medRxiv (Cold Spring Harbor Laboratory), Sep 1, 2020
The current revival of the world's economy is being predicated on social distancing, specifically... more The current revival of the world's economy is being predicated on social distancing, specifically the Six-Foot Rule, a guideline that offers little protection from pathogen-bearing aerosol droplets sufficiently small to be continuously mixed through an indoor space. The importance of airborne transmission of COVID-19 is now widely recognized. While tools for risk assessment have recently been developed, no safety guideline has been proposed to protect against it. We here build upon models of airborne disease transmission in order to derive an indoor safety guideline that would impose an upper bound on the "cumulative exposure time", the product of the number of occupants and their time in an enclosed space. We demonstrate how this bound depends on the rates of ventilation and air filtration, dimensions of the room, breathing rate, respiratory activity and face-mask use of its occupants, and infectiousness of the respiratory aerosols. By synthesizing available data from the best characterized indoor spreading events with respiratory drop-size distributions, we estimate an infectious dose on the order of ten aerosol-borne virions. The new virus is thus inferred to be an order of magnitude more infectious than its forerunner (SARS-CoV), consistent with the pandemic status achieved by COVID-19. Case studies are presented for classrooms and nursing homes, and a spreadsheet and online app are provided to facilitate use of our guideline. Implications for contact tracing and quarantining are considered, appropriate caveats enumerated. Particular consideration is given to respiratory jets, which may substantially elevate risk when face masks are not worn. C oronavirus disease 2019 (COVID-19) is an infectious pneumonia that appeared in Wuhan, Hubei Province, China in December 2019 and has since caused a global pandemic (1, 2). The pathogen responsible for COVID-19, severeacute-respiratory-syndrome coronavirus 2 (SARS-CoV-2), is known to be transported by respiratory droplets exhaled by an infected person (3-7). There are thought to be three primary routes of human-to-human transmission of COVID-19, large drop transmission from the mouth of an infected person to the mouth, nose or eyes of the recipient, physical contact with droplets deposited on surfaces (fomites) and subsequent transfer to the recipient's respiratory mucosae, and inhalation of the microdroplets ejected by an infected person and held aloft by ambient air currents (6, 8). We subsequently refer to these three modes of transmission as, respectively, 'large-drop', 'contact' and 'airborne' transmission, while noting that the distinction between large-drop and airborne transmission is somewhat nebulous given the continuum of sizes of emitted droplets (9). We here build upon the existing theoretical framework for describing airborne disease transmission in order to characterize the evolution of the concentration of pathogen-laden droplets in a well-mixed room, and the The possibility of pathogen resuspension from contaminated surfaces has also recently been explored (10, 11).
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Papers by John Bush