COVID-19: Transmission, Protection and Infection Control


Coronavirus disease – 2019 (COVID-19) is a highly infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-Cov-2). The outbreak of this disease was reported in Wuhan, China, in December 2019, but it has spread virtually to every country around the world. The specific mechanism through which the virus was transmitted to human beings is still debatable, with some claiming that it came from the consumption of bats or pangolins. The incubation period takes around 14 days, but symptoms could appear after 2 days, depending on the person who has been infected.

The common signs and symptoms include high fever, dry cough, and shortness of breath, or difficulty in breathing. Other signs may vary from one person to another, and they are tiredness, aches, chills, sore throat, loss of smell, loss of taste, diarrhea, and headaches. The symptoms could be mild or severe, and some people have tested positive while still asymptomatic even after the projected 14-days incubation period. Those at risk of being severely infected with adverse outcomes including death are the elderly and people with co-morbidities, such as heart diseases, diabetes, chronic kidney or liver disease, underlying respiratory complications, among other health conditions that compromise immunity. This paper discusses COVID-19 by addressing the mode of transmission, ways of protection, and infection control.

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Mode of Transmission

Information about various modes of transmission is still emerging. However, the virus is mainly transmitted via three main avenues – person-to-person, through the air, and different surfaces. Person-to-person transmission occurs when contaminated droplets from coughing, sneezing, or talking are exposed to another person. The droplets enter the body through the mouth, eyes, and nose. Additionally, when people shake hands, kiss or hug, they are likely to get the virus. A study by Loh et al. (2020) established that droplets from a cough could travel up to 15 feet. Even though the virus is not airborne, studies have shown that it could be suspended in the air for some time and be transmitted to another person (Asadi, Bouvier, Wexler, & Ristenpart, 2020). Droplets suspended in the air are likely to be inhaled after which they are transported to the lungs. According to the World Health Organisation, WHO (2020), several medical practices, such as cardiopulmonary resuscitation and intubation, trigger respiratory secretions, and if they are aerosolized, they could lead to transmissions.

In addition, the virus could be transmitted through various surfaces. For instance, when an infected person deposits the virus on a surface, a healthy person could touch the same place, contract the virus and pass it to the body through the mouth, nose, or eyes. This assertion explains why touching the face has been noted as one of the leading modes of transmission. The virus can remain active on different surfaces for varied periods. A study by van Doremalen et al. (2020) found out that the virus is more stable on stainless steel and plastic where it can remain for up to 48 hours and 72 hours respectively, as compared to cardboard and copper, where it cannot be detected after 24 hours and 4 hours respectively. However, the virus on these surfaces can be killed through fumigation and wiping with water and soap. If hands are contaminated, they can be washed or sanitized using the available sanitizing materials.

The virus spread so fast due to various reasons, including its mode of transmission. The person-to-person transmission mode through bodily contact, sneezing, coughing, and talking compounds the ease with which this disease spreads because most places are congested, and people are nearby. In addition, the culture of shaking hands as a way of greeting each other contributes significantly to its spread. However, Mallapaty (2020) argues that scientists have identified a protein on the virus’s surface, which could be linked to its fast spread. Human body cells have a receptor for this protein, hence the quick spread of the disease.

Protection

In the wake of the outbreak and spread of this virus, policy advisors and scientists have suggested various ways of protection against contracting the disease. The various proposed ways of protection include wearing different forms of masks, such as PPE and facemasks, self-isolation for people suspected to have been exposed to the virus, social distancing, frequent hand washing, use of disinfectants (sanitisers), quarantining the infected and lockdowns. The most effective way to deal with the spread of this virus is through lockdowns, self-isolation and quarantine. The rationale behind this argument is that if people stay at home or in confined places where they are not exposed to the disease, they will not contract it. Similarly, when those already infected or suspected to have been infected are isolated and quarantined, they cannot transmit the virus to other people. Self-isolation means that a person avoids interacting with other people, which could mean not leaving the house if staying alone or being locked in a room if other people are present in the house. This method is effective in preventing the spread of the disease because there is no exposure to the virus.

However, such a simplistic approach to this complex problem is not applicable due to conventional societal organisations. Even if a total lockdown was implemented, those offering essential services would still need to go to work. Additionally, people have to go shopping for their essentials and the sick have to be taken to hospitals. In other words, people have to interact; hence, the introduction of other protection measures is needed. Under these circumstances, the most appropriate way to prevent the spread of this virus is to ensure that it does not leave the infected person. Therefore, the use of masks to prevent droplets through sneezing, coughing or talking from entering the environment becomes the next viable option of dealing with this issue. There are several masks in the market that could be used, but this paper focuses on PPE masks and compares them to regular facemasks.

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According to the U.S. Food and Drug Administration (FDA) (2020), the most commonly used PPE masks are N95 respirators and surgical masks. The N95 respirator is a “respiratory protective device designed to achieve a very close facial fit and very efficient filtration of airborne particles” (para. 6). These devices are subjected to elaborate testing and design to block at least 95 per cent of minute particles measuring up to 0.3 microns. The FDA (2020) notes that if these devices are used appropriately, they are more effective at preventing the filtration of particles as compared to normal facemasks. On the other hand, a surgical mask “is a loose-fitting, disposable device that creates a physical barrier between the mouth and nose of the wearer and potential contaminants in the immediate environment” (FDA, 2020, para. 4). Surgical masks can reduce the probability of inhaling droplets by 20 to 30 per cent, while N95 can reduce the same up to 95 per cent (Semple & Cherrie, 2020). Therefore, based on this information, it suffices to argue that N95 respirators are more effective than surgical masks.

However, a meta-analysis to assess the effectiveness of standard and respirator (N95 or FFP) masks using 9171 participants with flu-like symptoms showed that these masks might not be useful in preventing the transmission of viruses. According to Greenhalgh et al. (2020), “There were no statistically significant differences in their efficacy in preventing laboratory-confirmed influenza, laboratory-confirmed respiratory viral infections, laboratory-confirmed respiratory infection and influenza-like illness, but respirators appeared to protect against bacterial colonisation” (p. 1). These findings are interesting given the widespread recommendation by various bodies for the use of such masks, especially among healthcare providers who are on the front line in the fight against COVID-19. Therefore, it is important for healthcare workers not to rely on PPEs as a fool proof way of preventing the transmission of this virus. Other methods should be used, including washing hands, social distancing and sanitisation for better results. In addition, for PPEs to achieve optimal results, they have to be worn correctly.

Nevertheless, the use of these devices creates another problem because in case they are contaminated, they could promote the spread of the disease. As such, they should be handled with maximum care as they move through the supply chain from production in factories until the point they are given to users. Additionally, healthcare workers should be given basic education or training on how to wear the masks properly and dispose of them after use. This way, the effectiveness of these devices will be optimised and will prevent the spread of the virus.

Infection Control

In the workplace, the risk of spreading the novel coronavirus could be reduced significantly by observing various rules. First, people who can work remotely should be encouraged to do so as a way of decongesting the workplace and reduce person-to-person interactions. However, in cases where individuals have to go to workplaces, they should observe personal hygiene, which includes the frequent washing of hands with soap and sanitisation. People should also avoid bodily contact through shaking hands and other unwarranted behaviours. Social distancing is important as it ensures that even if an infected person coughs or sneezes, the droplets produced in the process drop on the ground.

Importantly, workers should wear protective masks based on the nature of their workplaces. For instance, healthcare professionals are recommended to wear N95 masks, which are more effective than surgical masks or regular masks. Workers in other set-ups are encouraged to wear other locally available masks. N95 masks should be preserved for healthcare professionals because they are at a higher risk of contracting diseases, especially when dealing with infected people. Nevertheless, wearing masks, regardless of the type, serves a central purpose in the management of this disease. On the one hand, they prevent the inhalation of contaminated droplets. On the other hand, they prevent the already infected individuals from transmitting the virus to other healthy individuals.

In addition, in the workplace, people should observe social distancing and avoid person-to-person contact as much as possible. In case someone has tested positive, he or she should be placed under quarantine, and contact tracing must be initiated immediately to identify and isolate the involved individuals for testing before they can spread the virus to others. In the workplace, where possible, adequate aeration should be observed because the virus may not remain suspended in the air for long in well-ventilated spaces. Fumigation could also be carried out to kill all the viruses that might have attached to various surfaces in the workplace. All these measures are important because they work together to prevent the spread of this disease. It is important to note that no single prevention approach is fool proof, and, thus, people should use all methods available to them to increase control effectiveness.

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Conclusion

The first case of COVID-19 was reported in December 2019, in Wuhan, China, where it was reportedly transmitted to human beings from bats or pangolins. Currently, the disease has spread all over the world, with all countries recording at least a few cases. After infection, an individual may stay asymptomatic for 14 days, which is the incubation period for this disease. The common modes of transmission include person-to-person, through the air and via surfaces, such as plastics, where the virus could remain active for close to 72 hours. Concerning protection strategies, people are advised to observe social distancing, wash hands frequently, sanitise, self-isolate, stay at home if possible and wear protective masks. N95 masks are specifically designed to prevent the infiltration of micro particles, and, thus, they are more effective as compared to surgical and regular masks. However, a randomised controlled study showed that the available masks in the market might not be effective in preventing the transmission of the virus. Therefore, people should use a combination of strategies, especially in the workplace, where the risk of exposure is high.

References

  1. Asadi, S., Bouvier, N., Wexler, A. S., & Ristenpart, W. D. (2020). The coronavirus pandemic and aerosols: Does COVID-19 transmit via expiratory particles? Aerosol Science and Technology, 34(6), 635-638.
  2. FDA. (2020). N95 respirators and surgical masks (face masks). Web.
  3. Greenhalgh, T., Chan, X. H., Khunti, K., Durand-Moreau, Q., Straube, S., Devane, D.,… Ireland, C. (2020). What is the efficacy of standard face masks compared to respirator masks in preventing COVID-type respiratory illnesses in primary care staff? Web
  4. Loh, N. H. W., Tan, Y., Taculod, J., Gorospe, B., Teope, A. S., Somani, J., & Tan, A. Y. H. (2020). The impact of high-flow nasal cannula (HFNC) on coughing distance: Implications on its use during the novel coronavirus disease outbreak. Canadian Journal of Anaesthesia, 1-2. doi:10.1007/s12630-020-01634-3
  5. Mallapaty, S. (2020). Why does the coronavirus spread so easily between people? Nature, 597, 183. doi: 10.1038/d41586-020-00660-x
  6. Semple, S., & Cherrie, J. (2020). Covid-19: Protecting worker health. Annals of Work Exposures and Health, 1-4.
  7. van Doremalen, N., Morris, D., Holbrook, M., Gamble, A., Williamson, B., Tamin, A., … Wit, E. (2020). Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1. The New England Journal of Medicine, 382, 1564-1567. doi:10.1056/NEJMc2004973

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