Transmissieroute, Blootstellingsroute

  • RIVM
    (aangepast 14-4-2020)
    RIVM LCI COVID-19  - Besmettingsweg : De ziekte is van mens op mens overdraagbaar. https://lci.rivm.nl/richtlijnen/covid-19#index_Ziekte--Besmettelijkheid
    Direct
    Druppelinfectie: transmissie via grote druppels uit hoesten en niezen binnen een afstand van 1,5 meter. Via aerosolen tijdens aerosolvormende handelingen (tracheale intubatie, niet-invasieve beademing, tracheostomie, cardiopulmonaire reanimatie, manuele handmatige beademing voorafgaand aan intubatie, bronchoscopie, handelingen aan de tracheostoma, uitzuigen) (WHO 2020a).
    Aerogeen
    Er zijn geen aanwijzingen dat het virus zich aerogeen (via zwevende deeltjes in de lucht) verspreidt, behalve via aerosolen tijdens aerosolvormende handelingen (zoals tracheale intubatie, niet-invasieve beademing, tracheostomie, cardiopulmonaire reanimatie, manuele handmatige beademing voorafgaand aan intubatie, bronchoscopie, handelingen aan de tracheostoma, uitzuigen) (WHO 2020a).
  • WHO Interim guidance 13 March 2020”. https://www.who.int/publications-detail/clinical-management-of-severe-acute-respiratory-infection-when-novel-coronavirus-(ncov)-infection-is-suspected
  • Lancet  SARS-CoV-2 can be detected in the gastrointestinal tract, saliva, and urine: https://www.nejm.org/doi/full/10.1056/NEJMoa2002032
  • CDC - SARS-CoV-2 RNA has been detected in upper and lower respiratory tract specimens, and SARS-CoV-2 virus has been isolated from upper respiratory tract specimens and bronchoalveolar lavage fluid. SARS-CoV-2 RNA has been detected in blood and stool specimens, and SARS-CoV-2 virus has been isolated in cell culture from the stool of some patients, including a patient with pneumonia 15 days after symptom onset.: https://www.cdc.gov/coronavirus/2019-ncov/hcp/faq.html
  • CDC - Although the first human cases of COVID-19 likely resulted from exposure to infected animals, infected people can spread SARS-CoV-2 to other people. The virus is thought to spread mainly from person-to-person, including:
    - Between people who are in close contact with one another (within about 6 feet).
    - Through respiratory droplets produced when an infected person coughs or sneezes. These droplets can land in the mouths or noses of people who are nearby or possibly be inhaled into the lungs.
    It may be possible that a person can get COVID-19 by touching a surface or object that has SARS-CoV-2 on it and then touching their own mouth, nose, or possibly their eyes, but this is not thought to be the primary way the virus spreads. People are thought to be most contagious when they are most symptomatic (i.e., experiencing fever, cough, and/or shortness of breath). Some spread might be possible before people show symptoms; there have been reports of this type of asymptomatic transmission with this new coronavirus, but this is also not thought to be the main way the virus spreads. Although the United States has implemented public health measures to limit the spread of the virus, it is likely that some person-to-person transmission will continue to occur. The CDC website provides the latest information about COVID-19 transmission: www.cdc.gov/coronavirus/2019-ncov/about/transmission.htm
  • COVID-19 in relatie tot gebouwen https://tvvlconnect.nl/thema/duurzaamheid-circulariteit/blog/138-covid-19-in-relatie-tot-gebouwen
  • (toegevoegd 12-5-2020) Characteristics of pediatric SARS-CoV-2 infection and potential evidence for persistent fecal viral shedding  Nature Medicine volume 26, https://www.nature.com/articles/s41591-020-0817-4  
  • (toegevoegd 12-5-2020) Projecting the transmission dynamics of SARS-CoV-2 through the postpandemic period Science  14 Apr 2020:  DOI: 10.1126/science.abb5793  https://science.sciencemag.org/content/early/2020/04/14/science.abb5793 
    https://nos.nl/artikel/2330560-harvard-studie-zonder-vaccin-nog-jaren-afstand-houden.html   
  • (toegevoegd 12-5-2020) COVID-19 patients may be most contagious one to two days before symptoms appear, study finds USA TODAY, Published 3:25 PM EDT April 17, 2020 https://eu.usatoday.com/story/news/nation/2020/04/17/covid-19-patients-most-contagious-1-2-days-before-symptoms/5143641002/  
    COVID-19 patients may be most infectious in the days before they began showing symptoms, a new study from researchers in China found. Researchers examined "viral shedding" in 94 patients with COVID-19 admitted to Guangzhou Eighth People’s Hospital, according to a small study published Wednesday in the peer-reviewed journal "Nature." 

Dit krantenartikel van 7 mei 2020 is gebaseerd op volgende artikel:

  • (toegevoegd 12-5-2020) Temporal dynamics in viral shedding and transmissibility of COVID-19 Nature Medicine (2020) Published: 15 April 2020 https://www.nature.com/articles/s41591-020-0869-5  
  • (toegevoegd 12-5-2020) Abstract We report temporal patterns of viral shedding in 94 patients with laboratory-confirmed COVID-19 and modeled COVID-19 infectiousness profiles from a separate sample of 77 infector–infectee transmission pairs. We observed the highest viral load in throat swabs at the time of symptom onset, and inferred that infectiousness peaked on or before symptom onset. We estimated that 44% (95% confidence interval, 25–69%) of secondary cases were infected during the index cases’ presymptomatic stage, in settings with substantial household clustering, active case finding and quarantine outside the home. Disease control measures should be adjusted to account for probable substantial presymptomatic transmission. 
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