioning

confidence: 99%

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Assessment of Air Contamination by SARS-CoV-2 in Hospital Settings

et al. 2020

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IMPORTANCE Controversy remains regarding the transmission routes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).OBJECTIVE To review current evidence on air contamination with SARS-CoV-2 in hospital settings and the factors associated with contamination, including viral load and particle size. EVIDENCE REVIEWThe MEDLINE, Embase, and Web of Science databases were systematically queried for original English-language articles detailing SARS-CoV-2 air contamination in hospital settings between January 1 and October 27, 2020. This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) guidelines. The positivity rate of SARS-CoV-2 viral RNA and culture were described and compared according to the setting, clinical context, air ventilation system, and distance from patients. The SARS-CoV-2 RNA concentrations in copies per meter cubed of air were pooled, and their distribution was described by hospital areas. Particle sizes and SARS-CoV-2 RNA concentrations in copies or median tissue culture infectious dose (TCID50) per meter cubed were analyzed after categorization as less than 1 μm, from 1 to 4 μm, and greater than 4 μm. FINDINGS Among 2284 records identified, 24 cross-sectional observational studies were included in the review. Overall, 82 of 471 air samples (17.4%) from close patient environments were positive for SARS-CoV-2 RNA, with a significantly higher positivity rate in intensive care unit settings (intensive care unit, 27 of 107 [25.2%] vs non-intensive care unit, 39 of 364 [10.7%]; P < .001). There was no difference according to the distance from patients (Յ1 m, 3 of 118 [2.5%] vs >1-5 m, 13 of 236 [5.5%]; P = .22). The positivity rate was 5 of 21 air samples (23.8%) in toilets, 20 of 242 (8.3%) in clinical areas, 15 of 122 (12.3%) in staff areas, and 14 of 42 (33.3%) in public areas. A total of 81 viral cultures were performed across 5 studies, and 7 (8.6%) from 2 studies were positive, all from close patient environments. The median (interquartile range) SARS-CoV-2 RNA concentrations varied from 1.0 × 10 3 copies/m 3 (0.4 × 10 3 to 3.1 × 10 3 copies/m 3 ) in clinical areas to 9.7 × 10 3 copies/m 3 (5.1 × 10 3 to 14.3 × 10 3 copies/m 3 ) in the air of toilets or bathrooms. Protective equipment removal and patient rooms had high concentrations per titer of SARS-CoV-2 (varying from 0.9 × 10 3 to 40 × 10 3 copies/m 3 and 3.8 × 10 3 to 7.2 × 10 3 TCID50/m 3 ), with aerosol size distributions that showed peaks in the region of particle size less than 1 μm; staff offices had peaks in the region of particle size greater than 4 μm. CONCLUSIONS AND RELEVANCEIn this systematic review, the air close to and distant from patients with coronavirus disease 2019 was frequently contaminated with SARS-CoV-2 RNA; however, few of these samples contained viable viruses. High viral loads found in toilets and bathrooms, staff areas, and public hallways suggest that these areas should be carefully considered.

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Section: Characteristics Of Included Articles and Studiesmentioning

confidence: 99%

“…(83.3%) 3,[8][9][10][11][14][15][16][17][20][21][22][23][24][25][26][27][28][29][30] were published in peer-reviewed journals, and 4 (16.7%) 12,13,17,18 were posted on preprint servers.…”

Section: Characteristics Of Included Articles and Studiesmentioning

confidence: 99%

Section: Characteristics Of Included Articles and Studiesmentioning

confidence: 99%

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Assessment of Air Contamination by SARS-CoV-2 in Hospital Settings

et al. 2020

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“…It has been found to be highly contagious in the community, with transmission via respiratory droplets and direct contact [8]. Other studies discuss the possibility of aerosol transmission [9,10].…”

Section: Introductionmentioning

confidence: 99%

Risk Perception of COVID−19 Community Transmission among the Spanish Population

Domínguez

Jiménez

Eraso

et al. 2020

IJERPH

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On 11 March 2020 the SARS-CoV−2 virus was officially declared a pandemic and measures were set up in various countries to avoid its spread among the population. This paper aims to analyse the perception of risk of COVID−19 infection in the Spanish population. A cross-sectional, descriptive observational study was conducted with a total of 16,372 Spanish participants. An online survey was used to gather data for 5 consecutive days over the compulsory lockdown period which was established after the state of emergency was declared. There is an association between socio-demographic variables and risk perception, and a very strong relationship between this perception and contact and direct experience with the virus in a family, social or professional setting. We also found that compared to working from home, working outside the home increased the perception of risk of infection and the perception of worsening health. Understanding the public perception of the risk of COVID−19 infection is fundamental for establishing effective prevention measures.

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“…A further pilot study was performed to determine whether infectious (viable) respiratory viruses in aerosols could be collected from air in a real-world environment and to determine the efficiency of viable collection compared to the BioSampler. A variety of viable human respiratory viruses, including influenza A H1N1 and H3N2 viruses and influenza B viruses, were collected by the VIVAS located at least 2 m from seated patients, during a late-onset 2016 influenza virus outbreak [99]. The BioSampler did collect virus aerosols, butt was considered less successful.…”

Section: Bioaerosols and Virusesmentioning

confidence: 99%

Recent Advances in Occupational Exposure Assessment of Aerosols

Harper

2020

IJERPH

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Exposure science is underpinned by characterization (measurement) of exposures. In this article, six recent advances in exposure characterization by sampling and analysis are reviewed as tools in the occupational exposure assessment of aerosols. Three advances discussed in detail are (1) recognition and inclusion of sampler wall deposits; (2) development of a new sampling and analytical procedure for respirable crystalline silica that allows non-destructive field analysis at the end of the sampling period; and (3) development of a new sampler to collect the portion of sub-300 nm aerodynamic diameter particles that would deposit in human airways. Three additional developments are described briefly: (4) a size-selective aerosol sampler that allows the collection of multiple physiologically-relevant size fractions; (5) a miniaturized pump and versatile sampling head to meet multiple size-selective sampling criteria; and (6) a novel method of sampling bioaerosols including viruses while maintaining viability. These recent developments are placed in the context of the historical evolution in sampling and analytical developments from 1900 to the present day. While these are not the only advances in exposure characterization, or exposure assessment techniques, they provide an illustration of how technological advances are adding more tools to our toolkit. The review concludes with a number of recommended areas for future research, including expansion of real-time and end-of-shift on-site measurement, development of samplers that operate at higher flow-rates to ensure measurement at lowered limit values, and development of procedures that accurately distinguish aerosol and vapor phases of semi-volatile substances.

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Viable SARS-CoV-2 in the air of a hospital room with COVID-19 patients

Abstract: Graphical abstract

Cited by 555 publications

References 33 publications

Assessment of Air Contamination by SARS-CoV-2 in Hospital Settings

Assessment of Air Contamination by SARS-CoV-2 in Hospital Settings

Risk Perception of COVID−19 Community Transmission among the Spanish Population

Recent Advances in Occupational Exposure Assessment of Aerosols

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