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COVID-19: A Call for Physical Scientists and Engineers
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  • Haiyue Huang
    Haiyue Huang
    Department of Materials Science and Engineering, Northwestern University, Evanston, Illinois 60208, United States
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  • Chunhai Fan
    Chunhai Fan
    School of Chemistry and Chemical Engineering, Frontiers Science Center for Transformative Molecules, Shanghai Jiao Tong University, Shanghai 200240, China
    Institute of Molecular Medicine, Shanghai Key Laboratory for Nucleic Acid Chemistry and Nanomedicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
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    Orcidhttp://orcid.org/0000-0002-7171-7338
  • Min Li
    Min Li
    Department of Laboratory Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
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  • Hua-Li Nie
    Hua-Li Nie
    College of Chemistry, Chemical Engineering and Biotechnology, Donghua University, Shanghai 201620, China
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  • Fu-Bing Wang
    Fu-Bing Wang
    Department of Laboratory Medicine, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
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  • Hui Wang
    Hui Wang
    Center for Single-Cell Omics, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
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  • Ruilan Wang
    Ruilan Wang
    Department of Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201600, China
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  • Jianbo Xia
    Jianbo Xia
    Department of Laboratory Medicine, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430070, China
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  • Xin Zheng
    Xin Zheng
    Department of Infectious Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
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  • Xiaolei Zuo
    Xiaolei Zuo
    School of Chemistry and Chemical Engineering, Frontiers Science Center for Transformative Molecules, Shanghai Jiao Tong University, Shanghai 200240, China
    Institute of Molecular Medicine, Shanghai Key Laboratory for Nucleic Acid Chemistry and Nanomedicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
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  • Jiaxing Huang*
    Jiaxing Huang
    Department of Materials Science and Engineering, Northwestern University, Evanston, Illinois 60208, United States
    *Email: [email protected]
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    Orcidhttp://orcid.org/0000-0001-9176-8901
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ACS Nano

Cite this: ACS Nano 2020, 14, 4, 3747–3754
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https://doi.org/10.1021/acsnano.0c02618
Published April 8, 2020

Copyright © 2020 American Chemical Society. This publication is licensed under

CC-BY-NC-ND 4.0 .

Abstract

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The COVID-19 pandemic is one of those global challenges that transcends territorial, political, ideological, religious, cultural, and certainly academic boundaries. Public health and healthcare workers are at the frontline, working to contain and to mitigate the spread of this disease. Although intervening biological and immunological responses against viral infection may seem far from the physical sciences and engineering that typically work with inanimate objects, there actually is much that can—and should—be done to help in this global crisis. In this Perspective, we convert the basics of infectious respiratory diseases and viruses into physical sciences and engineering intuitions, and through this exercise, we present examples of questions, hypotheses, and research needs identified based on clinicians’ experiences. We hope researchers in the physical sciences and engineering will proactively study these challenges, develop new hypotheses, define new research areas, and work with biological researchers, healthcare, and public health professionals to create user-centered solutions and to inform the general public, so that we can better address the many challenges associated with the transmission and spread of infectious respiratory diseases.

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Copyright © 2020 American Chemical Society

Subjects

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COVID-19, an infectious respiratory disease caused by a novel coronavirus SARS-CoV-2, has quickly evolved into a global pandemic in just over two months. (1) Public health and healthcare professionals are at the frontline, working to contain and to mitigate the spread of this disease. Remarkably rapid progress has been made in biological and biomedical research, including identifying the virus, sequencing its genes, and resolving cogent protein structures. (2−4) The manufacture of testing and diagnosis kits and development and trials of vaccines, antiviral drugs, and other medical and psychological interventions are also being accelerated. Although these activities may seem a bit far from the fields of physical sciences and engineering that typically work with inanimate objects, there actually is much that can—and should—be done to help in such a global crisis. To start, one would need to establish basic understanding of the infection pathways of respiratory diseases and the virion (i.e., viable virus) structure.

General Infection Pathways

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The general infectious pathways for respiratory diseases such as influenza, SARS, MERS, and COVID-19 are illustrated in Figure 1, all of which start from virion-laden respiratory fluid droplets (from <1 to 2000 μm in diameter) released by an infected person through coughing, sneezing, and potentially even talking. (5) These droplets immediately start to evaporate and to shrink. Most of the droplets and dried nuclei deposit on various objects (e.g., door knobs, tabletops, buttons, handrails, and touchscreens), turning them into potentially infectious “fomites”, but some may even become airborne for a period of time. Direct infection could thus occur through inhalation by other people within close proximity (e.g., 1–2 m), especially for a crowd in a relatively closed space. Infection could also occur when virions released by an infected person are spread on their hands and clothing and then transferred to others through close contact, such as handshaking. Fomites infection (6) is indirect and rather stealthy; it occurs only if a person first picks up the virions from contaminated objects and surfaces (e.g., by their hands) and then transfers them to his or her mouth, nose, or eyes. Throughout these processes, the virions need to endure a complex and dynamic set of environmental conditions outside the human body. Therefore, there are many opportunities to set up barriers using physical sciences and engineering (dashed lines in Figure 1) to block and to deactivate the overwhelming majority of released virions before they reach hosts and breach the final biological and immunological defenses. Some examples include (a) isolating infectious patients and/or reducing the spread of their respiratory fluid droplets, (b) cleaning and sanitizing objects and surfaces, (c) filtering potentially contaminated air, (d) washing hands frequently, (e) establishing better personal hygiene habits, and (f) wearing personal protection equipment (PPE). Understanding the basic structure of virions and their surroundings is required for designing inactivation and removal strategies and maximizing the effectiveness of these barriers (Figure 1a–f). All of these defense barriers contribute to blocking the source of virions, breaking the spread pathways, and protecting the susceptible hosts. Compared to other known infectious diseases caused by coronaviruses, COVID-19 can spread through an additional stealth mode of asymptomatic transmission, (7−9) which dramatically increases the difficulty of detecting, monitoring, and preventing its spread.

Figure 1

Figure 1. Graphic illustrating common transmission pathways of respiratory diseases, which start with an infected person releasing virion-laden respiratory fluid droplets (left). Within close proximity, other people could be infected by directly inhaling airborne droplets or dried nuclei or by receiving virions through contact transfer. Indirect fomite infection occurs when virion-laden nuclei are picked up from contaminated surfaces (e.g., by hands) and then delivered to the mouth, nose, or eyes. There are many opportunities to set up several layers of defense barriers (dashed lines a–f) along the infection pathways to remove or to deactivate virions before they reach the next person.

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There are many opportunities to set up barriers using physical sciences and engineering to block and to deactivate the overwhelming majority of released virions before they reach hosts and breach the final biological and immunological defenses.

Basic Virion Structure

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Generally speaking, viruses are essentially metastable, core–shell nanoparticles that are biologically produced in cells with a quite remarkable self-assembly process. (10) The core is made of a coiled genomic polymer and tightly packaged in a protective protein shell called a capsid, which is tiled up by presynthesized subunits. For coronaviruses (Figure 2), such as those that cause SARS, MERS, and COVID-19, the RNA is directly complexed with and protected by a helical protein shell to form a coiled nucleocapsid. It is then enveloped by a lipid bilayer membrane decorated with various other proteins, such as the protruding “corona” spikes, which interact with the host cell. The biological function of viruses to preserve and, eventually, to deliver their nucleic acids to host cells depends on the virus’ structural integrity. For example, for enveloped viruses, their lipid bilayer must stay intact throughout the pathways to keep them infectious. The protein capsid must be sufficiently strong to confine the elastically strained genomic coil and sufficiently tough to sustain osmotic pressure fluctuation in changing surroundings, yet they must be able to disassemble readily inside the host cells to release the genomic core. These constraints demand rather intricate protein building blocks that also must maintain desirable configurations to avoid malfunction. The envelope and capsid, however, can be compromised by an array of physical treatments, such as UV irradiation, heating, and desiccation, as well as by chemical sanitization using acids, oxidants, alcohols, or some specialized surfactants. (10−12) Approaches like these may seem relatively primitive; however, they can be extremely effective in slowing down or even preventing virus spread and transmission.

Figure 2

Figure 2. Structural model of a coronavirus particle, showing the nucleocapsid coil (green) inside an envelope (brown) with protruding spike proteins (red). The inset shows the bilayer structure of the envelope and a segment of the nucleocapsid.

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Questions, Hypotheses, and Research Needs in Physical Sciences and Engineering

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Although intervening biological and immunological responses against viral infection seem to be out of the realm of physical sciences and engineering, surfactant bilayers, core–shell nanoparticles, self-assembly, surface functionalization, and mechanical stability of hollow shells are familiar subjects. There are many ways to contribute, so that more effective and user-centered strategies can be developed to battle virus transmission. To begin, one should examine the very beginning of the chain of events.

Virions Are Usually a Minority Component in Respiratory Droplets

The first barrier to infection should be put up at the starting point (Figure 1, dashed line a) to reduce the number and viability of virions released by an infected person. To this end, infected patients are required to wear medical masks, which can block and absorb large coughed droplets and reroute the smaller ones to reduce their forward traveling distance. (13,14) Masks are an important component in PPE (Figure 1, dashed line f) for frontline healthcare workers. In the current COVID-19 pandemic, there has been much discussion about whether masks are capable of blocking virus nanoparticles, which are typically around 100 nm in diameter. (15) However, this implies that virions released by an infected person stay airborne as individual uncoated nanoparticles, which is rather misleading. As shown in Figure 3, respiratory fluid droplets contain a variety of other components, typically of a few weight percent, (16,17) including insoluble particulates such as proteins, enzymes, commensal microflora (i.e., bacteria) colonized in the upper respiratory tract, and cell debris from the respiratory tract lining; amphiphilic liposomal matter such as lung surfactants and cholesterol; and soluble molecular species such as salt and lactate. Therefore, in the flying droplets or the final dried nuclei, virions are always surrounded by these materials and are usually a minority component, the loading of which varies by the conditions of the patients.

Figure 3

Figure 3. Typical components of a virus-laden respiratory fluid droplet. As it shrinks during evaporation, all components are concentrated. Finally, the virus particles are embedded in a semidried mass called “nuclei”.

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When designing physical and chemical approaches to deactivate virions, their surrounding respiratory mass must be factored in.

The pictorial representation in Figure 3 reminds us that when designing physical and chemical approaches to deactivate virions, their surrounding respiratory mass must be factored in. These noninfectious components may act as a protective matrix for the virions, rendering sanitization treatments ineffective, or they can be manipulated for accelerated inactivation. For example, it has been reported that both SARS-CoV-1 and SARS-CoV-2 virions can remain infectious for days on smooth surfaces such as glass, plastics, and stainless steel, whereas they remain infectious for just hours on porous surfaces such as textile and paper materials. (18,19) This observation is somewhat surprising and worrisome, especially because stainless steel is ubiquitous for making medical supplies and equipment, as well as most engineering structures and appliances. However, to the best of our knowledge, the effect of surface porosity is not well-understood. One hypothesis is that nuclei particles are more likely to pick up moisture from the air through capillary condensation on smooth surfaces than on porous ones. (20,21) The water-soluble, hygroscopic components in the nuclei can hold condensed water to protect embedded virions from desiccation. On porous surfaces, condensed water can be drained away from the nuclei to equilibrate with the rest of the surface, leading to faster water loss around the virions. Desiccation is effective for deactivating enveloped virions because the assembly of the membrane bilayer relies on water. (22,23) Moreover, capillary compression (24) can also mechanically squeeze the mixture in the drying droplets and potentially deform and damage the virion particles inside.

Chemical Modulation of Respiratory Fluid Droplets

In addition to blocking the droplets, it would also be effective to deactivate virions at the origin of the chain events leading up to infection. Here, one might employ ways to “pollute” virion-laden droplets with antiviral or sanitizing molecules (25) when they pass through a mask. For example, a useful strategy may involve on-mask chemical modulation in which such molecules are loaded on the mask to presanitize the exhaled droplets. These molecules should be released in the warm and moisturized air during exhalation but stay fixed on the mask during the inhalation of colder and drier air. It would be most useful to use the chemical modifier as a drop-in accessory, such as in the form of a sticky and permeable film that can adhere to the outer surface of a mask as needed. This may facilitate widespread use and does not need to disrupt the manufacturing and supply chain management of masks, which is already highly stressed by the explosive surge in demand. (26)

One might employ ways to “pollute” virion-laden droplets with antiviral or sanitizing molecules when they pass through a mask.

It is also well-known that metabolism and food can dramatically affect the composition of exhaled air (e.g., bad breath). Therefore, with the help of medical researchers and doctors, perhaps one could think of some in situ methods for altering the chemical composition of respiratory fluids by taking “saliva modifiers” (e.g., ingredients that help to inactivate virions) in the form of pills, lozenges, cough drops, or even chewing gums. One may even customize a diet or use food supplements such that antiviral molecules can be self-generated in the respiratory fluids by metabolism. Both on-mask and in situ chemical modulation approaches would benefit from the third power scaling law of droplet volume and diameter, which can greatly concentrate the antiviral molecules during droplet evaporation. Both strategies can be enhanced by deeper and more relevant scientific understandings in the molecular mechanisms of virion inactivation.

Self-Sanitizing Surfaces

Fomite transmission is hard to trace but common for many respiratory diseases. (6) This transmission is often mitigatable with physical and chemical sanitization, such as through spraying or wiping. However, sanitization is labor- and materials-intensive, impractical for covering all exposed areas, and needs to be reapplied periodically. Water- or alcohol-based sanitizers may not be able to act fully and uniformly across entire surfaces during practical operation due to issues related to dewetting and volatility. Therefore, it will be useful to engineer self-sanitizing surfaces that can slowly release disinfecting chemicals to mitigate fomite transmission. Such coatings should be durable against rubbing and washing, long-lasting, and nontoxic and should be grown easily on the surfaces of already-installed objects that people frequently touch. This direction can leverage knowledge gained through numerous material studies about control-release processes and may even define new research needs.

It will be very useful to engineer self-sanitizing surfaces that can slowly release disinfecting chemicals to mitigate fomite transmission.

For metal objects, copper metal or cations have broad spectrum antiviral effects and low toxicity to humans. (27,28) Therefore, surface copperization could provide stainless steel objects self-sanitizing properties, which could significantly cut down fomite infection rates due to stainless steel’s widespread use in hospitals and public spaces. In addition, properly patterned surfaces can avoid local capillary condensation of water, (21) which can bring additional self-desiccation property to deactivate virions. One may even design active or stimuli-responsive antiviral coatings based on photocatalytic, photothermal, or electrothermal treatments, either continuously or in pulsed mode, all of which are quite well-studied in materials science.

Personal Protection Equipment

The PPE used by healthcare professionals tending COVID-19 patients includes facial masks or respirators, protective suits, spill gowns, gloves, boot covers, and goggles or face shields for eye protection (Figure 4), and they are critical for protecting healthcare workers. It typically takes 30 min just to suit up to ensure proper protection, and frontline workers usually need to wear it continuously for extended hours. (29) During usage, the entire outer surface of their PPE must be treated as fomites, which requires extra caution when undressing. (30) User experiences under high stress speak for much needed improvement over current PPE. For example, goggle fogging turns out to be quite problematic because one cannot risk contamination to clear them by usual means. Therefore, antifogging functionality must be added. (31) For facial masks such as N95 aspirators, they usually need to be tightly fit to one’s face (e.g., with strong rubber bands) and can cause a great deal of discomfort or allergic reactions. (32) In practice, the one-size-fits-all aspirators sometimes do not match the diverse facial profiles of different users, leading to potential safety issues due to leakage or skin damage. Therefore, more adaptive, skin-friendly materials and interface design are needed to ensure good seal over extended periods of time and changing skin conditions due to perspiration.

Figure 4

Figure 4. (a) Photo showing a typical set of personal protection equipment used by clinicians tending COVID-19 patients in Wuhan, China, including N95 respirator, protective suit (with marker-written information for identification purposes), gloves, goggles, and boot covers (shown in b). (b) Additional medical mask, spill gown, and face shield are used before entering the isolation ward. (c) Additional helmet with pressured air (on the right) is needed before tracheal intubation procedures for COVID-19 patients. Image credit: Zhengyu Liu.

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The development of smart, multifunctional PPE with wireless communication and capabilities for detecting virus, controlling humidity and temperature, and monitoring clinicians’ physiological conditions without compromising protective function and flexibility, will be extremely helpful.

Hazmat suits are usually made of broad-spectrum protective synthetic fabrics with vapor-blocking functions. Although such fabrics serve as an effective barrier to virions and virion-laden droplets and nuclei, due to poor ventilation and heat dissipation, they become uncomfortable to wear for frontline healthcare workers, who often need to wear them for extended periods of time when there is a shortage in PPE supply or manpower. This discomfort adds to healthcare workers’ already high physical and psychological stress. Therefore, smart fabrics that can effectively block virions but enable better heat transfer and moisture control would be an ideal suit material. In addition, for the clinicians in emergency departments, the tedious and time-consuming processes of dressing up and undressing the entire set of PPE takes valuable time away from treating critically ill patients. Therefore, a multifunctional helmet-like unit with integrated mask compartment, goggles, and face shield, yet still maintain lightweight and durability, would be desirable. The development of smart, multifunctional PPE suits equipped with wireless communication capabilities and microsensors or even actuators for detecting virus, controlling humidity and temperature, and monitoring clinicians’ physiological conditions without compromising protective function and flexibility, will be extremely helpful. This need suggests many new research directions for researchers in materials chemistry, flexible electronics, and wearable devices, which have rapidly progressed in the past decade.
The shortage of PPE has been reported globally, especially at the early stages of outbreak in various areas, (33) which prevents frontline healthcare workers from replacing their PPE as needed and, under extreme conditions, may even need to reuse them. Therefore, durable antiviral surface coatings on PPE, (34) especially at the junctions of different parts, would be useful to prevent users from being infected and from infecting others.
On the other hand, when the supply of PPE is stabilized, another point of concern is their safe disposal and sustainable waste processing. Disposable PPE, such as facial masks, protective suits, facial shields, gowns, gloves, and boot covers, are mostly made of plastic materials, and they are used in massive quantities in a global pandemic. It will be worthwhile to develop biodegradable PPE for the future, enabling alternative ways to process this waste safely in addition to incineration.

Disposable PPE generates massive quantities of plastic waste, and it will be worthwhile to develop biodegradable PPE for the future, enabling alternative ways to process this waste safely in addition to incineration.

High-Throughput and Reconfigurable Manufacturing

Any innovation in diagnosis, prevention, or treatment of infectious respiratory diseases must be compatible with high-throughput manufacturing to be relevant because the explosive surge in demand puts great stress on the healthcare infrastructure and supply chains. Over the long-term, flexible manufacturing design should be implemented so that the production lines can be readily reconfigured and repurposed to meet the surging demands during a pandemic. Learning from and collaborating with manufacturing engineers would help to accelerate the impact of new discoveries. Innovations that can retrofit existing products (e.g., PPE) or already-installed appliances and surfaces to endow them with antiviral functions would also be desirable.
Testing is crucial for monitoring and containing the spread of all infectious disease. Current virus tests are typically accomplished by first collecting samples and then sending them to centralized analytical facilities for genome extraction, amplification, and analysis. If portable systems with sample-in-result-out rapid turnaround become available and widely deployed, it will enable much faster data acquisition, enabling public health workers and policy makers to respond to an outbreak more rapidly and precisely. To acquire such capability, close collaboration among scientists, engineers, and biomedical researchers will be needed.

If portable systems with sample-in-result-out rapid turnaround become available and widely deployed, it will enable much faster data acquisition, enabling public health workers and policy makers to respond to an outbreak more rapidly and precisely.

Model Systems for Virions

One of the major roadblocks preventing physical scientists and engineers from making more contributions is the lack of access to virions, such as those causing infectious diseases, because access is limited to only a small number of specialized laboratories. Many physical sciences and engineering approaches for virion deactivation are based on rather broad-spectrum mechanisms, and model systems for such studies, at least in the initial stages, do not need to be genome specific nor to contain any genomic material at all. For example, model systems that enable the study of how the lipid envelope bilayer is stabilized and destabilized, how the capsid or nucleocapsid is assembled and disintegrated, or how the virion particles interact with their surroundings in the flying droplets and surfaces after they land, with or without the respiratory mass, would be extremely useful and would help accelerate engineering solutions to slow and to prevent virus transmission and spread and to enhance our overall readiness to respond to any future virus outbreaks.

Outlook

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The COVID-19 pandemic is the type of global challenge that transcends territorial, political, ideological, religious, cultural, and academic boundaries. Researchers in physical sciences and engineering should rally to study such challenges, to develop new hypotheses, to define new research problems, to create user-centered solutions, and to educate ourselves and the general public, so that we can better work with biological and medical researchers to address the many aspects of challenges associated with the transmission and spread of infectious respiratory diseases. (35)

Author Information

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  • Corresponding Author
  • Authors
    • Haiyue Huang - Department of Materials Science and Engineering, Northwestern University, Evanston, Illinois 60208, United States
    • Chunhai Fan - School of Chemistry and Chemical Engineering, Frontiers Science Center for Transformative Molecules, Shanghai Jiao Tong University, Shanghai 200240, China;  Institute of Molecular Medicine, Shanghai Key Laboratory for Nucleic Acid Chemistry and Nanomedicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China;  Orcidhttp://orcid.org/0000-0002-7171-7338
    • Min Li - Department of Laboratory Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
    • Hua-Li Nie - College of Chemistry, Chemical Engineering and Biotechnology, Donghua University, Shanghai 201620, China
    • Fu-Bing Wang - Department of Laboratory Medicine, Zhongnan Hospital of Wuhan University, Wuhan 430071, China
    • Hui Wang - Center for Single-Cell Omics, School of Public Health, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
    • Ruilan Wang - Department of Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 201600, China
    • Jianbo Xia - Department of Laboratory Medicine, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430070, China
    • Xin Zheng - Department of Infectious Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
    • Xiaolei Zuo - School of Chemistry and Chemical Engineering, Frontiers Science Center for Transformative Molecules, Shanghai Jiao Tong University, Shanghai 200240, China;  Institute of Molecular Medicine, Shanghai Key Laboratory for Nucleic Acid Chemistry and Nanomedicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai 200127, China
  • Author Contributions

    H.H. and J.H. drafted the first version of the manuscript. Other authors placed in the middle are alphabetically ordered. All authors made substantial contributions through discussions of ideas, as well as commenting and polishing of the manuscript.

  • Notes
    The authors declare no competing financial interest.

Biographies

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Haiyue Huang ([email protected]) is a graduate student in the Department of Materials Science and Engineering at Northwestern University, Evanston, IL, United States. She believes all problems have solutions, some are just waiting to be created or discovered. She is developing material solutions to enhance personal protection equipment (PPE) for better protecting clinicians.

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Chunhai Fan ([email protected]) is a K.C. Wong Chair Professor at Shanghai Jiao Tong University. He is a member of the Chinese Academy of Sciences, an Associate Editor of ACS Applied Materials & Interfaces, and on the editorial advisory board of ACS Nano. He is conducting research in nucleic acid chemistry and biophotonics.

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Min Li ([email protected]) is the Director of Department of Laboratory Medicine, Renji Hospital, School of Medicine, Shanghai Jiao Tong University. Her work focuses on the pathogenic mechanism and rapid laboratory diagnosis of infectious pathogens. She supervises the laboratory tests in Renji Hospital to assist clinicians in screening for suspected COVID-19 patients.

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Hua-Li Nie ([email protected]) is an Associate Professor in the College of Chemistry, Chemical Engineering and Biotechnology at Donghua University in Shanghai, China. She is conducting research about responsive materials enhanced PPE for healthcare workers.

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Fu-Bing Wang ([email protected]) is a professor in the Department of Laboratory Medicine, Zhongnan Hospital of Wuhan University. He is interested in circulating biomarker and tumor biopsy. He oversees the nucleic acid and antibody tests to help clinicians screen for suspected COVID-19 cases and leads a team to investigate environmental contamination of SARS-CoV-2 in hospitals and methods of mitigation.

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Hui Wang ([email protected]) is the Dean of the School of Public Health, Shanghai Jiao Tong University School of Medicine. Her research areas include drug discovery and molecular pharmacology and toxicology. She is leading a major public health campaign to inform the general public and combat misinformation about COVID-19.

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Ruilan Wang ([email protected]) is a Professor and the Director of Emergency and Critical Care Medicine, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine. She conducts basic and clinical research on severe pneumonia, including viral pneumonia. At the early stage of COVID-19 outbreak in Wuhan, she led a team of ICU clinicians from Shanghai to work in the Wuhan Third Hospital with their counterparts to treat COVID-19 patients for 55 days.

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Jianbo Xia ([email protected]) is the director of the Department of Laboratory Medicine, Maternal and Child Health Hospital of Hubei Province, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. His work focuses on laboratory diagnosis of viral infections. He oversees the laboratory tests in the Maternal and Child Health Hospital of Hubei Province to screen and to evaluate COVID-19 cases.

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Xin Zheng ([email protected]) is a Professor and Director of the Department of Infectious Diseases, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology in Wuhan, China. She is the head of the COVID-19 expert team in her hospital and supervises the isolation wards of COVID-19 patients.

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Xiaolei Zuo ([email protected]) is a Professor in the Institute of Molecular Medicine at Renji Hospital, School of Medicine, Shanghai Jiao Tong University. His research focuses on the biosensor development and biomedical applications. He is developing RNA standard reference material of SARS-CoV-2.

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Jiaxing Huang ([email protected]) is a Professor of Materials Science and Engineering at Northwestern University in Evanston, IL, United States. He is interested in materials innovations for better living. He is developing physical science hypotheses and solutions to mitigate the spread of infectious respiratory diseases.

Acknowledgments

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The authors thank Profs. R.A. Lamb, J. Cao, L.T. Sun, Z.Y. Tang, S.T. Wang, and Dr. H. Park for helpful discussions; S.J. Fodor, C.T. Kang, Prof. Y. Huang, and Drs. L.S. Sapochak, B. Schwenzer, and C.M. Oertel for warm encouragement; E. Huang, A. Morris, and the ACS Nano editorial team for editing and proofreading the manuscript. J.H. thanks the support of the National Science Foundation (RAPID DMR-2026944). The authors salute the healthcare, public health workers, and many others that are at the frontline of this global pandemic and wish to see people breaking the boundaries and working together to create solutions.

References

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    In late Dec., 2019, patients presenting with viral pneumonia due to an unidentified microbial agent were reported in Wuhan, China. A novel coronavirus was subsequently identified as the causative pathogen, provisionally named 2019 novel coronavirus (2019-nCoV). As of Jan 26, 2020, more than 2000 cases of 2019-nCoV infection have been confirmed, most of which involved people living in or visiting Wuhan, and human-to-human transmission has been confirmed. We did next-generation sequencing of samples from bronchoalveolar lavage fluid and cultured isolates from nine inpatients, eight of whom had visited the Huanan seafood market in Wuhan. Complete and partial 2019-nCoV genome sequences were obtained from these individuals. Viral contigs were connected using Sanger sequencing to obtain the full-length genomes, with the terminal regions detd. by rapid amplification of cDNA ends. Phylogenetic anal. of these 2019-nCoV genomes and those of other coronaviruses was used to det. the evolutionary history of the virus and help infer its likely origin. Homol. modeling was done to explore the likely receptor-binding properties of the virus. The ten genome sequences of 2019-nCoV obtained from the nine patients were extremely similar, exhibiting more than 99·98% sequence identity. Notably, 2019-nCoV was closely related (with 88% identity) to two bat-derived severe acute respiratory syndrome (SARS)-like coronaviruses, bat-SL-CoVZC45 and bat-SL-CoVZXC21, collected in 2018 in Zhoushan, eastern China, but were more distant from SARS-CoV (about 79%) and MERS-CoV (about 50%). Phylogenetic anal. revealed that 2019-nCoV fell within the subgenus Sarbecovirus of the genus Betacoronavirus, with a relatively long branch length to its closest relatives bat-SL-CoVZC45 and bat-SL-CoVZXC21, and was genetically distinct from SARS-CoV. Notably, homol. modeling revealed that 2019-nCoV had a similar receptor-binding domain structure to that of SARS-CoV, despite amino acid variation at some key residues.2019-nCoV is sufficiently divergent from SARS-CoV to be considered a new human-infecting betacoronavirus. Although our phylogenetic anal. suggests that bats might be the original host of this virus, an animal sold at the seafood market in Wuhan might represent an intermediate host facilitating the emergence of the virus in humans. Importantly, structural anal. suggests that 2019-nCoV might be able to bind to the angiotensin-converting enzyme 2 receptor in humans. The future evolution, adaptation, and spread of this virus warrant urgent investigation. National Key Research and Development Program of China, National Major Project for Control and Prevention of Infectious Disease in China, Chinese Academy of Sciences, Shandong First Medical University. These data have been deposited in the ChinaNational Microbiol. Data Center (accession no. NMDC10013002 and genome accession nos. NMDC60013002-01 to NMDC60013002-10) and the datafrom BGI have been deposited in the China National GeneBank (accession nos. CNA000733235).
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  3. 3
    Zhu, N.; Zhang, D.; Wang, W.; Li, X.; Yang, B.; Song, J.; Zhao, X.; Huang, B.; Shi, W.; Lu, R.; Niu, P.; Zhan, F.; Ma, X.; Wang, D.; Xu, W.; Wu, G.; Gao, G. F.; Tan, W. A Novel Coronavirus from Patients with Pneumonia in China, 2019. N. Engl. J. Med. 2020, 382, 727– 733,  DOI: 10.1056/NEJMoa2001017
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    A novel coronavirus from patients with pneumonia in China, 2019
    Zhu, Na; Zhang, Dingyu; Wang, Wenling; Li, Xingwang; Yang, Bo; Song, Jingdong; Zhao, Xiang; Huang, Baoying; Shi, Weifeng; Lu, Roujian; Niu, Peihua; Zhan, Faxian; Ma, Xuejun; Wang, Dayan; Xu, Wenbo; Wu, Guizhen; Gao, George F.; Tan, Wenjie
    New England Journal of Medicine (2020), 382 (8), 727-733CODEN: NEJMAG; ISSN:1533-4406. (Massachusetts Medical Society)
    In Dec. 2019, a cluster of patients with pneumonia of unknown cause was linked to a seafood wholesale market in Wuhan, China. A previously unknown betacoronavirus was discovered through the use of unbiased sequencing in samples from patients with pneumonia. Human airway epithelial cells were used to isolate a novel coronavirus, named 2019-nCoV, which formed a clade within the subgenus sarbecovirus, Orthocoronavirinae subfamily. Different from both MERS-CoV and SARS-CoV, 2019-nCoV is the seventh member of the family of coronaviruses that infect humans. Enhanced surveillance and further investigation are ongoing. Complete genome sequences of the three novel coronaviruses were submitted to GISAID (BetaCoV/Wuhan/ IVDC-HB-01/2019, accession ID: EPI_ISL_402119; BetaCoV/Wuhan/IVDC-HB-04/2020, accession ID: EPI_ISL_402120; BetaCoV/Wuhan/IVDC-HB-05/2019, accession ID: EPI_ISL_402121).
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  4. 4
    Wrapp, D.; Wang, N.; Goldsmith, J. A.; Hsieh, C.-L.; McLellan, J. S.; Corbett, K. S.; Abiona, O.; Graham, B. S. Cryo-Em Structure of the 2019-Ncov Spike in the Prefusion Conformation. Science 2020, 367, 1260– 1263,  DOI: 10.1126/science.abb2507
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    Cryo-EM structure of the 2019-nCoV spike in the prefusion conformation
    Wrapp, Daniel; Wang, Nianshuang; Corbett, Kizzmekia S.; Goldsmith, Jory A.; Hsieh, Ching-Lin; Abiona, Olubukola; Graham, Barney S.; McLellan, Jason S.
    Science (Washington, DC, United States) (2020), 367 (6483), 1260-1263CODEN: SCIEAS; ISSN:1095-9203. (American Association for the Advancement of Science)
    The outbreak of a novel coronavirus (2019-nCoV) represents a pandemic threat that has been declared a public health emergency of international concern. The CoV spike (S) glycoprotein is a key target for vaccines, therapeutic antibodies, and diagnostics. To facilitate medical countermeasure development, we detd. a 3.5-angstrom-resoln. cryo-electron microscopy structure of the 2019-nCoV S trimer in the prefusion conformation. The predominant state of the trimer has one of the three receptor-binding domains (RBDs) rotated up in a receptor-accessible conformation. We also provide biophys. and structural evidence that the 2019-nCoV S protein binds angiotensin-converting enzyme 2 (ACE2) with higher affinity than does severe acute respiratory syndrome (SARS)-CoV S. Addnl., we tested several published SARS-CoV RBD-specific monoclonal antibodies and found that they do not have appreciable binding to 2019-nCoV S, suggesting that antibody cross-reactivity may be limited between the two RBDs. The structure of 2019-nCoV S should enable the rapid development and evaluation of medical countermeasures to address the ongoing public health crisis.
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  5. 5
    Weber, T. P.; Stilianakis, N. I. Inactivation of Influenza A Viruses in the Environment and Modes of Transmission: A Critical Review. J. Infect. 2008, 57, 361– 373,  DOI: 10.1016/j.jinf.2008.08.013
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    Inactivation of influenza A viruses in the environment and modes of transmission: a critical review
    Weber Thomas P; Stilianakis Nikolaos I
    The Journal of infection (2008), 57 (5), 361-73 ISSN:.
    OBJECTIVES: The relative importance of airborne, droplet and contact transmission of influenza A virus and the efficiency of control measures depends among other factors on the inactivation of viruses in different environmental media. METHODS: We systematically review available information on the environmental inactivation of influenza A viruses and employ information on infectious dose and results from mathematical models to assess transmission modes. RESULTS: Daily inactivation rate constants differ by several orders of magnitude: on inanimate surfaces and in aerosols daily inactivation rates are in the order of 1-10(2), on hands in the order of 10(3). Influenza virus can survive in aerosols for several hours, on hands for a few minutes. Nasal infectious dose of influenza A is several orders of magnitude larger than airborne infectious dose. CONCLUSIONS: The airborne route is a potentially important transmission pathway for influenza in indoor environments. The importance of droplet transmission has to be reassessed. Contact transmission can be limited by fast inactivation of influenza virus on hands and is more so than airborne transmission dependent on behavioral parameters. However, the potentially large inocula deposited in the environment through sneezing and the protective effect of nasal mucus on virus survival could make contact transmission a key transmission mode.
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  6. 6
    Otter, J. A.; Donskey, C.; Yezli, S.; Douthwaite, S.; Goldenberg, S. D.; Weber, D. J. Transmission of SARS and MERS Coronaviruses and Influenza Virus in Healthcare Settings: The Possible Role of Dry Surface Contamination. J. Hosp. Infect. 2016, 92, 235– 250,  DOI: 10.1016/j.jhin.2015.08.027
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    6
    Transmission of SARS and MERS coronaviruses and influenza virus in healthcare settings: the possible role of dry surface contamination
    Otter J A; Donskey C; Yezli S; Douthwaite S; Goldenberg S D; Weber D J
    The Journal of hospital infection (2016), 92 (3), 235-50 ISSN:.
    Viruses with pandemic potential including H1N1, H5N1, and H5N7 influenza viruses, and severe acute respiratory syndrome (SARS)/Middle East respiratory syndrome (MERS) coronaviruses (CoV) have emerged in recent years. SARS-CoV, MERS-CoV, and influenza virus can survive on surfaces for extended periods, sometimes up to months. Factors influencing the survival of these viruses on surfaces include: strain variation, titre, surface type, suspending medium, mode of deposition, temperature and relative humidity, and the method used to determine the viability of the virus. Environmental sampling has identified contamination in field-settings with SARS-CoV and influenza virus, although the frequent use of molecular detection methods may not necessarily represent the presence of viable virus. The importance of indirect contact transmission (involving contamination of inanimate surfaces) is uncertain compared with other transmission routes, principally direct contact transmission (independent of surface contamination), droplet, and airborne routes. However, influenza virus and SARS-CoV may be shed into the environment and be transferred from environmental surfaces to hands of patients and healthcare providers. Emerging data suggest that MERS-CoV also shares these properties. Once contaminated from the environment, hands can then initiate self-inoculation of mucous membranes of the nose, eyes or mouth. Mathematical and animal models, and intervention studies suggest that contact transmission is the most important route in some scenarios. Infection prevention and control implications include the need for hand hygiene and personal protective equipment to minimize self-contamination and to protect against inoculation of mucosal surfaces and the respiratory tract, and enhanced surface cleaning and disinfection in healthcare settings.
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    Bai, Y.; Yao, L.; Wei, T.; Tian, F.; Jin, D. Y.; Chen, L.; Wang, M. Presumed Asymptomatic Carrier Transmission of Covid-19. JAMA 2020,  DOI: 10.1001/jama.2020.2565
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    Hu, Z.; Song, C.; Xu, C.; Jin, G.; Chen, Y.; Xu, X.; Ma, H.; Chen, W.; Lin, Y.; Zheng, Y.; Wang, J.; Hu, Z.; Yi, Y.; Shen, H. Clinical Characteristics of 24 Asymptomatic Infections with COVID-19 Screened among Close Contacts in Nanjing, China. Sci. China: Life Sci. 2020,  DOI: 10.1007/s11427-020-1661-4
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    Aguilar, J. B.; Gutierrez, J. B. Investigating the Impact of Asymptomatic Carriers on COVID-19 Transmission. medRxiv 2020,  DOI: 10.1101/2020.03.18.20037994
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    Flint, S. J.; Racaniello, V. R.; Rall, G. F.; Skalka, A. M. Principles of Virology; American Society for Microbiology, 2015.
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    Wigginton, K. R.; Pecson, B. M.; Sigstam, T.; Bosshard, F.; Kohn, T. Virus Inactivation Mechanisms: Impact of Disinfectants on Virus Function and Structural Integrity. Environ. Sci. Technol. 2012, 46, 12069– 12078,  DOI: 10.1021/es3029473
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    Virus inactivation mechanisms: impact of disinfectants on virus function and structural integrity
    Wigginton, Krista Rule; Pecson, Brian M.; Sigstam, Therese; Bosshard, Franziska; Kohn, Tamar
    Environmental Science & Technology (2012), 46 (21), 12069-12078CODEN: ESTHAG; ISSN:0013-936X. (American Chemical Society)
    Oxidative processes are often harnessed as tools for pathogen disinfection. Although the pathways responsible for bacterial inactivation with various biocides are fairly well understood, virus inactivation mechanisms are often contradictory or equivocal. In this study, the authors provide a quant. anal. of the total damage incurred by a model virus (bacteriophage MS2) upon inactivation induced by five common virucidal agents (heat, UV, hypochlorous acid, singlet oxygen, and chlorine dioxide). Each treatment targets one or more virus functions to achieve inactivation. UV, singlet oxygen, and hypochlorous acid treatments generally render the genome nonreplicable, whereas chlorine dioxide and heat inhibit host-cell recognition/binding. Using a combination of quant. anal. tools, the authors identified unique patterns of mol. level modifications in the virus proteins or genome that lead to the inhibition of these functions and eventually inactivation. UV and chlorine treatments, for example, cause site-specific capsid protein backbone cleavage that inhibits viral genome injection into the host cell. These results should aid in developing better methods for combating waterborne and foodborne viral pathogens and further our understanding of the adaptive changes viruses undergo in response to natural and anthropogenic stressors.
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    Kampf, G.; Todt, D.; Pfaender, S.; Steinmann, E. Persistence of Coronaviruses on Inanimate Surfaces and their Inactivation with Biocidal Agents. J. Hosp. Infect. 2020, 104, 246– 251,  DOI: 10.1016/j.jhin.2020.01.022
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    12
    Persistence of coronaviruses on inanimate surfaces and their inactivation with biocidal agents
    Kampf G; Todt D; Pfaender S; Steinmann E
    The Journal of hospital infection (2020), 104 (3), 246-251 ISSN:.
    Currently, the emergence of a novel human coronavirus, SARS-CoV-2, has become a global health concern causing severe respiratory tract infections in humans. Human-to-human transmissions have been described with incubation times between 2-10 days, facilitating its spread via droplets, contaminated hands or surfaces. We therefore reviewed the literature on all available information about the persistence of human and veterinary coronaviruses on inanimate surfaces as well as inactivation strategies with biocidal agents used for chemical disinfection, e.g. in healthcare facilities. The analysis of 22 studies reveals that human coronaviruses such as Severe Acute Respiratory Syndrome (SARS) coronavirus, Middle East Respiratory Syndrome (MERS) coronavirus or endemic human coronaviruses (HCoV) can persist on inanimate surfaces like metal, glass or plastic for up to 9 days, but can be efficiently inactivated by surface disinfection procedures with 62-71% ethanol, 0.5% hydrogen peroxide or 0.1% sodium hypochlorite within 1 minute. Other biocidal agents such as 0.05-0.2% benzalkonium chloride or 0.02% chlorhexidine digluconate are less effective. As no specific therapies are available for SARS-CoV-2, early containment and prevention of further spread will be crucial to stop the ongoing outbreak and to control this novel infectious thread.
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    Li, Y. The Secret Behind the Mask. Indoor Air 2011, 21, 89– 91,  DOI: 10.1111/j.1600-0668.2011.00711.x
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    The secret behind the mask
    Li Yuguo
    Indoor air (2011), 21 (2), 89-91 ISSN:.
    There is no expanded citation for this reference.
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    Li, X.-p.; Niu, J.-l.; Gao, N.-p. Characteristics of Physical Blocking on Co-Occupant’s Exposure to Respiratory Droplet Residuals. J. Cent. South Univ. 2012, 19, 645– 650,  DOI: 10.1007/s11771-012-1051-0
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    Characteristics of physical blocking on co-occupant's exposure to respiratory droplet residuals
    Li, Xiao-ping; Niu, Jian-lei; Gao, Nai-ping
    Journal of Central South University (English Edition) (2012), 19 (3), 645-650CODEN: JCSUBS; ISSN:2095-2899. (Central South University)
    Existed evidences show that airborne transmission of human respiratory droplets may be related with the spread of some infectious disease, such as severe acute respiratory syndrome (SARS) and H1N1 pandemic. Non-pharmaceutical approaches, including ventilation system and personal protection, are believed to have certain pos. effects on the redn. of co-occupant's inhalation. This work then aims to numerically study the performances of mouth covering on co-occupant's exposure under mixing ventilation (MV), under-floor air distribution (UFAD) and displacement ventilation (DV) system, using drift-flux model. Desk partition, as one generally employed arrangement in plan office, is also investigated under MV. The dispersion of 1, 5 and 10 μm droplet residuals are numerically calcd. and CO2 is used to represent tracer gas. The results show that using mouth covering by the infected person can reduce the co-occupant's inhalation greatly by interrupting direct spread of the expelled droplets, and best performance can be achieved under DV since the coughed air is mainly confined in the microenvironment of the infected person. The researches under MV show that the two interventions, mouth covering and desk partition, achieve almost the same inhalation for fine droplets while the inhalation of the co-occupant is lower when using mouth covering for large droplets.
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  15. 15
    Zhou, P.; Yang, X. L.; Wang, X. G.; Hu, B.; Zhang, L.; Zhang, W.; Si, H. R.; Zhu, Y.; Li, B.; Huang, C. L.; Chen, H. D.; Chen, J.; Luo, Y.; Guo, H.; Jiang, R. D.; Liu, M. Q.; Chen, Y.; Shen, X. R.; Wang, X.; Zheng, X. S. A Pneumonia Outbreak Associated with a New Coronavirus of Probable Bat Origin. Nature 2020, 579, 270– 273,  DOI: 10.1038/s41586-020-2012-7
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    A pneumonia outbreak associated with a new coronavirus of probable bat origin
    Zhou, Peng; Yang, Xing-Lou; Wang, Xian-Guang; Hu, Ben; Zhang, Lei; Zhang, Wei; Si, Hao-Rui; Zhu, Yan; Li, Bei; Huang, Chao-Lin; Chen, Hui-Dong; Chen, Jing; Luo, Yun; Guo, Hua; Jiang, Ren-Di; Liu, Mei-Qin; Chen, Ying; Shen, Xu-Rui; Wang, Xi; Zheng, Xiao-Shuang; Zhao, Kai; Chen, Quan-Jiao; Deng, Fei; Liu, Lin-Lin; Yan, Bing; Zhan, Fa-Xian; Wang, Yan-Yi; Xiao, Geng-Fu; Shi, Zheng-Li
    Nature (London, United Kingdom) (2020), 579 (7798), 270-273CODEN: NATUAS; ISSN:0028-0836. (Nature Research)
    Abstr.: Since the outbreak of severe acute respiratory syndrome (SARS) 18 years ago, a large no. of SARS-related coronaviruses (SARSr-CoVs) have been discovered in their natural reservoir host, bats1-4. Previous studies have shown that some bat SARSr-CoVs have the potential to infect humans5-7. Here we report the identification and characterization of a new coronavirus (2019-nCoV), which caused an epidemic of acute respiratory syndrome in humans in Wuhan, China. The epidemic, which started on 12 Dec. 2019, had caused 2,794 lab.-confirmed infections including 80 deaths by 26 Jan. 2020. Full-length genome sequences were obtained from five patients at an early stage of the outbreak. The sequences are almost identical and share 79.6% sequence identity to SARS-CoV. Furthermore, we show that 2019-nCoV is 96% identical at the whole-genome level to a bat coronavirus. Pairwise protein sequence anal. of seven conserved non-structural proteins domains show that this virus belongs to the species of SARSr-CoV. In addn., 2019-nCoV virus isolated from the bronchoalveolar lavage fluid of a critically ill patient could be neutralized by sera from several patients. Notably, we confirmed that 2019-nCoV uses the same cell entry receptor-angiotensin converting enzyme II (ACE2)-as SARS-CoV.
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    Liu, L.; Wei, J.; Li, Y.; Ooi, A. Evaporation and Dispersion of Respiratory Droplets from Coughing. Indoor Air 2017, 27, 179– 190,  DOI: 10.1111/ina.12297
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    Evaporation and dispersion of respiratory droplets from coughing
    Liu, L.; Wei, J.; Li, Y.; Ooi, A.
    Indoor Air (2017), 27 (1), 179-190CODEN: INAIE5; ISSN:1600-0668. (Wiley-Blackwell)
    Understanding how respiratory droplets become droplet nuclei and their dispersion is essential for understanding the mechanisms and control of disease transmission via droplet-borne and airborne routes. A theor. model was developed to est. the size of droplet nuclei and their dispersion as a function of the ambient humidity and droplet compn. The model-predicted dried droplet nuclei size was 32% of the original diam., which agrees with the max. residue size in the classic study by Duguid, 1946, Edinburg Med. J.,52, 335 and the validation expt. in this study, but is smaller than the 50% size predicted by Nicas et al., 2005, J. Occup. Environ. Hyg., 2, 143. The droplet nuclei size at a relative humidity of 90% (25°C) could be 30% larger than the size of the same droplet at a relative humidity of less than 67.3% (25°C). The trajectories of respiratory droplets in a cough jet are significantly affected by turbulence, which promotes the wide dispersion of droplets. We found that medium-sized droplets (e.g., 60 μm) are more influenced by humidity than are smaller and larger droplets, while large droplets (≥100 μm), whose travel is less influenced by humidity, quickly settle out of the jet.
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    Vejerano, E. P.; Marr, L. C. Physico-Chemical Characteristics of Evaporating Respiratory Fluid Droplets. J. R. Soc., Interface 2018, 15, 20170939,  DOI: 10.1098/rsif.2017.0939
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    Physico-chemical characteristics of evaporating respiratory fluid droplets
    Vejerano, Eric P.; Marr, Linsey C.
    Journal of the Royal Society, Interface (2018), 15 (139), 20170939/1-20170939/10CODEN: JRSICU; ISSN:1742-5662. (Royal Society)
    The detailed physico-chem. characteristics of respiratory droplets in ambient air, where they are subject to evapn., are poorly understood. Changes in the concn. and phase of major components in a droplet-salt (NaCl), protein (mucin) and surfactant (dipalmitoylphosphatidylcholine)-may affect the viability of any pathogens contained within it and thus may affect the efficiency of transmission of infectious disease by droplets and aerosols. The objective of this study is to investigate the effect of relative humidity (RH) on the physico-chem. characteristics of evapg. droplets of model respiratory fluids. We labeled these components in model respiratory fluids and obsd. evapg. droplets suspended on a superhydrophobic surface using optical and fluorescence microscopy. When exposed to continuously decreasing RH, droplets of different model respiratory fluids assumed different morphologies. Loss of water induced phase sepn. as well as indication of a decrease in pH. The presence of surfactant inhibited the rapid rehydration of the non-volatile components. An enveloped virus, φ6, that has been proposed as a surrogate for influenza virus appeared to be homogeneously distributed throughout the dried droplet. We hypothesize that the increasing acidity and salinity in evapg. respiratory droplets may affect the structure of the virus, although at low enough RH, crystn. of the droplet components may eliminate their harmful effects.
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    Li, J.; Bao, Z.; Liu, S.; Zhuang, D.; Liu, Y.; Zhang, W.; Jiang, L. Survival Study of SARS Virus in Vitro. Chin. J. Disinfection 2003, 20, 3
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    van Doremalen, N.; Bushmaker, T.; Morris, D. H.; Holbrook, M. G.; Gamble, A.; Williamson, B. N.; Tamin, A.; Harcourt, J. L.; Thornburg, N. J.; Gerber, S. I.; Lloyd-Smith, J. O.; de Wit, E.; Munster, V. J. Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1. N. Engl. J. Med. 2020,  DOI: 10.1056/NEJMc2004973
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    de Gennes, P.-G.; Brochard-Wyart, F. O.; Quéré, D. Capillarity and Wetting Phenomena: Drops, Bubbles, Pearls, Waves; Springer: New York, 2004.
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    Koch, K.; Barthlott, W. Superhydrophobic and Superhydrophilic Plant Surfaces: An Inspiration for Biomimetic Materials. Philos. Trans. R. Soc., A 2009, 367, 1487– 1509,  DOI: 10.1098/rsta.2009.0022
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    Superhydrophobic and superhydrophilic plant surfaces: an inspiration for biomimetic materials
    Koch, Kerstin; Barthlott, Wilhelm
    Philosophical Transactions of the Royal Society, A: Mathematical, Physical & Engineering Sciences (2009), 367 (1893), 1487-1509CODEN: PTRMAD; ISSN:1364-503X. (Royal Society)
    A review. The diversity of plant surface structures, evolved over 460 million years, has led to a large variety of highly adapted functional structures. The plant cuticle provides structural and chem. modifications for surface wetting, ranging from superhydrophilic to superhydrophobic. In this paper, the structural basics of superhydrophobic and superhydrophilic plant surfaces and their biol. functions are introduced. Wetting in plants is influenced by the sculptures of the cells and by the fine structure of the surfaces, such as folding of the cuticle, or by epicuticular waxes. Hierarchical structures in plant surfaces are shown and further types of plant surface structuring leading to superhydrophobicity and superhydrophilicity are presented. The existing and potential uses of superhydrophobic and superhydrophilic surfaces for self-cleaning, drag redn. during moving in water, capillary liq. transport and other biomimetic materials are shown.
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    Cox, C. S. Roles of Water Molecules in Bacteria and Viruses. Origins Life Evol. Biospheres 1993, 23, 29– 36,  DOI: 10.1007/BF01581988
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    Assessment of the risks posed by severe acute respiratory syndrome (SARS) coronavirus (SARS-CoV) on surfaces requires data on survival of this virus on environmental surfaces and on how survival is affected by environmental variables, such as air temp. (AT) and relative humidity (RH). The use of surrogate viruses has the potential to overcome the challenges of working with SARS-CoV and to increase the available data on coronavirus survival on surfaces. Two potential surrogates were evaluated in this study; transmissible gastroenteritis virus (TGEV) and mouse hepatitis virus (MHV) were used to det. effects of AT and RH on the survival of coronaviruses on stainless steel. At 4°C, infectious virus persisted for as long as 28 days, and the lowest level of inactivation occurred at 20% RH. Inactivation was more rapid at 20°C than at 4°C at all humidity levels; the viruses persisted for 5 to 28 days, and the slowest inactivation occurred at low RH. Both viruses were inactivated more rapidly at 40°C than at 20°C. The relationship between inactivation and RH was not monotonic, and there was greater survival or a greater protective effect at low RH (20%) and high RH (80%) than at moderate RH (50%). There was also evidence of an interaction between AT and RH. The results show that when high nos. of viruses are deposited, TGEV and MHV may survive for days on surfaces at ATs and RHs typical of indoor environments. TGEV and MHV could serve as conservative surrogates for modeling exposure, the risk of transmission, and control measures for pathogenic enveloped viruses, such as SARS-CoV and influenza virus, on health care surfaces.
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    ACS Nano (2011), 5 (11), 8943-8949CODEN: ANCAC3; ISSN:1936-0851. (American Chemical Society)
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    With the imminent pandemic, health authorities need to decide rapidly whether they should adopt mass masking in their own localities and make advance prepns. to avoid confusion and chaos in the anticipated challenges ahead.
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    Antiviral Research (2012), 93 (2), 225-233CODEN: ARSRDR; ISSN:0166-3542. (Elsevier B.V.)
    The effect of cotton textiles contg. Cu2+ held by zeolites (CuZeo-textile) on the inactivation of H5 subtype viruses was examd. Allantoic fluid (AF) contg. a virus (AF virus) (0.1 mL) was applied to the textile (3 × 3-cm), and incubated for a specific period at ambient temp. After each incubation, 0.9 mL of culture medium was added followed by squeezing to recover the virus into the medium. The recovered virus was titrated using Madin-Darby canine kidney (MDCK) cells or 10-day-old embryonated chicken eggs. The highly pathogenic H5N1 and the low pathogenic H5N3 viruses were inactivated on the CuZeo-textile, even after short incubation. The titer of A/chicken/Yamaguchi/7/04 (H5N1) in MDCK cells and in eggs declined by >5.0 log10 and 5.0 log10, resp., in 30 s. The titer of A/whooper swan/Hokkaido/1/08 (H5N1) in MDCK cells declined by 2.3 and 3.5 in 1 and 5 min, resp. When A/whistling swan/Shimane/499/83 (H5N3) was treated on the CuZeo-textile for 10 min, the titer declined by >5.0 log10 in MDCK cells and by >3.5 log10 in eggs. In contrast, no decrease in the titers was obsd. on cotton textiles contg. zeolites alone (Zeo-textile). Neither cytopathic effects nor NP antigens were detected in MDCK cells inoculated with the H5N1 virus treated on the CuZeo-textile. The viral genes (H5, N1, M, and NP) were amplified from the virus treated on the CuZeo-textile by RT-PCR. The hemagglutinating activity of the CuZeo-textile treated virus was unaffected, indicating that virus-receptor interactions were maintained. Electron microscopic anal. revealed a small no. of particles with morphol. abnormalities in the H5N3 virus samples recovered immediately from the CuZeo-textile, while no particles were detectable in the 10-min treated sample, suggesting the rapid destruction of virions by the Cu2+ in the CuZeo-textile. The loss of infectivity of H5 viruses could, therefore, be due to the destruction of virions by Cu2+. Interestingly, CuCl2 treatment (500 and 5000 μM) did not have an antiviral effect on the AF viruses (H5N1 and H5N3) even after 48 h of incubation, although the titer of the purified H5N3 virus treated with CuCl2 declined greatly. The antiviral effect was inhibited by adding the AF to the purified H5N3 virus prior to the CuCl2 treatment. The known antibacterial/antifungal activities of copper suggest that the CuZeo-textile can be applied at a high level of hygiene in both animals and humans.
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    A review. Re-emergence of resistance in different pathogens including viruses are the major cause of human disease and death, which is posing a serious challenge to the medical, pharmaceutical and biotechnol. sectors. Though many efforts have been made to develop drug and vaccines against re-emerging viruses, researchers are continuously engaged in the development of novel, cheap and broad-spectrum antiviral agents, not only to fight against viruses but also to act as a protective shield against pathogens attack. Current advancement in nanotechnol. provides a novel platform for the development of potential and effective agents by modifying the materials at nanolevel with remarkable physicochem. properties, high surface area to vol. ratio and increased reactivity. Among metal nanoparticles, silver nanoparticles have strong antibacterial, antifungal and antiviral potential to boost the host immunity against pathogen attack. Nevertheless, the interaction of silver nanoparticles with viruses is a largely unexplored field. The present review discusses antiviral activity of the metal nanoparticles, esp. the mechanism of action of silver nanoparticles, against different viruses such HSV, HIV, HBV, MPV, RSV, etc. It is also focused on how silver nanoparticles can be used in therapeutics by considering their cytotoxic level, to avoid human and environmental risks.
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  • Abstract

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    Figure 1

    Figure 1. Graphic illustrating common transmission pathways of respiratory diseases, which start with an infected person releasing virion-laden respiratory fluid droplets (left). Within close proximity, other people could be infected by directly inhaling airborne droplets or dried nuclei or by receiving virions through contact transfer. Indirect fomite infection occurs when virion-laden nuclei are picked up from contaminated surfaces (e.g., by hands) and then delivered to the mouth, nose, or eyes. There are many opportunities to set up several layers of defense barriers (dashed lines a–f) along the infection pathways to remove or to deactivate virions before they reach the next person.

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    Figure 2

    Figure 2. Structural model of a coronavirus particle, showing the nucleocapsid coil (green) inside an envelope (brown) with protruding spike proteins (red). The inset shows the bilayer structure of the envelope and a segment of the nucleocapsid.

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    Figure 3

    Figure 3. Typical components of a virus-laden respiratory fluid droplet. As it shrinks during evaporation, all components are concentrated. Finally, the virus particles are embedded in a semidried mass called “nuclei”.

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    Figure 4

    Figure 4. (a) Photo showing a typical set of personal protection equipment used by clinicians tending COVID-19 patients in Wuhan, China, including N95 respirator, protective suit (with marker-written information for identification purposes), gloves, goggles, and boot covers (shown in b). (b) Additional medical mask, spill gown, and face shield are used before entering the isolation ward. (c) Additional helmet with pressured air (on the right) is needed before tracheal intubation procedures for COVID-19 patients. Image credit: Zhengyu Liu.

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  • References

    This article references 35 other publications.

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      There is no corresponding record for this reference.
    2. 2
      Lu, R.; Zhao, X.; Li, J.; Niu, P.; Yang, B.; Wu, H.; Wang, W.; Song, H.; Huang, B.; Zhu, N.; Bi, Y.; Ma, X.; Zhan, F.; Wang, L.; Hu, T.; Zhou, H.; Hu, Z.; Zhou, W.; Zhao, L.; Chen, J. Genomic Characterisation and Epidemiology of 2019 Novel Coronavirus: Implications for Virus Origins and Receptor Binding. Lancet 2020, 395, 565– 574,  DOI: 10.1016/S0140-6736(20)30251-8
      2
      Genomic characterisation and epidemiology of 2019 novel coronavirus: implications for virus origins and receptor binding
      Lu, Roujian; Zhao, Xiang; Li, Juan; Niu, Peihua; Yang, Bo; Wu, Honglong; Wang, Wenling; Song, Hao; Huang, Baoying; Zhu, Na; Bi, Yuhai; Ma, Xuejun; Zhan, Faxian; Wang, Liang; Hu, Tao; Zhou, Hong; Hu, Zhenhong; Zhou, Weimin; Zhao, Li; Chen, Jing; Meng, Yao; Wang, Ji; Lin, Yang; Yuan, Jianying; Xie, Zhihao; Ma, Jinmin; Liu, William J.; Wang, Dayan; Xu, Wenbo; Holmes, Edward C.; Gao, George F.; Wu, Guizhen; Chen, Weijun; Shi, Weifeng; Tan, Wenjie
      Lancet (2020), 395 (10224), 565-574CODEN: LANCAO; ISSN:0140-6736. (Elsevier Ltd.)
      In late Dec., 2019, patients presenting with viral pneumonia due to an unidentified microbial agent were reported in Wuhan, China. A novel coronavirus was subsequently identified as the causative pathogen, provisionally named 2019 novel coronavirus (2019-nCoV). As of Jan 26, 2020, more than 2000 cases of 2019-nCoV infection have been confirmed, most of which involved people living in or visiting Wuhan, and human-to-human transmission has been confirmed. We did next-generation sequencing of samples from bronchoalveolar lavage fluid and cultured isolates from nine inpatients, eight of whom had visited the Huanan seafood market in Wuhan. Complete and partial 2019-nCoV genome sequences were obtained from these individuals. Viral contigs were connected using Sanger sequencing to obtain the full-length genomes, with the terminal regions detd. by rapid amplification of cDNA ends. Phylogenetic anal. of these 2019-nCoV genomes and those of other coronaviruses was used to det. the evolutionary history of the virus and help infer its likely origin. Homol. modeling was done to explore the likely receptor-binding properties of the virus. The ten genome sequences of 2019-nCoV obtained from the nine patients were extremely similar, exhibiting more than 99·98% sequence identity. Notably, 2019-nCoV was closely related (with 88% identity) to two bat-derived severe acute respiratory syndrome (SARS)-like coronaviruses, bat-SL-CoVZC45 and bat-SL-CoVZXC21, collected in 2018 in Zhoushan, eastern China, but were more distant from SARS-CoV (about 79%) and MERS-CoV (about 50%). Phylogenetic anal. revealed that 2019-nCoV fell within the subgenus Sarbecovirus of the genus Betacoronavirus, with a relatively long branch length to its closest relatives bat-SL-CoVZC45 and bat-SL-CoVZXC21, and was genetically distinct from SARS-CoV. Notably, homol. modeling revealed that 2019-nCoV had a similar receptor-binding domain structure to that of SARS-CoV, despite amino acid variation at some key residues.2019-nCoV is sufficiently divergent from SARS-CoV to be considered a new human-infecting betacoronavirus. Although our phylogenetic anal. suggests that bats might be the original host of this virus, an animal sold at the seafood market in Wuhan might represent an intermediate host facilitating the emergence of the virus in humans. Importantly, structural anal. suggests that 2019-nCoV might be able to bind to the angiotensin-converting enzyme 2 receptor in humans. The future evolution, adaptation, and spread of this virus warrant urgent investigation. National Key Research and Development Program of China, National Major Project for Control and Prevention of Infectious Disease in China, Chinese Academy of Sciences, Shandong First Medical University. These data have been deposited in the ChinaNational Microbiol. Data Center (accession no. NMDC10013002 and genome accession nos. NMDC60013002-01 to NMDC60013002-10) and the datafrom BGI have been deposited in the China National GeneBank (accession nos. CNA000733235).
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    3. 3
      Zhu, N.; Zhang, D.; Wang, W.; Li, X.; Yang, B.; Song, J.; Zhao, X.; Huang, B.; Shi, W.; Lu, R.; Niu, P.; Zhan, F.; Ma, X.; Wang, D.; Xu, W.; Wu, G.; Gao, G. F.; Tan, W. A Novel Coronavirus from Patients with Pneumonia in China, 2019. N. Engl. J. Med. 2020, 382, 727– 733,  DOI: 10.1056/NEJMoa2001017
      3
      A novel coronavirus from patients with pneumonia in China, 2019
      Zhu, Na; Zhang, Dingyu; Wang, Wenling; Li, Xingwang; Yang, Bo; Song, Jingdong; Zhao, Xiang; Huang, Baoying; Shi, Weifeng; Lu, Roujian; Niu, Peihua; Zhan, Faxian; Ma, Xuejun; Wang, Dayan; Xu, Wenbo; Wu, Guizhen; Gao, George F.; Tan, Wenjie
      New England Journal of Medicine (2020), 382 (8), 727-733CODEN: NEJMAG; ISSN:1533-4406. (Massachusetts Medical Society)
      In Dec. 2019, a cluster of patients with pneumonia of unknown cause was linked to a seafood wholesale market in Wuhan, China. A previously unknown betacoronavirus was discovered through the use of unbiased sequencing in samples from patients with pneumonia. Human airway epithelial cells were used to isolate a novel coronavirus, named 2019-nCoV, which formed a clade within the subgenus sarbecovirus, Orthocoronavirinae subfamily. Different from both MERS-CoV and SARS-CoV, 2019-nCoV is the seventh member of the family of coronaviruses that infect humans. Enhanced surveillance and further investigation are ongoing. Complete genome sequences of the three novel coronaviruses were submitted to GISAID (BetaCoV/Wuhan/ IVDC-HB-01/2019, accession ID: EPI_ISL_402119; BetaCoV/Wuhan/IVDC-HB-04/2020, accession ID: EPI_ISL_402120; BetaCoV/Wuhan/IVDC-HB-05/2019, accession ID: EPI_ISL_402121).
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    4. 4
      Wrapp, D.; Wang, N.; Goldsmith, J. A.; Hsieh, C.-L.; McLellan, J. S.; Corbett, K. S.; Abiona, O.; Graham, B. S. Cryo-Em Structure of the 2019-Ncov Spike in the Prefusion Conformation. Science 2020, 367, 1260– 1263,  DOI: 10.1126/science.abb2507
      4
      Cryo-EM structure of the 2019-nCoV spike in the prefusion conformation
      Wrapp, Daniel; Wang, Nianshuang; Corbett, Kizzmekia S.; Goldsmith, Jory A.; Hsieh, Ching-Lin; Abiona, Olubukola; Graham, Barney S.; McLellan, Jason S.
      Science (Washington, DC, United States) (2020), 367 (6483), 1260-1263CODEN: SCIEAS; ISSN:1095-9203. (American Association for the Advancement of Science)
      The outbreak of a novel coronavirus (2019-nCoV) represents a pandemic threat that has been declared a public health emergency of international concern. The CoV spike (S) glycoprotein is a key target for vaccines, therapeutic antibodies, and diagnostics. To facilitate medical countermeasure development, we detd. a 3.5-angstrom-resoln. cryo-electron microscopy structure of the 2019-nCoV S trimer in the prefusion conformation. The predominant state of the trimer has one of the three receptor-binding domains (RBDs) rotated up in a receptor-accessible conformation. We also provide biophys. and structural evidence that the 2019-nCoV S protein binds angiotensin-converting enzyme 2 (ACE2) with higher affinity than does severe acute respiratory syndrome (SARS)-CoV S. Addnl., we tested several published SARS-CoV RBD-specific monoclonal antibodies and found that they do not have appreciable binding to 2019-nCoV S, suggesting that antibody cross-reactivity may be limited between the two RBDs. The structure of 2019-nCoV S should enable the rapid development and evaluation of medical countermeasures to address the ongoing public health crisis.
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    5. 5
      Weber, T. P.; Stilianakis, N. I. Inactivation of Influenza A Viruses in the Environment and Modes of Transmission: A Critical Review. J. Infect. 2008, 57, 361– 373,  DOI: 10.1016/j.jinf.2008.08.013
      5
      Inactivation of influenza A viruses in the environment and modes of transmission: a critical review
      Weber Thomas P; Stilianakis Nikolaos I
      The Journal of infection (2008), 57 (5), 361-73 ISSN:.
      OBJECTIVES: The relative importance of airborne, droplet and contact transmission of influenza A virus and the efficiency of control measures depends among other factors on the inactivation of viruses in different environmental media. METHODS: We systematically review available information on the environmental inactivation of influenza A viruses and employ information on infectious dose and results from mathematical models to assess transmission modes. RESULTS: Daily inactivation rate constants differ by several orders of magnitude: on inanimate surfaces and in aerosols daily inactivation rates are in the order of 1-10(2), on hands in the order of 10(3). Influenza virus can survive in aerosols for several hours, on hands for a few minutes. Nasal infectious dose of influenza A is several orders of magnitude larger than airborne infectious dose. CONCLUSIONS: The airborne route is a potentially important transmission pathway for influenza in indoor environments. The importance of droplet transmission has to be reassessed. Contact transmission can be limited by fast inactivation of influenza virus on hands and is more so than airborne transmission dependent on behavioral parameters. However, the potentially large inocula deposited in the environment through sneezing and the protective effect of nasal mucus on virus survival could make contact transmission a key transmission mode.
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    6. 6
      Otter, J. A.; Donskey, C.; Yezli, S.; Douthwaite, S.; Goldenberg, S. D.; Weber, D. J. Transmission of SARS and MERS Coronaviruses and Influenza Virus in Healthcare Settings: The Possible Role of Dry Surface Contamination. J. Hosp. Infect. 2016, 92, 235– 250,  DOI: 10.1016/j.jhin.2015.08.027
      6
      Transmission of SARS and MERS coronaviruses and influenza virus in healthcare settings: the possible role of dry surface contamination
      Otter J A; Donskey C; Yezli S; Douthwaite S; Goldenberg S D; Weber D J
      The Journal of hospital infection (2016), 92 (3), 235-50 ISSN:.
      Viruses with pandemic potential including H1N1, H5N1, and H5N7 influenza viruses, and severe acute respiratory syndrome (SARS)/Middle East respiratory syndrome (MERS) coronaviruses (CoV) have emerged in recent years. SARS-CoV, MERS-CoV, and influenza virus can survive on surfaces for extended periods, sometimes up to months. Factors influencing the survival of these viruses on surfaces include: strain variation, titre, surface type, suspending medium, mode of deposition, temperature and relative humidity, and the method used to determine the viability of the virus. Environmental sampling has identified contamination in field-settings with SARS-CoV and influenza virus, although the frequent use of molecular detection methods may not necessarily represent the presence of viable virus. The importance of indirect contact transmission (involving contamination of inanimate surfaces) is uncertain compared with other transmission routes, principally direct contact transmission (independent of surface contamination), droplet, and airborne routes. However, influenza virus and SARS-CoV may be shed into the environment and be transferred from environmental surfaces to hands of patients and healthcare providers. Emerging data suggest that MERS-CoV also shares these properties. Once contaminated from the environment, hands can then initiate self-inoculation of mucous membranes of the nose, eyes or mouth. Mathematical and animal models, and intervention studies suggest that contact transmission is the most important route in some scenarios. Infection prevention and control implications include the need for hand hygiene and personal protective equipment to minimize self-contamination and to protect against inoculation of mucosal surfaces and the respiratory tract, and enhanced surface cleaning and disinfection in healthcare settings.
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    7. 7
      Bai, Y.; Yao, L.; Wei, T.; Tian, F.; Jin, D. Y.; Chen, L.; Wang, M. Presumed Asymptomatic Carrier Transmission of Covid-19. JAMA 2020,  DOI: 10.1001/jama.2020.2565
      There is no corresponding record for this reference.
    8. 8
      Hu, Z.; Song, C.; Xu, C.; Jin, G.; Chen, Y.; Xu, X.; Ma, H.; Chen, W.; Lin, Y.; Zheng, Y.; Wang, J.; Hu, Z.; Yi, Y.; Shen, H. Clinical Characteristics of 24 Asymptomatic Infections with COVID-19 Screened among Close Contacts in Nanjing, China. Sci. China: Life Sci. 2020,  DOI: 10.1007/s11427-020-1661-4
      There is no corresponding record for this reference.
    9. 9
      Aguilar, J. B.; Gutierrez, J. B. Investigating the Impact of Asymptomatic Carriers on COVID-19 Transmission. medRxiv 2020,  DOI: 10.1101/2020.03.18.20037994
      There is no corresponding record for this reference.
    10. 10
      Flint, S. J.; Racaniello, V. R.; Rall, G. F.; Skalka, A. M. Principles of Virology; American Society for Microbiology, 2015.
      There is no corresponding record for this reference.
    11. 11
      Wigginton, K. R.; Pecson, B. M.; Sigstam, T.; Bosshard, F.; Kohn, T. Virus Inactivation Mechanisms: Impact of Disinfectants on Virus Function and Structural Integrity. Environ. Sci. Technol. 2012, 46, 12069– 12078,  DOI: 10.1021/es3029473
      11
      Virus inactivation mechanisms: impact of disinfectants on virus function and structural integrity
      Wigginton, Krista Rule; Pecson, Brian M.; Sigstam, Therese; Bosshard, Franziska; Kohn, Tamar
      Environmental Science & Technology (2012), 46 (21), 12069-12078CODEN: ESTHAG; ISSN:0013-936X. (American Chemical Society)
      Oxidative processes are often harnessed as tools for pathogen disinfection. Although the pathways responsible for bacterial inactivation with various biocides are fairly well understood, virus inactivation mechanisms are often contradictory or equivocal. In this study, the authors provide a quant. anal. of the total damage incurred by a model virus (bacteriophage MS2) upon inactivation induced by five common virucidal agents (heat, UV, hypochlorous acid, singlet oxygen, and chlorine dioxide). Each treatment targets one or more virus functions to achieve inactivation. UV, singlet oxygen, and hypochlorous acid treatments generally render the genome nonreplicable, whereas chlorine dioxide and heat inhibit host-cell recognition/binding. Using a combination of quant. anal. tools, the authors identified unique patterns of mol. level modifications in the virus proteins or genome that lead to the inhibition of these functions and eventually inactivation. UV and chlorine treatments, for example, cause site-specific capsid protein backbone cleavage that inhibits viral genome injection into the host cell. These results should aid in developing better methods for combating waterborne and foodborne viral pathogens and further our understanding of the adaptive changes viruses undergo in response to natural and anthropogenic stressors.
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    12. 12
      Kampf, G.; Todt, D.; Pfaender, S.; Steinmann, E. Persistence of Coronaviruses on Inanimate Surfaces and their Inactivation with Biocidal Agents. J. Hosp. Infect. 2020, 104, 246– 251,  DOI: 10.1016/j.jhin.2020.01.022
      12
      Persistence of coronaviruses on inanimate surfaces and their inactivation with biocidal agents
      Kampf G; Todt D; Pfaender S; Steinmann E
      The Journal of hospital infection (2020), 104 (3), 246-251 ISSN:.
      Currently, the emergence of a novel human coronavirus, SARS-CoV-2, has become a global health concern causing severe respiratory tract infections in humans. Human-to-human transmissions have been described with incubation times between 2-10 days, facilitating its spread via droplets, contaminated hands or surfaces. We therefore reviewed the literature on all available information about the persistence of human and veterinary coronaviruses on inanimate surfaces as well as inactivation strategies with biocidal agents used for chemical disinfection, e.g. in healthcare facilities. The analysis of 22 studies reveals that human coronaviruses such as Severe Acute Respiratory Syndrome (SARS) coronavirus, Middle East Respiratory Syndrome (MERS) coronavirus or endemic human coronaviruses (HCoV) can persist on inanimate surfaces like metal, glass or plastic for up to 9 days, but can be efficiently inactivated by surface disinfection procedures with 62-71% ethanol, 0.5% hydrogen peroxide or 0.1% sodium hypochlorite within 1 minute. Other biocidal agents such as 0.05-0.2% benzalkonium chloride or 0.02% chlorhexidine digluconate are less effective. As no specific therapies are available for SARS-CoV-2, early containment and prevention of further spread will be crucial to stop the ongoing outbreak and to control this novel infectious thread.
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    13. 13
      Li, Y. The Secret Behind the Mask. Indoor Air 2011, 21, 89– 91,  DOI: 10.1111/j.1600-0668.2011.00711.x
      13
      The secret behind the mask
      Li Yuguo
      Indoor air (2011), 21 (2), 89-91 ISSN:.
      There is no expanded citation for this reference.
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    14. 14
      Li, X.-p.; Niu, J.-l.; Gao, N.-p. Characteristics of Physical Blocking on Co-Occupant’s Exposure to Respiratory Droplet Residuals. J. Cent. South Univ. 2012, 19, 645– 650,  DOI: 10.1007/s11771-012-1051-0
      14
      Characteristics of physical blocking on co-occupant's exposure to respiratory droplet residuals
      Li, Xiao-ping; Niu, Jian-lei; Gao, Nai-ping
      Journal of Central South University (English Edition) (2012), 19 (3), 645-650CODEN: JCSUBS; ISSN:2095-2899. (Central South University)
      Existed evidences show that airborne transmission of human respiratory droplets may be related with the spread of some infectious disease, such as severe acute respiratory syndrome (SARS) and H1N1 pandemic. Non-pharmaceutical approaches, including ventilation system and personal protection, are believed to have certain pos. effects on the redn. of co-occupant's inhalation. This work then aims to numerically study the performances of mouth covering on co-occupant's exposure under mixing ventilation (MV), under-floor air distribution (UFAD) and displacement ventilation (DV) system, using drift-flux model. Desk partition, as one generally employed arrangement in plan office, is also investigated under MV. The dispersion of 1, 5 and 10 μm droplet residuals are numerically calcd. and CO2 is used to represent tracer gas. The results show that using mouth covering by the infected person can reduce the co-occupant's inhalation greatly by interrupting direct spread of the expelled droplets, and best performance can be achieved under DV since the coughed air is mainly confined in the microenvironment of the infected person. The researches under MV show that the two interventions, mouth covering and desk partition, achieve almost the same inhalation for fine droplets while the inhalation of the co-occupant is lower when using mouth covering for large droplets.
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    15. 15
      Zhou, P.; Yang, X. L.; Wang, X. G.; Hu, B.; Zhang, L.; Zhang, W.; Si, H. R.; Zhu, Y.; Li, B.; Huang, C. L.; Chen, H. D.; Chen, J.; Luo, Y.; Guo, H.; Jiang, R. D.; Liu, M. Q.; Chen, Y.; Shen, X. R.; Wang, X.; Zheng, X. S. A Pneumonia Outbreak Associated with a New Coronavirus of Probable Bat Origin. Nature 2020, 579, 270– 273,  DOI: 10.1038/s41586-020-2012-7
      15
      A pneumonia outbreak associated with a new coronavirus of probable bat origin
      Zhou, Peng; Yang, Xing-Lou; Wang, Xian-Guang; Hu, Ben; Zhang, Lei; Zhang, Wei; Si, Hao-Rui; Zhu, Yan; Li, Bei; Huang, Chao-Lin; Chen, Hui-Dong; Chen, Jing; Luo, Yun; Guo, Hua; Jiang, Ren-Di; Liu, Mei-Qin; Chen, Ying; Shen, Xu-Rui; Wang, Xi; Zheng, Xiao-Shuang; Zhao, Kai; Chen, Quan-Jiao; Deng, Fei; Liu, Lin-Lin; Yan, Bing; Zhan, Fa-Xian; Wang, Yan-Yi; Xiao, Geng-Fu; Shi, Zheng-Li
      Nature (London, United Kingdom) (2020), 579 (7798), 270-273CODEN: NATUAS; ISSN:0028-0836. (Nature Research)
      Abstr.: Since the outbreak of severe acute respiratory syndrome (SARS) 18 years ago, a large no. of SARS-related coronaviruses (SARSr-CoVs) have been discovered in their natural reservoir host, bats1-4. Previous studies have shown that some bat SARSr-CoVs have the potential to infect humans5-7. Here we report the identification and characterization of a new coronavirus (2019-nCoV), which caused an epidemic of acute respiratory syndrome in humans in Wuhan, China. The epidemic, which started on 12 Dec. 2019, had caused 2,794 lab.-confirmed infections including 80 deaths by 26 Jan. 2020. Full-length genome sequences were obtained from five patients at an early stage of the outbreak. The sequences are almost identical and share 79.6% sequence identity to SARS-CoV. Furthermore, we show that 2019-nCoV is 96% identical at the whole-genome level to a bat coronavirus. Pairwise protein sequence anal. of seven conserved non-structural proteins domains show that this virus belongs to the species of SARSr-CoV. In addn., 2019-nCoV virus isolated from the bronchoalveolar lavage fluid of a critically ill patient could be neutralized by sera from several patients. Notably, we confirmed that 2019-nCoV uses the same cell entry receptor-angiotensin converting enzyme II (ACE2)-as SARS-CoV.
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    16. 16
      Liu, L.; Wei, J.; Li, Y.; Ooi, A. Evaporation and Dispersion of Respiratory Droplets from Coughing. Indoor Air 2017, 27, 179– 190,  DOI: 10.1111/ina.12297
      16
      Evaporation and dispersion of respiratory droplets from coughing
      Liu, L.; Wei, J.; Li, Y.; Ooi, A.
      Indoor Air (2017), 27 (1), 179-190CODEN: INAIE5; ISSN:1600-0668. (Wiley-Blackwell)
      Understanding how respiratory droplets become droplet nuclei and their dispersion is essential for understanding the mechanisms and control of disease transmission via droplet-borne and airborne routes. A theor. model was developed to est. the size of droplet nuclei and their dispersion as a function of the ambient humidity and droplet compn. The model-predicted dried droplet nuclei size was 32% of the original diam., which agrees with the max. residue size in the classic study by Duguid, 1946, Edinburg Med. J.,52, 335 and the validation expt. in this study, but is smaller than the 50% size predicted by Nicas et al., 2005, J. Occup. Environ. Hyg., 2, 143. The droplet nuclei size at a relative humidity of 90% (25°C) could be 30% larger than the size of the same droplet at a relative humidity of less than 67.3% (25°C). The trajectories of respiratory droplets in a cough jet are significantly affected by turbulence, which promotes the wide dispersion of droplets. We found that medium-sized droplets (e.g., 60 μm) are more influenced by humidity than are smaller and larger droplets, while large droplets (≥100 μm), whose travel is less influenced by humidity, quickly settle out of the jet.
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    17. 17
      Vejerano, E. P.; Marr, L. C. Physico-Chemical Characteristics of Evaporating Respiratory Fluid Droplets. J. R. Soc., Interface 2018, 15, 20170939,  DOI: 10.1098/rsif.2017.0939
      17
      Physico-chemical characteristics of evaporating respiratory fluid droplets
      Vejerano, Eric P.; Marr, Linsey C.
      Journal of the Royal Society, Interface (2018), 15 (139), 20170939/1-20170939/10CODEN: JRSICU; ISSN:1742-5662. (Royal Society)
      The detailed physico-chem. characteristics of respiratory droplets in ambient air, where they are subject to evapn., are poorly understood. Changes in the concn. and phase of major components in a droplet-salt (NaCl), protein (mucin) and surfactant (dipalmitoylphosphatidylcholine)-may affect the viability of any pathogens contained within it and thus may affect the efficiency of transmission of infectious disease by droplets and aerosols. The objective of this study is to investigate the effect of relative humidity (RH) on the physico-chem. characteristics of evapg. droplets of model respiratory fluids. We labeled these components in model respiratory fluids and obsd. evapg. droplets suspended on a superhydrophobic surface using optical and fluorescence microscopy. When exposed to continuously decreasing RH, droplets of different model respiratory fluids assumed different morphologies. Loss of water induced phase sepn. as well as indication of a decrease in pH. The presence of surfactant inhibited the rapid rehydration of the non-volatile components. An enveloped virus, φ6, that has been proposed as a surrogate for influenza virus appeared to be homogeneously distributed throughout the dried droplet. We hypothesize that the increasing acidity and salinity in evapg. respiratory droplets may affect the structure of the virus, although at low enough RH, crystn. of the droplet components may eliminate their harmful effects.
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    18. 18
      Li, J.; Bao, Z.; Liu, S.; Zhuang, D.; Liu, Y.; Zhang, W.; Jiang, L. Survival Study of SARS Virus in Vitro. Chin. J. Disinfection 2003, 20, 3
      There is no corresponding record for this reference.
    19. 19
      van Doremalen, N.; Bushmaker, T.; Morris, D. H.; Holbrook, M. G.; Gamble, A.; Williamson, B. N.; Tamin, A.; Harcourt, J. L.; Thornburg, N. J.; Gerber, S. I.; Lloyd-Smith, J. O.; de Wit, E.; Munster, V. J. Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1. N. Engl. J. Med. 2020,  DOI: 10.1056/NEJMc2004973
      There is no corresponding record for this reference.
    20. 20
      de Gennes, P.-G.; Brochard-Wyart, F. O.; Quéré, D. Capillarity and Wetting Phenomena: Drops, Bubbles, Pearls, Waves; Springer: New York, 2004.
      There is no corresponding record for this reference.
    21. 21
      Koch, K.; Barthlott, W. Superhydrophobic and Superhydrophilic Plant Surfaces: An Inspiration for Biomimetic Materials. Philos. Trans. R. Soc., A 2009, 367, 1487– 1509,  DOI: 10.1098/rsta.2009.0022
      21
      Superhydrophobic and superhydrophilic plant surfaces: an inspiration for biomimetic materials
      Koch, Kerstin; Barthlott, Wilhelm
      Philosophical Transactions of the Royal Society, A: Mathematical, Physical & Engineering Sciences (2009), 367 (1893), 1487-1509CODEN: PTRMAD; ISSN:1364-503X. (Royal Society)
      A review. The diversity of plant surface structures, evolved over 460 million years, has led to a large variety of highly adapted functional structures. The plant cuticle provides structural and chem. modifications for surface wetting, ranging from superhydrophilic to superhydrophobic. In this paper, the structural basics of superhydrophobic and superhydrophilic plant surfaces and their biol. functions are introduced. Wetting in plants is influenced by the sculptures of the cells and by the fine structure of the surfaces, such as folding of the cuticle, or by epicuticular waxes. Hierarchical structures in plant surfaces are shown and further types of plant surface structuring leading to superhydrophobicity and superhydrophilicity are presented. The existing and potential uses of superhydrophobic and superhydrophilic surfaces for self-cleaning, drag redn. during moving in water, capillary liq. transport and other biomimetic materials are shown.
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      https://chemport.cas.org/services/resolver?origin=ACS&resolution=options&coi=1%3ACAS%3A528%3ADC%252BD1MXkvVWhtLo%253D&md5=98ee77d408ccad15909f775fe37c6d00
    22. 22
      Cox, C. S. Roles of Water Molecules in Bacteria and Viruses. Origins Life Evol. Biospheres 1993, 23, 29– 36,  DOI: 10.1007/BF01581988
      There is no corresponding record for this reference.
    23. 23
      Casanova, L. M.; Jeon, S.; Rutala, W. A.; Weber, D. J.; Sobsey, M. D. Effects of Air Temperature and Relative Humidity on Coronavirus Survival on Surfaces. Appl. Environ. Microbiol. 2010, 76, 2712– 2717,  DOI: 10.1128/AEM.02291-09
      23
      Effects of air temperature and relative humidity on coronavirus survival on surfaces
      Casanova, Lisa M.; Jeon, Soyoung; Rutala, William A.; Weber, David J.; Sobsey, Mark D.
      Applied and Environmental Microbiology (2010), 76 (9), 2712-2717CODEN: AEMIDF; ISSN:0099-2240. (American Society for Microbiology)
      Assessment of the risks posed by severe acute respiratory syndrome (SARS) coronavirus (SARS-CoV) on surfaces requires data on survival of this virus on environmental surfaces and on how survival is affected by environmental variables, such as air temp. (AT) and relative humidity (RH). The use of surrogate viruses has the potential to overcome the challenges of working with SARS-CoV and to increase the available data on coronavirus survival on surfaces. Two potential surrogates were evaluated in this study; transmissible gastroenteritis virus (TGEV) and mouse hepatitis virus (MHV) were used to det. effects of AT and RH on the survival of coronaviruses on stainless steel. At 4°C, infectious virus persisted for as long as 28 days, and the lowest level of inactivation occurred at 20% RH. Inactivation was more rapid at 20°C than at 4°C at all humidity levels; the viruses persisted for 5 to 28 days, and the slowest inactivation occurred at low RH. Both viruses were inactivated more rapidly at 40°C than at 20°C. The relationship between inactivation and RH was not monotonic, and there was greater survival or a greater protective effect at low RH (20%) and high RH (80%) than at moderate RH (50%). There was also evidence of an interaction between AT and RH. The results show that when high nos. of viruses are deposited, TGEV and MHV may survive for days on surfaces at ATs and RHs typical of indoor environments. TGEV and MHV could serve as conservative surrogates for modeling exposure, the risk of transmission, and control measures for pathogenic enveloped viruses, such as SARS-CoV and influenza virus, on health care surfaces.
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    24. 24
      Luo, J. Y.; Jang, H. D.; Sun, T.; Xiao, L.; He, Z.; Katsoulidis, A. P.; Kanatzidis, M. G.; Gibson, J. M.; Huang, J. X. Compression and Aggregation-Resistant Particles of Crumpled Soft Sheets. ACS Nano 2011, 5, 8943– 8949,  DOI: 10.1021/nn203115u
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      Compression and Aggregation-Resistant Particles of Crumpled Soft Sheets
      Luo, Jiayan; Jang, Hee Dong; Sun, Tao; Xiao, Li; He, Zhen; Katsoulidis, Alexandros P.; Kanatzidis, Mercouri G.; Gibson, J. Murray; Huang, Jiaxing
      ACS Nano (2011), 5 (11), 8943-8949CODEN: ANCAC3; ISSN:1936-0851. (American Chemical Society)
      Unlike flat sheets, crumpled paper balls have both high free vol. and high compressive strength, and can tightly pack without significantly reducing the area of accessible surface. Such properties would be highly desirable for sheet-like materials such as graphene, since they tend to aggregate in soln. and restack in the solid state, making their properties highly dependent on the material processing history. Here the authors report the synthesis of crumpled graphene balls by capillary compression in rapidly evapg. aerosol droplets. The crumpled particles are stabilized by locally folded, π-π stacked ridges as a result of plastic deformation, and do not unfold or collapse during common processing steps. They are remarkably aggregation-resistant in either soln. or solid state, and remain largely intact and redispersible after chem. treatments, wet processing, annealing, and even pelletizing at high pressure. For example, upon compression at 55 MPa, the regular flat graphene sheets turn into nondispersible chunks with drastically reduced surface area by 84%, while the crumpled graphene particles can still maintain 45% of their original surface area and remain readily dispersible in common solvents. Therefore, crumpled particles could help to standardize graphene-based materials by delivering more stable properties such as high surface area and soln. processability regardless of material processing history. This should greatly benefit applications using bulk quantities of graphene, such as in energy storage or conversion devices. As a proof of concept, microbial fuel electrodes modified by the crumpled particles indeed outperform those modified with their flat counterparts.
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    25. 25
      Rubino, I.; Choi, H. J. Respiratory Protection against Pandemic and Epidemic Diseases. Trends Biotechnol. 2017, 35, 907– 910,  DOI: 10.1016/j.tibtech.2017.06.005
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      Respiratory Protection against Pandemic and Epidemic Diseases
      Rubino, Ilaria; Choi, Hyo-Jick
      Trends in Biotechnology (2017), 35 (10), 907-910CODEN: TRBIDM; ISSN:0167-7799. (Elsevier Ltd.)
      Respiratory protection against airborne pathogens is crucial for pandemic/epidemic preparedness in the context of personal protection, healthcare systems, and governance. We expect that the development of technologies that overcome the existing challenges in current respiratory protective devices will lead to a timely and effective response to the next outbreak.
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    26. 26
      Leung, C. C.; Lam, T. H.; Cheng, K. K. Mass Masking in the COVID-19 Epidemic: People Need Guidance. Lancet 2020, 395, 945,  DOI: 10.1016/S0140-6736(20)30520-1
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      Mass masking in the COVID-19 epidemic: people need guidance
      Leung, Chi Chiu; Lam, Tai Hing; Cheng, Kar Keung
      Lancet (2020), 395 (10228), 945CODEN: LANCAO; ISSN:0140-6736. (Elsevier Ltd.)
      With the imminent pandemic, health authorities need to decide rapidly whether they should adopt mass masking in their own localities and make advance prepns. to avoid confusion and chaos in the anticipated challenges ahead.
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    27. 27
      Imai, K.; Ogawa, H.; Bui, V. N.; Inoue, H.; Fukuda, J.; Ohba, M.; Yamamoto, Y.; Nakamura, K. Inactivation of High and Low Pathogenic Avian Influenza Virus H5 Subtypes by Copper Ions Incorporated in Zeolite-Textile Materials. Antiviral Res. 2012, 93, 225– 233,  DOI: 10.1016/j.antiviral.2011.11.017
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      Inactivation of high and low pathogenic avian influenza virus H5 subtypes by copper ions incorporated in zeolite-textile materials
      Imai, Kunitoshi; Ogawa, Haruko; Bui, Vuong Nghia; Inoue, Hiroshi; Fukuda, Jiro; Ohba, Masayoshi; Yamamoto, Yu; Nakamura, Kikuyasu
      Antiviral Research (2012), 93 (2), 225-233CODEN: ARSRDR; ISSN:0166-3542. (Elsevier B.V.)
      The effect of cotton textiles contg. Cu2+ held by zeolites (CuZeo-textile) on the inactivation of H5 subtype viruses was examd. Allantoic fluid (AF) contg. a virus (AF virus) (0.1 mL) was applied to the textile (3 × 3-cm), and incubated for a specific period at ambient temp. After each incubation, 0.9 mL of culture medium was added followed by squeezing to recover the virus into the medium. The recovered virus was titrated using Madin-Darby canine kidney (MDCK) cells or 10-day-old embryonated chicken eggs. The highly pathogenic H5N1 and the low pathogenic H5N3 viruses were inactivated on the CuZeo-textile, even after short incubation. The titer of A/chicken/Yamaguchi/7/04 (H5N1) in MDCK cells and in eggs declined by >5.0 log10 and 5.0 log10, resp., in 30 s. The titer of A/whooper swan/Hokkaido/1/08 (H5N1) in MDCK cells declined by 2.3 and 3.5 in 1 and 5 min, resp. When A/whistling swan/Shimane/499/83 (H5N3) was treated on the CuZeo-textile for 10 min, the titer declined by >5.0 log10 in MDCK cells and by >3.5 log10 in eggs. In contrast, no decrease in the titers was obsd. on cotton textiles contg. zeolites alone (Zeo-textile). Neither cytopathic effects nor NP antigens were detected in MDCK cells inoculated with the H5N1 virus treated on the CuZeo-textile. The viral genes (H5, N1, M, and NP) were amplified from the virus treated on the CuZeo-textile by RT-PCR. The hemagglutinating activity of the CuZeo-textile treated virus was unaffected, indicating that virus-receptor interactions were maintained. Electron microscopic anal. revealed a small no. of particles with morphol. abnormalities in the H5N3 virus samples recovered immediately from the CuZeo-textile, while no particles were detectable in the 10-min treated sample, suggesting the rapid destruction of virions by the Cu2+ in the CuZeo-textile. The loss of infectivity of H5 viruses could, therefore, be due to the destruction of virions by Cu2+. Interestingly, CuCl2 treatment (500 and 5000 μM) did not have an antiviral effect on the AF viruses (H5N1 and H5N3) even after 48 h of incubation, although the titer of the purified H5N3 virus treated with CuCl2 declined greatly. The antiviral effect was inhibited by adding the AF to the purified H5N3 virus prior to the CuCl2 treatment. The known antibacterial/antifungal activities of copper suggest that the CuZeo-textile can be applied at a high level of hygiene in both animals and humans.
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    28. 28
      Rai, M.; Deshmukh, S. D.; Ingle, A. P.; Gupta, I. R.; Galdiero, M.; Galdiero, S. Metal Nanoparticles: The Protective Nanoshield against Virus Infection. Crit. Rev. Microbiol. 2016, 42, 46– 56,  DOI: 10.3109/1040841X.2013.879849
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      Metal nanoparticles: The protective nanoshield against virus infection
      Rai, Mahendra; Deshmukh, Shivaji D.; Ingle, Avinash P.; Gupta, Indarchand R.; Galdiero, Massimiliano; Galdiero, Stefania
      Critical Reviews in Microbiology (2016), 42 (1), 46-56CODEN: CRVMAC; ISSN:1040-841X. (Taylor & Francis Ltd.)
      A review. Re-emergence of resistance in different pathogens including viruses are the major cause of human disease and death, which is posing a serious challenge to the medical, pharmaceutical and biotechnol. sectors. Though many efforts have been made to develop drug and vaccines against re-emerging viruses, researchers are continuously engaged in the development of novel, cheap and broad-spectrum antiviral agents, not only to fight against viruses but also to act as a protective shield against pathogens attack. Current advancement in nanotechnol. provides a novel platform for the development of potential and effective agents by modifying the materials at nanolevel with remarkable physicochem. properties, high surface area to vol. ratio and increased reactivity. Among metal nanoparticles, silver nanoparticles have strong antibacterial, antifungal and antiviral potential to boost the host immunity against pathogen attack. Nevertheless, the interaction of silver nanoparticles with viruses is a largely unexplored field. The present review discusses antiviral activity of the metal nanoparticles, esp. the mechanism of action of silver nanoparticles, against different viruses such HSV, HIV, HBV, MPV, RSV, etc. It is also focused on how silver nanoparticles can be used in therapeutics by considering their cytotoxic level, to avoid human and environmental risks.
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    29. 29
      Kang, J.; O’Donnell, J. M.; Colaianne, B.; Bircher, N.; Ren, D.; Smith, K. J. Use of Personal Protective Equipment among Health Care Personnel: Results of Clinical Observations and Simulations. Am. J. Infect. Control 2017, 45, 17– 23,  DOI: 10.1016/j.ajic.2016.08.011
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      Use of personal protective equipment among health care personnel: Results of clinical observations and simulations
      Kang JaHyun; O'Donnell John M; Colaianne Bonnie; Bircher Nicholas; Ren Dianxu; Smith Kenneth J
      American journal of infection control (2017), 45 (1), 17-23 ISSN:.
      BACKGROUND: Very little is known about how health care personnel (HCP) actually use personal protective equipment (PPE). METHODS: The clinical PPE practices of 50 HCP from selected units at the University of Pittsburgh Medical Center (UPMC) Presbyterian Hospital were videotaped with HCP consent. For 2 PPE simulation sessions (simple and full-body sets), 82 HCP were recruited throughout the UPMC system. Simulation practices were videotaped and examined using fluorescent powder with ultraviolet lighting. All participants completed an electronic survey. For a follow-up evaluation simulation, 12 HCP were recruited among simulation participants. RESULTS: Among 130 total sessions from 65 participants, contamination occurred in 79.2% of simulations during the doffing process with various PPE items: simple set (92.3%) and full-body set (66.2%). Among 11 follow-up evaluation participants, contaminations still occurred in 82% after receiving individual feedback, but the overall contamination level was reduced. Using the contamination information gained during the simulation analysis, 66% of potential contamination was estimated for the clinical observation. Concerns and barriers in PPE use from HCP survey responses were as follows: time-consuming, cumbersomeness, and PPE effectiveness. CONCLUSIONS: Although HCP knew they were being videotaped, contamination occurred in 79.2% of the PPE simulations. Devising better standardized PPE protocols and implementing innovative PPE education are necessary to ensure HCP safety.
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    30. 30
      Honda, H.; Iwata, K. Personal Protective Equipment and Improving Compliance among Healthcare Workers in High-Risk Settings. Curr. Opin. Infect. Dis. 2016, 29, 400– 406,  DOI: 10.1097/QCO.0000000000000280
      30
      Personal protective equipment and improving compliance among healthcare workers in high-risk settings
      Honda Hitoshi; Iwata Kentaro
      Current opinion in infectious diseases (2016), 29 (4), 400-6 ISSN:.
      PURPOSE OF REVIEW: Personal protective equipment (PPE) protects healthcare workers (HCWs) from infection by highly virulent pathogens via exposure to body fluids and respiratory droplets. Given the recent outbreaks of contagious infectious diseases worldwide, including Ebola virus and Middle Eastern respiratory syndrome, there is urgent need for further research to determine optimal PPE use in high-risk settings. This review intends to provide a general understanding of PPE and to provide guidelines for appropriate use based on current evidence. RECENT FINDINGS: Although previous studies have focused on the efficacy of PPE in preventing transmission of pathogens, recent studies have examined the dangers to HCWs during removal of PPE when risk of contamination is highest. Access to adequate PPE supplies is crucial to preventing transmission of pathogens, especially in resource-limited settings. Adherence to appropriate PPE use is a challenge due to inadequate education on its usage, technical difficulties, and tolerability of PPE in the workplace. Future projects aim at ameliorating this situation, including redesigning PPE which is crucial to improving the safety of HCWs. SUMMARY: PPE remains the most important strategy for protecting HCW from potentially fatal pathogens. Further research into optimal PPE design and use to improve the safety of HCWs is urgently needed.
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    31. 31
      Han, Z.; Feng, X.; Guo, Z.; Niu, S.; Ren, L. Flourishing Bioinspired Antifogging Materials with Superwettability: Progresses and Challenges. Adv. Mater. 2018, 30, 1704652  DOI: 10.1002/adma.201704652
      There is no corresponding record for this reference.
    32. 32
      Locatelli, S. M.; LaVela, S. L.; Gosch, M. Health Care Workers’ Reported Discomfort While Wearing Filtering Face-Piece Respirators. Workplace Health Saf. 2014, 62, 362– 368,  DOI: 10.3928/21650799-20140804-03
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      Health care workers' reported discomfort while wearing filtering face-piece respirators
      Locatelli Sara M; LaVela Sherri L; Gosch Megan
      Workplace health & safety (2014), 62 (9), 362-8 ISSN:2165-0799.
      Filtering face-piece respirators (FFRs) are one method of protecting health care workers from airborne particles; however,research suggests adherence is poor, perhaps due to worker discomfort. Three separate focus groups were conducted at two Veterans Affairs health care facilities. Seventeen health care workers who reported using FFRs as part of their job duties were in the focus groups. Focus group transcripts were coded using qualitative descriptive coding techniques. Participants described experiences of discomfort and physical mask features they believed ,contributed to discomfort. Participants believed FFRs influenced patient care because some patients felt uneasy and changed healthcare workers' behaviors (e.g., doffing procedures, loss of concentration, rushed patient care, and avoidance of patients in isolation resulting from FFR discomfort). Assessment of comfort and tolerability should occur during fit-testing. These factors should also be taken into account by management when training employees on the proper use of FFRs, as well as in future research to improve comfort and tolerability.
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    33. 33
      Geneva Shortage of Personal Protective Equipment Endangering Health Workers Worldwide; https://www.who.int/news-room/detail/03-03-2020-shortage-of-personal-protective-equipment-endangering-health-workers-worldwide (accessed 2020-03-03).
      There is no corresponding record for this reference.
    34. 34
      Si, Y.; Zhang, Z.; Wu, W.; Fu, Q.; Huang, K.; Nitin, N.; Ding, B.; Sun, G. Daylight-Driven Rechargeable Antibacterial and Antiviral Nanofibrous Membranes for Bioprotective Applications. Sci. Adv. 2018, 4, eaar5931  DOI: 10.1126/sciadv.aar5931
      There is no corresponding record for this reference.
    35. 35
      NSF Dear Colleague Letter on the Coronavirus Disease 2019 (COVID-19); https://www.nsf.gov/pubs/2020/nsf20052/nsf20052.jsp (accessed 2020-03-4).
      There is no corresponding record for this reference.