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Air, Surface Environmental, and Personal Protective Equipment Contamination by Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) From a Symptomatic Patient

Educational Objective
Understand that COVID-19 can be transmitted through environmental contamination

Coronaviruses have been implicated in nosocomial outbreaks1 with environmental contamination as a route of transmission.2 Similarly, nosocomial transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been reported.3 However, the mode of transmission and extent of environmental contamination are unknown.

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Article Information

Accepted for Publication: February 27, 2020.

Corresponding Authors: Kalisvar Marimuthu, MBBS (kalisvar_marimuthu@ncid.sg), and Ng Oon Tek, MBBS, MPH (oon_tek_ng@ncid.sg), National Centre for Infectious Diseases, 16 Jalan Tan Tock Seng, Singapore 308442.

Published Online: March 4, 2020. doi:10.1001/jama.2020.3227

Author Contributions: Drs Ong and Marimuthu had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis. Drs Wong and Marimuthu contributed equally as senior authors.

Concept and design: Ong, Ng, Wong, Marimuthu.

Acquisition, analysis, or interpretation of data: Ong, Tan, Chia, Lee, Ng, Wong, Marimuthu.

Drafting of the manuscript: Ong, Ng, Wong, Marimuthu.

Critical revision of the manuscript for important intellectual content: Ong, Tan, Chia, Lee, Ng, Wong, Marimuthu.

Statistical analysis: Ong, Marimuthu.

Obtained funding: Wong, Marimuthu.

Administrative, technical, or material support: Ong, Tan, Chia, Ng, Wong, Marimuthu.

Supervision: Ng, Marimuthu.

Conflict of Interest Disclosures: None reported.

Funding/Support: Funding for this study was supported by the National Medical Research Council (NMRC) Seed Funding Program (TR19NMR119SD) and internal funds from DSO National Laboratories. Dr Ng is supported by NMRC Clinician Scientist Award MOH-000276. Dr Marimuthu is supported by an NMRC Clinician-Scientist Individual Research Grant (CIRG18Nov-0034).

Role of the Funder/Sponsor: The funding bodies had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; or decision to submit the manuscript for publication.

Additional Contributions: We thank Barnaby Edward Young, MB, BChir, and Ding Ying, PhD, National Centre for Infectious Diseases, Singapore, for assistance with sample processing; Marcus Gum, BSc, and Yvonne Lau, PhD, DSO National Laboratories, Singapore, for assistance with sample RT-PCR testing; and Brenda Sze Peng Ang, MBBS, National Centre for Infectious Diseases, Boon Huan Tan, PhD, DSO National Laboratories, and Yee-Sin Leo, MBBS, National Centre for Infectious Diseases, for overall supervision and guidance. No compensation was received for their roles in the study.

References
1.
Chowell  G , Abdirizak  F , Lee  S ,  et al.  Transmission characteristics of MERS and SARS in the healthcare setting: a comparative study.   BMC Med. 2015;13:210. doi:10.1186/s12916-015-0450-0PubMedGoogle ScholarCrossref
2.
Bin  SY , Heo  JY , Song  MS ,  et al.  Environmental contamination and viral shedding in MERS patients during MERS-CoV outbreak in South Korea.   Clin Infect Dis. 2016;62(6):755-760. doi:10.1093/cid/civ1020PubMedGoogle ScholarCrossref
3.
Wang  D , Hu  B , Hu  C ,  et al.  Clinical characteristics of 138 hospitalized patients with 2019 novel coronavirus-infected pneumonia in Wuhan, China.   JAMA. Published online February 7, 2020. doi:10.1001/jama.2020.1585PubMedGoogle Scholar
4.
Corman  VM , Landt  O , Kaiser  M ,  et al.  Detection of 2019 novel coronavirus (2019-nCoV) by real-time RT-PCR.   Euro Surveill. 2020;25(3). doi:10.2807/1560-7917.ES.2020.25.3.2000045PubMedGoogle Scholar
5.
Young  B , Ong  SWX , Kalimuddin  S ,  et al.  Epidemiologic features and clinical course of patients infected with SARS-CoV-2 in Singapore.   JAMA. Published online March 3, 2020. doi:10.1001/jama.2020.3204Google Scholar
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