Author Interviews, COVID -19 Coronavirus, Environmental Risks / 22.04.2021
Make Your Bathroom Breaks Brief: COVID Droplets Can Linger For Hours
MedicalResearch.com Interview with:
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Dr. Lashaki[/caption]
Masoud Jahandar Lashaki, Ph.D.
Assistant Professor
Department of Civil, Environmental and Geomatics Engineering
Florida Atlantic University
MedicalResearch.com: What is the background for this study?
Response: Toilet flushing can generate large quantities of microbe-containing aerosols depending on the design and water pressure or flushing energy of the toilet. Based on previous reports, a variety of different pathogens which are found in stagnant water or in waste products (e.g., urine, feces, and vomit) can get dispersed widely via such aerosolization, including the legionella bacterium responsible for causing Legionnaire’s disease, the Ebola virus, the norovirus which causes severe gastroenteritis (food poisoning), and the Middle East Respiratory Syndrome coronavirus (MERS-CoV).
Based on previous reports, such airborne dispersion is suspected to have played a key role in the outbreak of viral gastroenteritis aboard a cruise ship, where infection was twice as prevalent among passengers who used shared toilets compared to those who had private bathrooms. Similarly, transmission of norovirus via aerosolized droplets was linked to the occurrence of vomiting or diarrhea within an aircraft restroom, as passengers and crew who got infected subsequently were more likely to have visited restrooms than those that were not infected. The participants in the study reported that all of the restroom surfaces appeared to be clean, which indicates that infection is likely to have occurred via bioaerosols suspended within the restroom.
Although many of these studies blamed flush-generated aerosols for disease outbreak, a limited number of them quantified the presence of such aerosols. Consequently, we decided to conduct this study to demonstrate the spike in aerosol concentrations following flushing.
Dr. Lashaki[/caption]
Masoud Jahandar Lashaki, Ph.D.
Assistant Professor
Department of Civil, Environmental and Geomatics Engineering
Florida Atlantic University
MedicalResearch.com: What is the background for this study?
Response: Toilet flushing can generate large quantities of microbe-containing aerosols depending on the design and water pressure or flushing energy of the toilet. Based on previous reports, a variety of different pathogens which are found in stagnant water or in waste products (e.g., urine, feces, and vomit) can get dispersed widely via such aerosolization, including the legionella bacterium responsible for causing Legionnaire’s disease, the Ebola virus, the norovirus which causes severe gastroenteritis (food poisoning), and the Middle East Respiratory Syndrome coronavirus (MERS-CoV).
Based on previous reports, such airborne dispersion is suspected to have played a key role in the outbreak of viral gastroenteritis aboard a cruise ship, where infection was twice as prevalent among passengers who used shared toilets compared to those who had private bathrooms. Similarly, transmission of norovirus via aerosolized droplets was linked to the occurrence of vomiting or diarrhea within an aircraft restroom, as passengers and crew who got infected subsequently were more likely to have visited restrooms than those that were not infected. The participants in the study reported that all of the restroom surfaces appeared to be clean, which indicates that infection is likely to have occurred via bioaerosols suspended within the restroom.
Although many of these studies blamed flush-generated aerosols for disease outbreak, a limited number of them quantified the presence of such aerosols. Consequently, we decided to conduct this study to demonstrate the spike in aerosol concentrations following flushing. 
Rahul Subramanian[/caption]
Rahul Subramanian PhD candidate
Department of Ecology and Evolution
Biological Sciences Division
University of Chicago
Chicago, IL 60637
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Understanding the proportion of COVID-19 cases that become symptomatic, as well as the extent to which people without symptoms contribute to COVID-19 transmission, has important public health implications.
However, changes in PCR testing capacity over time have made these quantities hard to estimate precisely.
We used a model that incorporates daily changes in PCR testing capacity, cases, and serology to precisely estimate the proportion of cases that were symptomatic in New York City during the initial wave of the outbreak.
Only 1 in 7 to 1 in 5 cases were symptomatic.
Furthermore, non-symptomatic cases of the virus (this includes people who are either pre-symptomatic or asymptomatic) substantially contribute to community transmission, making up at least 50% of the driving force of SARS-CoV-2 infection. 
Asimanshu Das[/caption]
Asimanshu Das, Ph.D. student
Brown University School of Engineering
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: Driving in a car with ride-share or car-pool is a widely prevalent social interaction. The study aimed to address the airflows inside cars in various window open/closed configurations using computer simulations, and also looking into the possibility of movement of aerosol-type of particles from one occupant to other.
The main findings are that opening windows provides a likely benefit to reduce the potentially pathogenic aerosols inside the cabin. Generally, more windows the better, but at the least it would be advisable to have one rear side window and one frontside window open.
Dr. Profeta[/caption]
Paola Profeta, PhD
Professor of Public Economics, Department of Social and Political Sciences
Bocconi University
Director, Msc Politics and Policy Analysis, Bocconi University
Coordinator, Dondena Gender Initiative, Dondena Research Center
President, European Public Choice Society
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: We interview more than 20000 men and women in 8 OECD countries in two periods during the lockdown.
Using two waves from 8 OECD countries, we find that women are more likely to perceive the pandemic as a very serious health problem, to agree with restraining measures and to comply with public health rules, such as using facemasks. This gender differences are less strong for married individuals and for individuals who have been directly exposed to COVID, for instance by knowing someone who was infected.
Shane Riddell[/caption]
Shane Riddell MSc
CSIRO—Australian Animal Health Laboratory
Geelong, Australia
MedicalResearch.com: What is the background for this study? What are the main findings?
Response: While it is generally considered that SARS-CoV-2 is spread via aerosol and respiratory droplets, we still need to investigate how much of a role fomites play in transmission.
Understanding the risk first requires you to know how long the virus can survive on a surface. We therefore wanted to assess how long the virus would remain viable on various common surfaces such as stainless steel, glass and banknotes. We found that, under controlled conditions, we could recover infectious virus at 28 days for all non-porous surfaces at 20 degrees Celsius. When the temperature was raised to 40 degrees Celsius, SARS-CoV-2 only remained viable for 24hrs on most surfaces.
Dr. Glicksberg[/caption]
Benjamin Glicksberg, PhD
Assistant Professor of Genetics and Genomic Sciences
Member of the Mount Sinai COVID Informatics Center
Member of the Hasso Plattner Institute for Digital Healt
Icahn School of Medicine at Mount Sinai
MedicalResearch.com: What is the background for this study?
Response: Reports from health systems that detailed the clinical characteristics and outcomes of their COVID-19 patients were instrumental in helping other health systems rapidly adapt and know what to expect. There are few studies, however, that assess what happens to these patients after they were discharged from the hospital.
In our work, we address this gap by determining both how many individuals re-present to the hospital within 14 days, and what clinical characteristics of these patients differ from those who do not. Such information is critical in order to continue to refine optimal treatment plans and discharge decisions for patients of all backgrounds and clinical profiles. To provide more context to the question, we also determined if and how these factors changed between initial presentation and readmission to the hospital.
Dr. Heald-Sargent[/caption]
Taylor Heald-Sargent, M.D., Ph.D.
Ann & Robert H. Lurie Children’s Hospital
Chicago
MedicalResearch.com: What is the background for this study?
Response: Given the ongoing debate around the ability of children to transmit SARS-CoV-2, we noticed that our clinical data could address one of the prevalent assumptions. Some people postulated that the reason children have less severe infections with SARS-CoV-2 is because they are not able to replicate virus as much as adults and therefore may not transmit as readily. 
Dr. Sinha[/caption]
Pranay Sinha, MD
Research Fellow
Section of Infectious Diseases
Boston University School of Medicine
MedicalResearch.com: What is the background for this study?
Response: In the early days of the COVID-19 pandemic there were no evidence-based treatments for severely ill patients infected with this virus. We formed an interdisciplinary group of physicians from departments of adult and pediatric infectious diseases, rheumatology, and pulmonary/critical care as well as clinical pharmacy specialists. Given some promising data from China, we instituted treatment with off-label IL-6 receptor inhibitors (tocilizumab and sarilumab). The rationale was to mitigate the exuberant immune response observed in some patients infected with SARS-CoV-2 (also called cytokine storm or cytokine release syndrome).
Quite quickly, we started noticing that giving the drug to our sickest patients wasn’t eliciting dramatic improvement. We reasoned that by the time patients were severely ill and requiring ventilators, the damage to their lungs from the cytokine storm had already taken place. It was like closing the barn door after the horse had already bolted.
Prof. Garnier[/caption]
Gil Garnier PhD
Director and Professor
Bioresource Processing Research Institute of Australia (BioPRIA)
PALS ARC Industry Transformation Research Hub
Department of Chemical Engineering
Monash University
MedicalResearch.com: What is the background for this study?
Response: We wanted to develop a test that would be:
1) Reliable and fast to perform,
2) Easy and fast to manufacture,
3) Easy and fast to distribute and be adopted by the Health care community.
We also wanted to capitalize on our vast expertise and experience from developing novel blood typing tests. Our strategy was to develop a serology COVID test using the current Gel card technology available in most hospital and blood laboratories throughout the world. Equipment and expertise are already available from point of care setting to high throughput/automated systems measuring 100-200 test/ h. Also, these cards are currently produced by many companies all over and these can be shipped all international.
Dr. Ghaffari[/caption]
Abdi Ghaffari, Ph.D.
Associate Professor (adjunct)
Dept. of Pathology and Molecular Medicine
Queen’s University
MedicalResearch.com: What is the background for this study?
Response: SARS-CoV-2 virus has infected millions and changed our way of life by placing nearly 3 billion people under lockdown or some form of physical isolation. In the absence of a vaccine or reliable treatment, diagnostic testing must be a pillar of public health policy to control further spread of the virus and to guide gradual removal of lockdown measures.
COVID-19 antibody diagnostic tests are being increasingly used to assess the protective immunity status in the population. There are over 100 different COVID-19 antibody tests developed by companies worldwide in an effort to address this need. However, companies’ reported performance data are not always in line with the actual performance of these diagnostic tests in the real-world. In this work, we conducted a systemic review of independent studies (sponsored by academic or government institutions) that aimed to validate the performance of currently available COVID-19 antibody tests on the market. 
![MedicalResearch.com Interview with: Dr Herman Anne Service de Dermatologie Cliniques Universitaires Saint-Luc Avenue Hippocrate, 10 1200 Bruxelle MedicalResearch.com: What is the background for this study? Response: In the context of the COVID-19 pandemic, several cases of acro-located lesions (on foot or hands) suggestive of chilblains have been reported and were possibly related to COVID-19. We wanted to determine if chilblains, observed in many patients recently referred to our department, are indicative of COVID-19. MedicalResearch.com: Would you briefly explain what is meant by chilblains? Response: Chilblains are frequent cold induced inflammatory lesions. Chilblains are typically seen in winter and occur after repeated exposure to cold temperatures. Clinical presentation includes erythema and swelling on toes and/or digits followed by red-purple macules or patches. However, given the large number of patients affected, and the exceptionally high outdoor temperatures for the spring season over the past month and at the time of case-observation, cold-exposure seemed unlikely. These lesions were, therefore, suspected to be associated with COVID-19. However, to date, no study has proven a pathological link between these lesions and COVID-19. MedicalResearch.com: What are the main findings? Response: In our series of 31 patients who recently developed chilblains, negative nasopharyngeal swabs and the absence of anti-SARS-CoV-2 blood immunoglobulin (Ig)M and IgG antibodies in all patients included in your study suggested that these patients had not been infected with COVID-19. These lesions appeared not to be directly related to COVID-19. MedicalResearch.com: What should readers take away from your report? Response: One hypothesis points to an indirect consequence of the COVID-19 pandemic due to imposed community containment and lockdown measures. Indeed, all patients in this study had either been working from home or were home-schooled since the beginning of containment measures in Belgium (March 11, 2020) or were temporarily unemployed. As a result of containment measures, the majority (64.5%) of patients reported a decrease in their physical activity and significantly more time spent in sedentary positions in front of screens. Most of the patients declared that they remained barefoot or in socks most of the day. All these lifestyle changes can be considered as risk factors for developing chilblains. Therefore, it seems plausible that containment, through its collateral effects, may induce chilblains. Interestingly also, the mean BMI of the patients included was relatively low, suggesting that thin people may be more at risk of developing chilblains. MedicalResearch.com: What recommendations do you have for future research as a result of this work? Response: During the current pandemic, several reports have suggested a possible link between cutaneous manifestations including aural lesions such as chilblains, and COVID-19, however, only few patients were tested for SARS-CoV-2 by RT-PCR and no serologic tests were performed. Therefore, reliable testings (RT-PCR and serologic testing) are essential to confirm a potential association with COVID-19. Citation: Herman A, Peeters C, Verroken A, et al. Evaluation of Chilblains as a Manifestation of the COVID-19 Pandemic. JAMA Dermatol. Published online June 25, 2020. doi:10.1001/jamadermatol.2020.2368 https://jamanetwork.com/journals/jamadermatology/fullarticle/2767774 [subscribe] Last Modified: [last-modified] The information on MedicalResearch.com is provided for educational purposes only, and is in no way intended to diagnose, cure, or treat any medical or other condition. Always seek the advice of your physician or other qualified health and ask your doctor any questions you may have regarding a medical condition. In addition to all other limitations and disclaimers in this agreement, service provider and its third party providers disclaim any liability or loss in connection with the content provided on this website.](https://medicalresearch.com/wp-content/uploads/2020/06/chilblain-example-dermnet-nz.jpg)
Dr. Schünemann[/caption]
Holger Schünemann, MD, PhD, FRCPC
Professor of Clinical Epidemiology and of Medicine
Co-Director, WHO Collaborating Centre for Infectious Diseases,
Research Methods and Recommendations
Director, Cochrane Canada and McMaster GRADE Centre
Department of Health Research Methods, Evidence, and Impact
Canada
MedicalResearch.com: What is the background for this study?
Response: Many countries and regions have issued conflicting advice about physical distancing to reduce transmission of COVID-19, based on limited information. In addition, the questions of whether masks and eye coverings might reduce transmission of COVID-19 in the general population, and what the optimum use of masks in healthcare settings is, have been debated during the pandemic.
