The Infectious Nature of Patient-Generated SARS-CoV-2 Aerosol

Santarpia, J. L.; Herrera, V. L.; Rivera, D. N.; Ratnesar-Shumate, S.; Reid, S. P.; Denton, P. W.; Martens, J. W. S.; Fang, Y.; Conoan, N.; Callahan, M. V.; Lawler, J. V.; Brett-Major, D. M.; Lowe, J. J.

Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission causing coronavirus disease 2019 (COVID-19) may occur through multiple routes. We collected aerosol samples around six patients admitted into mixed acuity wards in April of 2020 to identify the risk of airborne SARS-CoV-2. Measurements were made to characterize the size distribution of aerosol particles, and size-fractionated, aerosol samples were collected to assess the presence of infectious virus in particles sizes of >4.1 m, 1-4 m, and <1 m in the patient environment. Samples were analyzed by real-time reverse-transcriptase polymerase chain reaction (rRT-PCR), cell culture, western blot, and transmission electron microscopy (TEM). SARS-CoV-2 RNA was detected in all six rooms in all particle size fractions (>4.1 m, 1-4 m, and <1 m). Increases in viral RNA during cell culture of the virus from recovered aerosol samples demonstrated the presence of infectious, replicating virions in three <1 m aerosol samples (P<0.05). Viral replication of aerosol was also observed in the 1-4 m stage but did not reach statistical significance (0.05