key: cord-0724362-vtgudna5 authors: Dietz, L.; Constant, D. A.; Fretz, M.; Horve, P. F.; Martinez-Olsen, A.; Stenson, J.; Wilkes, A.; Martindale, R. G.; Messer, W. B.; Van Den Wymelenberg, K. G. title: Exploring Integrated Environmental Viral Surveillance of Indoor Environments: A comparison of surface and bioaerosol environmental sampling in hospital rooms with COVID-19 patients date: 2021-03-26 journal: nan DOI: 10.1101/2021.03.26.21254416 sha: 5cade876c932bf551da78906cf6569ec0a766a2b doc_id: 724362 cord_uid: vtgudna5 The outbreak of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) has dramatically transformed policies and practices surrounding public health. One such shift is the expanded emphasis on environmental surveillance for pathogens. Environmental surveillance methods have primarily relied upon wastewater and indoor surface testing, and despite substantial evidence that SARS-CoV-2 commonly travels through space in aerosols, there has been limited indoor air surveillance. This study investigated the effectiveness of integrated surveillance including an active air sampler, surface swabs and passive settling plates to detect SARS-CoV-2 in hospital rooms with COVID-19 patients and compared detection efficacy among sampling methods. The AerosolSense active air sampler was found to detect SARS-CoV-2 in 53.8% of all samples collected compared to 12.1% detection by passive air sampling and 14.8% detection by surface swabs. Approximately 69% of sampled rooms (22/32) returned a positive environmental sample of any type. Among positive rooms, ~32% had only active air samples that returned positive, while ~27% and ~9% had only one or more surface swabs or passive settling plates that returned a positive respectively, and ~32% had more than one sample type that returned a positive result. This study demonstrates the potential for the AerosolSense to detect SARS-CoV-2 RNA in real-world healthcare environments and suggests that integrated sampling that includes active air sampling is an important addition to environmental pathogen surveillance in support of public health. CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. The copyright holder for this preprint this version posted March 26, 2021. 69 A global pandemic was declared 12 March 2020 and is ongoing 1 . Severe acute respiratory 70 syndrome coronavirus 2 (SARS-CoV-2) causes a respiratory illness known as Coronavirus 71 Disease 19 (COVID-19), which can present with a wide variety of symptoms. If symptomatic, 72 the symptoms can mimic the common cold and be extremely mild, or be quite severe requiring 73 medical attention and even hospitalization. In addition to the symptomatic individuals with 74 COVID-19, it is estimated that more than half of all SARS-CoV-2 transmission is due to 75 asymptomatic individuals 2 . and several other settings that provide services to susceptible occupants are also vulnerable to 88 disease transmission 16,20-24 . The ability to monitor indoor environments to detect potential 89 shedding from infectious individuals is an important layer of control to prevent or contain 90 outbreaks of highly infectious and deadly illnesses like COVID-19. . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) sampling using a vacuum pump to move a known volume of air across a capture mechanism 37 . Active air samplers span a range of airflow rates, wet and dry media, and physical collection 105 mechanisms including filters, cyclones, impingers and impactors 38-40 . Using any of these 106 collection devices, the sampling media can be evaluated for a target pathogen using molecular 107 techniques. CoV-2 in a large geographic region, possibly down to the scale of a cluster of buildings or a 113 single building, but less likely to provide spatial resolution down to specific zones or rooms 114 . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. techniques of SARS-CoV-2, it may be beneficial to supplement these with a sensitive and robust 127 bioaerosol sampling platform. To explore this question, we initiated a field study within a 128 healthcare environment including environmental sampling via surface swabs, settling plates, and 129 an active air sampler to explore the relationships of these sampling approaches. Sample processing 197 The sample cooler was hand carried to a BSL-2+ lab on the OHSU campus for processing. All The overall objective of this investigation was to explore integrated environmental surveillance Overall, all three sampling types (active air, swabs, settling plates) were able to successfully 255 isolate SARS-CoV-2 RNA (Figure 2) . In order to assess the potential for genomic material 256 capture differences, and ultimately to better understand sampling methods for environmental . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review) The copyright holder for this preprint this version posted March 26, 2021. ; https://doi.org/10.1101/2021.03.26.21254416 doi: medRxiv preprint WHO Declares COVID-19 a Pandemic SARS-CoV-2 Transmission From People Without COVID-19 The airborne lifetime of small speech 400 droplets and their potential importance in SARS-CoV-2 transmission Modes of transmission of virus causing COVID-19: 405 implications for IPC precaution recommendations: scientific brief Ventilation of Health Care Facilities Beyond hand hygiene: a qualitative study of the everyday work of 527 preventing cross-contamination on hospital wards Rapid implementation of real-time SARS-CoV-2 sequencing to 529 investigate healthcare-associated COVID-19 infections Prevention of 531 nosocomial COVID-19: Another challenge of the pandemic Nosocomial outbreak of COVID-19 pneumonia in Evaluation of a Bioaerosol Sampler for Indoor Environmental Surveillance of Severe Acute 537 TaqPath COVID-19 Combo Kit Instructions for Use Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) 541 Environmental Contamination and Childbirth Viable bacterial communities on hospital window components in patient 543 rooms Transmission potential of SARS-CoV-2 in viral shedding observed at 545 the University of International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. 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(which was not certified by peer review) The copyright holder for this preprint this version posted Comparing aerosol concentrations and particle size distributions 572 generated by singing, speaking and breathing Theoretical Considerations and Available Evidence Long-distance airborne dispersal of SARS-CoV-2 in COVID-19 wards High SARS-CoV-2 Attack Rate Following Exposure at a Choir Practice -579 SARS-CoV-2 (COVID-19) superspreader 582 events A quantitative risk 584 estimation platform for indoor aerosol transmission of Containment Strategy Transmission_modes-2020.1-eng.pdf (2020). . CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. CC-BY-NC-ND 4.0 International license It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)The copyright holder for this preprint this version posted March 26, 2021. ; https://doi.org/10.1101/2021.03.26.21254416 doi: medRxiv preprint It is made available under a is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity. (which was not certified by peer review)The copyright holder for this preprint this version posted March 26, 2021. ; https://doi.org/10.1101/2021.03.26.21254416 doi: medRxiv preprint