Breath-, air- and surface-borne SARS-CoV-2 in hospitals,Journal of Aerosol Science

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Breath-, air- and surface-borne SARS-CoV-2 in hospitals
Journal of Aerosol Science ( IF 3.9 ) Pub Date : 2021-02-01 , DOI: 10.1016/j.jaerosci.2020.105693
Lian Zhou ₁ , Maosheng Yao ₂ , Xiang Zhang ₃ , Bicheng Hu ₄ , Xinyue Li ₂ , Haoxuan Chen ₂ , Lu Zhang ₂ , Yun Liu ₃ , Meng Du ₅ , Bochao Sun ₆ , Yunyu Jiang ₇ , Kai Zhou ₈ , Jie Hong ₁ , Na Yu ₉ , Zhen Ding ₁ , Yan Xu ₁ , Min Hu ₂ , Lidia Morawska ₁₀ , Sergey A Grinshpun ₁₁ , Pratim Biswas ₁₂ , Richard C Flagan ₁₃ , Baoli Zhu _{1,

14} , Wenqing Liu ₁₅ , Yuanhang Zhang ₂

Affiliation

Department of Environment and Health, Jiangsu Provincial Center for Disease Control and Prevention, Nanjing, 210009, China.
College of Environmental Sciences and Engineering, Peking University, Beijing, 100871, China.
The First Affiliated Hospital of Nanjing Medical University (Jiangsu Province Hospital), Nanjing, 210009, China.
The Clinical Laboratory, Wuhan No.1 Hospital, Wuhan, 430022, China.
Zhenjiang Center for Disease Control and Prevention, Zhenjiang, 212003, China.
Yancheng Center for Disease Control and Prevention, Yancheng, 224002, China.
Taizhou Center for Disease Control and Prevention, Taizhou, 225306, China.
Suzhou Center for Disease Control and Prevention, Suzhou, 215004, China.
The First Hospital of China Medical University, Shenyang, 110001, China.
International Laboratory for Air Quality and Heath (ILAQH), WHO Collaborating Centre for Air Quality and Health, School of Earth and Atmospheric Sciences, Queensland University of Technology, Brisbane, Queensland, QLD 4001, Australia.
Center for Health-Related Aerosol Studies, Department of Environmental & Public Health Sciences, University of Cincinnati, Cincinnati, OH, 45267, USA.
Department of Energy, Environmental & Chemical Engineering, Washington University in St. Louis, St. Louis, MO, 63130, USA.
Department of Environmental Science and Engineering and Department of Chemical Engineering, California Institute of Technology, Pasadena, CA, 91109, USA.
Center for Global Health, School of Public Health, Nanjing Medical University, Nanjing, 211166, China.
Hefei Institutes of Physical Science, Chinese Academy of Sciences, Hefei City, Anhui Province, 230031, China.

The COVID-19 pandemic has brought an unprecedented crisis to the global health sector. When discharging COVID-19 patients in accordance with throat or nasal swab protocols using reverse transcription polymerase chain reaction (RT-PCR), the potential risk of reintroducing the infection source to humans and the environment must be resolved. Here, 14 patients including 10 COVID-19 subjects were recruited; exhaled breath condensate (EBC), air samples and surface swabs were collected and analyzed for SARS-CoV-2 using reverse transcription-polymerase chain reaction (RT-PCR) in four hospitals with applied natural ventilation and disinfection practices in Wuhan. Here we discovered that 22.2% of COVID-19 patients (n = 9), who were ready for hospital discharge based on current guidelines, had SARS-CoV-2 in their exhaled breath (∼105 RNA copies/m3). Although fewer surface swabs (3.1%, n = 318) tested positive, medical equipment such as face shield frequently contacted/used by healthcare workers and the work shift floor were contaminated by SARS-CoV-2 (3–8 viruses/cm2). Three of the air samples (n = 44) including those collected using a robot-assisted sampler were detected positive by a digital PCR with a concentration level of 9–219 viruses/m3. RT-PCR diagnosis using throat swab specimens had a failure rate of more than 22% in safely discharging COVID-19 patients who were otherwise still exhaling the SARS-CoV-2 by a rate of estimated ∼1400 RNA copies per minute into the air. Direct surface contact might not represent a major transmission route, and lower positive rate of air sample (6.8%) was likely due to natural ventilation (1.6–3.3 m/s) and regular disinfection practices. While there is a critical need for strengthening hospital discharge standards in preventing re-emergence of COVID-19 spread, use of breath sample as a supplement specimen could further guard the hospital discharge to ensure the safety of the public and minimize the pandemic re-emergence risk.

中文翻译：

医院中通过呼吸、空气和表面传播的 SARS-CoV-2

COVID-19大流行给全球卫生部门带来了前所未有的危机。当使用逆转录聚合酶链反应（RT-PCR）按照咽拭子或鼻拭子方案排出COVID-19患者时，必须解决将感染源重新引入人类和环境的潜在风险。这里招募了 14 名患者，其中包括 10 名 COVID-19 受试者；在武汉四家采用自然通风和消毒措施的医院中，使用逆转录聚合酶链反应 (RT-PCR) 收集呼出气冷凝物 (EBC)、空气样本和表面拭子，并分析 SARS-CoV-2。在这里，我们发现，根据现行指南准备出院的 COVID-19 患者 (n = 9) 中，有 22.2% 的呼出气中含有 SARS-CoV-2（约 105 个 RNA 拷贝/立方米）。尽管表面拭子检测呈阳性的情况较少（3.1%，n = 318），但医护人员经常接触/使用的面罩等医疗设备以及轮班地板均受到 SARS-CoV-2 污染（3-8 个病毒/cm2）。包括使用机器人辅助采样器采集的空气样本在内的三个空气样本 (n = 44) 通过数字 PCR 检测呈阳性，浓度水平为 9-219 个病毒/立方米。使用咽拭子样本进行 RT-PCR 诊断在安全排出 COVID-19 患者方面的失败率超过 22%，否则这些患者仍在以估计每分钟约 1400 个 RNA 拷贝的速度将 SARS-CoV-2 呼出到空气中。直接表面接触可能不代表主要传播途径，空气样本阳性率较低（6.8%）可能是由于自然通风（1.6-3.3 m/s）和定期消毒措施所致。虽然迫切需要加强出院标准以防止 COVID-19 再次传播，但使用呼吸样本作为补充样本可以进一步保护出院，以确保公众的安全并最大限度地减少大流行的再次出现风险。

更新日期：2021-02-01

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