Survival of Severe Acute Respiratory SyndromeCoronavirus 2 (SARS-CoV-2) and Influenza Virus onHuman Skin: Importance of Hand Hygiene in CoronavirusDisease 2019 (COVID-19).

Studies on the control of the novel coronavirus disease 2019 (COVID-19), caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), have progressed rapidly world- wide. Numerous studies on the stability of SARS-CoV and Middle East respiratory syndrome coronavirus (MERS-CoV) indicate that these coronaviruses have relatively higher stability compared with that of enveloped viruses, such as influenza A virus (IAV) [1–5]. Furthermore, the stability of SARS-CoV-2 on various surfaces was reported recently, providing essential information regarding the control of infection [6, 7]. Contact transmission through human skin is considered a significant risk factor in the spread of SARS-CoV-2 [8, 9]; hence, it is crit- ical to have information about the stability (survival time) of
Received 11 August 2020; editorial decision 28 September 2020; published online 3 October 2020.

Correspondence: R. Hirose, Department of Infectious Diseases, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajii-cho, Kawaramachi-Hirokoji, Kamigyo-ku, Kyoto 602–8566, Japan (ryo-hiro@koto.kpu-m.ac.jp).

Clinical Infectious Diseases® 2020;XX(XX):1–7

© The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail: journals.permissions@oup.com.
DOI: 10.1093/cid/ciaa1517

SARS-CoV-2 on human skin to develop approaches to prevent contact transmission. However, it is dangerous to apply highly pathogenic and infectious agents, including SARS-CoV-2, di- rectly to human skin. Moreover, even though skin samples can be procured from surgical procedures, the amount of tissue obtained is small, which is a deterrent in the construction of models to conduct experiments with high reproducibility [10]. Due to these limitations, the stability of highly pathogenic and infectious agents on human skin remains unknown.

To overcome the abovementioned limitations, we generated a model to evaluate the stability of pathogens on human skin obtained from forensic autopsy specimens. Human skin (partic- ularly the epidermis) is characterized by slower deterioration after death compared with other organs, and the collected skin can be used for grafting even 24 hours after death [11–13]. Therefore, this evaluation model, using skin collected from autopsy specimens (~1 day after death), could preserve skin functions and successfully model the in vivo conditions. Furthermore, at institutions per- forming forensic autopsy, fresh skin samples collected up to 1 day after death can be stably supplied for research, thus facilitating the generation of a high-quality and reproducible model [14].