I do not believe it is airborn it is touch

During March–June 2020, 14 (11%) of 123 West Virginia nursing homes experienced COVID-19 outbreaks. Compared with 1-star–rated (lowest rating) nursing homes, the odds of a COVID-19 outbreak were 87% lower among 2- to 3-star–rated facilities and 94% lower among 4- to 5-star–rated facilities.

• There was a 61% decrease in the number of respiratory specimens sent for influenza testing and a 98% decrease in test positivity during the COVID-19 pandemic period (March 1–May 16), which may indicate that COVID-19 mitigation measures can prevent influenza in the US, but the authors emphasize that influenza vaccination remains very important. More

• Denmark’s coronavirus reproduction, or “R” rate, has climbed to 1.5, meaning that every 10 people who are infected are infecting another 15, the Guardian reported. Health Minister Magnus Heunicke said restaurants, bars and cafés must close at 10 p.m. in the capital, Copenhagen. Denmark had counted 334 new infections in the past 24 hours, he told reporters.

Summary
What is already known about the topic?

Community and close contact exposures contribute to the spread of COVID-19.

What is added by this report?

Findings from a case-control investigation of symptomatic outpatients from 11 U.S. health care facilities found that close contact with persons with known COVID-19 or going to locations that offer on-site eating and drinking options were associated with COVID-19 positivity. Adults with positive SARS-CoV-2 test results were approximately twice as likely to have reported dining at a restaurant than were those with negative SARS-CoV-2 test results.

The “large” wedding, which included an indoor ceremony, reception and dance, was held on Aug. 22 in the small town of Ghent, according to a release from the state’s Southwest Health and Human Services.

“Several people in attendance at the wedding have symptoms and have tested positive for COVID-19, but it is likely many more were exposed and could be infectious,” said the Aug. 26 release, urging people who were in contact with a wedding guest who tested positive or had symptoms to quarantine for 14 days.

“If you don’t know whether you had such contact, but you were at the wedding, reception or dance at the KB’s Bar and Grill that night, you should still be very diligent about limiting interactions with people as much as possible during the 14 days after the wedding, and be very conscientious about wearing a face mask and social distancing during that time,” said the official release.

Published March 2, 2020
Updated March 6, 2020

686
Want to improve your chance of staying healthy? Stop touching your face!

One of the more difficult challenges in public health has been to teach people to wash their hands frequently and to stop touching the facial mucous membranes — the eyes, nose and mouth, all entry portals for the new coronavirus and many other germs.

“Scratching the nose, rubbing your eyes, leaning on your chin and your fingers go next to your mouth — there’s multiple ways we do it,” said Dr. Nancy C. Elder, a professor of family medicine at Oregon Health and Science University in Portland who has studied face touching among doctors and clinic staff members. “Everybody touches their face, and it’s a difficult habit to break.”

As communities prepare for the spread of coronavirus around the globe, the primary advice from health officials is for people to wash their hands. But a number of health researchers say the public health message also should include a more forceful warning about face touching.

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“The C.D.C. and W.H.O. still say something like ‘avoid' touching your eyes, nose and mouth,” said Dr. William P. Sawyer, a family physician in Sharonville, Ohio, and creator of HenrytheHand.com, which promotes hand and face hygiene. “The advice should be ‘absolutely do not touch them!’ If you never touch your facial mucous membranes, you’re less likely to be sick again from any viral respiratory infection.”

How to Stop Touching Your Face
We know it’s hard. Try these four tricks to help limit the number of times you touch your face each day to help prevent the spread of the coronavirus.
March 5, 2020

To understand why hand hygiene and face touching can make a meaningful difference during a pandemic, consider how a virus can spread. An infected person rides in an elevator, touching buttons both outside and inside the elevator or maybe sneezing during the ride. When that person leaves, microscopic droplets containing the virus stay behind. The next people who press the same buttons or touch a surface pick up the virus on their hands, then scratch their noses or rub their eyes.

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“Eyes, nose, mouth — all those mucous membranes are the portal into the body for a virus like Covid-19 or SARS,” said Mary-Louise McLaws, professor of epidemiology, health care infection and infectious diseases control at the University of New South Wales in Sydney, Australia.

“I was in a conference yesterday watching people, and in just about two minutes I counted a dozen times that I saw someone touching mucous membranes,” Dr. McLaws said. “It is a very common practice. We rub our eyes, scratch our nose, touch our mouth — the general community needs to be aware of how often they are touching their face.”

Dr. McLaws was the senior author of a 2015 study on face touching that documented the alarming number of times we do it. While medical students attended a lecture, the researchers filmed them and counted the number of times they touched any part of their faces. Over the course of an hour, students touched their faces, on average, 23 times. Nearly half of the touches were to the eyes, nose or mouth — what infectious disease researchers call “the T-zone.”

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THE LATEST Read our live coverage of the coronavirus outbreak here.
Other studies of primary care doctors, people doing office work, and students riding a simulated rail car have all found similar rates of touching the T-zone.

“I was really surprised,” Dr. McLaws said. “By touching your mucous membranes, you’re giving a virus 11 opportunities every hour if you’ve touched something infectious.”

The risk of picking up a virus by hand-to-face contact depends on a number of factors, including the type of virus, whether the surface was nonporous, how long ago the virus was left behind, how much time the infected person spent in the area and the temperature and humidity levels.

The World Health Organization notes that while we don’t know how long the new coronavirus survives on surfaces, it seems to behave like other coronaviruses — which is unsettling news. A recent study from the Journal of Hospital Infection found that similar coronaviruses have been shown to survive on surfaces for as long as nine days under ideal conditions. That’s far longer than the flu virus, which typically can survive under ideal conditions only up to 24 hours on hard surfaces. Public Health England says that, based on studies of other coronaviruses like SARS and MERS, “the risk of picking up a live virus from a contaminated surface” under real-life conditions “is likely to be reduced significantly after 72 hours.”

In general, a virus will survive the longest on nonporous surfaces made of metal and plastics — including door knobs, counters and railings. A virus will die sooner on fabrics or tissues. Once on your hand, a virus begins to lose potency, but it will probably live long enough for you to touch your face. Although more study is needed of coronavirus, in one study of rhinovirus, which causes the common cold, a small dose of virus was placed on a participant’s finger. An hour later, about 40 percent of the virus was still viable. After three hours, 16 percent could still be detected.

We also know from the 2003 epidemic of SARS, a more deadly coronavirus than the one currently spreading, that the virus was often transmitted from surface contact. In one Hong Kong hotel, an infected doctor who checked into his room on the ninth floor before going to the hospital for treatment left a trail of virus that infected at least seven people who also had rooms on the ninth floor, who then went on to spread the disease elsewhere. The doctor, who died from the infection, was later identified as a “super spreader” linked to about 4,000 cases of SARS that occurred during the epidemic.

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The good news is that frequent hand washing can make a meaningful difference in lowering your risk. During the SARS epidemic, hand-washing reduced the risk of transmission by 30 to 50 percent. But after washing your hands, you must still be mindful about face touching, Dr. Sawyer said.

“Your hands are only clean until the next surface you touch,” he said. “When you reach for the door knob or hand railing, you’ve recontaminated your hand with something. If you touch your mucous membranes, then you could inoculate yourself inadvertently with that organism. If there is one behavior change that could prevent infection, it’s do not touch your T-zone.”

But it’s not easy to stop face touching. In fact, many people say that the more they think about it, the more their eyes twitch and their nose itches. A number of memes have emerged on social media from people who say that ever since the warnings about coronavirus, they can’t stop touching their own faces.


Only humans and a few primates (gorillas, orangutans and chimpanzees) are known to touch their faces with little or no awareness of the habit. (Most animals touch their faces only to groom or swat away a pest.) German researchers analyzed the brain’s electrical activity before and after spontaneous face touching, and their findings suggested that we touch our faces as a way to relieve stress and manage our emotions.

To break the face-touching habit, try using a tissue if you need to scratch your nose or rub your eyes. Wearing makeup may reduce face touching, since it may make you more mindful of not smudging it. One study found that women touched their faces far less when they wore makeup. Another solution: Try to identify triggers for face touching, like dry skin or itchy eyes, and use moisturizers or eye drops to treat those conditions so you are less likely to rub or scratch your face.

It also may help to wear glasses to create a barrier to touching your eyes. Gloves or mittens can also make you more mindful of not touching your face (and can make it more difficult to put your finger in your nose or your eye). Although gloves, too, can become contaminated, viruses don’t live as long on fabric or leather.

Given that face touching is a long-ingrained habit, it makes sense to remain vigilant about frequent hand washing and wipe down your desk, phones and community surfaces. Carry hand sanitizer and use it often. The more mindful you are about regular hand washing, the more mindful you will be about your hands and what they are touching.

Dr. Chudnovsky, a theoretical physicist whose research has focused on the spread of the airborne infection, said a similar pattern is likely to be true for the new coronavirus, but the exact numbers are not known.

“I believe the C.D.C. is right when it says that surface transmission is not a dominant one,” said Dr. Chudnovsky. “Surfaces frequently touched by a large number of people, like door handles, elevator buttons, etc., may play a more significant role in spreading the infection than objects touched incidentally, like food packages delivered to homes.”

On January 22, the mall was shut down. During January 19–February 9, COVID-19 was diagnosed for 7 mall staff from floors B1–3 and for 10 mall customers. Close contacts associated with the mall were traced, and COVID-19 was confirmed for 11 persons. Sixteen patients had had direct contact with other patients or had gone shopping in the mall. The average incubation period was 7.3 (range 1–17) days.

Thumbnail of Cluster of COVID-19 cases associated with a shopping mall in Wenzhou, China. A) Distribution of COVID-19 case-patients by mall floor, time, and internal relationship. B) Dates of symptom onset, confirmed test results, and hospitalization information. Numbers within yellow bars indicate length of incubation period. Black vertical arrow indicates date when patient A returned from Wuhan, China. B1–7, mall floors; C, customer; COVID-19, coronavirus disease; Ct, cycle threshold; T, date
Figure. Cluster of COVID-19 cases associated with a shopping mall in Wenzhou, China. A) Distribution of COVID-19 case-patients by mall floor, time, and internal relationship. B) Dates of symptom onset, confirmed test...

The mall has 8 floors above ground and several basement levels; floors B1 to 6 are commercial shopping space, and floor 7 contains shopping and office space. We created an illustration showing the floors where the eventual COVID-19 case-patients worked or shopped, along with dates of symptom onset, potential incubation periods, symptom durations, confirmed times of positive diagnosis, and times of discharge (Figure, panel A).

Except for those who had been on floor 7, all other case-patients denied direct close contact with other case-patients. The possibility of customers being infected from other sources cannot be excluded. However, most customers reported early symptom onset in a concentrated time frame (Figure, panel B). We found no convincing evidence of definitive transmission pathways in this building. Patients A–G (Figure, panel A) worked in the same room on floor 7. Other case-patients who had been on other floors denied any direct contact with confirmed patients from floor 7, but they shared common building facilities (e.g., restrooms, elevators). Also, staff from floor 7 visited shops on other floors daily.

Until now, no evidence has shown that SARS-CoV-2 can survive outside the body for long. However, Middle East respiratory syndrome coronavirus demonstrates high robustness and a strong capability to survive outside the body and can remain infectious for up to 60 minutes after aerosolization (4). Hence, the rapid spread of SARS-CoV-2 in our study could have resulted from spread via fomites (e.g., elevator buttons or restroom taps) or virus aerosolization in a confined public space (e.g., restrooms or elevators). All case-patients other than those on floor 7 were female, including a restroom cleaner, so common restroom use could have been the infection source. For case-patients who were customers in the shopping mall but did not report using the restroom, the source of infection could have been the elevators. The Guangzhou Center for Disease Control and Prevention detected the nucleic acid of SARS-CoV-2 on a doorknob at a patient’s house (5), but Wenzhou Center for Disease Control and Prevention test results for an environmental sample from the surface of a mall elevator wall and button were negative.


We cannot exclude the possibility of unknown infected persons (e.g., asymptomatic carriers) spreading the virus. However, according to screening protocols implemented by the Wenzhou Center for Disease Control and Prevention, we traced all close contacts and included all patients with positive PCR results, including the asymptomatic carrier (patient A), in this study. Our findings appear to indicate that low intensity transmission occurred without prolonged close contact in this mall; that is, the virus spread by indirect transmission.

date 2007
Abstract
From 1999 – 2003, the hygiene of 1061 environmental surfaces from shopping, daycare, and office environments, personal items, and miscellaneous activities (i.e., gymnasiums, airports, movie theaters, restaurants, etc.), in four US cities, was monitored. Samples were analyzed for fecal and total coliform bacteria, protein, and biochemical markers. Biochemical markers, i.e., hemoglobin (blood marker), amylase (mucus, saliva, sweat, and urine marker), and urea (urine and sweat marker) were detected on 3% (26/801); 15% (120/801), and 6% (48/801) of the surfaces, respectively. Protein (general hygiene marker) levels ⩾ 200 μg/10 cm2 were present on 26% (200/801) of the surfaces tested. Surfaces from children's playground equipment and daycare centers were the most frequently contaminated (biochemical markers on 36%; 15/42 and 46%; 25/54, respectively). Surfaces from the shopping, miscellaneous activities, and office environments were positive for biochemical markers with a frequency of 21% (69/333), 21% (66/308), and 11% (12/105), respectively). Sixty samples were analyzed for biochemical markers and bacteria. Total and fecal coliforms were detected on 20% (12/60) and 7% (4/60) of the surfaces, respectively. Half and one-third of the sites positive for biochemical markers were also positive for total and fecal coliforms, respectively. Artificial contamination of public surfaces with an invisible fluorescent tracer showed that contamination from outside surfaces was transferred to 86% (30/35) of exposed individual's hands and 82% (29/35) tracked the tracer to their home or personal belongings hours later. Results provide information on the relative hygiene of commonly encountered public surfaces and aid in the identification of priority environments where contaminant occurrence and risk of exposure may be greatest. Children's playground equipment is identified as a priority surface for additional research on the occurrence of and potential exposure to infectious disease causing agents.

While the high attack rate and the distribution of cases on bus
2 is consistent with airborne transmission, there is no way to
rule out a common surface, such as a pole, because of possible insufficient recall. However, given that there were participants with infection sitting in the last row, airborne transmission is likely to be a partial transmission route.

Some 300 people attended the temple ceremony, but only 128 made the 50-minute trip by bus. One bus carried 68 passengers, including the individual who was infected, while the second bus carried 60 people. None of the worshipers wore masks.

The paper in JAMA Internal Medicine does not describe the infected individual and says the person did not have symptoms until the after returning from the temple. But a version of the study published in China says the individual was a 64-year-old woman and that she developed symptoms on Jan. 18, a day after dining with guests from Hubei and a day before going to the temple. She took medicine but did not see a doctor.


“The Chinese paper says the index case was unwell the day before going to the temple, so she was probably very infectious, because we know that viral load is really high around the time of symptom onset,” Dr. Cevik said.

The outdoor ceremony lasted two and a half hours and was followed by a brief lunch, which took place in a spacious room that did not have recirculating air-conditioning. When the passengers returned to their buses, they took the same seats they had occupied earlier.

In addition to the passengers who became infected, another seven individuals who attended the ceremony were infected. They did not travel by bus, but said they had been in close contact with the infected passenger.

Classification 117 and 2.18 Two different approaches to define high-risk and
low-risk COVID-19 zones are indicated: zone 1 (high-risk zone) and zone 2
(low-risk zones). Severity levels of cases were indicated. Windows are indicated
with ovals, and there are 4 green side windows and that could be opened for
fresh air. C indicates case; NC, noncase.

• Bae et al. report a single incidence of possible transmission of COVID-19 during an evacuation flight from Italy to South Korea. After airport screening, 299 asymptomatic passengers took an 11-hour flight to South Korea, during which most of them wore N95 respirators at all times. They were tested for SARS-CoV-2 by RT-PCR on days 1 and 14 during their subsequent quarantine period.
• Six passengers tested positive when the plane arrived in South Korea. One patient tested positive on day 14. She reported wearing an N95 mask at all times on the flight except for when she used a toilet. She was seated three rows away from one of the patients who tested positive on day 1 and used the same toilet during the flight.
• All 18 members of the cabin crew and medical staff tested negative at both day 1 and day 14 of quarantine after the flight.

Research from the Swinburne University of Technology  in Australia studied the amount and type of bacteria on personal faculty keyboards and shared keyboards and other surfaces around the university. They found that keyboards can have high levels of bacteria on them and that shared keyboards tend to have more bacteria than those used by only one person.[1]

Even more disturbing, research by University of Arizona researchers also found that the average desktop has 400 times more bacteria than the average toilet seat. That study took samples from offices across the United States, and also showed that women’s desks tended to harbor more bacteria than men’s.

A study at Chicago’s Northwestern Memorial Hospital found that two deadly drug-resistant types of bacteria (vancomycin-resistant Enterococcus faecium (VRE) and methicillin-resistant Staphylococcus aureus (MRSA)) could survive for up to 24 hours on a keyboard, while another common but less deadly bug (Pseudomonas aeruginosa) could survive for an hour.[2]

How Do Bacteria Get on Your Desk and Keyboard?
Most of the bacteria found by researchers are types that tend to live on people, usually in our skin and in our mouths and nasal passages. So it is likely that most of the bacteria came from our hands.

Although many of these bacteria won’t hurt you unless your immune system is weak because of another illness, it could still cause an infection in you have a cut on your fingers (even a tiny one you can’t see).It is still wise to be careful, especially if you are sharing a computer with other people. For example, if the person who used the keyboard before you was coming down with the flu, it is possible that you could catch the flu from using the keyboard afterwards.

A good precaution is to wash your hands before and after using a shared computer, telephone or other equipment and to encourage others to do the same. It is not a good idea, either, to eat at your computer, especially if you share it with others. When you eat and then type, you are probably transmitting bacteria from your mouth to the keyboard (not to mention getting crumbs everywhere).

Introduction
This case series assessed a commercial airline flight from Tel Aviv, Israel, to Frankfurt, Germany, that occurred on March 9th, 2020. Among 102 passengers on a Boeing 737-900 aircraft were 24 members of a tourist group. Starting 7 days earlier, the group had contact with a hotel manager who later received a diagnosis of coronavirus disease 2019 (COVID-19). No member of the group had received a diagnosis of COVID-19 before the flight, and no measures to prevent transmission (eg, wearing of masks) had been applied. The flight duration was 4 hours 40 minutes.

Results
Of the 24 members of the tourist group, 7 tested positive for SARS-CoV-2 RNA in a throat swab sample on arrival. Four of the 7 were symptomatic during the flight, 2 were presymptomatic, and 1 remained asymptomatic (Figure 1).

A total of 71 of the other 78 passengers (91%) who had been exposed to the group on the flight completed the interview. Serum samples were obtained from 13 of these individuals 6 to 9 weeks after the flight (Figure 2). One reported having tested positive by polymerase chain reaction 4 days after the flight. This passenger did not recall any symptoms. We detected SARS-CoV-2 IgG 7 weeks after the flight, and the PRNT result was also positive. The passenger negated contact with patients with COVID-19 before or after the flight.

Seven other passengers reported having had symptoms suggestive of COVID-19 within 14 days after the flight. One had a headache, muscle ache, and hoarseness starting 5 days after the flight. This passenger had not been tested and negated known contact with a patients with COVID-19. The passenger was in quarantine for 14 days starting 1 day after the flight. We obtained a serum sample 9 weeks after the flight and detected SARS-CoV-2 IgG. The PRNT had a borderline result.

We also obtained serum samples from 6 other symptomatic and 5 asymptomatic passengers 6 to 9 weeks after the flight. All tested negative except for 1, who had a borderline result on the SARS-CoV-2 IgG test but had a negative result on the PRNT. SARS-CoV-2 transmission during the flight was not excluded for 1 symptomatic passenger with previous contact with a patients with COVID-19 and 46 asymptomatic passengers who were not tested.

The latest new cases were reported to be within one family in South Auckland, including an individual in their 50s. They have no history of international travel. Family members have been tested and contact tracing is underway, New Zealand's Director-General of Health Ashley Bloomfield confirmed Tuesday.

Imported frozen foods may have caused New Zealand's new coronavirus outbreak. But it's very rare to get sick from such packages.

As I walked around the sun-dappled streets of Amsterdam, something felt strange in this world swept by fear and pandemic. There was laughter coming from barges sliding along the famous canals, clusters of cyclists clogged the streets, shoppers dipped into chic boutiques, the barber shops seemed busy and cafes served couples chatting over coffee.

I heard many voices of tourists in bars and restaurants, while even the seedier sides of this celebrated Dutch city had people strolling through them. It took me a moment to realise what was so weird. Then it struck me. It felt like I had stepped back in time, returning to the pre-pandemic normality of a bustling city filled with human beings whose faces were not covered by cloth.

For while 120 countries in the world, including much of Europe, have ordered citizens to wear masks in public places to prevent the spread of Covid-19, the Dutch are doing things differently.

The nation's top scientists, having examined key data and research, have declared there is no firm evidence to back the use of face coverings. Indeed, they argue that wearing the wretched things may actually hamper the fight against disease.

While 120 countries in the world ordered citizens to wear masks in public places to prevent the spread of Covid-19, the Dutch are doing things differently. Pictured, people enjoying a drink in Amsterdam +3
While 120 countries in the world ordered citizens to wear masks in public places to prevent the spread of Covid-19, the Dutch are doing things differently. Pictured, people enjoying a drink in Amsterdam

'Face masks in public places are not necessary, based on all the current evidence,' said Coen Berends, spokesman for the National Institute for Public Health and the Environment. 'There is no benefit and there may even be negative impact.'

This is a bold but highly controversial stance – especially as fears grow of a second wave sweeping through Europe. Last week, Downing Street joined the global stampede to enforce face masks in public spaces such as shops, supermarkets and stations, following Scotland, Spain and France, along with Holland's neighbouring nations of Belgium and Germany.

'We think masks have a great deal of value,' said Boris Johnson. 'Scientific evaluation of face coverings and their importance in stopping aerosol droplets has been growing. People should wear them in shops.'

But the Dutch disagree – to the delight of all the citizens I spoke with in Amsterdam. 'I hate wearing them,' said Aicha Meziati, 29, in the hip fashion store Das Werk Haus. 'They are horrible. People look like they have nappies on their faces.'

Margriet, a 24-year-old sales assistant in a pop-up drink shop, said it was hard to read people's facial expressions when they wore masks. 'You make contact with people better without them and it is easier to talk to them in the store.'


Visitors to Amsterdam's red light district must now wear...

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Holland's position is based on assessments by the Outbreak Management Team, a group of experts advising the government. It first ruled against masks in May and has re-evaluated the evidence several times, including again last week.

It believes they detract from a clear three-pronged message that has kept deaths from coronavirus down to less than half the rate in Britain: wash hands regularly, maintain social distancing of 1.5 metres and stay at home if suffering any symptoms.

The one exception outside of the medical frontline has been on public transport, where masks are mandatory on the basis it is difficult to stay apart on crowded buses, ferries and trains. 'We have seen this approach works,' said Christian Hoebe, a professor of infectious diseases in Maastricht and member of the advisory team. 'Face masks should not be seen as a magic bullet that halts the spread.

'The evidence for them is contradictory. In general, we think you must be careful with face masks because they can give a false sense of security. People think they're immune from disease or stop social distancing. That is very negative.'

Hoebe, head of infectious disease control in Zuid-Limburg, the region hit hardest when the pandemic struck Holland, pointed to a Norwegian study showing 200,000 people must wear surgical masks for one week to stop a single Covid-19 case.

Holland's top scientists, having examined key data and research, have declared there is no firm evidence to back the use of face coverings. Pictured, day trippers and tourists walk in Amsterdam on July 25 +3
Holland's top scientists, having examined key data and research, have declared there is no firm evidence to back the use of face coverings. Pictured, day trippers and tourists walk in Amsterdam on July 25

Yet few people have medical masks – in Britain they are rightly preserved for the NHS – while wearers routinely misuse or contaminate their coverings by fitting them incorrectly, failing to change them and touching their faces.

'I was in Belgium recently and saw many people putting them beneath their noses, upside down or under chins', says Hoebe. 'Others stuffed them in their pockets. The effectiveness also depends on the right fabric and the mask being worn very close to the nose.'

Studies by one membrane specialist at Eindhoven University found that while the coronavirus particles are caught by an electrostatic layer in medical masks, they can penetrate bigger pores found in cotton and even vacuum cleaner bags.

The World Health Organisation has also been sceptical, warning that 'widespread use of masks by healthy people in the community setting is not yet supported by high-quality or direct scientific evidence'.

Although changing its advice in June to back the encouragement of mask wearing in some settings, the WHO lists 11 'potential harms' that range from discomfort through to self-contamination and lower compliance with more critical preventative measures.

As in some other European countries, Holland has seen an alarming recent rise in reported infections, which have almost doubled to 1,329 cases over the past two weeks, combined with marginally higher rates of hospitalisation and fatality.

Yet the cabinet's advisory team says this was driven by clusters of people infecting each other at family gatherings and parties, where they would not have worn masks regardless of any changes to rules about public spaces.

Another outbreak came from a bar in Hillegom, near Amsterdam, where the owners told customers they could sit close together, shake hands and hug since the virus was dormant. 'We know what we are doing,' they wrote on Facebook. They were quickly proved wrong, however, after 39 cases were traced to the bar. It has since been closed and the social media post removed.

Holland, a country of 17 million people, has seen 6,147 pandemic deaths after adopting what it called 'intelligent lockdown', which imposed significantly fewer restrictions than Britain and relied more on trusting citizens to behave sensibly.

Although two recent polls claim a majority backing use of face masks for indoor public spaces, I found people on Amsterdam's busy shopping streets supported their government's stand and seemed very aware of the simple rules.

Holland, a country of 17 million people, has seen 6,147 pandemic deaths after adopting what it called 'intelligent lockdown'. Pictured, tourists on the Nieuwendijk in Amsterdam on July 23 +3
Holland, a country of 17 million people, has seen 6,147 pandemic deaths after adopting what it called 'intelligent lockdown'. Pictured, tourists on the Nieuwendijk in Amsterdam on July 23

'I like it when people can decide for themselves,' said Jesus Garcia, wielding the clippers in Barbershop Jordaan filled with mask-free staff and customers. 'You would have to really educate people how to use them properly for safety.'

He said he had worn masks during a trip to Spain. 'I did not feel it was really helping since people were wearing them all wrong, putting them in their pockets, placing them under their noses. It defeats the purpose.' One customer having a trim agreed. 'I find face masks absolutely awful. They're claustrophobic and don't work,' said Mark Casey, corporate finance partner at a major accountancy firm.

Coriem Warmenhoven, serving in a flower shop, said she was glad they did not have to wear masks. 'I'm afraid it will become necessary,' she said. 'We must deal with the virus but it is best to be intelligent and give people responsibility.'

She is right to be nervous. The mayors of Amsterdam and Rotterdam, the nation's two biggest cities, have been pressing for more power to impose mask-wearing in crowded areas, which was granted last week. Amsterdam mayor Femke Halsema, alarmed by throngs of tourists and young people making parts of her city too crowded, is insisting on compulsory masks for anyone aged over 13 in the Red Light District and two popular shopping streets.

Warmenhoven told me she was going to holiday in Holland after discussing with her husband where to go. 'He said he didn't want to go anywhere abroad that you have to wear masks,' she said. This bears out the hunch of the Netherlands Board of Tourism and Conventions, which has commissioned research to find out if their country has an edge in the struggle to entice dwindling numbers of tourists.

Ben Coates, the author of Why The Dutch Are Different, who lives in central Holland, said the speed with which normal life had returned in the country was remarkable.

'When you walk around, you are hard-pressed to see much difference now,' he said.

He added that while Dutch citizens tended to trust their governments, they also had strong libertarian instincts. 'People don't like being told what to do, so they will cycle without helmets and sleep with whom they want.'

The one family I found wandering along the canals clad in face masks turned out to be holidaying Italians from near Milan. 'We have been wearing them all the time for five months, so they don't feel uncomfortable any more,' said Michaele Muller. He added that they had been astonished when they arrived in Holland. 'We drove through Switzerland, where everyone has a mask, then in Germany, where it is also mandatory. Then we crossed the border and suddenly no one was wearing them.'

Later, I came across a British accent belonging to a scientist who had just moved from Milton Keynes to a new job in the city. 'It feels very different from the UK,' said Jenny White. 'It feels much more normal here. You can almost forget about the disease.'

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Five months after the coronavirus outbreak engulfed New York City, riders are still staying away from public transportation in enormous numbers, often because they are concerned that sharing enclosed places with strangers is simply too dangerous.

But the picture emerging in major cities across the world suggests that public transportation may not be as risky as nervous New Yorkers believe.

In countries where the pandemic has ebbed, ridership has rebounded in far greater numbers than in New York City — yet there have been no notable superspreader events linked to mass transit, according to a survey of transportation agencies conducted by The New York Times.

Those findings could be evidence that subways, commuter railways and buses may not be a significant source of transmission, as long as riders wear masks and train cars or buses never become as intensely crowded as they did in pre-pandemic rush hours.

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If the risks of mass transit can be addressed, that could have sweeping implications for many large American cities, particularly New York, where one of the biggest challenges in a recovery will be coaxing riders back onto subways, buses and suburban trains — a vast system that is the backbone of the region’s economy. When the city shut down in March, over 90 percent of the subway’s 5.5 million weekday riders abandoned the system. Even now, as the city has largely contained the virus and reopened some businesses, ridership is still just 20 percent of pre-pandemic levels, adding to the financial strain of New York’s transit agency, which relies on fare revenue for 40 percent of its operating budget.

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“What we are seeing in other cities makes me optimistic,” said Toph Allen, an epidemiologist who co-wrote a report on coronavirus transmission and public transportation with the Tri-State Transportation Campaign, a transit advocacy group. “If you know that you have a transit system that is functioning in an area where there are no major outbreaks, you know transit can be safe.”

In Paris, public health authorities conducting contact tracing found that none of the 386 infection clusters identified between early May and mid-July were linked to the city’s public transportation.

A study of coronavirus clusters in April and May in Austria did not tie any to public transit. And in Tokyo, where public health authorities have aggressively traced virus clusters, none have been linked to the city’s famously crowded rail lines.

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But public health experts warn that the evidence so far should be considered with caution. Ridership in other major cities is still well below pre-pandemic levels, tracing clusters directly to public transit is difficult, the quality of ventilation systems used to filter air varies, and the level of threat depends to a high degree on how well a city has reduced its overall infection rate.

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“There are so many other factors that go into levels of risk and how you assess risk,” said Dr. Michael Reid, an assistant professor at the University of California, San Francisco School of Medicine and a contact-tracing expert. “They are not equal comparisons.”

In fact, state and city officials have been unable to determine whether mass transit in New York contributed to the surge in March and April that devastated the city, killing more than 20,000 people.

The outbreak has exacted an especially devastating toll on transit workers. To date, over 4,000 have tested positive and 131 workers have died from the virus — nearly 90 percent of whom worked for the division that runs the city’s subways and buses.

For much of that time, riders were not required to wear masks, and the infection rate in the city was much higher than it is today, likely making public transportation a riskier venue. (One study at M.I.T. purported to show that the subway was a superspreader early in the pandemic, but its methodology was widely disputed.)

Still, some public health experts believe the experiences of other cities offer a blueprint for how to minimize the potential for transmission on public transit systems.

Among the range of urban activities, the experts say, riding the subway is probably riskier than walking outdoors but safer than indoor dining.

Abstract
The novel severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) originated in Wuhan, China in late 2019, and its resulting coronavirus disease, COVID-19, was declared a pandemic by the World Health Organization on March 11, 2020. The rapid global spread of COVID-19 represents perhaps the most significant public health emergency in a century. As the pandemic progressed, a continued paucity of evidence on routes of SARS-CoV-2 transmission has resulted in shifting infection prevention and control guidelines between classically-defined airborne and droplet precautions. During the initial isolation of 13 individuals with COVID-19 at the University of Nebraska Medical Center, we collected air and surface samples to examine viral shedding from isolated individuals. We detected viral contamination among all samples, supporting the use of airborne isolation precautions when caring for COVID-19 patients.

Conclusions
This cross-sectional study found that mandatory mask-wearing policies increased the mask-wearing rate among the general population during the COVID-19 pandemic. Wearing either a medical or fabric mask was associated with reduced face-touching behaviors, which might prevent transmission of COVID-19 among the general population in public areas.

Limited data are available about transmission of SARS-CoV-2, the virus that causes coronavirus disease 2019 (COVID-19), among youths. During June 17–20, an overnight camp in Georgia (camp A) held orientation for 138 trainees and 120 staff members; staff members remained for the first camp session, scheduled during June 21–27, and were joined by 363 campers and three senior staff members on June 21. Camp A adhered to the measures in Georgia’s Executive Order* that allowed overnight camps to operate beginning on May 31, including requiring all trainees, staff members, and campers to provide documentation of a negative viral SARS-CoV-2 test ≤12 days before arriving. Camp A adopted most† components of CDC’s Suggestions for Youth and Summer Camps§ to minimize the risk for SARS-CoV-2 introduction and transmission. Measures not implemented were cloth masks for campers and opening windows and doors for increased ventilation in buildings. Cloth masks were required for staff members. Camp attendees were cohorted by cabin and engaged in a variety of indoor and outdoor activities, including daily vigorous singing and cheering. On June 23, a teenage staff member left camp A after developing chills the previous evening. The staff member was tested and reported a positive test result for SARS-CoV-2 the following day (June 24). Camp A officials began sending campers home on June 24 and closed the camp on June 27. On June 25, the Georgia Department of Public Health (DPH) was notified and initiated an investigation. DPH recommended that all attendees be tested and self-quarantine, and isolate if they had a positive test result.

Attack rates increased with increasing length of time spent at the camp, with staff members having the highest attack rate (56%).

Abstract
Background
Train is a common mode of public transport across the globe; however, the risk of COVID-19 transmission among individual train passengers remains unclear.

Methods
We quantified the transmission risk of COVID-19 on high-speed train passengers using data from 2,334 index patients and 72,093 close contacts who had co-travel times of 0–8 hours from 19 December 2019 through 6 March 2020 in China. We analysed the spatial and temporal distribution of COVID-19 transmission among train passengers to elucidate the associations between infection, spatial distance, and co-travel time.

Results
The attack rate in train passengers on seats within a distance of 3 rows and 5 columns of the index patient varied from 0 to 10.3% (95% confidence interval [CI] 5.3% – 19.0%), with a mean of 0.32% (95%CI 0.29% – 0.37%). Passengers in seats on the same row as the index patient had an average attack rate of 1.5% (95%CI 1.3% – 1.8%), higher than that in other rows (0.14%, 95%CI 0.11% – 0.17%), with a relative risk (RR) of 11.2 (95%CI 8.6 –14.6). Travellers adjacent to the index patient had the highest attack rate (3.5%, 95%CI 2.9% – 4.3%) of COVID-19 infections (RR 18.0, 95%CI 13.9 – 23.4) among all seats. The attack rate decreased with increasing distance, but it increased with increasing co-travel time. The attack rate increased on average by 0.15% (p = 0.005) per hour of co-travel; for passengers at adjacent seats, this increase was 1.3% (p = 0.008), the highest among all seats considered.

Conclusions
COVID-19 has a high transmission risk among train passengers, but this risk shows significant differences with co-travel time and seat location. During disease outbreaks, when travelling on public transportation in confined spaces such as trains, measures should be taken to reduce the risk of transmission, including increasing seat distance, reducing passenger density, and use of personal hygiene protection.

Masks are distributed at some construction sites, but not many. Both knowledge about how to use these masks and especially the number available, are very insufficient. No other precautions are taken,” says Dr. Ercan Duman, a member of the Occupational Health and Workplace Medicine Commission of the Istanbul Chamber of Physicians. A recent report by the Confederation of Progressive Trade Unions of Turkey (DİSK), which includes Dev-Yapı-İş, indicates that DİSK members have tested positive for COVID-19 at a rate three times higher than the average rate per 1000 people tested among the general public in Turkey.

Equally worrisome is the fact that our projections put the direct exposure of each
individual in the frontline of the factors pushing the infection progress towards the
worst-case scenarios. These results deal directly with the rate at which citizens are
exposed to the virus. The use of personal protective equipment (PPE), such as surgical
or fabric-made masks, face shields, and hand sanitizers like alcohol-based solutions and
antiseptic products has been strongly recommended to the general public (WHO, 2020).
However, this strategy creates a debate. On one hand, the willingness of people to be
protected whenever performing any outside activity, or for those who work with
essential services and are frequently at moderate to high exposure risks (Bourouiba,
2020). On the other hand, the rational use of this equipment, once the global demand
has grown nearly as exponential as the outbreak itself (Feng et al., 2020).
So far, the most effective action seems to be imposing and encouraging the
rational use of masks and the offer of hygiene items by decree or other legal
dispositions. However, although most of these policies have been adopted in several
countries (e.g. Japan, UK, Singapore, and Germany), there is not enough evidence for
the real effectiveness of wearing masks alone or in combination with washing hands
frequently in preventing the contact- or aerosol-based transmission of SARS-CoV-2
(Feng et al., 2020; Y. Liu et al., 2020; Rothan and Byrareddy, 2020). Besides, the
incorrect use of PPE is thought to be worse than not using at all, as well as exaggerated
acquisition and overpricing of PPE could be similarly adverse. In this sense, we
particularly recommend that people should use PPE adequately, especially when there is
potential to spread or get in contact with droplets in the air. Nevertheless, we underline
that social distancing protocols seem considerably more effective.

The contact network is represented by the number of individuals (N; i.e.,
circles/nodes) as well as by their interactions (i.e., edges/links), whenever an
opportunity for transmission arises (Fig. S1). Theoretically, we assume that the
interaction between two nodes occurs whenever there is potential contact between
individuals (e.g., hugs, handshakes, or airdrops), or individuals may interact with
previously infected objects (e.g., doorknobs, handrails, and elevator panels). Thus, these
opportunities serve as windows for the spread of the virus from an already infected
individual to a new potential host.

Many of these same characteristics have previously been demonstrated for influenza and other common respiratory viruses. These data provide a useful theoretical framework for possible aerosol-based transmission for SARS-CoV-2, but what is less clear is the extent to which these characteristics lead to infections. Demonstrating that speaking and coughing can generate aerosols or that it is possible to recover viral RNA from air does not prove aerosol-based transmission; infection depends as well on the route of exposure, the size of inoculum, the duration of exposure, and host defenses.

Notwithstanding the experimental data suggesting the possibility of aerosol-based transmission, the data on infection rates and transmissions in populations during normal daily life are difficult to reconcile with long-range aerosol-based transmission. First, the reproduction number for COVID-19 before measures were taken to mitigate its spread was estimated to be about 2.5, meaning that each person with COVID-19 infected an average of 2 to 3 other people. This reproduction number is similar to influenza and quite different from that of viruses that are well known to spread via aerosols such as measles, which has a reproduction number closer to 18. Considering that most people with COVID-19 are contagious for about 1 week, a reproduction number of 2 to 3 is quite small given the large number of interactions, crowds, and personal contacts that most people have under normal circumstances within a 7-day period. Either the amount of SARS-CoV-2 required to cause infection is much larger than measles or aerosols are not the dominant mode of transmission.

Similarly, the secondary attack rate for SARS-CoV-2 is low. Case series that have evaluated close contacts of patients with confirmed COVID-19 have reported that only about 5% of contacts become infected. However, even this low attack rate is not spread evenly among close contacts but varies depending on the duration and intensity of contact. The risk is highest among household members, in whom transmission rates range between 10% and 40%.2-4 Close but less sustained contact such as sharing a meal is associated with a secondary attack rate of about 7%, whereas passing interactions among people shopping is associated with a secondary attack rate of 0.6%.4

• A contact investigation for an early confirmed COVID-19 case from Washington State identified 50 contacts, none of whom had evidence of SARS-CoV-2 infection through 6 weeks of follow-up. All contacts were monitored daily for 14 days following exposure. Eight developed symptoms but tested negative via rRT-PCR. Thirty-eight contacts underwent voluntary enhanced contact investigation, revealing varying degrees of unprotected face-to-face interactions with the case-patient. Negative rRT-PCR and serologic follow-up collected approximately 6 weeks post exposure suggest no evidence of secondary transmission.

Chu et al. (May 29, 2020). Investigation and Serologic Follow-Up of Contacts of Early Confirmed Case-Patient with COVID-19, United States. Emerging Infectious Diseases. https://doi.org/10.3201/eid2608.201423

• [Pre-print, not peer reviewed] An observational study of shoppers (n=5,517) entering 36 different grocery and retail locations across southeastern Wisconsin (June 3-9, 2020) found that the likelihood of an individual wearing a mask was associated with older age, being female, and shopping in an urban location. Fewer than 50% of individuals observed were wearing a mask.

Haischer et al. (July 14, 2020). Who Is Wearing a Mask Gender- Age- and Location-Related Differences during the COVID-19 Pandemic. Pre-print downloaded July 14 from https://doi.org/10.1101/2020.07.13.20152736

We conducted large-scale testing for active case-finding among persons who had visited the Itaewon nightclubs. Patients’ cell phone numbers were checked on site before testing. Demographic data were obtained by contacting those who tested positive. Of the 41,612 total tests conducted by May 25, a total of 35,827 (86.1%) were conducted on Itaewon nightclub visitors, 5,785 (13.9%) on contacts of case-patients linked to the Itaewon nightclubs, and 1,627 (3.9%) tests conducted on anonymous persons. The prevalence of positive results for COVID-19 in nightclub visitors was 0.19% (67/35,827); in their contacts, 0.88% (51/5,785); and in anonymously tested persons, 0.06% (1/1,627).

Shrestha et al. examined SARS-CoV-2 viral load over time among 230 health care personnel with COVID-19 who did not require hospitalization. Viral loads in the upper respiratory specimens (n=528) peaked by 2 or 3 days from symptom onset and decreased rapidly thereafter, with >85% of the area under the curve occurring in the first five days.

Zhou et al. collected air and surface samples from seven clinical areas occupied by COVID-19 patients, as well as one public area of a London hospital. Overall, viral RNA was detected on 52% (114/218) of surfaces and 39% (14/31) of air samples, but no virus was cultured. Viral RNA was more likely to be found in areas immediately occupied by COVID-19 patients than in other areas (64% vs. 45%). These findings suggest there is a high risk of environmental contamination with viral RNA within health care settings, though the implications for infectious virus are less clear.
Zhou et al. (July 8, 2020). Investigating SARS-CoV-2 Surface and Air Contamination in an Acute Healthcare Setting during the Peak of the COVID-19 Pandemic in London. Clinical Infectious Diseases. https://doi.org/10.1093/cid/ciaa905

As of May 25, 246 COVID-19 cases have been linked to an outbreak at a nightclub in Seoul, South Korea. Nightclubs in South Korea that had been closed previously as part of the social distancing policy re-opened on April 30, ahead of the April 30–May 5 Golden Week holiday. Through large scale contact tracing, Kang et al. tested 41,612 nightclub visitors and their contacts, of whom 0.6% were positive: 96 (39%) of SARS-CoV-2 positive persons were primary cases and 150 (61%) were secondary contacts. This suggests that superspreading events related to nightclubs have the potential to spark a resurgence of cases in South Korea.

The coronavirus is finding new victims worldwide, in bars and restaurants, offices, markets and casinos, giving rise to frightening clusters of infection that increasingly confirm what many scientists have been saying for months: The virus lingers in the air indoors, infecting those nearby.

......

Dr. Benedetta Allegranzi, the WHO’s technical lead on infection control, said the evidence for the virus spreading by air was unconvincing.

“Especially in the last couple of months, we have been stating several times that we consider airborne transmission as possible but certainly not supported by solid or even clear evidence,” she said. “There is a strong debate on this.”.....

...

“There is no incontrovertible proof that SARS-CoV-2 travels or is transmitted significantly by aerosols, but there is absolutely no evidence that it’s not,” said Dr. Trish Greenhalgh, a primary care doctor at the University of Oxford in Britain.

A preprint (not yet published) study led by Santarpia and his colleagues similarly found evidence of viral contamination in air samples and surfaces from rooms where COVID-19 patients were being kept in isolation. “I think there are a lot of us—myself included—who feel very strongly that the airborne route of transmission is very possible,” he says. “I would hesitate to call it proven by any means. But I think there’s mounting evidence to support it.”

Both the Nature study and Santarpia’s paper measured viral RNA, not actual virus, so it is not clear that the material found in aerosols was functionally infectious. “Finding RNA doesn’t tell you [that] you have aerosol spread,” says Perlman, who was not involved in either study.


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Another paper, recently published in the New England Journal of Medicine, showed that infectious SARS-CoV-2 virus can remain in aerosols for at least three hours—and for several days on various surfaces—in a laboratory setting. But the amount of viable virus diminished significantly during that time. Scientists do not know the infectious dose of SARS-CoV-2. (For influenza, studies have shown that just three virus particles are enough to make someone sick.)

Overall, most of the evidence that SARS-CoV-2 can become airborne comes from clinical settings—which tend to have a lot of sick people and may host invasive procedures, such as intubations, that can cause patients to cough, generating aerosols. It is not clear how representative of everyday environments these areas are. “There is not much convincing evidence that aerosol spread is a major part of transmission” of COVID-19, Perlman says.

The likelihood of airborne transmission—especially compared with other routes, such as droplets or surfaces—remains unclear. Most researchers still think the new coronavirus is primarily spread via droplets and touching infected people or surfaces. So diligent hand washing and social distancing are still the most important measures people can take to avoid infection.

The standard practice of surface disinfection using liquid-based chemistries according to product label instructions can render many viruses – including the coronaviruses – noninfectious,” Ikner said. “In contrast, high-touch surfaces treated with continuously active disinfectants are hostile environments to infectious viruses upon contact and demonstrate increasing effectiveness over time.”

Continuously active disinfectant technology has been around for almost a decade but has been focused primarily on controlling hospital-acquired bacterial infections, such as invasive methicillin-resistant Staphylococcus aureus, or MRSA.

UArizona researchers from the Mel and Enid Zuckerman College of Public Health investigated the impact of antimicrobial surface coatings in reducing health care-associated infections in two urban hospitals. The results of that study were published in October and found a 36% reduction in hospital-acquired infections with the use of a continually active antimicrobial.

“As communities are reopening after weeks of stay-at-home restrictions, there is significant interest in minimizing surface contamination and the indirect spread of viruses,” Gerba said.

Previous research on the environmental spread of viruses through contaminated surfaces modeled the spread of germs and the risk of infection in an office workplace. In that study, a contaminated push-plate door at the entrance of an office building led to the contamination of 51% of commonly touched surfaces and 38% of office workers’ hands within just four hours. With the use of disinfecting wipes, environmental contamination was reduced to 5% of surfaces and 11% of workers’ hands.

“We’re not seeing an increase in cases associated with the demonstrations (as of yet),” New York City Department of Health spokesman Michael Lanza wrote in an email to Yahoo News on Tuesday.

This black light experiment shows how easily a virus like the coronavirus can spread in public.

A popular video in Japan released May 8 shows how quickly a virus can spread among restaurant diners.
The Japanese state broadcaster NHK gathered 10 volunteers to eat as normal in a simulated buffet environment.
One person was chosen to be carrying the virus, and fluorescent paint was put on the person's hand to represent it.
The 10 people were then left for 30 minutes to get food from the buffet, sit down together, and eat.
Ultraviolet light was then used to lay bare how the paint had spread. Scroll down to watch the video.
All nine other people, table surfaces, glassware, and serving utensils bore traces of the paint within minutes, NHK said.
Three people had traces of the paint on their faces.
Hiroyuki Kunishima, of the St. Marianna University School of Medicine, told NHK that a "high-touch surface" like tongs or container lids were "harboring danger."
Two health experts told CNN the lesson to learn was that regular handwashing is key to stopping a virus from spreading.

An average person with the coronavirus infects about two other people, but an infected person sometimes passes the virus to far more people during a super-spreader event.

New research suggests such events, which typically involve indoor gatherings, are responsible for most coronavirus transmission.

Experts found that just 20% of coronavirus cases result in 80% of transmission. An estimated 70% of infected patients studied didn't pass the virus at all.

By targeting locations and activities that beget super-spreading, countries may be able to avoid more lockdowns during future waves of infections.

Visit Business Insider's homepage for more stories.

Super-spreader events, in which one person infects a disproportionately large number of others, are the primary means by which the coronavirus spreads, new research suggests.

A group of epidemiologists in Hong Kong found that just 20% of cases studied there were responsible for 80% of all coronavirus transmission. The researchers also found that 70% of people infected with the coronavirus didn't pass it to anyone else, and that all super-spreading events involved indoor social gatherings.

"That's the picture we have so far," Ben Cowling, one of the study co-authors, told Business Insider. "Super-spreading events are happening more than we expected, more than what could be explained by chance. The frequency of super-spreading is beyond what we could have imagined."

Microbes spread quickly in an outpatient clinic, reaching maximum contamination levels 2 hours after inoculation, with the highest contamination on examination room door handles and nurses’ station chairs. This study emphasizes the importance of targeted disinfection of high-touch surfaces.

In conclusion, testing two H1N1 strains of influenza A (one of which was a 2009 pandemic virus) demonstrates that in an environment that is consistent with indoor domestic settings in temperate zones, virus deposited onto the touched environment is likely to survive up to a few hours, though rarely more than nine hours, on the vast majority of surfaces. Metallic and non-metallic non-porous materials pose the greatest risk and should be targeted for frequent cleaning if situated in close proximity to patients infected with influenza virus; fortunately the latter are also more conducive to surface cleaning with a wide variety of simple cleaning agents [12]. Whilst our data suggest that the risk of virus transmission might last several hours after deposition, we generated very little data suggesting that appreciable amounts of virus survived much beyond nine hours. This probably means that frequently touched environments such as classrooms, offices and living rooms, which are then left unoccupied overnight, will not contain much viable virus on surfaces by the next morning. Nevertheless, the data still support frequent cleaning of commonly touched items and surfaces throughout the working day, particularly when symptomatic persons are present, for example in physician waiting rooms. In terms of cleaning regimens, one critically important consideration is that survival of virus in high titres for prolonged periods is not necessary for fomite transmission if surfaces are frequently re-inoculated (e.g. by toddlers). However the contribution of such indirect transmission relative to respiratory droplets directly from one person to another or relative to aerosol transmission remains unknown.

You collect more than a paycheck at work: Every time you touch your desk, keyboard, or telephone, you pick up germs. More than 10 million bacteria are on a typical office desk -- 400 times more bacteria than found on the average toilet seat -- which means that typing an email or making a call puts you at risk for illnesses.

The reason is pretty simple. "We touch a lot of different surfaces that hundreds of others might be touching," says Kelly Reynolds PhD, a professor and environmental microbiologist at the University of Arizona. "Germs spread quickly."

Even when professional cleaners do their best, germs linger. Bacteria counts are lowest at the beginning of the workday (because offices are often cleaned overnight), but it doesn't take long for germs to show up for work, too.

"As the day ramps up and more people touch more surfaces, the risk of coming in contact with bacteria goes up. Contamination levels reach their peak around lunch," Reynolds says.

CONTINUE READING BELOW
In one study, researchers asked volunteers to be artificially inoculated with a benign virus to test how fast it would spread. They found that "infected" co-workers spread the virus to 50% of workplace surfaces within 4 hours of arriving at work; thanks to shared contact with those surfaces, half of their co-workers also tested positive for the viruses.

To keep germs in check and avoid illness, clean your workspace. Wipe down your desktop, monitor, keyboard, computer mouse, and phone at least once a day -- but skip soap and water and opt for something stronger.

The CDC’s lesser emphasis on infected surfaces as part of the spread of COVID-19 is slightly different from that of the World Health Organization (WHO). The WHO states online that “COVID-19 spreads primarily from person to person,” but adds that, “it can also spread if you touch contaminated objects and surfaces.” The WHO even breaks down for readers all of the commonly-touched surfaces to be wary of, like doorknobs, computers, elevator buttons, and pens, noting that “If you touch something contaminated and then touch your face… you might fall ill.”

In a scientific brief posted to its website on 27 March, the World Health Organization said that there is not sufficient evidence to suggest that SARS-CoV-2 is airborne, except in a handful of medical contexts, such as when intubating an infected patient.

Whether people with COVID-19 produce enough virus-laden aerosols to constitute a risk is also unknown, says Lloyd-Smith. Air sampling from people when they talk, breathe, cough and sneeze — and testing for viable virus in those samples — “would be another big part of the puzzle”, he says. One such study failed to detect viral RNA in air collected 10 centimetres in front of one person with COVID-19 who was breathing, speaking and coughing, but the authors didn’t rule out airborne transmission entirely6.

Another crucial unknown is the infectious dose: the number of SARS-CoV-2 particles necessary to cause an infection, says Lloyd-Smith. “If you’re breathing aerosolized virus, we don’t know what the infectious dose is that gives a significant chance of being infected,” he says. An experiment to get at that number — deliberately exposing people and measuring the infection rate at different doses — would be unethical given the disease’s severity.

In the battle to slow or prevent the transmission of viruses, such as the novel coronavirus, continuously active disinfectants could provide a new line of defense, according to a recent University of Arizona study released on the health sciences preprint server MedRxiv.

While disinfecting high-contact surfaces is an important practice to prevent the spread of pathogens, these surfaces can be easily re-contaminated after the use of conventional surface disinfectants. Alternatively, continuously active disinfectants work to actively kill microorganisms and provide continued protection over an extended period of time.

"During the course of respiratory illnesses such as COVID-19, aerosols released during sneezing and coughing contain infectious viruses that will eventually settle onto various surfaces," said Luisa Ikner, associate research professor in the Department of Environmental Science and lead author of the study. "Factors including temperature, humidity and surface type can affect how long viruses such as SARS-CoV-2 will remain infectious after surface deposition."

"The only tools we have currently in reducing the environmental spread of viruses via surfaces are hand sanitizer, hand washing and the disinfection of surfaces," said Charles Gerba, a microbiologist and professor of environmental science in the College of Agriculture and Life Sciences. "This technology creates a new barrier in controlling the spread of viruses in indoor environments."

Gerba and his research team designed and conducted the study – which was funded by Allied BioScience, a company that manufactures antimicrobial surface coatings – to evaluate continuously active antimicrobial technology and its potential use against the transmission of viruses.

"We evaluated this technology by testing a modified antimicrobial coating against the human coronavirus 229E, which is one of the viruses that causes the common cold," Gerba said. "Even two weeks after the coating was applied, it was capable of killing more than 99.9% of the coronaviruses within two hours."

Human coronavirus 229E is similar in structure and genetics to SARS-CoV-2 but causes only mild respiratory symptoms. It can therefore be safely used as a model for SARS-CoV-2 to evaluate antiviral chemistries. The results from these experiments may provide new opportunities for controlling the environmental transmission of COVID-19.

"The standard practice of surface disinfection using liquid-based chemistries according to product label instructions can render many viruses – including the coronaviruses – noninfectious," Ikner said. "In contrast, high-touch surfaces treated with continuously active disinfectants are hostile environments to infectious viruses upon contact and demonstrate increasing effectiveness over time."

Continuously active disinfectant technology has been around for almost a decade but has been focused primarily on controlling hospital-acquired bacterial infections, such as invasive methicillin-resistant Staphylococcus aureus, or MRSA.

UArizona researchers from the Mel and Enid Zuckerman College of Public Health investigated the impact of antimicrobial surface coatings in reducing health care-associated infections in two urban hospitals. The results of that study were published in October and found a 36% reduction in hospital-acquired infections with the use of a continually active antimicrobial.

"As communities are reopening after weeks of stay-at-home restrictions, there is significant interest in minimizing surface contamination and the indirect spread of viruses," Gerba said.

Previous research on the environmental spread of viruses through contaminated surfaces modeled the spread of germs and the risk of infection in an office workplace. In that study, a contaminated push-plate door at the entrance of an office building led to the contamination of 51% of commonly touched surfaces and 38% of office workers' hands within just four hours. With the use of disinfecting wipes, environmental contamination was reduced to 5% of surfaces and 11% of workers' hands.

"Antimicrobial coatings could provide an additional means of protection, reducing the spread of coronaviruses in indoor environments and public places where there is continuous contamination," Gerba said. "We're evaluating a number of products right now and believe it may be the next major breakthrough in environmental infection control."

Tuberculosis (TB) is an airbone bacterial infection caused by Mycobacterium tuberculosis. TB can be acquired by breathing contaminated air droplets coughed or sneezed by a person nearby who has active Tuberculosis. Humans can also get ill with TB by ingesting unpasteurized milk products contaminated with Mycobacterium bovis, also known as Bovine Tuberculosis. The most common form of the infection is pulmonary TB which affects the lungs. In some cases, the bacteria can also attack the lymphatic system, central nervous system, urogenital area, joints, and bones.

Risk
Mycobacterium tuberculosis is present worldwide and typically spreads in cramped, overcrowded conditions. There is no evidence that pulmonary TB is more easily transmitted in airplanes or other forms of public transportation. Long-term travellers, those with a weakened immune system or visiting friends and relatives (VFR travellers) in areas where Tuberculosis is endemic are at risk. Humanitarian and healthcare personnel working in communities with active TB are also at increased risk. Persons with active TB should not travel.

Benjamin Neuman, a virologist at Texas A&M University-Texarkana who was not involved in the research.

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“This study doesn’t directly test whether the virus can be transmitted by talking

The basketball game
B’Anna Scroggins, her husband, Billy, and their friends packed into the Texan Dome at South Plains College on Friday, March 6, wearing their black and gold Vega Longhorns T-shirts. The regional basketball tournament had drawn a large crowd to watch the high school boys teams battle it out for a chance to go to the state finals.

The tournament was almost two hours away, but that’s what Vega residents do – support their students, even when their own kids have graduated or don’t play sports.

“The whole town was there,” said Shaye Pingel Warner, one of B’Anna’s best friends. “I bet there were 300-400 people there from our side. Probably more.”  

The threat of the disease spreading into Oldham County remains ever present. While the number of confirmed COVID-19 cases is still three, the rural county is surrounded by areas with far more cases.

Potter County, home of Amarillo and directly east of Oldham County, has about 1,000 cases of the virus. Nearby Moore County has more than 400 and Randall County has about 300.

Many Oldham residents commute to work in Amarillo or other cities, which means more cases could show up.