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Mechanistic transmission modeling of COVID-19 on the Diamond Princess cruise ship demonstrates the importance of aerosol transmission
Open accessPublished version of a preprint
Abstract
Significance: We find that airborne transmission likely accounted for >50% of disease transmission on the Diamond Princess cruise ship, which includes inhalation of aerosols during close contact as well as longer range. These findings underscore the importance of implementing public health measures that target the control of inhalation of aerosols in addition to ongoing measures targeting control of large-droplet and fomite transmission, not only aboard cruise ships but in other indoor environments as well. Guidance from health organizations should include a greater emphasis on controls for reducing spread by airborne transmission. Last, although our work is based on a cruise ship outbreak of COVID-19, the model approach can be applied to other indoor environments and other infectious diseases.
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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 [127]
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“showing that building-level strategies are key to reducing the spread of airborne infectious diseases.40, 127, 401, 402, 403”
From The Lancet Commission on lessons for the future from the COVID-19 pandemic (2022) · cites this paper as [127]
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Metadata
- Authors
- Azimi, P., Keshavarz, Z., Cedeno Laurent, J. G., Stephens, B., & Allen, J. G.
- Affiliations
- Harvard University (US)
- Environmental Health Department, Harvard T.H. Chan School of Public Health, Boston, MA 02115;
- Illinois Institute of Technology (US)
- Corresponding author
- Azimi, Parham
- Allen, Joseph G.
- Venue
- Proceedings of the National Academy of Sciences
- Publisher
- National Academy of Sciences
- Published
- 2021-02-03
- Volume
- 118
- Issue
- 8
- ISSN
- 0027-8424 (ISSN-L)
- 1091-6490
- PMC
- PMC7923347
- OpenAlex
- W3126546596
- Cited by
- 245
- References
- 46
- Citations by year
- 2026: 12 · 2025: 31 · 2024: 32 · 2023: 38 · 2022: 72 · 2021: 52
- FWCI
- 31.49
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Proceedings of the National Academy of Sciences (publishedVersion, cc-by)
- medRxiv (acceptedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- 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
- COVID-19 pandemic, airborne transmission, respiratory droplets, fomite transmission, long-range transmission, cruise ships, transmission modelling, ventilation, air recirculation
- MeSH terms
- COVID-19, SARS-CoV-2, Aerosols, Disease Outbreaks, Humans, Models, Theoretical, Quarantine, Ships
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