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Table.  Environmental Locations of Surface Swabs
Environmental Locations of Surface Swabs
1.
Cai  J, Sun  W, Huang  J, Gamber  M, Wu  J, He  G.  Indirect virus transmission in cluster of COVID-19 cases, Wenzhou, China, 2020.   Emerg Infect Dis. 2020;26(6):1343-1345. doi:10.3201/eid2606.200412 PubMedGoogle ScholarCrossref
2.
Li  Q, Guan  X, Wu  P,  et al.  Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia.   N Engl J Med. 2020;382(13):1199-1207. doi:10.1056/NEJMoa2001316 PubMedGoogle ScholarCrossref
3.
Ong  SWX, Tan  YK, Chia  PY,  et al.  Air, surface environmental, and personal protective equipment contamination by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from a symptomatic patient.   JAMA. 2020;323(16):1610. doi:10.1001/jama.2020.3227 PubMedGoogle ScholarCrossref
4.
Liang  W, Guan  W, Chen  R,  et al.  Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China.   Lancet Oncol. 2020;21(3):335-337. doi:10.1016/S1470-2045(20)30096-6 PubMedGoogle ScholarCrossref
5.
World Health Organization. Surface sampling of coronavirus disease (‎‎COVID-19)‎‎: a practical “how to” protocol for health care and public health professionals. World Health Organization; February 18, 2020. Accessed July 15, 2020. https://www.who.int/publications/i/item/surface-sampling-of-coronavirus-disease-(-covid-19)-a-practical-how-to-protocol-for-health-care-and-public-health-professionals
6.
The Lancet Oncology.  Safeguarding cancer care in a post-COVID-19 world.   Lancet Oncol. 2020;21(5):603. doi:10.1016/S1470-2045(20)30243-6 PubMedGoogle ScholarCrossref
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    1 Comment for this article
    More data required
    Arturo Tozzi, pediatrician | University of North Texas
    Dear Authors,
    because this study is potentially of foremost importance, more date are required to evaluate its clinical impact.
    Data on the COVID-19 positive subjects are lacking.
    How many COVID-19 patients entered the rooms where surface samplings were performed?
    How long before surface samplings the COVID-19 positive subjects left the rooms?

    Thanks
    CONFLICT OF INTEREST: None Reported
    Views 10,676
    Citations 0
    Research Letter
    August 27, 2020

    Prevalence of Surface Contamination With SARS-CoV-2 in a Radiation Oncology Clinic

    Author Affiliations
    • 1Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers University, New Brunswick
    • 2Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
    • 3Department of Pathology and Laboratory Medicine, Robert Wood Johnson Medical Center, Rutgers University, New Brunswick, New Jersey
    • 4Department of Environmental and Occupational Health, Rutgers School of Public Health, Rutgers University, Piscataway, New Jersey
    JAMA Oncol. Published online August 27, 2020. doi:10.1001/jamaoncol.2020.3552

    The outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection has resulted in a global pandemic. It is hypothesized that the virus spreads from person to person via respiratory droplets or contact with contaminated surfaces and objects.1,2 Prior studies evaluating environmental contamination with SARS-CoV-2 have been conducted in health care settings treating patients known to have coronavirus disease 2019 (COVID-19)3; however, studies evaluating clinics that do not routinely treat patients with COVID-19 are lacking. Patients who have cancer and become infected with SARS-CoV-2 may have greater morbidity and mortality compared with the general public.4 Therefore, assessing the presence or absence of SARS-CoV-2 may provide important information for health care practitioners, patients, and their families, who must weigh the benefit of cancer treatment vs the risk of infection with SARS-CoV-2.

    Methods

    This quality improvement study took place in a radiation oncology department housed in a large tertiary care COVID-19 referral center in New Jersey. Every Monday, Wednesday, and Friday from May 1, 2020, to May 13, 2020, for a total of 6 days during the period of peak daily rate of COVID-19 diagnosis in New Jersey, environmental swabbing following World Health Organization protocols for COVID-19 surface sampling5 occurred at 4:30 pm before scheduled cleaning and disinfection services at 5 pm. Areas targeted for sampling were selected based on a higher risk of contamination because of frequency of use and patient contact. The immobilization mask of a patient with COVID-19 was also tested daily for 5 of the radiation treatments. Specimens were analyzed using real-time reverse transcription polymerase chain reaction analysis (detailed methods are given in the eAppendix in the Supplement). Because all biospecimens were obtained from surface sampling, the Rutgers University institutional review board deemed this study not to be human-subjects research and exempted it from the need for approval and informed patient consent.

    Results

    A total of 128 environmental samples were taken in the radiation oncology department, and 0 were positive for SARS-CoV-2 (Table). The environmental samples were organized into 3 categories: (1) 80 samples taken from patient areas, (2) 19 samples taken from staff areas, and (3) 29 samples taken from department equipment. Of the 128 samples, 15 were taken from objects used by the patient with COVID-19. None of these 15 samples were positive for SARS-CoV-2.

    Discussion

    Systematic testing of environmental surfaces in the radiation oncology clinic revealed no detectable SARS-CoV-2 RNA. Patients, staff, and physicians may be concerned about the potential risks of SARS-CoV-2 transmission in a hospital-based or outpatient clinic. Moreover, radiation oncology clinics are often housed in tertiary care hospitals that can have a high prevalence of patients with COVID-19, perhaps intensifying fears of infection. Many of the patients with cancer at our clinic have deferred or canceled their scheduled follow-up visits because of fears about COVID-19, and many radiation oncology clinics have experienced substantial decreases in patient volume because of the pandemic. Although rescheduling follow-up visits or converting selected follow-up visits and consultations to telemedicine is good practice during the pandemic, some patients or clinicians may delay or decline important cancer therapies that can substantially affect quality of life and cancer outcomes.6 We believe that appropriate patient care should not be delayed because of the pandemic. The results of this study suggest that following strict prevention protocols and routine cleaning and disinfecting seem adequate for limiting surface contamination with SARS-CoV-2.

    This study had several limitations. No air samples were collected, because this study focused on surface contamination. In addition, because of the nature of environmental sampling, 100% of a surface could not be swabbed for analysis, which may have reduced sensitivity. Additional surface and air studies in varied environments are needed to better understand the role of environmental factors in spreading COVID-19.

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    Article Information

    Corresponding Author: Bruce G. Haffty, MD, Department of Radiation Oncology, Rutgers Cancer Institute of New Jersey, Rutgers University, 195 Little Albany St, New Brunswick, NJ 08903 (hafftybg@cinj.rutgers.edu).

    Published Online: August 27, 2020. doi:10.1001/jamaoncol.2020.3552

    Author Contributions: Dr Jan had full access to all of the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.

    Concept and design: Jan, Sayan, Laumbach, Ennis, Haffty.

    Acquisition, analysis, or interpretation of data: Jan, Chen, Uprety, Laumbach, Haffty.

    Drafting of the manuscript: Jan, Chen, Sayan, Haffty.

    Critical revision of the manuscript for important intellectual content: Jan, Chen, Sayan, Uprety, Laumbach, Ennis.

    Statistical analysis: Jan.

    Obtained funding: Jan, Haffty.

    Administrative, technical, or material support: Jan, Chen, Sayan, Laumbach, Haffty.

    Supervision: Jan, Chen, Ennis, Haffty.

    Conflict of Interest Disclosures: None reported.

    Funding/Support: Funding was provided by a Rutgers Cancer Institute of New Jersey Core Center Support Grant (P30CA072720) (Dr Haffty).

    Role of the Funder/Sponsor: The funder had no role in the design and conduct of the study; collection, management, analysis, and interpretation of the data; preparation, review, or approval of the manuscript; and decision to submit the manuscript for publication.

    Additional Contributions: Alan Espiritu, MFA, and Sheridan Waterfall (Rutgers University, Camden) helped create a map of the radiation oncology clinic. They received no compensation for their contribution. The Breast Cancer Research Foundation provided support staff.

    References
    1.
    Cai  J, Sun  W, Huang  J, Gamber  M, Wu  J, He  G.  Indirect virus transmission in cluster of COVID-19 cases, Wenzhou, China, 2020.   Emerg Infect Dis. 2020;26(6):1343-1345. doi:10.3201/eid2606.200412 PubMedGoogle ScholarCrossref
    2.
    Li  Q, Guan  X, Wu  P,  et al.  Early transmission dynamics in Wuhan, China, of novel coronavirus-infected pneumonia.   N Engl J Med. 2020;382(13):1199-1207. doi:10.1056/NEJMoa2001316 PubMedGoogle ScholarCrossref
    3.
    Ong  SWX, Tan  YK, Chia  PY,  et al.  Air, surface environmental, and personal protective equipment contamination by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from a symptomatic patient.   JAMA. 2020;323(16):1610. doi:10.1001/jama.2020.3227 PubMedGoogle ScholarCrossref
    4.
    Liang  W, Guan  W, Chen  R,  et al.  Cancer patients in SARS-CoV-2 infection: a nationwide analysis in China.   Lancet Oncol. 2020;21(3):335-337. doi:10.1016/S1470-2045(20)30096-6 PubMedGoogle ScholarCrossref
    5.
    World Health Organization. Surface sampling of coronavirus disease (‎‎COVID-19)‎‎: a practical “how to” protocol for health care and public health professionals. World Health Organization; February 18, 2020. Accessed July 15, 2020. https://www.who.int/publications/i/item/surface-sampling-of-coronavirus-disease-(-covid-19)-a-practical-how-to-protocol-for-health-care-and-public-health-professionals
    6.
    The Lancet Oncology.  Safeguarding cancer care in a post-COVID-19 world.   Lancet Oncol. 2020;21(5):603. doi:10.1016/S1470-2045(20)30243-6 PubMedGoogle ScholarCrossref
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