“Be mindful of what happens when you open up and throw caution to the wind,” Tony Fauci says.
“Be mindful of what happens when you open up and throw caution to the wind,” Tony Fauci says.
The overall decrease in COVID-19 cases in the United States is being driven by declines in New York, Connecticut, and New Jersey, but cases are surging in a handful of other states in the wake of reopening local economies, including Arizona, Arkansas, California, Florida, North Carolina, Texas, and Utah.
In Arizona yesterday, officials reported 30 new deaths from the novel coronavirus and last week tallied more than 1,000 hospitalizations per day. California reported record daily highs in the last week and through the weekend, averaging about 2,666 daily new cases, according to CNN. Last Friday, California tracked 3,593 new cases, its record case count.
Texas, Illinois, and Florida have also each averaged more than 1,000 new cases per day in the past week.
New data show that 600 frontline US health workers have died from COVID-19.
Late last week, in DHS: Decay Rate Calculator For SARS-CoV-2, we looked at tool to calculate the potential persistence of the SARS-CoV-2 virus on environmental surfaces based on temperature and humidity.
The `right’ temperature and humidity levels can increase the viability of the virus by days. Lower temperatures, and lower humidities – such as you often find in a hospital or office environment – are particularly helpful in extending the life of the virus.
With that in mind, we’ve a new Dispatch published in the CDC’s EID Journal that looks at the rapid (< 24 hrs) environmental contamination of surfaces in hotel rooms which were occupied by two presymptomatic students placed under quarantine.
I’ve only included some excerpts from the dispatch, so follow the link to read it in its entirety. I’ll have a postscript when you return.
Volume 26, Number 9—September 2020
Detection of Severe Acute Respiratory Syndrome Coronavirus 2 RNA on Surfaces in Quarantine Rooms
Fa-Chun Jiang1, Xiao-Lin Jiang1, Zhao-Guo Wang, Zhao-Hai Meng, Shou-Feng Shao, Benjamin D. Anderson, and Mai-Juan Ma
We investigated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) environmental contamination in 2 rooms of a quarantine hotel after 2 presymptomatic persons who stayed there were laboratory-confirmed as having coronavirus disease. We detected SARS-CoV-2 RNA on 8 (36%) of 22 surfaces, as well as on the pillow cover, sheet, and duvet cover.
Two Chinese students studying overseas returned to China on March 19 (patient A) and March 20 (patient B), 2020 (Table 1). On the day of their arrival in China, neither had fever or clinical symptoms, and they were transferred to a hotel for a 14-day quarantine. They had normal body temperatures (patient A, 36.3°C; patient B, 36.5°C) and no symptoms when they checked into the hotel. During the quarantine period, local medical staff were to monitor their body temperature and symptoms each morning and afternoon. On the morning of the second day of quarantine, they had no fever (patient A, 36.2°C for patient A; patient B, 36.7°C) or symptoms.
At the same time their temperatures were taken, throat swab samples were collected; both tested positive for SARS-CoV-2 RNA by real-time reverse transcription PCR (rRT-PCR).
The students were transferred to a local hospital for treatment. At admission, they remained presymptomatic, but nasopharyngeal swab, sputum, and fecal samples were positive for SARS-CoV-2 RNA with high viral loads (Table 1). In patient A, fever (37.5°C) and cough developed on day 2 of hospitalization, but his chest computed tomography images showed no significant abnormality during hospitalization. In patient B, fever (37.9°C) and cough developed on day 6 of hospitalization, and her computed tomography images showed ground-glass opacities.
Approximately 3 hours after the 2 patients were identified as positive for SARS-CoV-2 RNA, we sampled the environmental surfaces of the 2 rooms in the centralized quarantine hotel in which they had stayed.
Our study demonstrates extensive environmental contamination of SARS-CoV-2 RNA in a relatively short time (< 24 hours) in occupied rooms of 2 persons who were presymptomatic. We also detected SARS-CoV-2 RNA in the surface swab samples of the pillow cover, duvet cover, and sheet.
Evidence for SARS-CoV-2 transmission by indirect contact was identified in a cluster of infections at a shopping mall in China (10). However, no clear evidence of infection caused by contact with the contaminated environment was found. SARS-CoV-2 RNA has been detected on environmental surfaces in isolation rooms where the symptomatic or paucisymptomatic patients stayed for several days (3–5).
In our study, we demonstrate high viral load shedding in presymptomatic patients, which is consistent with previous studies (8,9), providing further evidence for the presymptomatic transmission of the virus (5,11–15). In addition, presymptomatic patients with high viral load shedding can easily contaminate the environment in a short period.
Our results also indicate a higher viral load detected after prolonged contact with sheets and pillow covers than with intermittent contact with the door handle and light switch. The detection of SARS-CoV-2 RNA in the surface samples of the sheet, duvet cover, and pillow cover highlights the importance of proper handling procedures when changing or laundering used linens of SARS-CoV-2 patients. Thus, to minimize the possibility of dispersing virus through the air, we recommend that used linens not be shaken upon removal and that laundered items be thoroughly cleaned and dried to prevent additional spread.
The absence of viral isolation in our investigation was an obstacle to demonstrating the infectivity of the virus, but SARS-CoV-2 has been reported to remain viable on surfaces of plastic and stainless steel for up to 4–7 days (6,7) and 1 day for treated cloth (7).
In summary, our study demonstrates that presymptomatic patients have high viral load shedding and can easily contaminate environments. Our data also reaffirm the potential role of surface contamination in the transmission of SARS-CoV-2 and the importance of strict surface hygiene practices, including regarding linens of SARS-CoV-2 patients.
Dr. Jiang is an epidemiologist in Qingdao Center for Disease Control and Prevention, Qingdao, Shandong Province, China. His primary research interests included infectious disease control and prevention and emerging infectious diseases.
Nearly all of the guidance we’ve seen on the environmental persistence of SARS-CoV-2 has focused on aerosols and hard surfaces like plastic, stainless steel, copper, and cardboard (see Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1).
Data on fabrics, clothing, and other porous materials appears to be lacking, although the CDC does offer this advice for laundering items from a `sick room’.
The guidance being offered to hotels and motels on cleaning and disinfecting rooms appears to vary widely by state. While bed linens are routinely changed and laundered daily, in most hotels bedspreads, blankets, and duvet covers are laundered only a few times each year.
California’s Hotel Guidance, which provides one of the most detailed plans I’ve seen, suggests:
What isn’t known is how long SARS-CoV-2 remains infectious on blankets, bedspreads, or duvet covers. It is likely a matter of hours, but I’d sleep a lot better knowing for sure.
|How to Wear Face Cover|
After much debate, late yesterday the CDC issued `Face Cover’ recommendations for the general public, along with some easy tutorials (below) on how to make these items at home.
Although a homemade face cover probably provides very limited protection to the wearer, it can reduce the transmission of the virus to others and it can remind us not to touch our face. They are not a substitute, however, for social distancing (staying 6 feet apart), handwashing, or staying home as much as possible.
While a imperfect solution, as part of a layered, NPI approach, they can help reduce community transmission of the virus. If nothing else, by wearing one, you are showing respect for the health and welfare of others, and are setting a good example at the same time.
Face coverings should—
- fit snugly but comfortably against the side of the face
- be secured with ties or ear loops
- include multiple layers of fabric
- allow for breathing without restriction
- be able to be laundered and machine dried without damage or change to shape
CDC on Homemade Face Covers
CDC recommends wearing cloth face coverings in public settings where other social distancing measures are difficult to maintain (e.g., grocery stores and pharmacies), especially in areas of significant community-based transmission.
CDC also advises the use of simple cloth face coverings to slow the spread of the virus and help people who may have the virus and do not know it from transmitting it to others. Cloth face coverings fashioned from household items or made at home from common materials at low cost can be used as an additional, voluntary public health measure.
Cloth face coverings should not be placed on young children under age 2, anyone who has trouble breathing, or is unconscious, incapacitated or otherwise unable to remove the mask without assistance.
The cloth face coverings recommended are not surgical masks or N-95 respirators. Those are critical supplies that must continue to be reserved for healthcare workers and other medical first responders, as recommended by current CDC guidance.
Should cloth face coverings be washed or otherwise cleaned regularly? How regularly?
Yes. They should be routinely washed depending on the frequency of use.
How does one safely sterilize/clean a cloth face cover?
A washing machine should suffice in properly washing a face covering.
How does one safely remove a used face cover?
Individuals should be careful not to touch their eyes, nose, and mouth when removing their face covering and wash hands immediately after removing.
While the numbers being reported out of Italy are sobering, over the past week we’ve see a significant reduction in daily case counts, dropping from more than 6,500 ten days ago to just over 4000 a day for the past two days.
Three weeks after entering into a nationwide lockdown, this is clear evidence that their social distance strategy is working.
Deaths, however, are always a lagging indicator, and over the past two days Italy has averaged more than 800 fatalities per day, raising their official death toll to 12,428. As high as that is, there are media reports suggesting that the actual toll could be considerably higher, as many non-hospital deaths may not have been tested.
Even so, the preliminary CFR (Case Fatality Rate) in Lombardy is an astronomical 16.67%, and for Italy as a whole, 11.7%. Both numbers clearly several times higher than anything we’ve seen reported anyplace else in the world.
While it is probable that many mild and moderate cases have not been counted – and adding those in would substantially lower the CFR – there are also numerous reports of overwhelmed hospitals, and a lack of staffed ICU beds, which has likely also contributed to Italy’s case fatality rate.
The after-action report from hard hit countries – including Italy – after this pandemic wave has passed, should tell us a great deal more about how, and why differing numbers of pandemic deaths occurred.
And while Italy’s numbers look huge today, they could easily be surpassed by other nations in the days and weeks ahead.
CURRENTLY POSITIVE 77635
Press conference at 6 pm on March 31st
105,792 total cases, currently positive people are 77,635, 12,428 dead and 15,729 recovered.
Among the 77,635 positives:
- 45,420 are in home isolation
- 28,192 hospitalized with symptoms
- 4,023 in intensive care
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