Another Case of  COVID Reinfection with Mutated Virus

Easy to Use Saliva Test Funded by Fluidigm

Mask, Filter and Distancing Strategies Need to be Coordinated with Value Rating System

University of Arizona Finding COVID Transmitters a Week Early by Sewage Tracing

H2O2 Fogger Used at Columbia MD Swimming Pool

H2O2 Disinfection for Super Yachts

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Another Case of  COVID Reinfection with Mutated Virus

Researchers in the United States are reporting their first documented case of a patient who got COVID, recovered and then got it again.

Scientists say that although reinfection is likely possible, it's also extremely rare. This is the first documented reinfection among nearly six million COVID-19 cases to date.

Nevertheless, the first documented reinfection is notable in how quickly the patient seemed to be reinfected after his initial recovery.

"Having had it doesn’t mean you can’t get it again, that’s what this shows," Dr. Mark Pandori, director of the Nevada State Public Health Laboratory and co-author of the study, said in an interview with ABC's World News Tonight. "It tells us possibly things we still don’t know about this virus ... or that there is a danger that even if you’ve had it that your immune system may not protect you from a significant illness next time."

The case report, which has not yet been peer-reviewed and is currently only available as a pre-print, tells the story of a 25-year-old man in Nevada. In late March, he developed some of the classic signs of COVID-19: sore throat, cough, diarrhea, headache and nausea. After testing positive on April 18, he began to gradually feel better, and the virus appeared to leave his system, seemingly verified with two consecutive negative tests in May.

But only a few weeks later, he started to feel ill again, testing positive for COVID-19 once again in June. This time, he was admitted to the hospital with serious symptoms.

At first, the researchers wondered if the virus had been hiding in his body the whole time -- mutating, changing and eventually developing into something that caused him to get sick with COVID-19 a second time. But they ultimately rejected this theory, saying that the two viruses were so different that it would have been nearly impossible for the virus to change that quickly inside his body. The only explanation was that he had been infected by a slightly different version of the coronavirus.

"There’s no invulnerability here," Pandori told ABC News. "Whether you’ve had this infection before or whether perhaps in the future vaccinated, there won’t be such a thing as invulnerability."

Easy to Use Saliva Test Funded by Fluidigm

A new saliva test to detect the SARS-CoV-2 virus has been developed by researchers at Washington University School of Medicine in St. Louis. Results from the COVID-19 diagnostic test are available in a few hours and, ideally, able to be communicated to people tested within a day. Highly sensitive to detecting even tiny levels of the virus in a saliva sample, the test does not require special swabs and reagents that have been in short supply.

Developed in collaboration with the biotechnology company Fluidigm, the test could help simplify and expand the availability of COVID-19 diagnostic testing across broad populations. Such testing does not rely on the extraction of viral RNA to detect the virus – a time-consuming and expensive process – and could be scaled up easily, in part because people can collect their own saliva samples, relieving health-care workers of the need to conduct sample collection as they do for nasal and throat swab tests.

On Aug. 25, Fluidigm received emergency use authorization (EUA) from the Food and Drug Administration as the manufacturer of the test. This authorization allows the university to perform the test. Washington University filed a separate EUA application with the FDA that is still pending.

This is a significant advance in COVID-19 testing that is a simpler, faster and more economical test that can greatly expand our ability to detect the level of COVID-19 infection within the community via large-scale population screening for the SARS-CoV-2 virus,” said Jeffrey Milbrandt, MD, PhD, the James S. McDonnell Professor and head of the Department of Genetics and the McDonnell Genome Institute.

According to the researchers, the test will allow for rapid testing of large numbers of people, which is essential for a safe return to work or school as economies strive to open up.

“People can collect the sample themselves, and it doesn’t require an uncomfortable nasal swab,” Milbrandt said. “Another problem with current testing is the shortage of certain lab supplies that are required to process viral samples. We have developed a method to process the saliva samples that doesn’t require these specialized supplies.”


Mask, Filter and Distancing Strategies Need to be Coordinated with Value Rating System

Highly efficient masks and air filters should be the primary weapons in fighting COVID. The initial assumption was that these products would not be available and so decisions were made to select lower value options. 

Now the filtration, HVAC, and other solutions suppliers can supply their best products. We now need  a holistic approach which rates each option and results in the higher value solutions being selected first and lower value options selected only when circumstances prevent a higher value option from being employed. Social distancing is not practiced in a pharmaceutical cleanroom because higher value options are employed.

A two day NAS conference last week on airborne virus generation showed ample evidence that small aerosols are a major transmission route.  If it turns out that large droplets on masks and filter media become aerosols this will add to the urgency to provide ways to capture these aerosols.

The selection of filtration methods is site specific. A MERV 8  filter media in an HVAC system has wide applicability even if the effectiveness is relatively low.  A HEPA room air purifier is more effective but with much less applicability. The benefits have to be weighed against both the economic and life quality costs.

The following generalized rating table is useful in determining the relative importance of various products. It is not particularly useful for the selection method in a specific situation which depends on the virus load, the air currents, and the activity of individuals.

The table is based on the assumption that the highest value options are chosen first.  Since social distancing is a low value option it is rated based on the assumption that everyone is wearing an N95 mask and or is in an environment with efficient air filtration.

The value formula is Value x % effectiveness  x % applicability  - economic and life quality costs = net value

·         Value is number of lives saved and sickness reduced x value factors

·         Effectiveness is the percentage of virus removed, resultant lives saved and sickness averted

·         Applicability is the percentage of situations where it can be used

·         Economic Cost is relative and is compared to the value. It is the cost of the product and associated operating costs as well as costs to economic productivity such as in lockdowns

·         The life quality cost is based on a concept called Quality Enhanced life days which has been used by Cardinal Health in the hospital industry.

In general an N95 mask is the greatest value. It will remove 95% of the virus and  can be used in 95% of the applications.  It has a modest economic cost and a modest life quality cost due to discomfort.

The N95 Mask with a valve is slightly more applicable and can be worn by those unable to use a non valved mask. It is somewhat less effective but it has a lower life quality comfort penalty. The wearer of an N95 mask is much less likely to become infected and to become a transmitter. So there is a small chance that his exhalation through a valve will transmit virus.

Given the new information on transmission through small aerosols and the potential for cloth masks to act as aerosol generators for large droplets initially retained the effectiveness is 20% or lower. So the net value is only 10.

MERV 16 filters have a higher initial cost and can have higher energy consumption with the same filter depth but with deeper filters the energy cost is similar to MERV 13 filters. By switching from a MERV 8 to MERV 16 the net value increases 33 points.

A lockdown can be very effective but is not universally applicable. The life quality and economic costs are substantial. However this chart does not take into account the economic and life quality costs of doing nothing. Wearing N95 masks would be the answer rather than a lockdown. But when there is a high positivity ratio the lockdown is better than nothing.

Room air purifiers are very effective and provide the best net value for elevators, hospital reception areas and many other applications. However the applicability is much less than larger HVAC systems. This lowers the general net value or importance.

There is little value in social distancing if the higher value options are chosen. Social distancing provides little safety from small aerosols which can travel long distances. It has limited applicability and has both economic and life quality costs. The net value is low. Social distancing is justified compared to doing nothing.  In fact it has been extremely important in the early attempts to fight COVID.

In specific situations such as eating masks may not be applicable and social distancing may be an option in conjunction with air filtration.

This net value ranking is completely at odds with what has been advised by CDC and WHO.  However, it is consistent with the ranking to fight air pollution or measles. In both cases the assumption is that if there is a source it will be airborne for long distances.

There are some who argue that there is not sufficient proof that virus will remain viable after being airborne. There has been lots of indirect evidence where other causes were eliminated. Now we are seeing direct evidence where with new sampling methods which do not damage the virus there are viable specimens being captured.

There are some who argue that the small amounts of virus conveyed by small droplets is not going to be infectious. New evidence shows that the quantity of virus in small droplets emanating directly from lungs is much higher than those in cough droplets which are composed of mucus with diluted virus quantities.

The fact that surfactants make up about 4% of large droplets means that as these droplets evaporate on the mask surface the surfactant concentration will increase and the surface tension be reduced to make the formation of smaller droplets easier.

University of Arizona Finding COVID Transmitters a Week Early by Sewage Tracing

The university has combined more common forms of coronavirus mitigation, swab testing and contact tracing, with a more exotic one: analyzing sewage.

The university had implemented a campus-wide initiative to conduct what’s known as wastewater-based epidemiology. This effort, which involves analyzing sewage samples for traces of the coronavirus, gave the university a way to quickly and repeatedly look for traces of the virus in discrete groups of people — in this case, dorms — as part of an early warning system to catch cases of COVID-19.

 “From one test, we get the prevalence of the virus within the whole community,” said Ian Pepper, an environmental microbiologist who is leading the wastewater testing effort on campus.

The idea is catching on. Researchers in the United Kingdom launched a program in July to conduct cross-country wastewater surveillance. In Israel, scientists who collected sewage samples nationwide in March and April heralded the effort as an effective, noninvasive way of tracking outbreaks across geographic regions.

At the University of Arizona, Pepper said this type of testing is especially useful for finding and isolating infected individuals before they have a chance to spread the virus widely. The two cases that have been identified at the university were both asymptomatic, and Pepper said wastewater testing could be sensitive enough to detect the coronavirus up to a week before a person develops symptoms.

“So, you have seven precious days in which you can undergo intervention,” he said.

Pepper’s team is conducting regular tests of sewage from 20 buildings across campus, including dorms and the university’s student union center.

If a sample comes back positive for the coronavirus, the school’s protocol is to then test everyone who lives or works in the building using traditional nasal swabs or antigen tests that are designed to detect viral proteins. Infected individuals are then quarantined, according to Dr. Robert C. Robbins, president of the University of Arizona.

Wastewater testing is designed to catch fragments of the virus that are shed from the body in fecal matter. Pepper’s team has been collecting sewage samples from buildings twice a week around 8:30 a.m. — a time that Pepper said is, “after people got up and typically go to the bathroom.

If there are positive results, the sampling can be done more frequently, he said, but the researchers also found that bits of the virus tend to linger in wastewater rather than being dispersed immediately.

Robbins said wastewater-based epidemiology is a crucial part of the school’s “test, trace and treat” protocol and is a valuable tool that allows for more precise testing.

“What we’re trying to find are those asymptomatic individuals who can be unknowing vectors infecting people,” Robbins said.

But this type of sampling can also be done at the neighborhood and community level, according to Pepper. In addition to studying sewage on campus, scientists at the University of Arizona have been analyzing samples from wastewater treatment plants across the country, including New York and Los Angeles.

In addition to finding potential hot spots, wastewater testing can help public health officials measure the severity of viral transmission in communities. In Arizona’s Pima County, for example, wastewater samples taken six weeks ago, when the state was dealing with a significant spike in cases, were found to have “sky-high” concentrations of the virus, according to Pepper. In the last two weeks, those concentrations, along with the number of new cases, “have dropped dramatically,” he said.

H2O2 Fogger Used at Columbia MD Swimming Pool

Goldfish Swim School Columbia MD has  adopted technology that has allowed the business to reopen to swimmers.

Goldfish Swim School Columbia is the only aquatics facility in the area using state-of-the-art HaloFogger technology to keep everyone in their facility as safe as possible. This innovative technology has been used at Michigan State University. MSU staff used HaloFogger machines to decontaminate spaces on campus, Goldfish Swim School Columbia General Manager Gillian Salazar told Patch.

"They realized that this technology could be effective to combat COVID-19.

The HaloFogger generates a turbulent aerosol that uses evaporation to quickly disperse H202 vapor and increasingly concentrated micro-droplets everywhere in complex rooms to kill germs where they hide, ensuring that the HaloMist cleaning formula reaches even those spaces beyond the reach of sprays, wipes or UV lights," Salazar said.

"This technology allows Goldfish Swim School Columbia to achieve uniform coverage and disinfection throughout their entire facility. The HaloFogger is getting national attention because it is 'winning against COVID-19' and has already proven successful in fighting SARS and Ebola. The EPA has approved this technology for emergency use against COVID-19. Some schools and public transportation services are also using this technology," she said.

Goldfish Swim School Columbia was closed from late March through June due to the coronavirus. But thanks to this new technology and outfitting swim instructors and other employees with personal protective equipment, it is now open.

H2O2 Disinfection for Super Yachts 

Cleaning standards have always been high on board superyachts, but the cleaning and disinfection of objects and surfaces, as well as the air in a room, is a particular challenge for the industry during the COVID-19 pandemic. As scientists have discovered, the coronavirus is mainly spread via droplet infection and aerosols (tiny particles suspended in the air) can also transmit the virus and sometimes stay in the air for hours.

While wipe and spray disinfection is effective for cleaning surfaces, hydrogen peroxide (H2O2) cold fogging can disinfect the air in a room, including its aerosols. In response to the COVID-19 pandemic, Cleanmarine is offering H2O2 cold nebulization as a safe and certifiable solution that reliably kills viruses, bacteria, fungi and spores.

The process works by using a special nozzle that atomizes the active ingredient, H2O2, very finely. This way a residue-free disinfection of all surfaces, technical devices, walls, fabrics and the room air takes place. The mobile nebulization process can be adapted to the diverse requirements of environmental hygiene such as room size, relative humidity, temperature, germ spectrum and material compatibility. This technology was first approved in the USA in 1985. 

Cleanmarine specializes in cleaning solutions and the care of interiors on board superyachts. With H2O2 disinfection, Cleanmarine complements its existing portfolio with an effective and sustainable cabin and room preparation in accordance with the EN standard.

“The superyacht industry is a very special niche market and places high demands on the quality and service of every company,” says André Kohnen, managing director of Cleanmarine GmbH. “This means that new trends are quickly picked up and implemented and new market potentials quickly emerge.”