ReviewJournal of internal medicine2021
Breathing, speaking, coughing or sneezing: What drives transmission of SARS-CoV-2?
Review in Journal of internal medicine, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 61 papers, 4 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
61 citing papers in PubMed, 4 syntheses or guidelines pooled it, 164 citations in OpenAlex.
- Severe acute respiratory syndrome coronavirus-2 shedding in exhaled material: a systematic review.Epidemiology and infection · 2025Pooled it
- Seroprevalence of SARS-CoV-2 antibodies among oral health care workers with natural seroconversion: a systematic review and meta-analysis.Scientific reports · 2025Pooled it
- Masks and respirators for prevention of respiratory infections: a state of the science review.Clinical microbiology reviews · 2024Pooled it
- Oral Health Implications of SARS-CoV-2/COVID-19: A Systematic Review.Oral health & preventive dentistry · 2022Pooled it
- Trial
- Integrating Alkali Lignin into Electrospun PET Nanofibers for Enhanced Viral Protection in Respiratory Masks.ACS omega · 2026Article
- Protocol: a systematic review+ (SR+) to combine associative and mechanistic evidence on the efficacy of face masks in reducing transmission of respiratory diseases.Systematic reviews · 2025Article
- Detection of SARS-CoV-2 RNA and Biomarkers in Device-Captured Droplets From the Lung.CHEST pulmonary · 2025Article
- Hotspot model shows how location-based superspreading accelerates and reshapes epidemics.PNAS nexus · 2025Article
- Review
- Why do some metal ions spontaneously form nanoparticles in water microdroplets? Disentangling the contributions of the air-water interface and bulk redox chemistry.Chemical science · 2025Article
- Experimental data on aerosols exhaled into the environment from different wind musical instruments.Scientific reports · 2025Article
- Debulking influenza and herpes simplex virus strains by a wide-spectrum anti-viral protein formulated in clinical grade chewing gum.Molecular therapy : the journal of the American Society of Gene Therapy · 2025Article
- In-Utero Maternal-to-Fetal Transmission of COVID-19: An Immunological and Virological Study in the Eastern Province of Saudi Arabia.Infection and drug resistance · 2025Article
- Editorial: COVID-19 crisis creates opportunity towards global monitoring & surveillance.Frontiers in cellular and infection microbiology · 2025Article
- Advancing DBD Plasma Chemistry: Insights into Reactive Nitrogen Species such as NOEnvironmental science & technology · 2024Article
- Comparison of microscopic and xpert MTB diagnoses of presumptive mycobacteria tuberculosis infection: retrospective analysis of routine diagnosis at Cape Coast Teaching Hospital.BMC infectious diseases · 2024Article
- Occupation and SARS-CoV-2 in Europe: a review.European respiratory review : an official journal of the European Respiratory Society · 2024Review
- Symptom propagation in respiratory pathogens of public health concern: a review of the evidence.Journal of the Royal Society, Interface · 2024Review
- Resolving the Loss of Intermediate-Size Speech Aerosols in Funnel-Guided Particle Counting Measurement.Atmosphere · 2024Article
1 more citing papers are in PubMed but not listed here.
Corrections and comments
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Authors and funding
3 authors at 1 institution in 1 country.
Funding
Abstract
The SARS-CoV-2 virus is highly contagious, as demonstrated by numerous well-documented superspreading events. The infection commonly starts in the upper respiratory tract (URT) but can migrate to the lower respiratory tract (LRT) and other organs, often with severe consequences. Whereas LRT infection can lead to shedding of virus via breath and cough droplets, URT infection enables shedding via abundant speech droplets. Their viral load can be high in carriers with mild or no symptoms, an observation linked to the abundance of SARS-CoV-2-susceptible cells in the oral cavity epithelium. Expelled droplets rapidly lose water through evaporation, with the smaller ones transforming into long-lived aerosol. Although the largest speech droplets can carry more virions, they are few in number, fall to the ground rapidly and therefore play a relatively minor role in transmission. Of more concern is small speech aerosol, which can descend deep into the LRT and cause severe disease. However, since their total volume is small, the amount of virus they carry is low. Nevertheless, in closed environments with inadequate ventilation, they can accumulate, which elevates the risk of direct LRT infection. Of most concern is the large fraction of speech aerosol that is intermediate-sized because it remains suspended in air for minutes and can be transported over considerable distances by convective air currents. The abundance of this speech-generated aerosol, combined with its high viral load in pre- and asymptomatic individuals, strongly implicates airborne transmission of SARS-CoV-2 through speech as the primary contributor to its rapid spread.
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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.