Cited by 734Infection Control and VentilationCOVID-19 epidemiological studiesCOVID-19 impact on air quality

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Transmission of SARS-CoV-2 by inhalation of respiratory aerosol in the Skagit Valley Chorale superspreading event

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Miller, Shelly L., Nazaroff, William W, Jimenez, Jose L., Boerstra, Atze, Buonanno, Giorgio, Dancer, Stephanie J., Kurnitski, Jarek, Marr, Linsey C., Morawska, Lidia, Noakes, Catherine·2021·Indoor Air

DOI 10.1111/ina.12751PMC PMC7537089

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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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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: Miller, Shelly L.
Nazaroff, William W
Jimenez, Jose L.
Boerstra, Atze
Buonanno, Giorgio
Dancer, Stephanie J.
Kurnitski, Jarek
Marr, Linsey C.
Morawska, Lidia
Noakes, Catherine
Venue: Indoor Air
Publisher: Wiley
Published: 2020-10-13
Volume: 31
Issue: 2
Pages: 314-323
ISSN: 0905-6947 (ISSN-L)
1600-0668
DOI: 10.1111/ina.12751
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: onlinelibrary.wiley.com/termsAndConditions#vor (vor)
doi.wiley.com/10.1002/tdm_license_1.1 (tdm)
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

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