Clean Hospitals Day – 10/10/20

Novaerus is delighted to be supporting Clean Hospitals Day, a global awareness campaign created to highlight the importance of healthcare environmental hygiene.

On the 10th of October 2020, Clean Hospitals Day will celebrate and empower key environmental hygiene healthcare workers. This day also represents a call to hospital management, decision-makers and stakeholders to champion environmental hygiene and to take action to make hospitals cleaner and safer.

Clean Hospitals Day aims to ensure recognition of the importance of healthcare environmental hygiene, to provide stronger focus and guidance and to define and share a global understanding for hygiene standards. The global campaign will address all the components of healthcare environmental hygiene such as surfaces, air, medical waste, fabrics and fittings, water, IT, digitalization and much more.

To learn more about Clean Hospitals Day, visit the website.

Please join us on 10/10/20 and let’s celebrate Clean Hospitals Day together – #CleanHospitalsDay.

As part of the campaign, Clean Hospitals are holding a  free teleclass – Clean Hospitals: The Next Frontier in Infection Prevention on the 20th of October at 7.30 PM CEST.  The teleclass will be taught by Prof Didier Pittet, Chair of Clean Hospitals, and Dr Pierre Parneix, Education Director of Clean Hospitals, who will address pressing questions in healthcare environmental hygiene, explaining why it is key for preventing healthcare-associated infections and protecting staff and our environment. 

Register for the free teleclass here. 

In preparation for the teleclass, from the 10th – 20th of October, Clean Hospitals will release 10 mini videos with questions about healthcare environmental hygiene. These questions will be answered during the teleclass. 

Follow Clean Hospitals on social media to make sure you don’t miss out!

Clean Hospitals is a coalition of international stakeholders who work explicitly to promote Healthcare Hygiene. Clean Hospital’s vision is to be the guardians protecting healthcare workers, patients and the environment, believing that by making care facilities a cleaner place, the healthcare system will be better equipped to protect its inhabitants.

Novaerus and Major Appliance Maker Galanz Create Commercial Partnership to Bring Air Disinfection to the Chinese Consumer Market

Novaerus Technology Powers New Galanz Air Disinfection Devices – Providing the First Line of Protection Against Airborne Viruses and Bacteria

Dublin, Ireland, September 1, 2020 – Novaerus, an Irish company that manufactures and sells medical-grade, clean air solutions, has announced that it has entered into a strategic partnership with Chinese powerhouse manufacturer, Galanz. By partnering with Novaerus, Galanz can provide a cutting-edge, air disinfection solution to China’s consumer market to protect people from airborne viruses and bacteria.

The license agreement will allow Galanz to manufacture the Novaerus designed air disinfection devices. Novaerus’s patented plasma-based nanotechnology, NanoStrikeâ will power the devices. Developed by the Novaerus team of scientists and engineers, this is the only air disinfection technology that kills and deactivates harmful airborne microorganisms on contact — in a sub-second time frame.

Specializing in manufacturing, Galanz provides a fundamental focus on quality and innovation. Starting with the microwave trade and becoming the largest microwave manufacturer globally, its business now covers award-winning technologies, including air conditioners, refrigerators, washing machines, dryers, dishwashers, and other small home appliances. In the past 20 years, Galanz has established strategic partnerships with many famous brands in Europe.

This is truly an ideal union of exceptional air disinfection technology combined with renowned manufacturing capabilities. Partnering with the Dublin based Novaerus helps Galanz develop a stronghold in the Chinese air disinfection market during a critical time. “Although our partnership with Galanz began in 2019, before the COVID-19 pandemic, the timing of the launch of their newest air disinfection solution could not come at a better time,” states Dr Kevin Devlin, CEO of WellAir. “There is mounting research to suggest that clean, disinfected air plays a vital role in preventing the spread of SARS-CoV-2, the virus causing COVID-19.

Novaerus’s NanoStrike air disinfection technology has been shown effective at reducing MS2 Bacteriophage, a surrogate for SARS-CoV-2 (COVID-19), by 99.99%.”

“We looked to partner with a company with a tested and proven air disinfection technology, a technology that was not available in China — until now. Novaerus has a strong reputation in the medical market, with solutions deployed in over 400 hospitals worldwide,” states Benjamin Leung, Vice Chairman of Galanz. “Their solutions are also registered on China’s National Online Record Information Service Platform for Disinfection Products, and the efficacy of their devices have been tested and qualified by the Guangzhou Institute of Microbiology.” The partnership will start with the launch of Galanz’s new GZ20 air disinfection unit, powered by Novaerus’s NanoStrike technology.

About Novaerus

Novaerus is part of WellAir, an Irish company on a mission to reduce indoor airborne pollutants to create living, working, and healing spaces that foster rather than detract from human health, productivity, and wellbeing. WellAir and its brands, Novaerus and Plasma Air, can be found installed in hundreds of hospitals, senior living facilities, schools, casinos, railway stations, residences, and industrial facilities in more than 60 countries around the world.

About Galanz

Galanz is a leading global home appliances manufacturer of a range of products, including microwave ovens, refrigerators, dishwashers, laundry, air conditioners, toaster ovens, and more. For decades, Galanz has been at the forefront of appliance invention, with more than 1,600 patents and product partnerships with some of the world’s most recognized and trusted brands. Galanz designs appliances with thoughtful engineering for the home and will continue to innovate to create efficient, dependable, and great products that consumers love.

Infection Spread in the NICU: “The Tip of the Iceberg” – Part 2

COVID-19 aside, respiratory viral infections (RVIs) strike newborns particularly hard and, according to Austrian researchers, are “more prevalent in the NICU than previously considered.” RVIs are likely underdiagnosed, the authors assert, as many NICUs don’t routinely test for viral pathogens in symptomatic patients. Respiratory viral infections are a leading cause of mortality among newborns and often are detected only late in the course of illness.

Read part one of this blog post here.

Viral Outbreaks in the NICU

Though the majority of NICU infections are bacterial, nosocomial viral infections have been widely reported, including outbreaks of syncytial virus (RSV), influenza H1N1, rotavirus, adenovirus, enterovirus, and norovirus.

COVID-19 aside, respiratory viral infections (RVIs) strike newborns particularly hard and, according to Austrian researchers, are “more prevalent in the NICU than previously considered.”

RVIs are likely underdiagnosed, the authors assert, as many NICUs don’t routinely test for viral pathogens in symptomatic patients. Respiratory viral infections are a leading cause of mortality among newborns and often are detected only late in the course of illness.

The hospital costs of RVIs are particularly high. A 6-year study of a NICU in Nottingham, UK, found that compared to uninfected newborns, infected NICU patients spent far longer in the hospital — 76 days compared to 41 days — and in-hospital care costs were significantly higher, £49,664 compared to £22,155.

Infected NICU staff are often the source of viral outbreaks, especially influenza infection.

Newborns, of course, cannot be vaccinated, and annual vaccination rates among the healthcare workers who care for these patients are alarmingly low.

An H1N1 influenza outbreak in a Greek NICU, for example, was traced to the nursing staff, just 15% of whom were vaccinated.

“Nosocomial influenza can cause considerable morbidity, especially in high-risk neonates,” the authors wrote, “and is readily transmissible in the NICU setting by unvaccinated staff members.”

Viral infection spreads quickly in the NICU. A norovirus outbreak at Texas Children’s Hospital, traced to one newborn, began spreading within 24 hours and within two weeks had afflicted 28 babies, along with 12 staff members, who had to be furloughed.

Disinfecting the NICU Air, Safely and Quietly

Hand hygiene has long been the cornerstone of hospital infection prevention, in the NICU and elsewhere, and healthcare workers are striving to be even more meticulous in the COVID era. Yet hundreds of studies demonstrate that over the decades, compliance has been, in the words of the World Health Organization, “abysmally low.”

Surface cleaning, too, has been augmented since the emergence of SARS-CoV-2 but inevitably falls short, as airborne pathogens continually settle on medical equipment, floors, clothing, and healthcare workers’ hands.

It is impossible to operate [NICU] environments in complete sterility,” a University of California team reported. The infants themselves, the adults who care for them, the equipment required for their care — all represent “fertile vectors for microbial transmission.”

Though stringent cleaning protocols for NICU surfaces have been in place for years, infections rates remain stubbornly high.

“It is tempting to speculate that more potent cleaning techniques or agents will lead to further decreases in nosocomial infections,” the researchers concluded, but reality may be otherwise. “Future improvement may require innovative approaches.”

Among the most effective innovations is ultra-low-energy plasma technology by Novaerus, now deployed in NICUs and COVID wards worldwide. Easily installed on the wall, a shelf, or a rolling stand, Novaerus devices quickly destroy airborne viral, bacterial, and fungal particles.

For example, lab tests found the company’s most powerful unit can reduce the airborne load of MS2 Bacteriophage, a virus used as a surrogate for SARS-CoV-2, by 99.99% in just 15 minutes. The technology decimates MRSA load just as thoroughly and quickly.

Dis-infecting air in the NICU, as well as other wards and common areas, is imperative, as study after study points to hospital infection spread via aerosolization. A Japanese team, for example, reported on an outbreak of Bacillus cereus in its NICU, concluding the bacteria spread via the airflow of the ventilation system. Numerous studies have detected MRSA and Clostridicum difficile in hospital air.

As for SARS-CoV-2, air-sampling studies have detected viral RNA in hospital hallways and in rooms where healthcare workers changed their clothing, prompting the World Health Organization to finally agree with scientists worldwide that aerosol transmission of COVID-19 cannot be ruled out.

In a year-long study of an American NICU, a team of environmental engineers noted in PLOS One: “Hospital hygiene protocols may undervalue the potential importance of the airborne transmission route.”

Throughout hospitals, but especially in the NICU, ultra-low-energy plasma technology is an important addition to ventilation and filtration. Whereas conventional filters capture only large particles, Novaerus units destroy the smaller and deadlier ones.

Novaerus units run continuously and quietly, a benefit given the adverse effect of noise on the heart rates and respiratory systems of preterm or very low birth weight infants.

The technology is safe to operate around even the smallest, most medically fragile NICU patients, unlike other air-sanitation methods that can produce harmful byproducts.

Novaerus technology not only helps prevent infection but also mitigates newborns’ exposure to chemicals such as volatile organic compounds (VOCs) and particulate matter. Lacking the protective buffer of the womb, research suggests, newborns in the NICU are exposed to chemicals that may permanently alter neurobehavioral outcomes.

Air quality in the NICU may have a “significant impact on their long-term development,” note researchers at the Icahn School of Medicine at Mount Sinai in New York City, who are conducting the first study of air quality in neonatal intensive care.

Infants admitted to the NICU often stay for long periods, putting them at elevated risk for contracting an infection. The average length of stay for a term or near-term infant with surgical or respiratory issues is about 15 days; the length of stay for preterm infants born at 26 weeks’ gestation is more than 2 months.

Throughout their stay, it is imperative that their infection risk is reduced by stringent hand hygiene, effective surface cleaning, and 24/7 air dis-infection.

Microbes accumulate 24 hours a day, as visitors, staff, and medical devices come and go. Healthcare workers’ hands and NICU equipment cannot be cleaned continually, but with the installation of Novaerus technology, the air in the NICU can.

Infection Spread in the NICU: “The Tip of the Iceberg” – Part 1

Late one summer at the Children’s Hospital of Philadelphia, a top American medical centre, routine microbiological surveillance revealed something unusual in the neonatal intensive care unit: Over four weeks, 23 newborns tested positive for adenovirus, though not a single NICU patient had been infected with the virus the entire previous year.

The outbreak was cause for alarm.

In healthy children, adenovirus particles — launched airborne by coughs and sneezes and hardy enough to survive for weeks on surfaces — cause little more than a sore throat or pink eye. But in ill newborns, the most fragile of patients, adenovirus can trigger dire respiratory complications. Indeed, among the infected babies in Philadelphia, 12 required extra breathing support and 5 developed pneumonia. Four babies died.

An intense investigation traced the outbreak to contaminated eye-exam instruments — lenses and scopes that, notably, had been touched only by providers. In other words, the investigators emphasized, adenovirus can be spread even by equipment “that does not directly contact patients.”

These days, concern about infection spread at hospitals largely revolves around Covid-19. But well before the emergence of SARS-CoV-2, containing dangerous pathogens was an urgent and complex battle for hospitals, particularly in the NICU.

The coronavirus pandemic has only increased the risks facing the smallest, most vulnerable patients. To protect hospitalized newborns and assuage their anxious parents, hospitals are bolstering their infection-control strategies, minimizing the number of healthcare staff and visitors allowed near NICU patients, augmenting hand-hygiene protocols, and deploying air dis-infection technology to eradicate pathogens in the NICU air.

“This is an exceptional time,” says Hany Aly, M.D, chair of neonatology at Cleveland Clinic, a prominent American hospital that has made numerous changes to its infection-control practices.

Airborne Pathogens: Nothing New in the NICU

Indeed, today’s circumstances are exceptional, but in reality, augmented infection-control practices in the NICU were warranted prior to the pandemic and will remain so when the Covid-19 crisis abates.

In developed countries worldwide, up to 25% or 30% of NICU patients may contract an infection, whether viral, bacterial, or fungal. Developing countries bear a much higher burden.

NICUs account for 18% of all hospital infection outbreaks recorded in the worldwide Outbreak Database, numbers that may represent “only the tip of the iceberg,” according to Jayashree Ramasethu, M.D., NICU director at MedStar Georgetown University Hospital in the United States.

Premature and ill infants are, of course, highly susceptible to infection, because of their immature immune systems and fragile skin and because the very devices they depend on for life, such as ventilators and catheters, are common channels for bacterial invasion.

What’s more, advances in neonatal care are increasing the NICU’s population of smaller and sicker infants, the patients most likely to develop and succumb to serious infection.

As Dr Ramasethu notes, infection spread in the NICU presents hospitals with a daunting trifecta: “serious consequences for patients, huge economic burdens and staffing issues.”

The average NICU infection outbreak strikes 24 patients, with a mortality rate of 6.4%, according to a German review of 276 NICU outbreaks. As for the financial burden, infections often add weeks to a newborn’s hospital stay while more than doubling the cost, as British research has shown.

Superbug Outbreaks in the NICU

Thus far, only a small number of infants have contracted Covid-19, primarily from their caregivers, and no cases of in-hospital transmission have been reported. Most infants who have contracted the disease have recovered without complication, though severe cases requiring mechanical ventilation have been reported, and clearly, the utmost precautions must be taken around infected babies.

Compared to adults, “neonates tend to have a milder infection based on the very limited number of cases published so far,” according to a peer-reviewed literature review.

However, the same cannot be said for the way newborns fare when infected by pathogens other than SARS-CoV-2. Among the dangerous microbes known to lurk in the NICU, the superbug MRSA may be the most concerning.

“Neonates are particularly vulnerable to colonization and infection with MRSA,” cautioned a research team at Yale University School of Medicine in the United States.

About 30% of MRSA-colonized babies will develop an invasive infection. Among the potentially dire consequences: sepsis, meningitis, necrotizing pneumonia, respiratory tract infection, and endocarditis.

MRSA outbreaks in NICUs have been reported worldwide — in Germany, Great Britain, Israel, Japan, Scotland, Taiwan, and elsewhere — and incidence of MRSA in the NICU is skyrocketing.

The Yale study, reviewing data from 149 NICUs, found MRSA infections increased by 308% over a decade. The emergence of multi-drug resistant MRSA strains, the authors warned, suggests “difficulties treating MRSA infections will only continue to escalate.”

Another study found MRSA infection in the NICU independently increased the newborns’ length of stay by 40 days and added, on average, over $164,000 in costs per patient.

MRSA droplets can hover in the air and can survive for weeks on floors, door handles, sinks, mops, nursing scrubs, and towels, allowing for easy transmission to newborns.

The bacteria is so easily spread that when a triplet, later discovered to have been colonized, was transferred from one Danish NICU to another, 32 newborns in the second NICU became colonized with the same rare MRSA strain. The index patient had become colonized during a 15-day stay in a room adjacent to an isolation room that had housed an MRSA-infected newborn.

Read part two here

When Life-Saving Procedures Emit Deadly Aerosols: How Hospitals Can Protect Front-line Workers

Well before SARS-CoV-2 began rampaging the globe, two virologists — one Dutch, one American — worried that just such a virus would explode and strike healthcare workers particularly hard.

The scientists, Vincent Munster, Ph.D., and Seth Judson, Ph.D., knew that the MERS and SARS coronaviruses had infected medical workers at alarmingly high rates. And they knew one reason why: many of these providers had performed or been present for, life-saving procedures that generated virus-laden aerosols.

Some healthcare workers had administered chest compressions. Others had performed bronchoscopies or tracheal intubations, airway-irritating procedures that can trigger forceful coughs and, in the process, release highly infectious aerosol clouds.

In a prescient paper, published two months before SARS-CoV-2 surfaced in China, Munster and Judson warned that emerging viruses, having jumped from animals to humans, would likely threaten the lives of doctors and nurses on the front lines.

“The viruses that pose the highest risk to healthcare workers performing aerosol-generating procedures may be some of the viruses that we know the least about,” they cautioned.

Of course, now we know about SARS-CoV-2.

Now more than 90,000 healthcare workers have been infected by the virus worldwide, and at least 1,000 have died.

Every day, nurses and doctors caring for Covid-19 patients perform the very procedures linked to provider infections during the outbreaks of Severe Acute Respiratory Syndrome (SARS) in 2002 and Middle Eastern Respiratory Syndrome (MERS) in 2012.

“During these procedures, viral particles can remain suspended in the air with a half-life of approximately 1 hour and be inhaled by those nearby,” a team of critical-care physicians cautioned in Circulation.

As the team noted, procedures such as CPR and tracheal intubation are often performed in tense, high-stress situations, as patients go into shock or cardiac arrest, their oxygen levels plummeting. Sufficient personal protective gear may not be at hand. Lapses in infection-control practices happen.

In these trying circumstances, healthcare workers need extra protection from infectious aerosols. Hospitals must look beyond face shields and respirators and consider the larger critical-care environment, ensuring appropriate room ventilation and outfitting ICUs and ERs with air dis-infection technology.

Aerosols Aloft: “Healthcare staff are extremely stressed”

When tuberculosis patients can’t cough up secretions on their own, they’re given a nebulized saline solution to inhale. This procedure, sputum induction, promotes coughing and can generate infectious aerosols. So can bronchoscopy, also performed often on TB patients.

Some years ago, the emergence of drug-resistant tuberculosis — now a serious global health threat — spurred concern about the potential risks of aerosol-generating procedures such as these. But it was the SARS outbreak that sounded a louder alarm.

During the eight-month, 29-country outbreak, infection rates among healthcare workers were astonishing: among SARS patients overall, 21% were healthcare workers. In Singapore, medical workers accounted for 40.8% of cases and in Toronto, 51%.

Initially, scientists assumed the SARS coronavirus was spread only via large droplets and close contact, the same assumption initially applied to SARS-CoV-2. But researchers later found cases in which droplet transmission simply “could not have been feasible.”

In one instance, chest compressions and tracheal intubation were performed on a SARS patient in respiratory failure. Three days later, one of the nine healthcare workers present tested positive for the virus — even though she’d worn two pairs of gloves, two gowns, safety glasses, a face shield, shoe covers, a hair cover, and an N95 respirator.

What’s more, she had not been involved in the CPR or intubation; her job was to insert an IV catheter into the patient’s left foot.

Had the nurse inhaled aerosols generated by those procedures? It’s impossible to know. And it would be near-impossible to capture air samples while providers converge around a desperately ill patient. (Air samples isolated during sputum induction of TB patients have proven to contain viable TB aerosols.)

Still, retrospective SARS studies make a compelling case.

For example, a Canadian team analyzed the treatment of 7 hospitalized SARS patients and the infection rate among the 122 healthcare workers who cared for them.

Compared to staff never involved in tracheal intubation, those present just prior to and during intubations were at “substantially increased risk” of contracting SARS.

Studies like these have alarmed today’s critical-care workers.

“Healthcare staff are extremely stressed about managing Covid-19 patients,” says Jerry Nolan, M.D., a CPR expert and chair of the European Resuscitation Council.

The high rate of Covid-19 infection throughout the pandemic has only compounded the stress. In Spain, healthcare workers account for nearly 14% of Covid-19 patients, and in Italy, about 10%.

Which Procedures Generate Aerosols?

There’s no definitive list of aerosol-generating procedures and a fair amount of controversy on the topic. For example, over the years, the World Health Organization (WHO) has listed, de-listed, and then re-listed CPR as an aerosol-generating procedure.

At the moment, says Dr Nolan, “a consensus is evolving that chest compressions are highly likely to be generating, at the very least, droplets and probably airborne particles.”

Performing CPR on Covid-19 patients appears to be so risky that experts have issued unprecedented guidelines for providers.

Typically, doctors and nurses spring into action to perform chest compressions; now, they’re being advised to “take a pause” and consider whether there may be a less perilous alternative.

CPR and endotracheal intubation are considered by most health organizations to generate aerosols. In addition, the World Health Organization (WHO) lists bronchoscopy, open suctioning, manual ventilation before intubation, turning a patient to the prone position, and disconnecting a patient from a ventilator.

The U.S. Centers for Disease Control and Prevention (CDC)’s list is less definitive. However, the CDC considers endotracheal intubation to be “especially hazardous,” as high viral loads of SARS-CoV-2 are found in sputum and upper respiratory secretions of patients with Covid-19.

Drs. Munster and Judson divide aerosol-generating procedures into two categories: 1.) those that mechanically create and disperse aerosols, such as CPR, intubation, and bronchoscopy, and 2.) those that induce the patient to produce aerosols, such as ventilation, suctioning, and nebulization.

Protect Medical Workers with Air Dis-infection Technology

It may take years for scientists to agree on which procedures generate aerosols, but front-line medical workers don’t have the luxury of time. They have patients in cardiac arrest and respiratory distress, and they need immediate protection from any SARS-CoV-2 particles wafting about.

So, healthcare workers are innovating. At some hospitals, they’re performing endotracheal intubations through clear plastic drapes outfitted with armholes or through a plexiglass box, known as an aerosol blocking shield, that fits over the patient’s head.

Still, these devices haven’t been well studied and may limit the anesthesiologist’s view and/or range of motion. Also, they’re designed for intubation and won’t help with the half-dozen other procedures likely to generate aerosols.

Certainly, all hospitals are trying to limit scenarios that would prolong aerosol exposure, such as failed intubation attempts, by assigning their most experienced clinicians. But this pandemic is an all-hands-on-deck situation. The best person for the job may not always be available.

Of course, for any procedure, the most critical protection is personal protective equipment (PPE). Both WHO and CDC recommend healthcare workers present for aerosol-generating procedures wear an N95 or higher-level respirator, eye protection, gloves, and a gown.

But PPE shortages have been dire worldwide, and in emergency settings, even a complete ensemble may not offer full protection. The Toronto nurse who contracted SARS despite wearing extensive PPE was not an isolated case.

Lab studies confirm the limits of PPE. For example, an Israeli team simulated endotracheal intubation using a fluorescent marker to visualize exhaled respiratory particles. They found fluorescent markers on the uncovered facial skin, hair, and shoes of personnel “performing” the intubations, even though all wore required PPE. It’s well known that viral particles on clothing can be re-launched airborne.

The upshot: PPE “may not fully prevent exposure” to aerosols generating during emergency endotracheal intubation.

Given the limits of these and other common precautions, hospitals are recognizing they must protect workers by optimizing the larger critical-care environment.

Ideally, all aerosol-generating procedures would be performed in negative-pressure isolation rooms; the ventilation system allows air to flow into, but not escape from, the infected patient’s room.

But in the United States, for example, only 2% to 4% of all hospital rooms are equipped for negative pressure, and hospitals hard hit by Covid-19 may not have the resources to quickly convert other spaces.

What’s more, even rooms designed for negative pressure may not do the job. In a study that analyzed over 600 of these rooms, just 32% met ventilation standards.

It’s important, then, for hospitals to provide workers with an additional layer of protection: ultra-low-energy plasma technology by Novaerus.

Commonly installed in ICUs and emergency departments, Novaerus air dis-infection devices operate continuously and are safe around the most vulnerable patients, including Covid-19 patients in respiratory or cardiac distress.

Novaerus technology kills 99.99% of MS2 Bacteriophage, a surrogate for SARS-CoV-2, in 15 minutes, laboratory testing shows.

The protection extends far beyond Covid-19 and other coronaviruses. Novaerus technology kills other highly contagious viruses, such as influenza, norovirus, and measles, as well as dangerous bacteria and fungi that plague hospitals, such as MRSA, Clostridium difficile, and Aspergillus niger.

In an interview for the This Week in Virology podcast, conducted two years before SARS-CoV-2 was unleashed upon the globe, Vincent Munster of the U.S. NIH, an expert on MERS-coronavirus, was interviewed about the pandemic potential of coronaviruses.

“As virologists, we always kind of work from a worst-case scenario,” he told the interviewer.

SARS-CoV-2 has become that worst-case scenario.

The virus has overwhelmed the world’s healthcare systems, infecting more than 5 million people and killing more than 350,000 — and counting.

To prevent the pandemic from inflicting even more damage, on healthcare workers and patients alike, hospitals must deploy all available weapons, including air dis-infection technology.

Covid-19 and PM 2.5: The Stakes Have Risen for Hospital Building Health

Vanishing air pollution has been a big Covid-19 story, told in dramatic before-and-after images: Skyscrapers once obscured by a yellowish haze suddenly appear in sharp focus, now that factories have closed and traffic is sparse.

But as nations emerge from lockdown and cities roar back to life, that toxic haze will reappear — and, as before, will seep into our medical centres, posing risks to patients and healthcare workers alike.

Except this time, with a new pathogen in our midst, the stakes for hospitals will be higher.

For the foreseeable future, healthcare facilities will be contending with Covid-19, a disease with strong and documented links to polluted air.

Two robust studies, one American and one Italian, have found that Covid-19 patients with more exposure to particulate matter face a higher risk of dying. The researchers focused on PM2.5, toxic particles small enough to penetrate lung tissue.

“If you’re breathing polluted air and your lungs are inflamed by the disease, you’re going to get very, very sick,” cautioned biostatistician Francesca Dominici, Ph.D., a Harvard University Harvard biostatistician and co-author of the American study.

Dr Dominici was referring to long-term PM2.5 exposure, as measured outdoors. However, other research has linked even daily spikes in particulate matter to surges in heart attacks and asthma attacks; still, other studies demonstrate that hospitals are not sealed off from the airborne toxins outside.

“Indoor concentrations of many pollutants can be higher than outdoors,” notes Joseph Allen, DSc, director of Harvard University’s Healthy Buildings Program and a forensic investigator in hospital disease outbreaks.

As a group, hospital patients are highly vulnerable to the health risks of air pollutants. Covid-19 patients, many of them intubated or ventilated, may be the most vulnerable among the vulnerable.

As these patients struggle to survive, what they need least is further exposure to airborne pollutants.

Though lockdowns will ease, the novel coronavirus will persist for some time, as that polluted haze reappears. It’s a worrisome scenario — and one hospitals must prepare for by eradicating indoor particulate matter, especially in wards where Covid-19 patients are treated.

Covid-19 and Pollution Exposure

Air pollution has long been linked to respiratory infection and disease. Just as PM2.5 damages nature, turning streams acidic and depleting soil nutrients, these toxic particles inflame human tissue and deplete immunity.

So when a respiratory virus strikes, those with pollution-impaired lungs and weakened defences are primed to suffer the most.

This proved true when the SARS coronavirus surfaced in 2002.

Patients from highly polluted regions in China were twice as likely to die as those who’d breathed relatively clean air in the previous two months, as well as the previous two years. Even SARS patients from moderately polluted regions in China were 84% more likely to die than those exposed to low pollution levels.

So, the study results on SARS-CoV-2, its wilier cousin, are unsurprising.

“We know fine particulate matter affects the respiratory system. And we know that Covid-19 kills by affecting the respiratory system. So we know, by science, that getting [the disease] is like adding gasoline to the fire,” says Harvard’s Dr. Dominici, co-author of the American study.

In her study, patients from heavily polluted counties in the United States were 15% more likely to die from Covid-19 than patients in counties with cleaner air.

Just a small increase in PM2.5 exposure corresponded with a large increase in the Covid-19 death rate. The impact of PM2.5 exposure on death from Covid-19 was 20 times greater than the impact of pollution exposure on death from all causes.

The Italian results were even starker.

Northern Italy is among Europe’s most polluted regions, due largely to an unlucky combination of climate and geography: wind is rare, and climatic inversions aren’t. Among patients in the region stricken with Covid-19, the death rate over a one-month period was an astonishing 12%, compared to 4.5% elsewhere in Italy.

“It is well known that pollution impairs the first line of defence of upper airways,” wrote the authors, in Environmental Pollution. It only follows, they observed, that residents who inhale more pollutants would be more vulnerable to respiratory infection.

For the vulnerable, it doesn’t take a lifetime of pollution exposure to trigger a poor health outcome; a few days of inhaling highly toxic air may do the job.

Diabetes, COPD, Parkinson’s disease, asthma, tissue infections, kidney failure — hospitalizations for all these conditions surge on days when air pollution spike.

What’s more, it doesn’t take exceedingly high levels of pollution to wreak havoc on the health of a vulnerable person.

In an American study, the link between exposure to fine particulate matter and hospitalizations held even when the daily air pollution levels were lower than current World Health Organization standards.

The health dangers of air pollution are “significantly larger than previously understood,” warned biostatistician Yaguang Wei, Ph.D., the study’s lead author.

Likewise, Australian researchers, using data from Japan, found that for older patients, even brief exposure to relatively low levels of particulate matter can increase risk of cardiac arrest. In their study, over 90% of the heart attacks occurred when pollution levels were below WHO standards.

“There is no safe level of air pollution,” cautioned study co-author, Kazuaki Negishi, M.D., a cardiologist University of Sydney School of Medicine.

Cleaner Hospital Air: Safer for Patients and Healthcare Workers Alike

Air pollution inside hospitals was a concern long before the novel coronavirus jumped from animals to humans.

We know this microscopic mixture of dust, soot, and chemical particles can travel hundreds of miles and can waft indoors via doors and windows. Other airborne toxins, such as volatile organic compounds (VOCs), originate inside buildings, emitted by building materials, cleaning supplies, even shampoos and lotions.

Particulate matter, like dangerous bacteria and viral particles, also can hitch a ride on clothing, only to be launched airborne when a lab coat or gown is removed.

Even among healthy people, PM2.5 can irritate the eyes and lungs, trigger headaches, exacerbate allergies, and impair memory and the ability to do simple math.

By contrast, studies show, breathing clean air on the job makes you feel better and think more clearly, especially in a crisis.

A few years back, Harvard’s Joseph Allen sent architects, managers, and other professionals to work amidst varying levels of airborne pollutants. He then challenged them with a series of simulated scenarios, such as taking charge in a crisis as an emergency coordinator.

The subjects had to plan, prioritize, and sift through loads of information under high-stress conditions.

“We found that breathing better air led to significantly better decision-making,” Dr Allen reported.

For hospitals, of course, crises occur daily, decisions are matters of life and death, and these pollution-sensitive skills are essential, more so than for the typical manager.

Dr Allen suspects the coronavirus pandemic will turn clean indoor air into an important commodity, one that business leaders and landlords will leverage “as recruitment tools and sources of competitive advantage.”

Hospitals, of course, have different priorities. Recruitment and competition take a back seat to saving lives and protecting healthcare workers.

Given these high stakes, hospitals must go well beyond measures used by business leaders, deploying medical-grade technology to eradicate the pollutants floating about their facilities.

Unlike SARS, Covid-19 will not vanish any time soon. A vaccine is far off, and more distant still is the day when vaccine rates are high enough to vanquish the disease.

As the WHO has warned, “the worst is yet ahead of us.”

Eyeing this future, Dr Allen advises an all-out attack on Covid-19: “That means unleashing the secret weapon in our arsenal — our buildings.”

By deploying a single air dis-infection technology, hospitals can achieve multiple goals: mitigating the spread of SARS-CoV-2 and eradicating the airborne toxins that may compromise the recovery of patients and the quick thinking of doctors and nurses.

Ultra-low energy plasma units by Novaerus not only kill  99.99% of MS2 Bacteriophage, a surrogate for SARS-CoV-2 (COVID-19), in 15 minutes according to laboratory studies but also remove 99% of PM2.5 inside a chamber in 6.26 minutes.

These portable units operate 24/7 and are safe for continuous use around the most vulnerable patients.

For these reasons, hospitals worldwide are installing Novaerus units in ICUs and Covid-19 wards.

It’s clear that cleaner hospital air may benefit not just coronavirus patients but also the staff who care for them.

Silent Spreaders: What Asymptomatic Transmission of Covid-19 Means for Hospitals

When Adriano Trevisan died of COVID-19 in early 2020, he became the disease’s first Italian fatality. His death, at age 77, spurred a chain of events that have shed light on a critical question: How often is the disease spread by people without symptoms?

Trevisan lived in a hillside village near Venice. Upon his death, the local governor not only quarantined the entire village but also ordered all 3,341 residents to be tested for SARS-CoV-2 twice, before the lockdown and two weeks later.

What the testers found: Among the 88 villagers infected, at least 50% were “completely asymptomatic,” reported Sergio Romagnani, M.D., a professor of clinical immunology at the University of Florence, who was involved in the testing.

Romagnani called asymptomatic transmission “a formidable source of contagion.”

How formidable?

That remains to be seen, but the Italian results, though unpublished and on the high side, generally align with COVID-19 studies of cruise-ship passengers, Icelandic volunteers, and hospitalized patients in Tibet.

The U.S. Centers for Disease Control and Prevention’s director, Robert Redfield, M.D., estimates the number of “covert cases” at 25%.

“This helps explain how rapidly this virus continues to spread,” Dr Redfield said.

The World Health Organization (WHO) maintains that most patients classified as asymptomatic are actually pre-symptomatic — people who felt fine when tested but later developed the telltale fever, cough, and aches. WHO has called the percentage of truly asymptomatic cases “relatively rare.”

Nonetheless, WHO agrees with the scientific consensus that asymptomatic transmission is not rare.

Whether asymptomatic people never fall ill or whether they go on to develop symptoms, the fact remains: infected people transmit SARS-CoV-2, the virus causing COVID-19, while feeling perfectly healthy.

“The bottom line is that there are people out there shedding the virus who don’t know that they’re infected,” said Jeffrey Shaman, Ph.D., a public health expert at Columbia University in New York City.

Silent spreaders, covert cases, submerged infections, stealth transmission — whatever term you use, the phenomenon poses no small challenge for controlling the spread of COVID-19, especially at healthcare facilities.

In the novel coronavirus, hospitals face a daunting combination of circumstances: a deadly disease that is likely transmitted through the air and spread by people who may never even get sick.

As evidence mounts that SARS-CoV-2 can be spread via aerosol, hospitals must respond by taking extra measures to prevent stealth transmission among healthcare workers.

How Common Are Covert Cases of COVID-19?

Submerged infection is nothing new. Norovirus, influenza, human respiratory virus, mild coronavirus strains — every day, millions walk around oblivious to the fact that they’re infected with one virus or another.

A few years back, before SARS-CoV-2 was unleashed upon humans, researchers stood at a New York City tourist attraction and swabbed 2,600 visitors who volunteered to be tested. Among the tourists, 6.2% tested positive for a virus; 65% to 97% of the infections were classified as asymptomatic.

Among people infected with measles, 8% may never develop symptoms; with norovirus, about 32% don’t fall ill.

As scientists work to determine where COVID-19 fits in, the most useful data comes from closed-off populations who’ve undergone comprehensive testing.

Adriano Trevisan’s Italian village was one such population; the Diamond Princess cruise ship was another. Quarantined for two weeks off the port of Yokohama, Japan, the Diamond Princess had over 3,700 passengers and crew aboard.

Two days after the ship docked, 21% of the passengers tested positive for COVID-19; among those infected, 17.9% never developed symptoms.

“The substantial asymptomatic proportion for COVID-19 is quite alarming,” said American epidemiologist Gerardo Chowell, Ph.D., part of the research team.

Chowell notes that most of the ship’s passengers were over 60 and therefore at elevated risk for developing symptoms; among the general population, he estimates, the proportion of covert cases may be as high as 40%.

In Iceland, about 50% of volunteers who tested positive for COVID-19 reported feeling no symptoms, though the sample of 9,000 was entirely self-selected, and it’s likely some of them were pre-symptomatic.

More compelling was an analysis of COVID-19 patients quarantined in a hospital in Tibet.

In this study, there were no doubts: All local residents who tested positive — 83 patients — were hospitalized for two weeks and thoroughly examined. Among them, 21.7% neither demonstrated nor reported symptoms during the surveillance period.

These patients weren’t feverish or coughing or achy, yet most had “viral pneumonia-like changes” in their medical workups. Some 83% had abnormal blood chemistry, and 39% had abnormal chest CT images.

How Contagious Are People Without Symptoms? 

Clearly, plenty of people infected with the novel coronavirus are walking around without fevers or coughs. But are they contagious?

Certainly, covert carriers of other viral diseases can transmit infection.

“For measles and norovirus infections, it is well established that asymptomatic individuals are frequently able to transmit the virus to others,” wrote the Diamond Princess research team.

Typically, it takes an onslaught of viral particles to overwhelm the immune system, invade a cell, and start replicating. It’s generally thought that the higher a patient’s viral load — the more virus their cells are emitting — the more infectious the patient.

With COVID-19, at least some asymptomatic patients seem to be just as virally loaded as those with fevers, coughs, and breathing difficulties.

One Chinese study describes an infected 26-year-old who never developed symptoms but whose viral load, based on nose and throat swabs, “was similar to that in the symptomatic patients.”

Another Chinese study traced a family cluster of nine members. Among the eight who became infected, two never developed symptoms, and two were infected by members who had not yet fallen ill.

“Asymptomatic patients can still infect others,” the authors wrote, “These ‘silent patients’ may remain undiagnosed and be able to spread the disease to a large number of people.”

In cases of pre-symptomatic transmission, those infected appear to be most contagious in the two days or so before symptom onset; after that, viral load begins to decline.

One Chinese team, using a variety of models, reported that “infectiousness peaked on or before symptom onset” and estimated that between 44% and 52% of COVID-19 transmission occurs before illness.

It remains unclear whether asymptomatic or mild cases are as contagious as severe cases. However, to protect patients and healthcare workers alike, hospitals must take stealth transmission every bit as seriously as transmission from severely ill patients.  

“Just because you get the disease from someone with mild symptoms does not mean yours are going to be mild,” cautions Columbia University’s Jeffrey Shaman. “You could still end up in the I.C.U.”

How Asymptomatic Transmission Occurs

No doubt, asymptomatic transmission is contributing to the spread of COVID-19. Infected people who feel just fine are passing on the virus simply by talking or breathing — no sneezing or coughing necessary.

It may be enough for an infected healthcare worker, one who may never become ill or may develop a fever tomorrow, to chat with a colleague. It may be enough for her to sit on a bench and sigh, releasing microscopic viral particles that waft about the hospital, only to be inhaled by someone else or to land on a computer keyboard that someone else touches.

“We can’t assume that any of us are not potential vectors at any time,” says Carl Bergstrom, Ph.D., an American expert in emerging infectious diseases.

Though droplet and contact transmission may be driving the pandemic, evidence for aerosol transmission of SARS-CoV-2 is accumulating.

In multiple hospital studies, air samples have tested positive for SARS-CoV-2 — in hallways and in rooms where healthcare workers removed protective clothing after treating COVID-19 patients.

And now a study conducted at two Wuhan hospitals has found the virus was “widely distributed” in the air and on surfaces in both the ICU and general COVID-19 ward, “implying a potentially high infection risk for medical staff and other close contacts.”

What’s more, the authors found the transmission distance of SARS-CoV-2 particles may actually be 4 metres, more than twice the distance that heavier droplets can travel.

The authors don’t know whether the airborne load of SARS-CoV-2 was potent enough to transmit infection. But they do not advise taking any chances and recommend their findings be “used to improve safety practices.”

Throughout the pandemic, hospitals have been doing all they can to maintain hand hygiene and surface cleaning and to provide healthcare workers with sufficient protective gear. But gear shortages have been dire, hand hygiene is notoriously inadequate, and cleaning crews simply cannot keep up.

The best defence against stealth transmission of COVID-19 is the outdoors, where air currents can disperse infectious particles. But inside a hospital, the best defence is ultra-low-energy plasma technology by Novaerus, an important addition to ventilation and filtration.

Independent laboratory testing has proven Novaerus technology highly effective against MS2 Bacteriophage, a commonly used surrogate for SARS-CoV, reducing the airborne load by 99.99%. The company’s latest innovation, the Defend 1050 shows this reduction happening in just 15 minutes.

At hospitals worldwide, including in Wuhan, China, Novaerus portable units have been installed in ICUs and COVID-19 wards to help prevent transmission of the virus among healthcare workers and patients.

Novaerus units operate continually and are safe around the most vulnerable patients, including critically ill COVID-19 patients.

In the superbug era, Novaerus technology has become vital for hospitals fighting MRSA, Clostridium difficile, Aspergillus niger, and other lethal airborne pathogens.

Now, amidst the COVID-19 pandemic, ultra-low-energy plasma technology has become indispensable.

Novaerus Defend 1050 Proven to Reduce Coronavirus Surrogate by 99.99%

The portable air dis-infection device has been independently tested and shown effective at reducing MS2 Bacteriophage, a surrogate for SARS-CoV-2 (COVID-19), by 99.99% in 15 minutes.

Dublin, Ireland, 27 April 2020 – Novaerus, an Irish company that manufactures and sells patented medical-grade, clean air solutions, has announced successful independent test results for its most powerful solution, the Defend 1050. The portable air dis-infection device has been shown effective at reducing MS2 Bacteriophage, a surrogate for SARS-CoV-2 (COVID-19), by 99.99% in 15 minutes.

The Defend 1050 combines rapid air dis-infection and purification into one safe and portable device. Designed for continuous cleaning of the air in large spaces and rapid remediation in situations with a high risk of infection, the Defend 1050 uses Novaerus patented ultra-low energy plasma technology combined with a triple-stage filtration system from Camfil®. As Novaerus plasma is a non-selective, rapid killing technology, it offers a unique and safe solution to kill airborne viruses 24/7, reducing the risk of disease and infectious outbreaks.

There is mounting research to suggest that clean, disinfected air plays a vital role in preventing the spread of SARS-CoV-2, the virus causing COVID-19. While respiratory droplets are considered the primary transmission route, aerosols are being considered by many health authorities as a possible mode of infection transmission. This suggests that viral particles can remain suspended in the air for long periods and can be inhaled.

To test the virus-destroying power of the Defend 1050, Aerosol Research and Engineering (ARE) Laboratories (a GLP certified laboratory), undertook experiments to investigate how effectively the device could remove small aerosolized viral particles from the air, to characterize how the device might work on capturing the particles that carry infectious viruses.

They performed the experiments in their Bioaerosol Test Chamber, which is located in their U.S. lab. The test chamber is 16m3, about the size of a small room. The Defend 1050 was placed in this sealed environment with aerosolized MS2, which is a viral RNA bacteriophage that is commonly used as a surrogate for the influenza virus and now being considered as a surrogate for other RNA viruses such as SARS-CoV-2.

Successful Test Results

When tested against MS2 bacteriophage, the Defend 1050 showed a high net reduction in a short amount of time. By the 15-minute time point, results showed an average 4.14 net LOG reduction, which equates to a 99.99% reduction in MS2 bacteriophage.

“The methods that are used by labs like Aerosol Research and Engineering are informed by consensus standards and established by international bodies and scientists,” says Dr Kevin Devlin, CEO at WellAir, the parent company of Novaerus. “Therefore, we are confident that the tests are indicative of how effective the Defend 1050 can be when removing viruses, like coronavirus, from the air.”

The efficacy of the Defend 1050 was also recently recognised by Chinese Health Authorities and registered on China’s National Online Record Information Service Platform for Disinfection Products. The Platform recognises products it deems suitable for disinfection in healthcare facilities, with all products independently tested to ensure compliance with national hygiene standards.

“We know conclusively that infection can be transmitted on air currents over distances, by direct and indirect contact or a combination of all three routes,” says Dr Felipe Soberon, Chief Technology Officer at WellAir. “These latest test results prove that the Defend 1050 is ideal for mitigating the risk of airborne dissemination of infection and contamination of surfaces and hands by reducing the bioburden in the air.”

As research continues, one thing is increasingly clear; standard infection prevention and control protocols need reinforcement. Many hospitals worldwide have installed Novaerus technology to help reduce transmission of SARS-CoV-2 among healthcare workers and patients. Novaerus recently donated several air dis-infection devices to two hospitals in Wuhan, China, Wuhan Xincheng Hospital, and Wuhan Third People’s Hospital, to help them reinforce their virus protection protocols. Among the donation of goods was a Defend 1050 for each facility.

“To successfully control the spread of pathogens and viruses, we need to close the infection control loop; hands, surfaces and air,” says Dr Kevin Devlin, CEO at WellAir. “Our unique technology is a facility’s first line of defence against infectious outbreaks”.

About Novaerus

Novaerus is part of WellAir, an Irish company on a mission to reduce indoor airborne pollutants to create living, working, and healing spaces that foster rather than detract from human health, productivity, and wellbeing. WellAir and its brands, Novaerus and Plasma Air, can be found installed in hundreds of hospitals, senior living facilities, schools, casinos, railway stations, residences, and industrial facilities in more than 40 countries around the world.

For more information, visit www.novaerus.com.

Is the New Coronavirus Airborne? (And What Does Airborne Mean, Anyway?)

How exactly does the novel coronavirus spread?

Do infectious particles — once launched by a sneeze, a cough, or an exhalation — drop from the air within seconds, or can they remain suspended for minutes, even hours? How far and fast can they travel?

The answers, trickling out in preliminary studies, have huge implications for preventing transmission of SARS-CoV-2, the coronavirus causing the infectious disease COVID-19, especially among healthcare workers.

Indeed, the safeguards hospitals must deploy — the personal protective gear, the intubation and ventilation protocols, the air dis-infection technology — largely depend on how readily the pathogens waft about.

As researchers race to understand SARS-CoV-2 transmission, the terms airborne, aerosol, and droplet are bandied about in medical journals and media, generating confusion and much debate.

Scientists put forth competing definitions, and the distinctions among terms are more nuanced than once thought.

Given the high stakes, “it’s important to clarify such terminology,” an international research team asserted in BMC Infectious Diseases.

Let’s start with airborne, the most nebulous of the terms used to describe virus transmission.

Strictly speaking, airborne means “transported by air,” so to some scientists, respiratory particles of any size — even large, wet gobs that sink quickly — are classified as airborne, in contrast to viral pathogens carried by blood or semen.

Many scientists, however, use airborne synonymously with aerosol.

An aerosol is often defined as a viral particle smaller than 5 micrometres (0.0002 inches), though some scientists include particles up to 10 μm.

By either definition, infectious aerosols are trouble: They can linger for long periods, travel down corridors, and slip through gaps in surgical masks. When inhaled, aerosols can invade the respiratory system; the smallest can penetrate the furthest, burrowing into the tiny air sacs of the lungs.

Measles, chicken pox, tuberculosis — all are spread via aerosol. Measles aerosols are so potent that if you’re unvaccinated and unprotected by (at least) an N-95 mask, you can become infected merely by walking into a room that was, an hour or two earlier, occupied by an infected person.

Aerosols have long been defined in sharp contrast to droplets, heftier particles that succumb to gravity within a few feet and are less threatening to public health. A sneeze spray can be blocked by an inexpensive surgical mask and evaded entirely by a few footsteps backward.

Droplet-transmitted diseases can be spread by contact — droplets might land on bedrail that’s touched by a nurse who then touches her eye, nose or mouth. But rigorous handwashing and surface cleaning can control transmission in ways that aren’t possible with aerosol-transmitted diseases.

Just how big is a droplet? That’s like asking, “How big is a large pizza?”

Some scientists define droplet as larger than 20 μm; others draw the line at 10 μm. Still others use droplet as a catchall term for particles of all sizes and consider the distinctions simplistic.

“Using arbitrary droplet size cutoffs may not accurately reflect what actually occurs with respiratory emissions,” argues Lydia Bourouiba, Ph.D., of the Massachusetts Institute of Technology, in JAMA Insights.

Donald Milton, Ph.D., an American infectious disease aerobiologist, puts it more bluntly: “The epidemiologists say if it’s ‘close contact,’ then it’s not airborne. That’s baloney.”

How Heavy Droplets Can Stay Afloat

The sink-or-float dichotomy overlooks the enormous gray area of respiratory-disease transmission.

First off, a single disease can be spread in multiple ways. Influenza, for example, can be transmitted via aerosols, large droplets, and direct contact.

What’s more, a sneeze or cough can expel viral particles in a continuum of sizes, all clustered in what Dr. Bourouiba calls a “turbulent gas cloud.”

Particles within the cloud, she posits, travel further than particles traveling solo, because the cloud’s moist, warm atmosphere prevents the droplets from quickly evaporating.

“Under these conditions,” she says, “the lifetime of a viral droplet could be considerably extended, by a factor of up to 1000, from a fraction of a second to minutes.” The droplet, her research suggests, might travel as far as 27 feet.

At this point, the droplet could sink and contaminate a surface. Or it could evaporate, leaving behind infectious residue that stays suspended for hours, venturing around a hospital at the whims its air-conditioning system.

The force of a sneeze or cough can give droplets an additional push. So can gusts from hospital activity.

“Suspension times will be far higher where there are significant cross-flows, . . . with doors opening, bed and equipment movement, and people walking back and forth,” the BMC Infectious Diseases authors note.

Even a surface landing may not represent the end of a droplet’s airborne life: Droplets can be kicked back up into the air when a healthcare worker removes a gown or exits the room, exposing the worker to infection yet again.

Compounding the risk to medical workers, infectious particles can be stirred up in the course of caring for ill patients. The very procedures used to save patient’ lives — intubation, ventilation, nebulizing, cardiopulmonary resuscitationcan cause doctors and nurses to become infected.

“Procedures that irritate the airway . . . can cause a patient to cough forcefully, potentially emitting virus-laden aerosols,” American researchers explain in Virus.

During the 2002-2003 SARS and 2012-2013 MERS crises, healthcare workers fell ill at alarming rates, due in part to aerosol-generating procedures.

Are the same procedures spreading Covid-19, too? Apparently so.

The World Health Organization (WHO) now recommends “airborne precautions” — including N-95 masks, which filter out 95% of aerosols — for circumstances in which “aerosol generating procedures and support treatment are performed.”

But how vulnerable are healthcare workers in other circumstances?

Are coronavirus aerosols hovering in patient rooms and common areas, primed to infect medical workers who might inhale them?

At the moment, WHO suspects they are not and recommends only droplet and contact precautions for general care of Covid-19 patients.

But much of the world disagrees.

Based on emerging research, the U.S. Centers for Diseases Control and Prevention and the European Centre for Disease Prevention and Control, are recommending airborne precautions for any situation involving the care of COVID-19 patients.

No one is suggesting Covid-19 is spread like the measles; the infection rates would be far higher than they are. (A single measles patient can infect 12 to 18 vulnerable people; each Covid-19 patient infects 2 to 3 others.)

However, experts strongly suspect some form of aerosol transmission is occurring — that Covid-19 is not simply spread by people sneezing on each other and touching infected doorknobs.

One clue is the high rate of people who are infected but have no symptoms, perhaps 25% of all those infected.

“I think increasing evidence suggests the virus is spread not just through droplets but through aerosols,” says Gerardo Chowell, Ph.D., an American epidemiologist whose research found 18% of infected passengers aboard the Diamond Princess cruise ship remained symptom free.

Other intriguing clues come from hospital air samples.

At the University of Nebraska Medical Center, an American hospital where cruise-ship evacuees and other Covid-19 patients have been either quarantined or hospitalized, samples were collected in 11 rooms and in adjacent hallways.

Among the findings: 66.7% of the hallway samples tested positive for SARS-CoV-2 RNA.

Numerous air samples inside the rooms turned up positive, too — even when the samples were captured more than 6 feet from patients, even among patients without fevers, even among patients who never once coughed in the presence of the researchers.

Unsurprisingly, the researchers found coronavirus RNA on 76.5% of personal items, such as cell phones, iPads, and reading glasses. But SARS-CoV-2 residue also was found on ventilation grates, on the floor under the patients’ beds, and on ledges of windows that patients had not opened.

Airflow modelling showed the particles likely had floated there.

Did the air samples contain enough virus to transmit infection? That’s still under investigation. But based on the results so far, the team is assuming aerosol transmission occurs.

“Our team was already taking airborne precautions with the initial patients we cared for,” said James Lawler, M.D., co-author of the study and director of the medical center’s Global Center for Health Security. “This report reinforces our suspicions.”

A Chinese team was similarly persuaded after sampling the air in a make-shift Wuhan hospital, fashioned from an indoor sports stadium. High RNA concentrations were found in rooms healthcare workers used to remove protective clothing after treating Covid-19 patients.

The researchers suspect that virus-laden aerosols on the clothing were re-launched when the gear was taken off or that contaminated floor dust was propelled airborne by foot traffic.

Either way, the researchers concluded, “The virus aerosol is a potential transmission pathway.”

How long might infectious SARS-CoV-2 aerosols stay suspended?

That critical question has yet to be answered. But laboratory research, conducted by the National Institute of Allergy and Infectious Diseases, suggests at least a half hour —and perhaps as long as three hours.

When the study was first reported, in a letter to the New England Journal of Medicine, the authors described aerosol transmission as “plausible.” Since then, study co-author Dylan Morris has revised his assessment considerably.

“When our stability paper came out, I said that we didn’t have clear evidence of principally aerosol-driven transmission in an everyday setting. We now do have such evidence.”

Morris was referring not to his laboratory research but to the tragic outcome of a choir rehearsal in the American northwest: Of the 56 singers who rehearsed in a large room, standing at a distance from one another, 45 became infected and two died.

Not only is aerosol transmission a threat for the general public, Morris maintains, but hospital settings “carry a particularly elevated risk.”

How Hospitals Can Fight Covid-19s

As evidence for aerosol transmission of SARS-CoV-2 mounts, so does the death toll of healthcare workers worldwide. In France and Spain, more than 30 healthcare professionals have died of Covid-19, and thousands of others have been forced to self-quarantine.

When Spain reached 40,000 confirmed coronavirus patients, nearly 14% were medical professionals. During China’s outbreak, more than 3,000 doctors were infected.

Hospitals must now operate on the assumption that aerosol transmission is happening.

First and foremost, this means providing healthcare workers on the front lines with appropriate protective gear — “even if they are farther than 6 feet away from a patient,” advises Lydia Bourouiba, Ph.D., of MIT.

She cautions that N-95 masks, already hard to come by, may not even suffice; it’s unknown whether they can block the “high-momentum multiphase turbulent gas cloud” that may be ejected when an infection patient sneezes or coughs.

In addition, hospitals should follow CDC guidelines for respiratory-assist procedures that are likely to induce coughing, performing them “cautiously” and avoiding them “if possible.” The CDC also recommends isolating Covid-19 patients in negative-pressure isolation rooms.

Of course, scrupulous hand hygiene and surface cleaning are critical, given the staying power of SARS-CoV-2 on surfaces.

Hospitals, however, are confronting an unfortunate reality: few of these precautions can reasonably be followed in the throes of a pandemic.

Dire gear shortages plague facilities worldwide, and hospitals are so overcrowded that patients in need of negative-pressure isolation rooms are instead being treated in sports arenas and tents.

Even in the best of circumstances, hospital hand hygiene and surface cleaning are inadequate, but when hospital staffs are collapsing from exhaustion, lapses will inevitably be greater.

Hospitals are doing the best they can with what they have to protect their workers from infection. But in these trying times, the recommended precautions must be augmented by medical-grade air dis-infection technology, such as ultra-low-energy units by Novaerus.

Independent laboratory testing has proven Novaerus technology highly effective against MS2 Bacteriophage, a commonly used surrogate for SARS-CoV, reducing the airborne load by 99.99%.

The same technology is used in hospitals and nursing homes to prevent the aerosol spread of other highly contagious viruses, such as influenza, norovirus, and measles, as well as dangerous bacteria and fungi, such as MRSA, Clostridium difficile, and Aspergillus niger.

Novaerus units operate continually and are safe around the most vulnerable patients, including Covid-19 patients in respiratory distress. A number of hospitals worldwide, including in Wuhan, China, have installed Novaerus portable units to help reduce transmission of SARS-CoV-2 among healthcare workers and patients.

Healthcare acquired infections already had reached worrisome levels before the new coronavirus was unleashed on the world. In the era of Covid-19, it’s become more urgent for hospitals to deploy every available safeguard against deadly aerosols.

Protecting Healthcare Workers from the COVID-19 Pandemic

As the novel coronavirus charges across the globe, no one faces more exposure than healthcare workers on the front lines.

Already, more than 3,330 healthcare workers have been infected and hundreds more remain under quarantine, decimating hospitals’ capacity to admit and treat patients.

“One hundred nurses and doctors can look after 100 ordinary beds and 16 ICU beds,” one Chinese doctor estimated. “If they are sick, not only do they occupy 100 beds, but the staff taking care of 100 beds are gone. That means a hospital loses the capacity of 200 beds.”

The ripple effect is profound: Hospitals in China have been forced to reject patients not infected by COVID-19, including those seeking life-saving surgeries, chemotherapy, and kidney dialysis.

“Health workers are the glue that holds the health system and outbreak response together,” said Tedros Adhanom Ghebreyesus, director-general of the World Health Organization (WHO).

For a host of reasons, healthcare workers are particularly vulnerable to COVID-19, and in China, at least 6 healthcare have workers have died from the disease, including doctors ages 29 and 34.

At one Wuhan hospital, two-thirds of the ICU staff were infected. At another, healthcare workers comprised 29% of patients infected in a one-month period. At yet another hospital, an estimated 130 of 500 medical staff were infected, and a quarantined nurse wrote that the floor where she is quarantined “is basically filled with colleagues.”

In Italy and the United Kingdom, too, healthcare workers have fallen ill with COVID-19. In the United States, 124 nurses at a California hospital have self-quarantined after possible exposure to a coronavirus patient, and at a nursing home, 25 staff have shown symptoms of the disease.

“If health care workers and nurses aren’t protected, no one is protected,” warned Bonnie Castillo, president of National Nurses United, an American union.

Why Healthcare Workers Are So Vulnerable to COVID-19

It’s not just the sick and elderly who are highly susceptible to infection from the new coronavirus. Despite their relative youth and good health, medical workers remain at high risk.

In part, this is because medical staff in close contact with infected patients are exposed to more viral particles than the general public. Patients may cough and sneeze directly in front of them.

Staff may then infect one another or other hospital patients before they realize they are ill themselves.

At hospitals in Wuhan and Beijing, staff members who presumed themselves healthy are thought to have infected one another in tea rooms and meeting areas, according to David Hui Shu-Cheong, a respiratory expert at the Chinese University of Hong Kong.

What’s more, the long, gruelling shifts and severe stress faced by medical workers, particularly in China, are likely to compromise their immune systems, exacerbating their risk of infection.

Further elevating their risk is the shortage of protective gear, such as N-95 respiratory masks, goggles, and protective suits.

At one Wuhan hospital, medical staff fashioned protective gear out of plastic trash bags. At others, they’ve used tape to patch up torn surgical masks and reused goggles intended for one-time use.

Adding to their risk of infection is the high number of staff working outside their areas of expertise. Psychiatrists and orthopedists pitching in to treat COVID-19 patients may have insufficient training in the use of protective gear. For example, they might touch the outside of the mask when they remove it and then touch their face, inadvertently contaminating themselves.

Make-shift staff also have less experience implementing hospital protocols pertaining to infectious patients. Of course, protocols are continually changing, putting even highly trained staff at risk.

Initially, for example, nausea, vomiting, and diarrhoea were not recognized as red flags for COVID-19. As a result of this knowledge gap, one coronavirus patient who checked into a Wuhan hospital with abdominal pain was sent to the surgical ward, only to infect 10 medical staff and 4 other patients.

At a university hospital in the United States, a patient was not tested for the virus because she didn’t meet existing criteria, such as relevant travel history or exposure to another known patient. Testing guidelines have since been updated, but the patient may have already have exposed more than 100 healthcare workers.

As hospital protocols evolve, workers on the front lines will continue to bear the brunt of knowledge gaps.

Protecting Healthcare Workers from the COVID-19 Pandemic

Of course, improving hand hygiene and acquiring protective gear must be top priorities for hospitals. In addition, hospitals must isolate patients who are infected or thought to be infected.

As the U.S. Centers for Disease Control and Prevention states, “isolation of potentially infectious patients [is] essential to prevent unnecessary exposures among patients, healthcare personnel, and visitors at the facility.”

However, many hospitals in China are so overwhelmed that isolating all COVID-19 patients is not possible. Furthermore, hand-hygiene compliance, known to be “abysmally low” at hospitals worldwide, is likely to be even lower than usual given medical workers’ exhaustion and high stress in the current crisis.

Meanwhile, protective gear, much of it manufactured in China, remains in short supply around the globe.

In the United States, medical facilities were facing delays in receiving N-95 masks. And panicked consumers have been hoarding surgical masks needed by hospitals.

The U.S. Surgeon General, the country’s top healthcare official, implored Americans to stop buying masks.

“If healthcare providers can’t get them to care for sick patients, it puts them and our communities at risk!” he tweeted.

Given all these challenges, it is critical for hospitals to enhance standard protection strategies with medical-grade air dis-infection technology, such as Novaerus portable units.

Independent laboratory testing has proven Novaerus ultra-low-energy plasma technology highly effective against MS2 Bacteriophage, a commonly used surrogate for SARS-CoV, reducing the airborne load by 99.99%.

The same technology is used in hospitals and nursing homes to prevent the spread of viruses such as influenza, norovirus, and measles, as well as dangerous bacteria and fungi, such as MRSA, Clostridium difficile, and Aspergillus niger.

Novaerus units operate continually, are safe around the most vulnerable patients, and allow medical facilities to close the infection control loop: hands, surfaces, and air.

COVID-19 is thought to spread mainly from person-to-person via respiratory droplets produced when an infected person coughs or sneezes. These droplets can land in the mouths or noses of people who are nearby or possibly inhaled into the lungs.

In addition, aerosol transmission has been added to the diagnosis and treatment plan issued by China’s National Health Commission as a possible route of coronavirus (COVID-19) infection.

This suggests that the virus is not only transmitted via airborne respiratory droplets but also via microscopic residue from evaporated droplets — aerosols that can remain suspended in the air for long periods and can be inhaled.

As the commission notes, the infection risk among healthcare workers is especially high with prolonged exposure, high viral concentrations, and in a closed environment. The ICU is a prime example of such an environment.

Despite its genetic similarity to the SARS virus, the novel coronavirus is proving to be considerably more contagious.

Like the common cold and seasonal influenza, the virus can trigger upper-respiratory infections, in the nose, pharynx, or larynx; at the same time, the virus can settle deep into the lower respiratory tract, causing deadly pneumonia.

“For a virus pretty closely related to SARS, it shows very effective person-to-person transmission, something nobody really expected,” noted Stephen Morse, a professor of epidemiology at Columbia University Mailman School of Public Health.

It’s already been established that a single hospitalized patient can infect 10 medical workers. The hospital setting is particularly hazardous for staff, as is the nursing-home setting.

At a long-term nursing facility in the United States, a healthcare worker in her 40s has been hospitalized for COVID-19, while two-dozen other staff members have shown symptoms of infection.

Residents are falling ill, too, and they are in the demographic — elderly and ill — most at risk from the coronavirus.

“Nursing homes will be extremely vulnerable to this epidemic, and it will be difficult to implement hygiene practices to prevent the spread,” warned Kevin Kavanagh, M.D., an American infection-control expert.

Novaerus portable air dis-infection units have been installed at nursing homes and hospitals worldwide, including in Wuhan, China, the city hit hardest by COVID-19. At no time has this technology been more critical than now: as the COVID-19 epidemic becomes a global pandemic.