The problem of aerosolization

Abstract

Transmission of COVID-19 is primarily through droplets (only short distances) and fomite spread (e.g., clothing, equipment, furniture) that can become contaminated by the virus [1]. In contrast, aerosols are composed of much smaller fluid particles that can remain suspended in the air for prolonged periods [2]. Current evidence suggests that coronaviruses can survive in the aerosol within fluid particles under certain conditions [3, 4]. Some events can potentially lead to aerosolization of virally contaminated body fluid (aerosol-generating procedures "AGPs"), including coughing/sneezing/expectorating, NIV, HFNC, jet ventilation, delivery of nebulized medications via simple face mask, cardiopulmonary resuscitation (before tracheal intubation) and tracheal extubation [5, 6]. A higher risk of viral aerosolization was reported with tracheal suction (without a closed system), tracheal intubation, laryngoscopy, bronchoscopy/gastroscopy and tracheostomy/cricothyroidotomy [6]. Thus, these procedures carry a potential increased risk of nosocomial infection to healthcare workers (HCWs) and COVID-19 has now been classified as a high consequence infectious disease (HCID), emphasizing the significant risk to HCWs and the healthcare system [1].