Bankstown Hospital - Grand Rounds - Further Reading

Welcome to the Grand Rounds Further Reading List, Infectious Diseases edition, brought to you by the Clinical Library, on Level 4, next to the Auditorium.

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Dai, H. and B. Zhao (2023). "Association between the infection probability of COVID-19 and ventilation rates: An update for SARS-CoV-2 variants." Building Simulation 16(1): 3-12  https://doi.org/10.1007/s12273-022-0952-6

                Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the cause of the current coronavirus disease 2019 (COVID-19) pandemic, is evolving. Thus, the risk of airborne transmission in confined spaces may be higher, and corresponding precautions should be re-appraised. Here, we obtained the quantum generation rate (q) value of three SARS-CoV-2 variants (Alpha, Delta, and Omicron) for the Wells-Riley equation with a reproductive number-based fitted approach and estimated the association between the infection probability and ventilation rates. The q value was 89–165 h−1 for Alpha variant, 312–935 h−1 for Delta variant, and 725–2,345 h−1 for Omicron variant. The ventilation rates increased to ensure an infection probability of less than 1%, and were 8,000–14,000 m3 h−1, 26,000–80,000 m3 h−1, and 64,000–250,000 m3 h−1 per infector for the Alpha, Delta, and Omicron variants, respectively. If the infector and susceptible person wore N95 masks, the required ventilation rates decreased to about 1/100 of the values required without masks, which can be achieved in most typical scenarios. An air purifier was ineffective for reducing transmission when used in scenarios without masks. Preventing prolonged exposure time in confined spaces remains critical in reducing the risk of airborne transmission for highly contagious SARS-CoV-2 variants.

Hui, D. S. (2023). "Hybrid immunity and strategies for COVID-19 vaccination." The Lancet Infectious Diseases 23(1): 2-3  https://doi.org/10.1016/S1473-3099(22)00640-5

Long, B., et al. (2022). "Clinical update on COVID-19 for the emergency clinician: Presentation and evaluation." The American Journal of Emergency Medicine 54: 46-57  https://www.sciencedirect.com/science/article/pii/S0735675722000304

                Introduction: Coronavirus disease of 2019 (COVID-19) has resulted in millions of cases worldwide. As the pandemic has progressed, the understanding of this disease has evolved. Objective: This first in a two-part series on COVID-19 updates provides a focused overview of the presentation and evaluation of COVID-19 for emergency clinicians. Discussion: COVID-19, caused by Severe Acute Respiratory Syndrome coronavirus 2 (SARS-CoV-2), has resulted in significant morbidity and mortality worldwide. Several variants exist, including a variant of concern known as Delta (B.1.617.2 lineage) and the Omicron variant (B.1.1.529 lineage). The Delta variant is associated with higher infectivity and poor patient outcomes, and the Omicron variant has resulted in a significant increase in infections. While over 80% of patients experience mild symptoms, a significant proportion can be critically ill, including those who are older and those with comorbidities. Upper respiratory symptoms, fever, and changes in taste/smell remain the most common presenting symptoms. Extrapulmonary complications are numerous and may be severe, including the cardiovascular, neurologic, gastrointestinal, and dermatologic systems. Emergency department evaluation includes focused testing for COVID-19 and assessment of end-organ injury. Imaging may include chest radiography, computed tomography, or ultrasound. Several risk scores may assist in prognostication, including the 4C (Coronavirus Clinical Characterisation Consortium) score, quick COVID Severity Index (qCSI), NEWS2, and the PRIEST score, but these should only supplement and not replace clinical judgment. Conclusion: This review provides a focused update of the presentation and evaluation of COVID-19 for emergency clinicians.

Tallei, T. E., et al. (2023). "Update on the omicron sub-variants BA.4 and BA.5." Reviews in Medical Virology 33(1): e2391  https://onlinelibrary.wiley.com/doi/abs/10.1002/rmv.2391

                Abstract. Several nations have recently begun to relax their public health protocols, particularly regarding the use of face masks when engaging in outdoor activities. This is because there has been a general trend towards fewer cases of coronavirus disease 2019 (COVID-19). However, new Omicron sub-variants (designated BA.4 and BA.5) have recently emerged. These two subvariants are thought to be the cause of an increase in COVID-19 cases in South Africa, the United States, and Europe. They have also begun to spread throughout Asia. They evolved from the Omicron lineage with characteristics that make them even more contagious and which allow them to circumvent immunity from a previous infection or vaccination. This article reviews a number of scientific considerations about these new variants, including their apparently reduced clinical severity.