Observational studyProceedings of the National Academy of Sciences of the United States of America2021
Exhaled aerosol increases with COVID-19 infection, age, and obesity.
Observational study in Proceedings of the National Academy of Sciences of the United States of America, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 126 papers, 3 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
126 citing papers in PubMed, 3 syntheses or guidelines pooled it, 246 citations in OpenAlex.
- Host factors associated with respiratory particle emission and virus presence within respiratory particles: a systematic review.Frontiers in microbiology · 2025Pooled it
- Superspreading of SARS-CoV-2: a systematic review and meta-analysis of event attack rates and individual transmission patterns.Epidemiology and infection · 2024Pooled it
- SARS-CoV-2 air sampling: A systematic review on the methodologies for detection and infectivity.Indoor air · 2022Pooled it
- Prevention of SARS-CoV-2 transmission during a large, live, indoor gathering (SPRING): a non-inferiority, randomised, controlled trial.The Lancet. Infectious diseases · 2022Trial
- Age-specific climate sensitivity of respiratory hospitalizations in a tropical coastal city: 20-year Random Forest forecasts.International journal of biometeorology · 2026Article
- Multimodal Optical and Ratiometric ATR-FTIR Discrimination of Mixed Aerosol Components Using pH-Responsive Methylcellulose-Phenol Red Films.Sensors (Basel, Switzerland) · 2026Article
- Heterogeneity of Airborne Virus Transmission in the Built Environment: A Narrative Review.Pathogens & immunity · 2026Review
- Assessing the generation and dispersal of respiratory particles using upper respiratory commensal bacteria as index organisms for respiratory pathogens.Scientific reports · 2025Article
- Determinants of respiratory tract aerosol generation in a diverse clinical population: an observational study.BMJ open respiratory research · 2025Observational
- Speaking Different Languages Impacts Size-Resolved Exhaled Breath Aerosol Particle Emission.Environment & health (Washington, D.C.) · 2025Article
- Aerosol emission and exposure in non-invasive ventilation.Scientific reports · 2025Article
- Epidemic evolutionarily stable strategies within an age-structured host population.Proceedings of the National Academy of Sciences of the United States of America · 2025Article
- Creating respiratory pathogen-free environments in healthcare and nursing-care settings: a comprehensive review.GeroScience · 2025Review
- Perspectives on physics-based one-dimensional modeling of lung physiology.Frontiers in physiology · 2025Article
- Meeting Report: Controlled Human Influenza Virus Infection Model Studies: Current Status and Future Directions for Innovation.Influenza and other respiratory viruses · 2024Article
- Inhaled alkaline hypertonic divalent salts reduce refractory chronic cough frequency.ERJ open research · 2024Article
- Insights into the fluid dynamics of bioaerosol formation in a model respiratory tract.Biomicrofluidics · 2024Article
- Host behaviour driven by awareness of infection risk amplifies the chance of superspreading events.Journal of the Royal Society, Interface · 2024Article
- Particles in Exhaled Air (PExA): Clinical Uses and Future Implications.Diagnostics (Basel, Switzerland) · 2024Review
- Building Environmental and Sociological Predictive Intelligence to Understand the Seasonal Threat of SARS-CoV-2 in Human Populations.The American journal of tropical medicine and hygiene · 2024Article
66 more citing papers are in PubMed but not listed here.
Corrections and comments
- Commented on by
- Commented on by
- Erratum issued
Authors and funding
12 authors at 4 institutions in 1 country.
Funding
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.
Indexed as
Identifiers
What OpenQuestion holds
Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.