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Health Care Safety

Airborne Spread of SARS-CoV-2 and a Potential Role for Air Disinfection

Educational Objective
To understand that COVID-19 is an airborne disease and can be spread through coughing, sneezing, and breathing

1 Credit CME

JAMA

Published Online: June 1, 2020

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Article Information and Disclosures

Edward A. Nardell, MD¹;

Ruvandhi R. Nathavitharana, MD, MPH²

Author Affiliations

¹Brigham and Women’s Hospital, Division of Global Health Equity, Harvard Medical School, Boston, Massachusetts
²Beth Israel Deaconess Medical Center, Division of Infectious Diseases, Harvard Medical School, Boston, Massachusetts

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An April 2, 2020, expert consultation from the National Academies of Sciences, Engineering, and Medicine to the White House Office of Science and Technology Policy concluded that available studies are consistent with the potential aerosol spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), not only through coughing and sneezing, but by normal breathing.¹ This response to a White House request for a rapid review of the literature likely contributed to the recommendation from the US Centers for Disease Control and Prevention (CDC) that healthy persons wear nonmedical face coverings, when in public, to reduce virus spread from undiagnosed infectious cases.

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Article Information

Corresponding Author: Edward A. Nardell, MD, Brigham and Women’s Hospital, Division of Global Health Equity, Harvard Medical School, 75 Francis St, Boston, MA 02115 (enardell@bwh.harvard.edu).

Published Online: June 1, 2020. doi:10.1001/jama.2020.7603

Conflict of Interest Disclosures: Dr Nardell has been supported entirely by research and implementation grants from the National Institutes of Health (NIH) and the United States Agency for International Development (USAID). Relevant to this commentary, Dr Nardell has consulted on a voluntary basis with the World Health Organization, USAID, Illuminating Engineering Society, and the National Academies of Sciences, Engineering, and Medicine. He has not served as a paid consultant and has no current or past commercial interest in any air disinfection technologies or related products. Dr Nathavitharana reports receipt of grants from NIH and the National Institute of Allergy and Infectious Diseases.

References

Fineberg HV . Rapid Expert Consultation on SARS-CoV-2 Viral Shedding and Antibody Response for the COVID-19 Pandemic (April 8, 2020). National Academies of Science, Engineering, and Medicine; 2020.

Centers for Disease Control and Prevention. Guidelines for Environmental Infection Control in Health-Care Facilities. US Dept of Health and Human Services Centers for Disease Control and Prevention. 2003. Updated July 2019. Accessed May 28, 2020. https://espanol.cdc.gov/infectioncontrol/pdf/guidelines/environmental-guidelines-P.pdf

Mphaphlele M , Dharmadhikari AS , Jensen PA , et al. Institutional tuberculosis transmission controlled trial of upper room ultraviolet air disinfection: a basis for new dosing guidelines. Am J Respir Crit Care Med. 2015;192(4):477-484. doi:10.1164/rccm.201501-0060OC PubMed Google Scholar Crossref

Darnell ME , Subbarao K , Feinstone SM , Taylor DR . Inactivation of the coronavirus that induces severe acute respiratory syndrome, SARS-CoV. J Virol Methods. 2004;121(1):85-91. doi:10.1016/j.jviromet.2004.06.006 PubMed Google Scholar Crossref

McDevitt JJ , Rudnick SN , Radonovich LJ . Aerosol susceptibility of influenza virus to UV-C light. Appl Environ Microbiol. 2012;78(6):1666-1669. doi:10.1128/AEM.06960-11 PubMed Google Scholar Crossref

Bourouiba L . Turbulent gas clouds and respiratory pathogen emissions: potential implications for reducing transmission of COVID-19. JAMA. 2020;323(18):1837-1838. doi:10.1001/jama.2020.4756 PubMed Google Scholar

Graham B . Virus spread that’s left scientists baffled. Daily Examiner. Published March 11, 2020. Accessed May 28, 2020. https://www.dailyexaminer.com.au/news/virus-spread-thats-left-scientists-baffled/3965731/

Yu IT , Li Y , Wong TW , et al. Evidence of airborne transmission of the severe acute respiratory syndrome virus. N Engl J Med. 2004;350(17):1731-1739. doi:10.1056/NEJMoa032867 PubMed Google Scholar Crossref

Waldrop T , Toropin K , Sutton J . 2 Dead from coronavirus, 45 ill after March choir rehearsal. Published (updated) April 2, 2020. Accessed May 28, 2020. www.cnn.com/2020/04/01/us/washington-choir-practice-coronavirus-deaths/index.html

Cowling BJ , Ip DK , Fang VJ , et al. Aerosol transmission is an important mode of influenza A virus spread. Nat Commun. 2013;4:1935. doi:10.1038/ncomms2922 PubMed Google Scholar Crossref

AMA CME Accreditation Information

Credit Designation Statement: The American Medical Association designates this Journal-based CME activity activity for a maximum of 1.00  AMA PRA Category 1 Credit(s)™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Successful completion of this CME activity, which includes participation in the evaluation component, enables the participant to earn up to:

1.00 Medical Knowledge MOC points in the American Board of Internal Medicine's (ABIM) Maintenance of Certification (MOC) program;;
1.00 Self-Assessment points in the American Board of Otolaryngology – Head and Neck Surgery’s (ABOHNS) Continuing Certification program;
1.00 MOC points in the American Board of Pediatrics’ (ABP) Maintenance of Certification (MOC) program;
1.00 Lifelong Learning points in the American Board of Pathology’s (ABPath) Continuing Certification program; and
1.00 CME points in the American Board of Surgery’s (ABS) Continuing Certification program

It is the CME activity provider's responsibility to submit participant completion information to ACCME for the purpose of granting MOC credit.