The world is facing a pandemic of unseen proportions caused by a corona virus named SARS-CoV-2 with unprecedent worldwide measures being taken to tackle its contagion. Person-to-person transmission is accepted but WHO only considers aerosol transmission when procedures or support treatments that produce aerosol are performed. Transmission mechanisms are not fully understood and there is evidence for an airborne route to be considered, as the virus remains viable in aerosols for at least 3 h and that mask usage was the best intervention to prevent infection. Heating, Ventilation and Air Conditioning Systems (HVAC) are used as a primary infection disease control measure. However, if not correctly used, they may contribute to the transmission/spreading of airborne diseases as proposed in the past for SARS. The authors believe that airborne transmission is possible and that HVAC systems when not adequately used may contribute to the transmission of the virus, as suggested by descriptions from Japan, Germany, and the Diamond Princess Cruise Ship. Previous SARS outbreaks reported at Amoy Gardens, Emergency Rooms and Hotels, also suggested an airborne transmission. Further studies are warranted to confirm our hypotheses but the assumption of such way of transmission would cause a major shift in measures recommended to prevent infection such as the disseminated use of masks and structural changes to hospital and other facilities with HVAC systems.
Keywords: Aerosol; COVID-19; HVAC; SARS-Cov-2; Ventilation.
Copyright © 2020 Elsevier Ltd. All rights reserved.
Conflict of interest statement
Declaration of Competing Interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
- Environmental factors involved in SARS-CoV-2 transmission: effect and role of indoor environmental quality in the strategy for COVID-19 infection control.Environ Health Prev Med. 2020 Nov 3;25(1):66. doi: 10.1186/s12199-020-00904-2.PMID: 33143660 Free PMC article. Review.
- Can Air-Conditioning Systems Contribute to the Spread of SARS/MERS/COVID-19 Infection? Insights from a Rapid Review of the Literature.Int J Environ Res Public Health. 2020 Aug 20;17(17):6052. doi: 10.3390/ijerph17176052.PMID: 32825303 Free PMC article. Review.
- [Viral transmission in COVID-19: the role of the aerosol].Ned Tijdschr Geneeskd. 2020 Sep 8;164:D5399.PMID: 33030322 Dutch.
- Model Calculations of Aerosol Transmission and Infection Risk of COVID-19 in Indoor Environments.Int J Environ Res Public Health. 2020 Nov 3;17(21):8114. doi: 10.3390/ijerph17218114.PMID: 33153155 Free PMC article.
- Air and environmental sampling for SARS-CoV-2 around hospitalized patients with coronavirus disease 2019 (COVID-19).Infect Control Hosp Epidemiol. 2020 Nov;41(11):1258-1265. doi: 10.1017/ice.2020.282. Epub 2020 Jun 8.PMID: 32507114 Free PMC article.
Cited by 71 articles
- Impulse dispersion of aerosols during playing wind instruments.PLoS One. 2022 Mar 3;17(3):e0262994. doi: 10.1371/journal.pone.0262994. eCollection 2022.PMID: 35239657 Free PMC article.
- Environmental factors influencing the transmission of the coronavirus 2019: a review.Environ Chem Lett. 2022 Feb 21:1-8. doi: 10.1007/s10311-022-01418-9. Online ahead of print.PMID: 35221835 Free PMC article. Review.
- Simulation Studies Provide Evidence of Aerosol Transmission of SARS-CoV-2 in a Multi-Story Building via Air Supply, Exhaust and Sanitary Pipelines.Int J Environ Res Public Health. 2022 Jan 29;19(3):1532. doi: 10.3390/ijerph19031532.PMID: 35162557 Free PMC article.
- Photothermal inactivation of universal viral particles by localized surface plasmon resonance mediated heating filter membrane.Sci Rep. 2022 Feb 2;12(1):1724. doi: 10.1038/s41598-022-05738-2.PMID: 35110635 Free PMC article.
- Airborne and aerosol pathogen transmission modeling of respiratory events in buildings: An overview of computational fluid dynamics.Sustain Cities Soc. 2022 Apr;79:103704. doi: 10.1016/j.scs.2022.103704. Epub 2022 Jan 19.PMID: 35070645 Free PMC article. Review.
- Coronavirus disease (COVID-2019) situation reports. 2020. (Accessed 26th of February 2020, at https://www.who.int/emergencies/diseases/novel-coronavirus-2019/situatio….).
- Wang D, Zhou M, Nie X, Qiu W, Yang M, Wang X, et al. Epidemiological characteristics and transmission model of Corona Virus Disease 2019 in China. J Infect [Internet]. 2020 Mar; Available from: https://linkinghub.elsevier.com/retrieve/pii/S0163445320301201. – PMC – PubMed
- Shiu EYC, Leung NHL, Cowling BJ. Controversy around airborne versus droplet transmission of respiratory viruses. Curr Opin Infect Dis [Internet]. 2019 Aug;32(4):372–9. Available from: http://insights.ovid.com/crossref?an=00001432-201908000-00012. – PubMed
- Han Q., Lin Q., Ni Z., You L. Uncertainties about the transmission routes of 2019 novel coronavirus. Influenza Other Respi Viruses. 2020:1–2.