Moving Personal Protective Equipment Into the CommunityFace Shields and Containment of COVID-19

JAMA. Published online April 29, 2020.doi:10.1001/jama.2020.7477
[...]

Experience and evidence, even during this pandemic, suggest that health care workers rarely acquire infections during patient care when proper PPE is used and that most of their infections are acquired in the community where PPE is typically not worn.5 Thus, it becomes important to know if practice from occupational safety can be used in the community as a bridge to longer-lasting measures, such as vaccines. Could a simple and affordable face shield, if universally adopted, provide enough added protection when added to testing, contact tracing, and hand hygiene to reduce transmissibility below a critical threshold? [...]

 

 

University of Hong Kong study finds eyes are ‘important route’ for coronavirus, up to 100 times more infectious than Sars

Researchers from HKU’s school of public health reveal the coronavirus is up to 100 times more infectious through the eyes and airways than Sars. Study in The Lancet Respiratory Medicine says that explains ‘higher transmissibility’ of Covid-19, compared with the 2003 contagion. 
The study reinforces advice to the public not to touch their eyes and to wash hands regularly to avoid infection, after the university researchers previously found the coronavirus could survive as long as seven days on stainless steel surfaces and plastic.

https://www.thelancet.com/cms/10.1016/S2213-2600(20)30193-4/attachment/c88225c5-4575-4cd3-be56-ba6d19c1d116/mmc1.pdf

https://www.hku.hk/press/news_detail_20976.html

  

Antimicrobial surface coating kills coronavirus for 90 days: study

The paper by researchers at the University of Arizona (UA), which has not yet been peer-reviewed, found that the amount of virus on coated surfaces reduced by 90 percent in 10 minutes and by 99.9 percent in two hours.

Charles Gerba, a microbiologist at UA who was the study's senior author, told AFP the technology was "the next advancement in infection control."

"I think it's mostly important for high-use surfaces like subways and buses, because you could disinfect them but then the next people that come in there will recontaminate the surfaces," he said.

 A 2019 paper by UA researchers found that coatings reduced hospital-acquired infections by 36 percent.

 

Controlling the Spread of Disease in Schools

Pandemic and seasonal infectious diseases such as influenza may have serious negative health and economic consequences. Certain non-pharmaceutical intervention strategies – including school closures – can be implemented rapidly as a first line of defense against spread. Such interventions attempt to reduce the effective number of contacts between individuals within a community; yet the efficacy of closing schools to reduce disease transmission is unclear, and closures certainly result in significant economic impacts for caregivers who must stay at home to care for their children. Using individual-based computer simulation models to trace contacts among schoolchildren within a stereotypical school setting, we show how alternative school-based disease interventions have great potential to be as effective as traditional school closures without the corresponding loss of workforce and economic impacts. Benjamin J. Ridenhour, Alexis Braun, Thomas Teyrasse, David Goldsman

https://journals.plos.org/plosone/article/file?id=10.1371/journal.pone.0029640&type=printable

 

Ultrafine particle removal and generation by portable air cleaners

Portable air cleaners can both remove and generate pollutants indoors. To investigate these phenomena, we conducted a two-phase investigation in a 14.75 m3 stainless steel chamber. In the first phase, particle size-resolved (12.6–514 nm diameter) clean air delivery rates (CADR) and efficiencies were determined, as were ozone emission rates, for two high-efficiency particle arresting (HEPA) filters, one electrostatic precipitator with a fan, and two ion generators without fans. The two HEPA air cleaners had count average CADR (standard deviation) of 188 (30) and 324 (44) m3 h−1; the electrostatic precipitator 284 (62) m3 h−1; and the two ion generators 41 (11) and 35 (13) m3 h−1. The electrostatic precipitator emitted ozone at a rate of 3.8±0.2 mg h−1, and the two ion generators 3.3±0.2 and 4.3±0.2 mg h−1. Ozone initiates reactions with certain unsaturated organic compounds that produce ultrafine and fine particles, carbonyls, other oxidized products, and free radicals. During the second phase, five different ion generators were operated separately in the presence of a plug-in liquid or solid air freshener, representing a strong terpene source. For air exchange rates of between 0.49 and 0.96 h−1, three ion generators acted as steady-state net particle generators in the entire measured range of 4.61–157 nm, and two generated particles in the range of approximately 10 to 39–55 nm. Terpene and aldehyde concentrations were also sampled for one ion generator, and concentrations of terpenes decreased and formaldehyde increased. Given these results, the pollutant removal benefits of ozone-generating air cleaners may be outweighed by the generation of indoor pollution. Michael S. WaringJeffrey A. Siegel , Richard L. Corsi

https://www.researchgate.net/publication/259912639_Ultrafine_particle_removal_and_generation_by_portable_air_cleaners

 

Projecting the transmission dynamics of SARS-CoV-2 through the postpandemic period

 

The effect of control strategies to reduce social mixing on outcomes of the COVID-19 epidemic in Wuhan, China: a modelling study

Summary
Background In December, 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a novel coronavirus, emerged in Wuhan, China. Since then, the city of Wuhan has taken unprecedented measures in response to the outbreak, including extended school and workplace closures. We aimed to estimate the effects of physical distancing measures on the progression of the COVID-19 epidemic, hoping to provide some insights for the rest of the world.

Kiesha Prem*, Yang Liu*, Timothy W Russell, Adam J Kucharski, Rosalind M Eggo, Nicholas Davies, Centre for the Mathematical Modelling of Infectious Diseases COVID-19 Working Group†, Mark Jit, Petra Klepac

https://www.thelancet.com/action/showPdf?pii=S2468-2667%2820%2930073-6

 

The Effect of Human Mobility and Control Measures on the COVID-19 Epidemic in China

The ongoing coronavirus disease 2019 (COVID-19) outbreak expanded rapidly throughout China. Major behavioral, clinical, and state interventions were undertaken to mitigate the epidemic and prevent the persistence of the virus in human populations in China and worldwide. It remains unclear how these unprecedented interventions, including travel restrictions, affected COVID-19 spread in China. We used real-time mobility data from Wuhan and detailed case data including travel history to elucidate the role of case importation in transmission in cities across China and to ascertain the impact of control measures. Early on, the spatial distribution of COVID-19 cases in China was explained well by human mobility data. After the implementation of control measures, this correlation dropped and growth rates became negative in most locations, although shifts in the demographics of reported cases were still indicative of local chains of transmission outside of Wuhan. This study shows that the drastic control measures implemented in China substantially mitigated the spread of COVID-19. Moritz U G Kraemer 1 2 3Chia-Hung Yang 4Bernardo Gutierrez 5 6Chieh-Hsi Wu 7Brennan Klein 4David M Pigott 8Open COVID-19 Data Working GroupLouis du Plessis 5Nuno R Faria 5Ruoran Li 9William P Hanage 9John S Brownstein 2 3Maylis Layan 10 11Alessandro Vespignani 4 12Huaiyu Tian 13Christopher Dye 5Oliver G Pybus 1 14Samuel V Scarpino 

 

Recette friction hydro-alcoolique maison validée HUG

Trente secondes de friction hydroalcoolique équivalent à deux minutes de lavage des mains au savon. Dans le premier cas, on tue les germes, dans le second, on les décroche. J’ai créé un tableau où on peut entrer le volume de son flacon et obtenir automatiquement les proportions. Tout le monde a parlé de la recette OMS, moi le premier, sans vraiment expliquer comment on pouvait la mettre en œuvre chez soi, quand on ne dispose ni de béchers ni d’autres ustensiles de laboratoire. En relation avec les spécialistes des HUG, lieu d’invention des solutions hydroalcooliques modernes, je suis arrivé à une recette pratique qui ne nécessite qu’une balance électronique comme nous en utilisons en cuisine.

https://tcrouzet.com/2020/03/20/recette-hydroalcoolique-maison-validee-hug/

 

Recette friction hydro-alcoolique maison recommandé par L'OMS

Guide de Production locale : Formulations des Produits hydro-alcooliques recommandés par l’OMS. Ce guide de production locale des solutions hydro-alcooliques selon les formulations recommandées par l’OMS se compose de deux parties étroitement liées. La partie A est le guide de préparation des solutions recommandées destiné aux professionnels de la pharmacie. S’ils le souhaitent, les utilisateurs peuvent afficher ces consignes sur le lieu de production. La partie B est une synthèse des informations techniques essentielles, issues des Recommandations de l’OMS pour l’Hygiène des Mains au cours des Soins (2009). Ces données complémentaires concernent la sécurité et les coûts de production et de distribution.

https://www.who.int/gpsc/5may/tools/system_change/guide_production_locale_produit_hydro_alcoolique.pdf?ua=1

 

Air, Surface Environmental, and Personal Protective Equipment Contamination by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) From a Symptomatic Patient

 

There was extensive environmental contamination by 1 SARS-CoV-2 patient with mild upper respiratory tract involvement. Toilet bowl and sink samples were positive, suggesting that viral shedding in stool5 could be a potential route of transmission. Postcleaning samples were negative, suggesting that current decontamination measures are sufficient.

Air samples were negative despite the extent of environmental contamination. Swabs taken from the air exhaust outlets tested positive, suggesting that small virus-laden droplets may be displaced by airflows and deposited on equipment such as vents. The positive PPE sample was unsurprising because shoe covers are not part of PPE recommendations. The risk of transmission from contaminated footwear is likely low, as evidenced by negative results in the anteroom and clean corridor.

This study has several limitations. First, viral culture was not done to demonstrate viability. Second, due to operational limitations during an outbreak, methodology was inconsistent and sample size was small. Third, the volume of air sampled represents only a small fraction of total volume, and air exchanges in the room would have diluted the presence of SARS-CoV-2 in the air. Further studies are required to confirm these preliminary results.

Significant environmental contamination by patients with SARS-CoV-2 through respiratory droplets and fecal shedding suggests the environment as a potential medium of transmission and supports the need for strict adherence to environmental and hand hygiene.

 

Efficacy of Face Shields Against Cough Aerosol Droplets From a Cough Simulator
William G Lindsley et al. J Occup Environ Hyg. 2014.

linkshttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC4734356/

Health care workers are exposed to potentially infectious airborne particles while providing routine care to coughing patients. However, much is not understood about the behavior of these aerosols and the risks they pose. We used a coughing patient simulator and a breathing worker simulator to investigate the exposure of health care workers to cough aerosol droplets, and to examine the efficacy of face shields in reducing this exposure. Our results showed that 0.9% of the initial burst of aerosol from a cough can be inhaled by a worker 46 cm (18 inches) from the patient. During testing of an influenza-laden cough aerosol with a volume median diameter (VMD) of 8.5 μm, wearing a face shield reduced the inhalational exposure of the worker by 96% in the period immediately after a cough. The face shield also reduced the surface contamination of a respirator by 97%. When a smaller cough aerosol was used (VMD = 3.4 μm), the face shield was less effective, blocking only 68% of the cough and 76% of the surface contamination. In the period from 1 to 30 minutes after a cough, during which the aerosol had dispersed throughout the room and larger particles had settled, the face shield reduced aerosol inhalation by only 23%. Increasing the distance between the patient and worker to 183 cm (72 inches) reduced the exposure to influenza that occurred immediately after a cough by 92%. Our results show that health care workers can inhale infectious airborne particles while treating a coughing patient. Face shields can substantially reduce the short-term exposure of health care workers to large infectious aerosol particles, but smaller particles can remain airborne longer and flow around the face shield more easily to be inhaled. Thus, face shields provide a useful adjunct to respiratory protection for workers caring for patients with respiratory infections. However, they cannot be used as a substitute for respiratory protection when it is needed. [Supplementary materials are available for this article. Go to the publisher's online edition of Journal of Occupational and Environmental Hygiene for the following free supplemental resource: tables of the experiments performed, more detailed information about the aerosol measurement methods, photographs of the experimental setup, and summaries of the experimental data from the aerosol measurement devices, the qPCR analysis, and the VPA.].

Keywords: airborne particulate matter; health care workers; infectious disease transmission; protective devices; respiratory infections/prevention; universal precautions.

 

 

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WHO

COVID-19 dashboard.

 

 

 

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