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      Echokardiographieuntersuchungen in Zeiten der COVID-19-Pandemie : Internationale Empfehlungen und Umsetzung Translated title: Echocardiographic examinations in times of the COVID-19 pandemic : International recommendations and implementation

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          Abstract

          Seit Dezember 2019 hat sich das neuartige Coronavirus SARS-CoV‑2 („severe acute respiratory syndrome coronavirus 2“), das die Erkrankung COVID-19 („coronavirus disease 2019“) auslöst, mit rasanter Geschwindigkeit über die gesamte Welt ausgebreitet. Ausgehend von der chinesischen Provinz Hubei, wurden mittlerweile 29,4 Mio. Menschen weltweit infiziert, und es sind mehr als 930.000 an den Folgen der Erkrankung gestorben (Stand 15.09.2020). Das Virus verbreitet sich durch Tröpfcheninfektion sowie über Aerosole. Enger Körperkontakt stellt daher ein deutlich erhöhtes Risiko für eine Übertragung dar. Insbesondere bei Untersuchungen mit engem Körperkontakt sollten daher zum Schutz nicht nur der Patienten, sondern auch des medizinischen Personals Maßnahmen ergriffen werden. In diesem Artikel werden die aktuellen Empfehlungen von internationalen Fachgesellschaften zur Verwendung von persönlicher Schutzausrüstung sowie ihre lokale Implementierung dargestellt.

          Translated abstract

          Since its first appearance in December 2019, the novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has spread all over the world at a rapid pace causing the coronavirus disease 2019 (COVID-19). Originating from the Chinese province Hubei, more than 29.4 million people globally have now been confirmed to have contracted the coronavirus and more than 930,000 patients have died so far from COVID-19 (situation as of 15 September 2020). The virus is mainly spread during close contact by small droplets and aerosols. During the close contact in medical examinations, such as echocardiography, the risk of contracting the virus is increased. Therefore, the use of personal protective equipment is recommended for the protection of patients and medical personnel alike. This article summarizes the current recommendations of international societies and describes the local implementation in Austria.

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          Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1

          Neeltje van Doremalen, Trenton Bushmaker, Dylan H Morris … (2021)
          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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            Aerosol Generating Procedures and Risk of Transmission of Acute Respiratory Infections to Healthcare Workers: A Systematic Review

            Khai Tran, Karen Cimon, Melissa Severn … (2012)
            Aerosol generating procedures (AGPs) may expose health care workers (HCWs) to pathogens causing acute respiratory infections (ARIs), but the risk of transmission of ARIs from AGPs is not fully known. We sought to determine the clinical evidence for the risk of transmission of ARIs to HCWs caring for patients undergoing AGPs compared with the risk of transmission to HCWs caring for patients not undergoing AGPs. We searched PubMed, EMBASE, MEDLINE, CINAHL, the Cochrane Library, University of York CRD databases, EuroScan, LILACS, Indian Medlars, Index Medicus for SE Asia, international health technology agencies and the Internet in all languages for articles from 01/01/1990 to 22/10/2010. Independent reviewers screened abstracts using pre-defined criteria, obtained full-text articles, selected relevant studies, and abstracted data. Disagreements were resolved by consensus. The outcome of interest was risk of ARI transmission. The quality of evidence was rated using the GRADE system. We identified 5 case-control and 5 retrospective cohort studies which evaluated transmission of SARS to HCWs. Procedures reported to present an increased risk of transmission included [n; pooled OR(95%CI)] tracheal intubation [n = 4 cohort; 6.6 (2.3, 18.9), and n = 4 case-control; 6.6 (4.1, 10.6)], non-invasive ventilation [n = 2 cohort; OR 3.1(1.4, 6.8)], tracheotomy [n = 1 case-control; 4.2 (1.5, 11.5)] and manual ventilation before intubation [n = 1 cohort; OR 2.8 (1.3, 6.4)]. Other intubation associated procedures, endotracheal aspiration, suction of body fluids, bronchoscopy, nebulizer treatment, administration of O2, high flow O2, manipulation of O2 mask or BiPAP mask, defibrillation, chest compressions, insertion of nasogastric tube, and collection of sputum were not significant. Our findings suggest that some procedures potentially capable of generating aerosols have been associated with increased risk of SARS transmission to HCWs or were a risk factor for transmission, with the most consistent association across multiple studies identified with tracheal intubation.
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              ASE Statement on Protection of Patients and Echocardiography Service Providers During the 2019 Novel Coronavirus Outbreak: Endorsed by the American College of Cardiology.

              James Kirkpatrick, Carol Mitchell, Cynthia C Taub … (2020)
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                Author and article information

                Contributors
                Michael Lichtenauer:
                ORCID: http://orcid.org/0000-0001-8403-3931
                michael.lichtenauer@chello.at
                Journal
                Journal ID (nlm-ta): Herz
                Journal ID (iso-abbrev): Herz
                Title: Herz
                Publisher: Springer Medizin (Heidelberg )
                ISSN (Print): 0340-9937
                ISSN (Electronic): 1615-6692
                Publication date (Electronic): 16 October 2020
                Publication date PMC-release: 16 October 2020
                Pages: 1-4
                Affiliations
                GRID grid.21604.31, ISNI 0000 0004 0523 5263, Department of Internal Medicine II, Division of Cardiology, , Paracelsus Medical University of Salzburg, ; Salzburg, Österreich
                Author information
                http://orcid.org/0000-0001-8403-3931
                Article
                Publisher ID: 4992
                DOI: 10.1007/s00059-020-04992-2
                PMC ID: 7562754
                SO-VID: 4d544d0e-dded-4c77-b2eb-a6e27a5d0179
                Copyright © © The Author(s) 2020
                License:

                Open Access Dieser Artikel wird unter der Creative Commons Namensnennung 4.0 International Lizenz veröffentlicht, welche die Nutzung, Vervielfältigung, Bearbeitung, Verbreitung und Wiedergabe in jeglichem Medium und Format erlaubt, sofern Sie den/die ursprünglichen Autor(en) und die Quelle ordnungsgemäß nennen, einen Link zur Creative Commons Lizenz beifügen und angeben, ob Änderungen vorgenommen wurden.

                Die in diesem Artikel enthaltenen Bilder und sonstiges Drittmaterial unterliegen ebenfalls der genannten Creative Commons Lizenz, sofern sich aus der Abbildungslegende nichts anderes ergibt. Sofern das betreffende Material nicht unter der genannten Creative Commons Lizenz steht und die betreffende Handlung nicht nach gesetzlichen Vorschriften erlaubt ist, ist für die oben aufgeführten Weiterverwendungen des Materials die Einwilligung des jeweiligen Rechteinhabers einzuholen.

                Weitere Details zur Lizenz entnehmen Sie bitte der Lizenzinformation auf http://creativecommons.org/licenses/by/4.0/deed.de.

                History
                Date received : 7 May 2020
                Date revision received : 15 September 2020
                Date accepted : 17 September 2020
                Funding
                Funded by: Paracelsus Medical University
                Open Access :

                Open access funding provided by Paracelsus Medical University.

                Categories
                Subject: Übersichten

                Keywords: coronavirus,sars-cov‑2,kardiovaskuläre diagnostik,infektionsrisiko,schutzausrüstung,cardiovascular diagnostics,risk of infection,personal protective equipment
                Data availability:
                Keywords: coronavirus, sars-cov‑2, kardiovaskuläre diagnostik, infektionsrisiko, schutzausrüstung, cardiovascular diagnostics, risk of infection, personal protective equipment

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