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Frontiers of Environmental Science & Engineering

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Front. Environ. Sci. Eng.    2021, Vol. 15 Issue (3) : 46    https://doi.org/10.1007/s11783-021-1386-6
RESEARCH ARTICLE
Aerosol transmission, an indispensable route of COVID-19 spread: case study of a department-store cluster
Guanyu Jiang1,2, Can Wang1,2(), Lu Song1,2, Xing Wang3, Yangyang Zhou3, Chunnan Fei4, He Liu4
1. School of Environmental Science and Engineering, Tianjin University, Tianjin 300350, China
2. Tianjin Key Laboratory of Indoor Air Environmental Quality Control, Tianjin 300350, China
3. Tianjin Haihe Hospital, Tianjin 300350, China
4. Tianjin Centers for Disease Control and Prevention, Tianjin 300350, China
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Abstract

• Aerosol transmission is an indispensable route of COVID-19 spread.

• Different outbreak sites have different epidemiologic feature.

• SRAS-CoV-2 can exist for a long time in aerosol.

• SRAS-CoV-2 RNA can be detected in aerosol in diverse places.

• Some environmental factors can impact SARS-CoV-2 transportation in aerosol.

Patients with COVID-19 have revealed a massive outbreak around the world, leading to widespread concerns in global scope. Figuring out the transmission route of COVID-19 is necessary to control further spread. We analyzed the data of 43 patients in Baodi Department Store (China) to supplement the transmission route and epidemiological characteristics of COVID-19 in a cluster outbreak. Incubation median was estimated to endure 5.95 days (2–13 days). Almost 76.3% of patients sought medical attention immediately upon illness onset. The median period of illness onset to hospitalization and confirmation were 3.96 days (0–14) and 5.58 days (1–21), respectively. Patients with different cluster case could demonstrate unique epidemiological characteristics due to the particularity of outbreak sites. SRAS-CoV-2 can be released into the surrounding air through patient’s respiratory tract activities, and can exist for a long time for long-distance transportation. SRAS-CoV-2 RNA can be detected in aerosol in different sites, including isolation ward, general ward, outdoor, toilet, hallway, and crowded public area. Environmental factors influencing were analyzed and indicated that the SARS-CoV-2 transportation in aerosol was dependent on temperature, air humidity, ventilation rate and inactivating chemicals (ozone) content. As for the infection route of case numbers 2 to 6, 10, 13, 16, 17, 18, 20 and 23, we believe that aerosol transmission played a significant role in analyzing their exposure history and environmental conditions in Baodi Department Store. Aerosol transmission could occur in some cluster cases when the environmental factors are suitable, and it is an indispensable route of COVID-19 spread.
Keywords SARS-CoV-2      COVID-19      Environmental factor      Aerosol transmission      Epidemiologic characteristic     
Corresponding Author(s): Can Wang   
Issue Date: 25 December 2020
 Cite this article:   
Guanyu Jiang,Can Wang,Lu Song, et al. Aerosol transmission, an indispensable route of COVID-19 spread: case study of a department-store cluster[J]. Front. Environ. Sci. Eng., 2021, 15(3): 46.
 URL:  
https://academic.hep.com.cn/fese/EN/10.1007/s11783-021-1386-6
https://academic.hep.com.cn/fese/EN/Y2021/V15/I3/46
Fig.1  Functional areas division and patients’ exposure places in Baodi Department Store.
Characteristic Total
(N = 43)		 Salespersons (N = 6) Customers (N = 20) Close contacts (N = 17)
Median age (range) — yr 50(10–90) 42(34–52) 50(26–69) 51(10–90)
Age group — No./total No. (%)<15 yr 1/43(2.3) 0/6(0) 0/20(0) 1/17(5.9)
Age group — No./total No. (%) 15–44 yr 16/43(37.2) 4/6(66.7) 6/20(30) 6/17(35.3)
Age group — No./total No. (%) 45–64 yr 17/43(39.5) 2/6(33.3) 11/20(55) 4/17(23.5)
Age group — No./total No. (%)≥65 yr 9/43(20.9) 0/6(0) 3/20(15) 6/17(35.3)
Female sex — No./total No. (%) 28/43(65.1) 0/6(0) 16/20(80) 6/17(35.3)
Clinical outcome — No./total No. (%) Severe type 3/43(7.0) 2/6(33.3) 0/20(0) 1/17(5.9)
Clinical outcome — No./total No. (%) Common type 20/43(46.5) 2/6(33.3) 10/20(50) 8/17(47.1)
Clinical outcome — No./total No. (%) Slight type 20/43(46.5) 2/6(33.3) 10/20(50) 8/17(47.1)
Tab.1  (a) Characteristics of patients with COIVD-19 in Baodi Department Store
Exposure to Baodi Department Store Total
(N = 26)		 Salespersons
(N = 6)		 Customers
(N = 20)
Costume and shoes area— No./total No. (%) 13/26(50) 4/6(66.7) 9/20(45)
Home appliance area — No./total No. (%) 1/26(3.8) 1/6(1.67) 0/20(0)
Jewelry area — No./total No. (%) 3/26(11.5) 1/6(1.67) 2/20(10)
Headwear area — No./total No. (%) 1/26(3.8) 0/6(0) 1/20(5)
Unknown area — No./total No. (%) 10/26(38.5) 0/6(0) 10/20(50)
  (b) Patients’ exposure in Baodi Department Store
Fig.2  The key dates relating to the epidemic identification of COVID-19.
Fig.3  Key periods distribution of epidemic development: (a) Incubation period; (b) Onset to the first medicine therapy; (c) Onset to hospitalization; (d) Onset to confirmation.
Fig.4  The transmission of exhaled virus between infected and susceptible population.
Fig.5  The transmission chain in salespersons, customers and their close contacts
Sites Environmental description Positivity/Total rate of positivity References
Isolation ward Patients in isolation underwent tracheal intubation the day before the samples 1/20 – 5% Jiang et al., 2020b
Intensive care unit Indoor air near the air outlet 5/14 – 35.7% Guo et al., 2020
Indoor air near the patients 8/18 – 44.4%
Indoor air near the doctors’ office area 1/8 – 12.5%
General ward Indoor air under the air inlet 2/13 – 15.4%
An industrial site of Bergamo Province PM10 samples 5/34 – 14.7% Setti et al., 2020
Isolation ward Isolation of asymptomatic or mildly ill 80/107 – 74.8% Santarpia et al., 2020
Personal care unit For individuals requiring hospital care 34/40 – 85.0%
Hallway Air Samples Sampling at the same time as the ward sample collection -/- – 66.7%
Personal Air Samples low volume personal air samples around patients 7/7 – 100%
Isolation ward Sampling at three isolation wards;
Samples from each room were pooled prior to analysis		 2/3 – 66.7% Chia et al., 2020
Tab.2  Positive SARS-CoV-2 RNA in aerosol at several sites
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