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Heterogeneity in transmissibility and shedding SARS-CoV-2 via droplets and aerosols.
Elife. 2021 04 16; 10E

Abstract

Background

Which virological factors mediate overdispersion in the transmissibility of emerging viruses remains a long-standing question in infectious disease epidemiology.

Methods

Here, we use systematic review to develop a comprehensive dataset of respiratory viral loads (rVLs) of SARS-CoV-2, SARS-CoV-1 and influenza A(H1N1)pdm09. We then comparatively meta-analyze the data and model individual infectiousness by shedding viable virus via respiratory droplets and aerosols.

Results

The analyses indicate heterogeneity in rVL as an intrinsic virological factor facilitating greater overdispersion for SARS-CoV-2 in the COVID-19 pandemic than A(H1N1)pdm09 in the 2009 influenza pandemic. For COVID-19, case heterogeneity remains broad throughout the infectious period, including for pediatric and asymptomatic infections. Hence, many COVID-19 cases inherently present minimal transmission risk, whereas highly infectious individuals shed tens to thousands of SARS-CoV-2 virions/min via droplets and aerosols while breathing, talking and singing. Coughing increases the contagiousness, especially in close contact, of symptomatic cases relative to asymptomatic ones. Infectiousness tends to be elevated between 1 and 5 days post-symptom onset.

Conclusions

Intrinsic case variation in rVL facilitates overdispersion in the transmissibility of emerging respiratory viruses. Our findings present considerations for disease control in the COVID-19 pandemic as well as future outbreaks of novel viruses.

Funding

Natural Sciences and Engineering Research Council of Canada (NSERC) Discovery Grant program, NSERC Senior Industrial Research Chair program and the Toronto COVID-19 Action Fund.

Authors+Show Affiliations

Department of Chemical Engineering & Applied Chemistry, University of Toronto, Toronto, Canada.Temerty Faculty of Medicine, University of Toronto, Toronto, Canada. Department of Critical Care Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada. O'Brien Institute of Public Health, University of Calgary, Calgary, Canada.Libraries & Cultural Resources, University of Calgary, Calgary, Canada.Department of Viroscience, Erasmus University Medical Center, Rotterdam, Netherlands.Division of Epidemiology, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada. Division of Infectious Diseases, Temerty Faculty of Medicine, University of Toronto, Toronto, Canada.Department of Chemical Engineering & Applied Chemistry, University of Toronto, Toronto, Canada. Institute of Biomedical Engineering, University of Toronto, Toronto, Canada.

Pub Type(s)

Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Systematic Review

Language

eng

PubMed ID

33861198

Citation

Chen, Paul Z., et al. "Heterogeneity in Transmissibility and Shedding SARS-CoV-2 Via Droplets and Aerosols." ELife, vol. 10, 2021.
Chen PZ, Bobrovitz N, Premji Z, et al. Heterogeneity in transmissibility and shedding SARS-CoV-2 via droplets and aerosols. Elife. 2021;10.
Chen, P. Z., Bobrovitz, N., Premji, Z., Koopmans, M., Fisman, D. N., & Gu, F. X. (2021). Heterogeneity in transmissibility and shedding SARS-CoV-2 via droplets and aerosols. ELife, 10. https://doi.org/10.7554/eLife.65774
Chen PZ, et al. Heterogeneity in Transmissibility and Shedding SARS-CoV-2 Via Droplets and Aerosols. Elife. 2021 04 16;10 PubMed PMID: 33861198.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Heterogeneity in transmissibility and shedding SARS-CoV-2 via droplets and aerosols. AU - Chen,Paul Z, AU - Bobrovitz,Niklas, AU - Premji,Zahra, AU - Koopmans,Marion, AU - Fisman,David N, AU - Gu,Frank X, Y1 - 2021/04/16/ PY - 2020/12/15/received PY - 2021/04/15/accepted PY - 2021/4/17/pubmed PY - 2021/5/29/medline PY - 2021/4/16/entrez KW - COVID-19 KW - emerging pathogens KW - epidemiology KW - global health KW - infectious disease KW - influenza KW - microbiology KW - none KW - overdispersion KW - superspreading JF - eLife JO - Elife VL - 10 N2 - Background: Which virological factors mediate overdispersion in the transmissibility of emerging viruses remains a long-standing question in infectious disease epidemiology. Methods: Here, we use systematic review to develop a comprehensive dataset of respiratory viral loads (rVLs) of SARS-CoV-2, SARS-CoV-1 and influenza A(H1N1)pdm09. We then comparatively meta-analyze the data and model individual infectiousness by shedding viable virus via respiratory droplets and aerosols. Results: The analyses indicate heterogeneity in rVL as an intrinsic virological factor facilitating greater overdispersion for SARS-CoV-2 in the COVID-19 pandemic than A(H1N1)pdm09 in the 2009 influenza pandemic. For COVID-19, case heterogeneity remains broad throughout the infectious period, including for pediatric and asymptomatic infections. Hence, many COVID-19 cases inherently present minimal transmission risk, whereas highly infectious individuals shed tens to thousands of SARS-CoV-2 virions/min via droplets and aerosols while breathing, talking and singing. Coughing increases the contagiousness, especially in close contact, of symptomatic cases relative to asymptomatic ones. Infectiousness tends to be elevated between 1 and 5 days post-symptom onset. Conclusions: Intrinsic case variation in rVL facilitates overdispersion in the transmissibility of emerging respiratory viruses. Our findings present considerations for disease control in the COVID-19 pandemic as well as future outbreaks of novel viruses. Funding: Natural Sciences and Engineering Research Council of Canada (NSERC) Discovery Grant program, NSERC Senior Industrial Research Chair program and the Toronto COVID-19 Action Fund. SN - 2050-084X UR - https://www.unboundmedicine.com/medline/citation/33861198/Heterogeneity_in_transmissibility_and_shedding_SARS_CoV_2_via_droplets_and_aerosols_ L2 - https://doi.org/10.7554/eLife.65774 DB - PRIME DP - Unbound Medicine ER -