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. 2021 Feb 3;18(4):1437.
doi: 10.3390/ijerph18041437.

Aerial Transmission of the SARS-CoV-2 Virus through Environmental E-Cigarette Aerosols: Implications for Public Policies

Roberto A Sussman  1 , Eliana Golberstein  2 , Riccardo Polosa  3
Affiliations

Aerial Transmission of the SARS-CoV-2 Virus through Environmental E-Cigarette Aerosols: Implications for Public Policies

Roberto A Sussman et al. Int J Environ Res Public Health. .

Abstract

We discuss the implications of possible contagion of COVID-19 through e-cigarette aerosol (ECA) for prevention and mitigation strategies during the current pandemic. This is a relevant issue when millions of vapers (and smokers) must remain under indoor confinement and/or share public outdoor spaces with non-users. The fact that the respiratory flow associated with vaping is visible (as opposed to other respiratory activities) clearly delineates a safety distance of 1-2 m along the exhaled jet to prevent direct exposure. Vaping is a relatively infrequent and intermittent respiratory activity for which we infer a mean emission rate of 79.82 droplets per puff (6-200, standard deviation 74.66) comparable to mouth breathing, it adds into shared indoor spaces (home and restaurant scenarios) a 1% extra risk of indirect COVID-19 contagion with respect to a "control case" of existing unavoidable risk from continuous breathing. As a comparative reference, this added relative risk increases to 44-176% for speaking 6-24 min per hour and 260% for coughing every 2 min. Mechanical ventilation decreases absolute emission levels but keeps the same relative risks. As long as direct exposure to the visible exhaled jet is avoided, wearing of face masks effectively protects bystanders and keeps risk estimates very low. As a consequence, protection from possible COVID-19 contagion through vaping emissions does not require extra interventions besides the standard recommendations to the general population: keeping a social separation distance of 2 m and wearing of face masks.

Keywords: COVID19; SARS-CoV-2; facemasks; risk analysis; smoking; vaping.

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Conflict of interest statement

R.A.S. has no competing interests to declare. E.G. is currently employed by Myriad Pharmaceuticals, She also provides consultancy work on research and development, regulatory affairs support, and formulation to several independent vaping companies in the Pacific Region she has worked for several pharmaceutical companies, including GlaxoSmithKline and Genomma Lab. She is as standards committee member at VTANZ and UKVIA. R.P. is full time employee of the University of Catania, Italy. In relation to his work in the area of tobacco control and respiratory diseases, R.P. has received lecture fees and research funding from Pfizer, GlaxoSmithKline, CV Therapeutics, NeuroSearch A/S, Sandoz, MSD, Boehringer Ingelheim, Novartis, Duska Therapeutics, and Forest Laboratories. He has also served as a consultant for Pfizer, Global Health Alliance for treatment of tobacco dependence, CVTherapeutics, NeuroSearch A/S, Boehringer Ingelheim, Novartis, Duska Therapeutics, Alfa-Wassermann, Forest Laboratories, ECITA (Electronic Cigarette Industry Trade Association, in the UK), Arbi Group Srl., and Health Diplomats. R.P. is the Founder of the Center of Excellence for the acceleration of Harm Reduction at the University of Catania (CoEHAR), which has received a grant from Foundation for a Smoke Free World to develop and carry out 8 research projects. R.P. is also currently involved in the following pro bono activities: scientific advisor for LIAF, Lega Italiana Anti Fumo (Italian acronym for Italian Anti Smoking League) and Chair of the European Technical Committee for standardization on Requirements and test methods for emissions of electronic cigarettes (CEN/TC 437; WG4).

Figures

Figure 1
Figure 1
Direct and indirect exposure to various respiratory activities. The figure displays a sketch of the area of direct exposure for droplet emitters not wearing a face mask and masked bystanders. Notice that the flow of droplet emission is visible only for vaping, making it easy for bystanders to avoid direct exposure to it. The percentages in the right hand side denote risks of indirect exposure with respect to the control state of continuous breathing.
See this image and copyright information in PMC

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