Below please find a summary and link(s) of new coronavirus-related content published today in Annals of Internal Medicine. The summary below is not intended to substitute for the full article as a source of information. A collection of coronavirus-related content is free to the public at http://go.annals.org/coronavirus.
1. Social distance proves key as respiratory route found to be the most common way to spread COVID-19
COVID-19 is spread most often through respiratory droplets or aerosols and little evidence exists supporting transmission through surfaces. As such, social distance and proper ventilation are key determinants of transmission risk. Findings from a review of published research, articles, and reports is published in Annals of Internal Medicine.
Researchers from Montefiore Medical Center, Hospital of the University of Pennsylvania, Massachusetts General Hospital, Harvard Medical School, and Brigham and Women's Hospital studied scientific articles published between January and September 2020, as well as relevant articles and institutional or governmental reports, to determine the viral, host, and environmental factors that contribute to transmission of COVID-19. They found that although several experimental studies suggest that virus particles could live for hours after inoculation in aerosols or on surfaces, the real-world studies that detect viral RNA in the environment report very low levels on surfaces, and few have isolated viable virus. Strong evidence from case and cluster reports indicates that respiratory transmission is dominant, with proximity and ventilation being key determinants of transmission risk. In the few cases where direct contact or transmission from materials or surfaces was presumed, respiratory transmission could still not be ruled out.
The researchers also identified patterns in virus transmission. The evidence showed that COVID-19 virus peaks around a day before symptom onset and declines within a week of symptom onset. All transmissions occur early on and none have ever been documented after a patient has had symptoms for about a week. Most persons do not transmit the virus, whereas some cause many secondary cases in transmission clusters called "superspreading events." According to the authors, their findings should help to inform evidence-based policies and practices to help educate the public and slow the spread of this virus. Read the full text: https://www.acpjournals.org/doi/10.7326/M20-5008.
Media contacts: A PDF for this article is not yet available. Please click the link to read full text. Author Eric A. Meyerowitz, MD can be reached through Elaine Landoli at elaine.iandoli@einsteinmed.org and author Aaron Richterman, MD can be reached through Alex Gardner at alex.gardner@pennmedicine.upenn.edu.
2. Novel, rapidly deployable community isolation quarantine facilities help to manage COVID-19
A substantial proportion of stable patients with COVID-19 can be isolated safely outside a hospital setting with a small health care team. Researchers from Singapore General Hospital discuss how isolation facilities can be created rapidly to care for patients without serious adverse outcomes. An article describing their process and outcomes is published in Annals of Internal Medicine.
Singapore is one of the most densely populated small island-states in the world. During the COVID-19 pandemic, Singapore implemented large-scale institutional isolation units called Community Care Facilities (CCFs) to combat the outbreak in the community. They housed stable, low-risk COVID-19 patients in CCFs from April to August 2020. These CCFs were created rapidly by converting existing public spaces into isolation facilities, and each was augmented by telemedicine to enable a low health care worker-patient ratio (98 health care workers for 3,200 beds).
In the first month, a total of 3,758 patients were admitted to 4 halls and 4,929 in-house medical consults occurred. The authors report that 136 patients were transferred to a hospital and only 1 patient died 2 weeks after discharge. No health care workers became infected. These results demonstrate that such facilities can successfully provide holistic patient care in the face of a public health crisis when health care resources are lean. Read the full text: https://www.acpjournals.org/doi/10.7326/M20-4746.
Media contacts: A PDF for this article is not yet available. Please click the link to read full text. To speak with the lead author, Kheng Sit Lim, B.Comp, MBBS, MMed(Surg), please contact Carol Ang at carol.ang@sgh.com.sg.
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Journal
Annals of Internal Medicine