The Infectious Nature of Patient-Generated SARS-CoV-2 Aerosol

Joshua L Santarpia, Vicki L Herrera, Danielle N Rivera, Shanna Ratnesar-Shumate, St. Patrick Reid, Paul W Denton, Jacob W.S. Martens, Ying Fang, Nicholas Conoan, Michael V Callahan, James V Lawler, David M Brett-Major, John J Lowe

Research output: Working paper


Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission causing coronavirus disease 2019 (COVID-19) may occur through multiple routes. We collected aerosol samples around six patients admitted into mixed acuity wards in April of 2020 to identify the risk of airborne SARS-CoV-2. Measurements were made to characterize the size distribution of aerosol particles, and size-fractionated, aerosol samples were collected to assess the presence of infectious virus in particles sizes of gt;4.1 μm, 1-4 μm, and lt;1 μm in the patient environment. Samples were analyzed by real-time reverse-transcriptase polymerase chain reaction (rRT-PCR), cell culture, western blot, and transmission electron microscopy (TEM). SARS-CoV-2 RNA was detected in all six rooms in all particle size fractions (gt;4.1 μm, 1-4 μm, and lt;1 μm). Increases in viral RNA during cell culture of the virus from recovered aerosol samples demonstrated the presence of infectious, replicating virions in three lt;1 μm aerosol samples (Plt;0.05). Viral replication of aerosol was also observed in the 1-4 μm stage but did not reach statistical significance (0.05lt;Plt;0.10). Western blot and TEM analysis of these samples also showed evidence of viral proteins and intact virions. The infectious nature of aerosol collected in this study further suggests that airborne transmission of COVID-19 is possible, and that aerosol prevention measures are necessary to effectively stem the spread of SARS-CoV-2.Competing Interest StatementThe authors have declared no competing interest.Funding StatementInternal Funding from the University of Nebraska Medical CenterAuthor DeclarationsAll relevant ethical guidelines have been followed; any necessary IRB and/or ethics committee approvals have been obtained and details of the IRB/oversight body are included in the manuscript.YesAll necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived.YesI understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance).Yes I have followed all appropriate research reporting guidelines and uploaded the relevant EQUATOR Network research reporting checklist(s) and other pertinent material as supplementary files, if applicable.YesAll data is available in the main text or the supplementary materials
Original languageEnglish (US)
PublisherCold Spring Harbor Laboratory Press
Number of pages12
StateIn preparation - Jul 20 2020

Publication series



  • Coronavirus
  • COVID-19
  • severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
  • Novel coronavirus
  • 2019-nCoV
  • Pandemic


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