Exposure to cough aerosols and development of pulmonary COVID-19
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Abstract
We hypothesized that most patients with severe pulmonary COVID-19 were exposed to cough aerosols. Among patients that were almost 100% certain which person infected them, only 14 out of 38 overall, and 9 out of 25 hospitalized patients requiring supplemental oxygen, were infected by someone who coughed, which did not support our hypothesis. Talking, especially with a loud voice, could be an alternative source generating SARS-CoV-2 aerosols. Further research is needed to determine how SARS-CoV-2 spreads. Avoiding to talk when you are not wearing your mask and not talking with a loud voice, ‘voice etiquette’, could be other public health interventions worthwhile exploring.
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SciScore for 10.1101/2020.06.03.20121004: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement IRB: The study received a review exemption from the Ethics Committee of Antwerp University Hospital in Belgium. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
Software and Algorithms Sentences Resources Confidence intervals (CI) for proportions were calculated using MedCalc® (MedCalc Software, Ostend, Belgium). MedCalcsuggested: (MedCalc, RRID:SCR_015044)Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following …SciScore for 10.1101/2020.06.03.20121004: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement IRB: The study received a review exemption from the Ethics Committee of Antwerp University Hospital in Belgium. Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
Software and Algorithms Sentences Resources Confidence intervals (CI) for proportions were calculated using MedCalc® (MedCalc Software, Ostend, Belgium). MedCalcsuggested: (MedCalc, RRID:SCR_015044)Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Participating patients were only asked to answer one question, which was both a strength and a limitation of our study. As with any case-control study, there is a risk of recall bias and misclassification: patients may not remember coughing as a symptom of the person who infected them. Nevertheless, a lot of the transmission did not seem to involve coughing at all. Alternatively, other respiratory maneuvers like sneezing, talking or breathing could have generated SARS-CoV-2 aerosols. When talking, vibration of the vocal cords generates 2.5-micron droplet nuclei (6). Ten seconds saying “aah” produces a comparable number of droplet nuclei as coughing for 10 seconds (7). The vocal cords are being lubricated by saliva, which contains large amounts of SARS-CoV-2 in most COVID-19 patients (8). During singing or talking with a loud voice, up to 50 times more droplet nuclei are being generated compared to talking with a quiet voice (9–10). Researchers also noticed that 1 in 5 people released 10 times more particles during talking than their peers for reasons not yet understood. Bringing all this information together, one could expect COVID-19 superspreader events in bars and clubs with loud music, choirs, and crowded markets. Lately these are increasingly being reported, in both non-scientific and scientific press. One could even argue that talking with a loud voice to hearing impaired elderly, could have contributed to the high COVID-19 incidence in nursing homes. Droplets have enou...
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
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