5:14 PM 4/4/2020 - Coronavirus: fecal aerosols are infectious - GS: Scientists say coronavirus can spread through 'aerosolized feces'...

Scientists say COVID-19 can come from 'aerosolized feces'

https://tweetsandnews.blogspot.com/2020/04/coronavirus-fecal-aerosols-are.html

Coronavirus: fecal aerosols are infectious - GS


6 days ago - Respiratory infections can be transmitted through droplets of different sizes: ... Further, the finding of COVID-19 virus in aerosol particles up to 3 hours ... from a stool specimen of a laboratory-confirmed case of the coronavirus ...

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Mar 16, 2020 - If it could easily exist as an aerosol, we would be seeing much ... People 'shed' high levels of coronavirus, study finds, but most are likely not infectious ... so cells there can become infected, shedding virus into fecal material.
3 days ago - The coronavirus, which causes the respiratory infection COVID-19, can be ... Additionally, aerosols released in stool likely drove two SARS ...
Mar 17, 2020 - The novel coronavirus, SARS-CoV-2, remains viable in aerosols for hours ... "Superspread" of the earlier disease arose from infection during ...
1 day ago - Scientists say coronavirus can spread through 'aerosolized feces' ... the spread of aerosols, sometimes containing infectious fecal matter, ...

Web results

Mar 9, 2020 - How does the new coronavirus disease, Covid-19, spread? ... us about why this disease seems to be even more contagious than SARS and MERS? ... transmission route: airborne transmission of virus-ridden feces aerosols.
Coronavirus and coronavirus-like infections have been described in swine, cattle, ... Turkey coronavirus, Bluecomb virus, Enteritis, Fecal–oral route, aerosol ...
Feb 19, 2020 - Scientists suspect a fecal-oral route for coronavirus that's infected tens of thousands worldwide. ... More than 600 Covid-19 infections were confirmed among ... A virus-laden aerosol plume emanating from a SARS patient with ...
by C Machacek - ‎2016 - ‎Cited by 10 - ‎Related articles
Infectious Diseases, National Institutes of Health, Hamilton, MT, USA ... A novel human coronavirus, now named severe acute respiratory syndrome ... studying virus viability in different matrices, such as nasal secretion, sputum and fecal matter ...
by X Peng - ‎2020 - ‎Cited by 19
Mar 3, 2020 - Most of the coronavirus can cause the infectious diseases in human and ... However, the aerosol transmission route and the fecal–oral ...
Historically human CoV infections (229E and OC43 CoV strains) were mild and ... of chickens, like SARS, spread by aerosol or possibly fecal-oral transmission, ...
A toilet plume is the dispersal of microscopic particles as a result of flushing a toilet. Normal use of a toilet by healthy people is considered unlikely to be a major health risk. There is indirect evidence that specific pathogens such as norovirus or SARS coronavirus could potentially be spread by toilet aerosols, ... The feces and vomit of infected people can contain high ...
In medicine, public health, and biology, transmission is the passing of a pathogen causing ... "Airborne transmission refers to infectious agents that are spread via droplet ... Main causes of fecal–oral disease transmission include lack of adequate ... respiratory infections (sneezing and coughing create infectious aerosols).
Feb 10, 2020 - The National Health Commission reiterated on Sunday that the transmission routes of the novel coronavirus through aerosols and digestive ...
Mar 17, 2020 - SARS-CoV-2, the virus causing COVID-19, was viable in aerosols for 3 hours, and ... of the National Institute of Allergy and Infectious Diseases in Hamilton, Montana, and ... virus compared with SARS-CoV-1 as the most closely related coronavirus. ... Study: COVID-19 Is Also Spread by Fecal-Oral Route.
Feb 19, 2020 - The novel coronavirus is shed in the feces of infected people, which may help ... More than 600 Covid-19 infections were confirmed among ...
The distribution of risk in buildings B, C, and D corresponded well with the three-dimensional spread of virus-laden aerosols predicted with the use of ...
by TR Frieden
Mar 18, 2020 - SARS-CoV-2 is present in stool (33); ensuring cleanliness of toilets and other ... Both of these coronavirus infections were fueled by SSEs. ... Influenza A virus transmission via respiratory aerosols or droplets as it relates to ...

Mar 25, 2020 - respiratory syndrome coronavirus 2 (SARS-CoV-2) is ... Human infectious dose by aerosol route ... Human infectious dose by fecal-oral route.

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Scientists say COVID-19 can come from 'aerosolized feces'

Michael_Novakhov shared this story from Kenneth Garger – New York Post.

Scientists say coronavirus can spread through ‘aerosolized feces’

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Closing the toilet lid is highly recommended amid the coronavirus outbreak, according to a report, as a group of researchers have found that the bug can spread through fecal matter that escapes from the bowl during a flush.
The disease caused by the coronavirus, which scientists had already warned can be spread from fecal-oral transmission, can also be transmitted via “aerosolized feces,” according to Forbes, citing a study published by the Association for Professionals in Infection Control and Epidemiology.
Aerosolized feces can be propelled into the air through what’s called a toilet plume — the spread of aerosols, sometimes containing infectious fecal matter, caused by a flush.
“Close the lid and then flush,” a mechanical engineering professor from Purdue University, Dr. Qingyan Chen, told Forbes. He said it was a simple solution to help control the spread of the disease through toilet plumes.
Chen told the outlet that closing the lid can prevent 80 percent of the fecal particles from escaping into the air.
Filed under Coronavirus  poop  research  toilets
Experts Warn Of Fecal-Oral Transmission Of COVID-19

Michael_Novakhov shared this story from Alexandra Sternlicht.

Topline: While scientists have warned that COVID-19 can be spread by fecal-oral transmission (hence the importance of post-bathroom hand washing) the disease can also be spread through what is known as "aerosolized feces" which means that it's more important than ever to close the lid of the toilet while flushing, according to experts. 
  • Because of a phenomenon known as toilet plume, stool or urine can escape from the toilet into the air and spread disease, according to the Association for Professionals in Infection Control and Epidemiology.
  • Qingyan Chen, Purdue’s James. G. Dwyer Professor of Mechanical Engineering at Purdue University, told Forbes there’s one “very easy way to help prevent the spread of coronavirus: “Close the lid and then flush.”
  • 80% of particles that escape from fecal matter into the air can be prevented by closing the lid when flushing, Chen told Forbes.
  • To avoid getting COVID-19 when using a public bathroom you should wash your hands, then flush (using gloves or paper towel to avoid contact with the handle) to minimize contamination period—and wait one to two minutes to use a public bathroom after someone has finished, says Chen.
  • The danger of fecal-oral transmission is higher for symptomatic people, so if you share a bathroom with a COVID-19 positive individual, disinfect the entire washroom with alcohol or ultraviolet light between uses, Chen also advises. 
  • A study from the City University of Hong Kong found that: “A toilet flush can release up to 80,000 polluted droplets and leave them suspended a metre in the air for hours if the lid is left up,” according to the South China Morning Post.
  • The researcher of this study, Alvin Lai said that “covering the toilet lid while flushing is definitely essential, but it should not be considered a complete prevention,” and advised  households to regularly clean bathrooms with diluted bleach, use ventilation and close the bathroom doors when not in use. 
Key Background: There are four methods of COVID-19 transmission: (1) direct contact or indirect contact (i.e. someone breathing on you or sharing a drink) (2) Droplets, which can be in a cough or skin-to-skin contact (3) Airborne, with COVID-19 passing through the air or via ventilation (4) oral-fecal transmission, meaning that contagions from fecal matter is inadvertently ingested. Though direct or indirect transmission is most likely candidate for transmission, according to Chen, there is no substantial research to trace origins of COVID-19 transmission on a per patient basis. 
Qingyan Chen has studied virus spread through transit ventilation systems and is developing a ventilation system that would prevent the spread of pathogens with individuals only breathing their own air, according to Purdue University.
Study: COVID-19 Is Also Spread by Fecal-Oral Route

Michael_Novakhov shared this story .

Illustrated coronaviruses over a photo of a flushing toilet
Illustrated coronaviruses over a photo of a flushing toilet
New research from China indicates that the novel coronavirus is also spread by fecal-oral transmission, not just by respiratory droplets or environmental contact.
Hong Shan, MD, PhD, of Fifth Affiliated Hospital, Sun Yat-sen University, in Zhuhai, Guangdong Province, and colleagues noted that the gastrointestinal tract is a welcoming environment for the virus, also known as severe acute respiratory syndrome (SARS) CoV-2. "Our immunofluorescent data showed that the ACE2 protein, which has been proved to be a cell receptor for SARS-CoV-2, is abundantly expressed in the glandular cells of gastric, duodenal, and rectal epithelia, supporting the entry of SARS-CoV-2 into the host cell," the team wrote.
Among the key findings of the study, published online in Gastroenterology:
  • A significant portion of coronavirus patients experience diarrhea, nausea, vomiting, and/or abdominal discomfort before the onset of respiratory symptoms
  • Viral RNA is detectable in fecal samples from suspected cases, indicating that the virus sheds into the stool
  • Viral gastrointestinal infection and potential fecal-oral transmission can last even after viral clearance from the respiratory tract
The study looked at 73 patients hospitalized for possible COVID-19 and tested from February 1 to 14, 2020. Testing included serum, nasopharyngeal, and oropharyngeal swabs, as well as urine, stool, and tissue samples in accordance with China Disease Control and Prevention guidelines.
A total of 39 patients (53.4%; 25 males and 14 females), tested positive for fecal SARS-CoV-2 RNA. The age of patients with positive RNA in stool ranged from 10 months to 78 years, and the duration of stool positivity ranged from 1 to 12 days. Furthermore, the stool of 17 patients (23.3%) remained positive even after respiratory samples tested negative.
Intracellular staining of viral nucleocapsid protein in gastric, duodenal, and rectal epithelia showed that the virus infected glandular epithelial cells in these areas, the researchers reported. "The continuous positive detection of the viral RNA from feces suggests that the infectious virions are secreted from the virus-infected gastrointestinal cells."
"Therefore, we strongly recommend that rRT-PCR [reverse transcriptase polymerase chain reaction] testing for SARS-CoV-2 from feces should be performed routinely in SARS-CoV-2 patients, and Transmission-Based Precautions for hospitalized SARS-CoV-2 patients should continue if feces tests positive by rRT-PCR testing," Shan and co-authors advised.
Asked for his perspective, Douglas A. Corley, MD, PhD, of Kaiser Permanente San Francisco Medical Center and the University of California San Francisco, who was not involved with the research, told MedPage Today: "A better understanding of how this virus is transmitted is key to preventing its spread. These observations may also help in improving how the disease is diagnosed through testing for the presence of virus in the stool of patients suspected of harboring this virus."
Also commenting, Peter Hotez, MD, of the National School of Tropical Medicine at Baylor College of Medicine in Houston, said the study adds to scientific discussions about whether gastrointestinal transmissions are relevant to the novel coronavirus infections, "especially in light of clinical descriptions of COVID-19 patients admitted to surgical wards in Wuhan who were thought to have abdominal emergencies."
"It is a potentially important finding of relevance to the emergence of COVID-19 globally, but the exact extent of gastrointestinal transmission of the virus remains unclear," Hotez told MedPage Today.
He added that whether fecal oral transmission is common or uncommon therefore requires additional investigation: "Also unclear is the significance of detection of viral RNA in the feces of patients with pulmonary disease, including those patients who were found to be PCR-negative in their respiratory secretions. The authors speculate that this might suggest that such patients may continue to transmit SARS-CoV-2, but this also requires further study," said Hotez, who was not involved in the study.
In a second paper posted on the same day in the journal, Jinyang Gu, MD, of Xinhua Hospital of Jiao Tong University in Shanghai, and colleagues noted that evidence from the 2003 SARS epidemic also showed enteric involvement and the presence of virus in the stool of patients even after discharge from hospital. Interestingly, the team said, the first confirmed case of COVID-19 in the U.S., which occurred in Washington state, reported a 2-day history of nausea and vomiting on admission, followed by a loose bowel movement on the second day of hospitalization. The viral nucleic acids of loose stool and both respiratory specimens from this patient later tested positive.
Gu's group also noted recent reports of mild to moderate liver injury in COVID-19 patients, including elevated aminotransferases, hypoproteinemia, and prothrombin time prolongation, while in the SARS epidemic of 2003, as many as 60% of patients had liver impairment.
"The presence of viral nucleic acids of SARS in liver tissue confirmed the coronavirus direct infection in liver, and percutaneous liver biopsies of SARS showed conspicuous mitoses and apoptosis along with atypical features such as acidophilic bodies, ballooning of hepatocytes, and lobular activities without fibrin deposition or fibrosis," Gu and co-authors wrote. "Altogether, many efforts should be made to be alert [to] the initial digestive symptoms of COVID-19 for early detection, early diagnosis, early isolation, and early intervention."
Disclosures
The study was funded by the National Natural Science Foundation of China.
Xiao and colleagues reported having no competing interests.
Gu and co-authors disclosed no competing interests.
Corley and Hotez reported having no competing interests in relation to their comments.
Additional Source
Source Reference:
Lifting the lid on toilet plume aerosol: A literature review with suggestions for future research

Michael_Novakhov shared this story .

Logo of hhspa
Am J Infect Control. Author manuscript; available in PMC 2015 Dec 28.
Published in final edited form as:
PMCID: PMC4692156
NIHMSID: NIHMS746087
PMID: 23040490

Lifting the lid on toilet plume aerosol: A literature review with suggestions for future research

Abstract

Background

The potential risks associated with “toilet plume” aerosols produced by flush toilets is a subject of continuing study. This review examines the evidence regarding toilet plume bioaerosol generation and infectious disease transmission.

Methods

The peer-reviewed scientific literature was searched to identify articles related to aerosol production during toilet flushing, as well as epidemiologic studies examining the potential role of toilets in infectious disease outbreaks.

Results

The studies demonstrate that potentially infectious aerosols may be produced in substantial quantities during flushing. Aerosolization can continue through multiple flushes to expose subsequent toilet users. Some of the aerosols desiccate to become droplet nuclei and remain adrift in the air currents. However, no studies have yet clearly demonstrated or refuted toilet plume-related disease transmission, and the significance of the risk remains largely uncharacterized.

Conclusion

Research suggests that toilet plume could play a contributory role in the transmission of infectious diseases. Additional research in multiple areas is warranted to assess the risks posed by toilet plume, especially within health care facilities.
Keywords: Aerosol, Droplet nuclei, Airborne infection, Bioaerosol
An association between inhalable bioaerosols produced from disturbed sewage and the transmission of infectious disease has been proposed for over 100 years. However, little study has been devoted to characterizing the potential risks posed by the “toilet plume” aerosols created by toilet flushing. We summarize the related scientific literature and identify gaps in the knowledge base, addressing the following questions: (1) “Do flush toilets produce potentially infectious aerosols?” (2) “Do toilet plume aerosols pose a risk for the spread of infectious disease?” and (3) “What future research is needed to further characterize the risks of exposure to toilet plume aerosols within a health care setting?”

DO FLUSH TOILETS PRODUCE POTENTIALLY INFECTIOUS AEROSOLS?

The potential for airborne transmission of sewage-related infectious disease was demonstrated by Horrocks over 100 years ago1 when he cultured airborne microorganisms from sewage drain systems and also detected airborne transport from one hospital building to another via the sewer drains. Similar results were seen by others including Andrewes.2
Bioaerosol production during toilet flushing was first reported in the 1950s by Jessen,3 who “seeded” several types of toilets with Serratia marcescens (then termed Bacillus prodigiosus) and measured bioaerosols produced by flushing. Agar-filled “settle plates” caught bioaerosols that fell out of the air because of gravity, and a Bourdillon slit impactor4 collected air samples. Cistern-fed, gravity-flow toilets and a mains-fed pressure-valve toilet were examined. In addition to colonies found on the floor-based settle plates, microbes were still being captured from the air 8 minutes after the flush, indicating collection of “droplet nuclei” bioaerosols. Droplet nuclei are the tiny particles that remain after the water in a droplet evaporates. They have negligible settling velocity and will float with natural air currents.5 Jessen observed that the amount of bioaerosol increased with increasing flush energy.3
Darlow and Bale6 seeded a “wash-down” type toilet with S marcescens and sampled air above the toilet with liquid impingers and a Bourdillon impactor. A wash-down toilet releases the flush water from the toilet rim where it flows down the bowl walls and washes the waste into the S-shaped exit trapway.7 Bioaerosol was detected in samples collected above the toilet 5 to 7 minutes after the flush, indicating droplet nuclei bioaerosol. Despite over 99% reductions in bowl water microbial concentrations with each flush, air samples indicated only 50% to 60% bioaerosol reductions. They concluded that this was at least partially attributable to a reduction in the number of bacteria per droplet rather than a reduction in the number of droplets containing bacteria because both a multi-organism droplet and a single-organism droplet would appear as 1 colony when deposited on an impactor agar plate.
Siphonic toilets, which feature a submerged jet that propels the waste into the trapway to initiate a siphon action that clears the waste, have generally replaced wash-down models. Bound and Atkinson8 found that the higher energy siphonic toilet produced approximately 1/14th as much bioaerosol as the wash-down design for the same flush volume. Newsom also demonstrated higher bioaerosol production with higher flush energy when he compared high and low cistern toilets seeded with homogenized feces or suspensions of various bacteria.9
Gerba et al10 seeded a siphonic gravity-flow toilet with Escherichia coli and sequentially placed 3 arrays of settle plates on the floor around the toilet, with each set exposed for 2 hours. For the first sample set (0–2 hours), cultured bacteria were predominantly from plates near the toilet, whereas, in later sample sets (2–4 and 4–6 hours), the positive plates were more randomly distributed around the room. This was consistent with an initial deposition of large droplets close to the toilet immediately after the flush, followed by dispersion and mixing of the droplet nuclei into the air with delayed deposition throughout the room. The E coli bioaerosol remained airborne and viable for at least 4 to 6 hours postflush.
Barker and Bloomfield11 seeded a gravity-flow toilet with Salmonella enteritidis PT4 and collected surface wipe and air samples after flushing. They observed contamination of the toilet seat and the underside of the lid and also cultured Salmonella from the air sample. They detected Salmonella in the bowl water after 12 days and in biofilm below the bowl waterline for 50 days after seeding, which suggested a possible role of biofilm as a long-term reservoir and active source of pathogenic organisms in the bowl water.
Barker and Jones seeded a toilet with S marcescens or MS2 bacteriophage.12 Air samples were collected in front of and above the toilet seat with the toilet seat lid open. They also exposed settle plates at 5 locations around the toilet, including 2 above and behind the seat. Bioaerosols were present up to 60 minutes after flushing, and all settle plates were positive for all test conditions and sampling locations, demonstrating droplet nuclei bioaerosol. They also examined toilet bowl clearance and bioaerosol production during sequential flushes without reseeding, with results similar to those of Darlow and Bale,6 Newsom,9 and Gerba et al10 in that bioaerosol concentration did not decrease in proportion to bowl water concentration.
Recently, Best et al13 flushed a toilet seeded with fecal suspensions of Clostridium difficile. Settle plates were placed near the toilet and air was sampled at seat height, flush handle height, and midway in-between, with the toilet lid both up and down. Settle plates showed widespread dissemination of large droplets with the lid up but not with the lid down. C difficile was recovered from air sampled at heights up to 25 cm above the toilet seat and up to 90 minutes after flushing, at concentrations 12-fold greater with the lid up than with the lid down. They concluded that lidless conventional toilets increase the risk of C difficile environmental contamination and thus discouraged their use. In the United States, however, this would contradict current Uniform Plumbing Code specifications regarding toilet seat design and the installation of toilet seat lids on health care and other public facility “water closets”14 as well as similar requirements for gap-front seats without cover for water closets in the US Veterans Administration specifications often cited for health care facility design.15
It may be concluded from the above that flush toilets produce substantial quantities of toilet plume aerosol capable of entraining microorganisms at least as large as bacteria, that sufficiently small microbe-laden droplets will evaporate to form droplet nuclei bioaerosols small enough to be inhaled deep into the lung, and that these bioaerosols may remain viable in the air for extended periods and travel with air currents. Production of these bioaerosols during multiple flushes after contamination suggests a long-term potential for a contaminated toilet to be an infectious bioaerosol generator.

DOES TOILET PLUME POSE A RISK FOR THE SPREAD OF INFECTIOUS DISEASE?

Contact transmission risk because of surface contamination by flush droplets

A number of studies have demonstrated the contamination of toilet seats and lids, the surrounding floors, and the nearby surfaces by toilet flush aerosols.3,6,9,10,12,13,16 Because both the vomit and feces of infected persons may contain extremely high pathogen concentrations, eg, 105 to 109 Shigella,17 104 to 108 Salmonella,17 and 108 to 109 norovirus18 per gram of stool and at least 106 norovirus per milliliter of vomit,19 some fraction of the aerosol droplets produced during toilet flushing may be expected to contain microbes.20
A critical determinant of the infection risk posed by a deposited pathogen will be the organism’s ability to survive on a surface.21 Many pathogens, including ShigellaE coliC difficile, severe acute respiratory syndrome (SARS) coronavirus, and norovirus can survive on surfaces for weeks or even months.22 These pathogens can also be present in vomit or stools of infected persons.
In 1956, Hutchinson associated the transmission of Sonne dysentery with Shigella contamination on toilet seats,23 and a number of subsequent field studies have detected contamination on toilet seats and surrounding surfaces with fecal organisms.9,11,24,25 Thorough cleaning and disinfection of environmental surfaces in health care facilities is a foundational component of infection control programs,26 and disinfection is particularly important because many studies have shown that microbial surface contamination (including C difficile, vancomycin-resistant Enterococcus, and methicillin-resistant Staphylococcus aureus [MRSA]) may persist even after cleaning.2729 The limits of environmental cleaning in preventing spread of viral disease are apparent with acute gastroenteritis (AGE). AGE is frequently caused by norovirus, and the diarrhea and vomiting typically associated with AGE as well as the high viral loads in both stools and vomit suggest a likely toilet role in disease transmission. Environmental contamination has been shown to be a major source of AGE infection on ships,3035 including during sequential voyages of a cruise ship in spite of aggressive sanitation efforts and a documented history of good Centers for Disease Control and Prevention (CDC) Vessel Sanitation Program inspection scores.34 This may be due in part to the ability of toilets to continue generating contaminated toilet plume during multiple flushes after original contamination as well as the apparent resistance of norovirus36 and perhaps other viruses to cleaning and disinfection. Gerba et al observed that MS2 bacteriophage and poliovirus were not completely cleared from a toilet even after 7 flushes and that scrubbing with or without addition of a surfactant to the water was only minimally effective in eliminating these residual organisms.10 The manner in which cleaning and disinfection is performed is also important in ensuring complete disinfection of surfaces, especially when surfaces are heavily contaminated.37

Airborne transmission risk because of toilet plume droplet nuclei

Although Chapin dismissed the airborne route as unimportant in his 1912 review of infectious disease transmission,38 by the 1960s it was accepted that droplet nuclei microbial aerosols were important in the transmission of many infectious diseases in both indoor and outdoor environments.39,40 We now understand that whether pathogenic droplet nuclei bioaerosols actually cause infection and disease will depend on numerous factors including the organism’s viability under existing environmental conditions, the size and chemical composition of the droplet nuclei matrix, the number of organisms inhaled and their virulence, and the exposed person’s immune status.40
A number of diseases are known or suspected to be transmissible by the airborne route. However, most are either not transmissible from human to human or are not present in feces or vomit and so are not relevant to the present discussion. Toilet-related pathogens that are of interest include those causing gastroenteritis, and a number of gastroenteritis-causing bacteria, protozoa, and especially viruses will be shed in stool and vomit. Giardia and Cryptosporidium protozoa may be present in feces, have low infective dose, and are stable in the environment, but aerosolization of oocyst-containing droplet nuclei has not been documented.41 Gram-negative bacteria, with the notable exception of Legionella, are susceptible to drying and do not usually spread by the airborne route. The gram-positive MRSA is an airborne nosocomial infection concern,42 but the potential for toilet plume bioaerosols to cause nosocomial MRSA infection has not yet been assessed.
Mycobacterium tuberculosis (TB) appears to be most efficiently transmitted via droplet nuclei43 and is an occupational hazard to health care workers as well as a nosocomial infection hazard to patients.44 TB affects primarily the lungs, but TB bacilli can also be swallowed in sputum to infect the gastrointestinal (GI) tract.45 At least 21% of 2009 US TB cases involved this “extrapulmonary” infection including infection of the GI tract,46 although perhaps less than 5% of all TB cases involve lower GI tract infection.45 The bacilli can survive intestinal transit to be shed in stool,47,48 and, because one of the symptoms of GI TB is diarrhea,45 there appears to be a possibility of aerosolizing infectious TB droplet nuclei in toilet flush aerosol. M tuberculosis is a lipid-rich, hydrophobic bacterium, and hydrophobic bacteria have been shown to concentrate on the surface of aqueous suspensions49,50 and to be aerosolized with even slight disturbance of liquid surfaces.51,52
The most significant toilet plume airborne infection risks are likely to be due to viruses, and perhaps the most significant of these is norovirus. Norovirus accounts for 73% to 95% of nonbacterial gastroenteritis outbreaks and half of all gastroenteritis outbreaks, worldwide.53 It may also be transmitted in aerosol and has a low infectious dose.54 It is shed both before and after—sometimes long after—the symptomatic phase of infection, is resistant to inactivation, and can persist on environmental surfaces for extended periods.5557 Diarrhea and vomiting are both common with norovirus AGE, so both the use of toilets by infected persons and the toilet disposal of feces or vomit by other persons could produce norovirus bioaerosols.
Another important viral pathogen is the SARS coronavirus (SARS CoV), which is known to be shed in both feces5860 and vomit.60 A number of studies (discussed below) have suggested that it can be spread by the airborne route,6164 and, although not presently a common disease, it has demonstrated its potential for explosive spread and high mortality.
Novel influenza A virus H1N1 has also demonstrated some important epidemiologic features that indicate a potential for airborne transmission via toilet plume. Seasonal influenza does not normally present with diarrhea or vomiting, but each had a prevalence of 25% in the first 642 US cases65 and 17% and 22%, respectively, among the first 938 US cases66 diagnosed during the 2009 pandemic H1N1 influenza outbreak. It has been measured in respirable-size aerosol in health care and other facilities,67,68 has been detected in both stools and urine of H1N1 patients even in the absence of significant GI symptoms,69 and has shown a potential for extended virus shedding in stool.70 The presence of H1N1 in vomit seems likely, and, although no report documenting this was found, a suggestive study by Papenburg et al noted that the likelihood of H1N1 transmission in a household was greatest for patients with both diarrhea and vomiting.71

Epidemiologic studies of disease outbreaks possibly related to toilet plume

Widdowson et al investigated AGE among passengers on an 8-hour international flight72 on which 8 of 14 flight crew members experienced vomiting and diarrhea. No episodes of diarrhea or vomiting occurred outside of a restroom, and there were no reported indications of restroom soiling with vomit or feces. Passengers who developed probable norovirus illness 18 to 60 hours after disembarkation were found to have visited a restroom significantly more often than noncases. The authors concluded that “inapparent environmental contamination” may have been an exposure source.
Ho et al studied an outbreak of viral AGE during a transatlantic passenger ship voyage.73 They compared disease frequency in cabins varying from 1 to 4 occupants either having or not having a private bathroom and showed an increasing AGE risk with increasing number of occupants where a private bathroom was available as compared with cabins where one was not available. AGE incidence among those using communal bathrooms correlated significantly with the bathroom usage density. It was also shown that, in cabins with multiple occupants, the risk of a second person developing disease was higher in cabins where the first person had vomited, even though none of the subsequent cases either assisted the ill person or cleaned up the vomit. Presence in the room when vomiting actually occurred also did not appear to matter. The authors concluded that person-to-person and aerosol routes were the likely modes of transmission, with vomit being implicated as a source, and suggested that contact spread was facilitated by contaminated communal bathrooms.
Marks et al74 studied restaurant diners who developed AGE following nonprojectile vomiting by the source diner and showed a pattern of decreasing attack rate with increasing distance from the source: 91% at the source’s table; 71% and 56% at the 2 adjacent tables, respectively; and lower rates farther away. This study strongly implicated airborne norovirus transmission by vomit aerosol and thus the likelihood of airborne transmissibility by toilet plume aerosol contaminated with vomit.
Epidemiologic, experimental, and modeling studies of SARS are among the most compelling indicators of the potential for toilet plume to cause airborne disease transmission. A report on the 2003 SARS outbreak in Hong Kong’s Amoy Gardens apartment complex concluded that exposure and disease propagation was likely due to virus-laden aerosols originating in the sanitary system.64 The system was contaminated with SARS CoV when the index patient, who was suffering from diarrhea, visited one of the apartments and used the toilet. Sewer drain bioaerosol was believed to be drawn through dry floor drain U-tube traps into the bathrooms of other apartments by bathroom exhaust fans, and some may have then been exhausted to the outside of the multistory building and carried upward to other apartments. Prevailing winds were thought to be responsible for carrying the infectious aerosol to nearby buildings where cases also occurred.63,75 These studies suggest that SARS CoV droplet nuclei bioaerosols produced from contaminated sewage may have been highly infectious for significant periods and over long distances. Because the infectious waste, whether feces or vomit, is most concentrated in the toilet bowl and substantial quantities of aerosol are known to be produced during flushing, it might reasonably be expected that infectious SARS CoV droplet nuclei bioaerosol would also be produced during toilet flushing. To date, however, this has not been either experimentally or epidemiologically demonstrated.
No epidemiologic studies of the 2009 H1N1 pandemic have conclusively shown airborne transmission via droplet nuclei, and the primary transmission mode is still considered to be by contact with large particle respiratory droplets or contaminated surfaces.76 Studies involving confined environment exposures in aircraft and buses concluded that the airborne route did not appear to be an important transmission mode,7780 in contrast to the high influenza transmission rate observed on an older aircraft with poor ventilation.81 Although these epidemiologic studies have not demonstrated airborne infection, 2 recent environmental studies measured influenza A virus in respirable size aerosols collected in health care facilities, day care centers, and aircraft.67,68 This finding, the shedding of influenza virus in stool and perhaps vomit, and the prevalence of diarrhea and vomiting in Novel H1N1 patients encourage exploration of the potential for toilet plume to contain infectious virus-containing droplet nuclei aerosols.

WHAT FUTURE RESEARCH IS NEEDED TO FURTHER CHARACTERIZE THE RISKS OF EXPOSURE TO TOILET PLUME?

Epidemiologic and laboratory studies provide evidence that potentially infectious aerosols may be produced during flushing of toilets contaminated with vomit or diarrhea from infected persons. Further assessment of the airborne infection risk requires research to address the following questions: (1) What are the physical properties of toilet plume? (2) How much toilet plume is produced, and which toilet design or operating characteristics most influence aerosol production? (3) How persistent are flush-generated droplet nuclei bioaerosols in the air? (4) Can infection be transmitted by toilet flush droplet nuclei bioaerosols, and, if so, what are the airborne concentrations and dispersion patterns of flush-generated pathogenic droplet nuclei bioaerosols in health care environments? (5) What interventions or practices might prove effective in controlling toilet plume bioaerosols?

SUMMARY AND CONCLUSIONS

Contaminated toilets have been clearly shown to produce large droplet and droplet nuclei bioaerosols during flushing, and research suggests that this toilet plume could play an important role in the transmission of infectious diseases for which the pathogen is shed in feces or vomit. The possible role of toilet plume in airborne transmission of norovirus, SARS, and pandemic influenza is of particular interest. Additional research is needed to assess the exposure risk posed by toilet flush bioaerosols in health care facilities.

Footnotes

Conflicts of interest: None to report.
The findings and conclusions in this report are those of the authors and do not necessarily represent the views of the National Institute for Occupational Safety and Health. Mention of company names and/or products does not constitute endorsement by the Centers for Disease Control and Prevention.

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Cluster Analysis of  Coronavirus cases in the U.S.: The hypothesis of transmission by the fecal aerosols to respiratory tract (by the infectious "toilet plumes", and/or due to plumbing problems, creating such aerosols, e.g. dysfunctioning "vent pipes"), dispersed by the central ventilation, heating, or air conditioning systems, and including possibly intentionally contaminated food as the source and origin. 

The largest and the most clearly defined clusters of the Coronavirus (COVID-19) cases in the U.S., by the places of occurrence, are: 

Nursing Homes and similar facilities,
Prisons and jails, 
and large ships. 


CASES CONNECTED TOCASES
Cook County Jail; Chicago270
Travel overseas178
Travel within the U.S.175
Life Care nursing facility; Kirkland, Wash.129
Community in New Rochelle, N.Y.119
Gallatin Center for Rehabilitation and Healing; Gallatin, Tenn.115
Biogen conference in Boston109
Pleasant View Nursing Home; Mount Airy, Md.95
The Resort at Texas City nursing home; Texas City, Texas83
Aboard the U.S.S. Theodore Roosevelt; Guam70
Golden Crest Nursing Centre; North Providence, R.I.58
Cedar Mountain Post Acute Care Facility; Yucaipa, Calif.57
Oak Hill Center nursing home; Pawtucket, R.I.54
Travel in Egypt52
Parnall Correctional Facility; Jackson, Mich.50
Signature HealthCARE long-term care; Cookeville, Tenn.44
Careage of Whidbey; Coupeville, Wash.44
Diamond Princess cruise ship43
Long-term care facility; DuPage County, Ill.42
Lambeth House senior living facility; New Orleans42
Travel in Italy39
First Assembly of God; Greers Ferry, Ark.37
Metron long-term care; Cedar Springs, Mich.36
Peconic Landing long-term care; Greenport, N.Y.33
Macomb Correctional Facility; Lenox, Mich.33
Shuksan Healthcare Center; Bellingham, Wash.32
Family of Caring nursing home; Montclair, N.J.30
St. Joseph's Senior Nursing Home; Woodbridge, N.J.29
Sundale Rehabilitation and Long-Term Care; Morgantown, W.Va.28
Spring break trip from Austin, Texas, to Mexico28
Skagit Valley Chorale practice; Mount Vernon, Wash.27
Orinda Care medical center; Orinda, Calif.27
Federal Correctional Institution; Danbury, Conn.26
Fairacres Manor long-term care; Greeley, Colo.26
Sunrise View Assisted Living; Everett, Wash.25
La Vida Llena long-term care; Albuquerque, N.M.25
Carter House assisted living; Blair, Neb.23
Federal Correctional Complex; Oakdale, La.22
Heritage Specialty Care; Cedar Rapids, Iowa21
Grand Princess cruise in March21
Grand Princess cruise in February21
Riverbend Post Acute Care Center; Kansas City, Kan.19
Josephine Caring Community; Stanwood, Wash.18
Douglas County Health Center; Omaha18
A. Holly Patterson Extended Care Facility; Uniondale, N.Y.18
Soldiers' Home in Holyoke; Holyoke, Mass.16
Life Care Center of Burlington; Burlington, Kan.16
Laurel Brook Rehabilitation and Healthcare Center; Mt. Laurel, N.J.16
Federal Correctional Complex; Lompoc, Calif.16
Edward C. Allworth Veterans' Home; Lebanon, Ore.16
Canterbury Rehabilitation Healthcare Center; Henrico, Va.16
Travel in China15
Lakeland Correctional Facility; Coldwater, Mich.14
Birchwood Terrace rehabilitation center; Burlington, Vt.14
Rolling Meadows Senior Living facility; Taylorville, Ill.13
Briarwood Nursing Home and Rehab; Little Rock, Ark.13
Atria Willow Wood assisted living; Fort Lauderdale, Fla.13
Women's Huron Valley Correctional Facility; Ypsilanti, Mich.12
Upper Valley Medical Center; Troy, Ohio12
Southeast Nursing and Rehabilitation Center; San Antonio12
Federal Medical Center prison facility; Butner, N.C.12
California Institution for Men prison; Chino, Calif.12
____________________________________________

These places have in common: 
closed public spaces, 
public toilets, very often equipped with the power flush devices, 
and the centralized ventilation - heating - air conditioning systems. 

Generically, these types of locations can be summarized as any closed public space with power flush toilets and centralized ventilation, such as office buildings, shopping malls, schools, hospitals, places of worship, etc., etc.

The stools of the Coronavirus patients, and very likely of the asymptomatic carriers is infectious in the aerosol form, and it was hypothesized that this particular mode of transmission: fecal aerosol to the respiratory system, might be responsible for the rapid spread of the disease. It was also discerned that this particular fecal - respiratory rout was the mechanism of the infection spread due to the malfunctioning plumbing systems in Hong Kong buildings, both during the SARS epidemic in 2003, in Amoy Gardens, and in the current COVID-19 Pandemic. 

The centralized ventilation systems are capable of dispersing the infectious aerosols throughout the large spaces, and this might explain the simultaneous outbreaks. 

The infectious material, hypothetically, may be the contaminant in food, the occasional, when the aerosol settles on it randomly, or the deliberate and intentional, as in the acts of Bioterrorism. 
The symptomatic or asymptomatic carriers excrete the infectious material in stools, repeating the cycles and spreading the infection. 

This hypothesis has to be researched and checked out, including experimentally. 

Michael Novakhov | 2:02 PM 4/4/2020
_____________________________________

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How scientists are tracking 8 strains of SARS-CoV-2 virus

Michael_Novakhov shared this story from GANNETT Syndication Service.

SAN FRANCISCO – At least eight strains of the coronavirusare making their way around the globe, creating a trail of death and disease that scientists are tracking by their genetic footprints.
While much is unknown, hidden in the virus's unique microscopic fragments are clues to the origins of its original strain, how it behaves as it mutates and which strains are turning into conflagrations while others are dying out thanks to quarantine measures.  
Huddled in once bustling and now almost empty labs, researchers who oversaw dozens of projects are instead focused on one goal: tracking the current strains of the SARS-CoV-2 virus that cause the illness COVID-19.
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Labs around the world are turning their sequencing machines, most about the size of a desktop printer, to the task of rapidly sequencing the genomes of virus samples taken from people sick with COVID-19. The information is uploaded to a website called NextStrain.org that shows how the virus is migrating and splitting into similar but new subtypes.
While researchers caution they're only seeing the tip of the iceberg, the tiny differences between the virus strains suggest shelter-in-place orders are working in some areas and that no one strain of the virus is more deadly than another. They also say it does not appear the strains will grow more lethal as they evolve. 
“The virus mutates so slowly that the virus strains are fundamentally very similar to each other,” said Charles Chiu, a professor of medicine and infectious disease at the University of California, San Francisco School of Medicine.
The SARS-CoV-2 virus first began causing illness in China sometime between mid-November and mid-December. Its genome is made up of about 30,000 base pairs. Humans, by comparison, have more than 3 billion. So far even in the virus's most divergent strains scientists have found only 11 base pair changes.
That makes it easy to spot new lineages as they evolve, said Chiu.
“The outbreaks are trackable. We have the ability to do genomic sequencing almost in real-time to see what strains or lineages are circulating,” he said.
So far, most cases on the U.S. West Coast are linked to a strain first identified in Washington state. It may have come from a man who had been in Wuhan, China, the virus’ epicenter, and returned home on Jan. 15. It is only three mutations away from the original Wuhan strain, according to work done early in the outbreak by Trevor Bedford, a computational biologist at Fred Hutch, a medical research center in Seattle.
On the East Coast there are several strains, including the one from Washington and others that appear to have made their way from China to Europe and then to New York and beyond, Chiu said.

Beware pretty phylogenetic trees

This isn’t the first time scientists have scrambled to do genetic analysis of a virus in the midst of an epidemic. They did it with Ebola, Zika and West Nile, but nobody outside the scientific community paid much attention.
“This is the first time phylogenetic trees have been all over Twitter,” said Kristian Andersen, a professor at Scripps Research, a nonprofit biomedical science research facility in La Jolla, California, speaking of the diagrams that show the evolutionary relationships between different strains of an organism.
The maps are available on NextStrain, an online resource for scientists that uses data from academic, independent and government laboratories all over the world to visually track the genomics of the SARS-CoV-2 virus. It currently represents genetic sequences of strains from 36 countries on six continents.
While the maps are fun, they can also be “a little dangerous” said Andersen. The trees showing the evolution of the virus are complex and it’s difficult even for experts to draw conclusions from them.
“Remember, we’re seeing a very small glimpse into the much larger pandemic. We have half a million described cases right now but maybe 1,000 genomes sequenced. So there are a lot of lineages we’re missing,” he said.

Different symptoms, same strains

COVID-19 hits people differently, with some feeling only slightly under the weather for a day, others flat on their backs sick for two weeks and about 15% hospitalized. Currently, an estimated 1% of those infected die. The rate varies greatly by country and experts say it is likely tied to testing rates rather than actual mortality.
Chiu says it appears unlikely the differences are related to people being infected with different strains of the virus.
“The current virus strains are still fundamentally very similar to each other,” he said.
The COVID-19 virus does not mutate very fast. It does so eight to 10 times more slowly than the influenza virus, said Anderson, making its evolution rate similar to other coronaviruses such as Severe Acute Respiratory Syndrome (SARS) and Middle East Respiratory Syndrome (MERS).
It’s also not expected to spontaneously evolve into a form more deadly than it already is to humans. The SARS-CoV-2 is so good at transmitting itself between human hosts, said Andersen, it is under no evolutionary pressure to evolve.

Shelter in place working in California

Chiu’s analysis shows California’s strict shelter in place efforts appear to be working.
Over half of the 50 SARS-CoV-2 virus genomes his San Francisco-based lab sequenced in the past two weeks are associated with travel from outside the state. Another 30% are associated with health care workers and families of people who have the virus.
“Only 20% are coming from within the community. It’s not circulating widely,” he said.
That’s fantastic news, he said, indicating the virus has not been able to gain a serious foothold because of social distancing.
It's like a wildfire, Chiu said. A few sparks might fly off the fire and land in the grass and start new fires. But if the main fire is doused and its embers stomped out, you can kill off an entire strain. In California, Chiu sees a lot of sparks hitting the ground, most coming from Washington, but they're quickly being put out. 
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An example was a small cluster of cases in Solano County, northeast of San Francisco. Chiu’s team did a genetic analysis of the virus that infected patients there and found it was most closely related to a strain from China.
At the same time, his lab was sequencing a small cluster of cases in the city of Santa Clara in Silicon Valley. They discovered the patients there had the same strain as those in Solano County. Chiu believes someone in that cluster had contact with a traveler who recently returned from Asia.
“This is probably an example of a spark that began in Santa Clara, may have gone to Solano County but then was halted,” he said.
The virus, he said, can be stopped.

China is an unknown
So far researchers don’t have a lot of information about the genomics of the virus inside China beyond the fact that it first appeared in the city of Wuhan sometime between mid-November and mid-December.
The virus’s initial sequence was published on Jan. 10 by professor Yong-Zhen Zhang at the Shanghai Public Health Clinical Center. But Chiu says scientists don’t know if there was just one strain circulating in China or more.
“It may be that they haven’t sequenced many cases or it may be for political reasons they haven’t been made available,” said Chiu. “It’s difficult to interpret the data because we’re missing all these early strains.”
Researchers in the United Kingdom who sequenced the genomes of viruses found in travelers from Guangdong in south China found those patients’ strains spanned the gamut of strains circulating worldwide.
“That could mean several of the strains we’re seeing outside of China first evolved there from the original strain, or that there are multiple lines of infection. It’s very hard to know,” said Chiu.
There's a new symptom of coronavirus, docs say:Sudden loss of smell or taste

The virus did not come from a lab

While there remain many questions about the trajectory of the COVID-19 disease outbreak, one thing is broadly accepted in the scientific community: The virus was not created in a lab but naturally evolved in an animal host. 
SARS-CoV-2’s genomic molecular structure – think the backbone of the virus – is closest to a coronavirus found in bats. Parts of its structure also resemble a virus found in scaly anteaters, according to a paper published earlier this month in the journal Nature Medicine.
Someone manufacturing a virus targeting people would have started with one that attacked humans, wrote National Institutes of Health Director Francis Collins in an editorial that accompanied the paper.
Andersen was lead author on the paper. He said it could have been a one-time occurrence.
“It’s possible it was a single event, from a single animal to a single human,” and spread from there. 
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Coronavirus's rapid spread may be due to fecal-oral ... - Fortune


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Feb 19, 2020 - Scientists suspect a fecal-oral route for coronavirus that's infected tens of thousands worldwide. ... More than 600 Covid-19 infections were confirmed among ... A virus-laden aerosol plume emanating from a SARS patient with ...


Coronaviridae - an overview | ScienceDirect Topics


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Coronavirus and coronavirus-like infections have been described in swine, cattle, ... Turkey coronavirus, Bluecomb virus, Enteritis, Fecal–oral route, aerosol ...


Aerosol and surface stability of HCoV-19 (SARS ... - medRxiv


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by C Machacek - ‎2016 - ‎Cited by 10 - ‎Related articles
Infectious Diseases, National Institutes of Health, Hamilton, MT, USA ... A novel human coronavirus, now named severe acute respiratory syndrome ... studying virus viability in different matrices, such as nasal secretion, sputum and fecal matter ...


Transmission routes of 2019-nCoV and controls in dental ...


<a href="http://www.nature.com" rel="nofollow">www.nature.com</a> › international journal of oral science › review articles
by X Peng - ‎2020 - ‎Cited by 19
Mar 3, 2020 - Most of the coronavirus can cause the infectious diseases in human and ... However, the aerosol transmission route and the fecal–oral ...


Fecal Transmission May Be Behind Coronavirus's Rapid Spread


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Feb 19, 2020 - The novel coronavirus is shed in the feces of infected people, which may help ... More than 600 Covid-19 infections were confirmed among ...


COVID-19 Transmission 'Plausible' on Surfaces, in the Air ...


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Mar 17, 2020 - SARS-CoV-2, the virus causing COVID-19, was viable in aerosols for 3 hours, and ... of the National Institute of Allergy and Infectious Diseases in Hamilton, Montana, and ... virus compared with SARS-CoV-1 as the most closely related coronavirus. ... Study: COVID-19 Is Also Spread by Fecal-Oral Route.


Aerosol, fecal routes of infection unconfirmed - Chinadaily ...


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Feb 10, 2020 - The National Health Commission reiterated on Sunday that the transmission routes of the novel coronavirus through aerosols and digestive ...


First known person-to-person transmission of severe acute ...


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by I Ghinai - ‎Cited by 9
Mar 13, 2020 - SARS-CoV-2, which causes the disease now named coronavirus disease ... higher concentrations of respiratory secretions or aerosols while not using ... a patient with laboratory-confirmed COVID-19 infection who was not wearing a ... sputum, urine, and stool specimens were collected and sent to CDC for ...


Toilet plume - Wikipedia


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A toilet plume is the dispersal of microscopic particles as a result of flushing a toilet. Normal use of a toilet by healthy people is considered unlikely to be a major health risk. There is indirect evidence that specific pathogens such as norovirus or SARS coronavirus could potentially be spread by toilet aerosols, ... The feces and vomit of infected people can contain high ...


Transmission (medicine) - Wikipedia


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In medicine, public health, and biology, transmission is the passing of a pathogen causing ... "Airborne transmission refers to infectious agents that are spread via droplet ... Main causes of fecal–oral disease transmission include lack of adequate ... respiratory infections (sneezing and coughing create infectious aerosols).


How COVID-19 Is Spread | The Scientist Magazine®


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Feb 21, 2020 - A paper published in The Journal of Hospital Infection earlier this month by ... See “Scientists Compare Novel Coronavirus to SARS and MERS viruses” ... On their own, these observations don't show that COVID-19 is spread via feces. ... When airborne, infective virus can drift through the air as an aerosol.


vaused by SARS-CoV-2 - Homeland Security


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Mar 25, 2020 - respiratory syndrome coronavirus 2 (SARS-CoV-2) is ... Human infectious dose by aerosol route ... Human infectious dose by fecal-oral route.


Viral infections acquired indoors ... - SciELO - Saúde Pública


<a href="http://www.scielosp.org" rel="nofollow">www.scielosp.org</a> › article › aiss
by G La Rosa - ‎2013 - ‎Cited by 65 - ‎Related articles
Reports on the presence of viral aerosols in indoor air are scarce, however, despite ... rhino-viruses, coronaviruses, adenoviruses, respiratory syncytial viruses, and ... and occasionally by airborne aerosols, but can also spread by the fecal-oral ...
Heating, ventilation, and air conditioning - Wikipedia

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AIRBORNE DISEASES[EDIT]

Natural ventilation is a key factor in reducing the spread of airborne illnesses such as tuberculosis, the common cold, influenza and meningitis. Opening doors, windows, and using ceiling fans are all ways to maximize natural ventilation and reduce the risk of airborne contagion. Natural ventilation requires little maintenance and is inexpensive.[18]
Toilet plume - Wikipedia

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Toilet plume

From Wikipedia, the free encyclopedia
Jump to navigation Jump to search
toilet plume is the dispersal of microscopic particles as a result of flushing a toilet. Normal use of a toilet by healthy people is considered unlikely to be a major health risk. There is indirect evidence that specific pathogens such as norovirus or SARS coronavirus could potentially be spread by toilet aerosols, but as of 2015, no direct experimental studies had clearly demonstrated or refuted actual disease transmission from toilet aerosols. It has been hypothesized that dispersal of pathogens may be reduced by closing the toilet lid before flushing, and by using toilets with lower flush energy.

Possible effects on disease transmission[edit]

A video discussing research on the health hazards of aerosol toilet plumes
There is indirect evidence that toilet aerosol can be a vector for diseases that involve acute gastroenteritis with the shedding of large numbers of pathogens through feces and vomit, with normal use of a toilet unlikely to be a major health risk.[1] For example, some epidemiological studies indicate transmission of norovirus in passenger airplanes[2] and ships,[3] and SARS coronavirus through a contaminated building sewage system,[4] via contaminated toilets rather than other routes.[5] The feces and vomit of infected people can contain high concentrations of pathogens, many of which are known to survive on surfaces for weeks or months, and toilets may continue to produce contaminated toilet plumes over multiple successive flushes. Some other pathogens speculatively identified as being of potential concern for these reasons include gram-positive MRSAMycobacterium tuberculosis, and the pandemic H1N1/09 virus commonly known as "swine flu".[5]
There is no direct experimental evidence on disease transmission by toilet aerosols. Whether or not aerosols can contain norovirus, SARS coronavirus, or other pathogens has not been directly measured as of 2015.[5][6] The combination of cleaning and disinfecting surfaces is usually effective at removing contamination, although some pathogens such as norovirus[7] have an apparent resistance to these techniques.[5]

Mechanism[edit]

Aerosol droplets produced by flushing the toilet can mix with the air of the room,[6] larger droplets will settle on a surface before they can dry,[5][8] and can contaminate surfaces such as the toilet seat and handle, which can then be contacted by hands.[1] Smaller aerosol particles can become droplet nuclei as a result of evaporation of the water in the droplet; these have negligible settling velocity and are carried by natural air currents.[8] Disease transmission through droplet nuclei is not a concern for many pathogens, because they are not excreted in feces or vomit, or are susceptible to drying.[5] The critical size dividing these dispersal modes depends on the evaporation rate and vertical distance between the toilet and the surface in question.[8]
Experiments to test bioaerosol production usually involve seeding a toilet with bacteria or virus particles,[5] or fluorescent microparticles,[8] and then testing for their presence on nearby surfaces and in the air, after varying amounts of time.[5][8] The amount of bioaerosol varies with the type of flush toilet. Older wash-down toilet designs produce more bioaerosol than modern siphoning toilets.[5] Among modern toilets, bioaerosol production increases as qualitative flush energy increases, from low-flush gravity-flow toilets common in residences, to pressure-assisted toilets, to vigorous flushometer toilets often found in public restrooms.[8]
One study found that lowering the toilet lid prevented dispersion of large droplets, and reduced the airborne bacteria concentrations by a factor of 12. The study recommended discouraging the use of lidless toilets, and thus contradicts the US Uniform Plumbing Code specifications for public toilets.[5][9]

History[edit]

Experiments on the bioaerosol content of toilet plumes were first performed in the 1950s.[5] A 1975 study by Charles P. Gerba popularized the concept of disease transmission through toilet plumes.[10] The term "toilet plume" was in use before 1999.[11]
Impact of the 2019–20 coronavirus pandemic on prisons - Wikipedia

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New York[edit]

After a guard and a prisoner tested positive for coronavirus at Rikers Island prison, New York City Mayor Bill de Blasio said that city officials will identify individuals for release, including persons arrested for minor crimes and those most vulnerable to infection due to chronic health problems. In addition to the cases at Rikers, other prisons in the state, including Sing Sing, have recorded positive tests among prisoners, and one member of the correction's department has died from the virus.[35]
As of March 25, 75 New York City inmates have tested positive for Covid-19 and 37 city corrections staff members, up from 50 inmates and 30 staffers the previous day. City jails are notoriously crowded, with beds often touching and in at least one instance, 29 people share a single toilet.[28]
Cook County Jail - Wikipedia

Michael_Novakhov shared this story from Wikipedia - Recent changes [en].

U.S. Department of Justice report[edit]

In July 2008, the civil rights division of the United States Department of Justice released a report finding that the Eighth Amendment civil rights of the inmates has been systematically violated.[5][6] The report found that the CCJ failed to adequately protect inmates from harm or risk of harm from other inmates or staff; failed to provide adequate suicide prevention; failed to provide adequate sanitary environmental conditions; failed to provide adequate fire safety precautions; and failed to provide adequate medical and mental health care.
Specific alleged violations that have resulted in Federal sanctions and/or class action lawsuits include:
  1. Systematic beatings by corrections officers
  2. Poor food quality
  3. Inmates' being forced to sleep on cell floors due to overcrowding and mismanagement (resulting in a $1,000 per inmate class-action settlement)
  4. Rodent infestation and injury caused to sleeping inmates by rat and mouse bites
  5. Violations of privacy during multiple invasive strip searches
  6. Failure to provide adequate medical care, including failure to dispense medications
  7. Invasive and painful mandatory tests for male STDs (resulting in a $200 per inmate class action settlement)
  8. Unnecessarily long waiting time for discharge upon payment of bond, completion of sentence, or charges' being dropped. Wait times are currently routinely in excess of 8 hours, nearly all of which is spent with many inmates packed into tiny cells.
Forensic epidemiology - Wikipedia

Michael_Novakhov shared this story from Wikipedia - Recent changes [en].

History[edit]

The term Forensic Epidemiology was first associated with the investigation of bioterrorism in 1999, and coined by Dr. Ken Alibek, the former chief deputy of the Soviet bioweapons program. The scope of FE at that time was confined to the investigation of epidemics that were potentially man-made. After the US Anthrax attacks of 2001 the CDC defined forensic epidemiology as a means of investigating possible acts of bioterrorism.
At the present time FE is more widely known and described as the systematic application of epidemiology to disputed issues of causation that are decided in (primarily) civil, but also criminal courts. The use of epidemiologic data and analysis as a basis for assessing general causation in US courts, particularly in toxic tort cases, has been described for more than 30 years, beginning with the investigation of the alleged relationship between exposure to the Swine Flu vaccine in 1976 and subsequent cases of Guillain–Barré syndrome.[1]
More recently FE has also been described as an evidence-based method of quantifying the probability of specific causation in individuals. The approach is particularly helpful when a clinical differential diagnosis approach to causation is disputed. Examples covering a wide variety of applications of FE are listed below under Examples of Investigative Questions Addressed by Forensic Epidemiologists.
6:45 PM 4/3/2020 - Ramapo is "the best place in New York State to live" | Cluster analysis in forensic epidemiology of Coronavirus cases in New York state: In "cluster analysis" of Coronavirus cases in Rockwell county, NY, the same pattern, as described previously for the Long Island clusters, is evident: the affected location is the prime target for the future Real Estate Development.

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Ramapo NY Homes for Sale | Real Estate Hudson Valley

Cluster analysis in forensic epidemiology of Coronavirus cases in New York state

Ramapo is "the best place in New York State to live". 

In "cluster analysisso to speak, or simply on some coarse, initial examination, of Coronavirus cases in Rockwell county, NY,  the same pattern, as described previously for the Long Island clusters, is evident: the affected location is the prime target for the future Real Estate Development. The other affected locations in this county probably fit the same pattern, although to somewhat lesser degree. 

M.N. | 6:45 PM 4/3/2020

Ramapo NY Homes for Sale | Real Estate Hudson Valley

Yes, there is a direct train departing from Suffern and arriving at Hoboken. Services depart hourly, and operate every day. The journey takes approximately 1h 11m.

Map of how to get from Ramapo to New York.
______________________________________

See also: 

Forensic epidemiology - GS 

Cluster analysis - GS 

Cluster Analysis in Forensic Epidemiology - GS

Cluster analysis in forensic epidemiology of Coronavirus cases in New York state - GS

___________________________________

Coronavirus NYC - GS

"Rockland County, northwest of New York City, has seen a higher concentration of virus cases than any place in the state besides neighboring Westchester County. It has reported more than 4,200 coronavirus cases, or about 1 per 75 residents — far higher than the rate in New York City. As of late Friday afternoon, county officials said the death toll had risen to 69 from the low 40s." 

Rockland County official seeks a “containment zone” to fight the virus. - NYT - 4.3.20


  • 902 - Town of Ramapo
  • 268 - Town of Clarkstown
  • 134 - Town of Orangetown
  • 90 - Town of Haverstraw
  • 27 - Town of Stony Point
The Monsey and Spring Valley zip codes are by far the areas with the most cases at 400 each. 
_____________________________________
"confirmed coronavirus cases: 902 - Town of Ramapo": 

Ramapo, New York

From Wikipedia
In 2006 Money magazine ranked Ramapo as the 49th best place in the United States and the best place in New York State to live. Arts and leisure, business, housing, low crime rates and open spaces/parkland determined the town's ranking. In the category of park space, percentage of land set aside for gardens and parks, the town finished first. Ramapo received the highest rating and one of the best in the country for its open spaces and parkland.
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» mikenov on Twitter: M.N.: Prime RE!:In the category of park space, percentage of land set aside for gardens and parks, the town finished first. Ramapo received the highest rating & one of the best in the country for its open spaces and parkland. Ram
03/04/20 18:26 from TWEETS BY MIKENOV from mikenova (1 sites)
M.N.: Prime RE!: In the category of park space, percentage of land set aside for gardens and parks, the town finished first. Ramapo received the highest rating & one of the best in the country for its open spaces and parkland. Ramapo...
» mikenov on Twitter: In 2006 Money ranked Ramapo as the 49th best place in the United States and the best place in New York State to live. Arts and leisure, business, housing, low crime rates and open spaces/parkland determined the town's ranking. Ramapo,
03/04/20 18:23 from TWEETS BY MIKENOV from mikenova (1 sites)
In 2006 Money ranked Ramapo as the 49th best place in the United States and the best place in New York State to live. Arts and leisure, business, housing, low crime rates and open spaces/parkland determined the town's ranking. Ramapo, Ne...
» mikenov on Twitter: Rockland County, NY coronavirus rates - Google Search google.com/search?q=Rockl…
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Rockland County, NY coronavirus rates - Google Search google.com/search?q=Rockl… Posted by mikenov on Friday, April 3rd, 2020 10:09pm mikenov on Twitter
» mikenov on Twitter: The area where Mr. Day seeks restrictions includes the ultra-Orthodox Jewish enclaves of Monsey, where a funeral this week drew a large crowd, and Kaser. nytimes.com/2020/04/03/nyr…
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The area where Mr. Day seeks restrictions includes the ultra-Orthodox Jewish enclaves of Monsey, where a funeral this week drew a large crowd, and Kaser. nytimes.com/2020/04/03/nyr… Posted by mikenov on Friday, April 3rd, 2020 10:09pm mi...
» mikenov on Twitter: deaths nearly doubling in just three days, from 1,550 on Tuesday to 2,935 on FridayLive Coronavirus New York Updates - The New York Times nytimes.com/2020/04/03/nyr…
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deaths nearly doubling in just three days, from 1,550 on Tuesday to 2,935 on Friday Live Coronavirus New York Updates - The New York Times nytimes.com/2020/04/03/nyr… Posted by mikenov on Friday, April 3rd, 2020 9:59pm mikenov on Twitter
» mikenov on Twitter: There are now 102,863 confirmed cases in New York State, up from 92,381 on Thursday. New York City has 57,159 cases — nearly a quarter of the confirmed cases in the whole country.Live Coronavirus New York Updates - The New York Times
03/04/20 17:58 from TWEETS BY MIKENOV from mikenova (1 sites)
There are now 102,863 confirmed cases in New York State, up from 92,381 on Thursday. New York City has 57,159 cases — nearly a quarter of the confirmed cases in the whole country. Live Coronavirus New York Updates - The New York Times ny...
» mikenov on Twitter: Live Coronavirus New York Updates - The New York Times nytimes.com/2020/04/03/nyr…
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Live Coronavirus New York Updates - The New York Times nytimes.com/2020/04/03/nyr… Posted by mikenov on Friday, April 3rd, 2020 9:52pm mikenov on Twitter
» mikenov on Twitter: Capt. Brett Crozier - Google Search google.com/search?q=Capt.…
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Capt. Brett Crozier - Google Search google.com/search?q=Capt.… Posted by mikenov on Friday, April 3rd, 2020 9:05pm mikenov on Twitter
» mikenov on Twitter: RT @Sotero269: Wrongfully relieved of command but did right by the sailors. #navy @UncleChaps @katebarstool @ZeroBlog30 @CaptainCons https:…
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Wrongfully relieved of command but did right by the sailors. #navy @UncleChaps @katebarstool @ZeroBlog30 @CaptainCons pic.twitter.com/M0aZhHNMXT Posted by Sotero269 on Friday, April 3rd, 2020 11:18am Retweeted by mikenov on Friday, April...
» mikenov on Twitter: Watch sailors cheer Navy captain relieved of command after raising alarm on coronavirus nbcnews.com/news/us-news/v… via @nbcnews
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Watch sailors cheer Navy captain relieved of command after raising alarm on coronavirus nbcnews.com/news/us-news/v… via @nbcnews Posted by mikenov on Friday, April 3rd, 2020 8:45pm mikenov on Twitter
» mikenov on Twitter: The vacant Comfort hospital ship is a symbol of our coronavirus failure | Ross Barkan theguardian.com/commentisfree/…
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The vacant Comfort hospital ship is a symbol of our coronavirus failure | Ross Barkan theguardian.com/commentisfree/… Posted by mikenov on Friday, April 3rd, 2020 8:40pm mikenov on Twitter
» mikenov on Twitter: “The solution is obvious enough. Open the navy hospital ship to coronavirus patients and let the Comfort join the ranks of other temporary hospitals in New York, like the 1,000-bed facility at the Javits Center” gu.com/p/dtav6/stw
03/04/20 16:40 from TWEETS BY MIKENOV from mikenova (1 sites)
“The solution is obvious enough. Open the navy hospital ship to coronavirus patients and let the Comfort join the ranks of other temporary hospitals in New York, like the 1,000-bed facility at the Javits Center” gu.com/p/dtav6/stw Posted...
Trump, Kushner, and Russian-Jewish Mafia have a financial interest in Coronavirus Pandemic: to drive the real estate prices down, and then to buy it up - Google Search

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5 hours ago - 1. Trumpism And Trump – Site Posts In Brief – Page on Site ... AM 4/3/2020 – TrumpKushner, and Russian-Jewish Mafia have a financial interest in Coronavirus Pandemic: to drive the real estate prices down, and then to buy it up – GS April 3, 2020; 1. ... Will coronavirus outbreak slam U.S. home prices?
7:49 AM 4/3/2020 - Michael Novakhov - SharedNewsLinks℠: NYC map shows patients testing positive for coronavirus

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Will coronavirus outbreak slam U.S. home prices? – Press Telegram
Are coronavirus statistics reliable?
NYC map shows patients testing positive for coronavirus
8:42 PM 4/1/2020 - Michael Novakhov – SharedNewsLinks℠: Coronavirus Could Spread Through Pipes in Buildings, Officials Fear
Coronavirus Could Spread Through Pipes in Buildings, Officials Fear
Residents of evacuated Hong Kong apartments test negative for coronavirus
WHO | Inadequate plumbing systems likely contributed to SARS transmission
Can the new coronavirus spread through building pipes? | Live Science
Coronavirus Live Updates: The Illness Now Has a Name: COVID-19 - The New York Times - 2.11.20
Mike Nova’s Shared NewsLinks Review In 250 Brief Posts: Forensic epidemiological cluster analysis of the published data on the Coronavirus cases in Long Island, New York.
Совещание с членами Правительства • Президент России
2:47 PM 4/1/2020 - Here I would like to offer you, my dear readers, a piece of amateur forensic epidemiological cluster analysis of the published data on the Coronavirus cases in Long Island, New York.
COVID-19 clusters appear on map as testing ramps up on Long Island | Newsday
John Snow - Wikipedia
Snow’s Cholera studies - Google Search
11:16 AM 4/1/2020 - Look at the Coronavirus map of New York City, it speaks for itself: This is the real Collusion: Trump + Russian Mafia! They conspired to bring to reality the old dream of Trump's: to get rid of the NYC eyesore, its public housing projects, and to build the luxury housing instead, making themselves the tens of billions of bloody $$$.
The coronavirus map of New York: City releases borough by borough breakdown of cases
9:51 AM 4/1/2020 - M.N.: Is Coronavirus Epidemic in NYC a plot by the Russian Mafia to introduce the virus into the NYC projects housing, following the pattern of the Hong Kong outbreak of SARS in 2003, so they could get rid of the projects and build their expensive multi-billion dollars luxury housing instead?! | The SARS epidemic in Hong Kong: what lessons have we learned?
Environmental transmission of SARS at Amoy Gardens. - PubMed - NCBI
Coronavirus pandemic | Take a look at some bizarre theories about COVID-19
Coronavirus in Plumbing Systems | Contractor
Map shows areas of NYC hardest hit by coronavirus
The FBI News Review - fbinewsreview.blogspot.com - Blog by Michael Novakhov: 1:30 PM 3/31/2020 - The American KGB spied on the whole country: without sufficient justifications, on made-up pretenses, needlessly, aggressively, stupidly, most of all to satis
Genetic analysis of the coronavirus gives scientists clues about how it's spreading
'Das Coronavirus' Podcast Captivates Germany With Scientific Info On The Pandemic
 _____________________________________________
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Who’s right? Both are well-respected and reputable.
A real estate trade association chief economist and a 44-year mortgage industry researcher and analyst are predicting entirely different conclusions about where the median home price lands by the end of 2020 as a consequence of the coronavirus pandemic.
“By year end, maybe no meaningful change to median home price for the country as a whole,” said National Association of Realtors Chief Economist Dr. Lawrence Yun when asked about 2020 year-end median home prices. “That assumes some rebound in jobs and private sector income after the precipitous fall in the second quarter.”
7:37 AM 4/3/2020 - Are coronavirus statistics reliable? | Will coronavirus outbreak slam U.S. home prices? | Is coronavirus spread through feces?

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News Review

4.2.20



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4.1.20

Will coronavirus outbreak slam U.S. home prices? – Press Telegram

Michael_Novakhov shared this story from Press Telegram.

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Who’s right? Both are well-respected and reputable.
A real estate trade association chief economist and a 44-year mortgage industry researcher and analyst are predicting entirely different conclusions about where the median home price lands by the end of 2020 as a consequence of the coronavirus pandemic.
“By year end, maybe no meaningful change to median home price for the country as a whole,” said National Association of Realtors Chief Economist Dr. Lawrence Yun when asked about 2020 year-end median home prices. “That assumes some rebound in jobs and private sector income after the precipitous fall in the second quarter.”
The upper end of the market, Yun conceded, is likely to experience a modest price decline.
But Tom LaMalfa, president of Cleveland-based TSL Consulting, sees dramatic danger for leveraged homeowners.
“Home prices will drop 20% to 30% over the course of this calendar year,” said LaMalfa.
Long before the 2008 bailout and government conservatorship of Fannie Mae and Freddie Mac, LaMalfa was sounding a similar leverage alarm about the two mortgage giants. LaMalfa predicted F & F would create major problems for all stakeholders with their risky positions, having so little capital. Fannie and Freddie remain in government conservatorship and will be there for the foreseeable future.
Other views?
“No forecasting until we get more clarity on government programs,” said John Burns, CEO of John Burns Real Estate Consulting. “I think the government will come to the rescue and throw the sink at this.”
The California Association of Realtors is currently updating its forecast which was not available by press time.
My view: I’m worried about median home prices dropping 15% by the end of 2020.
In the past few weeks, I’ve taken more than two dozen calls from clients and column readers with high anxiety about their jobs and businesses. How will they continue to make their house payments?
More disturbing than those conversations was the March 24 blog post by St. Louis Federal Reserve Bank economist Miguel Faria-Castro estimating potential unemployment of more than 32%.
How are some buyers and sellers reacting since the coronavirus lockdown started?
To my own admitted surprise, we have not seen any letup at my shop. We are receiving a steady number of new purchase mortgages as new purchase escrows continue to open. And, not a single cancellation (coronavirus related or otherwise) so far.
What we are also seeing is an almost insurmountable amount of coronavirus-related challenges to get both purchase and refinance mortgages funded. Here is just a sampling of the stressors:
  1. The Internal Revenue Service has temporarily stopped validating the accuracy of tax returns for mortgage lenders. This is especially challenging when it comes to self-employed borrowers. The good news is many lenders have workarounds.
  2. Mortgage payoff demand statements, HOA documents, employment verifications subordination agreements are taking several weeks in some cases.
  3. Property access is a challenge when interior home inspections and interior appraisal inspections may be required.
  4. Mortgage companies largely do not have sufficient staffing to manage the current heavy refinance application volume. Working remotely creates additional delays and obstacles for underwriters and loan processors.
  5. Pre-funding employment verifications and still-in-business company verifications add that much more lender detective work.
Besides being thankful and grateful to those on the coronavirus frontlines, please thank those underwriters, funders, loan processors and escrow officers who are maintaining housing transaction commerce and getting your desperately needed cash out.
Freddie Mac rate news: The 30-year fixed-rate averaged 3.33%, down 17 basis points from last week to the fifth-lowest rate in 49 years. The 15-year fixed-rate averaged 2.92%, 10 basis points lower than last week.
The Mortgage Bankers Association reported a 15.3% decrease in loan application volume from one week earlier.
Bottom line: Assuming a borrower gets the average 30-year fixed rate on a conforming $510,400 loan, last year’s payment was $216 more than this week’s payment of $2,244.
What I see: Locally, well-qualified borrowers can get the following fixed-rate mortgages without points: A 30-year FHA (up to $442,750 in the Inland Empire, up to $510,400 in Los Angeles and Orange counties) at 3%, a 15-year conventional at 3.375%, a 30-year conventional at 3.5%, a 30-year conventional high-balance ($510,401 to $765,600) at 3.875%, and a 30-year jumbo (over $765,600) at 5.25%.
Eye catcher loan of the week: A 30-year conventional, adjustable-rate locked in for five years at 2.625% for a two-point cost.
Jeff Lazerson is a mortgage broker and adjunct professor at Saddleback College. He can be reached at 949-334-2424 or <a href="mailto:jlazerson@mortgagegrader.com">jlazerson@mortgagegrader.com</a>. His website is www.mortgagegrader.com.

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