The Efficacy of High-Volume Evacuators and Extraoral Vacuum Aspirators in Reducing Aerosol and Droplet in Ultrasonic Scaling Procedures during the COVID-19 Pandemic

Objective SARS-CoV-2 can be carried by aerosols and droplets produced during dental procedures, particularly by the use of high-speed handpieces, air-water syringes, and ultrasonic scalers. High-volume evacuators (HVEs) and extraoral vacuum aspirators (EOVAs) reduce such particles. However, there is limited data on their efficacy. This study aimed to determine the efficacy of HVE and EOVA in reducing aerosols and droplets during ultrasonic scaling procedures. Materials and Methods Three ultrasonic scaling simulations were conducted on mannequins: 1. saliva ejector (SE) was used alone (control); 2. SE was used in combination with HVE; and 3. SE was used in combination with HVE and EOVA. Paper filters were placed on the operator's and assistant's face shields and bodies, and the contamination of aerosols and droplets was measured by counting blue spots on the paper filters. Statistical Analysis All data were analyzed for normality using the Kolmogorov–Smirnov test. The differences between each method were analyzed using a two-way ANOVA, followed by a posthoc test. The differences were considered statistically significant when p < 0.05 Result Using HVE and EOVA reduced aerosols and droplets better than using SE alone or SE and HVE: the posthoc test for contamination revealed a significant difference (p < 0.01). The assistant was subjected to greater contamination than the operator during all three ultrasonic scaling procedures. Conclusion The usage of HVE and EOVA significantly reduced aerosols and droplets compared with using SE solely. Using these techniques together could prevent the transmission of airborne disease during dental cleanings, especially COVID-19. Further studies of aerosol-reducing devices are still needed to ensure the safety of dental workers and patients.

Carbon dioxide, COVID-19 and the importance of restaurant ventilation: a case study from Spain approaching Christmas 2021

Restaurants present an especial challenge in the prevention of the spread of COVID-19 via exhalatory bioaerosols because customers are unprotected by facemasks while eating, so that ventilation protocols in such establishments become especial important. However, despite the fact that this pandemic airborne disease has been with us for two full years, many restaurants are still not successfully prioritising air renovation as a key tool for reducing infection risk. We demonstrate this in the run-up to the 2021 Christmas celebrations by reporting on CO2 concentration data obtained from a hotel breakfast room and restaurants during the 5-day Spanish holiday period of 4th-8th December. In the case of the breakfast room, poor ventilation resulted in average CO2 levels ranging from 868 to 1237 on five consecutive days, with the highest levels coinciding with highest occupancy numbers. Inside the five restaurants, three of these were well ventilated, maintaining stable average CO2 concentrations below 700ppm. In contrast, two restaurants failed to keep average CO2 levels below 1000ppm, despite sporadic, but ineffective, attempts by one of them to ventilate the establishment. More effort needs to be made to foster in both restaurant managers and the general public an improved awareness of the value of CO2 concentrations as an infection risk proxy and the relevance of ventilation issues to the propagation of respiratory diseases.

Wavelength-dependent DNA photodamage in a 3-D human skin model over the far-UVC and germicidal-UVC wavelength ranges from 215 to 255 nm

The effectiveness of UVC to reduce airborne-mediated disease transmission is well-established. However conventional germicidal UVC (~254 nm) cannot be used directly in occupied spaces because of the potential for damage to the skin and eye. A recently studied alternative with the potential to be used directly in occupied spaces is far-UVC (200 to 235 nm, typically 222 nm), as it cannot penetrate to the key living cells in the epidermis. Optimal far-UVC use is hampered by limited knowledge of the precise wavelength dependence of UVC-induced DNA damage, and thus we have used a monochromatic UVC exposure system to assess wavelength-dependent DNA damage in a realistic 3-D human skin model. We exposed a 3-D human skin model to mono-wavelength UVC exposures of 100 mJ/cm2, at UVC wavelengths from 215 to 255 nm (5-nm steps). At each wavelength we measured yields of DNA-damaged keratinocytes, and their distribution within the layers of the epidermis. No increase in DNA damage was observed in the epidermis at wavelengths from 215 to 235 nm, but at higher wavelengths (240-255 nm) significant levels of DNA damage were observed. These results support use of far-UVC light to safely reduce the risk of airborne disease transmission in occupied locations.

Beyond well-mixed: a simple probabilistic model of airborne disease transmission in indoor spaces

We develop a simple model for assessing risk of airborne disease transmission that accounts for non-uniform mixing in indoor spaces and is compatible with existing epidemiological models. A database containing 174 high-resolution simulations of airflow in classrooms, lecture halls, and buses is generated and used to quantify the spatial distribution of expiratory droplet nuclei for a wide range of ventilation rates, exposure times, and room configurations. Imperfect mixing due to obstructions, buoyancy, and turbulent dispersion results in concentration fields with significant variance. The spatial non-uniformity is found to be accurately described by a shifted lognormal distribution. A well-mixed mass balance model is used to predict the mean, and the standard deviation is parameterized based on ventilation rate and room geometry. When employed in a dose-response function risk model, infection probability can be estimated considering spatial heterogeneity that contributes to both short- and long-range transmission.

An upper bound on one-to-one exposure to infectious human respiratory particles

There is ample evidence that masking and social distancing are effective in reducing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission. However, due to the complexity of airborne disease transmission, it is difficult to quantify their effectiveness, especially in the case of one-to-one exposure. Here, we introduce the concept of an upper bound for one-to-one exposure to infectious human respiratory particles and apply it to SARS-CoV-2. To calculate exposure and infection risk, we use a comprehensive database on respiratory particle size distribution; exhalation flow physics; leakage from face masks of various types and fits measured on human subjects; consideration of ambient particle shrinkage due to evaporation; and rehydration, inhalability, and deposition in the susceptible airways. We find, for a typical SARS-CoV-2 viral load and infectious dose, that social distancing alone, even at 3.0 m between two speaking individuals, leads to an upper bound of 90% for risk of infection after a few minutes. If only the susceptible wears a face mask with infectious speaking at a distance of 1.5 m, the upper bound drops very significantly; that is, with a surgical mask, the upper bound reaches 90% after 30 min, and, with an FFP2 mask, it remains at about 20% even after 1 h. When both wear a surgical mask, while the infectious is speaking, the very conservative upper bound remains below 30% after 1 h, but, when both wear a well-fitting FFP2 mask, it is 0.4%. We conclude that wearing appropriate masks in the community provides excellent protection for others and oneself, and makes social distancing less important.

Assessment of Airborne Disease Transmission Risk and Energy Impact of HVAC Mitigation Strategies

The COVID-19 pandemic has focused renewed attention on the ways in which building HVAC systems may be operated to mitigate the risk of airborne disease transmission. The most common suggestion is to increase outdoor-air ventilation rates so as to dilute the concentrations of infectious aerosol particles indoors. Although this strategy does reduce the likelihood of disease spread, it is often much more costly than other strategies that provide equivalent particle removal or deactivation. To address this tradeoff and arrive at practical recommendations, we explain how different mitigation strategies can be expressed in terms of equivalent outdoor air (EOA) to provide a common basis for energy analysis. We then show the effects of each strategy on EOA delivery and energy cost in simulations of realistic buildings in a variety of climates. Key findings are that in-duct filtration is often the most efficient mitigation strategy, while significant risk reduction generally requires increasing total airflow to the system, either through adjusted HVAC setpoints or standalone disinfection devices.

A Computational Framework for Transmission Risk Assessment of Aerosolized Particles in Classrooms

The ongoing COVID-19 pandemic has rendered confined spaces as high-risk areas. There is an increasing push to resume in-person activities, for instance, teaching in K-12 and university settings. It becomes important to evaluate the risk of airborne disease transmission while accounting for the physical presence of humans, furniture, and electronic equipment, as well as ventilation. Here, we present a computational framework based on detailed flow physics simulations that allows straightforward evaluation of various seating and operating scenarios to identify risk factors and assess the effectiveness of various mitigation strategies. These scenarios include seating arrangement changes, presence/absence of computer screens, ventilation rate changes, and presence/absence of mask-wearing. This approach democratizes risk assessment by automating a key bottleneck in simulation-based analysis--creating an adequately refined mesh around multiple complex geometries. Not surprisingly, we find that wearing masks (with at least 74% inward protection efficiency) significantly reduced transmission risk against unmasked and infected individuals. The availability of such an analysis approach will allow education administrators, government officials (courthouses, police stations), and hospital administrators to make informed decisions on seating arrangements and operating procedures.

Assessment of Knowledge, Attitude and Practice (KAP) in Tuberculosis patients

Tuberculosis (TB) is a highly contagious airborne disease caused by Mycobacterium tuberculosis that primarily affects the lungs. TB is a significant and major public health emergency globally. According to the WHO Global Tuberculosis Report 2020, 10 million people developed TB disease in the year 2019. The main objective of the study was to assess the level of knowledge, attitude and practice in TB patients. The study also reveals the association between KAP and the demographics of the subjects. An observational study was employed to collect data from a total of 71 subjects. Both quantitative and qualitative statistical analysis were adopted. From the findings, the mean age of the study population was 45.5 ± 13.96 years. Over 15.50% of subjects appeared to have adequate knowledge, 87.33% of subjects had a fair attitude, and around 58% of subjects were reported to have good practices towards TB. A weak positive correlation between knowledge and attitude (p = 0.051), weak positive correlation between knowledge and practice (p = 0.138) whereas, a significant and moderately positive correlation between attitude and practice (p = 0.002) was observed. The mean knowledge scores of graduates and post-graduates were higher in comparison with other study subjects. The study findings showed that the majority of subjects had several misconceptions about TB and hence prioritized interventions and more awareness programs at the root levels are needed to aid TB control and eradication.