Reduction of exposure to simulated respiratory aerosols using ventilation, physical distancing, and universal masking

To limit community spread of SARS-CoV-2, CDC recommends universal masking indoors, maintaining 1.8 m of physical distancing, adequate ventilation, and avoiding crowded indoor spaces. Several studies have examined the independent influence of each control strategy in mitigating transmission in isolation, yet controls are often implemented concomitantly within an indoor environment. To address the influence of physical distancing, universal masking, and ventilation on very fine respiratory droplets and aerosol particle exposure, a simulator that coughed and exhaled aerosols (the source) and a second breathing simulator (the recipient) were placed in an exposure chamber. When controlling for the other two mitigation strategies, universal masking with 3-ply cotton masks reduced exposure to 0.3-3 μm coughed and exhaled aerosol particles by > 77% compared to unmasked tests, whereas physical distancing (0.9 or 1.8 m) significantly changed exposure to cough but not exhaled aerosols. The effectiveness of ventilation depended upon the respiratory activity, i.e., coughing or breathing, as well as the duration of exposure time. Our results demonstrate that a combination of administrative and engineering controls can reduce personal inhalation exposure to potentially infectious very fine respiratory droplets and aerosol particles within an indoor environment.

Caste in the Time of the COVID-19 Pandemic

Historically, it is a glaring fact that any disaster or pandemic made the Dalit and Adivasi as the worst victim. Therefore, it is of utmost importance to unfold the caste dynamics and social realities around the debate of the COVID-19 pandemic. A unique feature of India’s caste system is in its flexibility. Therefore, even during the time of the COVID-19 pandemic, the prescribed medical guidelines of ‘social distancing’ encourages the Savarnas to strengthen the caste prejudices in the name of science. Apart from this, the prescribed guidelines for ‘social distancing’ and ‘home quarantine’ exposed the graded caste inequality in India. The empirical evidence from this study brings it to the forefront that a graded caste inequality persists in household’s availability of exclusive room with attached toilet facilities and adequate ventilation facilities, household’s access to exclusive drinking water source, household’s affordability in practising hand wash with soap or detergent, etc. Therefore, when the Forward caste become the most privileged in maintaining the home quarantine and complete isolation, it becomes an unaffordable luxury for the Dalits. It makes the Dalits most vulnerable during this pandemic. Therefore, this pandemic provides a stark example of the pervasiveness and perniciousness of social inequality in India.

COVID-19 is in the air: Why are we still ignoring the importance of ventilation?

The main transmission mechanism of the SARS-CoV-2 virus is airborne, particularly in poorly ventilated indoor environments. Recognizing the importance of this mechanism has taken a long time, despite the evidence generated by aerosol scientists from an early stage of the pandemic. Hence, measures applied more widely by the population have focused on the disinfection of surfaces, often in an exaggerated way, while measures focused on reducing the concentration of aerosols in indoor environments, such as adequate ventilation and air filtration, have been timidly promoted. In addition to the progress of the National Vaccination Plan, it is necessary to intensify transmission prevention measures for a safer reopening of the economy. It is therefore urgent, to educate and generate clear guidelines for the evaluation and improvement of ventilation in indoor spaces.

Air Quality Monitoring During High-Level Biocontainment Ground Transport: Observations From Two Operational Exercises

Objective: Stretcher transport isolators provide mobile, high-level biocontainment outside the hospital for patients with highly infectious diseases, such as Ebola virus disease. Air quality within this confined space may pose human health risks. Methods: Ambient air temperature, relative humidity, and CO2 concentration were monitored within an isolator during 2 operational exercises with healthy volunteers, including a ground transport exercise of approximately 257 miles. In addition, failure of the blower unit providing ambient air to the isolator was simulated. A simple compartmental model was developed to predict CO2 and H2O concentrations within the isolator. Results: In both exercises, CO2 and H2O concentrations were elevated inside the isolator, reaching steady-state values of 4434 ± 1013 ppm CO2 and 22 ± 2 mbar H2O in the first exercise and 3038 ± 269 ppm CO2 and 20 ± 1 mbar H2O in the second exercise. When blower failure was simulated, CO2 concentration exceeded 10 000 ppm within 8 minutes. A simple compartmental model predicted CO2 and H2O concentrations by accounting for human emissions and blower air exchange. Conclusions: Attention to air quality within stretcher transport isolators (including adequate ventilation to prevent accumulation of CO2 and other bioeffluents) is needed to optimize patient safety.

Research into psychiatry trainees views around the impact COVID-19 has had on the provision of electroconvulsive therapy training

AimsThe current COVID-19 outbreak has changed the way electroconvulsive therapy (ECT) is provided. In many areas it has been moved from the more traditional ECT suites to general surgical theatres for a number of reasons, most notably being the need to ensure adequate ventilation. The introduction of the need for PPE to be worn throughout ECT and for general hospital operating procedures to be adhered to has also been a big change. The change in the required infection control procedures has had an impact on treatment capacity and has led many areas to reduce, relocate or centralise their ECT provisions which has had a knock on effect on training.This study assesses the perceived impact COVID-19 has had on the provision of training and learning in ECT for core and higher psychiatry trainees in the North West as well as their perceived competence levels.MethodViews were sought through surveys and focus groups from September to December 2020, participants were core and higher psychiatry trainees in the North West. Participants were recruited via email, the total population size was 87, 21 Core trainees responded and 14 higher trainees. From the survey respondents, 5 participants agreed to attend a focus group.ResultResults show that the provision of ECT training has been poor during the COVID-19 outbreak. Almost 81% of core trainees surveyed and 92.86% of higher trainees had participated in no ECT sessions from the start of the COVID-19 outbreak to the time of data collection eight to ten months later.81% of core trainees and 85.71% of higher trainees had received no teaching in any form about ECT over the period studied.When considering the competencies required in ECT for a core trainee, one (4.76%) felt they were fully competent, 3 (14.29%) nearly competent, 7(33.33%) needs some improvement, 10 (47.62%) not yet competent. Only one higher trainee felt they met the RCPsych competencies, 5 (35.71%) were nearly competent, 6 (42.86%) need some improvement and 2 (14.29%) were not yet competent.ConclusionThis study indicates a clear lack of provision of training which is very concerning ,and possibly pre dates the COVID outbreak, particularly in the case of specialty trainees who may well be consultants in a number of months and will not have the time to make up for the lost training. In order for ECT provision to continue it is crucial that we are able to adequately train the future workforce.

Building for Sustainable Ventilation and Air Quality

Most legislations concerning ventilation are based on perceived air quality criteria, but ventilation is also important for the health of the occupants. The perceived air quality criteria can be viewed as a pragmatic tool to achieve an adequate ventilation for precautionary health measures. From a comfort and health perspective, the ventilation rate and an efficient air distribution are both important for achieving a healthy and comfortable indoor environment. Yet, most legislative requirements focus on the ventilation rate. This is not enough, and it is recommended that legislation also address the air distribution with the same zeal. In particular, the efficient distribution of fresh air to the occupied zones or lowering the concentrations of pollutants in the occupied zones. Because there are clear links between ventilation and health, it is extremely worrying that the “energy efficiency first” principle advocated in the Energy Performance of Buildings Directive (EPBD) has led to decreasing ventilation requirements in the European Union legislations, at the same time as the objective is to aggressively tighten the envelopes of the building stock. A second consequence of EPBD is probably that many naturally ventilated buildings will be retrofitted with mechanical ventilation systems. It is not clear that this would be the more sustainable solution in the long run.

Tidal volume according to the 4-point sealing forces of a bag-valve-mask: an adult respiratory arrest simulator-based prospective, descriptive study

Background For adequate ventilation during bag-valve-mask ventilation, rescuers should ensure a proper mask seal using the one-handed or two-handed technique. Little is known about the magnitude of sealing forces of a bag-valve-mask needed for adequate ventilation. This study aimed to explore the effect of the 4-point sealing forces of a bag-valve-mask on tidal volume while using the one-handed technique, focusing on the moderating effect of C length (the distance from the thumb to the index finger in the C shape of the one-hand EC grip). Methods A prospective, descriptive simulation study was conducted. A convenience sample of 125 undergraduate paramedic students from two universities was recruited. A self-reported questionnaire was used to collect subjective variables. Tidal volumes, 4-point sealing forces of the mask, peak pressure, and C length of the C shape in the one-hand EC grip were measured using the mechanical lung model under a simulated adult respiratory arrest. Hierarchical regression analysis was used to determine the moderating effect of C length on tidal volume in bag-valve-mask ventilation. Results The average C length, peak pressure, and tidal volume were 7.54 (± 1.85) cm, 11.62 (± 5.40) cmH2O, and 321.66 (± 135.18) mL, respectively. The average range of the 4-point sealing forces was 0.03–0.69 N. The apex sealing force was the weakest among the 4-point sealing forces. Hierarchical regression analysis demonstrated that tidal volume accounted for 62.7% of the variance by C length, peak pressure, and apex sealing force during bag-valve-mask ventilation (F = 9.676, p < 0.001). C length moderated the effect of the apex sealing force and peak pressure on the tidal volume, meaning the higher the peak pressure and apex sealing force, the more the tidal volume and the longer the C length. Conclusion This first simulation study measuring the 4-point sealing forces during bag-valve-mask ventilation provides effective advice that can be adopted in clinical practice without side effects and underpins the importance of continuous retraining and assessment focused on individual physical characteristics, such as C length and bag-valve-mask sealing forces.

PENYULUHAN PENCEGAHAN PENYAKIT TUBERKULOSIS (TBC) ERA NEW NORMAL

Having good knowledge and attitude related to the prevention of Tuberculosis is very important as control disease efforts and also supported by a positive and appropriate attitude. Actually, positive behavior can improve the prevention of Tuberculosis disease that would support the government to control the disease. This community service aims to improve the knowledge of students about Tuberculosis disease that would inhibit the transmission of disease in the Islamic Boarding School Inshafuddin, Banda Aceh. This community service activity was implemented by presenting counseling information and distributing leaflets about Tuberculosis disease to all students who join in this event. The activity is held on strict health protocols such as open space that meets adequate ventilation requirements and wearing a mask, washing hands first before entering the counseling area, and sitting more than 1 meter apart. The number of students who participated in this event was about 30 students and was attended by several teachers. All activity participants stated that this activity was very useful and could improved knowledge related to Tuberculosis disease.

Investigation of ventilation conditions associated with CO2 concentration changes in ultrasonographic exam room from the perspective of COVID-19 infection control

ObjectivesVentilation is an important factor in preventing COVID-19 infection. To clarify the state of ventilation in ultrasonic exam rooms, as an index of ventilation rate, the carbon dioxide (CO2) concentration in our exam rooms was measured.MethodsWe measured the CO2 concentration in each exam room before the examination and 0–15 minutes after end of the exam.The subjects were 70 cases (abdomen: 24, breast: 16, neck: 16, and musculoskeletal: 14). In infant cases, one parent accompanied the patient during the examination.ResultsThe highest CO2 concentration was 2261 ppm, observed after the breast examination. In all cases, the CO2 concentration in the exam room was highest immediately after the examination or two minutes after. Almost all cases had recovered to within 120% of the pre-examination CO2 concentrations within 15 minutes after the examination. The average CO2 concentration after ultrasonography was significantly higher for breast examinations than others.ConclusionsEven in a hospital with modern ventilation equipment, the CO2 concentration in the ultrasound room was high after the exam and it takes 15 minutes to recover to the pre-exam state. Care must be taken to ensure adequate ventilation in ultrasonographic facilities.