SARS-CoV-2 aerosol transmission in schools: the effectiveness of different interventions.

BACKGROUND: Indoor aerosol transmission of SARS-CoV-2 has been widely recognised, especially in schools where children remain in closed indoor spaces and largely unvaccinated. Measures such as strategic natural ventilation and high efficiency particulate air (HEPA) filtration remain poorly implemented and mask mandates are often progressively lifted as vaccination rollout is enhanced. METHODS: We adapted a previously developed aerosol transmission model to study the effect of interventions (natural ventilation, face masks, HEPA filtration and their combinations) on the concentration of virus particles in a classroom of 160 m3 containing one infectious individual. The cumulative dose of viruses absorbed by exposed occupants was calculated. RESULTS: In the absence of interventions, the cumulative dose absorbed was 1.5 times higher in winter than in spring/summer, increasing chances of indoor airborne transmission in winter. However, natural ventilation was more effective in winter, leading to up to a 20-fold decrease in cumulative dose when six windows were fully open at all times. In winter, partly opening two windows all day or fully opening six windows at the end of each class was effective as well (2.7- to 3-fold decrease). In summer, good ventilation levels could be achieved through the opening of windows all day long (2- to 7-fold decrease depending on the number of windows open). Opening windows only during yard and lunch breaks had minimal effect (≤1.5-fold decrease). One HEPA filter was as effective as two windows partly open all day in winter (3-fold decrease) whereas two filters were more effective (5-fold decrease). Surgical face masks were very effective independently of the season (8-fold decrease). Combined interventions (i.e., natural ventilation, masks, and HEPA filtration) were the most effective (≥25-fold decrease) and remained highly effective in the presence of a super-spreader. INTERPRETATION: Natural ventilation, face masks, and HEPA filtration are effective interventions to reduce SARS-CoV-2 aerosol transmission. These measures should be combined and complemented by additional interventions (e.g., physical distancing, hygiene, testing, contact tracing and vaccination) to maximise benefit.

Modelling airborne transmission of SARS-CoV-2 using CARA: risk assessment for enclosed spaces.

The COVID-19 pandemic has highlighted the need for a proper risk assessment of respiratory pathogens in indoor settings. This paper documents the COVID Airborne Risk Assessment methodology, to assess the potential exposure of airborne SARS-CoV-2 viruses, with an emphasis on virological and immunological factors in the quantification of the risk. The model results from a multidisciplinary approach linking physical, mechanical and biological domains, enabling decision makers or facility managers to assess their indoor setting. The model was benchmarked against clinical data, as well as two real-life outbreaks, showing good agreement. A probability of infection is computed in several everyday-life settings and with various mitigation measures. The importance of super-emitters in airborne transmission is confirmed: 20% of infected hosts can emit approximately two orders of magnitude more viral-containing particles. The use of masks provides a fivefold reduction in viral emissions. Natural ventilation strategies are very effective to decrease the concentration of virions, although periodic venting strategies are not ideal in certain settings. Although vaccination is an effective measure against hospitalization, their effectiveness against transmission is not optimal, hence non-pharmaceutical interventions (ventilation, masks) should be actively supported. We also propose a critical threshold to define an acceptable risk level.