Viral Load of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) in Respiratory Aerosols Emitted by Patients With Coronavirus Disease 2019 (COVID-19) While Breathing, Talking, and Singing

Author:

Coleman Kristen K1ORCID,Tay Douglas Jie Wen2,Tan Kai Sen3456,Ong Sean Wei Xiang78,Than The Son12,Koh Ming Hui2,Chin Yi Qing7,Nasir Haziq9,Mak Tze Minn7,Chu Justin Jang Hann35610,Milton Donald K11,Chow Vincent T K35,Tambyah Paul Anantharajah59,Chen Mark78,Tham Kwok Wai2

Affiliation:

1. Program in Emerging Infectious Diseases, Duke-NUS Medical School, Singapore

2. Department of the Built Environment, National University of Singapore, Singapore

3. Department of Microbiology and Immunology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore

4. Department of Otolaryngology, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore

5. Infectious Diseases Translational Research Program, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore

6. Biosafety Level 3 Core Facility, Yong Loo Lin School of Medicine, National University of Singapore, National University Health System, Singapore

7. National Centre for Infectious Diseases, Singapore

8. Department of Infectious Diseases, Tan Tock Seng Hospital, Singapore

9. Division of Infectious Diseases, Department of Medicine, National University Health System, National University of Singapore, Singapore

10. Institute of Molecular and Cell Biology, Agency for Science, Technology and Research (A*STAR), Singapore

11. Maryland Institute for Applied Environmental Health, University of Maryland School of Public Health, College Park, Maryland, USA

Abstract

Abstract Background Multiple severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) superspreading events suggest that aerosols play an important role in driving the coronavirus disease 2019 (COVID-19) pandemic. To better understand how airborne SARS-CoV-2 transmission occurs, we sought to determine viral loads within coarse (>5 μm) and fine (≤5 μm) respiratory aerosols produced when breathing, talking, and singing. Methods Using a G-II exhaled breath collector, we measured viral RNA in coarse and fine respiratory aerosols emitted by COVID-19 patients during 30 minutes of breathing, 15 minutes of talking, and 15 minutes of singing. Results Thirteen participants (59%) emitted detectable levels of SARS-CoV-2 RNA in respiratory aerosols, including 3 asymptomatic and 1 presymptomatic patient. Viral loads ranged from 63–5821 N gene copies per expiratory activity per participant, with high person-to-person variation. Patients earlier in illness were more likely to emit detectable RNA. Two participants, sampled on day 3 of illness, accounted for 52% of total viral load. Overall, 94% of SARS-CoV-2 RNA copies were emitted by talking and singing. Interestingly, 7 participants emitted more virus from talking than singing. Overall, fine aerosols constituted 85% of the viral load detected in our study. Virus cultures were negative. Conclusions Fine aerosols produced by talking and singing contain more SARS-CoV-2 copies than coarse aerosols and may play a significant role in SARS-CoV-2 transmission. Exposure to fine aerosols, especially indoors, should be mitigated. Isolating viable SARS-CoV-2 from respiratory aerosol samples remains challenging; whether this can be more easily accomplished for emerging SARS-CoV-2 variants is an urgent enquiry necessitating larger-scale studies.

Publisher

Oxford University Press (OUP)

Subject

Infectious Diseases,Microbiology (medical)

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