Household Transmission of Severe Acute Respiratory Syndrome Coronavirus 2 in the United States: Living Density, Viral Load, and Disproportionate Impact on Communities of Color.

BACKGROUND: Households are hot spots for severe acute respiratory syndrome coronavirus 2 transmission. METHODS: This prospective study enrolled 100 coronavirus disease 2019 (COVID-19) cases and 208 of their household members in North Carolina though October 2020, including 44% who identified as Hispanic or non-White. Households were enrolled a median of 6 days from symptom onset in the index case. Incident secondary cases within the household were detected using quantitative polymerase chain reaction of weekly nasal swabs (days 7, 14, 21) or by seroconversion at day 28. RESULTS: Excluding 73 household contacts who were PCR-positive at baseline, the secondary attack rate (SAR) among household contacts was 32% (33 of 103; 95% confidence interval [CI], 22%-44%). The majority of cases occurred by day 7, with later cases confirmed as household-acquired by viral sequencing. Infected persons in the same household had similar nasopharyngeal viral loads (intraclass correlation coefficient = 0.45; 95% CI, .23-.62). Households with secondary transmission had index cases with a median viral load that was 1.4 log10 higher than those without transmission (P = .03), as well as higher living density (more than 3 persons occupying fewer than 6 rooms; odds ratio, 3.3; 95% CI, 1.02-10.9). Minority households were more likely to experience high living density and had a higher risk of incident infection than did White households (SAR, 51% vs 19%; P = .01). CONCLUSIONS: Household crowding in the context of high-inoculum infections may amplify the spread of COVID-19, potentially contributing to disproportionate impact on communities of color.

High household transmission of SARS-CoV-2 in the United States: living density, viral load, and disproportionate impact on communities of color.

Background: Few prospective studies of SARS-CoV-2 transmission within households have been reported from the United States, where COVID-19 cases are the highest in the world and the pandemic has had disproportionate impact on communities of color. Methods and Findings: This is a prospective observational study. Between April-October 2020, the UNC CO-HOST study enrolled 102 COVID-positive persons and 213 of their household members across the Piedmont region of North Carolina, including 45% who identified as Hispanic/Latinx or non-white. Households were enrolled a median of 6 days from onset of symptoms in the index case. Secondary cases within the household were detected either by PCR of a nasopharyngeal (NP) swab on study day 1 and weekly nasal swabs (days 7, 14, 21) thereafter, or based on seroconversion by day 28. After excluding household contacts exposed at the same time as the index case, the secondary attack rate (SAR) among susceptible household contacts was 60% (106/176, 95% CI 53%-67%). The majority of secondary cases were already infected at study enrollment (73/106), while 33 were observed during study follow-up. Despite the potential for continuous exposure and sequential transmission over time, 93% (84/90, 95% CI 86%-97%) of PCR-positive secondary cases were detected within 14 days of symptom onset in the index case, while 83% were detected within 10 days. Index cases with high NP viral load (>10^6 viral copies/ul) at enrollment were more likely to transmit virus to household contacts during the study (OR 4.9, 95% CI 1.3-18 p=0.02). Furthermore, NP viral load was correlated within families (ICC=0.44, 95% CI 0.26-0.60), meaning persons in the same household were more likely to have similar viral loads, suggesting an inoculum effect. High household living density was associated with a higher risk of secondary household transmission (OR 5.8, 95% CI 1.3-55) for households with >3 persons occupying <6 rooms (SAR=91%, 95% CI 71-98%). Index cases who self-identified as Hispanic/Latinx or non-white were more likely to experience a high living density and transmit virus to a household member, translating into an SAR in minority households of 70%, versus 52% in white households (p=0.05). Conclusions: SARS-CoV-2 transmits early and often among household members. Risk for spread and subsequent disease is elevated in high-inoculum households with limited living space. Very high infection rates due to household crowding likely contribute to the increased incidence of SARS-CoV-2 infection and morbidity observed among racial and ethnic minorities in the US. Quarantine for 14 days from symptom onset of the first case in the household is appropriate to prevent onward transmission from the household. Ultimately, primary prevention through equitable distribution of effective vaccines is of paramount importance.

Using a Low-Fidelity Simulation to Enhance Cultural Awareness and Emotional Intelligence in Nursing Students.

Undergraduate didactic nursing leadership courses lack experiential opportunities to address working with culturally diverse populations. The authors used Bafa Bafa©, a cross-cultural low-fidelity simulation, to further develop critical thinking and emotional intelligence skills in prelicensure nursing students. This article describes the authors' experiences of integrating this innovative teaching strategy in the classroom to increase cultural awareness. The students' discovery of unexpected feelings, thoughts, and perceptions has the potential to extend beyond the simulated experience when coupled with faculty reinforcement of engaging in self-reflective practice as a professional nurse.

The impact of multiuser virtual environments on student engagement.

The purpose of this pilot study was to test the hypothesis that web-based synchronous instruction utilizing Multi-user Virtual World Environments (MUVEs) increases student engagement compared to traditional asynchronous learning methods. In a quasi-experimental two group posttest only study, a sample of Family Nurse Practitioner students (n = 21) received instruction using either a synchronous (n = 10) or asynchronous (n = 11) learning method. Engagement was measured using the Community of Inquiry survey. Results indicated that engagement scores were significantly higher for the synchronous learning platform (mean = 3.61, SD = 1.13) compared to the asynchronous learning platform (mean = 3.49, SD = 1.08, t(1766) = -2.21, p < 0.05). Increased student engagement with synchronous MUVE platforms have the potential to improve learning outcomes and offer nursing students a multitude of educational opportunities to practice new skills and behaviors in real life scenarios, all within the safety of a controlled environment.

Silver tube coatings in pneumonia prevention.

BACKGROUND: Ventilator-associated pneumonia (VAP) is a common hospital-acquired infection that is associated with higher mortality rates, increased healthcare costs and longer hospitalisations. One intervention that has recently been used to reduce the prevalence of VAP is a new type of endotracheal tube impregnated with silver sulfadiazine. AIM: To investigate whether the use of silver-coated endotracheal tubes reduces VAP in adult intubated patients. METHOD: A thorough evidence-based literature review was conducted to investigate whether the use of silver-coated endotracheal tubes reduces the incidence of VAP. The following databases were consulted: CINAHL; Medline; Health Source: Nursing and Academic edition; ProQuest Nursing and Allied Health Source; Cochrane Database of Systematic Reviews; TRIP Database; and National Guideline Clearinghouse. RESULTS: The use of silver-coated endotracheal tubes reduces the prevalence of VAP in intubated patients but should not be used as an isolated intervention. CONCLUSION: More research is needed to assess whether the benefits of silver-coated endotracheal tubes, coupled with additional VAP prevention strategies, outweigh the costs incurred.