Aerosols

The role of aerosolized SARS-CoV-2 viruses in airborne transmission of COVID-19 has been debated. The aerosols are transmitted through breathing and vocalization by infectious subjects. Some authors state that this represents the dominant route of spreading, while others dismiss the option. Here we present an adjustable algorithm to estimate the infection risk for different indoor environments, constrained by published data of human aerosol emissions, SARS-CoV-2 viral loads, infective dose and other parameters. We evaluate typical indoor settings such as an office, a classroom, choir practice, and a reception/party. Our results suggest that aerosols from highly infective subjects can effectively transmit COVID-19 in indoor environments. This "highly infective" category represents approximately 20% of the patients who tested positive for SARS-CoV-2. We find that "super infective" subjects, representing the top 5-10% of subjects with a positive test, plus an unknown fraction of less-but still highly infective, high aerosol-emitting subjects-may cause COVID-19 clusters (>10 infections). In general, active room ventilation and the ubiquitous wearing of face masks (i.e., by all subjects) may reduce the individual infection risk by a factor of five to ten, similar to high-volume, high-efficiency particulate air (HEPA) filtering. A particularly effective mitigation measure is the use of high-quality masks, which can drastically reduce the indoor infection risk through aerosols.

BackgroundWhich virological factors mediate overdispersion in the transmissibility of emerging viruses remains a long-standing question in infectious disease epidemiology.MethodsHere, we use systematic review to develop a comprehensive dataset of respiratory viral loads (rVLs) of SARS-CoV-2, SARS-CoV-1 and influenza A(H1N1)pdm09. We then comparatively meta-analyze the data and model individual infectiousness by shedding viable virus via respiratory droplets and aerosols.ResultsThe analyses indicate heterogeneity in rVL as an intrinsic virological factor facilitating greater overdispersion for SARS-CoV-2 in the COVID-19 pandemic than A(H1N1)pdm09 in the 2009 influenza pandemic. For COVID-19, case heterogeneity remains broad throughout the infectious period, including for pediatric and asymptomatic infections. Hence, many COVID-19 cases inherently present minimal transmission risk, whereas highly infectious individuals shed tens to thousands of SARS-CoV-2 virions/min via droplets and aerosols while breathing, talking and singing. Coughing increases the contagiousness, especially in close contact, of symptomatic cases relative to asymptomatic ones. Infectiousness tends to be elevated between 1 and 5 days post-symptom onset.ConclusionsIntrinsic case variation in rVL facilitates overdispersion in the transmissibility of emerging respiratory viruses. Our findings present considerations for disease control in the COVID-19 pandemic as well as future outbreaks of novel viruses.FundingNatural Sciences and Engineering Research Council of Canada (NSERC) Discovery Grant program, NSERC Senior Industrial Research Chair program and the Toronto COVID-19 Action Fund.

Fine particle pollution, PM2.5, is associated with increased risk of death from cardiorespiratory diseases. A multidecadal shift in the United States (U.S.) PM2.5 composition towards organic aerosol as well as advances in predictive algorithms for secondary organic aerosol (SOA) allows for novel examinations of the role of PM2.5 components on mortality. Here we show SOA is strongly associated with county-level cardiorespiratory death rates in the U.S. independent of the total PM2.5 mass association with the largest associations located in the southeastern U.S. Compared to PM2.5, county-level variability in SOA across the U.S. is associated with 3.5× greater per capita county-level cardiorespiratory mortality. On a per mass basis, SOA is associated with a 6.5× higher rate of mortality than PM2.5, and biogenic and anthropogenic carbon sources both play a role in the overall SOA association with mortality. Our results suggest reducing the health impacts of PM2.5 requires consideration of SOA.

Nasal sprays could be used to prevent and manage respiratory tract infections (RTIs). As part of a randomized controlled trial (ISRCTN17936080), participants received one of two nasal sprays (gel-based vs. saline) and a digital intervention. The digital intervention used behaviour change theories to encourage nasal spray use to reduce the severity and occurrences of RTIs. We explored participants' experiences of the digital intervention and nasal spray. We interviewed 31 participants (aged 19-80), sampled from the two nasal spray intervention trial arms across 3 winter seasons (including at the height of COVID-19). We analysed the interviews using thematic analysis and found two themes regarding facilitators and barriers to nasal spray use. The facilitators of nasal spray use revolved around belief in nasal spray efficacy for infection, belief the nasal spray is safe, motivation to avoid infection, sense of control over infection, and how the nasal spray is integrated into lifestyle. Barriers to nasal spray use included the belief the nasal spray is ineffective, belief the nasal spray is unnecessary, and usage difficulties. Overall, the results highlight the role of beliefs, lifestyle integration, and usage difficulties in nasal spray adherence, with implications for future digital interventions, such as addressing concerns about the nasal spray being perceived as medication.