Transmission of SARS-CoV-2 by inhalation of respiratory aerosol in the Skagit Valley Chorale superspreading event
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Abstract
During the 2020 COVID-19 pandemic, an outbreak occurred following attendance of a symptomatic index case at a weekly rehearsal on 10 March of the Skagit Valley Chorale (SVC). After that rehearsal, 53 members of the SVC among 61 in attendance were confirmed or strongly suspected to have contracted COVID-19 and two died. Transmission by the aerosol route is likely; it appears unlikely that either fomite or ballistic droplet transmission could explain a substantial fraction of the cases. It is vital to identify features of cases such as this to better understand the factors that promote superspreading events. Based on a conditional assumption that transmission during this outbreak was dominated by inhalation of respiratory aerosol generated by one index case, we use the available evidence to infer the emission rate of aerosol infectious quanta. We explore how the risk of infection would vary with several influential factors: ventilation rate, duration of event, and deposition onto surfaces. The results indicate a best-estimate emission rate of 970 ± 390 quanta/h. Infection risk would be reduced by a factor of two by increasing the aerosol loss rate to 5 h−1 and shortening the event duration from 2.5 to 1 h.
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Laboratory, 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 [125]
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- Authors
- Miller, S. L., Nazaroff, W. W., Jimenez, J. L., Boerstra, A., Buonanno, G., Dancer, S. J., Kurnitski, J., Marr, L. C., Morawska, L., & Noakes, C.
- Affiliations
- University of Colorado Boulder (US)
- University of California, Berkeley (US)
- Cooperative Institute for Research in Environmental Sciences (US)
- REHVA (Federation of European Heating, Ventilation and Air Conditioning Associations) BBA Binnenmilieu Den Haag The Netherlands
- Università degli studi di Cassino e del Lazio Meridionale (IT)
- Edinburgh Napier University (GB)
- Tallinn University of Technology (EE)
- Virginia Tech (US)
- International Laboratory for Air Quality and Heath (ILAQH) WHO Collaborating Centre for Air Quality and Health School of Earth and Atmospheric Sciences Queensland University of Technology Brisbane Queensland Australia
- University of Leeds (GB)
- Corresponding author
- Miller, Shelly L.
- ORCID
- Venue
- Indoor Air
- Publisher
- Wiley
- Published
- 2020-10-13
- Volume
- 31
- Issue
- 2
- Pages
- 314-323
- ISSN
- 0905-6947 (ISSN-L)
- 1600-0668
- PMC
- PMC7537089
- OpenAlex
- W3089975294
- Cited by
- 734
- References
- 73
- Citations by year
- 2026: 31 · 2025: 58 · 2024: 79 · 2023: 101 · 2022: 182 · 2021: 229 · 2020: 52
- FWCI
- 79.48
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Licence
- Locations
- Indoor Air (publishedVersion)
- medRxiv (acceptedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- 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)
- Edinburgh Napier Research Repository (Edinburgh Napier University) (submittedVersion, other-oa)
- CU Scholar (University of Colorado Boulder) (submittedVersion)
- eScholarship (California Digital Library) (submittedVersion)
- Archivio Istituzionale della Ricerca - Università degli Studi di Cassino (submittedVersion)
- Edinburgh Napier Research Repository (Edinburgh Napier University) (submittedVersion, cc-by)
- VTechWorks (Virginia Tech) (submittedVersion, cc-by-nc-nd)
- 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, COVID-19 pandemic, superspreading events, aerosol deposition, ventilation rate, infection risk, choral rehearsal, indoor air quality
- MeSH terms
- COVID-19, SARS-CoV-2, Humans, Time Factors, Ventilation, Washington, Fomites, Singing
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
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