SARS-CoV-2 Droplet and Airborne Transmission Heterogeneity

Abstract

The spread dynamics of the SARS-CoV-2 virus have not yet been fully understood after two years of the pandemic. The virus's global spread represented a unique scenario for advancing infectious disease research. Consequently, mechanistic epidemiological theories were quickly dismissed, and more attention was paid to other approaches that considered heterogeneity in the spread. One of the most critical advances in aerial pathogens transmission was the global acceptance of the airborne model, where the airway is presented as the epicenter of the spread of the disease. Although the aerodynamics and persistence of the SARS-CoV-2 virus in the air have been extensively studied, the actual probability of contagion is still unknown. In this work, the individual heterogeneity in the transmission of 22 patients infected with COVID-19 was analyzed by close contact (cough samples) and air (environmental samples). Viral RNA was detected in 2/19 cough samples from patient subgroups, with a mean Ct (Cycle Threshold in Quantitative Polymerase Chain Reaction analysis) of 25.7 ± 7.0. Nevertheless, viral RNA was only detected in air samples from 1/8 patients, with an average Ct of 25.0 ± 4.0. Viral load in cough samples ranged from 7.3 × 10⁵ to 8.7 × 10⁸ copies/mL among patients, while concentrations between 1.1-4.8 copies/m³ were found in air, consistent with other reports in the literature. In patients undergoing follow-up, no viral load was found (neither in coughs nor in the air) after the third day of symptoms, which could help define quarantine periods in infected individuals. In addition, it was found that the patient's Ct should not be considered an indicator of infectiousness, since it could not be correlated with the viral load disseminated. The results of this work are in line with proposed hypotheses of superspreaders, which can attribute part of the heterogeneity of the spread to the oversized emission of a small percentage of infected people.

Keywords: COVID-19; airborne; bioaerosols; cough; infectious diseases; superspreaders; transmission heterogeneity.

Figure 1

Schematic representation of bioaerosols and droplets emission. Where, DPPC is dipalmitoylphosphatidylcholine protein, and DPPG is dipalmitoylphosphatidylglycerol protein.

Figure 2

Schematic representation of air sampling and analysis method. Where, PBS is Phosphate Buffered Saline.

Figure 3

Schematic representation of air sampling set-up at (a) the hospital and (b) in private homes.