US experts recommend who should get COVID-19 vaccine first
Healthcare workers, first responders, and adults with pre-existing conditions that put them at risk for severe symptoms of COVID-19 should be the initial recipients of the first approved vaccine in the United States, according to a framework from the National Academy of Medicine (NAM) published yesterday. Today, NAM will hold a virtual public meeting on the recommendations.
The NAM report offers a detailed approach about how to best prioritize and allocate a COVID-19 vaccine. Even though the virus was discovered only in December of 2019, several countries have produced vaccines that are currently in late-stage clinical trials, and US President Donald Trump has said America could see a vaccine by the end of the year.
But deciding who should first get access to the vaccine is a potential problem, compounded by lessons learned in the early months of the US pandemic on how the virus hits minority communities hardest.
The NAM framework offers four phases of vaccine deployment. In addition to the aforementioned groups, older adults in congregate living are included in phase 1. In phase 2, teachers, school staff, critical risk workers, prisoners, those in homeless shelters and group homes, and older adults not included in phase 1 can be vaccinated. Phase 3 is for children, young adults, and workers in industries with exposure to the virus. Phase 4 includes everyone else.
Sep 1 NAM draft report
Sep 2 NAM public listening session
Chinese bus study highlights airborne spread potential of SARS-CoV-2
A study yesterday in JAMA Internal Medicine on a COVID-19 outbreak among bus passengers attending a Buddhist ceremony in China highlights the potential for airborne spread of SARS-CoV-2, the virus that causes COVID-19.
The study looked at 128 people who took two buses to the outdoor worship event at a Buddhist temple in eastern China on Jan 19. Both buses had an air conditioning system on recirculation mode. The total time of travel to and from the event was 100 minutes. None of the people on bus 1 received a COVID-19 diagnosis, while 24 of 68 (35.3%, including the index patient, who was likely exposed on Jan 17) received a diagnosis of COVID-19 after the event. Among the 172 other people who attended the event, 7 (4.1%) subsequently received a COVID-19 diagnosis, and all described being in close contact with the index patient during the event.
Compared with individuals on bus 1, those on bus 2 had a 34.3% (95% confidence interval [CI], 24.1% to 46.3%) higher risk of getting COVID-19, and were 11.4 (95% CI, 5.1 to 25.4) times more likely to have COVID-19 compared with all other people who attended the worship event.
The researchers were able to identify seats for each passenger on bus 2 and divided the seats into high-risk and low-risk zones according to the distance from the index patient, who was asymptomatic during the bus ride. Comparison of COVID-19 risk in the two zones showed that passengers in the high-risk zone on bus 2 had moderately but non-significantly higher risk of COVID-19 than those in low-risk zones, a finding the authors of the study say suggests airborne spread likely played a role.
“If COVID-19 transmission occurred solely through close contact or respiratory droplets during this outbreak, the risk of COVID-19 would likely be associated with distance from the index patient, and high-risk zones on the bus would have more infected cases,” they wrote. “These data suggest that forced, circulating air might play an important role in airborne spread of the virus, and gatherings in enclosed settings with minimal air ventilation should be limited.”
Sep 1 JAMA Intern Med abstract
Spray from toilets may have caused COVID-19 transmission in China
A study yesterday in the Annals of Internal Medicine adds to the evidence that feces can play a role in the transmission of SARS-CoV2. The study looked at COVID-19 transmission in a cluster of three families living in a high-rise apartment building in Guangzhou, China.
Nine people in the families, who lived in vertically aligned apartments connected by drainage pipes in the bathrooms, were confirmed to have the virus between Jan 26 and Feb 13. After taking 237 surface and air samples from 11 of the 83 flats in the building, public areas, and building drainage systems, the researchers from the University of Hong Kong deduced that virus-containing fecal aerosols were probably produced in the associated vertical stack during toilet flushing, as all families’ master bathrooms were connected via plumbing.
“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,” the authors said.
In an accompanying commentary, Michael Gormley, PhD, the director of the Water Academy at Heriot-Watt University writes that the findings “add to the growing body of evidence that wastewater plumbing systems, particularly those in high-rise buildings, deserve closer investigation, both immediately in the context of SARS-CoV-2 and in the long term, because they may be a reservoir for other harmful pathogens.”
Sep 2 Ann Intern Med study
Sep 2 Ann Intern Med commentary