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      Challenges and solutions for addressing critical shortage of supply chain for personal and protective equipment (PPE) arising from Coronavirus disease (COVID19) pandemic – Case study from the Republic of Ireland

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          Abstract

          Coronavirus (COVID-19) is highly infectious agent that causes fatal respiratory illnesses, which is of great global public health concern. Currently, there is no effective vaccine for tackling this COVID19 pandemic where disease countermeasures rely upon preventing or slowing person-to-person transmission. Specifically, there is increasing efforts to prevent or reduce transmission to front-line healthcare workers (HCW). However, there is growing international concern regarding the shortage in supply chain of critical one-time-use personal and protective equipment (PPE). PPE are heat sensitive and are not, by their manufacturer's design, intended for reprocessing. Most conventional sterilization technologies used in hospitals, or in terminal medical device sterilization providers, cannot effectively reprocess PPE due to the nature and severity of sterilization modalities. Contingency planning for PPE stock shortage is important. Solutions in the Republic of Ireland include use of smart communication channels to improve supply chain, bespoke production of PPE to meets gaps, along with least preferred option, use of sterilization or high-level disinfection for PPE reprocessing. Reprocessing PPE must consider material composition, functionality post treatment, along with appropriate disinfection. Following original manufacturer of PPE and regulatory guidance is important. Technologies deployed in the US, and for deployment in the Republic of Ireland, are eco-friendly, namely vaporised hydrogen peroxide (VH2O2), such as for filtering facepiece respirators and UV irradiation and High-level liquid disinfection (Actichlor+) is also been pursed in Ireland. Safeguarding supply chain of PPE will sustain vital healthcare provision and will help reduce mortality.

          Graphical abstract

          Highlights

          • •

            There is pressing need to find solutions for reprocessing of PPE for COVID19

          • •

            Reprocessing of PPE is challenging as made for one-time-use

          • •

            Most sterilization technologies are not suitable for PPE reprocessing

          • •

            Use of vaporised hydrogen peroxide and UV irradiation may prove effective for PPE

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          Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus–Infected Pneumonia

          Qun Li, Xuhua Guan, Peng Wu … (2020)
          Abstract Background The initial cases of novel coronavirus (2019-nCoV)–infected pneumonia (NCIP) occurred in Wuhan, Hubei Province, China, in December 2019 and January 2020. We analyzed data on the first 425 confirmed cases in Wuhan to determine the epidemiologic characteristics of NCIP. Methods We collected information on demographic characteristics, exposure history, and illness timelines of laboratory-confirmed cases of NCIP that had been reported by January 22, 2020. We described characteristics of the cases and estimated the key epidemiologic time-delay distributions. In the early period of exponential growth, we estimated the epidemic doubling time and the basic reproductive number. Results Among the first 425 patients with confirmed NCIP, the median age was 59 years and 56% were male. The majority of cases (55%) with onset before January 1, 2020, were linked to the Huanan Seafood Wholesale Market, as compared with 8.6% of the subsequent cases. The mean incubation period was 5.2 days (95% confidence interval [CI], 4.1 to 7.0), with the 95th percentile of the distribution at 12.5 days. In its early stages, the epidemic doubled in size every 7.4 days. With a mean serial interval of 7.5 days (95% CI, 5.3 to 19), the basic reproductive number was estimated to be 2.2 (95% CI, 1.4 to 3.9). Conclusions On the basis of this information, there is evidence that human-to-human transmission has occurred among close contacts since the middle of December 2019. Considerable efforts to reduce transmission will be required to control outbreaks if similar dynamics apply elsewhere. Measures to prevent or reduce transmission should be implemented in populations at risk. (Funded by the Ministry of Science and Technology of China and others.)
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            The epidemiology and pathogenesis of coronavirus disease (COVID-19) outbreak

            Hussin A Rothan, Siddappa Byrareddy (2020)
            Coronavirus disease (COVID-19) is caused by SARS-COV2 and represents the causative agent of a potentially fatal disease that is of great global public health concern. Based on the large number of infected people that were exposed to the wet animal market in Wuhan City, China, it is suggested that this is likely the zoonotic origin of COVID-19. Person-to-person transmission of COVID-19 infection led to the isolation of patients that were subsequently administered a variety of treatments. Extensive measures to reduce person-to-person transmission of COVID-19 have been implemented to control the current outbreak. Special attention and efforts to protect or reduce transmission should be applied in susceptible populations including children, health care providers, and elderly people. In this review, we highlights the symptoms, epidemiology, transmission, pathogenesis, phylogenetic analysis and future directions to control the spread of this fatal disease.
            Article 0 comments Cited 2083 times – based on 0 reviews     Review now
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              Persistence of coronaviruses on inanimate surfaces and their inactivation with biocidal agents

              G Kampf, D Todt, S. Pfaender … (2020)
              Summary Currently, the emergence of a novel human coronavirus, SARS-CoV-2, has become a global health concern causing severe respiratory tract infections in humans. Human-to-human transmissions have been described with incubation times between 2-10 days, facilitating its spread via droplets, contaminated hands or surfaces. We therefore reviewed the literature on all available information about the persistence of human and veterinary coronaviruses on inanimate surfaces as well as inactivation strategies with biocidal agents used for chemical disinfection, e.g. in healthcare facilities. The analysis of 22 studies reveals that human coronaviruses such as Severe Acute Respiratory Syndrome (SARS) coronavirus, Middle East Respiratory Syndrome (MERS) coronavirus or endemic human coronaviruses (HCoV) can persist on inanimate surfaces like metal, glass or plastic for up to 9 days, but can be efficiently inactivated by surface disinfection procedures with 62–71% ethanol, 0.5% hydrogen peroxide or 0.1% sodium hypochlorite within 1 minute. Other biocidal agents such as 0.05–0.2% benzalkonium chloride or 0.02% chlorhexidine digluconate are less effective. As no specific therapies are available for SARS-CoV-2, early containment and prevention of further spread will be crucial to stop the ongoing outbreak and to control this novel infectious thread.
              Article 0 comments Cited 1467 times – based on 0 reviews     Review now
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                Author and article information

                Contributors
                Neil J. Rowan
                Journal
                Journal ID (nlm-ta): Sci Total Environ
                Journal ID (iso-abbrev): Sci. Total Environ
                Title: The Science of the Total Environment
                Publisher: The Authors. Published by Elsevier B.V.
                ISSN (Print): 0048-9697
                ISSN (Electronic): 1879-1026
                Publication date PMC-release: 6 April 2020
                Publication date (Print): 10 July 2020
                Publication date (Electronic): 6 April 2020
                Volume: 725
                Page: 138532
                Affiliations
                [a ]Department of Nursing and Healthcare, Athlone Institute of Technology, Ireland
                [b ]Centre for Disinfection, Sterilization and Biosecurity, Athlone Institute of Technology, Ireland
                [c ]Lung Biology Group, Regenerative Medicine Institute at CURAM Centre for Medical Devices, National University of Ireland Galway, Galway, Ireland
                [d ]Anaesthesia and Intensive Care Medicine, University Hospital Galway, Galway, Ireland
                Author notes
                [* ]Corresponding author at: CDSB, Athlone Institute of Technology, Ireland. nrowan@ 123456ait.ie
                Article
                Publisher ID: S0048-9697(20)32045-3 Publisher ID: 138532
                DOI: 10.1016/j.scitotenv.2020.138532
                PMC ID: 7195029
                PubMed ID: 32304970
                SO-VID: 94e61f26-bfb3-41a5-bca9-9640ee737e6d
                Copyright © © 2020 The Authors
                License:

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                Date received : 5 April 2020
                Date accepted : 5 April 2020
                Categories
                Subject: Article

                ScienceOpen disciplines: General environmental science
                Keywords: covid19,ppe,sterilization,healthcare workers,resource utilization,sustainability
                Data availability:
                ScienceOpen disciplines: General environmental science
                Keywords: covid19, ppe, sterilization, healthcare workers, resource utilization, sustainability

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