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Which factors influence the extent of indoor transmission of SARS-CoV-2? A rapid evidence review
BACKGROUND: This rapid evidence review identifies and integrates evidence from epidemiology, microbiology and fluid dynamics on the transmission of SARS-CoV-2 in indoor environments. METHODS: Searches were conducted in May 2020 in PubMed, medRxiv, arXiv, Scopus, WHO COVID-19 database, Compendex &...
Autores principales: | , , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
International Society of Global Health
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8021073/ https://www.ncbi.nlm.nih.gov/pubmed/33828849 http://dx.doi.org/10.7189/jogh.11.10002 |
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author | Goodwin, Lara Hayward, Toneka Krishan, Prerna Nolan, Gemma Nundy, Madhurima Ostrishko, Kayla Attili, Antonio Cárceles, Salva Barranco Epelle, Emmanuel I Gabl, Roman Pappa, Evanthia J Stajuda, Mateusz Zen, Simone Dozier, Marshall Anderson, Niall Viola, Ignazio M McQuillan, Ruth |
author_facet | Goodwin, Lara Hayward, Toneka Krishan, Prerna Nolan, Gemma Nundy, Madhurima Ostrishko, Kayla Attili, Antonio Cárceles, Salva Barranco Epelle, Emmanuel I Gabl, Roman Pappa, Evanthia J Stajuda, Mateusz Zen, Simone Dozier, Marshall Anderson, Niall Viola, Ignazio M McQuillan, Ruth |
author_sort | Goodwin, Lara |
collection | PubMed |
description | BACKGROUND: This rapid evidence review identifies and integrates evidence from epidemiology, microbiology and fluid dynamics on the transmission of SARS-CoV-2 in indoor environments. METHODS: Searches were conducted in May 2020 in PubMed, medRxiv, arXiv, Scopus, WHO COVID-19 database, Compendex & Inspec. We included studies reporting data on any indoor setting except schools, any indoor activities and any potential means of transmission. Articles were screened by a single reviewer, with rejections assessed by a second reviewer. We used Joanna Briggs Institute and Critical Appraisal Skills Programme tools for evaluating epidemiological studies and developed bespoke tools for the evaluation of study types not covered by these instruments. Data extraction and quality assessment were conducted by a single reviewer. We conducted a meta-analysis of secondary attack rates in household transmission. Otherwise, data were synthesised narratively. RESULTS: We identified 1573 unique articles. After screening and quality assessment, fifty-eight articles were retained for analysis. Experimental evidence from fluid mechanics and microbiological studies demonstrates that aerosolised transmission is theoretically possible; however, we found no conclusive epidemiological evidence of this occurring. The evidence suggests that ventilation systems have the potential to decrease virus transmission near the source through dilution but to increase transmission further away from the source through dispersal. We found no evidence for faecal-oral transmission. Laboratory studies suggest that the virus survives for longer on smooth surfaces and at lower temperatures. Environmental sampling studies have recovered small amounts of viral RNA from a wide range of frequently touched objects and surfaces; however, epidemiological studies are inconclusive on the extent of fomite transmission. We found many examples of transmission in settings characterised by close and prolonged indoor contact. We estimate a pooled secondary attack rate within households of 11% (95% confidence interval (CI) = 9, 13). There were insufficient data to evaluate the transmission risks associated with specific activities. Workplace challenges related to poverty warrant further investigation as potential risk factors for workplace transmission. Fluid mechanics evidence on the physical properties of droplets generated by coughing, speaking and breathing reinforce the importance of maintaining 2 m social distance to reduce droplet transmission. CONCLUSIONS: This review provides a snap-shot of evidence on the transmission of SARS-CoV-2 in indoor environments from the early months of the pandemic. The overall quality of the evidence was low. As the quality and quantity of available evidence grows, it will be possible to reach firmer conclusions on the risk factors for and mechanisms of indoor transmission. |
format | Online Article Text |
id | pubmed-8021073 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | International Society of Global Health |
record_format | MEDLINE/PubMed |
spelling | pubmed-80210732021-04-06 Which factors influence the extent of indoor transmission of SARS-CoV-2? A rapid evidence review Goodwin, Lara Hayward, Toneka Krishan, Prerna Nolan, Gemma Nundy, Madhurima Ostrishko, Kayla Attili, Antonio Cárceles, Salva Barranco Epelle, Emmanuel I Gabl, Roman Pappa, Evanthia J Stajuda, Mateusz Zen, Simone Dozier, Marshall Anderson, Niall Viola, Ignazio M McQuillan, Ruth J Glob Health Research Theme 6: UNCOVER - Usher Institute Network of COVID-19 Evidence Reviews BACKGROUND: This rapid evidence review identifies and integrates evidence from epidemiology, microbiology and fluid dynamics on the transmission of SARS-CoV-2 in indoor environments. METHODS: Searches were conducted in May 2020 in PubMed, medRxiv, arXiv, Scopus, WHO COVID-19 database, Compendex & Inspec. We included studies reporting data on any indoor setting except schools, any indoor activities and any potential means of transmission. Articles were screened by a single reviewer, with rejections assessed by a second reviewer. We used Joanna Briggs Institute and Critical Appraisal Skills Programme tools for evaluating epidemiological studies and developed bespoke tools for the evaluation of study types not covered by these instruments. Data extraction and quality assessment were conducted by a single reviewer. We conducted a meta-analysis of secondary attack rates in household transmission. Otherwise, data were synthesised narratively. RESULTS: We identified 1573 unique articles. After screening and quality assessment, fifty-eight articles were retained for analysis. Experimental evidence from fluid mechanics and microbiological studies demonstrates that aerosolised transmission is theoretically possible; however, we found no conclusive epidemiological evidence of this occurring. The evidence suggests that ventilation systems have the potential to decrease virus transmission near the source through dilution but to increase transmission further away from the source through dispersal. We found no evidence for faecal-oral transmission. Laboratory studies suggest that the virus survives for longer on smooth surfaces and at lower temperatures. Environmental sampling studies have recovered small amounts of viral RNA from a wide range of frequently touched objects and surfaces; however, epidemiological studies are inconclusive on the extent of fomite transmission. We found many examples of transmission in settings characterised by close and prolonged indoor contact. We estimate a pooled secondary attack rate within households of 11% (95% confidence interval (CI) = 9, 13). There were insufficient data to evaluate the transmission risks associated with specific activities. Workplace challenges related to poverty warrant further investigation as potential risk factors for workplace transmission. Fluid mechanics evidence on the physical properties of droplets generated by coughing, speaking and breathing reinforce the importance of maintaining 2 m social distance to reduce droplet transmission. CONCLUSIONS: This review provides a snap-shot of evidence on the transmission of SARS-CoV-2 in indoor environments from the early months of the pandemic. The overall quality of the evidence was low. As the quality and quantity of available evidence grows, it will be possible to reach firmer conclusions on the risk factors for and mechanisms of indoor transmission. International Society of Global Health 2021-04-03 /pmc/articles/PMC8021073/ /pubmed/33828849 http://dx.doi.org/10.7189/jogh.11.10002 Text en Copyright © 2021 by the Journal of Global Health. All rights reserved. http://creativecommons.org/licenses/by/4.0/ This work is licensed under a Creative Commons Attribution 4.0 International License. |
spellingShingle | Research Theme 6: UNCOVER - Usher Institute Network of COVID-19 Evidence Reviews Goodwin, Lara Hayward, Toneka Krishan, Prerna Nolan, Gemma Nundy, Madhurima Ostrishko, Kayla Attili, Antonio Cárceles, Salva Barranco Epelle, Emmanuel I Gabl, Roman Pappa, Evanthia J Stajuda, Mateusz Zen, Simone Dozier, Marshall Anderson, Niall Viola, Ignazio M McQuillan, Ruth Which factors influence the extent of indoor transmission of SARS-CoV-2? A rapid evidence review |
title | Which factors influence the extent of indoor transmission of SARS-CoV-2? A rapid evidence review |
title_full | Which factors influence the extent of indoor transmission of SARS-CoV-2? A rapid evidence review |
title_fullStr | Which factors influence the extent of indoor transmission of SARS-CoV-2? A rapid evidence review |
title_full_unstemmed | Which factors influence the extent of indoor transmission of SARS-CoV-2? A rapid evidence review |
title_short | Which factors influence the extent of indoor transmission of SARS-CoV-2? A rapid evidence review |
title_sort | which factors influence the extent of indoor transmission of sars-cov-2? a rapid evidence review |
topic | Research Theme 6: UNCOVER - Usher Institute Network of COVID-19 Evidence Reviews |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8021073/ https://www.ncbi.nlm.nih.gov/pubmed/33828849 http://dx.doi.org/10.7189/jogh.11.10002 |
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