ArticleClinical infectious diseases : an official publication of the Infectious Diseases Society of America2022
Infectious Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in Exhaled Aerosols and Efficacy of Masks During Early Mild Infection.
Article in Clinical infectious diseases : an official publication of the Infectious Diseases Society of America, 2022. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 74 papers, 3 of them syntheses that pooled it.
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Who cites it
74 citing papers in PubMed, 3 syntheses or guidelines pooled it.
- Severe acute respiratory syndrome coronavirus-2 shedding in exhaled material: a systematic review.Epidemiology and infection · 2025Pooled it
- Masks and respirators for prevention of respiratory infections: a state of the science review.Clinical microbiology reviews · 2024Pooled it
- Non-pharmaceutical interventions for COVID-19: a systematic review on environmental control measures.Philosophical transactions. Series A, Mathematical, physical, and engineering sciences · 2023Pooled it
- Mathematical Modeling of Viral RNA Copies in Indoor Environments: Pre-Processor for Risk Assessment and Decision-Making Support Tool for Public Health.Risk analysis : an official publication of the Society for Risk Analysis · 2026Article
- Loss of Infectivity of Influenza Virus and SARS-CoV‑2 during Aerosol Sampling.Environmental science & technology letters · 2026Article
- Heterogeneity of Airborne Virus Transmission in the Built Environment: A Narrative Review.Pathogens & immunity · 2026Review
- Mask wearing by COVID-19 index cases reduces SARS-CoV-2 transmission to household contacts.Epidemiology and infection · 2025Article
- Implementation of facemask sampling for the detection of infectious individuals with SARS-CoV-2 in high stakes clinical examinations - a feasibility study.Future healthcare journal · 2024Article
- Effect of multifunctional cationic polymer coatings on mitigation of broad microbial pathogens.Microbiology spectrum · 2024Article
- Morbidity and Mortality of Hospital-Onset SARS-CoV-2 Infections Due to Omicron Versus Prior Variants : A Propensity-Matched Analysis.Annals of internal medicine · 2024Article
- Ventilator-Associated Pneumonia, Ventilator-Associated Events, and Nosocomial Respiratory Viral Infections on the Leeside of the Pandemic.Respiratory care · 2024Review
- Article
- Reducing Transmission of Airborne Respiratory Pathogens: A New Beginning as the COVID-19 Emergency Ends.Environmental health perspectives · 2024Review
- Frequency, kinetics and determinants of viable SARS-CoV-2 in bioaerosols from ambulatory COVID-19 patients infected with the Beta, Delta or Omicron variants.Nature communications · 2024Article
- Impact of community mask mandates on SARS-CoV-2 transmission in Ontario after adjustment for differential testing by age and sex.PNAS nexus · 2024Article
- COVID-19: An overview on possible transmission ways, sampling matrices and diagnosis.BioImpacts : BI · 2024Review
- The time has come to protect healthcare workers and patients from aerosol transmissible disease.Frontiers in public health · 2024Article
- Five discoveries about COVID-19 made since the public health emergency ended.Nature medicine · 2023Article
- Infectivity of exhaled SARS-CoV-2 aerosols is sufficient to transmit covid-19 within minutes.Scientific reports · 2023Article
- Aerosol Particle Size Influences the Infectious Dose and Disease Severity in a Golden Syrian Hamster Model of Inhalational COVID-19.Journal of aerosol medicine and pulmonary drug delivery · 2023Article
14 more citing papers are in PubMed but not listed here.
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Authors and funding
21 authors.
Funding
Abstract
backgroundSevere acute respiratory syndrome coronavirus 2 (SARS-CoV-2) epidemiology implicates airborne transmission; aerosol infectiousness and impacts of masks and variants on aerosol shedding are not well understood.
methodsWe recruited coronavirus disease 2019 (COVID-19) cases to give blood, saliva, mid-turbinate and fomite (phone) swabs, and 30-minute breath samples while vocalizing into a Gesundheit-II, with and without masks at up to 2 visits 2 days apart. We quantified and sequenced viral RNA, cultured virus, and assayed serum samples for anti-spike and anti-receptor binding domain antibodies.
resultsWe enrolled 49 seronegative cases (mean days post onset 3.8 ± 2.1), May 2020 through April 2021. We detected SARS-CoV-2 RNA in 36% of fine (≤5 µm), 26% of coarse (>5 µm) aerosols, and 52% of fomite samples overall and in all samples from 4 alpha variant cases. Masks reduced viral RNA by 48% (95% confidence interval [CI], 3 to 72%) in fine and by 77% (95% CI, 51 to 89%) in coarse aerosols; cloth and surgical masks were not significantly different. The alpha variant was associated with a 43-fold (95% CI, 6.6- to 280-fold) increase in fine aerosol viral RNA, compared with earlier viruses, that remained a significant 18-fold (95% CI, 3.4- to 92-fold) increase adjusting for viral RNA in saliva, swabs, and other potential confounders. Two fine aerosol samples, collected while participants wore masks, were culture-positive.
conclusionsSARS-CoV-2 is evolving toward more efficient aerosol generation and loose-fitting masks provide significant but only modest source control. Therefore, until vaccination rates are very high, continued layered controls and tight-fitting masks and respirators will be necessary.
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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.