Search

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and resulting COVID-19 (coronavirus disease 2019) pandemic have required mass diagnostic testing, often taking place in testing sites within hospitals, clinics, or at satellite locations. To establish the potential of SARS-CoV-2 aerosol transmission and to identify junctures during testing that result in increased viral exposure, aerosol and surface samples were examined for the presence of SARS-CoV-2 RNA from locations within Nebraska Medicine COVID-19 testing and vaccine clinics. Aerosols containing SARS-CoV-2 RNA detected within clinics suggest viral shedding from infected individuals. SARS-CoV-2 RNA detection in aerosol samples was shown to correlate with clinic operation and patient infection, as well as with community infection findings. Additionally, SARS-CoV-2 RNA was detected in surface samples collected from clinics. The presence of SARS-CoV-2 RNA in aerosols in these clinics supports the continued use of respiratory protection and sanitization practices for healthcare workers, and other workers with public facing occupations.

Background Aerosol transmission of COVID-19 is the subject of ongoing policy debate. Characterizing aerosol produced by people with COVID-19 is critical to understanding the role of aerosols in transmission. Objective We investigated the presence of virus in size-fractioned aerosols from six COVID-19 patients admitted into mixed acuity wards in April of 2020. Methods Size-fractionated aerosol samples and aerosol size distributions were collected from COVID-19 positive patients. Aerosol samples were analyzed for viral RNA, positive samples were cultured in Vero E6 cells. Serial RT-PCR of cells indicated samples where viral replication was likely occurring. Viral presence was also investigated by western blot and transmission electron microscopy (TEM). Results SARS-CoV-2 RNA was detected by rRT-PCR in all samples. Three samples confidently indicated the presence of viral replication, all of which were from collected sub-micron aerosol. Western blot indicated the presence of viral proteins in all but one of these samples, and intact virions were observed by TEM in one sample. Significance Observations of viral replication in the culture of submicron aerosol samples provides additional evidence that airborne transmission of COVID-19 is possible. These results support the use of efficient respiratory protection in both healthcare and by the public to limit transmission.

Key Points Question Does weekly testing of kindergarten through 12th grade students and staff improve detection of SARS-CoV-2 infection and understanding of the epidemiology of SARS-CoV-2 in urban public school settings? Findings In this quality improvement study, weekly school-based saliva polymerase chain reaction testing at 3 urban public schools was associated with increased case detection among staff and students compared with symptom-based strategies, exceeding county-level case rates. SARS-CoV-2 was detected in school wastewater samples each week as well as air and surface samples from choir classrooms. Meaning This study suggests that routine SARS-CoV-2 testing may identify infected staff and students who are not identified through conventional case detection and may provide insight into disease burdens of undertested communities., Importance Scalable programs for school-based SARS-CoV-2 testing and surveillance are needed to guide in-person learning practices and inform risk assessments in kindergarten through 12th grade settings. Objectives To characterize SARS-CoV-2 infections in staff and students in an urban public school setting and evaluate test-based strategies to support ongoing risk assessment and mitigation for kindergarten through 12th grade in-person learning. Design, Setting, and Participants This pilot quality improvement program engaged 3 schools in Omaha, Nebraska, for weekly saliva polymerase chain reaction testing of staff and students participating in in-person learning over a 5-week period from November 9 to December 11, 2020. Wastewater, air, and surface samples were collected weekly and tested for SARS-CoV-2 RNA to evaluate surrogacy for case detection and interrogate transmission risk of in-building activities. Main Outcomes and Measures SARS-CoV-2 detection in saliva and environmental samples and risk factors for SARS-CoV-2 infection. Results A total of 2885 supervised, self-collected saliva samples were tested from 458 asymptomatic staff members (mean [SD] age, 42.9 [12.4] years; 303 women [66.2%]; 25 Black or African American [5.5%], 83 Hispanic [18.1%], 312 White [68.1%], and 35 other or not provided [7.6%]) and 315 students (mean age, 14.2 [0.7] years; 151 female students [48%]; 20 Black or African American [6.3%], 201 Hispanic [63.8%], 75 White [23.8%], and 19 other race or not provided [6.0%]). A total of 46 cases of SARS-CoV-2 (22 students and 24 staff members) were detected, representing an increase in cumulative case detection rates from 1.2% (12 of 1000) to 7.0% (70 of 1000) among students and from 2.1% (21 of 1000) to 5.3% (53 of 1000) among staff compared with conventional reporting mechanisms during the pilot period. SARS-CoV-2 RNA was detected in wastewater samples from all pilot schools as well as in air samples collected from 2 choir rooms. Sequencing of 21 viral genomes in saliva specimens demonstrated minimal clustering associated with 1 school. Geographical analysis of SARS-CoV-2 cases reported district-wide demonstrated higher community risk in zip codes proximal to the pilot schools. Conclusions and Relevance In this study of staff and students in 3 urban public schools in Omaha, Nebraska, weekly screening of asymptomatic staff and students by saliva polymerase chain reaction testing was associated with increased SARS-CoV-2 case detection, exceeding infection rates reported at the county level. Experiences differed among schools, and virus sequencing and geographical analyses suggested a dynamic interplay of school-based and community-derived transmission risk. Collectively, these findings provide insight into the performance and community value of test-based SARS-CoV-2 screening and surveillance strategies in the kindergarten through 12th grade educational setting., This quality improvement study characterizes SARS-CoV-2 infections in staff and students in an urban public school setting and evaluates test-based strategies to support ongoing risk assessment and mitigation for kindergarten through 12th grade in-person learning.

ImportanceScalable programs for school-based SARS-CoV-2 testing and surveillance are needed to guide in-person learning practices and inform risk assessments in K-12 settings.ObjectivesTo characterize SARS-CoV-2 infections in staff and students in an urban public school setting and evaluate test-based strategies to support ongoing risk assessment and mitigation for K-12 in-person learning.Design, Setting, and ParticipantsThe pilot program engaged three schools for weekly saliva PCR testing of staff and students participating in in-person learning over a 5-week period. Wastewater, air, and surface samples were collected weekly and tested for SARS-CoV-2 RNA to determine surrogacy for case detection and interrogate transmission risk of in-building activities.Main Outcomes and MeasuresSARS-CoV-2 detection in saliva and environmental samples and risk factors for SARS-CoV-2 infection.Results2,885 supervised self-collected saliva samples were tested from 773 asymptomatic staff and students during November and December, 2020. 46 cases (22 students, 24 staff) were detected, representing a 5.8- and 2.5-fold increase in case detection rates among students and staff, respectively, compared to conventional reporting mechanisms. SARS-CoV-2 RNA was detected in wastewater samples from all pilot schools, as well as in air samples collected from two choir rooms. Sequencing of 21 viral genomes in saliva specimens demonstrated minimal clustering associated with one school. Geographic analysis of SARS-CoV-2 cases reported district-wide demonstrated higher community risk in zip codes proximal to the pilot schools.Conclusions and RelevanceWeekly screening of asymptomatic staff and students by saliva PCR testing dramatically increased SARS-CoV-2 case detection in an urban public-school setting, exceeding infection rates reported at the county level. Experiences differed among schools, and virus sequencing and geographic analyses suggest a dynamic interplay of school-based and community-derived transmission risk. Environmental testing for SARS-CoV-2 RNA in air and surface samples enabled real-time risk assessment of in-school activities and allowed for interventions in choir classes. Wastewater testing demonstrated the utility of school building-level SARS-CoV-2 surveillance. Collectively, these findings provide insight into the performance and community value of test-based SARS-CoV-2 screening and surveillance strategies in the K-12 educational setting.KEY POINTSQuestionDo test-based programs reduce SARS-CoV-2 risk in K-12 schools?FindingsWeekly school-based saliva PCR testing at three urban public schools doubled case detection among staff and students over symptom-based strategies, exceeding county-level case rates. SARS-CoV-2 was detected in school wastewater samples each week, as well as air and surface samples related to choir classrooms.MeaningRoutine SARS-CoV-2 testing removes infected staff and students from school who are not identified through conventional case detection. With rigorous infection control and environmental monitoring, this helps mitigate risk during school operations. Furthermore, screening in K-12 schools may provide insight into disease burdens of undertested communities.

The COVID-19 pandemic has reintroduced questions regarding the potential risk of SARS-CoV-2 exposure amongst passengers on an aircraft. Quantifying risk with computational fluid dynamics models or contact tracing methods alone is challenging, as experimental results for inflight biological aerosols is lacking. Using fluorescent aerosol tracers and real time optical sensors, coupled with DNA-tagged tracers for aerosol deposition, we executed ground and inflight testing on Boeing 767 and 777 airframes.Analysis here represents tracer particles released from a simulated infected passenger, in multiple rows and seats, to determine the exposure risk via penetration into breathing zones in that row and numerous rows ahead and behind the index case. We completed over 65 releases of 180,000,000 fluorescent particles from the source, with 40+ Instantaneous Biological Analyzer and Collector sensors placed in passenger breathing zones for real-time measurement of simulated virus particle penetration.Results from both airframes showed a minimum reduction of 99.54% of 1 µm aerosols from the index source to the breathing zone of a typical passenger seated directly next to the source. An average 99.97 to 99.98% reduction was measured for the breathing zones tested in the 767 and 777, respectively. Contamination of surfaces from aerosol sources was minimal, and DNA-tagged 3 µm tracer aerosol collection techniques agreed with fluorescent methodologies.

Introduction As a result of the COVID-19 pandemic and highly contagious nature of SARS-CoV-2, emergency departments (EDs) have been forced to implement new measures and protocols to minimize the spread of the disease within their departments. The primary objective of this study was to determine if the implementation of a designated COVID-19 cohort area (hot zone) within a busy ED mitigated the dissemination of SARS-CoV-2 throughout the rest of the department. Methods In an ED of a tertiary academic medical center, with 64,000 annual visits, an eight room pod was designated for known COVID-19 or individuals with high suspicion for infection. There was a single entry and exit for donning and doffing personal protective equipment (PPE). Health care workers (HCW) changed gowns and gloves between patients, but maintained their N-95 mask and face shield, cleaning the shield with a germicidal wipe between patients. Staffing assignments designated nurses and technicians to remain in this area for 4 h, where physicians regularly moved between the hot zone and rest of the ED. Fifteen surface samples and four air samples were taken to evaluate SARS-CoV-2 contamination levels and the effectiveness of infection control practices. Samples were collected outside of patient rooms in 3 primary ED patient care areas, the reception area, the primary nurses station, inside the cohort area, and the PPE donning and doffing areas immediately adjacent. Samples were recovered and analyzed for the presence of the E gene of SARS-CoV-2 using RT-PCR. Results SARS-CoV-2 was not detected on any surface samples, including in and around the cohort area. All air samples outside the COVID-19 hot zone were negative for SARS-CoV-2, but air samples within the cohort area had a low level of viral contamination. Conclusion A designated COVID-19 cohort area resulted in no air or surface contamination outside of the hot zone, and only minimal air, but no surface contamination, within the hot zone.

As the world recovers from the lockdown imposed by the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) pandemic, returning to shared indoor spaces is considered a formidable risk. It is now clear that transmission of SARS-CoV-2 is driven by respiratory microdroplets expelled by infected persons, which can become suspended in the air. Several layering technologies are being explored to mitigate indoor transmission in the hopes of re-opening business, schools and transportation systems. Here we coupled the water adsorptive and photocatalytic capacity of novel Metal Organic Frameworks (MOFs) to demonstrate the capture and inactivation of SARS-CoV-2. Discussion is given on the methods of analysis and the differences between the photocatalytic activity of several MOFs, and the difference between MOF induced photocatalysis and ultra violet photolysis of SARS-CoV-2. Our results are intended to provide support to industry looking for alternative methods secure indoor spaces.

Study Objectives: Over 90,000 health care workers worldwide have been infected with SARS-CoV-2 In response to the COVID-19 pandemic, emergency departments (EDs) implemented new measures to minimize the spread of the disease within their patient care areas The primary objective of this study was to determine if SARS-CoV-2 viral particles were present on surfaces or in the air, in a designated COVID-19 cohort area, or ‘hot zone ’ Secondary analysis involved testing for viral particles in others areas of the ED outside of the ‘hot zone ’ Methods: This study took place in the ED of a tertiary academic medical center, with approximately 64,000 annual visits We designated a pod of 8 rooms for known COVID-19 infection or individuals with high suspicion for infection The area consisted of a single entry (Personal protective equipment donning area) and exit (PPE doffing area) Health workers would change gowns and gloves between patients, but maintain their N-95 mask and face shield, after cleaning with a germicidal wipe Fifteen surface samples and four air samples were taken in the ED to evaluate SARS-CoV-2 contamination levels and the effectiveness of infection control practices Samples were collected outside of patient rooms in 3 primary areas, the reception area, the primary nurses station, inside the cohort area, and the PPE donning and doffing areas immediately adjacent The 15 surface samples were collected using 3x3 sterile gauze pads pre-wetted with 3 mL of phosphate buffered saline (PBS), over an approximately 100 cm2 area by wiping in an “S” pattern in 2 directions Stationary air samples were collected using a Sartorius Airport MD8 air sampler operating at 30 liters per minute for 30 minutes onto an 80mm gelatin filter All samples were recovered in sterile PBS, had RNA extracted and were analyzed for the presence of SARS-CoV-2 by RT-PCR targeting the E gene of SARS-CoV-2 Results: SARS-CoV-2 was not detected on any surface samples collected in the ED All air samples outside the COVID-19 hot zone were also negative for SARS-CoV-2 The air samples from inside the cohort area had a low level of viral contamination, but no surface samples in or around the cohort area showed any indication of viral contamination These data suggest that despite having a large influx of COVID-19 patients on the day of sampling, the infection control practices were sufficient to either prevent or eliminate surface contamination The positive air sample from the cohort area suggests that respiratory protection with an N-95 respirator inside the cohort area, even outside of patient rooms is warranted to adequately protect health care providers Conclusion: A designated COVID-19 cohort area resulted in no air or surface contamination outside of the hot zone, and only minimal air, but no surface contamination, within the hot zone

An amendment to this paper has been published and can be accessed via a link at the top of the paper.

The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) originated in Wuhan, China in late 2019, and its resulting coronavirus disease, COVID-19, was declared a pandemic by the World Health Organization on March 11, 2020. The rapid global spread of COVID-19 represents perhaps the most significant public health emergency in a century. As the pandemic progressed, a continued paucity of evidence on routes of SARS-CoV-2 transmission has resulted in shifting infection prevention and control guidelines between classically-defined airborne and droplet precautions. During the initial isolation of 13 individuals with COVID-19 at the University of Nebraska Medical Center, we collected air and surface samples to examine viral shedding from isolated individuals. We detected viral contamination among all samples, supporting the use of airborne isolation precautions when caring for COVID-19 patients.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission causing coronavirus disease 2019 (COVID-19) may occur through multiple routes. We collected aerosol samples around six patients admitted into mixed acuity wards in April of 2020 to identify the risk of airborne SARS-CoV-2. Measurements were made to characterize the size distribution of aerosol particles, and size-fractionated, aerosol samples were collected to assess the presence of infectious virus in particles sizes of >4.1 µm, 1-4 µm, and 4.1 µm, 1-4 µm, and

We describe a second case of human infection caused by Thelazia gulosa (the cattle eye worm), likely acquired in California. For epidemiologic purposes, it is important to identify all Thelazia recovered from humans in North America to the species level.

Although not always the first topic discussed when preparing for a bioemergency, the availability of a competent clinical laboratory is vital for the optimal care of a patient with a risk group 4 (RG-4) high-consequence pathogen. The recent development of highly specialized facilities in the United States to assess and treat patients with highly hazardous communicable diseases has led to the design of dedicated laboratories or the redesign of laboratory space to safely process and test specimens that might contain one of these pathogens. For frontline and other acute care facilities to be prepared, safety practices need to be assessed and reviewed as necessary as pertaining to all laboratory activities, to include the pre-analytical (specimen collection and processing), analytical (specimen testing), and post-analytical (specimen disposal/waste management and reporting) processes. Laboratorians and administrative personnel need to consider the risks in handling specimens containing these pathogens and subsequently develop or revise processes to mitigate risks. In addition, issues such as scalability to handle large volume testing, the availability of trained staff, and long-term sustainability to meet the requirements of regulatory agencies need to be adopted within a fiscally responsible budget setting. This chapter provides generalized information on how clinical laboratories, from those supporting small frontline medical facilities to highly specialized laboratories supporting acute care treatment centers, can safely manage specimens from a patient known or potentially infected with a high-consequence pathogen.

Beginning in 2003, the Nebraska Medical Center in Omaha developed a laboratory capability plan in conjunction with the creation of a biocontainment unit (BCU) for treatment of patients harboring emerging infectious organisms. The laboratory response planning involved experts at the Nebraska Public Health

Four isolates of Klebsiella pneumoniae obtained from patients at a Maryland medical centre exhibited reduced susceptibility to carbapenems and were found to produce the novel, class A, plasmid-mediated, carbapenem-hydrolysing enzyme, KPC-2. This enzyme has 99% identity with the plasmid-mediated, carbapenem-hydrolysing enzyme KPC-1, reported previously in a North Carolina K. pneumoniae isolate. The KPC-2-producing isolates were either susceptible or intermediate to imipenem and meropenem, unlike the KPC-1-producing isolate, which was resistant to these agents. Detection of KPC-2 may be a problem for clinical laboratories because in this study it was associated with positive extended-spectrum beta-lactamase (ESBL) confirmation tests (clavulanate-potentiated activities of ceftriaxone, ceftazidime, cefepime and aztreonam). Therefore, a failure to recognize the significance of reduced carbapenem susceptibility in the isolates that remained susceptible to imipenem or meropenem could have resulted in the isolates being incorrectly identified as ESBL producers.