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SARS-CoV-2 and Health Care Worker Protection in Low-Risk Settings: a Review of Modes of Transmission and a Novel Airborne Model Involving Inhalable Particles.

Authors
  • Zhang, X Sophie1, 2, 3, 4
  • Duchaine, Caroline5, 6
  • 1 Department of General Medicine, CIUSSS Centre-Sud-de-l'Île-de-Montréal, Montreal, Canada [email protected] [email protected] , (Canada)
  • 2 CHSLD Bruchési and CHSLD Jean De La Lande, Montreal, Canada. , (Canada)
  • 3 GMF-U Faubourgs, Montreal, Canada. , (Canada)
  • 4 Centre de Recherche et d'Aide aux Narcomanes, Montreal, Canada. , (Canada)
  • 5 Department of Biochemistry, Microbiology, and Bioinformatics, Université Laval, Quebec City, Canada [email protected] [email protected] , (Canada)
  • 6 Quebec Heart and Lung Institute-Université Laval (CRIUCPQ), Quebec City, Canada. , (Canada)
Type
Published Article
Journal
Clinical Microbiology Reviews
Publisher
American Society for Microbiology
Publication Date
Dec 16, 2020
Volume
34
Issue
1
Identifiers
DOI: 10.1128/CMR.00184-20
PMID: 33115724
Source
Medline
Keywords
Language
English
License
Unknown

Abstract

Since the beginning of the COVID-19 pandemic, there has been intense debate over SARS-CoV-2's mode of transmission and appropriate personal protective equipment for health care workers in low-risk settings. The objective of this review is to identify and appraise the available evidence (clinical trials and laboratory studies on masks and respirators, epidemiological studies, and air sampling studies), clarify key concepts and necessary conditions for airborne transmission, and shed light on knowledge gaps in the field. We find that, except for aerosol-generating procedures, the overall data in support of airborne transmission-taken in its traditional definition (long-distance and respirable aerosols)-are weak, based predominantly on indirect and experimental rather than clinical or epidemiological evidence. Consequently, we propose a revised and broader definition of "airborne," going beyond the current droplet and aerosol dichotomy and involving short-range inhalable particles, supported by data targeting the nose as the main viral receptor site. This new model better explains clinical observations, especially in the context of close and prolonged contacts between health care workers and patients, and reconciles seemingly contradictory data in the SARS-CoV-2 literature. The model also carries important implications for personal protective equipment and environmental controls, such as ventilation, in health care settings. However, further studies, especially clinical trials, are needed to complete the picture. Copyright © 2020 American Society for Microbiology.

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