Airborne Transmission of COVID-19: Epidemiologic Evidence from An Outbreak Investigation

19 Pages Posted: 23 Jul 2020

See all articles by Ye Shen

Ye Shen

University of Georgia

Changwei Li

University of Georgia - Department of Epidemiology and Biostatistics

Hongjun Dong

Ningbo Municipal Centre for Disease Control and Prevention

Zhen Wang

Zhejiang Provincial Center for Disease Control and Prevention

Leonardo Martinez

Stanford University - Division of Infectious Diseases and Geographic Medicine

Zhou Sun

Hangzhou Municipal Center for Disease Control and Prevention

Andreas Handel

University of Georgia - Department of Epidemiology and Biostatistics

Zhiping Chen

Zhejiang Provincial Center for Disease Control and Prevention - Immunization Program Department

Enfu Chen

Zhejiang Provincial Center for Disease Control and Prevention

Mark Ebell

University of Georgia - Department of Epidemiology and Biostatistics

Fan Wang

Renmin University of China - School of Statistics

Bo Yi

Ningbo Municipal Centre for Disease Control and Prevention

Haibin Wang

Haishu Center for Disease Control and Prevention

Xiaoxiao Wang

Zhejiang Provincial Center for Disease Control and Prevention

Aihong Wang

Ningbo Municipal Centre for Disease Control and Prevention

Bingbing Chen

Haishu Center for Disease Control and Prevention

Yanling Qi

California State University, Long Beach

Lirong Liang

Capital Medical University - Department of Clinical Epidemiology & Tobacco Dependence Treatment Research

Yang Li

Renmin University of China - School of Statistics

Feng Ling

Zhejiang Provincial Center for Disease Control and Prevention

Junfang Chen

Hangzhou Municipal Center for Disease Control and Prevention

Guozhang Xu

Ningbo Municipal Centre for Disease Control and Prevention

Date Written: May 11, 2020

Abstract

SARS-CoV-2, the pathogen causing COVID-19, first emerged in humans in late 2019 in Wuhan, China. Much remains unknown about COVID-19 transmission dynamics hampering the ability to implement effective preventive interventions. Understanding the mechanisms of COVID-19 transmission is critical to the prevention and containment of the disease. Several case studies have demonstrated transmission routes through close contact and respiratory droplets produced when an infected person coughs or sneezes. Evidence on whether SARS-CoV-2 can be transmitted as an aerosol (i.e., airborne) is highly sought after, and has profound public health implications during the global pandemic. To inform the knowledge gap and investigate potential transmission routes of COVID-19, we present the result from an outbreak investigation of COVID-19 among lay Buddhists worshiping in a temple. The attack rate on an enclosed bus containing an individual with COVID-19 was 34.3% while no one on a second similar bus was infected. The natural experiment provided convincing evidence that the disease transmission largely occurred during the bus rides. Through further epidemiologic investigation, we determined that the possibility of transmission by direct contact on the exposed bus was low. The absence of a significantly increased risk in the part of the bus closer to the index case suggested that the risk was fairly evenly distributed throughout, and thus, airborne spread of the virus may, at least partially, explain the extraordinarily high attack rate observed. This finding has important public health significance and future efforts at prevention and control should consider the potential for airborne spread of COVID-19, particularly in enclosed spaces with re-circulating air conditioning systems.

Note: Funding: Ningbo Science and Technology Major Project Emergency science and technology project for prevention and control of Coronavirus disease 2019(2020C50001). (Guozhang Xu). Zhejiang Scientific and Technological Major Project under the 2020 Emergency Grant no. 2020C03124, titled “Key technologies for prevention and control of pneumonia caused by novel coronavirus infection”.

Conflict of Interest: None.

Ethical Approval: The research protocol was approved by institutional review board at the Zhejiang Provincial CDC and all human participants gave written informed consent.

Keywords: COVID-19, airborne transmission, bus, central air-conditioners

JEL Classification: I10

Suggested Citation

Shen, Ye and Li, Changwei and Dong, Hongjun and Wang, Zhen and Martinez, Leonardo and Sun, Zhou and Handel, Andreas and Chen, Zhiping and Chen, Enfu and Ebell, Mark and Wang, Fan and Yi, Bo and Wang, Haibin and Wang, Xiaoxiao and Wang, Aihong and Chen, Bingbing and Qi, Yanling and Liang, Lirong and Li, Yang and Ling, Feng and Chen, Junfang and Xu, Guozhang, Airborne Transmission of COVID-19: Epidemiologic Evidence from An Outbreak Investigation (May 11, 2020). Available at SSRN: https://ssrn.com/abstract=3567505 or http://dx.doi.org/10.2139/ssrn.3567505

Ye Shen (Contact Author)

University of Georgia ( email )

101 Buck Rd
Athens, GA GA 30602
United States
30602 (Fax)

Changwei Li

University of Georgia - Department of Epidemiology and Biostatistics ( email )

Athens, GA
United States

Hongjun Dong

Ningbo Municipal Centre for Disease Control and Prevention

Ningbo, Zhejiang
China

Zhen Wang

Zhejiang Provincial Center for Disease Control and Prevention

Binjiang
Hangzhou, Zhejiang 310051
China

Leonardo Martinez

Stanford University - Division of Infectious Diseases and Geographic Medicine

Stanford, CA
United States

Zhou Sun

Hangzhou Municipal Center for Disease Control and Prevention

Zhejiang
China

Andreas Handel

University of Georgia - Department of Epidemiology and Biostatistics

Athens, GA
United States

Zhiping Chen

Zhejiang Provincial Center for Disease Control and Prevention - Immunization Program Department ( email )

Zhejiang
China

Enfu Chen

Zhejiang Provincial Center for Disease Control and Prevention

Binjiang
Hangzhou, Zhejiang 310051
China

Mark Ebell

University of Georgia - Department of Epidemiology and Biostatistics

Athens, GA
United States

Fan Wang

Renmin University of China - School of Statistics

No.59 Zhongguancun Street, Renmin University
Beijing, 100872
China

Bo Yi

Ningbo Municipal Centre for Disease Control and Prevention

Ningbo, Zhejiang
China

Haibin Wang

Haishu Center for Disease Control and Prevention

Ningbo
China

Xiaoxiao Wang

Zhejiang Provincial Center for Disease Control and Prevention

Binjiang
Hangzhou, Zhejiang 310051
China

Aihong Wang

Ningbo Municipal Centre for Disease Control and Prevention

Ningbo, Zhejiang
China

Bingbing Chen

Haishu Center for Disease Control and Prevention

Ningbo
China

Yanling Qi

California State University, Long Beach ( email )

Long Beach, CA 90840
United States
(562) 985-4009 (Phone)
(562) 985-5886 (Fax)

HOME PAGE: http://sites.google.com/site/econyq

Lirong Liang

Capital Medical University - Department of Clinical Epidemiology & Tobacco Dependence Treatment Research

Beijing
China

Yang Li

Renmin University of China - School of Statistics

No.59 Zhongguancun Street, Renmin University
Beijing, 100872
China

Feng Ling

Zhejiang Provincial Center for Disease Control and Prevention

Binjiang
Hangzhou, Zhejiang 310051
China

Junfang Chen

Hangzhou Municipal Center for Disease Control and Prevention

Zhejiang
China

Guozhang Xu

Ningbo Municipal Centre for Disease Control and Prevention

Ningbo, Zhejiang
China

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