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The Crucial Role of ACE2 Transcription in the Hospital Transmission of SARS-CoV-2: A Detailed Investigation

Our recent investigation has delved into the human-to-human transmission dynamics of SARS-CoV-2, particularly the role of the angiotensin-converting enzyme 2 (ACE2). We have specifically explored the relation between nasopharyngeal ACE2 transcription and secondary transmission in a series of concurrent hospital-associated SARS-CoV-2 outbreaks in British Columbia, Canada. By merging epidemiological case data from outbreak investigations with public health laboratory records, we reconstructed the transmission network making use of whole genome sequencing.

We found potential transmission events in a majority of the cases examined. Interestingly, high ACE2 transcription was found in about 98.6% of transmission events, indicating a possible connection between ACE2 levels and transmission probability. Our multivariable analysis showed that the relationship between ACE2 transcription and secondary transmission varied among patients and healthcare workers.

In healthcare workers, an increase in ACE2 transcription was associated with a decrease in the number of secondary cases. But in patients, the opposite was observed; an increase in ACE2 transcription resulted in a higher number of secondary cases. This divergence warrants further investigation of ACE2 as a risk-factor for SARS-CoV-2 transmission in hospital environments.

Historically, human-to-human transmission of pathogenic coronaviruses such as SARS and MERS has been linked primarily to healthcare settings. They could often be controlled by public health interventions. The case with SARS-CoV-2, however, is notably different. This virus has been able to spread widely within communities, and its evolution over time has resulted in becoming more infectious, and vaccines have had limited effect on its prevention or transmission.

ACE2 is notably involved in SARS-CoV-2 transmission due to its high expression in the upper and lower respiratory tract. SARS-CoV-2 attaches to the ACE2 receptor, facilitating viral entry into host cells. As our study suggests, the level of ACE2 can impact SARS-CoV-2 transmission in a significant way, reinforcing the role of this cellular receptor in the ongoing global pandemic.

Research conducted on landscape scales shows that ACE2 transcription has a positive association with SARS-CoV-2 secondary transmission in inpatients, but not health care workers. This disparity reinforces the importance of preventative measures such as mask usage and enhanced infection control in limiting nosocomial spread of the virus.


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