Disclaimers before we get this started. The following is my opinion. This article has not been peer-reviewed. I am going to attempt to be said peer. A hat tip to the folks at the University of Nebraska Medical center who have looked into trying to determine if COVID-19, or SARS-CoV-2 (the virus that causes COVID-19) is airborne. They are working to find the answers to the questions we are all asking to take care of all of us. I encourage you to download the article for yourself and read it. There are many details I am intentionally going to gloss over. For additional content on COVID-19, CLICK HERE.
Airborne or droplet? That is the question.
This paper is quite concerning. Spoiler alert: they recommend the use of airborne isolation precautions.
n=13 confirmed COVID patients.
Some of these patients were hospitalized (NBU unit) and some of these patients were quarantined (NQU) either asymptomatic or with mild symptoms. They did the best they could to contain the virus regarding PPE, negative pressure, and the like. They obtained a total of 163 surface and air samples in these rooms combined. Those samples were analyzed by PCR methods.
77.3% of those samples were positive for SARS-CoV-2.
76.5% of all personal items were positive.
– Cell phones: 83.3% positive
– Toilets: 81% positive
– Remote controls: 64.7% positive
– Bedside tables and rails: 75% positive
– Window ledges (how did it get over there?!!?): 81.8% positive
Here’s the kicker, though
– Room air samples: 63.2% positive
– They stated a case where the sampler was greater than 6ft away from a patient who was on 1L NC and the sample was positive for COVID-19.
– The highest airborne concentrations noted on patients receiving nasal cannula. They mentioned that these patients hadn’t coughed. Again, they were not looking at any other modality of oxygenation.
– 66.7% of HALLWAY air samples had virus-containing particles. People going in and out of the rooms were carrying the airborne virus.
We are in deep poop, team.
I know the CDC and WHO are saying something different but that can they provide a similar study to this? Crickets.
-EJ
Aerosol and Surface Transmission Potential of SARS-CoV-2Joshua L Santarpia, Danielle N Rivera, Vicki Herrera, M. Jane Morwitzer, HannahCreager, George W. Santarpia, Kevin K Crown, David Brett-Major, ElizabethSchnaubelt, M. Jana Broadhurst, James V. Lawler, St. Patrick Reid, John J. LowemedRxiv 2020.03.23.20039446; doi:https://doi.org/10.1101/2020.03.23.20039446
Link to Abstract
Link to FULL FREE Article
ADDENDUM #1:
The World Health Organization has obtained the paper I referenced above as well as the study in the NEJM that I covered on 3/18/2020. Please read the document for yourself. I have provided links, as always. Please interpret this data yourself. Don’t trust me on whether COVID is airborne.
Regarding the NEJM study which concluded that the virus could be in the air up to three hours:
Their take: “the finding of COVID-19 virus in aerosol particles up to 3 hours does not reflect a clinical setting in which aerosol-generating procedures are performed—that is, this was an experimentally induced aerosol-generating procedure.”
My take: okay then, can you please give us some data as to how long we could expect it during clinical settings of aerosol-generating procedures to be in the room? Can we have some expert guidance?
Regarding the study I posted yesterday, 3/30.
The WHO provided citations for two studies, one published in JAMA (Ong study) and the other in Infection Control and Hospital Epidemiology to disprove the Santarpia study on why COVID is or isn’t airborne.
Their take: “It is important to note that the detection of RNA in environmental samples based on PCR-based assays is not indicative of viable virus that could be transmissible. Further studies are needed to determine whether it is possible to detect COVID-19 virus in air samples from patient rooms where no procedures or support treatments that generate aerosols are ongoing. As evidence emerges, it is important to know whether viable virus is found and what role it may play in transmission.”
My take: since we don’t know with reasonable certainty, then we should err on the side of caution and protect our teams.
Here are the two studies cited by WHO as to why it is NOT airborne.
Ong study: sampled 3 patients, the one who was the sickest noted the virus in the air outlet fans (airborne infection isolation rooms). Per the article, this suggests “that small virus-laden droplets may be displaced by airflows and deposited on equipment such as vents”. The limitation stated by the authors includes that “the volume of air sampled represents only a small fraction of total volume, and air exchanges in the room would have diluted the presence of SARS-CoV-2 in the air. Further studies are required to confirm these preliminary results.” In this study they also found the virus on the shoe of a physician.
My take: Hardly concrete not definitive.
Cheng study: “air samples were all undetectable for SARS-CoV-2 RNA when the patients were performing 4 different maneuvers (normal breathing, deep breathing, speaking 1, 2, and 3 continuously, and coughing continuously) while putting on and putting off the surgical mask.”
It seems based on the discussion that they did this on only ONE patient. They state “we may not be able to make a definite conclusion based on the analysis of a single patient”.
My take: inconclusive.
My understanding is that a viral culture is needed to assess viability rather than PCR. Neither of these studies looked at viral cultures. WHO, can you get this for us?
Citations:
WHO Commentary on Transmission Modalities
Cheng V, Wong S-C, Chen J, Yip C, Chuang V, Tsang O, et al. Escalating infection control response to the rapidly evolving epidemiology of the Coronavirus disease 2019 (COVID-19) due to SARS-CoV-2 in Hong Kong. Infect Control Hosp Epidemiol. 2020 Mar 5 [Epub ahead of print].
Link to Abstract
Link to FULL FREE PDF
Ong SW, Tan YK, Chia PY, Lee TH, Ng OT, Wong MS, et al. Air, surface environmental, and personal protective equipment contamination by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from a symptomatic patient. JAMA. 2020
Link to FULL FREE Article
FINAL ADDENDUM! I WAS RIGHT about COVID being transmitted airborne.
The CDC has FINALLY come out and said that COVID is airborne. I have only been saying this since March.
“It is possible that COVID-19 may spread through the droplets and airborne particles that are formed when a person who has COVID-19 coughs, sneezes, sings, talks, or breathes.“
Link
ADDENDUM AGAIN on 9/21. The CDC has changed their site removing claims that it is airborne!
Medical misinformation is out there. No doubt about it. Is it a good thing? Absolutely not. But can you blame the lay folks who don’t “trust the science” when the bodies that are supposed to be the absolute authorities, the CDC and WHO, have lost their credibility during this pandemic with numerous examples to reference?
Case in point is this post. I hate saying I was right because, like a broken clock, I’m only right twice a day. But back in March some studies (broken down on my website) demonstrated that COVID was airborne. I took apart these studies and disagreed with the initial recommendations that it was only droplet. At least call it aerosolized, right? The CDC and WHO cited some of lackluster papers and explanations as to why it wasn’t airborne. I personally wasn’t convinced. My point was, let’s call it airborne and treat it as such until we have further data. Better be safe than sorry, right? For whatever reasons, they kept their recommendations. We can discuss that in the comments section.
On 9/18/20, the CDC released their most recent guidance on the matter where they stated “It is possible that COVID-19 may spread through the droplets and airborne particles that are formed when a person who has COVID-19 coughs, sneezes, sings, talks, or breathes.”
Thank goodness I screenshotted it because it now nowhere to be found.
They changed their stance YET AGAIN from airborne on 9/21. Check out their rationale and don’t trust me. “A draft version of proposed changes to these recommendations was posted in error to the agency’s official website.” Draft version? This means you’re thinking about it, right? Thinking about it so hard that you accidentally posted it on the CDC website for 3 days before you took it down, right? Why don’t we, once again, be safe rather than sorry and just call this airborne?
This is only leading to mistrust “in the science”. I know science is imperfect and evolving. But let’s be damned serious now, why don’t we have the answer for this yet? I’ve already ranted that we spend billions of taxpayer dollars with the NIH and we don’t have this simple (explicative that starts with an F and ends with -ing) answer?
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