How did we get here: what are droplets and aerosols and how far do they go? A historical perspective on the transmission of respiratory infectious diseases
Open accessAbstract
The COVID-19 pandemic has exposed major gaps in our understanding of the transmission of viruses through the air. These gaps slowed recognition of airborne transmission of the disease, contributed to muddled public health policies and impeded clear messaging on how best to slow transmission of COVID-19. In particular, current recommendations have been based on four tenets: (i) respiratory disease transmission routes can be viewed mostly in a binary manner of ‘droplets’ versus ‘aerosols’; (ii) this dichotomy depends on droplet size alone; (iii) the cut-off size between these routes of transmission is 5 µm; and (iv) there is a dichotomy in the distance at which transmission by each route is relevant. Yet, a relationship between these assertions is not supported by current scientific knowledge. Here, we revisit the historical foundation of these notions, and how they became entangled from the 1800s to today, with a complex interplay among various fields of science and medicine. This journey into the past highlights potential solutions for better collaboration and integration of scientific results into practice for building a more resilient society with more sound, far-sighted and effective public health policies.
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The greater frequency of close-contact transmission, combined with scientists' desire to refute miasma theory, led to promotion of infection-control recommendations centred on hygiene and sanitation.
“Nonetheless, the greater frequency of transmission by close contact, combined with a desire of scientists to refute miasma theory—the prevailing theory of the transmission of respiratory infectious disease from the mid-to-late 19th century, in which vague explanations for the causes of disease, such as so-called bad air, were perpetuated with little to no causative basis136—led to the desire to”
From The Lancet Commission on lessons for the future from the COVID-19 pandemic (2022) · cites this paper as [136]
Such recommendations helped perpetuate the erroneous idea that spray transmission was the dominant mode of spread for respiratory infectious diseases, including COVID-19.
“Such recommendations contributed to the perpetuation of the erroneous idea that spray transmission was the dominant mode of spread of respiratory infectious diseases, including COVID-19.136”
From The Lancet Commission on lessons for the future from the COVID-19 pandemic (2022) · cites this paper as [136]
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References 53 · Cited by 12
Research works printed but not linked: 3
- Albuquerque Morning Journal. 1918 Steps are taken by Blue to head off epidemic of influenza. Albuquerque Morn. J. 14 September.
- The Citizen. 1918 Uncle Sam's advice on flu: US Public Health Service issues official health bulletin on influenza. The Citizen. 10 October.
- Hatch, Gross. 1964. 100. Hatch. 1942. 101. Hinds. 1982. 102. Jennison. 1941. 103. Karanfil et al. 1999. 104. Knight. 1973. 105. Knight. 1980. 106. Mlinaric-Galinovic, Vardo-Brkic. 2000. 107. Murray. 1986. 108. Owen, Ensor, Sparks. 1992. 109. Phalen et al. 1986. 110. Seto et al. 2003. 111. Wenzel. 2003. 112. WHO. 2002. 113. Wong et al. 2004. 114. Yu. 2007. royalsocietypublishing.org/journal/rsfs Interface Focus 11: 20210049
- Authors
- Randall, K., Ewing, E. T., Marr, L. C., Jimenez, J. L., & Bourouiba, L.
- Affiliations
- Virginia Tech (US)
- Blacksburg, VA, USA 1
- Boulder, CO, USA 2
- Massachusetts Institute of Technology (US)
- Corresponding author
- Bourouiba, L.
- Venue
- Interface Focus
- Publisher
- The Royal Society
- Published
- 2021-10-12
- Volume
- 11
- Issue
- 6
- Pages
- 20210049-20210049
- ISSN
- 2042-8898 (ISSN-L)
- 2042-8901
- PMC
- PMC8504878
- OpenAlex
- W3159329543
- Cited by
- 12
- References
- 53
- Citations by year
- 2023: 4 · 2022: 4 · 2021: 4
- FWCI
- 1.95
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- Interface Focus (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- DSpace@MIT (Massachusetts Institute of Technology) (submittedVersion, cc-by-nc)
- SSRN Electronic Journal (submittedVersion)
- VTechWorks (Virginia Tech) (submittedVersion, cc-by)
- Funders
- National Science Foundation (2025151, 1542100)
- Burroughs Wellcome Fund
- Richard and Susan Smith Family Foundation
- Wellcome Trust
- Centers for Disease Control and Prevention
- National Institute of Allergy and Infectious Diseases (HHSN272201400007C)
- Division of Electrical, Communications and Cyber Systems (1542100, ECCS 2025151, 2025151, ECCS 1542100)
- Topics
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Infection Control and Ventilation
- Health Sciences › Dentistry › General Dentistry › Dental Research and COVID-19
- Physical Sciences › Mathematics › Modeling and Simulation › COVID-19 epidemiological studies
- Keywords
- airborne transmission, respiratory infections, droplets, aerosols, droplet size, transmission distance, COVID-19 pandemic, history of medicine, public health policy, research-practice gap, respiratory virus transmission
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