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      Letter to the Editor on “An Imperative Need for Research on the Role of Environmental Factors in Transmission of Novel Coronavirus (COVID-19)”, Back to Basics

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          Abstract

          The recent viewpoint article by Qu et al. entitled “An Imperative Need for Research on the Role of Environmental Factors in Transmission of Novel Coronavirus (COVID-19)” highlights an imperative need for research on SARS-CoV-2 in environmental sciences. 1 It is promising that advanced environmental science and technology will identify environmental factors modifying the infectivity of the virus, the severity of COVID-19, and help to control its environmental spread. Here we highlight research showing the importance of basic sanitations to control the spread of infectious diseases applicable to the prevention of COVID-19. SARS-CoV-2 in culture media is easily disinfected with 70% ethanol, 0.05% chlorhexidine, 2% hand soap, 1% bleach, etc. 2 Hence, good hand hygiene is likely to prevent COVID-19 transmission via contacts. Although there has not yet been an intervention study for COVID-19, a previous meta-analysis of the effects of hand hygiene in a community setting showed significant reductions in the spread of gastrointestinal illness of 31% and also in respiratory illness of 21%. 3 Hand hygiene costs using alcohol-based handrubs in intensive care units was estimated at USD 0.025 per application, compared to nosocomial infections resulting in far higher cost implications (e.g., USD 25,546 for a surgical site infection). 4 The aerosol transmission route for SARS-CoV-2 in aerosols 5 means effective ventilation, including both natural and mechanical ventilation, is an important, easy and basic way to reduce risk of transmission. For example, in a study of the common cold (around a quarter caused by ordinary coronaviruses), low ventilation rates in dormitories was shown to increase the risk of infections among students. 6 While exhaust-only mechanical ventilation has an associated cost (e.g., USD 64 annually for a 1780 ft2 home, including annualized cost of installation), 7 natural ventilation (opening windows and doors), provides a comparable efficient exchange of indoor air. 8 A case study of the nosocomial spread of SARS in a Vietnam hospital with 33 SARS patients during the 2003 SARS outbreak demonstrated the effectiveness of face masks, gloves, hand sanitizer, and cross-ventilation in the hospital in reducing cross-infection rates. 9 The cross-infection measures discussed are not state of the art, but remain underutilized in low- and middle-income countries. Although comparisons of the cost-effectiveness of basic versus advanced technologies are not yet available, COVID-19 cases in low- and middle-income countries are rapidly rising. We acknowledge the importance of these basic sanitations and engineering solutions for COVID-19, and encourage preparedness for future infectious diseases.

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          Most cited references 4

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          Effect of hand hygiene on infectious disease risk in the community setting: a meta-analysis.

          To quantify the effect of hand-hygiene interventions on rates of gastrointestinal and respiratory illnesses and to identify interventions that provide the greatest efficacy, we searched 4 electronic databases for hand-hygiene trials published from January 1960 through May 2007 and conducted meta-analyses to generate pooled rate ratios across interventions (N=30 studies). Improvements in hand hygiene resulted in reductions in gastrointestinal illness of 31% (95% confidence intervals [CI]=19%, 42%) and reductions in respiratory illness of 21% (95% CI=5%, 34%). The most beneficial intervention was hand-hygiene education with use of nonantibacterial soap. Use of antibacterial soap showed little added benefit compared with use of nonantibacterial soap. Hand hygiene is clearly effective against gastrointestinal and, to a lesser extent, respiratory infections. Studies examining hygiene practices during respiratory illness and interventions targeting aerosol transmission are needed.
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            Lack of SARS Transmission among Public Hospital Workers, Vietnam

            The severe acute respiratory syndrome (SARS) outbreak in Vietnam was amplified by nosocomial spread within hospital A, but no transmission was reported in hospital B, the second of two designated SARS hospitals. Our study documents lack of SARS-associated coronavirus transmission to hospital B workers, despite variable infection control measures and the use of personal protective equipment.
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              In China, Students in Crowded Dormitories with a Low Ventilation Rate Have More Common Colds: Evidence for Airborne Transmission

              Objective To test whether the incidence of common colds among college students in China is associated with ventilation rates and crowdedness in dormitories. Methods In Phase I of the study, a cross-sectional study, 3712 students living in 1569 dorm rooms in 13 buildings responded to a questionnaire about incidence and duration of common colds in the previous 12 months. In Phase II, air temperature, relative humidity and CO2 concentration were measured for 24 hours in 238 dorm rooms in 13 buildings, during both summer and winter. Out-to indoor air flow rates at night were calculated based on measured CO2 concentrations. Results In Phase I, 10% of college students reported an incidence of more than 6 common colds in the previous 12 months, and 15% reported that each infection usually lasted for more than 2 weeks. Students in 6-person dorm rooms were about 2 times as likely to have an incidence of common colds ≥6 times per year and a duration ≥2 weeks, compared to students in 3-person rooms. In Phase II, 90% of the measured dorm rooms had an out-to indoor air flow rate less than the Chinese standard of 8.3 L/s per person during the heating season. There was a dose-response relationship between out-to indoor air flow rate per person in dorm rooms and the proportion of occupants with annual common cold infections ≥6 times. A mean ventilation rate of 5 L/(s•person) in dorm buildings was associated with 5% of self reported common cold ≥6 times, compared to 35% at 1 L/(s•person). Conclusion Crowded dormitories with low out-to indoor airflow rates are associated with more respiratory infections among college students.
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                Author and article information

                Journal
                Environ Sci Technol
                Environ. Sci. Technol
                es
                esthag
                Environmental Science & Technology
                American Chemical Society
                0013-936X
                1520-5851
                18 June 2020
                Affiliations
                []Department of Health and Environmental Sciences, Kyoto University Graduate School of Medicine , Yoshida Konoe, Sakyo, Kyoto 6068501, Japan
                []Department of Environmental Health Sciences, Graduate School of Public Health, Seoul National University , Seoul, 08826, Republic of Korea
                Author notes
                Article
                10.1021/acs.est.0c02850
                7307710
                32551532
                Copyright © 2020 American Chemical Society

                This article is made available via the PMC Open Access Subset for unrestricted RESEARCH re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for the duration of the World Health Organization (WHO) declaration of COVID-19 as a global pandemic.

                Categories
                Letter to the Editor
                Custom metadata
                es0c02850
                es0c02850

                General environmental science

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