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      Lüftungskonzepte in Schulen zur Prävention einer Übertragung hochinfektiöser Viren (SARS-CoV‑2) über Aerosole in der Raumluft Translated title: Ventilation concepts in schools for the prevention of transmission of highly infectious viruses (SARS-CoV-2) by aerosols in indoor air

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          Abstract

          Aller Kenntnis nach spielen die mit der Atmung ausgeschiedenen Aerosolpartikel eine wichtige Rolle bei der Verbreitung des 2019 erstmalig aufgetretenen Coronavirus SARS-CoV‑2, insbesondere im Rahmen menschlicher Zusammenkünfte in Innenräumen. Diese Arbeit fasst die für den Schulbetrieb relevanten Sachverhalte und Maßnahmen zur Verminderung von Infektionen über den Aerosolpfad zusammen. Eine wichtige Maßnahme ist die Verstärkung der Raumlüftung, d. h. der Austausch möglicherweise kontaminierter Innenraumluft mit Außenluft. Neben der Verminderung der Konzentration infektiöser Aerosole ist Lüftung unabdingbar zur Abfuhr des in Klassenräumen erzeugten Kohlendioxids, der Luftfeuchte und anderer chemischer Stoffe in der Innenraumluft. Unabhängig von Lüftung erweist sich das Tragen von Mund-Nasen-Masken (medizinische Masken bzw. filtrierende Halbmasken) als wirksame Maßnahme. Eine für virushaltige Partikel wirksame Luftreinigung durch feste bzw. mobile Anlagen kann die genannten Maßnahmen unterstützen bzw. in Fällen aushelfen, wenn Räume trotz schlechter Lüftungsmöglichkeit genutzt werden müssen. Der Artikel gibt den Stand des Wissens im Oktober 2021 über verschiedene technische Schutzmaßnahmen wieder, die sich seit Beginn der Pandemie als sinnvoll erwiesen haben, wobei der Fokus auf der Reduzierung von indirekten Infektionen liegt. Neu hinzukommende Varianten von SARS-CoV‑2, der Fortschritt der Impfkampagne bei Kindern und Jugendlichen sowie die Zunahme der allgemeinen Immunität werden möglicherweise eine Neubewertung der Maßnahmen erfordern. Neben kurzfristigen und schnell wirksamen Maßnahmen zum Infektionsschutz erscheint es auch geboten, die in Deutschland existierenden Defizite bei Raum- und Gebäudelüftung an Schulen durch eine langfristige Strategie zu beheben. Im Sinne einer dauerhaften Verbesserung der Innenraumluft und der Prävention gegen künftige luftübertragene Infektionskrankheiten erscheint die zunehmende Ausstattung von Schulen mit fest installierten Lüftungsanlagen bzw. raumlufttechnischen Anlagen – mit Option auf Wärme- und Feuchterückgewinnung – als nachhaltige gesellschaftliche Investition.

          Translated abstract

          Exhaled aerosol particles play an important role in the transmission of SARS-CoV‑2, particularly when many people gather indoors. This article summarises the knowledge on virus transmission in schools and practical measures to reduce aerosol-driven infections. A central preventive measure is to enhance room and building ventilation, i.e. the exchange of possibly contaminated indoor air with ambient air. Besides the concentrations of possibly infectious particles, ventilation reduces carbon dioxide concentrations, humidity and other chemical substances in indoor air as well. Irrespective of ventilation, face masks (surgical or FFP2) represent a vital part of hygiene measures. Fixed or mobile air purifiers can support these measures particularly when rooms providing only poor ventilation must be utilized. The article reflects the state of knowledge in October 2021 of the various techniques that have been shown as useful for the prevention of indirect infections. New variants of SARS-CoV‑2, the progress of the vaccination campaign in children and adolescents, and the increase in general immunity might require a re-evaluation of the prevention strategies described. The COVID-19 pandemic has revealed common deficits in room and building ventilation, not least in schools. Apart from short-term measures for the prevention of airborne infectious diseases, a long-term strategy seems advisable to alleviate the deficits encountered in schools with respect to room and building ventilation. In view of a permanent improvement of indoor air and prevention against airborne infections the fitting of schools with fixed ventilation systems – preferably including heat and moisture recovery – appears to be a sustainable social investment.

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          Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1

          To the Editor: A novel human coronavirus that is now named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (formerly called HCoV-19) emerged in Wuhan, China, in late 2019 and is now causing a pandemic. 1 We analyzed the aerosol and surface stability of SARS-CoV-2 and compared it with SARS-CoV-1, the most closely related human coronavirus. 2 We evaluated the stability of SARS-CoV-2 and SARS-CoV-1 in aerosols and on various surfaces and estimated their decay rates using a Bayesian regression model (see the Methods section in the Supplementary Appendix, available with the full text of this letter at NEJM.org). SARS-CoV-2 nCoV-WA1-2020 (MN985325.1) and SARS-CoV-1 Tor2 (AY274119.3) were the strains used. Aerosols (<5 μm) containing SARS-CoV-2 (105.25 50% tissue-culture infectious dose [TCID50] per milliliter) or SARS-CoV-1 (106.75-7.00 TCID50 per milliliter) were generated with the use of a three-jet Collison nebulizer and fed into a Goldberg drum to create an aerosolized environment. The inoculum resulted in cycle-threshold values between 20 and 22, similar to those observed in samples obtained from the upper and lower respiratory tract in humans. Our data consisted of 10 experimental conditions involving two viruses (SARS-CoV-2 and SARS-CoV-1) in five environmental conditions (aerosols, plastic, stainless steel, copper, and cardboard). All experimental measurements are reported as means across three replicates. SARS-CoV-2 remained viable in aerosols throughout the duration of our experiment (3 hours), with a reduction in infectious titer from 103.5 to 102.7 TCID50 per liter of air. This reduction was similar to that observed with SARS-CoV-1, from 104.3 to 103.5 TCID50 per milliliter (Figure 1A). SARS-CoV-2 was more stable on plastic and stainless steel than on copper and cardboard, and viable virus was detected up to 72 hours after application to these surfaces (Figure 1A), although the virus titer was greatly reduced (from 103.7 to 100.6 TCID50 per milliliter of medium after 72 hours on plastic and from 103.7 to 100.6 TCID50 per milliliter after 48 hours on stainless steel). The stability kinetics of SARS-CoV-1 were similar (from 103.4 to 100.7 TCID50 per milliliter after 72 hours on plastic and from 103.6 to 100.6 TCID50 per milliliter after 48 hours on stainless steel). On copper, no viable SARS-CoV-2 was measured after 4 hours and no viable SARS-CoV-1 was measured after 8 hours. On cardboard, no viable SARS-CoV-2 was measured after 24 hours and no viable SARS-CoV-1 was measured after 8 hours (Figure 1A). Both viruses had an exponential decay in virus titer across all experimental conditions, as indicated by a linear decrease in the log10TCID50 per liter of air or milliliter of medium over time (Figure 1B). The half-lives of SARS-CoV-2 and SARS-CoV-1 were similar in aerosols, with median estimates of approximately 1.1 to 1.2 hours and 95% credible intervals of 0.64 to 2.64 for SARS-CoV-2 and 0.78 to 2.43 for SARS-CoV-1 (Figure 1C, and Table S1 in the Supplementary Appendix). The half-lives of the two viruses were also similar on copper. On cardboard, the half-life of SARS-CoV-2 was longer than that of SARS-CoV-1. The longest viability of both viruses was on stainless steel and plastic; the estimated median half-life of SARS-CoV-2 was approximately 5.6 hours on stainless steel and 6.8 hours on plastic (Figure 1C). Estimated differences in the half-lives of the two viruses were small except for those on cardboard (Figure 1C). Individual replicate data were noticeably “noisier” (i.e., there was more variation in the experiment, resulting in a larger standard error) for cardboard than for other surfaces (Fig. S1 through S5), so we advise caution in interpreting this result. We found that the stability of SARS-CoV-2 was similar to that of SARS-CoV-1 under the experimental circumstances tested. This indicates that differences in the epidemiologic characteristics of these viruses probably arise from other factors, including high viral loads in the upper respiratory tract and the potential for persons infected with SARS-CoV-2 to shed and transmit the virus while asymptomatic. 3,4 Our results indicate that aerosol and fomite transmission of SARS-CoV-2 is plausible, since the virus can remain viable and infectious in aerosols for hours and on surfaces up to days (depending on the inoculum shed). These findings echo those with SARS-CoV-1, in which these forms of transmission were associated with nosocomial spread and super-spreading events, 5 and they provide information for pandemic mitigation efforts.
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            Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Infection in Children and Adolescents: A Systematic Review

            The current rapid worldwide spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection justifies the global effort to identify effective preventive strategies and optimal medical management. While data are available for adult patients with coronavirus disease 2019 (COVID-19), limited reports have analyzed pediatric patients infected with SARS-CoV-2.
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              It is Time to Address Airborne Transmission of COVID-19

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                Author and article information

                Contributors
                wolfram.birmili@uba.de
                Journal
                Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz
                Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz
                Bundesgesundheitsblatt, Gesundheitsforschung, Gesundheitsschutz
                Springer Berlin Heidelberg (Berlin/Heidelberg )
                1436-9990
                1437-1588
                5 November 2021
                5 November 2021
                : 1-11
                Affiliations
                [1 ]GRID grid.425100.2, ISNI 0000 0004 0554 9748, Umweltbundesamt, Abteilung II 1 „Umwelthygiene“, ; Corrensplatz 1, 14195 Berlin, Deutschland
                [2 ]GRID grid.425100.2, ISNI 0000 0004 0554 9748, Umweltbundesamt, Beratungsstelle Umwelthygiene II BU, ; Wörlitzer Platz 1, 06844 Dessau, Deutschland
                Article
                3452
                10.1007/s00103-021-03452-4
                8569287
                34739549
                6461271a-c7c6-4ef6-a7ab-18c8b3a19384
                © The Author(s) 2021

                Open Access Dieser Artikel wird unter der Creative Commons Namensnennung 4.0 International Lizenz veröffentlicht, welche die Nutzung, Vervielfältigung, Bearbeitung, Verbreitung und Wiedergabe in jeglichem Medium und Format erlaubt, sofern Sie den/die ursprünglichen Autor(en) und die Quelle ordnungsgemäß nennen, einen Link zur Creative Commons Lizenz beifügen und angeben, ob Änderungen vorgenommen wurden.

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                History
                : 2 July 2021
                : 19 October 2021
                Funding
                Funded by: Umweltbundesamt (4257)
                Categories
                Leitthema

                sars-cov‑2,infektion,aerosol,lüftung,luftreinigung schulen innenraum,infection,ventilation,air purification schools indoor

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