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Relative contributions of transmission routes for COVID-19 among healthcare personnel providing patient care.
J Occup Environ Hyg. 2020 Sep; 17(9):408-415.JO

Abstract

The routes of COVID-19 transmission to healthcare personnel from infected patients is the subject of debate, but is critical to the selection of personal protective equipment. The objective of this paper was to explore the contributions of three transmission routes-contact, droplet, and inhalation-to the risk of occupationally acquired COVID-19 infection among healthcare personnel (HCP). The method was quantitative microbial risk assessment, and an exposure model, where possible model parameters were based on data specific to the SARS-CoV-2 virus when available. The key finding was that droplet and inhalation transmission routes predominate over the contact route, contributing 35%, 57%, and 8.2% of the probability of infection, on average, without use of personal protective equipment. On average, 80% of inhalation exposure occurs when HCP are near patients. The relative contribution of droplet and inhalation depends upon the emission of SARS-CoV-2 in respirable particles (<10 µm) through exhaled breath, and inhalation becomes predominant, on average, when emission exceeds five gene copies per min. The predicted concentration of SARS-CoV-2 in the air of the patient room is low (< 1 gene copy per m3 on average), and likely below the limit of quantification for many air sampling methods. The findings demonstrate the value of respiratory protection for HCP, and that field sampling may not be sensitive enough to verify the contribution of SARS-CoV-2 inhalation to the risk of occupationally acquired COVID-19 infection among healthcare personnel. The emission and infectivity of SARS-CoV-2 in respiratory droplets of different sizes is a critical knowledge gap for understanding and controlling COVID-19 transmission.

Authors+Show Affiliations

Department of Family and Preventive Medicine, School of Medicine, University of Utah, Salt Lake City, Utah. Rocky Mountain Center for Occupational and Environmental Health, University of Utah, Salt Lake City, Utah.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

32643585

Citation

Jones, Rachael M.. "Relative Contributions of Transmission Routes for COVID-19 Among Healthcare Personnel Providing Patient Care." Journal of Occupational and Environmental Hygiene, vol. 17, no. 9, 2020, pp. 408-415.
Jones RM. Relative contributions of transmission routes for COVID-19 among healthcare personnel providing patient care. J Occup Environ Hyg. 2020;17(9):408-415.
Jones, R. M. (2020). Relative contributions of transmission routes for COVID-19 among healthcare personnel providing patient care. Journal of Occupational and Environmental Hygiene, 17(9), 408-415. https://doi.org/10.1080/15459624.2020.1784427
Jones RM. Relative Contributions of Transmission Routes for COVID-19 Among Healthcare Personnel Providing Patient Care. J Occup Environ Hyg. 2020;17(9):408-415. PubMed PMID: 32643585.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Relative contributions of transmission routes for COVID-19 among healthcare personnel providing patient care. A1 - Jones,Rachael M, Y1 - 2020/07/09/ PY - 2020/7/10/pubmed PY - 2020/9/18/medline PY - 2020/7/10/entrez KW - Respiratory protection KW - exposure modeling KW - personal protective equipment KW - quantitative microbial risk assessment KW - viral aerosol SP - 408 EP - 415 JF - Journal of occupational and environmental hygiene JO - J Occup Environ Hyg VL - 17 IS - 9 N2 - The routes of COVID-19 transmission to healthcare personnel from infected patients is the subject of debate, but is critical to the selection of personal protective equipment. The objective of this paper was to explore the contributions of three transmission routes-contact, droplet, and inhalation-to the risk of occupationally acquired COVID-19 infection among healthcare personnel (HCP). The method was quantitative microbial risk assessment, and an exposure model, where possible model parameters were based on data specific to the SARS-CoV-2 virus when available. The key finding was that droplet and inhalation transmission routes predominate over the contact route, contributing 35%, 57%, and 8.2% of the probability of infection, on average, without use of personal protective equipment. On average, 80% of inhalation exposure occurs when HCP are near patients. The relative contribution of droplet and inhalation depends upon the emission of SARS-CoV-2 in respirable particles (<10 µm) through exhaled breath, and inhalation becomes predominant, on average, when emission exceeds five gene copies per min. The predicted concentration of SARS-CoV-2 in the air of the patient room is low (< 1 gene copy per m3 on average), and likely below the limit of quantification for many air sampling methods. The findings demonstrate the value of respiratory protection for HCP, and that field sampling may not be sensitive enough to verify the contribution of SARS-CoV-2 inhalation to the risk of occupationally acquired COVID-19 infection among healthcare personnel. The emission and infectivity of SARS-CoV-2 in respiratory droplets of different sizes is a critical knowledge gap for understanding and controlling COVID-19 transmission. SN - 1545-9632 UR - https://www.unboundmedicine.com/medline/citation/32643585/Relative_contributions_of_transmission_routes_for_COVID_19_among_healthcare_personnel_providing_patient_care_ L2 - https://www.tandfonline.com/doi/full/10.1080/15459624.2020.1784427 DB - PRIME DP - Unbound Medicine ER -