SARS-CoV-2 in Droplets and Aerosols

S A R S - Co V - 2 i n

D r o p l e t s a n d A e ros o l s

LINSEY C. MARR

CHARLES P. LUNSFORD PROFESSOR

CIVIL AND ENVIRONMENTAL ENGINEERING

VIRGINIA TECH

7 JULY 2020

Topics

1. Transmission modes

2. Size distributions

3. Evaporation and transport

4. Air sampling results and challenges

Linsey Marr, Virginia Tech, July 2020 https://phil.cdc.gov/Details.aspx?pid=11160

The origin of the 5-10 µm cutoff is not clear. This cutoff is not supported by modern aerosol science. This distinction has hampered our understanding of transmission.

Traditional Modes of Transmission

http://www.phac-aspc.gc.ca/cpip-pclcpi/annf/v2-eng.php

direct contact indirect contact

large droplets airborne/aerosols

Linsey Marr, Virginia Tech, July 2020 3

Defined as >5 m and happening at close-range only (<2 m)

Defined as <5 m and happening mainly at long-distance (>2 m)

Multiple Modes at Close Contact

Linsey Marr, Virginia Tech, July 2020 4 https://www.cidrap.umn.edu/news-perspective/2020/03/commentary-covid-19-transmission-messages-should-hinge-science

droplet spray AND

inhalation of aerosols

Aerosols Dilute and Spread

Aerosols Can Build Up Indoors

ventilation to eliminate buildup of aerosols

Face Coverings for Source Control

Droplets vs. Aerosols

• Distinguishing feature should be route of exposure

CONTACT with DROPLETS landing on the body

INHALATION of AEROSOLS into the respiratory system

Transmission by inhalation of aerosols can happen at short and long range.

Why is size so important?

Virus Size

influenza 0.1 m

SARS-CoV-2 0.12 m

rhinovirus 0.03 m

https://www.cdc.gov/flu/resource-center/freeresources/graphics/images.htm, http://solutionsdesignedforhealthcare.com/rhinovirus, https://phil.cdc.gov/Details.aspx?pid=23312, https://pdb101.rcsb.org/motm/132

adenovirus 0.1 m

Size Matters

• Airborne viruses are not naked!

• An aerosol is just a very small droplet

• Size determines • How far they can travel in air • Where they deposit in the respiratory system

(0.2-100 m)

respiratory fluid

Humidity Affects Size and Chemistry

Low RH Very high RH Medium RH

protein

Settling Velocity and Time

Droplets smaller than 10 m can remain suspended for many minutes to hours

𝑠𝑒𝑡𝑡𝑖𝑛𝑔 𝑣𝑒𝑙𝑜𝑐𝑖𝑡𝑦 𝑣 = 𝑔𝐷𝑝

2𝜌𝑝

18𝜇

particle diameter particle density

dynamic viscosity of air

0 20 40 60 80

Distance (m)

Low indoor air velocity (5 cm/s)

Droplets Can Travel More Than 2 m

Nazaroff, 2020, personal communication

trajectory of 5 m droplet

0 50 100 150 200 250 300

Distance (m)

High indoor air velocity (20 cm/s)

Position of droplets released from a height of 1 m

Viruses in droplets/aerosols >5-10 µm remain in air for many minutes and can travel farther than 1-2 m. What do we know about SARS-CoV-2 in droplets/aerosols?

Virus Detection Methods

1. Total virus • Number of genome copies

(GC) determined by molecular techniques (quantitative polymerase chain reaction, qPCR)

• Reflects number of viruses with intact DNA or RNA

• Does NOT indicate whether virus is infectious or not

Linsey Marr, Virginia Tech, July 2020 18 https://www.cdc.gov/flu/resource-center/freeresources/graphics/images.htm

RNA is wrapped around the ribonucleoprotein

Virus Detection Methods

2. Infectious virus • Number of viruses that are able

to infect cells determined by culture (growing)

• PFU = plaque forming units, number of viruses capable of forming plaques on host cells, focus forming units (FFU) are related

• TCID50 = median tissue culture infectious dose, concentration at which half of cells are infected after being exposed to the sample

Linsey Marr, Virginia Tech, July 2020 19 https://phil.cdc.gov/Details.aspx?pid=23213

Linsey Marr, Virginia Tech, July 2020 20 Ong et al., 2020, JAMA, https://jamanetwork.com/journals/jama/fullarticle/2762692

Samples in patient A’s and B’s rooms were negative after cleaning. These results are for patient C before cleaning.

table, bed rail, locker, chair, light switches, stethoscope, sink, floor, window, door and handle, toilet, air outlet fan

control panel on bed, call bell, rail in bathroom, outer rim of sink in bathroom, all anteroom, air

negative

positive

Linsey Marr, Virginia Tech, July 2020 21 Chia et al., 2020, https://www.nature.com/articles/ s41467-020-16670-2; Santarpia et al., 2020, https://www.medrxiv.org/content/10.1101/2020.03.23.20039446v2

Airborne Viral RNA in Hospitals

I estimate a viral RNA emission rate of 10,000 genome copies per minute in “small” droplets.

Liu et al., 2020, Nature, https://www.nature.com/articles/s41586-020-2271-3

SARS-CoV-2 Size Distributions

SARS-CoV-2 Survival in Aerosols

Linsey Marr, Virginia Tech, July 2020 23 van Doremalen et al., 2020, NEJM, https://www.nejm.org/doi/full/10.1056/NEJMc2004973

Half-life is 1.1 hours in culture medium at 65% RH.

SARS-CoV-2 Survival in Aerosols

Linsey Marr, Virginia Tech, July 2020 24 Fears et al., 2020, https://wwwnc.cdc.gov/eid/article/26/9/20-1806_article

Virus survives 16 hours in aerosols in culture medium at 53% RH

Sampling Challenges

• Low concentrations of ~103 viral RNA copies/m3

• Probably need ~104 copies to get 1 PFU (10 m3 air)

• Ideally want size separation

Linsey Marr, Virginia Tech, July 2020 25 Prussin II et al., 2014, https://onlinelibrary.wiley.com/ doi/abs/10.1111/1574-6968.12487; https://www.vox.com/science-and-health/2020/3/11/21173187/coronavirus-covid-19-hand-washing-sanitizer-compared-soap-is-dope

Must must elute and extract large filter

Low flow rates require 20-40 hr of sampling

Loss of infectivity during sampling

Major Unknowns

• Which transmission route is dominant: direct contact, indirect contact with contaminated objects (fomites), contact with droplets, inhalation of aerosols?

• How much virus is released in what size droplets/aerosols at different stages of infection?

• How are viruses inactivated in air and on surfaces?

Linsey Marr, Virginia Tech, July 2020 26 Liu et al., 2016, Indoor Air, https://onlinelibrary.wiley.com/doi/abs/10.1111/ina.12314

Acknowledgments Karen Kormuth Seema Lakdawala Weinan Leng Kaisen Lin AJ Prussin II Elankumaran Subbiah Eric Vejerano Peter Vikesland Haoran Wei Wan Yang

SARS-CoV-2 in Droplets and Aerosols

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