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Further work could pursue data from early investigation of cases where available, to explore the relative importance of different settings to transmission.

Importantly, this may counter a bias towards small cluster sizes: with a lack of follow-up only some of the cases actually linked to a setting may be reported and linked.

Detailed outbreak investigations should also be explored to get information on the places where transmission is unlikely to have occurred, e.

We found that many clusters of cases were linked to indoor settings, but this may be because early spread in China was during their winter, with people naturally spending more time inside close spaces.

Further work is needed to clarify this. We found only few clusters in school settings. However, there were many clusters associated with household transmission, and children could be the entry point for the virus into this setting.

More generally, the role of children in widespread transmission of the virus is unclear, and whether reopening schools could trigger increased introductions of the virus into households and further within-household spread will have to be carefully monitored.

Further investigation of settings that facilitate clusters of transmission could provide important information for containment strategies as countries lift some of the current restrictions.

Previous work has suggested that there might be considerable heterogeneity in individual transmission, which would imply a disproportionate impact from preventing large transmission events from occurring Endo et al.

Whilst widespread contact tracing is often considered part of future containment strategies, there is a need for this to be complemented with retrospective investigation of clusters in order to better understand the extent to which certain settings and behaviours are at particular risk of generating clusters of transmission.

This could, in turn, inform contact tracing efforts and might be particularly relevant in the context of contact tracing using mobile phone apps, which has recently been suggested in support of more traditional contact tracing Ferretti et al.

For example, past co-location in certain settings could be a trigger for notification of risk from an app instead of, or in addition to, individual contacts.

This database will be kept as a static source linked to this report, but with an additional tab for newly reported settings. However, reporting should be improved in the majority of settings, with implementation of systematic reporting on the number of potentially exposed individuals and the number of confirmed and suspected cases from these settings, to allow the estimation of attack rates.

This database provides references and information on cluster sizes as well as notes about the studies. We would also like to thank all the anonymous individuals who suggested updates for transmission events in our online database.

They can now be found at the top of the panel on the right, linked from the box entitled Open Peer Review. Choose the reviewer report you wish to read and click the 'read' link.

You can also read all the peer review reports by downloading the PDF. Is the work clearly and accurately presented and does it cite the current literature?

Is the study design appropriate and is the work technically sound? Are sufficient details of methods and analysis provided to allow replication by others?

If applicable, is the statistical analysis and its interpretation appropriate? Are all the source data underlying the results available to ensure full reproducibility?

Competing Interests: No competing interests were disclosed. Alongside their report, reviewers assign a status to the article:. All Comments 3.

Provide sufficient details of any financial or non-financial competing interests to enable users to assess whether your comments might lead a reasonable person to question your impartiality.

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We have sent an email to , please follow the instructions to reset your password. ALL Metrics. Get PDF. Get XML. How to cite this article.

NOTE: it is important to ensure the information in square brackets after the title is included in all citations of this article. Close Copy Citation Details.

Naomi M. Lisa E. Gwenan M. However, there are increasing concerns about the severe economic and wider societal consequences of these measures.

The aim of this work was to inform such exit strategies by exploring the types of indoor and outdoor settings where transmission of SARS-CoV-2 has been reported to occur and result in clusters of cases.

Methods : We performed a systematic review of available literature and media reports to find settings reported in peer reviewed articles and media with these characteristics.

These sources are curated and made available in an editable online database. Few reports came from schools, many from households, and an increasing number were reported in hospitals and elderly care settings across Europe.

However, in part due to the limits in surveillance capacities in many settings, the gathering of information such as cluster sizes and attack rates is limited in several ways: inherent recall bias, biased media reporting and missing data.

Corresponding Author s. Leclerc quentin. Knight gwen. The funders had no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript.

Revised Amendments from Version 1 This article has been updated in response to reviewer comments, and to include 49 new transmission events which have been added to our online database.

Search strategy References were found in four ways. Cluster characteristics and setting definition With the above data, we then aimed to estimate both the final proportion of people in that setting who became infected and secondary proportion of contacts of one case who became infected attack rates in each setting.

Table 1. Summary of gathered reported events as of 20th April Table 2. Definitions used for each of our transmission setting types.

The definitions describe in what environment transmission was deemed to occur. Discussion In this review of SARS-CoV-2 transmission events, we found that clusters of cases were reported in many, predominantly indoor, settings.

Settings associated with large cluster sizes One type of setting that was associated with large numbers of eventual cases was religious venues.

Implications for further work We found that many clusters of cases were linked to indoor settings, but this may be because early spread in China was during their winter, with people naturally spending more time inside close spaces.

Infect Control Hosp Epidemiol. Wellcome Open Res. N Engl J Med. Nat Med. Microbiol Spectr. Influenza Other Resp. Biotech Meeting.

Environ Int. Emerg Infect Dis. World Health Organization. Reference Source. Looking for the Open Peer Review Reports?

Comments on this article Comments 3. Version 2. Reader Comment 23 Jun Reader Comment. At the time, it was found that without blood, cell growth and virus titres were poorer.

I have recently observed locally in North Wales 2 major clusters from the 2 Sisters Poultry processing plant on Anglesey and a meat processing plant in Wrexham.

This caused me to look further into commonality of Covid outbreaks in other meat processing plants.

It resulted in me coming across your paper. I am mindful of the fact that the first outbreak was traced back to a food market in Wuhan China.

The coronavirus likely jumped to people in a wet market there where meat, seafood, and live animals were handled.

Barney Duncan Chemical Engineer ret'd. Report a concern. Reader Comment 08 Jun This is an important topic.

I am concerned about your search. I may have missed it, but I think having done this scoping exercise that you should rerun your searches Continue reading This is an important topic.

I may have missed it, but I think having done this scoping exercise that you should rerun your searches with specific terms and synonyms for the settings of interests: schools churches, weddings, meatworks lots of synonyms etc.

I am guessing that you will get a lot more hits. I don't think that 'transmission cluster' is a sufficiently sensitive term.

Discussion is closed on this version, please comment on the latest version above. Reader Comment 21 May Aprox 40, fans from the Region attended the match.

The region only went into lockdown on the 4th of March. This gave ample time 1. Further study is needed but this could be very well explain the explosion of cases that followed and is in line with your proposed explanation for super spread of the virus.

Article Versions 2 version 2 Revised. This is an open access article distributed under the terms of the Creative Commons Attribution License , which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Manager RIS Sente. Track an article to receive email alerts on any updates to this article. Approved with reservations A number of small changes, sometimes more significant revisions are required to address specific details and improve the papers academic merit.

Not approved Fundamental flaws in the paper seriously undermine the findings and conclusions. How to cite this report:.

NOTE: it is important to ensure the information in square brackets after the title is included in this citation. Samuel V.

VIEWS 0. After assembling their data set, the authors discuss the possible similarities in settings associated with transmission.

As stated, understanding how transmission risk varies across settings is critical for the safe relaxation of measures implemented to control the spread of COVID This paper provides a valuable resource and synthesis of what is currently known.

I should note that this article has already been evaluated and I believe the authors have adequately addressed the points raised by the previous reviewer.

While Google Sheets is a convenient tool for entering and sharing small data sets, it is not "permanent" and also has the potential to be corrupted or heavily modified.

There is also no easy way for authors to cite the "version" of the sheet used. The authors do provide a Figshare, but that appears to date back prior to the revised version.

I would strongly suggest regularly archiving a version of the data set and assigning each update a version number. At a minimum, please provide a DOI for the revised data set.

I am concerned that one reason we don't see more evidence for transmission at schools is that schools were closed early in nearly all locations.

To my knowledge, Sweden is not reporting data on whether there have been significant transmission in their schools as the authors know not all of which are open.

I believe the authors should provide a strong disclaimer, either in the abstract or early in the discussion that we really don't have much to go on w.

Of course this is my opinion and likely subject to debate. The authors state, "More generally, the role of children in widespread transmission of the virus is unclear, and whether reopening schools could trigger increased introductions of the virus into households and further within-household spread will have to be carefully monitored.

The authors note that they, "use peer reviewed articles as a quality threshold," and, while I strongly disagree with the exclusion of pre-prints, I think the authors should at least provide some information on how many studies or clusters were excluded.

Given the long and increasing lag between pre-print and publication, is this study missing half of all clusters that are currently published or in-review?

Providing information around what's been excluded is standard practice for such reviews and feels critical in this case. Yes Is the study design appropriate and is the work technically sound?

Partly Are sufficient details of methods and analysis provided to allow replication by others? Partly If applicable, is the statistical analysis and its interpretation appropriate?

Not applicable Are all the source data underlying the results available to ensure full reproducibility? Partly Are the conclusions drawn adequately supported by the results?

Scarpino SV. Respond or Comment. Mossong J. Approved with Reservations. This manuscript aims to provide a descriptive analysis of transmission settings of Covid19 based on published articles or media reports, which is of major interest for controlling the epidemic.

This needs to be added to the discussion as a major limitation. Some important and widely reported outbreaks in particular settings are missing.

This somehow questions the completeness of the systematic review. The authors could have widened their search terms to include the settings church, ship, etc.

Given that this manuscript from a team in the UK, it is surprising that only 4 outbreak settings were reported for the UK.

The authors need to discuss why they were not able to find more reports from the local and national media outlets in English speaking countries like UK, Ireland, and possibly also Australia, Canada and the US.

The authors should discuss reasons for under reporting: public health surveillance systems in many countries were quickly overwhelmed to investigate transmission settings and chains of transmissions.

This setting should be included separately in Table 1. Minor comments: Add the sum of cases for all clusters per setting in table 1.

While this is an interesting concept, it isn't really being addressed in this article. No country presented herein has collected more than events.

The paragraph in the discussion on this seems therefore irrelevant and could be deleted. The authors mention that there is increasing evidence for airborne transmission.

The current consensus is that most transmission occurs via airborne droplets, which is different to aerosol transmission. I suggest to replace "be airborne" by "occur via airborne droplets".

Yes If applicable, is the statistical analysis and its interpretation appropriate? Yes Are all the source data underlying the results available to ensure full reproducibility?

Yes Are the conclusions drawn adequately supported by the results? Author Response 05 Jun Author Response. Continue reading This manuscript aims to provide a descriptive analysis of transmission settings of Covid19 based on published articles or media reports, which is of major interest for controlling the epidemic.

Thank you for taking the time to review our article. Some of these new elements overlap with your suggestions.

Our Discussion section has also been updated to reflect these new results. Thank you for raising this point. For example, as for me the best and the most responsibly working service is this one - HelpWriting.

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Actions Shares. Embeds 0 No embeds. No notes for slide. Acids and Bases 1. Acids and Bases 2. What are these? Lemon CokeVinegar 3.

What is an Acid? What is an Alkali? Examples of Acids Names of acids Chemical formula Where can it be found? Acidic or not?

Chemical name Name of compound Is it Acidic? The gas forms a white precipitate with limewater. Uses of Acids Acids Preserving food -acetic acid in vinegar Making industrial products -nitric acid in fertilisers -sulphuric acid in detergents Rust removal from iron and steel -Sulphuric acid -Hydrochloric acid Car battery -Sulphuric acid Complete the Puzzle Across 1.

Down 2. Answer Across 1. Acids react with bases to give salt and water only. Only aqueous solution of acids have acidic properties.

In a strong acid, the acid molecules are completely ionised. Ethanoic acid is an example of a weak acid.

Acids have a sour taste. Answer Down 2. Sulphuric acid is an example of a strong acid which is found in car battery. Carbonates react with acids to give off a gas that forms a white precipitate with limewater.

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