Practical Indicators for Risk of Airborne Transmission in Shared Indoor Environments and their application to COVID-19 Outbreaks

Some infectious diseases, including COVID-19, can be transmitted via aerosols that are emitted by an infectious person and inhaled by susceptible individuals. Although physical distancing effectively reduces short-range airborne transmission, many infections have occurred when sharing room air despite maintaining distancing. We propose two simple parameters as indicators of infection risk for this situation. They combine the key factors that control airborne disease transmission indoors: virus-containing aerosol generation rate, breathing flow rate, masking and its quality, ventilation and air cleaning rates, number of occupants, and duration of exposure. COVID-19 outbreaks show a clear trend in relation to these parameters that is consistent with an airborne infection model, supporting the importance of airborne transmission for these outbreaks. The observed trends of outbreak size vs. risk parameters allow us to recommend values of the parameters to minimize COVID-19 indoor infection risk. All of the pre-pandemic spaces are in a regime where they are highly sensitive to mitigation efforts. Measles outbreaks occur at much lower risk parameter values than COVID-19, while tuberculosis outbreaks are observed at much higher risk parameter values. Since both diseases are accepted as airborne, the fact that COVID-19 is less contagious than measles does not rule out airborne transmission. It is important that future outbreak reports include ventilation information, to allow expanding our knowledge of the circumstances conducive to airborne transmission of different diseases.