Rapid Expert Consultation Update on SARS-CoV-2 Surface Stability and Incubation for the COVID-19 Pandemic (March 27, 2020) (2020) / Chapter Skim
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Rapid Expert Consultation
Rapid Expert Consultation
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Harvey Fineberg approved this document as chair of the Standing Committee on Emerging Infectious Diseases and 21st Century Health Threats. The following individuals served as reviewers: Kathryn Edwards, Vanderbilt University Medical Center; James LeDuc, University of Texas Medical Branch; and Linsey Marr, Virginia Tech.
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natural history studies, typically involving the characterization of environments naturally contaminated by a virus, such as hospital rooms recently occupied by patients. Each approach has strengths and weaknesses: with experimental studies there is control over important parameters, but almost always the conditions fail to adequately mimic those of the natural setting; with natural history studies, the conditions are relevant and reflect the real world, but there is typically little control of environmental conditions and potentially confounding factors.
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However, the lack of detection of the virus in air samples does not necessarily contradict the finding of the virus on the air outlet fan in Patient C's room, which presumably deposited from 4 Personal communication, George Korch and Mike Hevey, National Biodefense Analysis and Countermeasures Center, March 24, 2020. 5 Personal communication, Vincent Munster, Rocky Mountain Laboratories, March 24, 2020.
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Of note, air collectors positioned more than 6 feet from each of two patients yielded positive samples, as did air samplers placed outside patient rooms in the hallways. Although the results are preliminary, it appears that some samples are positive for infectious virus, including an air 8 Jiang et al.
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The authors believe that a direct source of SARS-CoV-2 may be due to a resuspension of virus-laden aerosol from the surface of medical staff protective apparel during removal, which may come from direct deposition of respiratory droplets while medical staff are working. Floor dust aerosol containing the virus is also subject to resuspension -- meaning that virus-laden aerosols could first deposit on the surface of protective gear and then fall to the floor to be resuspended by medical staff movement.
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It is quite possible that virus from naturally infected humans when directly disseminated to the nearby environment has different survival properties than virus grown in TC media, even when the latter is purified and spiked into a relevant human body fluid such as saliva. However, environmental dissemination of clinically relevant human fluids spiked with TC-grown virus will be more predictive of real-world environmental survival than environmental dissemination of TC-grown virus in TC media.
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would be expected to contribute to variation in study results. Before too many public health decisions are made on the basis of experimental or natural history studies using just one virus strain, some attention should be paid to the possibility of variation among different SARS-CoV-2 strains in their environmental survival properties.
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. Given the small number of human studies evaluating these disease characteristics for COVID-19, additional studies to confirm incubation period estimates and infectiousness prior to symptom onset are urgently needed.
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Prior to changing current public health guidance, it may be prudent to compare observed incubation periods among different SARS-CoV-2 strains. Future studies related to incubation period and viral loads in asymptomatic patients may help to inform pressing questions related to, for example, the role of super spreaders and children in transmission.
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