COVID-19 Resources by Topic
The COVID-19 pandemic is a major health crisis straining the healthcare system and affecting us all. The IARS is committed to supporting our members who are addressing this illness on the front lines in any way we can.
IARS has assembled a content base with the latest peer-reviewed articles on COVID-19 from leading medical journals, sorted by topic and chronologically. In the COVID-19 Resource Newsletter healthcare professionals on the frontlines are given access to global peer experiences and education from publications hand-selected and reviewed by the IARS COVID-19 Scientific Advisory Board. All of these articles are openly available without login.
Click on a phrase below to see resources on that topic. To search by keyword, select Ctrl + F on a PC and Command + F on a Mac. Then, enter keyword and Enter.
IV. Infection Control
December 6, 2021
- The removal of airborne SARS-CoV-2 and other microbial bioaerosols by air filtration on COVID-19 surge units. 10/30/21. Conway Morris A. Clin Infect Dis.
A British COVID-19 surge ward and an ICU surge unit that were ventilated with 2-4 air changes/hour at baseline were equipped with HEPA filtration + UV sterilization units that circulated 5-10 room-volumes/hour. Air sampling was done using National Institute for Occupational Safety and Health BC 251 two-stage cyclone aerosol samplers and analyzed for SARS-CoV-2 with PCR testing. On the ward, sampling revealed SARS-CoV-2 by PCR on most days during the two weeks without operation of the HEPA/UV units, however none during daily sampling during the week with the unit operating. In contrast to the ward, in the ICU limited evidence of airborne SARS-CoV-2 was found with the filter off, and only a single sample was positive with the filter on. Ten other pathogens that were detected at baseline were also nearly absent during filtration. The authors conclude that air HEPA/UV filtration and sterilization may reduce the risk of COVID-19 and other disease transmission in hospitals.
November 22, 2021
- Bain H: Innovative Modification of Bain Circuit for the Resuscitation and Transportation of Patients With Coronavirus Disease 2019. 10/21/21. Jain A. A A Pract.
The author provides a practical solution for transportation and resuscitation of COVID-19 patients with an innovative modified breathing circuit to decrease healthcare worker exposure from droplets and airborne contamination. The authors termed this modified breathing circuit as the Bain H circuit, where “H” stands for high efficiency particulate air (HEPA) filter which contains exhalation contaminants and accommodates high-flow circuit requirements. The article is accompanied with helpful illustrations.
SAB Comment: The conventional Bain circuit = coaxial modification of the Mapleson D system.
September 13, 2021
- Hospital admission and emergency care attendance risk for SARS-CoV-2 delta (B.1.617.2) compared with alpha (B.1.1.7) variants of concern: a cohort study. 8/27/21. Twohig KA. Lancet Infect Dis.
All English National Health System patients diagnosed with COVID-19 by PCR from March 29 – May 23, 2021, and found by whole-genome sequencing to have alpha or delta variants, were studied. Delta grew from 0.1% to 45.8% during the study. The adjusted risk (aHR) of an emergency care visit or hospital admission within 14 days of a first positive test was 1.45 in those with delta (n=8,682) compared with alpha (n=34,656). For hospital admission, aHR for delta vs. alpha was 2.26. Median age was 31 years old; 74% were unvaccinated in both variant groups. Patients seen in emergency care or admitted on the day of their first COVID-positive test were excluded to reduce bias of screening tests at the time of presentation for non-COVID related illness.
March 24, 2021
- SARS-CoV-2 infection, COVID-19 and timing of elective surgery: A multidisciplinary consensus statement on behalf of the Association of Anaesthetists, the Centre for Peri-operative Care, the Federation of Surgical Specialty Associations, the Royal College of Anaesthetists and the Royal College of Surgeons of England. 3/18/21. El-Boghdadly K. Anaesthesia.
This consensus statement uses evidence from a systematic review and expert opinion to highlight key principles in the timing of surgery. Elective surgery should not be scheduled within 7 weeks of a diagnosis of SARS‐CoV‐2 infection unless the risks of deferring surgery outweigh the risk of postoperative morbidity or mortality associated with COVID‐19. Patients with persistent symptoms of COVID‐19 are at increased risk of postoperative morbidity and mortality even after 7 weeks. Vaccination several weeks before surgery will reduce risk to patients and might lessen the risk of nosocomial SARS‐CoV‐2 infection of other patients and staff.
March 12, 2021
- Association of State-Issued Mask Mandates and Allowing On-Premises Restaurant Dining with County-Level COVID-19 Case and Death Growth Rates — United States, March 1–December 31, 2020. 3/5/21. Guy GP. MMWR Morb Mortal Wkly Rep.
During March 1-December 31, 2020, state-issued mask mandates applied in 2,313 (73.6%) of the 3,142 U.S. counties. Mandating masks was associated with a decrease in daily COVID-19 case and death growth rates within 20 days of implementation. During the study period, states allowed restaurants to reopen for on-premises dining in 3,076 (97.9%) U.S. counties. This was associated with an increase in daily COVID-19 case growth rates 41–100 days after implementation and an increase in daily death growth rates 61–100 days after implementation. The study did not distinguish between indoor and outdoor on-premises dining.
March 10, 2021
- The Answer to the Silent “Super Spreader”: An Innovative Way to Manage Chest Drains on Coronavirus Patients With Active Air Leaks. 3/8/21. Angeles C. A A Pract.
In this brief and well-illustrated report, authors propose an innovative mechanism to minimize potential aerosolization of SARS-CoV-2 virus during transportation of patients with chest drains and an active air leak. The main venting of the drain is filtered with an adapted section of an endotracheal tube and airway viral filter while the positive pressure release valve is sealed with bone wax.
February 1, 2021
- Evaluation of N95 respirators, modified snorkel masks and low-cost powered air-purifying respirators: a prospective observational cohort study in healthcare workers. 1/20/2021. Clinkard D. Anaesthesia.
Authors used qualitative fit testing in 51 individuals to evaluate N95 FFR, and Snorkel masks adapted with high efficiency filters (>99%) or adapted with positive air purifying respirators. N95s failed one or more testing steps in 59%, and snorkel masks with high‐efficiency filters failed in 20% of participants. 24% and 12% failed overall fit factors, respectively. The snorkel masks with powered‐air purifying respirators had zero individual or overall failures.
- Repeated vaporised hydrogen peroxide disinfection of 3M 1860 N95 mask respirators does not degrade quantitative fit performance. 1/24/2021. Moschella P. Br J Anaesth.
Authors tested randomly selected 3M model 1860 N95 respirators, a widely available model, for fit and function after repeated vaporized hydrogen peroxide (VHP) sterilization. They found that fit and function were preserved after either 5 or 10 disinfection Bioquell VHP cycles. They used quantitative NIOSH fit testing involving talking and head movements in accordance with 29 Code of Federal Regulations 1910.134, utilising a TSI PortaCount® device.
January 19, 2021
- Stability of SARS-CoV-2 on critical personal protective equipment. 1/13/21. Kasloff SB. Nature Scientific Reports.
Persistence of viable virus was measured on eight PPE materials. Viable SARS-CoV-2 persisted for 21 days on plastic, 14 days on stainless steel, 7 days on nitrile gloves and 4 days on chemical resistant gloves, though at significantly reduced levels compared to the initial inoculum. Viable SARS-CoV-2 was nearly undetectable, but could still be recovered from N-95 and N-100 materials for up to 21 days. On 100% cotton, the virus underwent rapid degradation and was not detectable within 24 hours. These findings underline the importance of appropriate handling of contaminated PPE and a potential advantage of cotton.
SAB Comment: Many of the results in this study differ from other often-quoted reports. This is not surprising as experimental conditions including contaminating load, medium, ambient temperature and humidity have a large influence on the time viruses remain viable and vary among studies.
December 4, 2020
- SARS-CoV-2 analysis on environmental surfaces collected in an intensive care unit: keeping Ernest Shackleton’s spirit. 11/23/20. Escudero D. Intensive Care Med Exp.
This study analyzed environmental contamination by SARS-CoV-2 of surfaces in a Spanish intensive care unit dedicated exclusively to the care of patients with COVID-19 and equipped with negative pressure of – 10Pa and an air change rate of 20 cycles per hour. None of 102 surface samples collected at different times of day over 2 weeks were positive by RT-PCR nor did any of the 237 ICU workers become infected by the virus. The ICU was cleaned with detergent and sodium hypochlorite twice daily. Authors discuss the contrast with studies sampling surfaces in other institutions.
December 2, 2020
- Aerosol Retention Characteristics of Barrier Devices. 10/30/20. Fidler RL. Anesthesiology.
Investigators studied 6 barriers designed to protect health care professionals from potentially infectious aerosolized particles during airway interventions. Particle counters and mass spectrometry were used to evaluate particle spread following experimental aerosol generation and simulated cough. Performance varied widely, with closed devices performing best. Some increased exposure to the operator compared with no device. Addition of smoke evacuation techniques (e.g. suction) was also evaluated. All barriers should be used in conjunction with appropriate PPE.
An accompanying editorial discusses the importance of bioaerosol science to mitigate disease transmission in health care settings. Current experimental aerosol models remain imperfect surrogates for airborne viral disease transmission. Collaboration with bioaerosol scientists is lauded.
November 23, 2020
- Influence of room ventilation settings on aerosol clearance and distribution. 11/16/20. Sperna Weiland NH. Br J Anaesth.
This study from the Netherlands used actual hospital rooms and ventilation systems to measure the clearance of aerosols after a simulated aerosol generating procedure. Higher air exchange rates were much more effective than manipulating the pressure gradient (i.e. negative or positive pressure rooms). A freestanding air purification unit also markedly improved aerosol removal. In positive pressure rooms, small amounts of aerosol were detected in adjacent hallways. This information could be useful when deciding on the best location for aerosol-generating procedures in SARS-CoV-2 infected patients.
October 28, 2020
- Reusability of filtering facepiece respirators after decontamination through drying and germicidal UV irradiation. 10/22/2020. Vernez D. BMJ Glob Health.
A “drying cycle” (30 min, 70°C) plus 60 mJ/cm2 of UV-C irradiation (UVGI) effectively decontaminated 2 Staphylococcus aureus’ bacteriophages on 2 models of FFP2 disposable respirators (the European standard most similar to N95) with preserved functional characteristics after 10 cycles. (n=12) Testing included cultures, scanning electron microscopy, Fourier-transform infrared spectroscopy, 10–300 nm NaCl aerosol particle penetration, and visual inspection. 4 respirators treated with the heat alone showed complete decontamination of the phages however UVGI adds protection. H2O2 production during UVGI was observed. Respirators worn for 1 work shift showed slightly increased particle penetration. No fit testing reported.
October 19, 2020
- COVID-19 Transmission in US Child Care Programs. 10/1/20. Gilliam WS. Pediatrics.
This is an analysis of a survey completed in late May 2020 by 57,335 childcare providers from all 50 states that were asked about their exposure, their transmission mitigation efforts and whether or not they had ever tested positive for having COVID-19. While 427 (0.7%) of the respondents had tested positive, there was no association found between exposure to childcare and contracting COVID-19. The authors note that results may depend upon the mitigation efforts taken (outlined in the article) and on the relatively low prevalence rates across the United States at the time of the study. Transmission home to parents or siblings was not evaluated.
- The Effect of Temperature on Persistence of SARS-CoV-2 on Common Surfaces. 10/7/20. Riddel S. Virology.
In this study, SARS-CoV-2 viability was measured on polymer and paper bank notes, stainless steel, glass, vinyl and cotton cloth at 20, 30, and 40°C. High titer virus was applied, and samples stored in the dark at 50% relative humidity. Half-lives were a few days on all surfaces at 20°C and reduced to a few hours at 40°C. Hard surfaces support viable virus longer than absorbent ones. Some remained detectable for 28 days on nonabsorbent surfaces at ambient temperature. Fomite transmission may be more important than previously thought. Concerns regarding bank notes, touchscreens and mobile phones are of particular importance.
October 14, 2020
- Duration of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infectivity: When Is It Safe to Discontinue Isolation? 10/8/20. Rhee C. Clin Infect Dis.
In the review, SARS-CoV-2 is most contagious right before and immediately after symptom onset, and contagiousness rapidly decreases to near-zero about 10 days from symptom onset in mild-moderately ill patients and 15 days in critically ill and immunocompromised patients. The longest duration of viral viability reported is 20 days from symptom onset. Persistently positive SARS-CoV-2 RNA PCR does not indicate replication-competent virus and is not associated with contagiousness. Chain reaction assays that alternate between positive and negative results in recovered patients from COVID-19 most likely reflect sampling variability. The infection confers at least short-term immunity in most cases, but duration of immunity is unclear and several cases of re-infection have now been confirmed.
October 9, 2020
- Survival of SARS-CoV-2 and influenza virus on the human skin: Importance of hand hygiene in COVID-19. 10/3/20. Hirose R. Clin Infect Dis.
In this in vitro cadaveric skin model, and insert surfaces, these investigators noted that COVID viruses survive statistically significantly longer (8x) when compared with influenza virus. The authors found the virus can be completely inactivated within 15 seconds of exposure to 80% (w/w) ethanol. Thus, appropriate hand hygiene using ethanol-based disinfectants leads to rapid viral inactivation and may reduce the risk of contact infections. It should be noted that these studies were carried out at room temperature, which may allow longer viral viability compared with normal in vivo skin temperature.
September 23, 2020
- The role of fit testing N95/FFP2/FFP3 masks: a narrative review. 9/15/20. Regli A. Anaesthesia.
Fit testing confirms which respirator model provides adequate respiratory protection to an individual. Required to comply with respirator standards, fit testing is costly and not consistently performed. Quantitative fit testing is superior to qualitative fit testing; however, the tested respirator is discarded as it is punctured. Fit checking by the wearer is not a reliable substitute, although strongly recommended with each respirator donning. The role of potential aerosol transmission of SARS-CoV-2 is an area of active research and debate. N95 or higher-level protection is recommended for aerosol generating procedures.
September 16, 2020
- Facial Masking for Covid-19 — Potential for “Variolation” as We Await a Vaccine. 9/8/20. Gandhi M. N Engl J Med.
This opinion piece presents evidence that wearing a face mask may reduce the viral inoculum the wearer receives thereby reducing COVID-19 infection symptoms. Results from animal models and comparisons of outbreaks on cruise ships and in processing plants with and without mask use support conclusions. In addition to protecting others, masking may reduce the rate and severity of new infections for mask wearers.
September 14, 2020
- The Effect of Ultraviolet C Radiation Against Different N95 Respirators Inoculated with SARS-CoV-2. 8/28/20. Ozog DM. Int J Infect Dis.
This study from Michigan provides new data regarding the ability of ultraviolet (UV)-C to inactivate SARS-CoV-2 on specific N95 respirator models. A dose of 1.5 J/cm2 to each mask side was adequate for 3M 1860 and Moldex 1511. Straps of 3M 1860 required secondary decontamination. Three other models tested had residually detectable virus when cultured, confirming model-dependent heterogeneity and need for secondary strap decontamination found in previous studies. No fit testing was done. Implementation of UV-C decontamination of N95 respirators requires careful consideration of model, material type, design, and fit-testing following irradiation.
August 31, 2020
- Immune response to SARS-CoV-2 in health care workers following a COVID-19 outbreak: A prospective longitudinal study. 8/11/2020. Fill Malfertheiner S. J Clin Virol.
To continue the operation of German perinatology unit during the pandemic, the authors decided to study (complicated & sophisticated) longitudinally the immune response of 166 (RT PCR + Ve n= 31) health care workers for 8-12 weeks. The authors concluded that the immune response after a COVID-19 outbreak increases significantly over time but still approximately 22% of COVID-19 patients did not have a measurable serologic immune response within 60 days after symptoms. Additionally summarize that exposed co-workers did not develop any relevant IgG antibody levels over time. Meaning no silent seroconversion in HCW from diseased coworkers. IgA is not an adequate marker for long-term immunity. The HCW in the facility can be protected by the necessary measures that are taken fast and furiously with protective measures as neither immunity after infection nor herd immunity are reliable.
- Microwave- and Heat-Based Decontamination of N95 Filtering Facepiece Respirators: A Systematic Review. 8/24/2020. Gertsman S. J Hosp Infect.
This systematic review looked at data from 13 (2007-2020) reports involving heat or microwave-based decontamination of N95 respirators. Both 60-90°C heat and microwave methods were found generally effective to deactivate viral pathogens and maintain respirator fit and function. Higher heat and autoclave methods sometimes caused significant degradation. Firm conclusions difficult to reach due to heterogeneity of mask models, methods, and assessments as well as lack of real-world fit testing. No advice on number of cycles is reported. Monitoring of durability is strongly advised.
August 26, 2020
- What are the sources of exposure in healthcare personnel with coronavirus disease 2019 infection? 8/11/20. Zabarsky TF. Am J Infect Control.
In an analysis at the Cleveland VA Medical Center, 25% of healthcare personnel testing positive for SARS-CoV-2 had a higher-risk exposure at work and an additional 14% of infected personnel reported higher-risk exposures to family members or other infected individuals in the community. The issue was that in certain patients’ rooms where COVID-19 wasn’t suspected, they actually had the disease and nurses were exposed. Then, out in the community, not all wore masks. No cases occurred in personnel working on COVID-19 wards.
August 25, 2020
- Inactivation of SARS-CoV-2 and Diverse RNA and DNA Viruses on 3D Printed Surgical Mask Materials. 8/12/20. Welch JL. Infect Control Hosp Epidemiol.
In a step toward solutions for personal protective equipment (PPE) shortages, investigators tested viral disinfection methods on multiple 3D-printed materials. Complete inactivation of multiple viruses including SARS-CoV-2 was demonstrated with a single application of 10% bleach, quaternary ammonium sanitizer, 3% hydrogen peroxide or 70% isopropyl alcohol and exposure to heat (50°C, and 70°C). 70°C dry heat for 30 minutes completely inactivated all viruses tested. 70% isopropyl alcohol reduced viral titers significantly less well following a single application. Materials remained intact after 100 exposures.
August 7, 2020
- Reopening Primary Schools during the Pandemic. 7/29/20. Levinson M. N Engl J Med.
This is a narrative summary and commentary on the literature and debate around reopening primary schools in the US, written by educators and medical epidemiologists. Primary schools in many other countries have re-opened successfully for in-person classes, but that success hinged on low community transmission rates, and extensive testing and surveillance. The authors believe that there is time in the US to achieve successful reopening in some areas if resources and effort are increased. The argument is made that primary schools are essential services, and “whether (or how) to reopen primary schools is not just a scientific and technocratic question. It is also an emotional and moral one.”
- Reprocessing filtering facepiece respirators in primary care using medical autoclave: prospective, bench-to-bedside, single-centre study. 8/4/20. Harskamp RE. BMJ Open.
Dutch investigators studied standard autoclave machines for decontamination of FFP2 and FFP3 respirators. They found that one model of FFP2 (the closest European Standard to US N95 respirators) tolerated up to 3 decontamination cycles at 121°C x 17 min. without significant change in filtration, resistance, or fit. Others, including the tested FFP3 model (higher filtration), did not. Referenced published studies support efficacy of this temperature to kill SARS-CoV-2. This study corroborates great variation between mask models observed in other studies and the critical importance of careful fit testing with each donning when considering decontamination and reuse of filtering facepiece respirators.
July 22, 2020
- Association Between Universal Masking in a Health Care System and SARS-CoV-2 Positivity Among Health Care Workers. 7/14/20. Wang X. JAMA.
This research letter from the Mass General Brigham healthcare system reports an association between the requirement for universal masking for their healthcare workers and a reduction in their percent positive COVID-19 PCR test results during a period of time when the disease continued to increase in the general population. The decrease in healthcare worker infections could have been confounded by other interventions inside and outside of the health care system, such as restrictions on elective procedures, social distancing measures, and increased masking in public spaces. However, the authors contend these results support universal masking as part of a multi-pronged infection reduction strategy in healthcare settings.
July 15, 2020
- Factors affecting stability and infectivity of SARS-CoV-2. 7/6/20. Chan KH. J Hosp Infect.
Review by the SAB
Authors from a Chinese laboratory report the results of several (virus strain line, temperature, tissue infectivity dose, humidity, pH, etc.) experiments for the COVID-19 virus and its survival under different environmental situations. COVID-19 was able to retain viability for 3-5 days in dried form or 7 days in solution at room temperature, could be detected under a wide range of pH (2-13) conditions for several days and also 1-2 days in stool at room temperature but lost 5 logs infectivity. Common fixatives, nucleic acid extraction methods, and heat inactivation were found to significantly reduce viral infectivity. That will likely ensure hospital and laboratory safety during the COVID-19 pandemic but transmission related to food handlers and workers in meat and poultry processing facilities is possible. The presence of the virus on high-risk hospital surfaces should lead to concern about cleaning on other surfaces. It is estimated that 18% of infections are asymptomatic. With its propensity to cause milder infections, COVID-19 spreads more efficiently in communities in the absence of rigorous social distancing and environmental cleaning measures.
June 29, 2020
- Wearing an N95 Respiratory Mask: An Unintended Exercise Benefit? 6/1/20. Davis BA. Anesthesiology.
Review by the SAB
By Dr. Lydia Cassorla, on behalf of the SAB
The authors of this letter to the editor discuss the physiologic effects of N95 FFR use. They review data from previous studies, particularly one by Sinkule in 2013 that measured the potential physiologic effects of using an N95 respirator with and without a surgical mask in front of it. The data were generated using an automatic breathing and metabolic simulator. Effects are largely due to increased work of breathing due to the resistance of the respirator, and increased dead space ventilation. VD varies with mask design (folded models have more VD than molded models) and tidal volume (lower tidal volumes increase % VD). At 2 METs energy expenditure (~walking quietly) average inspired O2 is estimated to be 16.1-17.5% and CO2 is estimated to be 2.5-3.5%. With increased efforts and associated ventilation, minute ventilation increases, along with the work of breathing. However, effects of dead space decrease. Consequently, N95 users may experience multiple symptoms, even with minimal activity. Associated work of breathing and more marked thoracic pressure swings also generate cardiopulmonary training, a potential benefit.
June 5, 2020
- Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis
June 1. Chu DK. The Lancet.
Opinion from SAB Member: Dr. Barry Perlman
Meta-analysis published in Lancet and featured in the NYT 6/2/20 reporting that physical distancing > 1 m and use of face mask and eye protection decrease transmission of virus. However, a variety of issues limit the strength of their conclusions.
2 m distance was more effective than 1 m. As compared with no mask use, N95 or similar respirators were more effective than surgical or cotton masks in decreasing risk of infection. Of note, no intervention provided complete protection from infection. The authors suggest the findings from this review of 172 observational (44 comparative) studies from 16 countries regarding COVID-19, SARS, and MERS transmission can be used to guide protection policies for the public and health-care workers.
However, the analysis was based on non-randomized studies, most involved SARS and MERS, the impact of duration or setting (e.g. ward, ER, OR, ICU) of exposure was not addressed, most studies reported on bundled interventions, the need for appropriate fit and proper use of N95 masks to achieve maximum effectiveness was not considered, only three non-health-care setting studies were included, there was no direct effectiveness comparison of N95 or similar masks to surgical or cotton masks, and the conclusions were rated at a low to moderate degree of certainty.
Therefore, further research is required to determine optimal protection from COVID-19 infection, and which are most appropriate for health-care versus non-health-care settings.
May 16, 2020
- Considerations for Assessing Risk of Provider Exposure to SARS-CoV-2 after a Negative Test. May 8. Long. Anesthesiology.
Decisions will need to be made about how to address airway management and degree of PPE going forward. This is a discussion of the statistical methods necessary to predict the risk of exposure of an anesthesiologist to SARS-CoV-2 if a patient has had a single negative test. The authors discuss the factors including prevalence in the population, volume of surgery, and degree of risk tolerance in the face of uncertainty. They suggest that policies should place a priority on a low threshold of negative predictive value and argue for universal airborne precautions, irrespective of preoperative test results.
- The electronic medical record and COVID-19: is it up to the challenge?
May 2. Pryor. American Journal of Infection Control.
Opinion from SAB Member: Dr. Barry Perlman
This is a discussion of existing EMR barriers during the COVID-19 pandemic. Currently, hospital infection prevention (IP) teamwork and communication with caregivers and other hospital staff involve too many manual processes. Identified areas in need of more EMR assisted automation include: notification and identification of suspected and positive COVID-19 patients, tracking infected and suspected inpatients and inter-facility transfers, and ensuring proper isolation orders are executed. For example, EMR screens should be more standardized across disciplines, improved EMR communication between health systems is needed, and IPs should receive more automated alerts regarding testing and patient disposition.
May 8, 2020
- Infection prevention and control compliance in Tanzanian outpatient facilities: a cross-sectional study with implications for the control of COVID-19. May 6. Powell-Jackson. The Lancet.
Researchers from the Dept of Global Health and Development at the London School of Hygiene and Tropical Medicine set out to find studies investigating health care workers’ compliance with infection prevention and control practices in low-income countries. They found a few papers and decided to focus on data collected in 2018 in Tanzania as part of a randomized trial comparing private for profit dispensaries vs. health centers in faith-based dispensaries. The result was uniformly disappointing with only 7% compliance with hand hygiene and 5% with disinfection of reusable equipment. Nurses and midwives performed uniformly better than physicians and other health care workers.
In a pandemic, this result will have implications on SARS-CoV-2 transmission among health care workers around the globe.
May 7, 2020
- A Trial of Lopinavir-Ritonavir in Covid-19: Letter Series with Author Response
May 5. Dalerba. The New England Journal of Medicine.
Opinion from SAB Member: Dr. W. Heinrich Wurm
This investigation from Wuhan, China, published in early April, elicited a number of responses which culminated in the following message: Abandoning an available antiviral at this stage of the pandemic based on a statistically under-powered trial is unwise. Larger cohorts, earlier enrollment and control for secondary therapies might yet point towards a role for these drugs in the management of the SARS-CoV-2 virus. Larger studies are currently underway.
May 5, 2020
- COVID-19, superinfections and antimicrobial development: What can we expect? May 4. Clancy. Clin Infect Dis.
Authors are concerned about superinfection of Covid-19 (700,000 deaths/year), drug resistance and no new drugs in the pipeline, a weak government response, a counterproductive regulation of prescription model, raw material for antibiotics coming from China and India, market forces drying out due to stakeholders…
Coronavirus disease 2019 (COVID-19) arose at a time of great concern about antimicrobial resistance (AMR). No studies have specifically assessed COVID-19-associated superinfections or AMR. Based on limited data from case series, it is reasonable to anticipate that an appreciable minority of patients with severe COVID-19 will develop superinfections, most commonly pneumonia due to nosocomial bacteria and Aspergillus.
Microbiology and AMR patterns are likely to reflect institutional ecology. Broad-spectrum antimicrobial use is likely to be widespread among hospitalized patients, both as directed and empiric therapy. Stewardship will have a crucial role in limiting unnecessary antimicrobial use and AMR. Congressional COVID-19 relief bills are considering antimicrobial reimbursement reforms and antimicrobial subscription models, but it is unclear if these will be included in final legislation. Prospective studies on COVID-19 superinfections are needed, data from which can inform rational antimicrobial treatment and stewardship strategies, and models for market reform and sustainable drug development. A plea for rational antimicrobial treatment and stewardship strategies, and models for market reform and sustainable drug development.
- SARS-CoV-2 asymptomatic and symptomatic patients and risk for transfusion transmission. May 4. Corman. Transfusion.
German authors caution on blood donor poll getting contamination by COVID-19. They noted low risk transfusion risk, but avoid all donor that + RN – PCR. 18 Patient with PCR positive, RNAemia (Actual RNA of virus) was neither detected in 3 patients without symptoms nor in 14 patients with flu‐like symptoms, fever or pneumonia (Mild to moderate symptoms). The only one patient with RNAemia suffered from acute respiratory distress syndrome (ARDS). Risk for SARS‐CoV‐2 transmission through blood components in asymptomatic SARS‐CoV‐2 infected individuals therefore seems negligible but further studies are needed to decease contamination. RNAemia is closely linked to IL 6. RNAemia is NOT considered as infectivity. Stresses need of standardization of RN – PCR all across the world. Male had higher incidence of + RNAemia.
April 28, 2020
- It’s Not the Heat, It’s the Humidity: Effectiveness of a Rice Cooker-Steamer for Decontamination of Cloth and Surgical Face Masks and N95 Respirators. Apr 26. Li. Am J Infect Control.
This study from Case Western University Medical School and the Cleveland VA Medical Center studied the inactivation of test organisms on surgical face masks (Precept; Arden, NC), 3M 1860 N95 respirators (3M; Saint Paul, MN), and cotton and quilting fabric cloth face masks using a rice cooker. Authors demonstrated that a short cycle of steam treatment (13-15 minutes total including heating and 5 min steam) applied via a commonly used kitchen rice cooker-steamer was effective for decontamination of methicillin-resistant Staphylococcus aureus (MRSA) and RNA virus bacteriophage MS2. Dry heat at the same temperature levels was much less effective.
- N95 Mask Decontamination Information
Apr 27. Cassorla L; Przybylo JH; Clement DM; Perlman B. IARS Coronavirus (COVID-19) Resources.
Opinion from SAB Member: Dr. Lydia Cassorla
Interest in decontamination and re-use of N95 and similarly rated particle filtering masks (e.g. Filtering Face Piece grades 2,3 [FFP2, FFP3]–Euro standards for N95 type masks) designed for single use has skyrocketed due to extraordinary demand that cannot be met during the current COVID-19 pandemic. For a decontamination technique to be considered worthy it must satisfy at least 4 criteria: 1) Effective in inactivating the targeted pathogen; 2) Preserve desired particle filtration after decontamination; 3) Preserve mask fit; 4) Be safe for reuse. The most promising techniques appear to involve heat (wet or dry), hydrogen peroxide, and ultraviolet light. Other decontamination techniques such as alcohols, high heat, and bleach were shown by multiple investigators to destroy the filtering properties of the masks. Readers should note constraints and limitations for each study. Not all assessed masks fit after processing. Decontamination was assessed using established norms or by the inactivation of pathogens other than SARS-CoV-2, due to tests being performed before the current pandemic or the risks that would have been incurred. How many times the fabric or whole masks were re-sterilized also varies. Some websites, such as those from the Centers for Disease Control and the industry-academic consortium N95Decon.org are being continuously updated with new information and potential recommendations as they become available. We have assembled potentially useful resources and references on this topic.
- Personal protective equipment (PPE) for both anesthesiologists and other airway managers: principles and practice during the COVID-19 pandemic
Apr 23. Lockhart. Canadian Journal of Anesthesia/Journal canadien d’anesthesie.
Opinion from SAB Member: Dr. W. Heinrich Wurm
A call to arms from several Canadian anesthesia departments stressing the fact that protecting health care personnel from infection is the most important factor determining the success of a prolonged campaign against COVID-19. Their exhaustive recommendations exceed WHO standards in the area of high risk aerosol generating medical procedures (AGMPs) like endotracheal intubation and include head, neck and wrist protection. A sobering table highlights the odds-ratio of transmission for a number of anesthesia related procedures including AGMPs, but a reminder to avoid self-contamination during the doffing procedure is of equal importance. This guide is a valuable reference for practitioners, students and instructors.
April 25, 2020
- Presymptomatic SARS-CoV-2 Infections and Transmission in a Skilled Nursing Facility
Apr 24. Arons. NEJM.
Opinion from SAB Member: Dr. W. Heinrich Wurm
Second epidemiological analysis of institutional spread of COVID-19 in a Kings County, WA Skilled Nursing Facility. Triggered by just one symptomatic patient who came in contact with an infected health care worker, this meticulous study highlights the spread of the virus over the next 23 days resulting in 57 (65%) additional infections. Most notably, 89% of asymptomatic residents testing positive one week into the outbreak, were symptomatic 4-7 days later. These findings underscore the role asymptomatic and pre-symptomatic patients play in spreading the virus, as well as the need for low threshold serial institutional testing.
April 21, 2020
- Barrier System for Airway Management of COVID-19 Patients. Apr 18. Brown. Anesthesia & Analgesia.
UW and Seattle Children’s Hospital report on using a low cost, flexible, clear barrier drape that protects from aerosolized virus during airway manipulations. Advantage over bulky acrylic alternatives are patient tolerance, lower cost, and access for an assistant.
April 20, 2020
- The use of UV fluorescent powder for COVID-19 airway management simulation training. Apr 17. Gardiner C. Anaesthesia.
A simulation demonstrating the dispersal of infectious material during airway management.
April 16, 2020
- Setup of a Dedicated Coronavirus Intensive Care Unit: Logistical Aspects. Apr 7. Mojoli F. Anesthesiology.
This is a blueprint for re-organizing an existing ICU to accommodate infectious disease patients safely within an ICU environment. Valuable but not unique as a concept.
April 15, 2020
- Anesthesia Management and Perioperative Infection Control in Patients With the Novel Coronavirus. Apr 14. Li. J Cardiothorac Vasc Anesth.
Review article discussing now established COVID-19 suspected or confirmed patients’ anesthetic management; tables included. While the information is interesting, current practice incorporates recommendations for screening, airway management and other precautions. No additional pertinent findings discussed.
- Rapid COVID-19-related Clinical Adaptations and Unanticipated Risks. Apr 14. Schrock CR. Anesthesiology.
Pall filter on the circuit caused hypercarbia….3 anesthesia providers…focused on anti viral regime…tolerated High Paco2!!! Paco2 of 100 mmHg. Corrected by taking Pall anti-viral filter = large dead space …….. Editorial: Caught up in the race to “do something” under current pandemic circumstances, clinicians may feel hesitant to reverse an even obviously harmful intervention (the addition of large dead space to small patients), because of concerns for the unknown consequences of a decision to remove the filter. We caution that from our experience, it is perhaps too easy to implement a hasty change and difficult to anticipate all clinical effects, and decision-makers cannot wholly rely upon subsequent providers to quickly correct our errors even when they become apparent.
- Role of mask/respirator protection against SARS-CoV-2. Apr 14. Smereka. Anesthesia & Analgesia.
N95 for high risk area. Surgical mask for low risk area. FFP 1, 2 & 3. Surgical masks – to protect against droplets or particles with a diameter > 100 μm, whereas SARS-CoV-2 virus is essentially spherical with a diameter of 60–140 nm, (thus 100 times smaller than the pore diameter.) FFP1, FFP2, and FFP3. The maximum internal leakage limit is 25% for FFP1, 11% for FFP2, and 5% for FFP3. Class P1 masks retain about 80% of particles smaller than 2 μm, P2 ones retain 94% of particles smaller than 0.5 μm, and P3 ones retain 99.95% of particles smaller than 0.5 μm (Table 1). N95 – NO INFECTION. N95: Dead space (face & mask area) efficiency decrease with long term use. Either way a mask with some “snugness” is better. Two masks may be better than one??
April 11, 2020
- Use of Shield and Tent Method for Protection During Airway Manipulation Apr 5. Ririe. Wake Forest University School of Medicine.
Opinion from SAB Member: Dr. Louis McNabb
Good video illustration of simple method to protect personnel from droplet exposure during intubation. Easy to obtain parts and easy access to airway vs. awkward intubation box.
April 9, 2020
- Alert for SARS-CoV-2 infection caused by fecal aerosols in rural areas in China Apr 7. Meng. Infection Control & Hospital Epidemiology.
COVID-19 SAB Opinion from: Dr. Jagdip Shah
SARS-CoV-2 can be detected in feces and urine of COVID-19 cases, especially the asymptomatic cases. SARS-CoV can persist in feces from infected people for as long as four days, and SARS-CoV-2 may persist in feces for a longer time. The feces may form high concentrations of viral aerosol and travel through the air to cause infection. Close the lid & then flush, ventilation system, spray disinfectant/wash floor weekly, skeptic to a smell in pumping station.
- The Challenge of Preventing COVID-19 Spread in Correctional Facilities. Apr 8. Rubin. JAMA.
A sobering assessment of the challenges the U.S. Prison system faces once COVID-19 gains access. Among the 146,000 inmates, 10,000 of the 146,000 are over 60 and 1/3 of all incarcerated in federal prison have underlying conditions. Valuable review of recently updated guidelines and policies and a worrisome highlight of the lack of basic items, like thermometers and hand sanitizers in some prisons. As of April 2, 75 inmates and 39 staff have been infected by COVID-19.
April 8, 2020
- Beyond the assistance: additional exposure situations to COVID-19 for healthcare workers. Apr 4. Belingheri. J Hosp Infect.
PAP Letter to Editor reminding all HCW that physical distancing guidelines need to be taken even when not caring for patients.
- Clear plastic drapes may be effective at limiting aerosolization and droplet spray during extubation: implications for COVID-19. Apr 5. Matava. Can J Anaesth.
Simulated test of clear plastic drapes, which work well. Not surprising, lacks comparison to other methods, and not clinically tested, but a nice idea.
- Safely conducting essential research in the face of COVID-19. Apr 5. Gewin. Nature.
Though universities are closed, not all laboratories within universities can close since their work might involve development of therapies or vaccines for COVID-19. Four scientists offer their thoughts on precautionary measures to consider when keeping research labs open.
- Shelter hospital mode: how to prevent novel coronavirus infection 2019 (COVID-19) hospital-acquired infection? Mar 30. Yang. Infection Control & Hospital Epidemiology.
COVID-19 SAB Opinion from: Dr. Barry Perlman
Methods used in Wuhan shelter hospital to prevent any healthcare personnel from becoming infected with COVID-19. Requires significant availability of PPE resources.
- The COVID-19 pandemic in the USA: what might we expect? Apr 6. Chowell. Lancet.
Explores how pandemic may unfold in USA.
- The COVID-19 Pandemic in the US: A Clinical Update. Apr 7. Omer. JAMA.
An April 2 update on COVID-19 addressing fatality rate, testing, re-infection, immune response and viral spread. Includes a look into the future, the end of social distancing and the arrival of vaccines.
- With COVID-19, modeling takes on life and death importance. Mar 27. Enserink. Science.
Outlines the approach to containment of COVID-19 in The Netherlands and prediction models to determine spread.
April 7, 2020
- PCORI Funds Registry and Large-Scale Study of Effectiveness of Hydroxychloroquine to Prevent COVID-19 Infection in U.S. Healthcare Workers. Apr 7. Patient-Centered Outcomes Research Institute (PCORI).
PCORI provides $50 million to Duke to evaluate the use of HCQ in both preventing COVID-19 infection in exposed healthcare workers and limiting the amount of virus HCWs without symptoms might spread and thus unintentionally disperse to others.
April 6, 2020
- Oral and nasal decontamination for COVID-19 patients: More harm than good? Apr 3. Maguire. Anesthesia & Analgesia.
Opinion on why the proposed method for patient decolonization may be counterintuitive for infection control in the operating room.
- Turbulent Gas Clouds and Respiratory Pathogen Emissions, Potential Implications for Reducing Transmission of COVID-19 Mar 26. Bourouiba. JAMA.
COVID-19 SAB Opinion from: Dr. David Clement
A review of the science behind what is known of respiratory aerosol transmission of infectious pathogens, and current COVID-19 recommendations. Includes graphic videos that are changing our understanding of this process.
April 2, 2020
- Universal Masking in Hospitals in the Covid-19 Era Apr 1. Klompas. NEJM.
COVID-19 SAB Opinion from: Dr. Jack Lance Lichtor
Though not a panacea, universal masking may reduce the likelihood of transmission from asymptomatic and minimally symptomatic health care workers with COVID-19 to other providers and patients. In a patient with active COVID-19, meticulous hand hygiene, eye protection, gloves, and a gown are also important.
April 1, 2020
- Surgical Mask and Gown Conservation Strategies – Letter to Healthcare. Mar 11. FDA.
PPE conservation strategies for use by healthcare organizations and personnel, categorized for a range of needs and supply levels.
March 31, 2020
- To Protect Healthcare Workers Better, To Save More Lives. Mar 30. Chen. Anesthesia & Analgesia.
First-hand practical experience and perspective from China, focusing on healthcare worker protection and risk factors related to their infection.
March 27, 2020
March 26, 2020
March 25, 2020
- Podcast: Practical Measures to Help Prevent Covid-19. A conversation with Dr. Eric Rubin, Dr. Lindsey Baden, and Stephen Morrissey. NEJM. March 25, 2020.
March 24, 2020
- Perioperative COVID-19 Defense: An Evidence-Based Approach for Optimization of Infection Control and Operating Room Management. Mar 24. Dexter. Anesthesia & Analgesia.
Describes a plan for infection control in the operating room with emphasis on protection of both providers and patients. Also, there is a section that applies OR management to the present COVID-19 crisis with respect to OR utilization for essential cases.
March 23, 2020
- Editorial: Recommendations for Endotracheal Intubation of COVID-19 Patients. Orser, Beverley A. MD, PhD. March 23, 2020.
March 20, 2020
- Information for Health Care Professionals. RECOMMENDATIONS:
- When caring for a patient with known or suspected COVID-19 infection.
- When considering a procedure for a patient with known or suspected COVID-19.
- When patients with known or suspected COVID-19 infection need to be transported.
- When performing procedures on patients with known or suspected COVID-19 infection. March 20, 2020.
March 19, 2020
- CDC: Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings. Last updated: March 19, 2020.
- COVID-19 Town Hall Webinar about personal protective and anesthesia equipment, patient treatment, elective procedures, personal safety and economic issues.
March 17, 2020
- New coronavirus stable for hours on surfaces. SARS-CoV-2 stability similar to original SARS virus. NIH. March 17, 2020.
March 12, 2020
March 11, 2020
- CPR and Emergency Cardiovascular Care Interim Guidance for Healthcare Providers during COVID-19 Outbreak. March 11, 2020.
February 13, 2020
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