Speech can produce jet-like transport relevant to asymptomatic spreading of virus

Airborne respiratory aerosol transport and deposition in a two-person office using a novel diffusion-based numerical model

BACKGROUND

The COVID-19 pandemic was caused by the SARS-CoV-2 coronaviruses transmitted mainly through exposure to airborne respiratory droplets and aerosols carrying the virus.

OBJECTIVE

To assess the transport and dispersion of respiratory aerosols containing the SARS-CoV-2 virus and other viruses in a small office space using a diffusion-based computational modeling approach.

METHODS

A 3-D computational model was used to simulate the airflow inside the 70.2 m3 ventilated office. A novel diffusion model accounting for turbulence dispersion and gravitational sedimentation was utilized to predict droplet concentration transport and deposition. The numerical model was validated and used to investigate the influences of partition height and different ventilation rates on the concentration of respiratory aerosols of various sizes (1, 10, 20, and 50 µm) emitted by continuous speaking.

RESULTS

An increase in the hourly air change rate (ACH) from 2.0 to 5.6 decreased the 1 μm droplet concentration inside the office by a factor of 2.8 and in the breathing zone of the receptor occupant by a factor of 3.2. The concentration at the receptor breathing zone is estimated by the area-weighted average of a 1 m diameter circular disk, with its centroid at the center of the receptor mannequin mouth. While all aerosols were dispersed by airflow turbulence, the gravitational sedimentation significantly influenced the transport of larger aerosols in the room. The 1 and 10 μm aerosols remained suspended in the air and dispersed throughout the room. In contrast, the larger 20 and 50 μm aerosols deposited on the floor quickly due to the gravitational sedimentation. Increasing the partition between cubicles by 0.254 m (10") has little effect on the smaller aerosols and overall exposure.

IMPACT

This paper provides an efficient computational model for analyzing the concentration of different respiratory droplets and aerosols in an indoor environment. Thus, the approach could be used for assessing the influence of the spatial concentration variations on exposure for which the fully mixed model cannot be used.

A safer framework to evaluate characterization technologies of exhaled biologic materials using electrospun nanofibers

Exhaled biologic material is the source for the spread of many respiratory tract infections. To avoid the high-level of biosafety required to manage dangerous pathogens, we developed a safer framework using the endogenous surrogate targets RNase P and Streptococcus mitis as a means to sample exhaled biologics. Our exhalation collection scheme uses nanoscale fibrous poly(vinyl alcohol) substrates as facemask inserts. After a period of breathing or speaking, the inserts are removed and dissolved. RNase P RNA and S. mitis DNA are extracted for quantification by multiplexed RT-qPCR. Both surrogate biomarkers were detected in all samples obtained during breathing for at least five minutes or speaking for one minute. Phrases repeated 30 times had the most copies with 375 ± 247 of S. mitis and 54 ± 33 of RNase P. When the phrases were repeated just 5 times, the S. mitis copies collected were still detectable but at a significantly lower level of 11 ± 5 for S. mitis and 12 ± 9 for RNase P. These results demonstrate a collection and quantification framework that can be readily adapted to further characterize the exhalation of nanoscale biologic materials from healthy individuals, explore new collection designs safely, and serve as a method to incorporate sample controls for future pathogen exhalation studies.

The role of mucosal barriers in disease progression and transmission

Mucus is a biological hydrogel that coats and protects all non-keratinized wet epithelial surfaces. Mucins, the primary structural components of mucus, are critical components of the gel layer that protect against invading pathogens. For communicable diseases, pathogen-mucin interactions contribute to the pathogen's fate and the potential for disease progression in-host, as well as the potential for onward transmission. We begin by reviewing in-host mucus filtering mechanisms, including size filtering and interaction filtering, which regulate the permeability of mucus barriers to all molecules including pathogens. Next, we discuss the role of mucins in communicable diseases at the point of transmission (i.e. how the encapsulation of pathogens in emitted mucosal droplets externally to hosts may modulate pathogen infectivity and viability). Overall, mucosal barriers modulate both host susceptibility as well as the dynamics of population-level disease transmission. The study of mucins and their use in models and experimental systems are therefore crucial for understanding the mechanistic biophysical principles underlying disease transmission and the early stages of host infection.

Influence of two-dimensional expiratory airflow variations on respiratory particle propagation during pronunciation of the fricative [f]

Propagation of respiratory particles, potentially containing viable viruses, plays a significant role in the transmission of respiratory diseases (e.g., COVID-19) from infected people. Particles are produced in the upper respiratory system and exit the mouth during expiratory events such as sneezing, coughing, talking, and singing. The importance of considering speaking and singing as vectors of particle transmission has been recognized by researchers. Recently, in a companion paper, dynamics of expiratory flow during fricative utterances were explored, and significant variations of airflow jet trajectories were reported. This study focuses on respiratory particle propagation during fricative productions and the effect of airflow variations on particle transport and dispersion as a function of particle size. The commercial ANSYS-Fluent computational fluid dynamics (CFD) software was employed to quantify the fluid flow and particle dispersion from a two-dimensional mouth model of sustained fricative [f] utterance as well as a horizontal jet flow model. The fluid velocity field and particle distributions estimated from the mouth model were compared with those of the horizontal jet flow model. The significant effects of the airflow jet trajectory variations on the pattern of particle transport and dispersion during fricative utterances were studied. Distinct differences between the estimations of the horizontal jet model for particle propagation with those of the mouth model were observed. The importance of considering the vocal tract geometry and the failure of a horizontal jet model to properly estimate the expiratory airflow and respiratory particle propagation during the production of fricative utterances were emphasized.

First impressions of a new face are shaped by infection concerns

Along with a classical immune system, we have evolved a behavioral one that directs us away from potentially contagious individuals. Here I show, using publicly available cross-cultural data, that this adaptation is so fundamental that our first impressions of a male stranger are largely driven by the perceived health of his face. Positive (likeable, capable, intelligent, trustworthy) and negative (unfriendly, ignorant, lazy) first impressions are affected by facial health in adaptively different ways, inconsistent with a mere halo effect; they are also modulated by one's current state of health and inclination to feel disgusted by pathogens. These findings, which replicated across two countries as different as the USA and India, suggest that instinctive perceptions of badness and goodness from faces are not two sides of the same coin but reflect the (nonsymmetrical) expected costs and benefits of interaction. Apparently, pathogens run the show-and first impressions come second. Lay Summary: Our first impressions of strangers (whether they seem trustworthy, intelligent, unfriendly, or aggressive) are shaped by how healthy their faces look and by our unconscious motivation to avoid infections. Bad and good impressions turn out to reflect the concrete, potentially vital, expected costs and benefits of interacting with our fellow humans. Apparently, pathogens run the show-and first impressions come second.

Comparison of Aerosol Emissions during Specific Speech Tasks

OBJECTIVES/HYPOTHESIS

Recent investigations into the behavior of aerosolized emissions from the oral cavity have shown that particulate emissions do indeed occur during speech. To date, there is little information about the relative contribution of different speech sounds in producing particle emissions in a free field. This study compares airborne aerosol generation in participants producing isolated speech sounds: fricative consonants, plosive consonants, and vowel sounds.

STUDY DESIGN

Prospective, reversal experimental design, where each participant served as their own control and all participants were exposed to all stimuli.

METHODS

While participants produced isolated speech tasks, a planar beam of laser light, a high-speed camera, and image software calculated the number of particulates detected over time. This study compared airborne aerosols emitted by human participants at a distance of 2.54 cm between the laser sheet and the mouth.

RESULTS

Statistically significant increases in particulate count over ambient dust distribution for all speech sounds. When collapsed across loudness levels, emitted particles in vowel sounds were statistically greater than consonants, suggesting that mouth opening, as opposed to the place of vocal tract constriction or manner of sound production, might also be influential in the degree to which particulates become aerosolized during speech.

CONCLUSIONS

The results of this research will inform boundary conditions for computational models of aerosolized particulates during speech.

Aerosols, airflow, and more: examining the interaction of speech and the physical environment

We describe ongoing efforts to better understand the interaction of spoken languages and their physical environments. We begin by briefly surveying research suggesting that languages evolve in ways that are influenced by the physical characteristics of their environments, however the primary focus is on the converse issue: how speech affects the physical environment. We discuss the speech-based production of airflow and aerosol particles that are buoyant in ambient air, based on some of the results in the literature. Most critically, we demonstrate a novel method used to capture aerosol, airflow, and acoustic data simultaneously. This method captures airflow data via a pneumotachograph and aerosol data via an electrical particle impactor. The data are collected underneath a laminar flow hood while participants breathe pure air, thereby eliminating background aerosol particles and isolating those produced during speech. Given the capabilities of the electrical particle impactor, which has not previously been used to analyze speech-based aerosols, the method allows for the detection of aerosol particles at temporal and physical resolutions exceeding those evident in the literature, even enabling the isolation of the role of individual sound types in the production of aerosols. The aerosols detected via this method range in size from 70 nanometers to 10 micrometers in diameter. Such aerosol particles are capable of hosting airborne pathogens. We discuss how this approach could ultimately yield data that are relevant to airborne disease transmission and offer preliminary results that illustrate such relevance. The method described can help uncover the actual articulatory gestures that generate aerosol emissions, as exemplified here through a discussion focused on plosive aspiration and vocal cord vibration. The results we describe illustrate in new ways the unseen and unheard ways in which spoken languages interact with their physical environments.

Large eddy simulation of droplet transport and deposition in the human respiratory tract to evaluate inhalation risk

As evidenced by the worldwide pandemic, respiratory infectious diseases and their airborne transmission must be studied to safeguard public health. This study focuses on the emission and transport of speech-generated droplets, which can pose risk of infection depending on the loudness of the speech, its duration and the initial angle of exhalation. We have numerically investigated the transport of these droplets into the human respiratory tract by way of a natural breathing cycle in order to predict the infection probability of three strains of SARS-CoV-2 on a person who is listening at a one-meter distance. Numerical methods were used to set the boundary conditions of the speaking and breathing models and large eddy simulation (LES) was used for the unsteady simulation of approximately 10 breathing cycles. Four different mouth angles when speaking were contrasted to evaluate real conditions of human communication and the possibility of infection. Breathed virions were counted using two different approaches: the breathing zone of influence and direction deposition on the tissue. Our results show that infection probability drastically changes based on the mouth angle and the breathing zone of influence overpredicts the inhalation risk in all cases. We conclude that to portray real conditions, the probability of infection should be based on direct tissue deposition results to avoid overprediction and that several mouth angles must be considered in future analyses.

Conversational head movement decreases close-contact exposure to expired respiratory droplets

People constantly move their heads during conversation, as such movement is an important non-verbal mode of communication. Head movement alters the direction of people's expired air flow, therefore affecting their conversational partners' level of exposure. Nevertheless, there is a lack of understanding of the mechanism whereby head movement affects people's exposure. In this study, a dynamic meshing method in computational fluid dynamics was used to simulate the head movement of a human-shaped thermal manikin. Droplets were released during the oral expiration periods of the source manikin, during which it was either motionless, was shaking its head or was nodding its head, while the head of a face-to-face target manikin remained motionless. The results indicate that the target manikin had a high level of exposure to respiratory droplets when the source manikin was motionless, whereas the target manikin's level of exposure was significantly reduced when the source manikin was shaking or nodding its head. The source manikin had the highest level of self-exposure when it was nodding its head and the lowest level of self-exposure when its head was motionless. People's level of exposure during close contact is highly variable, highlighting the need for further investigations in more realistic conversational scenarios.

Inhalation of virus-loaded droplets as a clinically plausible pathway to deep lung infection

Respiratory viruses, such as SARS-CoV-2, preliminarily infect the nasopharyngeal mucosa. The mechanism of infection spread from the nasopharynx to the deep lung-which may cause a severe infection-is, however, still unclear. We propose a clinically plausible mechanism of infection spread to the deep lung through droplets, present in the nasopharynx, inhaled and transported into the lower respiratory tract. A coupled mathematical model of droplet, virus transport and virus infection kinetics is exercised to demonstrate clinically observed times to deep lung infection. The model predicts, in agreement with clinical observations, that severe infection can develop in the deep lung within 2.5-7 days of initial symptom onset. Results indicate that while fluid dynamics plays an important role in transporting the droplets, infection kinetics and immune responses determine infection growth and resolution. Immune responses, particularly antibodies and T-lymphocytes, are observed to be critically important for preventing infection severity. This reinforces the role of vaccination in preventing severe infection. Managing aerosolization of infected nasopharyngeal mucosa is additionally suggested as a strategy for minimizing infection spread and severity.

Predominance of inhalation route in short-range transmission of respiratory viruses: Investigation based on computational fluid dynamics

During the Coronavirus disease 2019 pandemic, short-range virus transmission has been observed to have a higher risk of causing infection than long-range virus transmission. However, the roles played by the inhalation and large droplet routes cannot be distinguished in practice. A recent analytical study revealed the predominance of short-range inhalation over the large droplet spray route as causes of respiratory infections. In the current study, short-range exposure was analyzed via computational fluid dynamics (CFD) simulations using a discrete phase model. Detailed facial membranes, including eyes, nostrils, and a mouth, were considered. In CFD simulations, there is no need for a spherical approximation of the human head for estimating deposition nor the "anisokinetic aerosol sampling" approximation for estimating inhalation in the analytical model. We considered two scenarios (with two spheres [Scenario 1] and two human manikins [Scenario 2]), source-target distances of 0.2 to 2 m, and droplet diameters of 3 to 1,500 µm. The overall CFD exposure results agree well with data previously obtained from a simple analytical model. The CFD results confirm the predominance of the short-range inhalation route beyond 0.2 m for expiratory droplets smaller than 50 µm during talking and coughing. A critical droplet size of 87.5 µm was found to differentiate droplet behaviors. The number of droplets deposited on the target head exceeded those exposed to facial membranes, which implies a risk of exposure through the immediate surface route over a short range.

Electronic Supplementary Material ESM

the Supplementary Materials are available in the online version of this article at 10.1007/s12273-022-0968-y.

Multiscale landscaping of droplet wettability on fibrous layers of facial masks

Liquid mobility is ubiquitous in nature, with droplets emerging at all size scales, and artificial surfaces have been designed to mimic such mobility over the past few decades. Meanwhile, millimeter-sized droplets are frequently used for wettability characterization, even with facial mask applications, although these applications have a droplet-size target range that spans from millimeters to aerosols measuring less than a few micrometers. Unlike large droplets, microdroplets can interact sensitively with the fibers they contact with and are prone to evaporation. However, wetting behaviors at the single-microfiber level remain poorly understood. Herein, we characterized the wettability of fibrous layers, which revealed that a multiscale landscape of droplets ranged from the millimeter to the micrometer scale. The contact angle (CA) values of small droplets on pristine fibrous media showed sudden decrements, especially on a single microfiber, owing to the lack of air cushions for the tiny droplets. Moreover, droplets easily adhered to the pristine layer during droplet impact tests and then yielding widespread areas of contamination on the microfibers. To resolve this, we carved nanowalls on the pristine fibers by plasma etching, which effectively suppressed such wetting phenomena. Significantly, the resulting topographies of the microfibers managed the dynamic wettability of droplets at the multiscale, which reduced the probability of contamination with impact droplets and suppressed the wetting transition upon evaporation. These findings for the dynamic wettability of fibrous media will be useful in the fight against infectious droplets.

Effects of upper respiratory tract anatomy and head movement on the buoyant flow and particle dispersion generated in a violent expiratory event

In the wake of the COVID-19 pandemic, interest in understanding the turbulent dispersion of airborne pathogen-laden particles has significantly increased. The ability of infectious particles to stay afloat and disperse in indoor environments depends on their size, the environmental conditions and the hydrodynamics of the flow generated by the exhalation. In this work we analyze the impact of three different aspects, namely, the buoyancy force, the upper airways geometry and the head rotation during the exhalation on the short-term dispersion. Large-Eddy Simulations have been used to assess the impact of each separate effect on the thermal puff and particle cloud evolution over the first 2 s after the onset of the exhalation. Results obtained during this short-term period suggest that due to the rapid mixing of the turbulent puff, buoyancy forces play a moderate role on the ability of the particles to disperse. Because of the enhanced mixing, buoyancy reduces the range and increases the vertical size of the small particle clouds. In comparison to the fixed frame case, head rotation has been found to notably affect the size and shape of the cloud by enhancing the vertical transport as the exhalation axial direction sweeps vertically during the exhalation. The impact of the upper airway geometry, in comparison to an idealized mouth consisting in a pipe of circular section, has been found to be the largest when it is considered along with the head rotation.

Snoring may transmit infectious aerosols from the upper to the lower respiratory tract

Migration to the lungs of an initial upper airway infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) or other respiratory pathogens can lead to pneumonia, associated with progression from mild to severe symptoms. Chemical pneumonitis or bacterial pneumonia may be caused by the ‘macroaspiration’ of large volumes of oropharyngeal or gastroesophageal secretions into the lower respiratory tract. ‘Microaspiration’, i.e., a similar mechanism but involving much smaller amounts of oropharyngeal secretions, is considered the pathogenetic mechanism for most pneumonias, including that associated with COVID-19. Here, we hypothesize an alternative mechanism: Rather than by microaspiration, these fluids enter the lungs as microdroplets that are generated by snoring and then carried by the inspired airstream. Laboratory measurements indicate that snoring generates (a) comparable numbers and sizes of oral fluid droplets as loud speaking and (b) total fluid quantities that are similar to those reported for microaspiration. Snoring propensity is strongly correlated to known risk factors for severe COVID-19, including male gender, age, obesity, diabetes, obstructive sleep apnea, and pregnancy. Therefore, more research is urgently needed to determine if various methods that decrease snoring can prevent progression to pneumonia after initial infection of the upper airways.

Risk assessment for long- and short-range airborne transmission of SARS-CoV-2, indoors and outdoors

Preventive measures to reduce infection are needed to combat the COVID-19 pandemic and prepare for a possible endemic phase. Current prophylactic vaccines are highly effective to prevent disease but lose their ability to reduce viral transmission as viral evolution leads to increasing immune escape. Long-term proactive public health policies must therefore complement vaccination with available nonpharmaceutical interventions aiming to reduce the viral transmission risk in public spaces. Here, we revisit the quantitative assessment of airborne transmission risk, considering asymptotic limits that considerably simplify its expression. We show that the aerosol transmission risk is the product of three factors: a biological factor that depends on the viral strain, a hydrodynamical factor defined as the ratio of concentration in viral particles between inhaled and exhaled air, and a face mask filtering factor. The short-range contribution to the risk, present both indoors and outdoors, is related to the turbulent dispersion of exhaled aerosols by air drafts and by convection (indoors), or by the wind (outdoors). We show experimentally that airborne droplets and CO₂ molecules present the same dispersion. As a consequence, the dilution factor, and therefore the risk, can be measured quantitatively using the CO₂ concentration, regardless of the room volume, the flow rate of fresh air, and the occupancy. We show that the dispersion cone leads to a concentration in viral particles, and therefore a short-range transmission risk, inversely proportional to the squared distance to an infected person and to the flow velocity. The aerosolization criterion derived as an intermediate result, which compares the Stokes relaxation time to the Lagrangian time-scale, may find application for a broad class of aerosol-borne pathogens and pollutants.

The effects of indoor temperature and humidity on local transmission of COVID-19 and how it relates to global trends

During the COVID-19 pandemic, analyses on global data have not reached unanimous consensus on whether warmer and humid weather curbs the spread of the SARS-CoV-2 virus. We conjectured that this lack of consensus is due to the discrepancy between global environmental data such as temperature and humidity being collected outdoors, while most infections have been reported to occur indoors, where conditions can be different. Thus, we have methodologically investigated the effect of temperature and relative humidity on the spread of expired respiratory droplets from the mouth, which are assumed to be the main cause of most short-range infections. Calculating the trajectory of individual droplets using an experimentally validated evaporation model, the final height and distance of the evaporated droplets is obtained, and then correlated with global COVID-19 spread. Increase in indoor humidity is associated with reduction in COVID-19 spread, while temperature has no statistically significant effect.

Assessing suspension and infectivity times of virus-loaded aerosols involved in airborne transmission

Airborne transmission occurs through droplet-mediated transport of viruses following the expulsion of an aerosol by an infected host. Transmission efficiency results from the interplay between virus survival in the drying droplet and droplet suspension time in the air, controlled by the coupling between water evaporation and droplet sedimentation. Furthermore, droplets are made of a respiratory fluid and thus, display a complex composition consisting of water and nonvolatile solutes. Here, we quantify the impact of this complex composition on the different phenomena underlying transmission. Solutes lead to a nonideal thermodynamic behavior, which sets an equilibrium droplet size that is independent of relative humidity. In contrast, solutes do not significantly hinder transport due to their low initial concentration. Realistic suspension times are computed and increase with increasing relative humidity or decreasing temperature. By uncoupling drying and suspended stages, we observe that enveloped viruses may remain infectious for hours in dried droplets. However, their infectivity decreases with increasing relative humidity or temperature after dozens of minutes. Examining expelled droplet size distributions in the light of these results leads to distinguishing two aerosols. Most droplets measure between 0 and 40 µm and compose an aerosol that remains suspended for hours. Its transmission efficiency is controlled by infectivity, which decreases with increasing humidity and temperature. Larger droplets form an aerosol that only remains suspended for minutes but corresponds to a much larger volume and thus, viral load. Its transmission efficiency is controlled by droplet suspension time, which decreases with increasing humidity and decreasing temperature.

Propagation of H1N1 virus through saliva movement in oesophagus: a mathematical model

H1N1 (Swine flu) is caused by the influenza A virus which belongs to the Orthomyxoviridae family. Influenza A is very harmful to the elderly, and people with chronic respiratory disease and cardiovascular disease. Therefore, it is essential to analyse the behaviour of virus transmission through the saliva movement in oesophagus. A mathematical paradigm is developed to study the saliva movement under the applications of transverse magnetic field. Jeffrey fluid model is considered for saliva to show the viscoelastic nature. The flow nature is considered creeping and assumptions of long wavelength and low Reynolds number are adopted for analytical solutions. The Basset-Boussinesq-Oseen equation is employed to understand the propagation of H1N1 virus through saliva under the effect of applicable forces such as gravity, virtual mass, basset force, and drag forces. The suitable data for saliva, oesophagus and H1N1 virus are taken from the existing literature for simulation of the results using MATLAB software. From the graphical results, it is observed that the susceptibility to viral infections is less because the magnetic field reduces the motion of the virus particle. Further, the chances of infections in males are more as compared to females and children due to variation in viscosity of saliva. Such findings provide an understanding of the mechanics of the virus floating through the saliva (viscoelastic fluids) in the oesophagus.

Exposure and respiratory infection risk via the short-range airborne route

Leading health authorities have suggested short-range airborne transmission as a major route of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). However, there is no simple method to assess the short-range airborne infection risk or identify its governing parameters. We proposed a short-range airborne infection risk assessment model based on the continuum model and two-stage jet model. The effects of ventilation, physical distance and activity intensity on the short-range airborne exposure were studied systematically. The results suggested that increasing physical distance and ventilation reduced short-range airborne exposure and infection risk. However, a diminishing return phenomenon was observed when the ventilation rate or physical distance was beyond a certain threshold. When the infectious quantum concentration was less than 1 quantum/L at the mouth, our newly defined threshold distance and threshold ventilation rate were independent of quantum concentration. We estimated threshold distances of 0.59, 1.1, 1.7 and 2.6 m for sedentary/passive, light, moderate and intense activities, respectively. At these distances, the threshold ventilation was estimated to be 8, 20, 43, and 83 L/s per person, respectively. The findings show that both physical distancing and adequate ventilation are essential for minimising infection risk, especially in high-intensity activity or densely populated spaces.

Electropalatography (EPG) activities in Japan and the impact of the COVID-19 pandemic on EPG research and therapy: A report of presentations at the 7th EPG Symposium

BACKGROUND

At the 7th Electropalatography Symposium in Japan, held online on the 24 January 2021, a few speakers were invited to talk about how the COVID-19 pandemic had impacted their research and/or speech therapy that involved the use of electropalatography (EPG) as well as the procedures adopted in order to continue their work in a safe manner. The information on protective measures when using instrumental techniques in speech research and therapy may be useful for colleagues in research and the clinic.

AIMS

The primary aims are: (1) to find out whether there are any published recommendations regarding protective measures for using EPG in research and clinic settings; (2) to discuss the impact of the pandemic and the corresponding restrictions and general protective measures directed (or advised) by local government and professional bodies at each stage of EPG work; and (3) to share experiences in using modified procedures for face-to-face EPG therapy sessions and combined EPG teletherapy. In addition, a brief overview of EPG and a summary of EPG research and clinical activities in Japan presented by one of the symposium organizers at the symposium are included.

METHODS & PROCEDURES

A review of the literature regarding protective measures recommended for using EPG for speech assessment and treatment or research, supplemented by a discussion of our own experiences.

MAIN CONTRIBUTION

The literature review showed that there are no guidelines regarding protective measures for using EPG, but there is some advice regarding speech recording using microphones. Most published articles related to speech and language therapy (SLT) service during COVID-19 are about telepractice or general clinical guidelines for face-to-face speech therapy sessions. The protective measures for using EPG developed based on the general guidelines recommended by local government and professional bodies (e.g., using visors, transparent acrylic board) were described. Using EPG in telepractice was discussed as well.

CONCLUSIONS

It has been challenging to continue EPG research and therapy during the pandemic. In order to deal with this crisis, available knowledge regarding infection control and recommendations from local government and professional bodies were applied to design methods and procedures that allowed EPG research and therapy to continue.

WHAT THIS PAPER ADDS

What is already known on the subject There are general protective measures recommended by local government and professional bodies regarding speech therapy sessions (e.g., using personal protective equipment (PPE), social distancing), but little is known about the measures for using instrumental techniques in speech research and therapy, particularly EPG. The equipment of each instrumental technique is different, so measures that are appropriate for one may not be suitable for others. Hence, specific recommendations are needed for EPG. What this paper adds to existing knowledge This paper provides pointers to information about recommendations regarding protective measures for speech research and therapy, supplemented with suggestions specific to EPG provided by experienced users based on actual experience. What are the potential or actual clinical implications of this work? In evaluating the impact of the COVID-19 pandemic on EPG research and therapy, an analytical approach was taken to break down the steps involved in carrying out those activities, and the challenges we faced and the possible alternatives for completing the tasks were discussed. A similar approach can be applied to evaluate other aspects of speech therapy service.

Hybrid measurement of respiratory aerosol reveals a dominant coarse fraction resulting from speech that remains airborne for minutes

Respiratory droplets are widely recognized as the primary vehicle in viral respiratory disease transmission. Accurate information on their number and size distributions is important for appropriate mitigation strategies, for quantitative modeling of airborne disease transmission, and for evaluating the relative importance of droplets originating from saliva versus airway lining fluid. A straightforward experimental setup using inexpensive, readily available components is developed for simultaneous characterization of larger particles by video analysis of laser light scattering and monitoring of smaller sizes by an optical particle counter. Measurements indicate that in a healthy volunteer, the airborne mass of speech aerosol far exceeds that generated by breathing, even when accounting for faster sedimentation of the larger particles.

Accurate measurements of the size and quantity of aerosols generated by various human activities in different environments are required for efficacious mitigation strategies and accurate modeling of respiratory disease transmission. Previous studies of speech droplets, using standard aerosol instrumentation, reported very few particles larger than 5 μm. This starkly contrasts with the abundance of such particles seen in both historical slide deposition measurements and more recent light scattering observations. We have reconciled this discrepancy by developing an alternative experimental approach that addresses complications arising from nucleated condensation. Measurements reveal that a large volume fraction of speech-generated aerosol has diameters in the 5- to 20-μm range, making them sufficiently small to remain airborne for minutes, not hours. This coarse aerosol is too large to penetrate the lower respiratory tract directly, and its relevance to disease transmission is consistent with the vast majority of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections initiating in the upper respiratory tract. Our measurements suggest that in the absence of symptoms such as coughing or sneezing, the importance of speech-generated aerosol in the transmission of respiratory diseases is far greater than generally recognized.

Aerosol Transport Modeling: The Key Link Between Lung Infections of Individuals and Populations

The recent COVID-19 pandemic has propelled the field of aerosol science to the forefront, particularly the central role of virus-laden respiratory droplets and aerosols. The pandemic has also highlighted the critical need, and value for, an information bridge between epidemiological models (that inform policymakers to develop public health responses) and within-host models (that inform the public and health care providers how individuals develop respiratory infections). Here, we review existing data and models of generation of respiratory droplets and aerosols, their exhalation and inhalation, and the fate of infectious droplet transport and deposition throughout the respiratory tract. We then articulate how aerosol transport modeling can serve as a bridge between and guide calibration of within-host and epidemiological models, forming a comprehensive tool to formulate and test hypotheses about respiratory tract exposure and infection within and between individuals.

TU Delft COVID-app: A tool to democratize CFD simulations for SARS-CoV-2 infection risk analysis

This work describes a modelling approach to SARS-CoV-2 dispersion based on experiments. The main goal is the development of an application integrated in Ansys Fluent to enable computational fluid dynamics (CFD) users to set up, in a relatively short time, complex simulations of virion-laden droplet dispersion for calculating the probability of SARS-CoV-2 infection in real life scenarios. The software application, referred to as TU Delft COVID-app, includes the modelling of human expiratory activities, unsteady and turbulent convection, droplet evaporation and thermal coupling. Data describing human expiratory activities have been obtained from selected studies involving measurements of the expelled droplets and the air flow during coughing, sneezing and breathing. Particle Image Velocimetry (PIV) measurements of the transient air flow expelled by a person while reciting a speech have been conducted with and without a surgical mask. The instantaneous velocity fields from PIV are used to determine the velocity flow rates used in the numerical simulations, while the average velocity fields are used for validation. Furthermore, the effect of surgical masks and N95 respirators on particle filtration and the probability of SARS-CoV-2 infection from a dose-response model have also been implemented in the application. Finally, the work includes a case-study of SARS-CoV-2 infection risk analysis during a conversation across a dining/meeting table that demonstrates the capability of the newly developed application.

Characterization of aerosol plumes from singing and playing wind instruments associated with the risk of airborne virus transmission

The exhalation of aerosols during musical performances or rehearsals posed a risk of airborne virus transmission in the COVID-19 pandemic. Previous research studied aerosol plumes by only focusing on one risk factor, either the source strength or convective transport capability. Furthermore, the source strength was characterized by the aerosol concentration and ignored the airflow rate needed for risk analysis in actual musical performances. This study characterizes aerosol plumes that account for both the source strength and convective transport capability by conducting experiments with 18 human subjects. The source strength was characterized by the source aerosol emission rate, defined as the source aerosol concentration multiplied by the source airflow rate (brass 383 particle/s, singing 408 particle/s, and woodwind 480 particle/s). The convective transport capability was characterized by the plume influence distance, defined as the sum of the horizontal jet length and horizontal instrument length (brass 0.6 m, singing 0.6 m and woodwind 0.8 m). Results indicate that woodwind instruments produced the highest risk with approximately 20% higher source aerosol emission rates and 30% higher plume influence distances compared with the average of the same risk indicators for singing and brass instruments. Interestingly, the clarinet performance produced moderate source aerosol concentrations at the instrument's bell, but had the highest source aerosol emission rates due to high source airflow rates. Flute performance generated plumes with the lowest source aerosol emission rates but the highest plume influence distances due to the highest source airflow rate. Notably, these comprehensive results show that the source airflow is a critical component of the risk of airborne disease transmission. The effectiveness of masking and bell covering in reducing aerosol transmission is due to the mitigation of both source aerosol concentrations and plume influence distances. This study also found a musician who generated approximately five times more source aerosol concentrations than those of the other musicians who played the same instrument. Despite voice and brass instruments producing measurably lower average risk, it is possible to have an individual musician produce aerosol plumes with high source strength, resulting in enhanced transmission risk; however, our sample size was too small to make generalizable conclusions regarding the broad musician population.

Comparison between fully resolved and time-averaged simulations of particle cloud dispersion produced by a violent expiratory event

In this work we compare the DNS results (Fabregat et al. 2021, Fabregat et al. 2021) for a mild cough already reported in the literarure with those obtained with a compressible URANS equations with a k-ϵ turbulence model. In both cases, the dispersed phase has been modelled as spherical Lagrangian particles using the one-way coupling assumption. Overall, the URANS model is capable of reproducing the observed tendency of light particles under 64 µm in diameter to rise due to the action of the drag exerted by the buoyant puff generated by the cough. Both DNS and URANS found that particles above 64 µm will tend to describe parabolic trajectories under the action of gravitational forces. Grid independence analysis allows to qualify the impact of increasing mesh resolution on the particle cloud statistics as flow evolves. Results suggest that the k-ϵ model overpredicts the horizontal displacement of the particles smaller than 64 µm while the opposite occurs for the particles larger than 64 µm.

COVID-19: the case for aerosol transmission

The COVID-19 pandemic is the most severe pandemic caused by a respiratory virus since the 1918 influenza pandemic. As is the case with other respiratory viruses, three modes of transmission have been invoked: contact (direct and through fomites), large droplets and aerosols. This narrative review makes the case that aerosol transmission is an important mode for COVID-19, through reviewing studies about bioaerosol physiology, detection of infectious SARS-CoV-2 in exhaled bioaerosols, prolonged SARS-CoV-2 infectivity persistence in aerosols created in the laboratory, detection of SARS-CoV-2 in air samples, investigation of outbreaks with manifest involvement of aerosols, and animal model experiments. SARS-CoV-2 joins influenza A virus as a virus with proven pandemic capacity that can be spread by the aerosol route. This has profound implications for the control of the current pandemic and for future pandemic preparedness.

Variations in human saliva viscoelasticity affect aerosolization propensity

Some contagious diseases, such as COVID-19, spread through the transmission of aerosols and droplets. Aerosol and droplet formation occurs inside and outside of the respiratory tract, the latter being observed during speaking and sneezing. Upon sneezing, saliva is expelled as a flat sheet, which destabilizes into filaments that subsequently break up into droplets. The presence of macromolecules (such as mucins) in saliva influences the dynamics of aerosol generation, since elasticity is expected to stabilize both fluid sheets and filaments, hence deterring droplet formation. In this study, the process of aerosol formation outside the respiratory tract is systematically replicated using an impinging jet setup, where two liquid jets collide and form a thin fluid sheet that can fragment into ligaments and droplets. The experimental setup enables us to investigate a range of dynamic conditions, quantified by the relevant non-dimensional numbers, which encompass those experienced during sneezing. Experiments are conducted with human saliva provided by different donors, revealing significant variations in their stability and breakup. We quantify the effect of viscoelasticity via shear and extensional rheology experiments, concluding that the extensional relaxation time is the most adequate measure of a saliva's elasticity. We summarize our results in terms of the dimensionless Weber, Reynolds, and Deborah numbers and construct universal state diagrams that directly compare our data to human sneezing, concluding that the aerosolization propensity is correlated with diminished saliva elasticities, higher emission velocities, and larger ejecta volumes. This could entail variations in disease transmission between individuals which hitherto have not been recognized.

The source control effect of personal protection equipment and physical barrier on short-range airborne transmission

In order to control the spread of Covid-19, authorities provide various prevention guidelines and recommendations for health workers and the public. Personal protection equipment (PPE) and physical barrier are the most widely applied prevention measures in practice due to their affordability and ease of implementation. This study aims to investigate the effect of PPE and physical barriers on mitigating the short-range airborne transmission between two people in a ventilated environment. Four types of PPE (surgical mask, two types of face shield, and mouth visor), and two different sizes of the physical barrier were tested in a controlled environment with two life-size breathing thermal manikins. The PPE was worn by the source manikin to test the efficiency of source control. The measurement results revealed that the principles of PPE on preventing short-range droplet and airborne transmission are different. Instead of filtering the fine droplet nuclei, they mainly redirect the virus-laden exhalation jet and avoid the exhaled flow entering the target's inhalation region. Physical barriers can block the spreading of droplet nuclei and create a good micro environment at short distances between persons. However, special attention should be paid to arranging the physical barrier and operating the ventilation system to avoid the stagnant zone where the contaminant accumulates.

Beyond well-mixed: A simple probabilistic model of airborne disease transmission in indoor spaces

We develop a simple model for assessing risk of airborne disease transmission that accounts for non-uniform mixing in indoor spaces and is compatible with existing epidemiological models. A database containing 174 high-resolution simulations of airflow in classrooms, lecture halls, and buses is generated and used to quantify the spatial distribution of expiratory droplet nuclei for a wide range of ventilation rates, exposure times, and room configurations. Imperfect mixing due to obstructions, buoyancy, and turbulent dispersion results in concentration fields with significant variance. The spatial non-uniformity is found to be accurately described by a shifted lognormal distribution. A well-mixed mass balance model is used to predict the mean, and the standard deviation is parameterized based on ventilation rate and room geometry. When employed in a dose-response function risk model, infection probability can be estimated considering spatial heterogeneity that contributes to both short- and long-range transmission.

Modeling the filtration efficiency of a woven fabric: The role of multiple lengthscales

During the COVID-19 pandemic, many millions have worn masks made of woven fabric to reduce the risk of transmission of COVID-19. Masks are essentially air filters worn on the face that should filter out as many of the dangerous particles as possible. Here, the dangerous particles are the droplets containing the virus that are exhaled by an infected person. Woven fabric is unlike the material used in standard air filters. Woven fabric consists of fibers twisted together into yarns that are then woven into fabric. There are, therefore, two lengthscales: the diameters of (i) the fiber and (ii) the yarn. Standard air filters have only (i). To understand how woven fabrics filter, we have used confocal microscopy to take three-dimensional images of woven fabric. We then used the image to perform lattice Boltzmann simulations of the air flow through fabric. With this flow field, we calculated the filtration efficiency for particles a micrometer and larger in diameter. In agreement with experimental measurements by others, we found that for particles in this size range, the filtration efficiency is low. For particles with a diameter of 1.5 μm, our estimated efficiency is in the range 2.5%-10%. The low efficiency is due to most of the air flow being channeled through relatively large (tens of micrometers across) inter-yarn pores. So, we conclude that due to the hierarchical structure of woven fabrics, they are expected to filter poorly.

Risk of SARS-CoV-2 in a car cabin assessed through 3D CFD simulations

In this study, the risk of infection from SARS-CoV-2 Delta variant of passengers sharing a car cabin with an infected subject for a 30-min journey is estimated through an integrated approach combining a recently developed predictive emission-to-risk approach and a validated CFD numerical model numerically solved using the open-source OpenFOAM software. Different scenarios were investigated to evaluate the effect of the infected subject position within the car cabin, the airflow rate of the HVAC system, the HVAC ventilation mode, and the expiratory activity (breathing vs. speaking). The numerical simulations here performed reveal that the risk of infection is strongly influenced by several key parameters: As an example, under the same ventilation mode and emitting scenario, the risk of infection ranges from zero to roughly 50% as a function of the HVAC flow rate. The results obtained also demonstrate that (i) simplified zero-dimensional approaches limit proper evaluation of the risk in such confined spaces, conversely, (ii) CFD approaches are needed to investigate the complex fluid dynamics in similar indoor environments, and, thus, (iii) the risk of infection in indoor environments characterized by fixed seats can be in principle controlled by properly designing the flow patterns of the environment.

Aerosol transmission in passenger car cabins: Effects of ventilation configuration and driving speed

Identifying the potential routes of airborne transmission during transportation is of critical importance to limit the spread of the SARS-CoV-2 virus. Here, we numerically solve the Reynolds-averaged Navier-Stokes equations along with the transport equation for a passive scalar in order to study aerosol transmission inside the passenger cabin of an automobile. Extending the previous work on this topic, we explore several driving scenarios including the effects of having the windows fully open, half-open, and one-quarter open, the effect of opening a moon roof, and the scaling of the aerosol transport as a function of vehicle speed. The flow in the passenger cabin is largely driven by the external surface pressure distribution on the vehicle, and the relative concentration of aerosols in the cabin scales inversely with vehicle speed. For the simplified geometry studied here, we find that the half-open windows configuration has almost the same ventilation effectively as the one with the windows fully open. The utility of the moonroof as an effective exit vent for removing the aerosols generated within the cabin space is discussed. Using our results, we propose a "speed-time" map, which gives guidance regarding the relative risk of transmission between driver and passenger as a function of trip duration and vehicle speed. A few strategies for the removal of airborne contaminants during low-speed driving, or in a situation where the vehicle is stuck in traffic, are suggested.

Modelling the direct virus exposure risk associated with respiratory events

The outbreak of the COVID-19 pandemic highlighted the importance of accurately modelling the pathogen transmission via droplets and aerosols emitted while speaking, coughing and sneezing. In this work, we present an effective model for assessing the direct contagion risk associated with these pathogen-laden droplets. In particular, using the most recent studies on multi-phase flow physics, we develop an effective yet simple framework capable of predicting the infection risk associated with different respiratory activities in different ambient conditions. We start by describing the mathematical framework and benchmarking the model predictions against well-assessed literature results. Then, we provide a systematic assessment of the effects of physical distancing and face coverings on the direct infection risk. The present results indicate that the risk of infection is vastly impacted by the ambient conditions and the type of respiratory activity, suggesting the non-existence of a universal safe distance. Meanwhile, wearing face masks provides excellent protection, effectively limiting the transmission of pathogens even at short physical distances, i.e. 1 m.

Indoor aerosol science aspects of SARS-CoV-2 transmission

Knowledge about person-to-person transmission of SARS-CoV-2 is reviewed, emphasizing three components: emission of virus-containing particles and drops from infectious persons; transport and fate of such emissions indoors; and inhalation of viral particles by susceptible persons. Emissions are usefully clustered into three groups: small particles (diameter 0.1-5 µm), large particles (5-100 µm), and ballistic drops (>100 µm). Speaking generates particles and drops across the size spectrum. Small particles are removed from indoor air at room scale by ventilation, filtration, and deposition; large particles mainly deposit onto indoor surfaces. Proximate exposure enhancements are associated with large particles with contributions from ballistic drops. Masking and social distancing are effective in mitigating transmission from proximate exposures. At room scale, masking, ventilation, and filtration can contribute to limit exposures. Important information gaps prevent a quantitative reconciliation of the high overall global spread of COVID-19 with known transmission pathways. Available information supports several findings with moderate-to-high confidence: transmission occurs predominantly indoors; inhalation of airborne particles (up to 50 µm in diameter) contributes substantially to viral spread; transmission occurs in near proximity and at room scale; speaking is a major source of airborne SARS-CoV-2 virus; and emissions can occur without strong illness symptoms.

Control of airborne infectious disease in buildings: Evidence and research priorities

The evolution of SARS-CoV-2 virus has resulted in variants likely to be more readily transmitted through respiratory aerosols, underscoring the increased potential for indoor environmental controls to mitigate risk. Use of tight-fitting face masks to trap infectious aerosol in exhaled breath and reduce inhalation exposure to contaminated air is of critical importance for disease control. Administrative controls including the regulation of occupancy and interpersonal spacing are also important, while presenting social and economic challenges. Indoor engineering controls including ventilation, exhaust, air flow control, filtration, and disinfection by germicidal ultraviolet irradiation can reduce reliance on stringent occupancy restrictions. However, the effects of controls-individually and in combination-on reducing infectious aerosol transfer indoors remain to be clearly characterized to the extent needed to support widespread implementation by building operators. We review aerobiologic and epidemiologic evidence of indoor environmental controls against transmission and present a quantitative aerosol transfer scenario illustrating relative differences in exposure at close-interactive, room, and building scales. We identify an overarching need for investment to implement building controls and evaluate their effectiveness on infection in well-characterized and real-world settings, supported by specific, methodological advances. Improved understanding of engineering control effectiveness guides implementation at scale while considering occupant comfort, operational challenges, and energy costs.

Poor ventilation worsens short-range airborne transmission of respiratory infection

To explain the observed phenomenon that most SARS-CoV-2 transmission occurs indoors whereas its outdoor transmission is rare, a simple macroscopic aerosol balance model is developed to link short- and long-range airborne transmission. The model considers the involvement of exhaled droplets with initial diameter ≤50 µm in the short-range airborne route, whereas only a fraction of these droplets with an initial diameter within 15 µm or equivalently a final diameter within 5 µm considered in the long-range airborne route. One surprising finding is that the room ventilation rate significantly affects the short-range airborne route, in contrast to traditional belief. When the ventilation rate in a room is insufficient, the airborne infection risks due to both short- and long-range transmission are high. A ventilation rate of 10 L/s per person provides a similar concentration vs distance decay profile to that in outdoor settings, which provides additional justification for the widely adopted ventilation standard of 10 L/s per person. The newly obtained data do not support the basic assumption in the existing ventilation standard ASHRAE 62.1 (2019) that the required people outdoor air rate is constant if the standard is used directly for respiratory infection control. Instead, it is necessary to increase the ventilation rate when the physical distance between people is less than approximately 2 m.

Discrepancy of particle passage in 101 mask batches during the first year of the Covid-19 pandemic in Germany

During the first wave of Covid-19 infections in Germany in April 2020, clinics reported a shortage of filtering face masks with aerosol retention> 94% (FFP2 & 3, KN95, N95). Companies all over the world increased their production capacities, but quality control of once-certified materials and masks came up short. To help identify falsely labeled masks and ensure safe protection equipment, we tested 101 different batches of masks in 993 measurements with a self-made setup based on DIN standards. An aerosol generator provided a NaCl test aerosol which was applied to the mask. A laser aerosol spectrometer measured the aerosol concentration in a range from 90 to 500 nm to quantify the masks' retention. Of 101 tested mask batches, only 31 batches kept what their label promised. Especially in the initial phase of the pandemic in Germany, we observed fluctuating mask qualities. Many batches show very high variability in aerosol retention. In addition, by measuring with a laser aerosol spectrometer, we were able to show that not all masks filter small and large particles equally well. In this study we demonstrate how important internal and independent quality controls are, especially in times of need and shortage of personal protection equipment.

Revisiting Airflow and Aerosol Transport Phenomena in the Deep Lungs with Microfluidics

The dynamics of respiratory airflows and the associated transport mechanisms of inhaled aerosols characteristic of the deep regions of the lungs are of broad interest in assessing both respiratory health risks and inhalation therapy outcomes. In the present review, we present a comprehensive discussion of our current understanding of airflow and aerosol transport phenomena that take place within the unique and complex anatomical environment of the deep lungs, characterized by submillimeter 3D alveolated airspaces and nominally slow resident airflows, known as low-Reynolds-number flows. We exemplify the advances brought forward by experimental efforts, in conjunction with numerical simulations, to revisit past mechanistic theories of respiratory airflow and particle transport in the distal acinar regions. Most significantly, we highlight how microfluidic-based platforms spanning the past decade have accelerated opportunities to deliver anatomically inspired in vitro solutions that capture with sufficient realism and accuracy the leading mechanisms governing both respiratory airflow and aerosol transport at true scale. Despite ongoing challenges and limitations with microfabrication techniques, the efforts witnessed in recent years have provided previously unattainable in vitro quantifications on the local transport properties in the deep pulmonary acinar airways. These may ultimately provide new opportunities to explore improved strategies of inhaled drug delivery to the deep acinar regions by investigating further the mechanistic interactions between airborne particulate carriers and respiratory airflows at the pulmonary microscales.

Spatiotemporal droplet dispersion measurements demonstrate face masks reduce risks from singing

COVID-19 has restricted singing in communal worship. We sought to understand variations in droplet transmission and the impact of wearing face masks. Using rapid laser planar imaging, we measured droplets while participants exhaled, said 'hello' or 'snake', sang a note or 'Happy Birthday', with and without surgical face masks. We measured mean velocity magnitude (MVM), time averaged droplet number (TADN) and maximum droplet number (MDN). Multilevel regression models were used. In 20 participants, sound intensity was 71 dB for speaking and 85 dB for singing (p < 0.001). MVM was similar for all tasks with no clear hierarchy between vocal tasks or people and > 85% reduction wearing face masks. Droplet transmission varied widely, particularly for singing. Masks decreased TADN by 99% (p < 0.001) and MDN by 98% (p < 0.001) for singing and 86-97% for other tasks. Masks reduced variance by up to 48%. When wearing a mask, neither singing task transmitted more droplets than exhaling. In conclusion, wide variation exists for droplet production. This significantly reduced when wearing face masks. Singing during religious worship wearing a face mask appears as safe as exhaling or talking. This has implications for UK public health guidance during the COVID-19 pandemic.

Modeling and multiobjective optimization of indoor airborne disease transmission risk and associated energy consumption for building HVAC systems

The COVID-19 pandemic has renewed interest in assessing how the operation of HVAC systems influences the risk of airborne disease transmission in buildings. Various processes, such as ventilation and filtration, have been shown to reduce the probability of disease spread by removing or deactivating exhaled aerosols that potentially contain infectious material. However, such qualitative recommendations fail to specify how much of these or other disinfection techniques are needed to achieve acceptable risk levels in a particular space. An additional complication is that application of these techniques inevitably increases energy costs, the magnitude of which can vary significantly based on local weather. Moreover, the operational flexibility available to the HVAC system may be inherently limited by equipment capacities and occupant comfort requirements. Given this knowledge gap, we propose a set of dynamical models that can be used to estimate airborne transmission risk and energy consumption for building HVAC systems based on controller setpoints and a forecast of weather conditions. By combining physics-based material balances with phenomenological models of the HVAC control system, it is possible to predict time-varying airflows and other HVAC variables, which are then used to calculate key metrics. Through a variety of examples involving real and simulated commercial buildings, we show that our models can be used for monitoring purposes by applying them directly to transient building data as operated, or they may be embedded within a multi-objective optimization framework to evaluate the tradeoff between infection risk and energy consumption. By combining these applications, building managers can determine which spaces are in need of infection risk reduction and how to provide that reduction at the lowest energy cost. The key finding is that both the baseline infection risk and the most energy-efficient disinfection strategy can vary significantly from space to space and depend sensitively on the weather, thus underscoring the importance of the quantitative predictions provided by the models.

An upper bound on one-to-one exposure to infectious human respiratory particles

There is ample evidence that masking and social distancing are effective in reducing severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission. However, due to the complexity of airborne disease transmission, it is difficult to quantify their effectiveness, especially in the case of one-to-one exposure. Here, we introduce the concept of an upper bound for one-to-one exposure to infectious human respiratory particles and apply it to SARS-CoV-2. To calculate exposure and infection risk, we use a comprehensive database on respiratory particle size distribution; exhalation flow physics; leakage from face masks of various types and fits measured on human subjects; consideration of ambient particle shrinkage due to evaporation; and rehydration, inhalability, and deposition in the susceptible airways. We find, for a typical SARS-CoV-2 viral load and infectious dose, that social distancing alone, even at 3.0 m between two speaking individuals, leads to an upper bound of 90% for risk of infection after a few minutes. If only the susceptible wears a face mask with infectious speaking at a distance of 1.5 m, the upper bound drops very significantly; that is, with a surgical mask, the upper bound reaches 90% after 30 min, and, with an FFP2 mask, it remains at about 20% even after 1 h. When both wear a surgical mask, while the infectious is speaking, the very conservative upper bound remains below 30% after 1 h, but, when both wear a well-fitting FFP2 mask, it is 0.4%. We conclude that wearing appropriate masks in the community provides excellent protection for others and oneself, and makes social distancing less important.

Model-based assessment of the risks of viral transmission in non-confined crowds

This work assesses the risks of Covid-19 spread in diverse daily-life situations involving crowds of maskless pedestrians, mostly outdoors. More concretely, we develop a method to infer the global number of new infections from patchy observations, by coupling ad hoc spatial models for disease transmission via respiratory droplets to detailed field-data about pedestrian trajectories and head orientations. This allows us to rank the investigated situations by the infection risks that they present; importantly, the obtained hierarchy of risks is very largely conserved across transmission models: Street cafés present the largest average rate of new infections caused by an attendant, followed by busy outdoor markets, and then metro and train stations, whereas the risks incurred while walking on fairly busy streets are comparatively quite low. While our models only approximate the actual transmission risks, their converging predictions lend credence to these findings. In situations with a moving crowd, density is the main factor influencing the estimated infection rate. Finally, our study explores the efficiency of street and venue redesigns in mitigating the viral spread: While the benefits of enforcing one-way foot traffic in (wide) walkways are unclear, changing the geometry of queues substantially affects disease transmission risks.

Removal and dispersal of biofluid films by powered medical devices: Modeling infectious agent spreading in dentistry

Medical procedures can disperse infectious agents and spread disease. Particularly, dental procedures may pose a high risk of disease transmission as they use high-powered instruments operating within the oral cavity that may contain infectious microbiota or viruses. Here we assess the ability of powered dental devices in removing the biofluid films and identified mechanical, hydrodynamic, and aerodynamic forces as the main underlying mechanisms of removal and dispersal processes. Our results indicate that potentially infectious agents can be removed and dispersed immediately after dental instrument engagement with the adherent biofluid film, while the degree of their dispersal is rapidly depleted owing to the removal of the source and dilution by the coolant water. We found that droplets created by high-speed drill interactions typically travel ballistically, while aerosol-laden air tends to flow as a current over surfaces. Our mechanistic investigation offers plausible routes for reducing the spread of infection during invasive medical procedures.

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Mechanical, hydrodynamic, and aerodynamic forces drive removal/dispersal processes

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The air-rotor has the highest ability to remove and disperse infectious agents

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The aerosol cloud flows as a current and continuously settles

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Manipulating rheological properties of the fluids can suppress aerosol generation

Close proximity risk assessment for SARS-CoV-2 infection

Although the interpersonal distance represents an important parameter affecting the risk of infection due to respiratory viruses, the mechanism of exposure to exhaled droplets remains insufficiently characterized. In this study, an integrated risk assessment is presented for SARS-CoV-2 close proximity exposure between a speaking infectious subject and a susceptible subject. It is based on a three-dimensional transient numerical model for the description of exhaled droplet spread once emitted by a speaking person, coupled with a recently proposed SARS-CoV-2 emission approach. Particle image velocimetry measurements were conducted to validate the numerical model. The contribution of the large droplets to the risk is barely noticeable only for distances well below 0.6 m, whereas it drops to zero for greater distances where it depends only on airborne droplets. In particular, for short exposures (10 s) a minimum safety distance of 0.75 m should be maintained to lower the risk below 0.1%; for exposures of 1 and 15 min this distance increases to about 1.1 and 1.5 m, respectively. Based on the interpersonal distances across countries reported as a function of interacting individuals, cultural differences, and environmental and sociopsychological factors, the approach presented here revealed that, in addition to intimate and personal distances, particular attention must be paid to exposures longer than 1 min within social distances (of about 1 m).

Variability in expiratory trajectory angles during consonant production by one human subject and from a physical mouth model: Application to respiratory droplet emission

The COVID-19 pandemic has highlighted the need to improve understanding of droplet transport during expiratory emissions. While historical emphasis has been placed on violent events such as coughing and sneezing, the recognition of asymptomatic and presymptomatic spread has identified the need to consider other modalities, such as speaking. Accurate prediction of infection risk produced by speaking requires knowledge of both the droplet size distributions that are produced, as well as the expiratory flow fields that transport the droplets into the surroundings. This work demonstrates that the expiratory flow field produced by consonant productions is highly unsteady, exhibiting extremely broad inter- and intra-consonant variability, with mean ejection angles varying from ≈+30° to -30°. Furthermore, implementation of a physical mouth model to quantify the expiratory flow fields for fricative pronunciation of [f] and [θ] demonstrates that flow velocities at the lips are higher than previously predicted, reaching 20-30 m/s, and that the resultant trajectories are unstable. Because both large and small droplet transport are directly influenced by the magnitude and trajectory of the expirated air stream, these findings indicate that prior investigations of the flow dynamics during speech have largely underestimated the fluid penetration distances that can be achieved for particular consonant utterances.

Short-range exposure to airborne virus transmission and current guidelines

After the Spanish flu pandemic, it was apparent that airborne transmission was crucial to spreading virus contagion, and research responded by producing several fundamental works like the experiments of Duguid [J. P. Duguid, J. Hyg. 44, 6 (1946)] and the model of Wells [W. F. Wells, Am. J. Hyg. 20, 611-618 (1934)]. These seminal works have been pillars of past and current guidelines published by health organizations. However, in about one century, understanding of turbulent aerosol transport by jets and plumes has enormously progressed, and it is now time to use this body of developed knowledge. In this work, we use detailed experiments and accurate computationally intensive numerical simulations of droplet-laden turbulent puffs emitted during sneezes in a wide range of environmental conditions. We consider the same emission-number of drops, drop size distribution, and initial velocity-and we change environmental parameters such as temperature and humidity, and we observe strong variation in droplets' evaporation or condensation in accordance with their local temperature and humidity microenvironment. We assume that 3% of the initial droplet volume is made of nonvolatile matter. Our systematic analysis confirms that droplets' lifetime is always about one order of magnitude larger compared to previous predictions, in some cases up to 200 times. Finally, we have been able to produce original virus exposure maps, which can be a useful instrument for health scientists and practitioners to calibrate new guidelines to prevent short-range airborne disease transmission.

Airborne transmission of respiratory viruses

The COVID-19 pandemic has revealed critical knowledge gaps in our understanding of and a need to update the traditional view of transmission pathways for respiratory viruses. The long-standing definitions of droplet and airborne transmission do not account for the mechanisms by which virus-laden respiratory droplets and aerosols travel through the air and lead to infection. In this Review, we discuss current evidence regarding the transmission of respiratory viruses by aerosols-how they are generated, transported, and deposited, as well as the factors affecting the relative contributions of droplet-spray deposition versus aerosol inhalation as modes of transmission. Improved understanding of aerosol transmission brought about by studies of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection requires a reevaluation of the major transmission pathways for other respiratory viruses, which will allow better-informed controls to reduce airborne transmission.

Airborne transmission of respiratory viruses

The COVID-19 pandemic has revealed critical knowledge gaps in our understanding of and a need to update the traditional view of transmission pathways for respiratory viruses. The long-standing definitions of droplet and airborne transmission do not account for the mechanisms by which virus-laden respiratory droplets and aerosols travel through the air and lead to infection. In this Review, we discuss current evidence regarding the transmission of respiratory viruses by aerosols-how they are generated, transported, and deposited, as well as the factors affecting the relative contributions of droplet-spray deposition versus aerosol inhalation as modes of transmission. Improved understanding of aerosol transmission brought about by studies of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection requires a reevaluation of the major transmission pathways for other respiratory viruses, which will allow better-informed controls to reduce airborne transmission.

Fluid Dynamics of Respiratory Infectious Diseases

The host-to-host transmission of respiratory infectious diseases is fundamentally enabled by the interaction of pathogens with a variety of fluids (gas or liquid) that shape pathogen encapsulation and emission, transport and persistence in the environment, and new host invasion and infection. Deciphering the mechanisms and fluid properties that govern and promote these steps of pathogen transmission will enable better risk assessment and infection control strategies, and may reveal previously underappreciated ways in which the pathogens might actually adapt to or manipulate the physical and chemical characteristics of these carrier fluids to benefit their own transmission. In this article, I review our current understanding of the mechanisms shaping the fluid dynamics of respiratory infectious diseases.

Effect of H2O2 Antiseptic on Dispersal of Cavitation-Induced Microdroplets

The persisting outbreak of SARS-CoV-2 has posed an enormous threat to global health. The sustained human-to-human transmission of SARS-CoV-2 via respiratory droplets makes the medical procedures around the perioral area vulnerable to the spread of the disease. Such procedures include the ultrasonic dental cleaning method, which occurs within the oral cavity and involves cavitation-induced sprays, thus increasing the risk of pathogen transmission via advection. To understand the associated health and safety risks for patients and clinicians, it is critical to understand the flow pattern of the spray cloud around the operating region, the size and velocity distribution of the emitted droplets, and the extent of fluid dispersion until ultimate deposit on surfaces or escape through air vents. In this work, the droplet size and velocity distributions of the spray emerging from the tip of a free-standing common ultrasonic dental cleaning device were characterized via high-speed imaging. Deionized water and 1.5% and 3% aqueous hydrogen peroxide (H₂O₂) solutions were used as working fluids, with the H₂O₂-an established oxidizing agent-intended to curb the survival of virus released in aerosols generated from dental procedures. The measurements reveal that the presence of H₂O₂ in the working fluid increases the mean droplet size and ejection velocity. Detailed computational fluid dynamic simulations with multiphase flow models reveal benefits of adding small amounts of H₂O₂ in the feed stream of the ultrasonic cleaner; this practice causes larger droplets with shorter residence times inside the clinic before settling down or escaping through air vents. The results suggest optimal benefits (in terms of fluid spread) of adding 1.5% H₂O₂ in the feed stream during dental procedures involving ultrasonic tools. The present findings are not specific to the COVID-19 pandemic but should also apply to future outbreaks caused by airborne droplet transmission.