Echoes Through Time: The Historical Origins of the Droplet Dogma and its Role in the Misidentification of Airborne Respiratory Infection Transmission

48 Pages Posted: 21 Sep 2021

See all articles by Jose Jimenez

Jose Jimenez

University of Colorado

Linsey Marr

Virginia Tech

Katherine Randall

Virginia Tech

E. Thomas Ewing

Department of History

Zeynep Tufekci

University of North Carolina (UNC) at Chapel Hill - School of Information and Library Science (SILS)

Trish Greenhalgh

University of Oxford

Donald K. Milton

University of Maryland - School of Public Health

Raymond Tellier

University of Calgary - Cumming School of Medicine

Julian Tang

University of Leicester

Yuguo Li

The University of Hong Kong - Department of Mechanical Engineering

Lidia Morawska

Queensland University of Technology

Jonathan Mesiano-Crookston

Goldman Hine LLP

David Fisman

University of Toronto - Dalla Lana School of Public Health; University of Toronto, Faculty of Medicine, Department of Medicine, Division of Infectious Diseases

Orla Hegarty

University College Dublin (UCD)

Stephanie Dancer

Edinburgh Napier University

Philomena Bluyssen

Delft University of Technology

Giorgio Buonanno

University of Cassino and Southern Lazio - Department of Civil and Mechanical Engineering

Marcel Loomans

Eindhoven University of Technology (TUE)

William Bahnfleth

Pennsylvania State University

Maosheng Yao

Peking University - College of Environmental Science and Engineering

Chandra Sekhar

National University of Singapore (NUS) - Department of the Built Environment

Pawel Wargocki

Technical University of Denmark

Arsen Krikor Melikov

Technical University of Denmark

Kimberly Prather

University of California, San Diego (UCSD) - Scripps Institution of Oceanography

Date Written: August 11, 2021

Abstract

The question of whether SARS-CoV-2 is transmitted by droplets or aerosols has been very controversial. We sought to explain this controversy through a historical analysis of transmission research in other diseases. For most of human history, many diseases were thought to transmit through the air, often over long distances and in a phantasmagorical way, and often in error (e.g. malaria, cholera). Building on the germ theory of disease developed in the mid 19th century and on the demise of miasma theory, prominent public health official Charles Chapin in 1910 urged the public health community to focus on contact and droplet infection. However, he introduced a major error in the process: that ease of infection in close proximity is associated exclusively with large “sprayborne” droplets that fall to the ground quickly, and he deemed airborne transmission as very unlikely. This new paradigm became dominant, leading to systematic errors in the interpretation of research evidence on transmission. For the next five decades, no disease was accepted by the general medical and infection control communities as airborne, until tuberculosis (which had been misclassified as droplet) in 1962. Chapin’s paradigm remained dominant and only a few diseases were widely accepted as transmitted by aerosols before COVID-19: those that were clearly transmitted over long distances or time scales. Resistance to the idea of airborne spread of a respiratory infection is not new. In fact, it has occurred repeatedly over much of the last century and greatly hampered understanding of how diseases transmit.

Note:
Funding Information: M. Yao was supported by National Natural Science Foundation of China grants (21725701, 22040101) and Guangzhou Laboratory (EKPG21-02). T. Greenhalgh was supported by a Wellcome Senior Investigator grant (WT104830MA).

Declaration of Interests: The authors declare no competing interest.

Keywords: COVID-19, aerosols, droplets, transmission, history

Suggested Citation

Jimenez, Jose and Marr, Linsey and Randall, Katherine and Ewing, E. Thomas and Tufekci, Zeynep and Greenhalgh, Trish and Milton, Donald K. and Tellier, Raymond and Tang, Julian and Li, Yuguo and Morawska, Lidia and Mesiano-Crookston, Jonathan and Fisman, David and Hegarty, Orla and Dancer, Stephanie and Bluyssen, Philomena and Buonanno, Giorgio and Loomans, Marcel and Bahnfleth, William and Yao, Maosheng and Sekhar, Chandra and Wargocki, Pawel and Melikov, Arsen Krikor and Prather, Kimberly, Echoes Through Time: The Historical Origins of the Droplet Dogma and its Role in the Misidentification of Airborne Respiratory Infection Transmission (August 11, 2021). Available at SSRN: https://ssrn.com/abstract=3904176 or http://dx.doi.org/10.2139/ssrn.3904176

Jose Jimenez (Contact Author)

University of Colorado ( email )

1070 Edinboro Drive
Boulder, CO 80309
United States

Linsey Marr

Virginia Tech ( email )

250 Drillfield Drive
Blacksburg, VA 24061
United States

Katherine Randall

Virginia Tech ( email )

Blacksburg, VA 24061
United States

E. Thomas Ewing

Department of History ( email )

United States

Zeynep Tufekci

University of North Carolina (UNC) at Chapel Hill - School of Information and Library Science (SILS) ( email )

United States

Trish Greenhalgh

University of Oxford

Donald K. Milton

University of Maryland - School of Public Health

4200 Valley Drive
College Park, MD 20742
United States

Raymond Tellier

University of Calgary - Cumming School of Medicine

3330 Hospital Drive NW
Calgary, Alberta T2N 4N1
Canada

Julian Tang

University of Leicester ( email )

University Road
Leicester, LE1 7RH
United Kingdom

Yuguo Li

The University of Hong Kong - Department of Mechanical Engineering

China

Lidia Morawska

Queensland University of Technology

2 George Street
Brisbane, Queensland 4000
Australia

Jonathan Mesiano-Crookston

Goldman Hine LLP ( email )

Canada

David Fisman

University of Toronto - Dalla Lana School of Public Health ( email )

Toronto, Ontario
Canada

University of Toronto, Faculty of Medicine, Department of Medicine, Division of Infectious Diseases ( email )

Canada

Orla Hegarty

University College Dublin (UCD) ( email )

Belfield
Belfield, Dublin 4 4
Ireland

Stephanie Dancer

Edinburgh Napier University ( email )

Edinburgh, EH10 5LG
United States

Philomena Bluyssen

Delft University of Technology ( email )

Delft
Netherlands

Giorgio Buonanno

University of Cassino and Southern Lazio - Department of Civil and Mechanical Engineering ( email )

Cassino
Italy

Marcel Loomans

Eindhoven University of Technology (TUE) ( email )

PO Box 513
Eindhoven, 5600 MB
Netherlands

William Bahnfleth

Pennsylvania State University ( email )

University Park
State College, PA 16802
United States

Maosheng Yao

Peking University - College of Environmental Science and Engineering ( email )

Beijing, 100080
China

Chandra Sekhar

National University of Singapore (NUS) - Department of the Built Environment ( email )

4 Architecture Drive
Singapore, 117566
Japan

Pawel Wargocki

Technical University of Denmark ( email )

Anker Engelunds Vej 1
Building 101A
Lyngby, 2800
Denmark

Arsen Krikor Melikov

Technical University of Denmark ( email )

Anker Engelunds Vej 1
Building 101A
Lyngby, 2800
Denmark

Kimberly Prather

University of California, San Diego (UCSD) - Scripps Institution of Oceanography ( email )

San Diego, CA
United States

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