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Friday, March 27, 2020

Impact of Asymptomatic Coronavirus

I feel a bit like a broken wheel as the last several weeks have only focused about COVID-19.  But we are watching history unfold.  By that, I do not mean the number of infections, recoveries or deaths.  I mean that each week, each day and even every hour we learn something new.  Studies and data are being published all the time.

This week, I came across two studies looking at the impact of asymptomatic transmission. The rate of transmission seems to be what makes COVID-19 a more serious threat then outbreaks of coronavirus we have seen previously.   As discussed in last week’s blog, the ability of SARS-CoV-2 to live on the surface was found to be the same as SARS-CoV-1 that caused the 2003 outbreak.  This means that other factors are impacting its spread.  Some additional factors could be higher viral loads in the upper respiratory tract which could account for spread, but also the potential for SARS-CoV-2 infected people to shed the virus even before they show symptoms.

With the COVID-19 pandemic we are seeing that most secondary transmission is occurring in the community as opposed to healthcare settings.  In the first study, Japanese investigators looked at the 634 passengers from the Diamond Princess who tested positive for COVID-19.  They found that 17.9% of the passengers were asymptomatic meaning they could presumably spread the virus.  The second study published by Dutch researchers estimated a 48% occurrence for asymptomatic transmission for Singapore and a 62% for Tianjin, China.

This data raises concerns about the protocols being used for screening and the potential impact for further community transmission.  It also highlights the potential for transmission to healthcare workers who would not be in PPE but could be exposed to infected patients who are not showing signs and symptoms of COVID-19. 

The long and the short is while we are learning and sharing as much information as we can, and as quickly as we can, we must rely on some of the key tenets of infection prevention to minimize the spread of COVID-19.  Hand hygiene is something that needs to be on the top of our minds.  Wash your hands as frequently as possible and particularly before eating or touching your face.  Keeping you and your hands to yourself via social distancing.  Respiratory droplets can be projected quite some distance, hence the need to cover your mouth and nose when you cough or sneeze.  This is the reason for the recommended six (6) feet space between people.  Disinfection of high-touch surfaces and increasing the frequency of disinfection will help to limit the chance of secondary transmission from touching contaminated surfaces.

I’m sure next week more will be found, until then….

Bugging Off!


Friday, March 20, 2020

COVID-19 Surface Survival

Infection prevention experts are calling COVID-19 an infodemic, meaning misinformation spreading quicker than the virus itself.  Everyday we are reading updates on the increasing number of cases and deaths.  We are unfortunately not talking about the positive: the increased number of cases who have recovered.

As more time passes, researchers are sharing and publishing more information about the virus itself.  One of the exciting studies that is being published in the New England Journal of Medicine investigates the length of time that SARS-CoV-2, the virus that causes COVID-19 disease, can survive on surfaces.  It is generally believed that COVID-19 is transmitted in droplet form after sneezing or coughing.  The importance of this is that droplets are heavier and can only stay suspended in air for a short period of time before dropping to land on a surface.  If you are close enough for the virus particles to reach you after someone coughs or sneezes, you can become infected.

The ability for the virus to survive in the air and on surfaces has a direct impact on its ability to transmit from person to person.  The study investigated and compared SARS-CoV-2 and the original SARS virus to determine their aerosol stability and surface survival capability.  When it came to stability of SARS-CoV-2 on surfaces, researchers looked at the ability to survive on the surface for up to 7 days.  The testing conducted indicated that viable virus could be found on plastic and stainless steel for up to 72 hours.   The virus was found to survive better (higher concentrations for longer) on plastic.  On copper, SARS-CoV-2 did not survive past 4 hours and on cardboard, it did not survive past 24 hours.  When it came to the viability of SARS-CoV-2 surviving as an aerosol, researchers used 3 hours as the point of time to test and found that viable virus was found in aerosols throughout the duration of the study.

Gaining clarity into SARS-CoV-2’s ability to survive on surfaces and after being “shed” via coughing and sneezing is an important piece of the puzzle.  The shorter timeframe it can survive, the better our chance of stopping its spread.  It’s important to understand that these tests were conducted under carefully controlled conditions in a lab.  In the real world, where conditions (e.g. temperature, humidity and sunlight) can impact the ability to survive as well.  For example, we know that sunlight can help in reducing the infectivity of viruses on surfaces. 

The long and the short is we still have so much more to learn about this virus.  There is speculation that infected people may be shedding the virus and infecting others before they even exhibit symptoms.  If true, this certainly impacts the speed with which we can curb the pandemic. However, many countries are taking precautions such as cancelling large gatherings, closing schools and restaurants as well as asking for people to work from home and follow social distancing, all of which will help curb transmission.  If the virus is only capable of surviving for 3 days as opposed to initial indications of much longer, then we can continue wage war against SARS-CoV-2 and be victorious by all working together.

Bugging Off!


Friday, March 13, 2020

Leprechaun Luck for St Paddy’s Day

Next week is St Patrick’s Day and for many each year it signifies a day of celebrating, wearing green and perhaps a few sips of green beer.   Saint Patrick, who was the foremost patron saint of Ireland, is the name sake for Saint Patrick's Day, or the Feast of Saint Patrick which celebrates the heritage and culture of the Irish.

In the wake of the school closures, travel bans, restrictions on mass gatherings and cancellation of conferences, sporting events, concerts and award ceremonies due to COVID—19, many of the traditional celebrations for St. Paddy’s will likely also be cancelled.   For those that have the luck of the Irish and intend to celebrate regardless of recommendations of social distancing the following are a few tips to help you enjoy your night and help to reduce you chances of getting sick:
  • Wash your hands regularly for at least 20 seconds with soap and water, or with an alcohol-based hand rub, like hand sanitizer, when soap and water isn’t available.
  • Avoid touching your eyes, nose, and mouth as much as possible. 
  • Use your knuckles to press buttons and your sleeves to open doors to help minimize contaminating your hands.
  • Maintain at least a 3-foot distance from anyone who is coughing or sneezing.
  • Cover your mouth and nose with a bent elbow or tissue when you cough or sneeze (don’t spread your germs, and if you are sick – stay home).

If you’re thinking of celebrating at home with a group of friends, you may also want to consider adding the following additional precautions:
  • Limit movement around the house (e.g. keep to the main floor).
  • Consider removing your reusable hand towel and use disposable paper towels.
  • Clean and disinfect all high touch surfaces before your guests arrive and again after they’ve gone (less area to clean if you limit their movement!)

While COVID-19 is firmly on our minds, the recommendations given to keep yourself disease-free is the same for Influenza and many other communicable diseases.  The long and short if you want to stay healthy is to wash your hands, avoid touching your face and disinfect high touched surfaces to reduce the chance of picking something!

Bugging Off!


Friday, March 6, 2020

Canine Case of COVID-19

As if the increased number of COVID-19 cases around the world is not enough, Hong Kong announced a case of COVID-19 associated with a pet dog of a positive COVID-19 patient.  We know the likely source of COVID-19 is zoonotic, and while during SARS there was some evidence cats could pick up the virus from the environment there was no infection.

According to infectious disease experts, some animals do have the same receptor for COVID-19 so it’s plausible they can have the disease but do not tend to be symptomatic and pets are unlikely to spread the virus further.

Initial information from Hong Kong indicated that the result could be caused by environmental contamination meaning that the dog picked up traces of the virus from their environment or person.  However, on Wednesday a new statement was issued stating that the dog had been tested two more times (nasal and oral) which returned positive tests. After consulting medical and veterinary experts and the World Organization for Animal Health, Hong Kong officials concluded it is a case of human-to-animal transmission of the virus.

This does not mean we should panic.  At this point, the testing conducted has been completed using PCR which is a very sensitive test which can detect minute amount of the COVID-19 viral RNA, however, PCR does not differentiate between viable virus that is capable of causing infection and inactivated virus.  Infectious Disease Experts are stating that pet parents need not be overly concerned and under no circumstances should they abandon their pets.  We should, however, practice good hygiene practices such as washing your hands before and after being around or handling animals, their food, or supplies, as well as avoiding kissing them or them kissing you.  Like other respiratory diseases we should also work to maintain a clean and hygienic household environment through cleaning and disinfection.  The other advice is for people who are sick to restrict contacting animals and if their pets have any changes in their health seek advice from a veterinarian as soon as possible.

Unfortunately, in Wuhan, China, authorities are reportedly euthanizing animals that are found in homes of people infected with the virus.  Hong Kong is being more level-headed and only recommending that animals of positive patients be quarantined, as the likelihood of pets getting sick or spreading the disease is very low.

Bugging Off!