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How can airborne transmission of COVID-19 indoors be minimised?
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During the rapid rise in COVID-19 illnesses and deaths globally, and notwithstanding recommended precautions, questions are voiced about routes of transmission for this pandemic disease. Inhaling small airborne droplets is probable as a third route of infection, in addition to more widely recognized transmission via larger respiratory droplets and direct contact with infected people or contaminated surfaces. While uncertainties remain regarding the relative contributions of the different transmission pathways, we argue that existing evidence is sufficiently strong to warrant engineering controls targeting airborne transmission as part of an overall strategy to limit infection risk indoors. Appropriate building engineering controls include sufficient and effective ventilation, possibly enhanced by particle filtration and air disinfection, avoiding air recirculation and avoiding overcrowding. Often, such measures can be easily implemented and without much cost, but if only they are recognised as significant in contributing to infection control goals. We believe that the use of engineering controls in public buildings, including hospitals, shops, offices, schools, kindergartens, libraries, restaurants, cruise ships, elevators, conference rooms or public transport, in parallel with effective application of other controls (including isolation and quarantine, social distancing and hand hygiene), would be an additional important measure globally to reduce the likelihood of transmission and thereby protect healthcare workers, patients and the general public.
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Self-citation
Metadata
- Authors
- Morawska, L., Tang, J. W., Bahnfleth, W., Bluyssen, P. M., Boerstra, A., Buonanno, G., Cao, J., Dancer, S., Floto, A., Franchimon, F., Haworth, C., Hogeling, J., Isaxon, C., Jimenez, J. L., Kurnitski, J., Li, Y., Loomans, M., Marks, G., Marr, L. C., Mazzarella, L., Melikov, A. K., Miller, S., Milton, D. K., Nazaroff, W., Nielsen, P. V., Noakes, C., Peccia, J., Querol, X., Sekhar, C., Seppänen, O., Tanabe, S.-I., Tellier, R., Tham, K. W., Wargocki, P., Wierzbicka, A., & Yao, M.
- Affiliations
- University of Leicester (GB)
- Pennsylvania State University (US)
- Delft University of Technology (NL)
- Università degli studi di Cassino e del Lazio Meridionale (IT)
- Chinese Academy of Sciences (CN)
- Edinburgh Napier University (GB)
- University of Cambridge (GB)
- Lund University (SE)
- Cooperative Institute for Research in Environmental Sciences (US)
- Tallinn University of Technology (EE)
- University of Hong Kong (HK)
- Eindhoven University of Technology (NL)
- UNSW Sydney (AU)
- Virginia Tech (US)
- Politecnico di Milano (IT)
- Technical University of Denmark (DK)
- University of Colorado Boulder (US)
- Aalborg University (DK)
- University of Leeds (GB)
- Yale University (US)
- Consejo Superior de Investigaciones Científicas (ES)
- National University of Singapore (SG)
- Aalto University (FI)
- McGill University (CA)
- Peking University (CN)
- ORCID
- Tang, Julian W.
- Bahnfleth, William
- Bluyssen, Philomena M.
- Boerstra, Atze
- Buonanno, Giorgio
- Cao, Junji
- Dancer, Stephanie
- Floto, Andres
- Haworth, Charles
- Hogeling, Jaap
- Isaxon, Christina
- Jimenez, Jose L.
- Kurnitski, Jarek
- Li, Yuguo
- Loomans, Marcel
- Marks, Guy
- Marr, Linsey C.
- Mazzarella, Livio
- Melikov, Arsen Krikor
- Miller, Shelly
- Milton, Donald K.
- Nazaroff, William
- Nielsen, Peter V.
- Noakes, Catherine
- Peccia, Jordan
- Querol, Xavier
- Sekhar, Chandra
- Seppänen, Olli
- Tanabe, Shin-ichi
- Tellier, Raymond
- Tham, Kwok Wai
- Wargocki, Pawel
- Wierzbicka, Aneta
- Yao, Maosheng
- Venue
- Environment International
- Publisher
- Elsevier BV
- Published
- 2020-09
- Volume
- 142
- Pages
- 105832
- ISSN
- 0160-4120 (ISSN-L)
- PMC
- PMC7250761
- OpenAlex
- W3032857945
- Cited by
- 1,343
- References
- 66
- Citations by year
- 2026: 75 · 2025: 103 · 2024: 138 · 2023: 172 · 2022: 322 · 2021: 411 · 2020: 121
- FWCI
- 144.24
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Environment International (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- TU/e Research Portal (publishedVersion, other-oa)
- White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
- QUT ePrints (Queensland University of Technology) (submittedVersion, cc-by-nc-nd)
- NOAA Institutional Repository (submittedVersion, cc-by-nc-nd)
- VBN Forskningsportal (Aalborg Universitet) (submittedVersion, cc-by-nc-nd)
- Virtual Community of Pathological Anatomy (University of Castilla La Mancha) (submittedVersion, other-oa)
- Edinburgh Napier Research Repository (Edinburgh Napier University) (submittedVersion, cc-by-nc-nd)
- Data Archiving and Networked Services (DANS) (submittedVersion, cc-by-nc-nd)
- CU Scholar (University of Colorado Boulder) (submittedVersion)
- National University of Singapore (submittedVersion, cc-by-nc-nd)
- Aaltodoc (Aalto University) (submittedVersion, other-oa)
- DIGITAL.CSIC (Spanish National Research Council (CSIC)) (submittedVersion)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- eScholarship@McGill (McGill) (submittedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Archivio Istituzionale della Ricerca - Università degli Studi di Cassino (submittedVersion)
- Lund University Publications (Lund University) (submittedVersion)
- Research Output (Edinburgh Napier University) (submittedVersion, cc-by-nc-nd)
- Technical University of Denmark, DTU Orbit (Technical University of Denmark, DTU) (submittedVersion, other-oa)
- Research Repository (Delft University of Technology) (submittedVersion)
- TU/e Research Portal (submittedVersion, other-oa)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Infection Control and Ventilation
- Physical Sciences › Environmental Science › Global and Planetary Change › COVID-19 impact on air quality
- Physical Sciences › Environmental Science › Health, Toxicology and Mutagenesis › Indoor Air Quality and Microbial Exposure
- Keywords
- COVID-19 pandemic, airborne transmission, indoor air quality, ventilation, particle filtration, air disinfection, air recirculation, overcrowding, engineering controls, infection control, public buildings, healthcare workers
- MeSH terms
- Betacoronavirus, COVID-19, SARS-CoV-2, Aerosols, Air Microbiology, Crowding, Disinfection, Filtration, Humans, Pneumonia, Viral, Ventilation, Coronavirus Infections, Inhalation Exposure, Pandemics
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