Dismantling myths on the airborne transmission of severe acute respiratory syndrome coronavirus (SARS-CoV-2)

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Abstract

The Covid-19 pandemic has caused untold disruption and enhanced mortality rates around the world. Understanding the mechanisms for transmission of SARS-CoV-2 is key to preventing further spread but there is confusion over the meaning of “airborne” whenever transmission is discussed. Scientific ambivalence originates from evidence published many years ago, which has generated mythological beliefs that obscure current thinking. This article gathers together and explores some of the most commonly held dogmas on airborne transmission in order to stimulate revision of the science in the light of current evidence. Six ‘myths’ are presented, explained, and ultimately refuted on the basis of recently published papers and expert opinion from previous work related to similar viruses. There is little doubt that SARS-CoV-2 is transmitted via a range of airborne particle sizes subject to all the usual ventilation parameters and human behaviour. Experts from specialties encompassing aerosol studies, ventilation, engineering, physics, virology and clinical medicine have joined together to present this review, in order to consolidate the evidence for airborne transmission mechanisms and offer justification for modern strategies for prevention and control of Covid-19 in healthcare and community.

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Most cited references 67

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Respiratory virus shedding in exhaled breath and efficacy of face masks

Nancy Leung, Daniel Chu, Eunice Shiu … (2020)

We identified seasonal human coronaviruses, influenza viruses and rhinoviruses in exhaled breath and coughs of children and adults with acute respiratory illness. Surgical face masks significantly reduced detection of influenza virus RNA in respiratory droplets and coronavirus RNA in aerosols, with a trend toward reduced detection of coronavirus RNA in respiratory droplets. Our results indicate that surgical face masks could prevent transmission of human coronaviruses and influenza viruses from symptomatic individuals.

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Airborne transmission of SARS-CoV-2: the world should face the reality

Lidia Morawska, Junji Cao (2020)

Hand washing and maintaining social distance are the main measures recommended by the World Health Organization (WHO) to avoid contracting COVID-19. Unfortunately, these measured do not prevent infection by inhalation of small droplets exhaled by an infected person that can travel distance of meters or tens of meters in the air and carry their viral content. Science explains the mechanisms of such transport and there is evidence that this is a significant route of infection in indoor environments. Despite this, no countries or authorities consider airborne spread of COVID-19 in their regulations to prevent infections transmission indoors. It is therefore extremely important, that the national authorities acknowledge the reality that the virus spreads through air, and recommend that adequate control measures be implemented to prevent further spread of the SARS-CoV-2 virus, in particularly removal of the virus-laden droplets from indoor air by ventilation.

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Turbulent Gas Clouds and Respiratory Pathogen Emissions: Potential Implications for Reducing Transmission of COVID-19

Lydia Bourouiba (2020)

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Author and article information

Journal

Journal ID (nlm-ta): J Hosp Infect

Journal ID (iso-abbrev): J Hosp Infect

Title: The Journal of Hospital Infection

Publisher: The Healthcare Infection Society. Published by Elsevier Ltd.

ISSN (Print): 0195-6701

ISSN (Electronic): 1532-2939

Publication date PMC-release: 13 January 2021

Publication date (Electronic): 13 January 2021

Affiliations

[1 ]Respiratory Sciences, University of Leicester, Leicester, UK

[2 ]Department of Architectural Engineering, The Pennsylvania State University, US

[3 ]Faculty of Architecture and the Built Environment, Delft University of Technology, The Netherlands

[4 ]Department of Civil and Mechanical Engineering, University of Cassino and Southern Lazio, Cassino, Italy

[5 ]Department of Chemistry and CIRES; Univ. of Colorado-Boulder

[6 ]REHVA Technology and Research Committee, Tallinn University of Technology, Estonia

[7 ]Dept. of Mechanical Engineering, University of Hong Kong, Hong Kong, China

[8 ]Mechanical Engineering, University of Colorado. Boulder, US

[9 ]Department of Building, National University of Singapore, Singapore

[10 ]International Laboratory for Air Quality and Health, Queensland University of Technology, Australia

[11 ]Civil and Environmental Engineering, Virginia Tech, US

[12 ]International Centre for Indoor Environment and Energy, Dept. of Civil Engineering, Technical University of Denmark, Denmark

[13 ]Department of Civil and Environmental Engineering, University of California, Berkeley, California, US

[14 ]Faculty of Engineering and Science, Department of Civil Engineering, Aalborg University, Denmark

[15 ]Department of Medicine, McGill University, Canada

[16 ]International Centre for Indoor Environment and Energy, Dept. of Civil Engineering, Technical University of Denmark, Denmark

[17 ]Department of Microbiology, NHS Lanarkshire, and Edinburgh Napier University, UK

Author notes

[∗ ]Corresponding author. Professor Stephanie Dancer, Dept. of Microbiology, Hairmyres Hospital, East Kilbride, Glasgow G75 8RG, Scotland. Tel.: +1355 585000x4792

Article

Publisher Item ID: S0195-6701(21)00007-4

DOI: 10.1016/j.jhin.2020.12.022

PMC ID: 7805396

PubMed ID: 33453351

SO-VID: a5996beb-115e-4c97-85ed-f1dd5b627a5c

License:

Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

History

Date received : 10 November 2020

Date revision received : 21 December 2020

Date accepted : 23 December 2020

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Dismantling myths on the airborne transmission of severe acute respiratory syndrome coronavirus (SARS-CoV-2)

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Abstract

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Novel Coronavirus Disease COVID-19

Most cited references 67

Respiratory virus shedding in exhaled breath and efficacy of face masks

Airborne transmission of SARS-CoV-2: the world should face the reality

Turbulent Gas Clouds and Respiratory Pathogen Emissions: Potential Implications for Reducing Transmission of COVID-19

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Cited by 136

Most referenced authors 3,749