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      Dose-response Relation Deduced for Coronaviruses from COVID-19, SARS and MERS Meta-analysis Results and its Application for Infection Risk Assessment of Aerosol Transmission

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          Abstract

          Background

          A comprehensive understanding of the transmission routes of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is of great importance for the effective control of the spread of Corona Virus Disease 2019 (COVID-19). However, the fundamental dose-response relation is still missing for better evaluating and controlling the infection risk.

          Methods

          We developed a simple framework to integrate the a priori dose-response relation for SARS-CoV based on mice experiments, the recent data on infection risk from a meta-analysis and the respiratory virus shedding in exhaled breath, to shed light on the dose-response relation for human. The aerosol transmission infection risk was evaluated based on the dose-response model for typical indoor environment.

          Results

          The developed dose-response relation is an exponential function with a constant k in the range of about 6.4×10 4 to 9.8×10 5 virus copies, which means that the infection risk caused by one virus copy in viral shedding is on the order of 10 -6 to 10 -5. The median infection risk via aerosol transmission with one-hour exposure (10 -6 to 10 -4) was significantly lower than the risk caused by close contact (10 -1) in a room of the area from 10 to 400 m 2 with one infected individual in it and with typical ventilation rate 1 ACH (Air Changes per Hour).

          Conclusions

          The infection risk caused by aerosol transmission was significantly lower than the risk caused by close contact. It is still necessary to be precautious for the potential aerosol transmission risk in small rooms with prolonged exposure duration.

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          Most cited references19

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          Physical distancing, face masks, and eye protection to prevent person-to-person transmission of SARS-CoV-2 and COVID-19: a systematic review and meta-analysis

          Summary Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes COVID-19 and is spread person-to-person through close contact. We aimed to investigate the effects of physical distance, face masks, and eye protection on virus transmission in health-care and non-health-care (eg, community) settings. Methods We did a systematic review and meta-analysis to investigate the optimum distance for avoiding person-to-person virus transmission and to assess the use of face masks and eye protection to prevent transmission of viruses. We obtained data for SARS-CoV-2 and the betacoronaviruses that cause severe acute respiratory syndrome, and Middle East respiratory syndrome from 21 standard WHO-specific and COVID-19-specific sources. We searched these data sources from database inception to May 3, 2020, with no restriction by language, for comparative studies and for contextual factors of acceptability, feasibility, resource use, and equity. We screened records, extracted data, and assessed risk of bias in duplicate. We did frequentist and Bayesian meta-analyses and random-effects meta-regressions. We rated the certainty of evidence according to Cochrane methods and the GRADE approach. This study is registered with PROSPERO, CRD42020177047. Findings Our search identified 172 observational studies across 16 countries and six continents, with no randomised controlled trials and 44 relevant comparative studies in health-care and non-health-care settings (n=25 697 patients). Transmission of viruses was lower with physical distancing of 1 m or more, compared with a distance of less than 1 m (n=10 736, pooled adjusted odds ratio [aOR] 0·18, 95% CI 0·09 to 0·38; risk difference [RD] −10·2%, 95% CI −11·5 to −7·5; moderate certainty); protection was increased as distance was lengthened (change in relative risk [RR] 2·02 per m; p interaction=0·041; moderate certainty). Face mask use could result in a large reduction in risk of infection (n=2647; aOR 0·15, 95% CI 0·07 to 0·34, RD −14·3%, −15·9 to −10·7; low certainty), with stronger associations with N95 or similar respirators compared with disposable surgical masks or similar (eg, reusable 12–16-layer cotton masks; p interaction=0·090; posterior probability >95%, low certainty). Eye protection also was associated with less infection (n=3713; aOR 0·22, 95% CI 0·12 to 0·39, RD −10·6%, 95% CI −12·5 to −7·7; low certainty). Unadjusted studies and subgroup and sensitivity analyses showed similar findings. Interpretation The findings of this systematic review and meta-analysis support physical distancing of 1 m or more and provide quantitative estimates for models and contact tracing to inform policy. Optimum use of face masks, respirators, and eye protection in public and health-care settings should be informed by these findings and contextual factors. Robust randomised trials are needed to better inform the evidence for these interventions, but this systematic appraisal of currently best available evidence might inform interim guidance. Funding World Health Organization.
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            It is Time to Address Airborne Transmission of COVID-19

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              Size distribution and sites of origin of droplets expelled from the human respiratory tract during expiratory activities

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                Author and article information

                Journal
                Clin Infect Dis
                Clin Infect Dis
                cid
                Clinical Infectious Diseases: An Official Publication of the Infectious Diseases Society of America
                Oxford University Press (US )
                1058-4838
                1537-6591
                29 October 2020
                : ciaa1675
                Affiliations
                [1 ] Institute of Environmental Engineering (IfU), ETH Zürich, Zürich , CH-8093, Switzerland
                [2 ] Laboratory for Advanced Analytical Technologies, Empa, Dübendorf , CH-8600, Switzerland
                Author notes
                Corresponding author: Prof. Dr. Jing Wang; e-mail address: jing.wang@ 123456ifu.baug.ethz.ch
                Author information
                http://orcid.org/0000-0003-2078-137X
                Article
                ciaa1675
                10.1093/cid/ciaa1675
                7665418
                33119733
                21bbd07a-0011-43a2-9441-7dfeaa26b881
                © The Author(s) 2020. Published by Oxford University Press for the Infectious Diseases Society of America.

                This is an Open Access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs licence ( http://creativecommons.org/licenses/by-nc-nd/4.0/), which permits non-commercial reproduction and distribution of the work, in any medium, provided the original work is not altered or transformed in any way, and that the work is properly cited. For commercial re-use, please contact journals.permissions@oup.com

                History
                : 30 July 2020
                Categories
                Major Article
                AcademicSubjects/MED00290
                Custom metadata
                PAP
                accepted-manuscript

                Infectious disease & Microbiology
                dose-response relation,covid-19,sars-cov-2,quantitative microbial risk assessment,infection risk

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