Aerosol SARS-CoV-2 in hospitals and long-term care homes during the COVID-19 pandemic

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Abstract

Few studies have quantified aerosol concentrations of SARS-CoV-2 in hospitals and long-term care homes, and fewer still have examined samples for viability. This information is needed to clarify transmission risks beyond close contact.

Methods

We deployed particulate air samplers in rooms with COVID-19 positive patients in hospital ward and ICU rooms, rooms in long-term care homes experiencing outbreaks, and a correctional facility experiencing an outbreak. Samplers were placed between 2 and 3 meters from the patient. Aerosol (small liquid particles suspended in air) samples were collected onto gelatin filters by Ultrasonic Personal Air Samplers (UPAS) fitted with <2.5μm (micrometer) and <10 μm size-selective inlets operated for 16 hours (total 1.92m 3 ), and with a Coriolis Biosampler over 10 minutes (total 1.5m 3 ). Samples were assayed for viable SARS-CoV-2 virus and for the viral genome by multiplex PCR using the E and N protein target sequences. We validated the sampling methods by inoculating gelatin filters with viable vesicular stomatitis virus (VSV), and with three concentrations of viable SARS-CoV-2, operating personal samplers for 16hrs, and quantifying viable virus recovery by TCID 50 assay.

Results

In total, 138 samples were collected from 99 rooms. RNA samples were positive in 9.1% (6/66) of samples obtained with the UPAS 2.5μm samplers, 13.5% (7/52) with the UPAS 10μm samplers, and 10.0% (2/20) samples obtained with the Coriolis samplers. Culturable virus was not recovered in any samples. Viral RNA was detected in 15.1% of the rooms sampled. There was no significant difference in viral RNA recovery between the different room locations or samplers. Method development experiments indicated minimal loss of SARS-CoV-2 viability via the personal air sampler operation.

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  1. SciScore for 10.1101/2021.05.31.21257841: (What is this?)

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

    Table 1: Rigor

    EthicsField Sample Permit: Coriolis air samples were collected into sterile cones containing 5mL of VTM, which was reduced to 3mL by evaporation during sample collection.
    Consent: Moreover, as personal information was not being collected, the boards felt that patient consent was not required.
    Sex as a biological variablenot detected.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.
    Cell Line Authenticationnot detected.

    Table 2: Resources

    Experimental Models: Cell Lines
    SentencesResources
    Virus viability and titration: VeroE6 cells were seeded the day prior in 96-well plates to attain 80% confluence on the day of titrations.
    VeroE6
    suggested: JCRB Cat# JCRB1819, RRID:CVCL_YQ49)
    Software and Algorithms
    SentencesResources
    Statistical analysis: Data was tabulated in Excel spreadsheets and analyzed using SPSS version 27 (IBM corporation).
    Excel
    suggested: None
    SPSS
    suggested: (SPSS, RRID:SCR_002865)

    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:
    COVID-19 infection due to the novel SARS-CoV-2 virus has caused a global pandemic, with over 165 million cases reported worldwide, and over 3.4 million deaths at the time of this writing.[43] Furthermore, respiratory morbidity, activity limitation, and mental health conditions are prevalent, among other complications.[44] Previous studies have suggested aerosol transmission is occurring beyond close contact, as per evidence from super spreading events, transmission occurrences between adjacent rooms, viable virus measurements in air, and animal studies.[8] Our data suggests that SARS-CoV-2 RNA virus may be present at low levels in aerosols <10um in diameter, >2 m from COVID-19 patients in a variety of settings, but viable virus appears to be uncommon, as has been described elsewhere.[6] In classical terms, respiratory viruses have been considered to be spread by droplets. Large droplets (e.g., > 5 microns in diameter) were believed to contaminate the immediate environment of an infectious patient, including the air within 2m, leading to infection by direct deposition of virus onto mucosal surfaces. In addition, large droplets settle in the proximal (within 2m) environment, leading to fomite transmission where contaminated surfaces are contacted by another person prior to touching their face thereby acquiring infection. In classical terms, aerosol (or “airborne”) spread occurs via small droplets (e.g., < 5µm) that can remain suspended in air more than 2m from a patient, leadin...

    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

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