1. In this case study involving one generally well infant with coronavirus disease 2019 (COVID-19), various parts of the isolation room were found to be contaminated with PCR-detectable SARS-CoV-2 on day 2 of admission.

2. Despite close physical contact with the infant during feeding, all three items of personal protective equipment worn by the healthcare worker were found to be negative for the virus.

Evidence Rating Level: 4 (Below Average)

Study Rundown: Severe acute respiratory syndrome-coronavirus 2 (SARS-CoV-2) is suspected to spread primarily through droplets and direct contact, but it is unknown whether airborne and fomite transmission are also causes for concern. Additionally, there is no data available regarding the risk of transmission from asymptomatic or pauci-symptomatic infants and children. This case study of an asymptomatic 6-month-old infant with COVID-19 revealed that, by day 2 of admission, the bedding, cot rail, and table in the isolation room all carried detectable amounts of the virus. While the viral load of the bedding was higher than that of the railing, the table, situated one meter from the patient, was found to have nearly the same concentration of viral particles as the bedding. Because viral load in the environment ought to fall with increasing distance from the source for droplet transmission, this unusual finding supports the possibility of contamination via indirect contact when the healthcare worker transferred items such as baby formula and baby wipes between the patient and the table. While virus viability was not assessed, these results reaffirm the importance of hand hygiene and social distancing to prevent unwitting spread by asymptomatic or presymptomatic carriers.

Click here to read the study in Annals of Internal Medicine

Relevant Reading: A Well Infant With Coronavirus Disease 2019 With High Viral Load

In-Depth [case study]: In this case study, a 6-month-old male was admitted to KK Womens and Childrens Hospital in Singapore after both his parents developed fever and sore throat within three days of each other. Upon arrival, the infant was afebrile and in no respiratory distress, but real-time reverse transcription polymerase chain reaction (rRT-PCR) testing of a nasopharyngeal specimen confirmed COVID-19 infection with very high viral load and cycle threshold (Ct) values of 15.6 and 13.7 for the N gene and Orf1ab gene, respectively. Ct values of <36 were considered positive, with lower values corresponding to higher viral load. On day 2 of admission, nasopharynx Ct values for the N gene and Orf1ab gene were 18.8 and 18.6, respectively, while urine and stool samples continued to test negative. After the infant was carried and fed within a span of 15 minutes, synthetic fiber flocked swabs with Universal Transport Medium were run over nearly 100% of the infants bedding, the cot rail, and a table located 1 meter away from the bed as well as the healthcare workers face shield, N95 mask, and waterproof gown. All three PPE samples were found to be negative for SARS-nCov-2, but the RdRp gene Ct values for the bedding, rail, and table were 28.7, 33.3, and 29.7, respectively.

Image: PD

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SARS-CoV-2 detected on various surroundings of asymptomatic COVID-19 positive infant - 2 Minute Medicine