Objective In the current absence of vaccine for COVID-19, public health response target breaking the chain of infection by focusing on the mode of transmission. This paper summarizes current evidence-base around the transmission dynamics, pathogenic, and clinical features of COVID-19, to critically identify if there are any gaps in the current IPC guidelines.
Methods This study involved a review of global COVID-19 IPC guidelines such as WHO, the CDC, and European Centre for Disease Prevention and Control (ECDC). Guidelines from two high income countries (Australia and UK) and one middle income country (China) were also reviewed. We searched publications in English on ‘Pubmed’ and Google Scholars. We extracted information related to COVID-19 transmission dynamics, clinical presentations and exposures that may facilitate the transmission and compared and contrasted these findings with the recommended IPC measures.
Results The review findings showed nosocomial transmission of SARS-CoV-2 in health settings through droplet, aerosol and by an oral-fecal or fecal-droplet route. However, the IPC guidelines fail to cover all transmission modes and the recommendations also conflict with each other. Most guidelines recommend surgical masks for healthcare providers during routine care and N95 respirators for aerosol generating procedures. However, recommendations around type of surgical masks varied. In addition, CDC recommends cloth masks when the surgical mask is totally unavailable.
Conclusion IPC strategies should consider all the possible routes of transmission and target all patient care activities where there may be person to person transmission risk. This review may assist international health agencies to update their guidelines.