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      Disease transmission through expiratory aerosols on an urban bus

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          Abstract

          Airborne respiratory diseases such as COVID-19 pose significant challenges to public transportation. Several recent outbreaks of SARS-CoV-2 indicate the high risk of transmission among passengers on public buses if special precautions are not taken. This study presents a combined experimental and numerical analysis to identify transmission mechanisms on an urban bus and assess strategies to reduce risk. The effects of the ventilation and air-conditioning systems, opening windows and doors, and wearing masks are analyzed. Specific attention is paid to the transport of submicron- and micron-sized particles relevant to typical respiratory droplets. High-resolution instrumentation was used to measure size distribution and aerosol response time on a campus bus of the University of Michigan under these different conditions. Computational fluid dynamics was employed to measure the airflow within the bus and evaluate risk. A risk metric was adopted based on the number of particles exposed to susceptible passengers. The flow that carries these aerosols is predominantly controlled by the ventilation system, which acts to uniformly distribute the aerosol concentration throughout the bus while simultaneously diluting it with fresh air. The opening of doors and windows was found to reduce the concentration by approximately one half, albeit its benefit does not uniformly impact all passengers on the bus due to the recirculation of airflow caused by entrainment through windows. Finally, it was found that well fitted surgical masks, when worn by both infected and susceptible passengers, can nearly eliminate the transmission of the disease.

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          Epidemiological and clinical characteristics of 99 cases of 2019 novel coronavirus pneumonia in Wuhan, China: a descriptive study

          Summary Background In December, 2019, a pneumonia associated with the 2019 novel coronavirus (2019-nCoV) emerged in Wuhan, China. We aimed to further clarify the epidemiological and clinical characteristics of 2019-nCoV pneumonia. Methods In this retrospective, single-centre study, we included all confirmed cases of 2019-nCoV in Wuhan Jinyintan Hospital from Jan 1 to Jan 20, 2020. Cases were confirmed by real-time RT-PCR and were analysed for epidemiological, demographic, clinical, and radiological features and laboratory data. Outcomes were followed up until Jan 25, 2020. Findings Of the 99 patients with 2019-nCoV pneumonia, 49 (49%) had a history of exposure to the Huanan seafood market. The average age of the patients was 55·5 years (SD 13·1), including 67 men and 32 women. 2019-nCoV was detected in all patients by real-time RT-PCR. 50 (51%) patients had chronic diseases. Patients had clinical manifestations of fever (82 [83%] patients), cough (81 [82%] patients), shortness of breath (31 [31%] patients), muscle ache (11 [11%] patients), confusion (nine [9%] patients), headache (eight [8%] patients), sore throat (five [5%] patients), rhinorrhoea (four [4%] patients), chest pain (two [2%] patients), diarrhoea (two [2%] patients), and nausea and vomiting (one [1%] patient). According to imaging examination, 74 (75%) patients showed bilateral pneumonia, 14 (14%) patients showed multiple mottling and ground-glass opacity, and one (1%) patient had pneumothorax. 17 (17%) patients developed acute respiratory distress syndrome and, among them, 11 (11%) patients worsened in a short period of time and died of multiple organ failure. Interpretation The 2019-nCoV infection was of clustering onset, is more likely to affect older males with comorbidities, and can result in severe and even fatal respiratory diseases such as acute respiratory distress syndrome. In general, characteristics of patients who died were in line with the MuLBSTA score, an early warning model for predicting mortality in viral pneumonia. Further investigation is needed to explore the applicability of the MuLBSTA score in predicting the risk of mortality in 2019-nCoV infection. Funding National Key R&D Program of China.
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            Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1

            To the Editor: A novel human coronavirus that is now named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (formerly called HCoV-19) emerged in Wuhan, China, in late 2019 and is now causing a pandemic. 1 We analyzed the aerosol and surface stability of SARS-CoV-2 and compared it with SARS-CoV-1, the most closely related human coronavirus. 2 We evaluated the stability of SARS-CoV-2 and SARS-CoV-1 in aerosols and on various surfaces and estimated their decay rates using a Bayesian regression model (see the Methods section in the Supplementary Appendix, available with the full text of this letter at NEJM.org). SARS-CoV-2 nCoV-WA1-2020 (MN985325.1) and SARS-CoV-1 Tor2 (AY274119.3) were the strains used. Aerosols (<5 μm) containing SARS-CoV-2 (105.25 50% tissue-culture infectious dose [TCID50] per milliliter) or SARS-CoV-1 (106.75-7.00 TCID50 per milliliter) were generated with the use of a three-jet Collison nebulizer and fed into a Goldberg drum to create an aerosolized environment. The inoculum resulted in cycle-threshold values between 20 and 22, similar to those observed in samples obtained from the upper and lower respiratory tract in humans. Our data consisted of 10 experimental conditions involving two viruses (SARS-CoV-2 and SARS-CoV-1) in five environmental conditions (aerosols, plastic, stainless steel, copper, and cardboard). All experimental measurements are reported as means across three replicates. SARS-CoV-2 remained viable in aerosols throughout the duration of our experiment (3 hours), with a reduction in infectious titer from 103.5 to 102.7 TCID50 per liter of air. This reduction was similar to that observed with SARS-CoV-1, from 104.3 to 103.5 TCID50 per milliliter (Figure 1A). SARS-CoV-2 was more stable on plastic and stainless steel than on copper and cardboard, and viable virus was detected up to 72 hours after application to these surfaces (Figure 1A), although the virus titer was greatly reduced (from 103.7 to 100.6 TCID50 per milliliter of medium after 72 hours on plastic and from 103.7 to 100.6 TCID50 per milliliter after 48 hours on stainless steel). The stability kinetics of SARS-CoV-1 were similar (from 103.4 to 100.7 TCID50 per milliliter after 72 hours on plastic and from 103.6 to 100.6 TCID50 per milliliter after 48 hours on stainless steel). On copper, no viable SARS-CoV-2 was measured after 4 hours and no viable SARS-CoV-1 was measured after 8 hours. On cardboard, no viable SARS-CoV-2 was measured after 24 hours and no viable SARS-CoV-1 was measured after 8 hours (Figure 1A). Both viruses had an exponential decay in virus titer across all experimental conditions, as indicated by a linear decrease in the log10TCID50 per liter of air or milliliter of medium over time (Figure 1B). The half-lives of SARS-CoV-2 and SARS-CoV-1 were similar in aerosols, with median estimates of approximately 1.1 to 1.2 hours and 95% credible intervals of 0.64 to 2.64 for SARS-CoV-2 and 0.78 to 2.43 for SARS-CoV-1 (Figure 1C, and Table S1 in the Supplementary Appendix). The half-lives of the two viruses were also similar on copper. On cardboard, the half-life of SARS-CoV-2 was longer than that of SARS-CoV-1. The longest viability of both viruses was on stainless steel and plastic; the estimated median half-life of SARS-CoV-2 was approximately 5.6 hours on stainless steel and 6.8 hours on plastic (Figure 1C). Estimated differences in the half-lives of the two viruses were small except for those on cardboard (Figure 1C). Individual replicate data were noticeably “noisier” (i.e., there was more variation in the experiment, resulting in a larger standard error) for cardboard than for other surfaces (Fig. S1 through S5), so we advise caution in interpreting this result. We found that the stability of SARS-CoV-2 was similar to that of SARS-CoV-1 under the experimental circumstances tested. This indicates that differences in the epidemiologic characteristics of these viruses probably arise from other factors, including high viral loads in the upper respiratory tract and the potential for persons infected with SARS-CoV-2 to shed and transmit the virus while asymptomatic. 3,4 Our results indicate that aerosol and fomite transmission of SARS-CoV-2 is plausible, since the virus can remain viable and infectious in aerosols for hours and on surfaces up to days (depending on the inoculum shed). These findings echo those with SARS-CoV-1, in which these forms of transmission were associated with nosocomial spread and super-spreading events, 5 and they provide information for pandemic mitigation efforts.
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              Identifying airborne transmission as the dominant route for the spread of COVID-19

              Significance We have elucidated the transmission pathways of coronavirus disease 2019 (COVID-19) by analyzing the trend and mitigation measures in the three epicenters. Our results show that the airborne transmission route is highly virulent and dominant for the spread of COVID-19. The mitigation measures are discernable from the trends of the pandemic. Our analysis reveals that the difference with and without mandated face covering represents the determinant in shaping the trends of the pandemic. This protective measure significantly reduces the number of infections. Other mitigation measures, such as social distancing implemented in the United States, are insufficient by themselves in protecting the public. Our work also highlights the necessity that sound science is essential in decision-making for the current and future public health pandemics.
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                Author and article information

                Contributors
                Journal
                Phys Fluids (1994)
                Phys Fluids (1994)
                PHFLE6
                Physics of Fluids
                AIP Publishing LLC
                1070-6631
                1089-7666
                01 January 2021
                12 January 2021
                12 January 2021
                : 33
                : 1
                : 015116
                Affiliations
                [1 ]Department of Naval Architecture and Marine Engineering, University of Michigan , 138 NAME Bldg, 2600 Draper Drive, Ann Arbor, Michigan 48109-2145, USA
                [2 ]Department of Mechanical Engineering, University of Michigan , 2045 AL (W.E. Lay Auto Lab), 1231 Beal, Ann Arbor, Michigan 48109-2121, USA
                [3 ]Department of Mechanical Engineering, University of Michigan , 2011 AL (W.E. Lay Auto Lab), 1231 Beal, Ann Arbor, Michigan 48109-2121, USA
                [4 ]Department of Naval Architecture and Marine Engineering, University of Michigan , 210 NAME Bldg, 2600 Draper Drive, Ann Arbor, Michigan 48109-2145, USA
                Author notes
                [a)]

                Also at: Department of Aerospace Engineering, University of Michigan, USA.

                [b) ]Author to whom correspondence should be addressed: kjmaki@ 123456umich.edu
                Author information
                http://orcid.org/0000-0001-9398-072X
                http://orcid.org/0000-0003-2030-5891
                http://orcid.org/0000-0001-7541-3553
                http://orcid.org/0000-0002-1684-4967
                http://orcid.org/0000-0002-0965-9288
                http://orcid.org/0000-0001-7286-7402
                Article
                5.0037452 POF20-AR-FATV2020-03913
                10.1063/5.0037452
                7976046
                3777d92b-da18-43c8-bd9f-45fa349418dc
                © 2021 Author(s)

                Published under license by AIP Publishing.

                1070-6631/2021/33(1)/015116/16/ $30.00

                All article content, except where otherwise noted, is licensed under a Creative Commons Attribution (CC BY) license ( http://creativecommons.org/licenses/by/4.0/).

                History
                : 13 November 2020
                : 16 December 2020
                Page count
                Pages: 16
                Categories
                ARTICLES
                Turbulent Flows
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