Possible Transmission of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in a Public Bath Center in Huai’an, Jiangsu Province, China | Critical Care Medicine | JAMA Network Open | JAMA Network
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Zhu  N, Zhang  D, Wang  W,  et al; China Novel Coronavirus Investigating and Research Team.  A novel coronavirus from patients with pneumonia in China, 2019.   N Engl J Med. 2020;382(8):727-733. doi:10.1056/NEJMoa2001017PubMedGoogle ScholarCrossref
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    1 Comment for this article
    EXPAND ALL
    April 2, 2020
    Educate on how to close the toilet knob taps, or replace them
    Alberto Donzelli, MD | Scientific Committee of the Foundation “Allineare Sanità e Salute” Milan, Via Ricordi, 4 - 20131 Milano - Italy
    The confirmed transmission modes of SARS-CoV-2 include respiratory droplets and physical contact, but it is called into question also the contact with contaminated surfaces. The Research Letter of Luo et al1 reports a cluster-spreading event in which a patient with SARS-CoV-2 may have transmitted the virus to 8 other healthy individuals via bathing in a public bath center. However, there was a lack of detail regarding the transmission routes of the patients in the bath center.
    Recently, an article published in the NEJM2 analyzed the SARS-CoV-2 resistance on certain surfaces.
    The paper2 confirmed that also SARS-CoV-2 is quite stable     on surfaces like stainless steel, being detected up to 48-72 hours after application.
    In this case, it may be also possible that some individuals have been infected by touching common surfaces contaminated by a SARS-CoV-2 positive patient, such as the taps in the bathrooms.
    By turning the knob, especially after coughing, sneezing or cleaning with toilet paper (stool/anal swabs can contain SARS-CoV-2),3,4 everyone deposits germs on it. After washing hands with soap, closing the knob the germs are taken back. Every follower paradoxically collects them by implementing a "preventive" measure, maybe before bringing food into the mouth or changing contact lenses.
    The CDC recommends to clean and disinfect high touch surfaces,5 but it is unrealistic to do so after each tap use.
    Knob taps are critical points in the transmission chain: instead, new toilets should install long elbow-levers, or at least short levers, provided people are educated to close them with the forearm or the cut of the hand, foremost in high-risk communities (retirement homes, prisons), but also in workplaces, schools and families. Meantime, existing knobs must be closed with disposable paper towel wipes, or with toilet paper sheets.

    e-mail: adonzelli1@libero.it 

    1. Luo C, Yao L, Li Zhang L, et al. Possible Transmission of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in a Public Bath Center in Huai’an, Jiangsu Province, China. JAMA Network Open. 2020;3(3):e204583. doi:10.1001/jamanetworkopen.2020.4583
    2. van Doremalen N, Bushmaker T, Morris DH, et al. Aerosol and Surface Stability of SARS-CoV-2 as Compared with SARS-CoV-1. N Engl J Med. March 17, 2020. DOI: 10.1056/NEJMc2004973.
    3. Zhang W, Du RH, Li B, et al. Molecular and serological investigation of 2019-nCoV infected
    patients: implication of multiple shedding routes. Emerg Microbes Infect. 2020;9(1):386-389.
    4. Gu J, Han B, Wang J. COVID-19: Gastrointestinal manifestations and potential fecal-oral transmission. Gastroenterology. 2020 (in press). DOI: https://doi.org/10.1053/j.gastro.2020.02.054.
    5. CDC-Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/prepare/disinfecting-your-home.html
    CONFLICT OF INTEREST: None Reported
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    Research Letter
    Infectious Diseases
    March 30, 2020

    Possible Transmission of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in a Public Bath Center in Huai’an, Jiangsu Province, China

    Chao Luo, MD, PhD1; Lun Yao, MD2; Li Zhang, MD, PhD1; et al Mengchu Yao, MD3; Xiaofei Chen, MD, PhD3; Qilong Wang, MD, PhD1; Hongbing Shen, MD, PhD4
    Author Affiliations Article Information
    • 1Department of Central Laboratory, The Affiliated Huai’an No. 1 People’s Hospital, Nanjing Medical University, Huai’an, China
    • 2Department of Infection Diseases, Huai’an No. 4 Hospital, Huai’an, China
    • 3Department of Clinical Oncology, The Affiliated Huai’an No. 1 People’s Hospital, Nanjing Medical University, Huai’an, China
    • 4Department of Epidemiology and Biostatistics, Jiangsu Key Lab of Cancer Biomarkers, Prevention, and Treatment, Collaborative Innovation Center for Cancer Medicine, School of Public Health, Nanjing Medical University, Nanjing, China
    JAMA Netw Open. 2020;3(3):e204583. doi:10.1001/jamanetworkopen.2020.4583
    COVID-19 Resource Center
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    In December 2019, a novel pneumonia named coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), emerged in Wuhan, China, and has since spread to 25 countries. Current reports show that SARS-CoV-2 is closely related to severe acute respiratory syndrome coronavirus (SARS-CoV) and Middle East respiratory syndrome coronavirus (MERS-CoV)1,2 and that it has a greater transmissibility than other coronaviruses. The confirmed transmission modes of SARS-CoV-2 include respiratory droplets and physical contact, and the incubation period for the virus is approximately 3 to 7 days, but it can be as long as 24 days.3 In this case series, we report a cluster-spreading event in Huai’an (700 km northeast of Wuhan) in Jiangsu Province, China, in which a patient with SARS-CoV-2 may have transmitted the virus to 8 other healthy individuals via bathing in a public bath center.

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