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Deprecated: Implicit conversion from float 231.6 to int loses precision in C:\Inetpub\vhosts\kidney.de\httpdocs\pget.php on line 534 Ann+Intern+Med 2020 ; 173 (12): 974-980 Nephropedia Template TP
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Probable Evidence of Fecal Aerosol Transmission of SARS-CoV-2 in a High-Rise Building #MMPMID32870707
Kang M; Wei J; Yuan J; Guo J; Zhang Y; Hang J; Qu Y; Qian H; Zhuang Y; Chen X; Peng X; Shi T; Wang J; Wu J; Song T; He J; Li Y; Zhong N
Ann Intern Med 2020[Dec]; 173 (12): 974-980 PMID32870707show ga
BACKGROUND: The role of fecal aerosols in the transmission of severe acute respiratory syndrome coronavirus 2 has been suspected. OBJECTIVE: To investigate the temporal and spatial distributions of 3 infected families in a high-rise apartment building and examine the associated environmental variables to verify the role of fecal aerosols. DESIGN: Epidemiologic survey and quantitative reverse transcriptase polymerase chain reaction analyses on throat swabs from the participants; 237 surface and air samples from 11 of the 83 flats in the building, public areas, and building drainage systems; and tracer gas released into bathrooms as a surrogate for virus-laden aerosols in the drainage system. SETTING: A high-rise apartment building in Guangzhou, China. PARTICIPANTS: 9 infected patients, 193 other residents of the building, and 24 members of the building's management staff. MEASUREMENTS: Locations of infected flats and positive environmental samples, and spread of virus-laden aerosols. RESULTS: 9 infected patients in 3 families were identified. The first family had a history of travel to the coronavirus disease 2019 (COVID-19) epicenter Wuhan, whereas the other 2 families had no travel history and a later onset of symptoms. No evidence was found for transmission via the elevator or elsewhere. The families lived in 3 vertically aligned flats connected by drainage pipes in the master bathrooms. Both the observed infections and the locations of positive environmental samples are consistent with the vertical spread of virus-laden aerosols via these stacks and vents. LIMITATION: Inability to determine whether the water seals were dried out in the flats of the infected families. CONCLUSION: On the basis of circumstantial evidence, fecal aerosol transmission may have caused the community outbreak of COVID-19 in this high-rise building. PRIMARY FUNDING SOURCE: Key-Area Research and Development Program of Guangdong Province and the Research Grants Council of Hong Kong.
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Ann+Intern+Med 2020 ; 173 (12): 974-980
