Exhaled aerosol increases with COVID-19 infection, age, and obesity

David A. Edwards, Dennis Ausiello, Jonathan Salzman, Tom Devlin, Robert Langer, Brandon J. Beddingfield, Alyssa C. Fears, Lara A. Doyle-Meyers, Rachel K. Redmann, Stephanie Z. Killeen, Nicholas J. Maness, Chad J. Roy

Research output: Contribution to journalArticlepeer-review

94 Scopus citations

Abstract

COVID-19 transmits by droplets generated from surfaces of airway mucus during processes of respiration within hosts infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus. We studied respiratory droplet generation and exhalation in human and nonhuman primate subjects with and without COVID-19 infection to explore whether SARS-CoV-2 infection, and other changes in physiological state, translate into observable evolution of numbers and sizes of exhaled respiratory droplets in healthy and diseased subjects. In our observational cohort study of the exhaled breath particles of 194 healthy human subjects, and in our experimental infection study of eight nonhuman primates infected, by aerosol, with SARS-CoV-2, we found that exhaled aerosol particles vary between subjects by three orders of magnitude, with exhaled respiratory droplet number increasing with degree of COVID-19 infection and elevated BMI-years. We observed that 18% of human subjects (35) accounted for 80% of the exhaled bioaerosol of the group (194), reflecting a superspreader distribution of bioaerosol analogous to a classical 20:80 superspreader of infection distribution. These findings suggest that quantitative assessment and control of exhaled aerosol may be critical to slowing the airborne spread of COVID-19 in the absence of an effective and widely disseminated vaccine.

Original languageEnglish (US)
Article numbere2021830118
JournalProceedings of the National Academy of Sciences of the United States of America
Volume118
Issue number8
DOIs
StatePublished - Feb 23 2021
Externally publishedYes

Keywords

  • Aerosols
  • COVID-19
  • Respiratory medicine
  • Superspreaders

ASJC Scopus subject areas

  • General

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