Low Risk of Severe Acute Respiratory Syndrome Coronavirus 2 Transmission by Fomites: A Clinical Observational Study in Highly Infectious Coronavirus Disease 2019 Patients

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Abstract

Background

The contribution of droplet-contaminated surfaces for virus transmission has been discussed controversially in the context of the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) pandemic. More importantly, the risk of fomite-based transmission has not been systematically addressed. Therefore, the aim of this study was to evaluate whether confirmed hospitalized coronavirus disease 2019 (COVID-19) patients can contaminate stainless steel carriers by coughing or intensive moistening with saliva and to assess the risk of SARS-CoV-2 transmission upon detection of viral loads and infectious virus in cell culture.

Methods

We initiated a single-center observational study including 15 COVID-19 patients with a high baseline viral load (cycle threshold value ≤25). We documented clinical and laboratory parameters and used patient samples to perform virus culture, quantitative polymerase chain reaction, and virus sequencing.

Results

Nasopharyngeal and oropharyngeal swabs of all patients were positive for viral ribonucleic acid on the day of the study. Infectious SARS-CoV-2 could be isolated from 6 patient swabs (46.2%). After coughing, no infectious virus could be recovered, however, intensive moistening with saliva resulted in successful viral recovery from steel carriers of 5 patients (38.5%).

Conclusions

Transmission of infectious SARS-CoV-2 via fomites is possible upon extensive moistening, but it is unlikely to occur in real-life scenarios and from droplet-contaminated fomites.

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  1. SciScore for 10.1101/2022.03.22.22272773: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    EthicsConsent: Study design: After written informed consent, two combined nasopharyngeal and oropharyngeal swabs were collected from each patient.
    IRB: Legal and ethical considerations: The study was conducted according to the revised principles of the Declaration of Helsinki and was approved by the ethics committee of the Ruhr-University Bochum (registration number 20-7065) in November 2020.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power AnalysisSample size calculation was performed using G*Power Version 3.1.9.6 for windows [12].
    Cell Line Authenticationnot detected.

    Table 2: Resources

    Experimental Models: Cell Lines
    SentencesResources
    Total RNA was purified from VeroE6 cells using the RNeasy Mini Kit (QIAGEN®, www.qiagen.com).
    VeroE6
    suggested: JCRB Cat# JCRB1819, RRID:CVCL_YQ49)
    Software and Algorithms
    SentencesResources
    Statistical analysis was performed using GraphPad Prism version 8.0.0 for Windows (GraphPad Software, San Diego, California USA, www.graphpad.com).
    GraphPad Prism
    suggested: (GraphPad Prism, RRID:SCR_002798)
    GraphPad
    suggested: (GraphPad Prism, RRID:SCR_002798)
    Sample size calculation was performed using G*Power Version 3.1.9.6 for windows [12].
    G*Power
    suggested: (G*Power, RRID:SCR_013726)
    Sequencing libraries were prepared from 4·5μl cDNA using NEBNext® ARTIC SARS-CoV-2 Library Prep Kit for Illumina sequencing platforms (New England BioLabs® Inc., neb.com, catalog #E7650).
    New England BioLabs®
    suggested: (New England Biolabs, RRID:SCR_013517)
    In addition, variants in spike domains were identified and annotated using Geneious prime 2021.2.2 (https://www.geneious.com).
    https://www.geneious.com
    suggested: (Geneious, RRID:SCR_010519)

    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 encompasses several limitations. Patients were encouraged to forcefully cough twice to contaminate surfaces. However, we cannot exclude that potentially repeated coughing over a prolonged time results in a more effective virus transfer compared to our controlled conditions. Moreover, sneezing can produce significantly more infectious droplets potentially containing infectious particles, therefore, we cannot exclude potential transmissions via other this route. Furthermore, a selection bias cannot be excluded, and the included patients are not demographically representative. Strengths of the present study include the high viral load of the patients included, a standardized protocol for sample acquisition, laboratory procedures and the inclusion of VoC.

    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.

    Results from scite Reference Check: We found no unreliable references.


    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.