SARS-CoV-2 and Health Care Worker Protection in Low-Risk Settings: a Review of Modes of Transmission and a Novel Airborne Model Involving Inhalable Particles
CLINICAL MICROBIOLOGY REVIEWS
Authors: Zhang, X. Sophie; Duchaine, Caroline
Since the beginning of the COVID-19 pandemic, there has been intense debate over SARS-CoV-2's mode of transmission and appropriate personal protective equipment for health care workers in low-risk settings. The objective of this review is to identify and appraise the available evidence (clinical trials and laboratory studies on masks and respirators, epidemiological studies, and air sampling studies), Clarify key concepts and necessary conditions for airborne transmission, and shed light on knowledge gaps in the field. We find that, except for aerosol-generating procedures, the overall data in support of airborne transmission-taken in its traditional definition (long-distance and respirable aerosols)-are weak, based predominantly on indirect and experimental rather than clinical or epidemiological evidence. Consequently, we propose a revised and broader definition of "airborne," going beyond the current droplet and aerosol dichotomy and involving short-range inhalable particles, supported by data targeting the nose as the main viral receptor site. This new model better explains clinical observations, especially in the context of close and prolonged contacts between health care workers and patients, and reconciles seemingly contradictory data in the SARS-CoV-2 literature. The model also carries important implications for personal protective equipment and environmental controls, such as ventilation, in health care settings. However, further studies, especially clinical trials, are needed to complete the picture.
Relationship between obesity and severe COVID-19 outcomes in patients with type 2 diabetes: Results from the CORONADO study
DIABETES OBESITY & METABOLISM
Authors: Smati, Sarra; Tramunt, Blandine; Wargny, Matthieu; Caussy, Cyrielle; Gaborit, Benedicte; Vatier, Camille; Verges, Bruno; Ancelle, Deborah; Amadou, Coralie; Bachir, Leila A.; Bourron, Olivier; Coffin-Boutreux, Christine; Barraud, Sara; Dorange, Anne; Fremy, Benedicte; Gautier, Jean-Francois; Germain, Natacha; Larger, Etienne; Laugier-Robiolle, Stephanie; Meyer, Laurent; Monier, Arnaud; Moura, Isabelle; Potier, Louis; Sabbah, Nadia; Seret-Begue, Dominique; Winiszewski, Patrice; Pichelin, Matthieu; Saulnier, Pierre-Jean; Hadjadj, Samy; Cariou, Bertrand; Gourdy, Pierre
Aim To assess the relationship between body mass index (BMI) classes and early COVID-19 prognosis in inpatients with type 2 diabetes (T2D). Methods From the CORONAvirus-SARS-CoV-2 and Diabetes Outcomes (CORONADO) study, we conducted an analysis in patients with T2D categorized by four BMI subgroups according to the World Health Organization classification. Clinical characteristics and COVID-19-related outcomes (i.e. intubation for mechanical ventilation [IMV], death and discharge by day 7 [D7]) were analysed according to BMI status. Results Among 1965 patients with T2D, 434 (22.1%) normal weight (18.5-24.9 kg/m(2), reference group), 726 (36.9%) overweight (25-29.9 kg/m(2)) and 805 (41.0%) obese subjects were analysed, including 491 (25.0%) with class I obesity (30-34.9 kg/m(2)) and 314 (16.0%) with class II/III obesity (>= 35 kg/m(2)). In a multivariable-adjusted model, the primary outcome (i.e. IMV and/or death by D7) was significantly associated with overweight (OR 1.65 [1.05-2.59]), class I (OR 1.93 [1.19-3.14]) and class II/III obesity (OR 1.98 [1.11-3.52]). After multivariable adjustment, primary outcome by D7 was significantly associated with obesity in patients aged younger than 75 years, while such an association was no longer found in those aged older than 75 years. Conclusions Overweight and obesity are associated with poor early prognosis in patients with T2D hospitalized for COVID-19. Importantly, the deleterious impact of obesity on COVID-19 prognosis was no longer observed in the elderly, highlighting the need for specific management in this population.