Aerosol measurement identifies SARS-CoV 2 PCR positive adults compared with healthy controls
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Abstract
Background
SARS-CoV-2 is spread primarily through droplets and aerosols. Exhaled aerosols are generated in the lung periphery by ‘reopening of collapsed airways’. Aerosol measuring may detect highly contagious individuals (“super spreaders or super-emitters”) and discriminate between SARS-CoV-2 infected and non-infected individuals. This is the first study comparing exhaled aerosols in SARS-CoV-2 infected individuals and healthy controls.
Design
A prospective observational cohort study in 288 adults, comprising 64 patients testing positive by SARS CoV-2 PCR before enrollment, and 224 healthy adults testing negative (matched control sample) at the University Hospital Frankfurt, Germany, from February to June 2021. Study objective was to evaluate the concentration of exhaled aerosols during physiologic breathing in SARS-CoV-2 PCR-positive and -negative subjects. Secondary outcome measures included correlation of aerosol concentration to SARS-CoV-2 PCR results, change in aerosol concentration due to confounders, and correlation between clinical symptoms and aerosol.
Results
There was a highly significant difference in respiratory aerosol concentrations between SARS-CoV-2 PCR-positive (median 1490.5/L) and -negative subjects (median 252.0/L; p<0.0001). There were no significant differences due to age, sex, smoking status, or body mass index. ROC analysis showed an AUC of 0.8918.
Conclusions
Measurements of respiratory aerosols were significantly elevated in SARS-CoV-2 positive individuals and may become a helpful tool in detecting highly infectious individuals via a noninvasive breath test.
Clinical Trial Number
ClinicalTrials.gov Identifier: NCT04739020 .
Summary of the main point
In this prospective, comparative cohort study, higher numbers of exhaled respiratory aerosols correlate with a positive PCR test for SARS-CoV-2. Measurement of exhaled aerosols may become a helpful tool in detecting contagious individuals via a readily available breath test.
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SciScore for 10.1101/2022.01.21.22269423: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics Consent: Prior to the start of the study, written consent was obtained from all patients and controls.
IRB: The study was approved by the Ethics Committee of the Goethe University Frankfurt (number 20-1001) and registered under the number ClinicalTrials.gov Identifier: NCT04739020.Sex as a biological variable not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
Software and Algorithms Sentences Resources Spirometry: Spirometry was performed according to the recommendations of the American Thoracic Society (ATS) and the European Respiratory Society (ERS)36 by a hand-held device (Asthma Monitor® AM; VIASYS Healthcare GmbH, Höchberg, Germany). VIAS…SciScore for 10.1101/2022.01.21.22269423: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Ethics Consent: Prior to the start of the study, written consent was obtained from all patients and controls.
IRB: The study was approved by the Ethics Committee of the Goethe University Frankfurt (number 20-1001) and registered under the number ClinicalTrials.gov Identifier: NCT04739020.Sex as a biological variable not detected. Randomization not detected. Blinding not detected. Power Analysis not detected. Table 2: Resources
Software and Algorithms Sentences Resources Spirometry: Spirometry was performed according to the recommendations of the American Thoracic Society (ATS) and the European Respiratory Society (ERS)36 by a hand-held device (Asthma Monitor® AM; VIASYS Healthcare GmbH, Höchberg, Germany). VIASYS Healthcaresuggested: NoneStatistical analysis: GraphPad Prism 5.01 (GraphPad Software, Inc.) and R 4.0.4 were used for statistical analysis. GraphPadsuggested: (GraphPad Prism, RRID:SCR_002798)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:Our study has several limitations, including that the SARS-CoV-2 PCR and aerosol particle measurements were not performed simultaneously. A timeframe from PCR test to aerosol measurement of 72 hours was accepted for all patients; this may affect the results, as other studies have found peak viral loads around day four of infection, which might be present 1-3 days before the onset of symptoms and followed by a steady decline in viral load.36 In addition, only hospitalized SARS-CoV-2 positive patients were included. And it seems reasonable that aerosol particle counts may be greater in patients with severe disease, reflecting a certain level of lung framework damage due to this viral infection. This might explain the lower exhaled particle counts reported in the immunocompromised sub-group, when compared with the pneumonia and respiratory failure groups. Further studies should assess whether similar quantities of aerosol particles are produced by asymptomatic individuals and patients with mild infection. The utility of this approach as a diagnostic tool for patients at earlier stages of infection, a critical time for diagnosis, is not addressed by this work and will be the focus of further research. Moreover, the duration of elevated particle counts is unclear in SARS-CoV-2 PCR-positive patients. This may only be verified by longitudinal measurements of aerosol particles and serial SARS-CoV-2 PCR measurements. In addition, this study allows no statement concerning differences i...
Results from TrialIdentifier: We found the following clinical trial numbers in your paper:
Identifier Status Title NCT04739020 Recruiting Respiratory Aerosols in Patients With COVID-19 and Healthy C… 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.
Results from scite Reference Check: We found no unreliable references.
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