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BackgroundSpurred by the Coronavirus infectious disease 2019 pandemic, aerosol containment devices (ACDs) were developed to capture infectious respiratory aerosols generated by patients at their source. Prior reviews indicated that such devices had low evidence of effectiveness, but did not address how ACDs should be evaluated, how well they should perform, nor have clearly defined performance standards. Towards developing design criteria for ACDs, two questions were posed: 1) What characteristics have guided the design of ACDs? 2) How have these characteristics been evaluated?MethodsA scoping review was performed consistent with PRISMA guidelines. Data were extracted with respect to general study information, intended use of the device, device design characteristics and evaluation.ResultsFifty-four articles were included. Evaluation was most commonly performed with respect to device aerosol containment (n = 31, 61%), with only 5 (9%), 3 (6%) and 8 (15%) formally assessing providing experience, patient experience and procedure impact, respectively. Nearly all of the studies that explored provider experience and procedure impact studied intubation. Few studies provided a priori performance criteria for any evaluation metric, or referenced any external guidelines by which to bench mark performance.ConclusionWith respect to aerosol containment, ACDs should reduce exposure among HCP with the device compared with the absence of the device, and provide ≥90% reduction in respirable aerosols, equivalent in performance to N95 filtering facepiece respirators, if the goal is to reduce reliance on personal protective equipment. The ACD should not increase awkward or uncomfortable postures, or adversely impact biomechanics of the procedure itself as this could have implications for procedure outcomes. A variety of standardized instruments exist to assess the experience of patients and healthcare personnel. Integration of ACDs into routine clinical practice requires rigorous studies of aerosol containment and the user experience.

Summary: The COVID‐19 pandemic has highlighted the importance of environmental ventilation in reducing airborne pathogen transmission. Carbon dioxide monitoring is recommended in the community to ensure adequate ventilation. Dynamic measurements of ventilation quantifying human exhaled waste gas accumulation are not conducted routinely in hospitals. Instead, environmental ventilation is allocated using static hourly air change rates. These vary according to the degree of perceived hazard, with the highest change rates reserved for locations where aerosol‐generating procedures are performed, where medical/anaesthetic gases are used and where a small number of high‐risk infective or immunocompromised patients may be isolated to reduce cross‐infection. We aimed to quantify the quality and distribution of ventilation in hospital by measuring carbon dioxide levels in a two‐phased prospective observational study. First, under controlled conditions, we validated our method and the relationship between human occupancy, ventilation and carbon dioxide levels using non‐dispersive infrared carbon dioxide monitors. We then assessed ventilation quality in patient‐occupied (clinical) and staff break and office (non‐clinical) areas across two hospitals in Scotland. We selected acute medical and respiratory wards in which patients with COVID‐19 are cared for routinely, as well as ICUs and operating theatres where aerosol‐generating procedures are performed routinely. Between November and December 2022, 127,680 carbon dioxide measurements were obtained across 32 areas over 8 weeks. Carbon dioxide levels breached the 800 ppm threshold for 14% of the time in non‐clinical areas vs. 7% in clinical areas (p < 0.001). In non‐clinical areas, carbon dioxide levels were > 800 ppm for 20% of the time in both ICUs and wards, vs. 1% in operating theatres (p < 0.001). In clinical areas, carbon dioxide was > 800 ppm for 16% of the time in wards, vs. 0% in ICUs and operating theatres (p < 0.001). We conclude that staff break, office and clinical areas on acute medical and respiratory wards frequently had inadequate ventilation, potentially increasing the risks of airborne pathogen transmission to staff and patients. Conversely, ventilation was consistently high in the ICU and operating theatre clinical environments. Carbon dioxide monitoring could be used to measure and guide improvements in hospital ventilation. [ABSTRACT FROM AUTHOR]

Tracer gas experiments were conducted in a 158 m3 room with overhead supply diffusers to study dispersion of contaminants from simulated speaking in physically distanced meeting and classroom configurations. The room was contained within a 237 m3 cell with open plenum return to the HVAC system. Heated manikins at desks and a researcher operating the tracer release apparatus presented 8-9 thermal plumes. Experiments were conducted under conditions of no forced air and neutral, cooled, or heated air supplied at 980-1100 cmh, and with/out 20% outdoor air. CO2 was released at the head of one manikin in each experiment to simulate small (5× perfectly mixed conditions. Operation of two within-zone air cleaners together moving ≥400 cmh vertically in the room provided enough mixing to mitigate elevated exposure variations.

Tracer gas experiments were conducted in a 158 m3 room with overhead supply diffusers to study dispersion of contaminants from simulated speaking in physically distanced meeting and classroom configurations. The room was contained within a 237 m3 cell with open plenum return to the HVAC system. Heated manikins at desks and a researcher operating the tracer release apparatus presented 8-9 thermal plumes. Experiments were conducted under conditions of no forced air and neutral, cooled, or heated air supplied at 980-1100 cmh, and with/out 20% outdoor air. CO2 was released at the head of one manikin in each experiment to simulate small (5× perfectly mixed conditions. Operation of two within-zone air cleaners together moving ≥400 cmh vertically in the room provided enough mixing to mitigate elevated exposure variations.

The outbreak of the novel coronavirus disease (COVID-19) severely threatens the public health worldwide, but the transmission mechanism and the effectiveness of mitigation measures remain uncertain. Here we assess the role of airborne transmission in spreading the disease and the effectiveness of face covering in preventing inter-human transmission for the top-fifteen infected U.S. states during March 1 and May 18, 2020. For all fifteen states, the curve of total confirmed infections exhibits an initial sub-exponential growth and a subsequent linear growth after implementing social distancing/stay-at-home orders. The linearity extends one to two months for the six states without mandated face covering and to the onset of mandated face covering for the other nine states with this measure, reflecting a dynamic equilibrium between first-order transmission kinetics and intervention. For the states with mandated face covering, significant deviation from this linearity and curve flattening occur after the onset of this measure for seven states, with exceptions for two states. Most states exhibit persistent upward trends in the daily new infections after social distancing/stay-at-home orders, while reversed downward or slowing trends occur for eight states after implementing mandated face covering. The inadequacy of social distancing and stay-at-home measures alone in preventing inter-human transmission is reflected by the continuous linear growth in the total infection curve after implementing these measures, which is mainly driven by airborne transmission. We estimate that the number of the total infections prevented by face covering reaches ~252,000 on May 18 in seven states, which is equivalent to ~17% of the total infections in the nation. We conclude that airborne transmission and face covering play the dominant role in spreading the disease and flattening the total infection curve, respectively. Our findings provide policymakers and the public with compelling evidence that universal face covering, in conjunction with social distancing and hand hygiene, represents the maximal protection against inter-human transmission and the combination of these intervention measures with rapid and extensive testing as well as contact tracing is crucial in containing the COVID-19 pandemic.

Background: Spurred by the Coronavirus infectious disease 2019 pandemic, aerosol containment devices (ACDs) were developed to capture infectious respiratory aerosols generated by patients at their source. Prior reviews indicated that such devices had low evidence of effectiveness, but did not address how ACDs should be evaluated, how well they should perform, nor have clearly defined performance standards. Towards developing design criteria for ACDs, two questions were posed: 1) What characteristics have guided the design of ACDs? 2) How have these characteristics been evaluated?Methods: A scoping review was performed consistent with PRISMA guidelines. Data were extracted with respect to general study information, intended use of the device, device design characteristics and evaluation.Results: Fifty-four articles were included. Evaluation was most commonly performed with respect to device aerosol containment (n = 31, 61%), with only 5 (9%), 3 (6%) and 8 (15%) formally assessing providing experience, patient experience and procedure impact, respectively. Nearly all of the studies that explored provider experience and procedure impact studied intubation. Few studies provided a priori performance criteria for any evaluation metric, or referenced any external guidelines by which to bench mark performance.Conclusion: With respect to aerosol containment, ACDs should reduce exposure among HCP with the device compared with the absence of the device, and provide ≥90% reduction in respirable aerosols, equivalent in performance to N95 filtering facepiece respirators, if the goal is to reduce reliance on personal protective equipment. The ACD should not increase awkward or uncomfortable postures, or adversely impact biomechanics of the procedure itself as this could have implications for procedure outcomes. A variety of standardized instruments exist to assess the experience of patients and healthcare personnel. Integration of ACDs into routine clinical practice requires rigorous studies of aerosol containment and the user experience. [ABSTRACT FROM AUTHOR]

Background: The knowledge on the concentration of viral particles in exhaled breath is limited. The aim of this study was to explore if severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) can be detected in aerosol from subjects with the coronavirus disease 2019 (COVID‐19) during various types of breathing and coughing and how infection with SARS‐CoV‐2 may influence the number and size of exhaled aerosol particles. Methods: We counted and collected endogenous particles in exhaled breath in subjects with COVID‐19 disease by two different impaction‐based methods, during 20 normal breaths, 10 airway opening breaths, and three coughs, respectively. Breath samples were analyzed with reverse transcription real‐time polymerase chain reaction (RT‐PCR). Results: Detection of RNA in aerosol was possible in 10 out of 25 subjects. Presence of virus RNA in aerosol was mainly found in cough samples (n = 8), but also in airway opening breaths (n = 3) and in normal breaths (n = 4), with no overlap between the methods. No association between viral load in aerosol and number exhaled particles <5 μm was found. Subjects with COVID‐19 exhaled less particles than healthy controls during normal breathing and airway opening breaths (all P < 0.05), but not during cough. Conclusion: SARS‐CoV‐2 RNA can be detected in exhaled aerosol, sampled during a limited number of breathing and coughing procedures. Detection in aerosol seemed independent of viral load in the upper airway swab as well as of the exhaled number of particles. The infectious potential of the amount of virus detected in aerosol needs to be further explored. [ABSTRACT FROM AUTHOR]

In this experimental study, the focus is to address the challenges of cross-contamination due to the presence of an infected individual in a meeting room environment. A detailed analysis is performed to identify effective methods to reduce the spread of infectious aerosols generated due to breathing and coughing. Infectious aerosols are simulated using a Paraffin oil-based solution with a respiratory exhalation simulator integrated with a breathing/coughing machine and an atomizer. Filtration-based active strategies such as the room air purifier, personal air purifier, and facemasks (FFP2 and surgical) along their wearing patterns are examined and compared with structural measures such as face shields and partition walls. The impact of the infectors' location on the exposed person is also studied. Facemasks are the most effective protective measure for both examined respiratory activities and provide over 60 % protection. Other mitigating strategies behaved differently for breathing and coughing trials. In the well-mixed room, during breathing, the portable room air purifier designed for clean air delivery rates (CADR) 2.5 times the ventilation rate effectively reduced aerosol spread. A personal air purifier, with a flow rate of 0.02 times the ventilation rate, offered only partial protection to the exposed occupant. Structural partitions showed marginal effectiveness for breathing but were effective during coughing events. The infector's location has little impact on contaminant levels in a well-mixed meeting room, except for a slight increase when seated next to the exposed person. This study provides a valuable reference for using different mitigation strategies in indoor settings. • A combination of structural and air distribution strategies was studied for a meeting room. • Mitigation methods show varying effectiveness for breathing and coughing instances. • The facemasks give good protection for both breathing and coughing situations. • Room air purifier is more effective in breathing compared to coughing events. • Structural methods are effective in case of coughing. [ABSTRACT FROM AUTHOR]

• Face masks reduce the expulsion of respiratory aerosols (called source control). • Poorly fitted masks allow respiratory aerosols to escape through face seal leaks. • Fit modifications improve the performance of face masks as source control devices. • Unmodified medical masks blocked ≥56% of cough aerosols and ≥42% of exhaled aerosols. • An elastic brace over a mask blocked ≥95% of cough and ≥99% of exhaled aerosols. During the COVID-19 pandemic, face masks are used as source control devices to reduce the expulsion of respiratory aerosols from infected people. Modifications such as mask braces, earloop straps, knotting and tucking, and double masking have been proposed to improve mask fit however the data on source control are limited. The effectiveness of mask fit modifications was determined by conducting fit tests on human subjects and simulator manikins and by performing simulated coughs and exhalations using a source control measurement system. Medical masks without modification blocked ≥56% of cough aerosols and ≥42% of exhaled aerosols. Modifying fit by crossing the earloops or placing a bracket under the mask did not increase performance, while using earloop toggles, an earloop strap, and knotting and tucking the mask increased performance. The most effective modifications for improving source control performance were double masking and using a mask brace. Placing a cloth mask over a medical mask blocked ≥85% of cough aerosols and ≥91% of exhaled aerosols. Placing a brace over a medical mask blocked ≥95% of cough aerosols and ≥99% of exhaled aerosols. Fit modifications can greatly improve the performance of face masks as source control devices for respiratory aerosols. [ABSTRACT FROM AUTHOR]

Respiratory aerosols from breathing and talking are an important transmission route for viruses, including severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Previous studies have found that particles with diameters ranging from 10 nm to 145 μm are produced from different regions in the respiratory system and especially smaller particles can remain airborne for long periods while carrying viral RNA. We present the first study in which respiratory aerosols have been simultaneously measured with carbon dioxide (CO2) to establish the correlation between the two concentrations. CO2 concentrations are easily available through low-cost sensors and could be used to estimate viral exposure through this correlation, whereas source-specific aerosol measurements are complicated and not possible with low-cost sensors. The increase in both respiratory aerosols and CO2 was linear over ten minutes in a 2 m 3 chamber for all participants, suggesting a strong correlation. On average, talking released more particles than breathing, with 14,600 ± 16,800 min−1 (one- σ standard deviation) and 6210 ± 5630 min−1 on average, respectively, while CO2 increased with 139 ± 33 ppm min−1 during talking and 143 ± 29 ppm min−1 during breathing. Assuming a typical viral load of 7 × 10 6 RNA copies per mL of oral fluid, ten minutes of talking and breathing are estimated to produce 1 and 16 suspended RNA copies, respectively, correlating to a CO2 concentration of around 1800 ppm in a 2 m 3 chamber. However, viral loads can vary by several orders of magnitude depending on the stage of the disease and the individual. It was therefore concluded that, by measuring CO2 concentrations, only the number and volume concentrations of released particles can be estimated with reasonable certainty, while the number of suspended RNA copies cannot. [ABSTRACT FROM AUTHOR]

Individual and interacting effects of uniform flow, plane shear, and near-wall proximity on spherical droplet heat and mass transfer have been assessed for low Reynolds number conditions beyond the creeping flow regime. Validated resolved volume simulations were used to compute heat and mass transfer surface gradients of two-dimensional axisymmetric droplets and three-dimensional spherical droplets near planar wall boundaries for conditions consistent with inhalable aerosols (5⩽d⩽300 μm) in the upper respiratory tract. Results indicate that planar shear significantly impacts droplet heat and mass transfer for shear-based Reynolds numbers greater than 1, which occur for near-wall respiratory aerosols with diameters in excess of 50 μm. Wall proximity is shown to significantly enhance heat and mass transfer due to conduction and diffusion at separation distances less than five particle diameters and for small Reynolds numbers. For the Reynolds number conditions of interest, significant non-linear effects arise due to the concurrent interaction of uniform flow and shear such that linear superposition of Sherwood or Nusselt number terms is not allowable. Based on the validated numeric simulations, multivariable Sherwood and Nusselt number correlations are provided to account for individual flow characteristics and concurrent non-linear interactions of uniform flow, planar shear, and near-wall proximity. These heat and mass transfer correlations can be applied to effectively compute condensation and evaporation rates of potentially toxic or therapeutic aerosols in the upper respiratory tract, where non-uniform flow and wall proximity are expected to significantly affect droplet transport, deposition, and vapor formation. [Copyright &y& Elsevier]

The outbreak of the novel coronavirus disease (COVID-19) severely threatens the public health worldwide, but the transmission mechanism and the effectiveness of mitigation measures remain uncertain. Here we assess the role of airborne transmission in spreading the disease and the effectiveness of face covering in preventing inter-human transmission for the top-fifteen infected U.S. states during March 1 and May 18, 2020. For all fifteen states, the curve of total confirmed infections exhibits an initial sub-exponential growth and a subsequent linear growth after implementing social distancing/stay-at-home orders. The linearity extends one to two months for the six states without mandated face covering and to the onset of mandated face covering for the other nine states with this measure, reflecting a dynamic equilibrium between first-order transmission kinetics and intervention. For the states with mandated face covering, significant deviation from this linearity and curve flattening occur after the onset of this measure for seven states, with exceptions for two states. Most states exhibit persistent upward trends in the daily new infections after social distancing/stay-at-home orders, while reversed downward or slowing trends occur for eight states after implementing mandated face covering. The inadequacy of social distancing and stay-at-home measures alone in preventing inter-human transmission is reflected by the continuous linear growth in the total infection curve after implementing these measures, which is mainly driven by airborne transmission. We estimate that the number of the total infections prevented by face covering reaches ~252,000 on May 18 in seven states, which is equivalent to ~17% of the total infections in the nation. We conclude that airborne transmission and face covering play the dominant role in spreading the disease and flattening the total infection curve, respectively. Our findings provide policymakers and the public with compelling evidence that universal face covering, in conjunction with social distancing and hand hygiene, represents the maximal protection against inter-human transmission and the combination of these intervention measures with rapid and extensive testing as well as contact tracing is crucial in containing the COVID-19 pandemic., Competing Interests: Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper., (Copyright © 2020 Elsevier B.V. All rights reserved.)