The size and culturability of patient-generated SARS-CoV-2 aerosol
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Abstract
BACKGROUND: Aerosol transmission of COVID-19 is the subject of ongoing policy debate. Characterizing aerosol produced by people with COVID-19 is critical to understanding the role of aerosols in transmission. OBJECTIVE: We investigated the presence of virus in size-fractioned aerosols from six COVID-19 patients admitted into mixed acuity wards in April of 2020. METHODS: Size-fractionated aerosol samples and aerosol size distributions were collected from COVID-19 positive patients. Aerosol samples were analyzed for viral RNA, positive samples were cultured in Vero E6 cells. Serial RT-PCR of cells indicated samples where viral replication was likely occurring. Viral presence was also investigated by western blot and transmission electron microscopy (TEM). RESULTS: SARS-CoV-2 RNA was detected by rRT-PCR in all samples. Three samples confidently indicated the presence of viral replication, all of which were from collected sub-micron aerosol. Western blot indicated the presence of viral proteins in all but one of these samples, and intact virions were observed by TEM in one sample. SIGNIFICANCE: Observations of viral replication in the culture of submicron aerosol samples provides additional evidence that airborne transmission of COVID-19 is possible. These results support the use of efficient respiratory protection in both healthcare and by the public to limit transmission.
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Viral minimum physical size is da > 0.1 μm.
“particle sizes smaller than the minimum pathogen physical size (viral [da > 0.1 µm] [44,45] and bacterial [da > 1 µm] [46]) were assumed to be non-infectious”
From Comparative Mask Protection against Inhaling Wildfire Smoke, Allergenic Bioaerosols, and Infectious Particles (2022) · cites this paper as [45]
The Results and Discussion report infectious SARS-CoV-2 in submicron aerosol particles, but give no minimum virion size or 0.1 µm aerodynamic-diameter cutoff. Searches for 0.1 µm and virion diameter found no passage establishing that threshold or saying smaller particles are non-infectious. (LLM, conf=0.74)
Experimental — accuracy not yet measuredLaboratory, field, modelling, and case studies have shown that airborne transmission through inhalation of virus-laden aerosol is important, if not dominant, for COVID-19.
“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 [122]
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- Authors
- Santarpia, J. L., Herrera, V. L., Rivera, D. N., Ratnesar-Shumate, S., Reid, S. P., Ackerman, D. N., Denton, P. W., Martens, J. W. S., Fang, Y., Conoan, N., Callahan, M. V., Lawler, J. V., Brett-Major, D. M., & Lowe, J. J.
- Affiliations
- National Strategic Research Institute (US)
- University of Nebraska Medical Center (US)
- University of Nebraska at Omaha (US)
- Massachusetts General Hospital (US)
- Corresponding author
- Santarpia, Joshua L.
- ORCID
- Venue
- Journal of Exposure Science & Environmental Epidemiology
- Published
- 2021-08-18
- Volume
- 32
- Issue
- 5
- Pages
- 706-711
- ISSN
- 1559-0631 (ISSN-L)
- 1559-064X
- PMC
- PMC8372686
- OpenAlex
- W3194845932
- Cited by
- 196
- References
- 37
- Citations by year
- 2026: 8 · 2025: 20 · 2024: 22 · 2023: 40 · 2022: 43 · 2021: 43 · 2020: 19
- FWCI
- 24.03
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- Journal of Exposure Science & Environmental Epidemiology (publishedVersion, cc-by)
- medRxiv (acceptedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DigitalCommons@UNO (submittedVersion, cc-by)
- DigitalCommons@UNMC (submittedVersion, cc-by)
- Funders
- National Science Foundation (2032135)
- University of Nebraska Medical Center
- National Institute for Occupational Safety and Health
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Infection Control and Ventilation
- Health Sciences › Dentistry › General Dentistry › Dental Research and COVID-19
- Health Sciences › Medicine › Infectious Diseases › SARS-CoV-2 and COVID-19 Research
- Keywords
- SARS-CoV-2, COVID-19 pandemic, airborne transmission, aerosol size distribution, size-fractionated aerosols, viral replication, submicron aerosols, viral RNA, viral proteins, virus particles, respiratory protection, hospital wards
- MeSH terms
- COVID-19, SARS-CoV-2, Respiratory Aerosols and Droplets, Humans, RNA, Viral, Viral Proteins
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