Prevention of SARS-CoV-2 and respiratory viral infections in healthcare settings: current and emerging concepts.
Journal
Current opinion in infectious diseases
ISSN: 1473-6527
Titre abrégé: Curr Opin Infect Dis
Pays: United States
ID NLM: 8809878
Informations de publication
Date de publication:
01 08 2022
01 08 2022
Historique:
entrez:
18
7
2022
pubmed:
19
7
2022
medline:
22
7
2022
Statut:
ppublish
Résumé
COVID-19 has catalyzed a wealth of new data on the science of respiratory pathogen transmission and revealed opportunities to enhance infection prevention practices in healthcare settings. New data refute the traditional division between droplet vs airborne transmission and clarify the central role of aerosols in spreading all respiratory viruses, including Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), even in the absence of so-called 'aerosol-generating procedures' (AGPs). Indeed, most AGPs generate fewer aerosols than talking, labored breathing, or coughing. Risk factors for transmission include high viral loads, symptoms, proximity, prolonged exposure, lack of masking, and poor ventilation. Testing all patients on admission and thereafter can identify early occult infections and prevent hospital-based clusters. Additional prevention strategies include universal masking, encouraging universal vaccination, preferential use of N95 respirators when community rates are high, improving native ventilation, utilizing portable high-efficiency particulate air filters when ventilation is limited, and minimizing room sharing when possible. Multifaceted infection prevention programs that include universal testing, masking, vaccination, and enhanced ventilation can minimize nosocomial SARS-CoV-2 infections in patients and workplace infections in healthcare personnel. Extending these insights to other respiratory viruses may further increase the safety of healthcare and ready hospitals for novel respiratory viruses that may emerge in the future.
Identifiants
pubmed: 35849526
doi: 10.1097/QCO.0000000000000839
pii: 00001432-202208000-00013
doi:
Substances chimiques
Aerosols
0
Types de publication
Journal Article
Review
Research Support, U.S. Gov't, P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
353-362Informations de copyright
Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
Références
Wang CC, Prather KA, Sznitman J, et al. Airborne transmission of respiratory viruses. Science 2021; 373:eabd9149.
Remington PL, Hall WN, Davis IH, et al. Airborne transmission of measles in a physician's office. JAMA 1985; 253:1574–1577.
Menkhaus NA, Lanphear B, Linnemann CC. Airborne transmission of varicella-zoster virus in hospitals. Lancet 1990; 336:1315.
Escombe AR, Oeser C, Gilman RH, et al. The detection of airborne transmission of tuberculosis from HIV-infected patients, using an in vivo air sampling model. Clin Infect Dis 2007; 44:1349–1357.
Klompas M, Milton DK, Rhee C, et al. Current insights into respiratory virus transmission and potential implications for infection control programs: a narrative review. Ann Intern Med 2021; 174:1710–1718.
Greenhalgh T, Jimenez JL, Prather KA, et al. Ten scientific reasons in support of airborne transmission of SARS-CoV-2. Lancet 2021; 397:1603–1605.
Chen W, Zhang N, Wei J, et al. Short-range airborne route dominates exposure of respiratory infection during close contact. Building Environ 2020; 176:106859.
Eiche T, Kuster M. Aerosol release by healthy people during speaking: possible contribution to the transmission of SARS-CoV-2. Int J Environ Res Public Health 2020; 17:
Coleman KK, Tay DJW, Sen Tan K, et al. Viral load of SARS-CoV-2 in respiratory aerosols emitted by COVID-19 patients while breathing, talking, and singing. Clin Infect Dis 2022; 74:1722–1728.
Johansson MA, Quandelacy TM, Kada S, et al. SARS-CoV-2 transmission from people without COVID-19 symptoms. JAMA Netw Open 2021; 4:e2035057.
Shen Y, Li C, Dong H, et al. Community outbreak investigation of SARS-CoV-2 transmission among bus riders in Eastern China. JAMA Intern Med 2020; 180:1665–1671.
Groves LM, Usagawa L, Elm J, et al. Community transmission of SARS-CoV-2 at three fitness facilities – Hawaii, June-July 2020. MMWR Morb Mortal Wkly Rep 2021; 70:316–320.
Hamner L, Dubbel P, Capron I, et al. High SARS-CoV-2 attack rate following exposure at a choir practice – Skagit County, Washington, March 2020. MMWR Morb Mortal Wkly Rep 2020; 69:606–610.
Li Y, Qian H, Hang J, et al. Probable airborne transmission of SARS-CoV-2 in a poorly ventilated restaurant. Build Environ 2021; 196:107788.
Katelaris AL, Wells J, Clark P, et al. Epidemiologic evidence for airborne transmission of SARS-CoV-2 during Church Singing, Australia, 2020. Emerg Infect Dis 2021; 27:1677–1680.
Kwon KS, Park JI, Park YJ, et al. Evidence of long-distance droplet transmission of SARS-CoV-2 by direct air flow in a restaurant in Korea. J Korean Med Sci 2020; 35:e415.
Kang M, Wei J, Yuan J, et al. Probable evidence of Fecal aerosol transmission of SARS-CoV-2 in a high-rise building. Ann Intern Med 2020; 173:974–980.
Bulfone TC, Malekinejad M, Rutherford GW, Razani N. Outdoor transmission of SARS-CoV-2 and other respiratory viruses: a systematic review. J Infect Dis 2021; 223:550–561.
Gu H, Krishnan P, Ng DYM, et al. Probable transmission of SARS-CoV-2 omicron variant in quarantine hotel, Hong Kong, China, November 2021. Emerg Infect Dis 2022; 28:460–462.
Lednicky JA, Lauzard M, Fan ZH, et al. Viable SARS-CoV-2 in the air of a hospital room with COVID-19 patients. Int J Infect Dis 2020; 100:476–482.
Nissen K, Krambrich J, Akaberi D, et al. Long-distance airborne dispersal of SARS-CoV-2 in COVID-19 wards. Sci Rep 2020; 10:19589.
Centers for Disease Control and Prevention. Scientific brief: SARS-COV-2 transmission (updated May 7, 2021) [Available from: https://www.cdc.gov/coronavirus/2019-ncov/science/science-briefs/sars-cov-2-transmission.html .
Lindsley WG, Blachere FM, Beezhold DH, et al. Viable influenza A virus in airborne particles expelled during coughs versus exhalations. Influenza Other Respir Viruses 2016; 10:404–413.
Lindsley WG, Blachere FM, Davis KA, et al. Distribution of airborne influenza virus and respiratory syncytial virus in an urgent care medical clinic. Clin Infect Dis 2010; 50:693–698.
Stelzer-Braid S, Oliver BG, Blazey AJ, et al. Exhalation of respiratory viruses by breathing, coughing, and talking. J Med Virol 2009; 81:1674–1679.
Leung NHL, Chu DKW, Shiu EYC, et al. Respiratory virus shedding in exhaled breath and efficacy of face masks. Nat Med 2020; 26:676–680.
Kutter JS, de Meulder D, Bestebroer TM, et al. SARS-CoV and SARS-CoV-2 are transmitted through the air between ferrets over more than one meter distance. Nat Commun 2021; 12:1653.
Marks M, Millat-Martinez P, Ouchi D, et al. Transmission of COVID-19 in 282 clusters in Catalonia, Spain: a cohort study. Lancet Infect Dis 2021.
Hu M, Lin H, Wang J, et al. Risk of coronavirus disease 2019 transmission in train passengers: an epidemiological and modeling study. Clin Infect Dis 2021; 72:604–610.
Luo L, Liu D, Liao X, et al. Contact settings and risk for transmission in 3410 close contacts of patients with COVID-19 in Guangzhou, China: a prospective cohort study. Ann Intern Med 2020; 173:879–887.
Andrejko KL, Pry JM, Myers JF, et al. Effectiveness of face mask or respirator use in indoor public settings for prevention of SARS-CoV-2 Infection - California, February-December 2021. MMWR Morb Mortal Wkly Rep 2022; 71:212–216.
Stankiewicz Karita HC, Dong TQ, Johnston C, et al. Trajectory of Viral RNA load among persons with incident SARS-CoV-2 G614 infection (Wuhan Strain) in association with COVID-19 symptom onset and severity. JAMA Netw Open 2022; 5:e2142796.
Cheng HY, Jian SW, Liu DP, et al. Contact tracing assessment of COVID-19 transmission dynamics in Taiwan and risk at different exposure periods before and after symptom onset. JAMA Intern Med 2020; 180:1156–1163.
Cevik M, Tate M, Lloyd O, et al. SARS-CoV-2, SARS-CoV, and MERS-CoV viral load dynamics, duration of viral shedding, and infectiousness: a systematic review and meta-analysis. Lancet Microbe 2021; 2:e13–e22.
Suess T, Remschmidt C, Schink SB, et al. Comparison of shedding characteristics of seasonal influenza virus (sub)types and influenza A(H1N1)pdm09; Germany. PLoS One 2012; 7:e51653.
Chu DK, Akl EA, Duda S, et al. Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis. Lancet 2020; 395:1973–1987.
Hamilton FW, Gregson FKA, Arnold DT, et al. Aerosol emission from the respiratory tract: an analysis of aerosol generation from oxygen delivery systems. Thorax 2022; 77:276–282.
Wilson NM, Marks GB, Eckhardt A, et al. The effect of respiratory activity, noninvasive respiratory support and facemasks on aerosol generation and its relevance to COVID-19. Anaesthesia 2021; 76:1465–1474.
Tran K, Cimon K, Severn M, et al. Aerosol generating procedures and risk of transmission of acute respiratory infections to healthcare workers: a systematic review. PLoS One 2012; 7:e35797.
Chan VW, Ng HH, Rahman L, et al. Transmission of severe acute respiratory syndrome coronavirus 1 and severe acute respiratory syndrome coronavirus 2 during aerosol-generating procedures in critical care: a systematic review and meta-analysis of observational studies. Crit Care Med 2021; 49:1159–1168.
Klompas M, Baker M, Rhee C. What is an aerosol-generating procedure? JAMA Surg 2021; 156:113–114.
Brown J, Gregson FKA, Shrimpton A, et al. A quantitative evaluation of aerosol generation during tracheal intubation and extubation. Anaesthesia 2021; 76:174–181.
Gaeckle NT, Lee J, Park Y, et al. Aerosol generation from the respiratory tract with various modes of oxygen delivery. Am J Respir Crit Care Med 2020; 202:1115–1124.
Bem RA, van Mourik N, Klein-Blommert R, et al. Risk of aerosol formation during high-flow nasal cannula treatment in critically ill subjects. Respir Care 2021; 66:891–896.
Janssen ML, Klazen YP, de Man P, et al. Airborne SARS-CoV-2 RNA excretion by patients with COVID-19 on different oxygen delivery systems: a prospective observational study. J Hosp Infect 2022.
Gantner S, Echternach M, Veltrup R, et al. Impulse dispersion of aerosols during playing wind instruments. PLoS One 2022; 17:e0262994.
O’Neil CA, Li J, Leavey A, et al. Characterization of aerosols generated during patient care activities. Clin Infect Dis 2017; 65:1335–1341.
Cummings DAT, Radonovich LJ, Gorse GJ, et al. Risk factors for healthcare personnel infection with endemic coronaviruses (HKU1, OC43, NL63, 229E): results from the respiratory protection effectiveness clinical trial (ResPECT). Clin Infect Dis 2021; 73:e4428–e4432.
Heinzerling A, Stuckey MJ, Scheuer T, et al. Transmission of COVID-19 to healthcare personnel during exposures to a hospitalized patient – Solano County, California, February 2020. MMWR Morb Mortal Wkly Rep 2020; 69:472–476.
Arnold FW, Bishop S, Oppy L, et al. Surveillance testing reveals a significant proportion of hospitalized patients with SARS-CoV-2 are asymptomatic. Am J Infect Control 2021; 49:281–285.
Smith L, Pau S, Fallon S, et al. Impact of weekly asymptomatic testing for severe acute respiratory coronavirus virus 2 (SARS-CoV-2) in inpatients at an academic hospital. Infect Control Hosp Epidemiol 2021; 1–3.
Rhee C, Baker MA, Kanjilal S, et al. Prospective clinical assessments of hospitalized patients with positive SARS-CoV-2 PCR tests for necessity of isolation. Open Forum Infect Dis 2021; 8:ofab194.
Kobayashi T, Trannel A, Holley SA, et al. Coronavirus Disease 2019 serial testing among hospitalized patients in a Midwest Tertiary Medical Center, July-September 2020. Clin Infect Dis 2021; 73:e3116–e3119.
Shenoy ES, Weber DJ. Routine surveillance of asymptomatic healthcare personnel for severe acute respiratory coronavirus virus 2 (SARS-CoV-2): Not a prevention strategy. Infect Control Hosp Epidemiol 2021; 42:592–597.
Baker MA, Fiumara K, Rhee C, et al. Low risk of coronavirus disease 2019 (COVID-19) among patients exposed to infected healthcare workers. Clin Infect Dis 2021; 73:e1878–e1880.
Klompas M, Baker MA, Rhee C, et al. A SARS-CoV-2 cluster in an acute care hospital. Ann Intern Med 2021; 174:794–802.
Paltansing S, Sikkema RS, de Man SJ, et al. Transmission of SARS-CoV-2 among healthcare workers and patients in a teaching hospital in the Netherlands confirmed by whole-genome sequencing. J Hosp Infect 2021; 110:178–183.
Klompas M, Baker MA, Griesbach D, et al. Transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) from asymptomatic and presymptomatic individuals in healthcare settings despite medical masks and eye protection. Clin Infect Dis 2021; 73:1693–1695.
Sanchez-Taltavull D, Castelo-Szekely V, Murugan S, et al. Regular testing of asymptomatic healthcare workers identifies cost-efficient SARS-CoV-2 preventive measures. PLoS One 2021; 16:e0258700.
Wee LE, Conceicao EP, Sim JX, et al. Utilisation of SARS-CoV-2 rapid antigen assays in screening asymptomatic hospital visitors: mitigating the risk in low-incidence settings. Int J Infect Dis 2022; 114:132–134.
Lim WY, Tan GSE, Htun HL, et al. First nosocomial cluster of COVID-19 due to the Delta variant in a major acute care hospital in Singapore: investigations and outbreak response. J Hosp Infect 2021; 122:27–34.
Dancer SJ, Cormack K, Loh M, et al. Healthcare-acquired clusters of COVID-19 across multiple wards in a Scottish health board. J Hosp Infect 2022; 120:23–30.
de Man P, Paltansing S, Ong DSY, et al. Outbreak of coronavirus disease 2019 (COVID-19) in a nursing home associated with aerosol transmission as a result of inadequate ventilation. Clin Infect Dis 2021; 73:170–171.
Miller SL, Nazaroff WW, Jimenez JL, et al. Transmission of SARS-CoV-2 by inhalation of respiratory aerosol in the Skagit Valley Chorale superspreading event. Indoor Air 2021; 31:314–323.
Feathers L, Hinde T, Bale T, et al. Outbreak of SARS-CoV-2 at a hospice: terminated after the implementation of enhanced aerosol infection control measures. Interface Focus 2022; 12:20210066.
Thuresson S, Fraenkel C, Sasinovich S, et al. Airborne SARS-CoV-2 in hospitals - effects of aerosol-generating procedures, HEPA-filtration units, patient viral load and physical distance. Clin Infect Dis 2022.
Li J, Jing G, Fink JB, et al. Airborne particulate concentrations during and after pulmonary function testing. Chest 2021; 159:1570–1574.
Patel RB, Skaria SD, Mansour MM, Smaldone GC. Respiratory source control using a surgical mask: an in vitro study. J Occup Environ Hyg 2016; 13:569–576.
Cortellessa G, Stabile L, Arpino F, et al. Close proximity risk assessment for SARS-CoV-2 infection. Sci Total Environ 2021; 794:148749.
Karan A, Klompas M, Tucker R, et al. The risk of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission from patients with undiagnosed coronavirus disease 2019 (COVID-19) to roommates in a large Academic Medical Center. Clin Infect Dis 2022; 74:1097–1100.
Chow K, Aslam A, McClure T, et al. Risk of healthcare-associated transmission of SARS-CoV-2 in hospitalized cancer patients. Clin Infect Dis 2022; 74:1579–1585.
Trannel AM, Kobayashi T, Dains A, et al. Coronavirus disease 2019 (COVID-19) incidence after exposures in shared patient rooms in a tertiary-care center in Iowa, July 2020-May 2021. Infect Control Hosp Epidemiol 2021; 1–4.
Conway Morris A, Sharrocks K, Bousfield R, et al. The removal of airborne SARS-CoV-2 and other microbial bioaerosols by air filtration on COVID-19 surge units. Clin Infect Dis 2021.
Garzona-Navas A, Sajgalik P, Csecs I, et al. Mitigation of aerosols generated during exercise testing with a portable high-efficiency particulate air filter with fume hood. Chest 2021; 160:1388–1396.
Lindsley WG, Derk RC, Coyle JP, et al. Efficacy of portable air cleaners and masking for reducing indoor exposure to simulated exhaled SARS-CoV-2 aerosols – United States. MMWR Morb Mortal Wkly Rep 2021; 70:972–976.
Rodriguez M, Palop ML, Sesena S, Rodriguez A. Are the Portable Air Cleaners (PAC) really effective to terminate airborne SARS-CoV-2? Sci Total Environ 2021; 785:147300.
Klompas M, Ye S, Vaidya V, et al. Association between airborne infection isolation room utilization rates and healthcare worker COVID-19 infections in two academic hospitals. Clin Infect Dis 2021.
Rhee C, Baker MA, Tucker R, et al. Sources of exposure identified through structured interviews of healthcare workers who test positive for severe acute respiratory coronavirus 2 (SARS-CoV-2): a prospective analysis at two teaching hospitals. Antimicrob Stewardsihp Healthc Epidemiol 2021; 1:E65.
Birgand G, Peiffer-Smadja N, Fournier S, et al. Assessment of air contamination by SARS-CoV-2 in hospital settings. JAMA Netw Open 2020; 3:e2033232.
Cheng VC, Fung KS, Siu GK, et al. Nosocomial outbreak of coronavirus disease 2019 by possible airborne transmission leading to a superspreading event. Clin Infect Dis 2021; 73:e1356–e1364.
Rhee C, Baker MA, Tucker R, Klompas M. Absence of long-range severe acute respiratory coronavirus virus 2 (SARS-CoV-2) transmission from a highly infectious patient with undiagnosed coronavirus disease 2019 (COVID-19) in a positive-pressure room. Infect Control Hosp Epidemiol 2021; 1–2.
Shitrit P, Zuckerman NS, Mor O, et al. Nosocomial outbreak caused by the SARS-CoV-2 Delta variant in a highly vaccinated population, Israel, July 2021. EuroSurveill 2021; 26:2100822.
Hetemäki I, Kääriäinen S, Alho P, et al. An outbreak caused by the SARS-CoV-2 Delta variant (B.1.617.2) in a secondary care hospital in Finland, May 2021. Eurosurveillance 2021; 26:2100636.
Abbas M, Robalo Nunes T, Cori A, et al. Explosive nosocomial outbreak of SARS-CoV-2 in a rehabilitation clinic: the limits of genomics for outbreak reconstruction. J Hosp Infect 2021; 117:124–134.
Yu IT, Li Y, Wong TW, et al. Evidence of airborne transmission of the severe acute respiratory syndrome virus. N Engl J Med 2004; 350:1731–1739.
Qian H, Zheng X. Ventilation control for airborne transmission of human exhaled bio-aerosols in buildings. J Thorac Dis 2018; 10: (Suppl 19): S2295–S2304.
Li Y, Leung GM, Tang JW, et al. Role of ventilation in airborne transmission of infectious agents in the built environment - a multidisciplinary systematic review. Indoor Air 2007; 17:2–18.
Tang JW, Nicolle A, Pantelic J, et al. Different types of door-opening motions as contributing factors to containment failures in hospital isolation rooms. PLoS One 2013; 8:e66663.
Chou R, Dana T, Jungbauer R. Update Alert 7: masks for prevention of respiratory virus infections, including SARS-CoV-2, in Healthcare and Community Settings. Ann Intern Med 2022.
Hetemaki I, Kaariainen S, Alho P, et al. An outbreak caused by the SARS-CoV-2 Delta variant (B.1.617.2) in a secondary care hospital in Finland, May 2021. Euro Surveill 2021; 26:2100636.
Shitrit P, Zuckerman NS, Mor O, et al. Nosocomial outbreak caused by the SARS-CoV-2 Delta variant in a highly vaccinated population, Israel, July 2021. Euro Surveill 2021; 26:2100822.
Goldberg L, Levinsky Y, Marcus N, et al. SARS-CoV-2 infection among healthcare workers despite the use of surgical masks and physical distancing-the role of airborne transmission. Open Forum Infect Dis 2021; 8:ofab036.
Adenaiye OO, Lai J, de Mesquita PJB, et al. Infectious SARS-CoV-2 in exhaled aerosols and efficacy of masks during early mild infection. Clin Infect Dis 2021.
Sickbert-Bennett EE, Samet JM, Clapp PW, et al. Filtration efficiency of hospital face mask alternatives available for use during the COVID-19 pandemic. JAMA Intern Med 2020; 180:1607–1612.
Klompas M, Karan A. Preventing SARS-CoV-2 transmission in healthcare settings in the context of the omicron variant. JAMA 2022; 327:619–620.
Lawton T, Butler M, Peters C. Airborne protection for staff is associated with reduced hospital-acquired COVID-19 in English NHS trusts. J Hosp Infect 2022; 120:81–84.
McEllistrem MC, Clancy CJ, Buehrle DJ, et al. SARS-CoV-2 is associated with high viral loads in asymptomatic and recently symptomatic healthcare workers. PLoS One 2021; 16:e0248347.
Braun KM, Moreno GK, Buys A, et al. Viral sequencing reveals US healthcare personnel rarely become infected with SARS-CoV-2 through patient contact. Clin Infect Dis 2021.
Jinadatha C, Jones LD, Choi H, et al. Transmission of SARS-CoV-2 in inpatient and outpatient settings in a veterans affairs healthcare system. Open Forum Infect Dis 2021; 8:ofab328.
Klompas M, Rhee C, Baker MA. Universal use of N95 respirators in healthcare settings when community coronavirus disease 2019 rates are high. Clin Infect Dis 2022; 74:529–531.
Wang X, Ferro EG, Zhou G, et al. Association between universal masking in a healthcare system and SARS-CoV-2 positivity among healthcare workers. JAMA 2020; 324:703–704.
Barda N, Dagan N, Cohen C, et al. Effectiveness of a third dose of the BNT162b2 mRNA COVID-19 vaccine for preventing severe outcomes in Israel: an observational study. Lancet 2021; 398:2093–2100.
Thompson MG, Stenehjem E, Grannis S, et al. Effectiveness of Covid-19 vaccines in ambulatory and inpatient care settings. N Engl J Med 2021; 385:1355–1371.
Ferdinands JM, Rao S, Dixon BE, et al. Waning 2-dose and 3-dose effectiveness of mRNA vaccines against COVID-19-associated emergency department and urgent care encounters and hospitalizations among adults during periods of delta and omicron variant predominance - VISION Network, 10 States, August 2021-January 2022. MMWR Morb Mortal Wkly Rep 2022; 71:255–263.
Eyre DW, Taylor D, Purver M, et al. Effect of Covid-19 vaccination on transmission of alpha and delta variants. N Engl J Med 2022; 386:744–756.
Petrie JG, Ohmit SE, Johnson E, et al. Efficacy studies of influenza vaccines: effect of end points used and characteristics of vaccine failures. J Infect Dis 2011; 203:1309–1315.
McGarry BE, Barnett ML, Grabowski DC, Gandhi AD. Nursing home staff vaccination and Covid-19 outcomes. N Engl J Med 2022; 386:397–398.
Klompas M, Pearson M, Morris C. The case for mandating COVID-19 vaccines for healthcare workers. Ann Intern Med 2021; 174:1305–1307.
Pitts SI, Maruthur NM, Millar KR, et al. A systematic review of mandatory influenza vaccination in healthcare personnel. Am J Prev Med 2014; 47:330–340.
Giurgea LT, Han A, Memoli MJ. Universal coronavirus vaccines: the time to start is now. NPJ Vaccines 2020; 5:43.
Morens DM, Taubenberger JK, Fauci AS. Universal coronavirus vaccines – an urgent need. N Engl J Med 2022; 386:297–299.