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Breath-, air- and surface-borne SARS-CoV-2 in hospitals.

ABSTRACT: The COVID-19 pandemic has brought an unprecedented crisis to the global health sector. When discharging COVID-19 patients in accordance with throat or nasal swab protocols using RT-PCR, the potential risk of reintroducing the infection source to humans and the environment must be resolved. Here, 14 patients including 10 COVID-19 subjects were recruited; exhaled breath condensate (EBC), air samples and surface swabs were collected and analyzed for SARS-CoV-2 using reverse transcription-polymerase chain reaction (RT-PCR) in four hospitals with applied natural ventilation and disinfection practices in Wuhan. Here we discovered that 22.2% of COVID-19 patients (n = 9), who were ready for hospital discharge based on current guidelines, had SARS-CoV-2 in their exhaled breath (~10⁵ RNA copies/m³). Although fewer surface swabs (3.1%, n = 318) tested positive, medical equipment such as face shield frequently contacted/used by healthcare workers and the work shift floor were contaminated by SARS-CoV-2 (3-8 viruses/cm²). Three of the air samples (n = 44) including those collected using a robot-assisted sampler were detected positive by a digital PCR with a concentration level of 9-219 viruses/m³. RT-PCR diagnosis using throat swab specimens had a failure rate of more than 22% in safely discharging COVID-19 patients who were otherwise still exhaling the SARS-CoV-2 by a rate of estimated ~1400 RNA copies per minute into the air. Direct surface contact might not represent a major transmission route, and lower positive rate of air sample (6.8%) was likely due to natural ventilation (1.6-3.3 m/s) and regular disinfection practices. While there is a critical need for strengthening hospital discharge standards in preventing re-emergence of COVID-19 spread, use of breath sample as a supplement specimen could further guard the hospital discharge to ensure the safety of the public and minimize the pandemic re-emergence risk.

SUBMITTER: Zhou L

PROVIDER: S-EPMC7557302 | biostudies-literature | 2021 Feb

REPOSITORIES: biostudies-literature

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Breath-, air- and surface-borne SARS-CoV-2 in hospitals.

Zhou Lian L Yao Maosheng M Zhang Xiang X Hu Bicheng B Li Xinyue X Chen Haoxuan H Zhang Lu L Liu Yun Y Du Meng M Sun Bochao B Jiang Yunyu Y Zhou Kai K Hong Jie J Yu Na N Ding Zhen Z Xu Yan Y Hu Min M Morawska Lidia L Grinshpun Sergey A SA Biswas Pratim P Flagan Richard C RC Zhu Baoli B Liu Wenqing W Zhang Yuanhang Y

Journal of aerosol science 20201015

The COVID-19 pandemic has brought an unprecedented crisis to the global health sector. When discharging COVID-19 patients in accordance with throat or nasal swab protocols using RT-PCR, the potential risk of reintroducing the infection source to humans and the environment must be resolved. Here, 14 patients including 10 COVID-19 subjects were recruited; exhaled breath condensate (EBC), air samples and surface swabs were collected and analyzed for SARS-CoV-2 using reverse transcription-polymerase ...[more]

PMID: 33078030

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Project description:BackgroundFrom a public health perspective, the identification of individuals with mild respiratory symptoms due to SARS-CoV-2 infection is important to contain the spread of the disease. The objective of this study was to identify volatile organic compounds (VOCs) in exhaled breath common to infection with different variants of the SARS-CoV-2 virus to inform the development of a point-of-care breath test to detect infected individuals with mild symptoms.MethodsA prospective, real-world, observational study was conducted on mildly symptomatic out-patients presenting to community test-sites for RT-qPCR SARS-CoV-2 testing when the Alpha, Beta, and Delta variants were driving the COVID-19 pandemic. VOCs in exhaled breath were compared between PCR-positive and negative individuals using TD-GC-ToF-MS. Candidate VOCs were tested in an independent set of samples collected during the Omicron phase of the pandemic.FindingsFifty breath samples from symptomatic RT-qPCR positive and 58 breath samples from test-negative, but symptomatic participants were compared. Of the 50 RT-qPCR-positive participants, 22 had breath sampling repeated 8-12 weeks later. PCA-X model yielded 12 distinct VOCs that discriminated SARS-CoV-2 active infection compared to recovery/convalescence period, with an area under the receiver operator characteristic curve (AUROC), of 0.862 (0.747-0.977), sensitivity, and specificity of 82% and 86%, respectively. PCA-X model from 50 RT-qPCR positive and 58 negative symptomatic participants, yielded 11 VOCs, with AUROC of 0.72 (0.604-0.803) and sensitivity of 72%, specificity 65.5%. The 11 VOCs were validated in a separate group of SARS-CoV-2 Omicron positive patients' vs healthy controls demonstrating an AUROC of 0.96 (95% CI 0.827-0.993) with sensitivity of 80% specificity of 90%.InterpretationExhaled breath analysis is a promising non-invasive, point-of-care method to detect mild COVID-19 infection.FundingFunding for this study was a competitive grant awarded from the Vancouver Coastal Research Institute as well as funding from the BC Cancer Foundation.

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Breath-, air- and surface-borne SARS-CoV-2 in hospitals.

Publications

Breath-, air- and surface-borne SARS-CoV-2 in hospitals.

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