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Quantitative assessment of the risk of airborne transmission of SARS-CoV-2 infection: Prospective and retrospective applications
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Abstract
Airborne transmission is a recognized pathway of contagion; however, it is rarely quantitatively evaluated. The numerous outbreaks that have occurred during the SARS-CoV-2 pandemic are putting a demand on researchers to develop approaches capable of both predicting contagion in closed environments (predictive assessment) and analyzing previous infections (retrospective assessment). This study presents a novel approach for quantitative assessment of the individual infection risk of susceptible subjects exposed in indoor microenvironments in the presence of an asymptomatic infected SARS-CoV-2 subject. The application of a Monte Carlo method allowed the risk for an exposed healthy subject to be evaluated or, starting from an acceptable risk, the maximum exposure time. We applied the proposed approach to four distinct scenarios for a prospective assessment, highlighting that, in order to guarantee an acceptable risk of 10−3 for exposed subjects in naturally ventilated indoor environments, the exposure time could be well below one hour. Such maximum exposure time clearly depends on the viral load emission of the infected subject and on the exposure conditions; thus, longer exposure times were estimated for mechanically ventilated indoor environments and lower viral load emissions. The proposed approach was used for retrospective assessment of documented outbreaks in a restaurant in Guangzhou (China) and at a choir rehearsal in Mount Vernon (USA), showing that, in both cases, the high attack rate values can be justified only assuming the airborne transmission as the main route of contagion. Moreover, we show that such outbreaks are not caused by the rare presence of a superspreader, but can be likely explained by the co-existence of conditions, including emission and exposure parameters, leading to a highly probable event, which can be defined as a “superspreading event”.
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“Laboratory, field, modelling, and case studies have shown that airborne transmission through the inhalation of a virus-laden aerosol is important, if not dominant, for COVID-19.119, 120, 121, 122, 123, 124, 125, 126, 127, 128, 129, 130, 131, 132”
From The Lancet Commission on lessons for the future from the COVID-19 pandemic (2022) · cites this paper as [126]
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Arpino, F., Grossi, G., Cortellessa, G., Mikszewski, A., Morawska, L., Buonanno, G., & Stabile, L. (2022) · Indoor Air · doi:10.1111/ina.13012 · Cited by 39
Self-citationAirborne spread of infectious SARS-CoV-2: Moving forward using lessons from SARS-CoV and MERS-CoV
da Silva, P. G., Nascimento, M. S. J., Soares, R. R. G., Sousa, S. I. V., & Mesquita, J. R. (2020) · The Science of The Total Environment · doi:10.1016/j.scitotenv.2020.142802 · Cited by 40
“Although not investigating SARS-CoV-2 viability, some studies suggested that airborne transmission might occur (Buonanno et al., 2020; Cai et al., 2020; Hamner et al., 2020; Li et al., 2020a, 2020b).”
Kühn, M. J., Abele, D., Mitra, T., Koslow, W., Abedi, M., Rack, K., Siggel, M., Khailaie, S., Klitz, M., Binder, S. C., et al. (2021) · Mathematical Biosciences · doi:10.1016/j.mbs.2021.108648 · Cited by 50
Inflight transmission of COVID-19 based on experimental aerosol dispersion data
Wang, Z., Galea, E. R., Grandison, A., Ewer, J., & Jia, F. (2021) · Journal of Travel Medicine · doi:10.1093/jtm/taab023 · Cited by 39
“These values are also consistent with quanta rate distributions (for breathing, speaking∗, and speaking loudly∗ index cases) (∗adjusted for resting conditions, see Supplementary Table S2) proposed by Buonanno et al.(18) (see Supplementary Material Section S1.”
BackgroundUhde, E., Salthammer, T., Wientzek, S., Springorum, A., & Schulz, J. (2022) · Indoor Air · doi:10.1111/ina.13087 · Cited by 38
Kim, S., Kim, S., Park, H.-J., Park, S., Kim, J. Y., Jeong, Y. W., Yang, H. H., Choi, Y.-S., Yeom, M., Song, D., et al. (2021) · Environmental Research · doi:10.1016/j.envres.2021.112036 · Cited by 38
Link between SARS-CoV-2 emissions and airborne concentrations: Closing the gap in understanding
Buonanno, G., Robotto, A., Brizio, E., Morawska, L., Civra, A., Corino, F., Lembo, D., Ficco, G., & Stabile, L. (2022) · Journal of Hazardous Materials · doi:10.1016/j.jhazmat.2022.128279 · Cited by 37
Self-citationAvoiding COVID-19: Aerosol GuidelinesPreprint
Evans, M. (2020) · medRxiv · doi:10.1101/2020.05.21.20108894 · Cited by 41
“The truth is more nuanced, and includes the possibility of a dominant short-range aerosol path limited by pathogen dilution, deposition, and decay [18, 19, 20].”
Koley, S. (2024) · Trends in Sciences · doi:10.48048/tis.2024.8287 · Cited by 38
“Since the initial reports of a novel infectious disease outbreak in the Chinese province of Hubei, public health experts have investigated the transmission of this new virus [43].”
BackgroundOutdoor Airborne Transmission of Coronavirus Among Apartments in High-Density Cities
Huang, J., Jones, P., Zhang, A., Hou, S. S., Hang, J., & Spengler, J. D. (2021) · Frontiers in Built Environment · doi:10.3389/fbuil.2021.666923 · Cited by 36
“9 to 31 for speaking (Buonanno et al., 2020a), 460 (Prentiss et al.”
BackgroundThe nexus between in-car aerosol concentrations, ventilation and the risk of respiratory infection
Kumar, P., Omidvarborna, H., Tiwari, A., & Morawska, L. (2021) · Environment International · doi:10.1016/j.envint.2021.106814 · Cited by 39
Self-citationRisbeck, M. J., Bazant, M. Z., Jiang, Z., Lee, Y. M., Drees, K. H., & Douglas, J. D. (2021) · Energy and Buildings · doi:10.1016/j.enbuild.2021.111497 · Cited by 39
“For airborne diseases, the primary transmission route is via viruses or bacteria that are entrained in aerosolized particles released into the air by exhalation of an actively infectious individual [3,4].”
Assessment of SARS-CoV-2 airborne infection transmission risk in public buses
Bertone, M., Mikszewski, A., Stabile, L., Riccio, G., Cortellessa, G., Ambrosio, F. D., Papa, V., Morawska, L., & Buonanno, G. (2022) · Geoscience Frontiers · doi:10.1016/j.gsf.2022.101398 · Cited by 41
Self-citationZhang, X., & Wang, J. (2022) · Journal of Safety Science and Resilience · doi:10.1016/j.jnlssr.2022.09.001 · Cited by 37
Prentiss, M. G., Chu, A., & Berggren, K. K. (2020) · medRxiv · doi:10.1101/2020.10.21.20216895 · Cited by 36
Faulkner, C. A., Lutes, R. G., Huang, S., Zuo, W., & Vrabie, D. (2023) · Building and Environment · doi:10.1016/j.buildenv.2023.110371 · Cited by 34
Nozza, E., Valentini, S., Melzi, G., Vecchi, R., & Corsini, E. (2021) · The Science of The Total Environment · doi:10.1016/j.scitotenv.2021.146391 · Cited by 34
Predicted Infection Risk for Aerosol Transmission of SARS-CoV-2Preprint
Kriegel, M., Buchholz, U., Gastmeier, P., Bischoff, P., Abdelgawad, I., & Hartmann, A. (2020) · medRxiv · doi:10.1101/2020.10.08.20209106 · Cited by 34
Lau, Z., Griffiths, I. M., English, A., & Kaouri, K. (2022) · Proceedings of the Royal Society A Mathematical Physical and Engineering Sciences · doi:10.1098/rspa.2021.0383 · Cited by 36
“On the other hand, our values are in the 95th–99th percentile of the values obtained in [62].”
BackgroundMethodFantozzi, F., Lamberti, G., Leccese, F., & Salvadori, G. (2022) · Architectural Science Review · doi:10.1080/00038628.2022.2080637 · Cited by 30
Buonomano, A., Forzano, C., Giuzio, G. F., & Palombo, A. (2023) · Renewable and Sustainable Energy Reviews · doi:10.1016/j.rser.2023.113378 · Cited by 31
“The accurate description of this number is out of the scope of this study, nonetheless, it is necessary to specify that it is function of the infection probability (P – evaluated as in equation (2)) and of the number of exposed susceptible people [24].”
Chen, L., Ban, G., Long, E., Kalonji, G., Zhu, C., Zhang, L., & Guo, S. (2021) · Environmental Science and Pollution Research · doi:10.1007/s11356-021-13617-y · Cited by 29
“The floating virus in the air can spread over a long distance and may have a chance to be inhaled by healthy people under particular indoor, crowded, and inadequately ventilated spaces (Buonanno et al. 2020a; Correia et al. 2020).”
BackgroundMethodInfluentialManaging the risk of a COVID-19 outbreak from border arrivals
Steyn, N., Plank, M. J., James, A., Binny, R. N., Hendy, S. C., & Lustig, A. G. (2021) · Journal of The Royal Society Interface · doi:10.1098/rsif.2021.0063 · Cited by 28
Assessment of the risks of viral transmission in non-confined crowdsPreprint
Garcia, W., Mendez, S., Fray, B., & Nicolas, A. (2020) · arXiv (Cornell University) · doi:10.1016/j.ssci.2021.105453 · Cited by 3
“This variety better reflects our current uncertainty with regard to the transmission of SARS-CoV-2, but also the established inter-individual and inter-case variability [16, 18], depending on physiology, talking characteristics [53], viral mutations, etc.”
BackgroundXu, S., Zhang, G., Liu, X., & Li, X. (2023) · Energy and Buildings · doi:10.1016/j.enbuild.2023.113033 · Cited by 30
Barbosa, B. P. P., & Brum, N. D. C. L. (2021) · Journal of the Brazilian Society of Mechanical Sciences and Engineering · doi:10.1007/s40430-021-03029-x · Cited by 27
“[42, 43] was used in this study in a coupled multizone-CFD analysis to estimate the long-range airborne infection risk of a cohabitant in a model of a small office configuration with two occupants.”
BackgroundMethodInfluentialFrattolillo, A., Stabile, L., & Dell’Isola, M. (2021) · Journal of Building Engineering · doi:10.1016/j.jobe.2021.102478 · Cited by 26
Self-citationEpidemic disease and the state: Is there a tradeoff between public health and liberty?
Koyama, M. (2021) · Public Choice · doi:10.1007/s11127-021-00944-4 · Cited by 27
Faulkner, C. A., Castellini, J. E., Lou, Y., Zuo, W., Lorenzetti, D. M., & Sohn, M. D. (2022) · Building and Environment · doi:10.1016/j.buildenv.2022.109282 · Cited by 28
“We select a typical virus generation rate of 25 quanta/hr [27,28] and a viral decay rate of 0.”
MethodThornton, G. M., Fleck, B. A., Kroeker, E., Dandnayak, D., Fleck, N., Zhong, L., & Hartling, L. (2022) · PLOS Global Public Health · doi:10.1371/journal.pgph.0000552 · Cited by 25
Metadata
- Authors
- Buonanno, G., Morawska, L., & Stabile, L.
- Affiliations
- Queensland University of Technology (AU)
- Università degli studi di Cassino e del Lazio Meridionale (IT)
- Corresponding author
- Stabile, L.
- Venue
- Environment International
- Publisher
- Elsevier BV
- Published
- 2020-12
- Volume
- 145
- Pages
- 106112
- ISSN
- 0160-4120 (ISSN-L)
- PMC
- PMC7474922
- OpenAlex
- W3083235507
- Cited by
- 449
- References
- 46
- Citations by year
- 2026: 20 · 2025: 48 · 2024: 55 · 2023: 78 · 2022: 96 · 2021: 117 · 2020: 35
- FWCI
- 45.83
- Type
- journal article
- Language
- en
- Open access
- gold
- doi.org
- Licence
- Locations
- Environment International (publishedVersion, cc-by)
- medRxiv (acceptedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- QUT ePrints (Queensland University of Technology) (submittedVersion, cc-by)
- DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion, cc-by-sa)
- Archivio Istituzionale della Ricerca - Università degli Studi di Cassino (submittedVersion)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Infection Control and Ventilation
- Physical Sciences › Mathematics › Modeling and Simulation › COVID-19 epidemiological studies
- Physical Sciences › Environmental Science › Global and Planetary Change › COVID-19 impact on air quality
- Keywords
- SARS-CoV-2, airborne transmission, infection risk assessment, indoor microenvironments, asymptomatic infection, exposure time, superspreading events, superspreaders, outbreak investigation, Monte Carlo simulation, attack rate
- MeSH terms
- Betacoronavirus, COVID-19, SARS-CoV-2, Aerosols, China, Humans, Pneumonia, Viral, Prospective Studies, Retrospective Studies, Air Pollution, Indoor, Coronavirus, Coronavirus Infections, Risk Assessment, Pandemics
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