COVID-19 Has Amplified the Superbug Crisis. Hospitals Must Respond Part 2

COVID-19 Has Amplified the Superbug Crisis. Hospitals Must Respond Part 2

read part 1 of this blog post here.

TB patients have rationed medication, yet another practice known to spur antibiotic resistance. During the pandemic, most countries have reported sharp drops in tuberculosis cases, which means huge numbers of patients are going undiagnosed. In 2020, an estimated 500,000 more people than usual may have died of TB, and the number receiving TB treatment dropped by over 1 million.

“The more [patients] you leave undiagnosed and untreated, the more you will have next year and the year after,” warns Lucica Ditiu, M.D., of Stop TB Partnership.

Before COVID, tuberculosis ranked as the world’s leading infectious disease killer; it’s now number two. Drug-resistant forms of the disease account for about 29% of all deaths worldwide caused by bacterial infections. Treatment can last over 2 years and is both highly toxic and often ineffective.

Far worse is XDR-TB, extensively drug-resistant tuberculosis. Now found in 127 countries, this strain is resistant to four anti-TB drugs and represents 6% of all multidrug-resistant tuberculosis cases.

The TB Alliance calls XDR-TB “an extremely deadly and costly global health threat that the world must mobilize rapidly to tackle.”

Instead, understandably, the world is mobilizing against COVID-19.

Before the pandemic, the pipeline for antibiotic development had slowed to a trickle. Now, it’s essentially dry. When COVID emerged, the United States launched Operation Warp Speed to develop a vaccine; no such urgency has been mustered to fight TB or MRSA.

That’s because no incentive exists for drug companies to invest. Antibiotics, after all, must be used sparingly. In the United States, the development of a single antibiotic can cost $985 million, for an annual sales return of perhaps $50 million.

The global economic crisis, driven by COVID, has further dimmed investor enthusiasm. With all hands on deck to fight the pandemic, antimicrobial trials have been delayed. Reagents and researchers alike have been redeployed.

“Very few new innovative anti-bacterial treatments will come to the patients’ bedside in the coming years, and even fewer are targeting the most dangerous resistant bacteria,” warns Peter Beyer, Ph.D., a senior adviser to WHO on antibiotic resistance.

The Silver Lining: COVID Shines Spotlight on Airborne Pathogens

Yet, all is not bleak in the fight against superbugs.

While COVID-19 has suppressed antimicrobial research, the pandemic also has sparked awareness of airborne pathogens. 

Hospitals now know: It’s not just door handles, bed rails, and scalpels that can be teeming with lethal microbes. The air we all share — in the emergency department, the operating theatre, the ICU — may be contaminated, too.

Of course, airborne superbugs have long been implicated in the transmission of hospital-acquired infection. As Iranian scientists observed well before the pandemic, “Antibiotic-resistant airborne bacteria can survive in the various hospital environments and remain suspended in the air for long periods of time.”

In fact, airborne superbugs posed such a danger that these scientists urged hospitals to deploy stand-alone air cleaning devices: “Use of advanced air purification and ventilation equipment, their constant monitoring, as well as a continuous microbial sampling of the hospital air are strongly recommended for preventing nosocomial infection.”

The COVID-19 pandemic has strengthened the case, prompting hospitals worldwide to install air dis-infection technology, such as NanoStrikeTechnology by Novaerus.

After all, the same devices that remove SARS-CoV aerosols also inactivate airborne superbugs.

MRSA, C. difficile, Acinetobacter species, and tuberculosis are among the bacteria shown by independent testing to be obliterated by Novaerus’ ultra-low energy NanoStrikeTechnology. Common viruses such as influenza and norovirus are removed by the same process.

NanoStrike Technology harnesses a range of physical concurrent pathogen inactivation processes to safely disinfect the air. NanoStrike coils provide a powerful strike that works to burst airborne pathogen cells, rapidly inactivating them, ensuring they are no longer a threat of infection.

Mounted above ICU beds, or wheeled into operating theatres, installed in wards and emergency rooms, Novaerus units safely operate 24/7 proximity to even the most vulnerable patients and protect medical staff as well.

It’s clear that both antibiotic stewardship and infection prevention are critical to slowing the rise of antibiotic resistance. Some experts argue that of the two approaches, infection prevention is the more urgent.

“Antimicrobial resistance is affected by many factors, but too much of our focus has been on antimicrobial usage,” two Australian physicians have asserted in JAC-Antimicrobial Resistance.  “The major factor that drives resistance rates globally is spread.”

The countries most burdened by antimicrobial resistance, these doctors note, are those in which pathogen spread, rather than antibiotic overuse, is the dominant factor.

One of the most effective, most accessible, and least expensive, weapons against transmission is air disinfection.

Right now, all attention is focused on taming COVID-19, but the world cannot wait for the pandemic to subside before tackling the rise of superbugs. As a Harvard University scientist notes, “The antibiotic resistance crisis will continue well beyond the resolution of the COVID-19 pandemic.”

COVID-19 Has Amplified the Superbug Crisis. Hospitals Must Respond Part 1

COVID-19 Has Amplified the Superbug Crisis. Hospitals Must Respond.

When the world gains control over COVID-19, infection control experts won’t get a reprieve. To the contrary, hospitals will need to confront the “pandemic lying in wait”: antibiotic resistance.

For decades, pathogens have been outwitting the antibiotics that revolutionized medicine in the 1940s. Well before COVID-19 emerged, drug-resistant “superbugs” were a global menace, costing 700,000 lives a year and straining hospital resources. Resistance had arisen to over 70% of bacteria — and to every antibiotic ever developed for use in the ICU setting. Infections once easily treated were requiring more toxic and complex regimens. None of this stopped when SARS-CoV-2 exploded.

“In the shadows of the COVID-19 pandemic,” Croatian scientists have warned, “there has been an ongoing antimicrobial resistance pandemic.”

Actually, the superbug crisis isn’t just “ongoing”; it’s primed to accelerate. Even more patients have taken antibiotics they don’t need. At the same time, those in dire need — patients with drug-resistant tuberculosis, for example — have seen their treatments interrupted. Research on new antibiotics, already lagging, has been halted.

In combination, these developments may well spawn new lethal variants and vexing nosocomial outbreaks. Without immediate action, common procedures — caesarean sections, knee replacements, cancer chemotherapy — will become riskier.

“We might be soon headed towards a post-antibiotic era, where a simple wound or a dental infection can be fatal,” warns Hatim Sati, M.D., a member of a World Health Organization (WHO) task force on antimicrobial resistance. “That is what’s at stake here.”

In response, hospitals must act on two fronts, dispensing antibiotics more judiciously while deploying more robust precautions against infection spread. Critical among these precautions is air disinfection.

Hand hygiene and surface cleaning remain important, but as the COVID-19 catastrophe has laid bare, all the antibacterial rub in the world won’t halt the transmission of an airborne pathogen.

Among the most worrisome superbugs, deemed “urgent” or “serious” threats by the U.S. Centers for Disease Control and Prevention (CDC), are Mycobacterium tuberculosis, Methicillin-resistant Staphylococcus aureus (MRSA), Carbapenem-resistant Acinetobacter and Clostridium difficile — all readily spread via air currents.

“The uncontrolled movement of air in and out of the hospital environment makes the bacterial persistence worse,” a research team noted in the Annals of Clinical Microbiology and Antimicrobials, “since these infectious microorganisms may spread easily through sneezing, coughing, talking and contact with hospital materials.”

Routine activities — mopping a floor, making a bed, cutting a bandage, removing a glove — can propel drug-resistant bacteria into the air. These aerosols can hover for hours and travel far.

Hospitals must be equipped to destroy airborne superbugs on a continual basis before these bacteria infiltrate open wounds, are inhaled by vulnerable patients, or mutate into strains that are impossible to treat.

How COVID-19 Has Amplified The Superbug Crisis

Antibiotics, of course, are worthless against viral infections, whether COVID-19, influenza or the common cold. Yet these drugs are routinely prescribed for patients infected by a virus, a practice that fuels antibiotic resistance.

Prior to the pandemic, over 30% of oral antibiotic prescriptions were unwarranted. Then COVID struck, and the percentage shot up.

Initially, doctors had trouble distinguishing COVID-19 from bacterial pneumonia, often prescribing antibiotics as a default. Or, antibiotics were prescribed for fear COVID patients might have bacterial co-infections. In most cases, the drugs were administered before tests confirmed, or ruled out bacterial infection.

This scenario was repeated on a global scale. Among COVID patients at 38 U.S. hospitals, 56% of patients received antibiotics early on, though just 3.5% actually turned out to harbour bacterial infections. In Europe, 75% of severe COVID patients received antimicrobials, though only 15% had documented infections. Similar numbers were reported in Asia.

Rampant overprescribing of antibiotics to COVID patients has largely stopped, but the damage may already have been done.

What’s more, the pandemic-driven increase in telemedicine has increased antibiotic use among non-COVID patients. In the absence of physical exams or lab tests, doctors reflexively prescribe these drugs for a wide range of symptoms.

“Antimicrobial stewardship may be another casualty of the COVID-19 pandemic,” the Croatian team observed.

An additional casualty: the treatment of patients who actually require antibiotics. Microchips, sofas, and stoves aren’t the only commodities in short supply these days. Antibiotics and diagnostic tests have been scarce, too, what with manufacturing interrupted, stockpiles depleted, travel restricted, and medical clinics shuttered.

Read part 2 of this blog post here

Preventing Airborne Infection in the Operating Theatre Part 2

“Air quality deserves close attention”: Preventing Airborne Infection in the Operating Theatre 

read part 1 of this blog post here.

Air Contamination in the Operating Theatre

For decades, a surgical patient’s risk of becoming infected was considered largely a factor of the patient’s own health, the surgical team’s skill, and the sterility of the surgical instruments.

Certainly, these factors matter. Patients who smoke, are obese, or have poorly controlled diabetes are at greater risk for infection. Procedures performed meticulously and with sterile instruments lead to fewer infections. However, as Danish scientists have noted, when it comes to infection risk factors, air quality is often disregarded.

It shouldn’t be.

In orthopedic and cardiothoracic operations, in particular, “the risk of surgical site infection is strongly correlated with the amount of airborne bacteria being present in the operating room and the surgical field,” asserts Mikael Persson, Ph.D., a Swedish mechanical engineer.

For example, research confirms airborne transmission of Mycobacterium chimaera from contaminated heater-cooler units commonly used in open-heart surgery. Patients have become infected even when the operating theatres were equipped with ultraclean air ventilation (laminar airflow).

With abdominal and breast surgeries, too, OT air contamination has been directly correlated with surgical site infection.

A team from Denmark and Ghana collected air samples during 124 surgical procedures, 11 of which (9%) resulted in confirmed infection. Substantially more air contamination was detected during the procedures that resulted in infection than during the procedures that did not.

Cementing the link, the scientists used genetic methods to match the bacteria captured in the air with the bacteria collected from the wounds.

In 8 of the 11 infection cases, a species match was found between bacteria isolated from the infection and the corresponding air isolates. In 6 cases, matching ribotypes were found.

The authors note that the hospital, a major teaching facility in Ghana, took great care to prevent infection. The scrub team wore sterile gowns and gloves. Incision sites were disinfected three times. Antibiotics were administered prior to first incision. Between procedures, surfaces and floors were cleaned with a 10% chlorine solution. The room was equipped with HEPA filtration.

Nonetheless, air sampling detected “high levels of airborne bacteria,” far higher, on average, than maximum levels recommended by the Healthcare Infection Society. Pathogens included S. aureus, Klebsiella spp. and Acinetobacter spp.

How do these bacteria infiltrate the operating theatre air and find their way into open wounds?

Airborne pathogens have many sources, including skin scales, dust, textile fibers, and aerosols produced by coughing and talking.

Particles can circulate via the convection currents created by the temperature differences between the body and the environment, explains French surgeon Dominique Chauveaux. In addition, particles settled on an unsterile floor can be dispersed by air eddies generated from opening doors and foot traffic.

In about 30% of SSI cases caused by airborne contamination, infection can be attributed to “direct settling of the particles on the wound,” according to Chauveaux. In the other 70% of cases, bacteria settle on the instruments and surgeon’s hands, “followed by transfer to the wound.”

Helping to Prevent Airborne Infection in the Operating Theatre 

For years, surgeons have relied largely upon prophylactic antibiotics to prevent surgical site infection. However, given the rise of antimicrobial resistance, overuse of antibiotics has become a serious problem.

“Everyone just wants to [use] more antibiotics, [but surgeons] have to be good antibiotic stewards so that we are not the ones who are complicit in creating antimicrobial resistance,” cautions Bryan Springer, M.D., an American orthopedic surgeon.

Recently, attention has turned to keeping the OT air clean, so pathogens don’t have the opportunity to infiltrate wounds or settle on surgical instruments.

“Measures that decrease airborne particle counts are central to diminishing the risk of contamination by airborne microorganisms,” asserts Chauveaux.

Some of these measures rely on the behavior of surgical staff. For example, the surgical team should limit door openings, talk only when necessary, and enter the theatre one by one, rather than as a group. Healthcare workers should remove their gloves away from the surgical instruments and avoid cutting or stretching bandages near the surgical site.

But these strategies can only accomplish so much. As American surgeons have noted, behavioral measures have had just “a marginal impact” in reducing OT contamination or the risk of infections related to joint replacements.

What would have a larger impact? Air disinfection, particularly NanoStrike technology from WellAir.

WellAir’s Novaerus devices utilize NanoStrike Technology to inactivate airborne viruses, bacteria and mould spores. The technology harnesses a range of physical concurrent pathogen inactivation processes to safely disinfect the air. NanoStrike coils provide a powerful strike that works to burst airborne pathogen cells, rapidly inactivating them, ensuring they are no longer a threat of infection. Installed in operating theatres and ICUs worldwide, Novaerus devices safely operate next to the most vulnerable patients.

Though HEPA filtration is considered the gold standard in air purification, filters only trap pathogens. NanoStrike technology inactivates them, one reason Novaerus units are a critical addition to environmental control in the operating theatre.

Cleared by the FDA as a Class II Medical Device, the Novaerus Defend 1050 also protects OT personnel from exposure to “surgical smoke,” the toxic mix of volatile organic compounds (VOCs), other gases, and ultrafine particles emitted by lasers and cautery devices. As the U.S. Centers for Disease Control and Prevention confirms, these particles can cause headache, asthma-like symptoms, and eye, nose and throat irritation.

Surgical site infections are a global problem, affecting countries of all income levels. The cost of these infections, to patients and hospitals alike, is enormous, and hospitals must deploy every possible precaution, including air disinfection.

Writing in The Lancet Infectious Diseases, an American surgeon, Robert Sawyer, describes the magnitude of the SSI crisis, imploring hospitals worldwide to implement more robust measures. “An ounce of prevention,” he asserts, “is worth a pound, yuan, birr, or peso of cure.”

Preventing Airborne Infection in the Operating Theatre Part 1

“Air quality deserves close attention”: Preventing Airborne Infection in the Operating Theatre 

A few years back, in an operating theatre at a Japanese hospital, two physicians and two nurses donned gowns and gloves and prepared for a total knee replacement surgery. As the surgical team readied the instrument table and wrapped the patient’s leg, a highly sensitive camera filmed the action — not the team’s performance but rather the whirl of airborne particles stirred up by their movements and illuminated by a green laser. 

Nobody’s knee was actually replaced in that room. The procedure was a simulation, designed to determine which movements spawn the most airborne particles which cause airborne infection in the operating theatre (OT) and where in the room these particles congregate.

Super-high magnification of coronavirus particles (like the current SARS-CoV-2 pandemic) spread through tiny droplets of liquid (aerosols) floating through the air. Illustration for means of transmission: droplet and aerosolized infection.

Preventing Airborne Infection in the Operating Theatre 

These are vital concerns. Airborne particles — dust, bandage fibers, skin scales, respiratory aerosols — can transport dangerous bacteria onto a surgeon’s gloves or scalpel or directly into an open wound, triggering serious infection.

Surgical site infections (SSI), the costliest and most feared of all healthcare acquired infections, plague hospitals worldwide. In low-income countries, over 10% of surgical patients become infected; in some regions a C-section or GI surgery might carry an infection risk of 19% or 23%. Even in wealthy countries, 2% to 4% of surgical patients develop infection; in emergency trauma surgery, that risk may rise to 15%.

Treatment for SSI can require a lengthy hospital stay and complex revision surgery. In the United States, surgical site infections are associated with nearly 1 million additional inpatient days, and 3% of surgical site infections turn lethal. In Africa, the death rate is nearly 10%.

Mortality rates are highest among patients infected with drug-resistant bacteria, such as Methicillin-resistant Staphylococcus aureus (MRSA), a common scenario and grave concern in the superbug era.

Even when hospitals take extreme care to disinfect wounds, sterilize devices, and clean the operating theatre, infections can take root. That’s because in most SSI cases — perhaps 80% to 90% — infections are triggered by pathogens that descended from the air.

“Contamination by airborne microorganisms plays a central role in the pathogenesis of surgical site infections,” asserts Dominique Chauveaux, a French orthopedic surgeon, who urges hospitals to make SSI prevention a “major priority.”

U.S. surgeons, writing in the American Journal of Infection Control, consider bacterial contamination of OT air “an underappreciated factor” in the origin of prosthetic joint infections.

Air quality deserves close attention

How do airborne pathogens infiltrate the operating theatre despite high disinfection standards and use of HEPA filters? Most important, how can the particle count be reduced?

The Japanese knee-replacement simulation offered some insight. Even the smallest movements — removing a glove, cutting a bandage, lifting a patient’s leg — can unleash an abundance of particles. When a surgical team files into the operating theatre, another study found, the particles stirred up by their shoes and gown hems drift to the level of the operating table.

Certainly, moving less, talking less, and limiting OT personnel can minimize air contamination. Still, measures like these aren’t enough. Neither are ventilation and air-filtration systems.

As U.S. surgeons point out, traditional precautions “have thus far resulted in failure to reduce the risk of microbial aerosols or contamination of implantable devices during arthroplasty surgery.”

Given the prevalence and virulence of surgical site infections, the surgeons argue, hospitals must augment traditional precautions with “innovative air purification technologies.”  

A clean, quiet operating theatre and skilled surgical staff can do much to protect a patient from infection. Air disinfection technology that inactivates pathogens at the DNA level can amplify that protection considerably.

Prosthetic Joint Infections: “Particularly devastating”

Appendectomy, abdominal hysterectomy, craniotomy, coronary bypass — all surgical procedures carry a risk of infection. However, prosthetic joint infections are “particularly devastating,” as Japanese scientists observe. Reducing these infections is both urgent and challenging.

“Since fighting infections depends on blood flow (which artificial implants obviously don’t have), both for an effective immune system response and to deliver antibiotics to the area, joint replacements can become safe havens for bacteria,” explains Jonathan Cluett, M.D., an American orthopedic surgeon.

What’s more, as the global population ages and obesity rates rise, hip and knee replacements will become increasingly common. Experts project a 13% increase in joint replacements and a 14% increase in resulting infections by 2030. A single infection can cost over $400,000. The death rate in these cases is an estimated 2% to 7%.

“A periprosthetic joint infection can be as medically challenging to the patient as having cancer,” says Jeremy M. Gililland, M.D., a American orthopedic surgeon. Though the infection risk is 2% for a low-risk patient, “if that patient gets an infection, it is 100% detrimental to them.”

In many cases, the surgeon must remove the infected implant, cleanse the joint cavity, and implant a temporary joint spacer that is removed after 6 weeks of IV antibiotic treatment. About 10% of all arthroplasties are revisions. For these surgeries, the infection risk rises to 15% to 20%.

It’s not just joint replacements that often require re-operation after infection. In a British study, for example, 8% of neurosurgery patients became infected, and 9 out of the 20 infected patients required reoperation.

Read part 2 of this blog here.

Hospitals Must Prepare for the Next Pandemic – Part 2

Read part one of this blog post here.

“We Need to Face Reality Here”: Hospitals Must Prepare for the Next Pandemic

What Hospitals Must Do to Avert the Next Pandemic

Certainly, many critical pandemic precautions fall beyond the scope of hospitals. Governments, for example, must invest in more robust pathogenic surveillance — that is, sampling of animal populations to detect viruses that lurk — and in the development of vaccines that protect against multiple viruses at once. At the same time, much can be done at the hospital level.

Covid-19 Pandemic Effect On Hospitals 

When Covid-19 struck, overrun emergency departments not only lacked the staff to care for infected patients but also lacked sufficient personal protective gear. On top of that, public-health experts assumed SARS-CoV-2 did not spread via aerosol, the same deadly and erroneous assumption that had been made decades earlier with measles and tuberculosis.

As a result, Covid-19 ripped through hospitals. A review of early cases in China found 44% of Covid-19 infections were hospital acquired. At a hospital in South Africa, a single case led to 119 infections and 15 deaths among staff and patients at five hospital wards, a nursing home, and dialysis unit. Eventually, precautions and protocols changed. Today, lessons learned from the early Covid period are driving hospital planning for the next pandemic.

Increasing surge capacity is a top priority, and plans run the gamut. Some hospitals are training rheumatologists and pediatricians to jump to intensive care in a pinch. Others are looking to architectural solutions, such as airport-like docking stations with interlocking modules that could quickly expand the emergency department — an improvement over the tent-in-the-parking-lot approach hospitals deployed at the height of the Covid crisis.

“Most EDs are poorly designed to protect staff, other patients, and visitors from highly contagious airborne transmission of an epidemic disease,” says Frank Zilm an architect specializing in healthcare design at the University of Kansas in the United States.

A hospital in Italy installed a “plug-in biocontainment pod” devised from a shipping container. In Los Angeles, architects are working on a way to erect, within days, a medical mini-city that could accommodate 1,000 patients and 6,000 staff.

Less grand and expensive ways of defending against pandemic disease include zero-contact intake systems, which allow for remote triage and patient registration. At one Boston hospital, for example, an iPad-equipped robot named Spot acts as intermediary between medical staff and potentially infectious patients. Still, all the innovations in architecture, robotics, and telemedicine won’t change reality: Hospitals are full of human beings, including infectious ones who need to be cared for, up close, by medical staff, and who share the same air as vulnerable patients on the premises.

That’s why hundreds of hospitals have turned to air dis-infection, particularly Novaerus NanoStrike technology by WellAir, as a means of preventing spread of Covid-19 and other airborne diseases, current and future.

Even before SARS-CoV-2 emerged, hospital-acquired infections — whether caused by viruses, bacteria, or fungi — were endemic. Each year in high income countries, 5% to 10% of hospitalized patients, including 30% of patients in intensive care units, were contracting an infection during their stay. Before Covid-19, in Europe and the United States, hospital pathogens were infecting nearly 6 million patients annually and were responsible for 140,000 deaths.

Covid-19 has only amplified the crisis and brought more attention to the airborne route of transmission.

NanoStrike Technology 

NanoStrike is the unique, patented technology at the core of all Novaerus portable air dis-infection devices. The nanotechnology harnesses a range of physical concurrent pathogen inactivation process to safely dis-infect the air. Hospitals in over 65 countries have deployed Novaerus devices, particularly in operating rooms, intensive care units, emergency departments, waiting rooms, and surgical theatres.

Independent laboratory testing shows that within 15 minutes, the Novaerus Defend 1050 achieves a 99.99% reduction of the MS2 bacteriophage RNA virus, an accepted surrogate for SARS-CoV-2.

NanoStrike technology has shown similar efficacy with other airborne pathogens that hover in hospitals, including influenza, Clostridium difficile, Aspergillus, and surrogates for Measles virus, Mycobacterium tuberculosis, and Methicillin-Resistant Staphylococcus Aureus (MRSA).

In a 2015 article titled “The Next Pandemic: Hospital Management,” three physicians wrote: “The threat of pandemic infectious disease lurks quietly beneath the surface of everyday hospital operations and society at large.”

Though “moments of panic inspire waves of planning,” the doctors continued, the waves inevitably crest, planning becomes submerged by daily demands, and ultimately, nothing changes.

Post-Covid, of course, complacency is impossible. Hospitals, nursing homes, society at large — we’ve all experienced a tidal wave, and the threat of the next one can’t be ignored.

Even when the Covid pandemic ends, SARS-CoV-2 will remain among us, and the next pandemic pathogen will almost certainly be airborne as well. No matter what other precautions hospitals invest in, they must also upgrade their air dis-infection technology, one of the least expensive and most effective defenses against the spread of deadly disease.  

If you are a medical or healthcare facility interested in learning more about the Novaerus products, additional information can be found here, or please contact Novaerus.

Hospitals Must Prepare for the Next Pandemic – Part 1

“We Need to Face Reality Here”: Hospitals Must Prepare for the Next Pandemic 

Back in 2018, a year before SARS-CoV-2 began stalking the globe, American scholars issued a report on the likely traits of the next pandemic pathogen. 

The scholars, from the Johns Hopkins Center for Health Security, were on the hunt for microorganisms that could cause worldwide catastrophe — “a sudden, extraordinary, widespread disaster” that would trigger great suffering, death, and economic damage. 

What they concluded: The culprit would be airborneand the resulting respiratory disease, with a low but significant fatality rate, would be contagious before symptoms surface. 

“We need to get serious about respiratory viruses,” Amesh Adalja, M.D., the report’s lead authorwarned at the time. “There’s a lot of focus on diseases that aren’t going to be able to change civilization in a way that something that’s spread through the respiratory route would be.” 

Of course, Adalja’s report, which listed coronaviruses among the most likely suspects, was spot on. 

Now that the predicted catastrophe has materialized and much of the world was caught flat-footed, experts have issued a new warning they hope will be better heeded: We must prepare, in a more serious way, for the next pandemic.  

The risk of pandemics is increasing rapidly, with more than five new diseases emerging in people every year, any one of which has the potential to spread and become pandemic,” warns a United Nations report, issued during the Covid crisis. 

Whether the pandemic is set off by a coronavirus, an influenza strain, or another pathogen altogetherAdajla says today, preparations should focus on “any kind of efficiently spreading respiratory virus” — in other words, disease with the capacity to spread through the air. 

We need to face reality here,” says Edward Holmes, Ph.D., a virologist at the University of Sydney, who monitors bat viruses and suspects another coronavirus pandemic is imminent. “The next one could come at any time. It could come in 50 years or in 10 years. Or it could be next year.” 

When it does come, will hospitals be ready?  

As they continue to battle Covid-19, healthcare facilities are simultaneously planning ahead, exploring, if not already implementing,protocols and technologies that will better protect patients and staff from airborne microorganisms. 

Given the toll of the current pandemic, no hospital can delay preparing for the next onesays Richard Waldhorn, M.D., an expert on hospital emergency preparedness with the Johns Hopkins Center for Health Security.  

“It’s very important to prevent the hospital from becoming a disease amplifier.”  

“The Virusphere is Just Immense” 

Pathogens harboured by animals have jumped to humans for decades, but in the distant past, when individuals acquired deadly infections this waythey likely fell ill and died in the vicinity 

“Now an infected person can be on a plane to Paris or New York before they know they have it,” says Dennis Carroll, PhD, an emerging infectious disease expert with the U.S. Agency for International Development. 

Global travel and trade, urbanisationdeforestation, agricultural expansion, climate change — all are bringing humans into closer contact with bats, livestock, and other animals that harbour dangerous viruses.  

“We are rolling the dice faster and faster and more and more often,” says Raina Plowright, Ph.D., a virus researcher at the Bozeman Disease Ecology Lab in Montana. 

According to the U.N. report, mammals and birds may host more than 800,000 undiscovered viruses that could be transferred to humans. 

Edward Holmes, the Australian virologist, found 24 new coronaviruses in several hundred bats in a small region of southern China; a number of the pathogens were related to SARS-CoV-2 and SARS-CoV, the virus that caused the 2003 SARS outbreak in China and four other countries. 

“We’re only just starting to scratch the surface,” says Holmes. “The virusphere of coronaviruses is just immense.” 

Then again, the next pandemic pathogen may not be a coronavirus. The deadly Nipah virus, another airborne virus carried by bats, ranks among the World Health Organization’s top 10 priority diseases. So does MERS, a respiratory coronavirus harboured by camels that emerged in 2012 in the Arabian peninsula and remains a threat. 

Then there’s influenza: 30 influenza pandemics have occurred in the past 400 years, including four in the last century.  

“Based on [influenza’s] genetic structure, it’s really only a matter of time before new strains emerge that have the capacity for efficient human-to-human transmission,” says Amesh Adalja. 

Read part 2 here

Yes, Covid-19 Aerosols Are Infectious, And More Dangerous than Droplets – Part 2

Read part one of this blog post here.

Infectious Aerosols: Small but Potent

Many Covid-19 precautions — plexiglass dividers, desks spaced 6 feet apart, reduced restaurant occupancy — are premised on the notion that large droplets, generated by sneezes and coughs, pose the greatest danger to vulnerable people.

In reality, the most dangerous droplets are the invisible ones, particularly those in the range of 2 μm to 3 μm.

Not only can aerosols hover for hours and travel across rooms, but they also carry more infectious virus than large droplets.

“Humans produce infectious aerosols in a wide range of particle sizes, but pathogens predominate in small particles,” explains Kevin Fennelly of the NIH.

This is true for influenza, SARS-CoV-2, and other respiratory viruses, says William Lindsley, PhD, a biochemical engineer with the U.S. Centers for Disease Control and Prevention.

“You see a lot more virus in small aerosols,” Lindsley told a panel at an international conference on the aerosol transmission of Covid-19.

This is because of where aerosols originate: in the lungs. Research shows the viral load of SARS-CoV-2 is higher in the lungs compared to the upper respiratory tract.

What makes aerosols so dangerous is that once inhaled, they can penetrate deeper into the lungs. For a patient to develop severe Covid-19 symptoms, such as pneumonia or acute respiratory distress syndrome, the virus must reach the lower airways, and only small aerosols can travel that far.

“We know that if the virus makes it down deeper into the respiratory system, fewer viruses are required to initiate infection, and this can also affect the severity of disease,” Marr reported at the international Covid-19 conference.

To those still sceptical that aerosol transmission is driving Covid-19 spread, NIH’s Fennelly responds: “There is no evidence to support the concept that most respiratory infections are associated with primarily large droplet transmission. In fact, small particle aerosols are the rule, rather than the exception, contrary to current guidelines.”

NanoStrike Technology: Fighting Aerosol Spread of Viruses

How can guidelines be updated to reflect the reality of aerosol transmission?

Healthcare facilities cannot simply rely on personal protective gear, hand hygiene, and cleaning protocols. And distancing protocols, whether implemented in nursing homes, offices, or pubs, are of limited use indoors; the 6-foot/2-metre rule does not stop aerosols from floating across a room.

With SARS-CoV-2 hovering, undetectable, what all indoor environments need is high-powered air dis-infection, such as Nanostrike technology from Novaerus.

Novaerus’ compact devices use a plasma field that obliterates pathogens at the molecular level, instantly rendering them inactive. The technology has been used in over 65 countries to help combat Covid-19, particularly in hospital operating rooms, intensive care units, emergency rooms, waiting rooms, and surgical theatres.

The Novaerus Defend 1050, cleared by the U.S. Food and Drug Administration as a 510(k) Class II medical device, has been proven in independent laboratory testing to filter out and inactivate a wide range of airborne viruses and bacteria.

Within 15 minutes, the Defend 1050 has demonstrated a 99.99% reduction of the MS2 bacteriophage RNA virus, an accepted surrogate for SARS-CoV-2. The device, like other Novaerus units, has shown similar efficacy with other airborne pathogens, including influenza, Clostridium difficile, Aspergillus, and surrogates for Measles virus, Tuberculosis and Methicillin-Resistant Staphylococcus Aureus (MRSA).

Upon obliterating pathogens, the Defend 1050, a portable, free-standing system, releases clean air back into the room. Unlike other technologies, which can pose risks to humans, Novaerus devices are safe for 24/7 use among the most vulnerable patients.

Though NanoStrike technology was designed for use in medical settings, Novaerus’ sleek, compact devices have also been installed in retail, hospitality, and office settings, from wine-tasting rooms to hotel lobbies, offering medical-grade protection to customers and staff alike.

From Measles to Covid-19

In 1982, one year after those seven American children contracted measles during a visit to the paediatrician, a similar outbreak occurred in another American paediatrics practice.

This time, three children contracted measles despite arriving at the doctor’s office more than an hour after the source patient had left the building.

And this time, instead of dismissing the incident as an outlier, scientists conceded that the conventional wisdom about measles likely had been wrong.

“Airborne transmission may occur more often than previously suspected,” a team of public-health physicians wrote in the Journal of the American Medical Association.

With regard to Covid-19, scientists have come to that conclusion more quickly. Now, building operators must make sure the precautions keep up with the science.

Yes, Covid-19 Aerosols Are Infectious, And More Dangerous than Droplets – Part 1

Covid-19 Aerosols Are Infectious, And More Dangerous than Droplets – Part 1

More and more evidence supports the case that Covid-19 Aerosols are infectious and more dangerous than droplets, in this blog post we take a look at how a similar debate was made around measles in the 1980s and how health officials reacted compared to how the health officials have reacted to the current Covid-19 pandemic.

In 1981, seven American children contracted measles during a visit to the same doctor’s office.

Three of the children had never crossed paths with the 12-year-old source patient. One child arrived at the office an hour after the infected boy had left.

The outbreak caused a stir. At the time, public-health authorities believed measles was transmitted via large respiratory droplets, the kind generated by phlegmy coughs, and required contact within about 1 meter of an infected person.

So ingrained was this belief that a major medical journal, Pediatrics, deemed the outbreak an outlier, concluding that for measles, “Infectious Aerosol spread is unusual.”

Of course, today we know the opposite is true. Microscopic measles particles can remain airborne and infectious for up to 2 hours and can drift far and wide. In one case, an infected athlete transmitted the disease to spectators 100 feet (30.5 meters) away. The notion that measles is primarily contracted through contact with large droplets, rather than via tiny, inhaled aerosols, has been thoroughly debunked.

One year into the Covid-19 pandemic, that same theory has been debunked with respect to SARS-CoV-2 transmission, though infection-control measures have lagged behind the science.

In one regard, the evidence supporting aerosol transmission for Covid-19 is actually stronger than it is for measles: Viable SARS-CoV-2 has been captured via air sampling, a feat that has yet to be achieved with the measles virus.

In fact, only one study, published in 2016, long after experts declared measles airborne, has captured measles RNA in the air — a study its authors called “the first study to directly detect evidence of airborne transmission of measles.” Yet in that study, testing in cell cultures failed to detect viable measles virus.

By contrast, at least six air-sampling studies have isolated SARS-CoV-2 RNA. And one, conducted at the University of Florida, proved SARS-CoV-2 viral particles — captured as far as 4.8 meters from a Covid-19 patient — were viable.

“If this isn’t a smoking gun, then I don’t know what is,” asserts Linsey Marr, PhD, a Virginia Tech aerosol scientist who was not involved in the study.

Marr calls the results “unambiguous evidence that there is infectious virus in aerosols.”

The Florida study, piled atop volumes of other evidence pointing to aerosol transmission, has intensified calls for more robust infection control indoors — in hospitals, nursing homes, dental practices, and retail establishments.

With ultra-contagious SARS-CoV-2 variants now surging globally, the stakes could not be higher.

“It is very clear that aerosols play a considerable role in the transmission of Covid-19 and that we are unlikely to prevail against this pandemic unless we acknowledge that fact,” asserts Justin Morganstern, M.D., a Canadian emergency physician, in an evidence review.

While physical distancing and masks remain important, Morganstern argues, “We should be looking at the extra precautions we can add to stem the spread of this disease.”

Foremost among these precautions should be air filtration and dis-infection, say experts, including Kevin Fennelly, M.D., of the U.S. National Institutes of Health.

At hospitals and nursing homes, infection-control protocols are based on “old data and inferences,” Fennelly asserts in The Lancet Respiratory Medicine. Droplet transmission is not driving the pandemic, he argues, and precautions should be updated to “account for the predominance of small particles within infectious aerosols.”

Covid-19 Aerosols are Infectious in the Air

At the pandemic’s outset, health authorities made the same assumption about SARS-CoV-2 that they’d made, erroneously, about measles in the 1980s and tuberculosis in the 1950s: that aerosol transmission, if it happened at all, was “probably very rare.”

But that assumption soon began to wither.

Quickly, it became clear that asymptomatic carriers were spreading Covid-19 in huge numbers, without sneezing or coughing.

What’s more, scientists identified outbreaks — on cruise ships and bus rides, at choir practices and ski resorts, in call centres, restaurants, and shopping malls — that could not be explained by surface or droplet transmission.

Strengthening the case for aerosol spread, scientists captured SARS-CoV-2 genetic material on surfaces that patients could not possibly have touched, such as air outlet vents and air-handling grates.

Even more compelling, coronavirus particles were captured in the air — above flushing toilets, in hospital nurses’ stations and changing rooms, in hallways outside patient rooms, and inside patient rooms beyond 6 feet from the patients.

Still, questions persisted: Was the RNA viable? Could the captured particles actually invade a cell, replicate, and trigger infection? Or were they inert, harmless fragments of genetic material?

The answer was elusive because aerosols, microscopic and fragile, are easily damaged by the air-sampling process.

But the University of Florida team used new, more sophisticated technology, preserving SARS-CoV-2 RNA captured in the air 15 feet from a Covid-19 patient. The genome sequence of the collected virus matched the sequence isolated from the patient.

The study, says lead researcher John Lednicky, PhD, proved “conclusively” that viable SARS-CoV-2 particles, small enough to be inhaled, can linger in the air and pose a risk to those in the vicinity.

The study squelched doubt that Covid-19 can spread — and readily — via aerosols.

Read part two here.