Modeling aerial transmission of pathogens (including the SARS-CoV-2 virus) through aerosol emissions from e-cigarettes

Sussman, Roberto A.; Golberstein, Eliana; Polosa, Riccardo

doi:10.1101/2020.11.21.20235283

Cited by 3 publications

(37 citation statements)

References 147 publications

(416 reference statements)

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“…We include here a review of these issues. Readers interested in technical details are advised to consult [ 11 ] and references cited therein.…”

Section: Exhaled Eca As a Visible Respiratory Flow: Direct Exposurmentioning

confidence: 99%

“…The diameter distributions of ECA droplets peak at submicron values [ 11 ] This should also hold for respiratory droplets that would be transported by ECA (see Section 4 ). The few larger ECA and respiratory droplets leave the flow of the carrier fluid at a rate that depends on their size and follow ballistic trajectories.…”

Section: Exhaled Eca As a Visible Respiratory Flow: Direct Exposurmentioning

confidence: 99%

“…Having little inertia, submicron droplets follow the flow of the carrier fluid, which for the involved distance scales and temperature gradients can be considered to a good approximation as isothermal. Optical properties of liquid droplets in large numbers (light scattering, see [ 11 ]) make the flow of ECA a visible cloud [ 46 , 47 ], i.e., the droplets act as visual tracers of the associated respiratory flow. In fact, aerosols with submicron droplets (like ECA) approximately evolve like gases with its particles behaving as molecular contaminants and are thus widely used to visualize respiratory flows [ 48 ] (even tobacco smoke has been used for this purpose [ 49 ]).…”

Section: Exhaled Eca As a Visible Respiratory Flow: Direct Exposurmentioning

confidence: 99%

“…However, there is no empiric evidence of aerial transmission of the SARS-CoV-2 virus (or any pathogen) through environmental e-cigarette aerosol (ECA) or environmental tobacco smoke (ETS) exhaled by infected vapers or smokers. In order to address this lack of evidence and proper elaborate research, a comprehensive study [ 11 ] was undertaken to infer and assess rigorously and extensively the plausibility, scope and risks of pathogen transmission through exhaled ECA (previous literature consisted of only three opinion pieces presenting weak arguments [ 12 , 13 , 14 ]). In the present paper we consider and extend the findings of [ 11 ] in order to contribute to the setting up of guidelines for public policies on vaping and smoking in the context of containment, prevention and mitigation strategies in the COVID-19 pandemic.…”

Section: Introductionmentioning

confidence: 99%

“…In order to address this lack of evidence and proper elaborate research, a comprehensive study [ 11 ] was undertaken to infer and assess rigorously and extensively the plausibility, scope and risks of pathogen transmission through exhaled ECA (previous literature consisted of only three opinion pieces presenting weak arguments [ 12 , 13 , 14 ]). In the present paper we consider and extend the findings of [ 11 ] in order to contribute to the setting up of guidelines for public policies on vaping and smoking in the context of containment, prevention and mitigation strategies in the COVID-19 pandemic. We believe this is a relevant mission, given the fact that these policies affect millions of vapers and smokers (and those around them), who need to share indoor and outdoor spaces at varying levels of home confinement and mobility constraints, including compulsory domestic confinement in the form of complete or partial lockdowns, closure of non-essential enterprises, restaurants, colleges, leisure activities, mass gatherings.…”

Section: Introductionmentioning

confidence: 99%

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Aerial Transmission of the SARS-CoV-2 Virus through Environmental E-Cigarette Aerosols: Implications for Public Policies

Sussman

Golberstein²,

Polosa

2021

IJERPH

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We discuss the implications of possible contagion of COVID-19 through e-cigarette aerosol (ECA) for prevention and mitigation strategies during the current pandemic. This is a relevant issue when millions of vapers (and smokers) must remain under indoor confinement and/or share public outdoor spaces with non-users. The fact that the respiratory flow associated with vaping is visible (as opposed to other respiratory activities) clearly delineates a safety distance of 1–2 m along the exhaled jet to prevent direct exposure. Vaping is a relatively infrequent and intermittent respiratory activity for which we infer a mean emission rate of 79.82 droplets per puff (6–200, standard deviation 74.66) comparable to mouth breathing, it adds into shared indoor spaces (home and restaurant scenarios) a 1% extra risk of indirect COVID-19 contagion with respect to a “control case” of existing unavoidable risk from continuous breathing. As a comparative reference, this added relative risk increases to 44–176% for speaking 6–24 min per hour and 260% for coughing every 2 min. Mechanical ventilation decreases absolute emission levels but keeps the same relative risks. As long as direct exposure to the visible exhaled jet is avoided, wearing of face masks effectively protects bystanders and keeps risk estimates very low. As a consequence, protection from possible COVID-19 contagion through vaping emissions does not require extra interventions besides the standard recommendations to the general population: keeping a social separation distance of 2 m and wearing of face masks.

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“…We include here a review of these issues. Readers interested in technical details are advised to consult [ 11 ] and references cited therein.…”

Section: Exhaled Eca As a Visible Respiratory Flow: Direct Exposurmentioning

confidence: 99%

Section: Exhaled Eca As a Visible Respiratory Flow: Direct Exposurmentioning

confidence: 99%

Section: Exhaled Eca As a Visible Respiratory Flow: Direct Exposurmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Aerial Transmission of the SARS-CoV-2 Virus through Environmental E-Cigarette Aerosols: Implications for Public Policies

Sussman

Golberstein²,

Polosa

2021

IJERPH

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Prediction of potential passive exposure from commercial electronic nicotine delivery systems using exhaled breath analysis and computational fluid dynamic techniques

Oldham¹,

Bailey²,

Castro

et al. 2021

J. Breath Res.

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Use of computational fluid dynamic (CFD) modeling to predict temporal and spatial constituent exposure for non-electronic nicotine delivery systems (ENDS) users (passive exposure) provides a more efficient methodology compared to conducting actual exposure studies. We conducted a clinical study measuring exhaled breath concentrations of glycerin, propylene glycol, nicotine, benzoic acid, formaldehyde, acetaldehyde, acrolein, menthol and carbon monoxide from use of eight different commercial ENDS devices and a non-menthol and menthol cigarette. Because baseline adjusted levels of other constituents were not consistently above the limit of detection, the mean minimum and maximum per puff exhaled breath concentrations (N = 20/product) of glycerin (158.7–260.9 µg), propylene glycol (0.941–3.58 µg), nicotine (0.10–1.06 µg), and menthol (0.432–0.605 µg) from use of the ENDS products were used as input parameters to predict temporal and spatial concentrations in an environmental chamber, office, restaurant, and car using different ENDS use scenarios. Among these indoor locations and ENDS use scenarios, the car with closed windows resulted in the greatest concentrations while opening the car windows produced the lowest concentrations. The CFD predicted average maximum glycerin and propylene glycol concentration ranged from 0.25 to 1068 µg m−3 and 1.5 pg m−3 to 13.56 µg m−3, respectively. For nicotine and menthol the CFD predicted maximum concentration ranged from 0.16 pg m−3 to 4.02 µg m−3 and 0.068 pg m−3 to 2.43 µg m−3, respectively. There was better agreement for CFD-predicted nicotine concentrations than glycerin and propylene glycol with published reports highlighting important experimental and computational variables. Maximum measured nicotine levels from environmental tobacco smoke in offices, restaurants, and cars exceeded our maximum average CFD predictions by 7–97 times. For all the measured exhaled breath constituents and CFD predicted constituents, except for propylene glycol and glycerin, concentrations were less from use of ENDS products compared to combustible cigarettes. NCT number: NCT04143256

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Analytic modeling and risk assessment of aerial transmission of SARS-CoV-2 virus through vaping expirations in shared micro-environments

Sussman

Golberstein

Polosa

2021

Preprint

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Background. E-cigarettes are an important harm reduction tool that provides smokers an alternative for nicotine consumption that is much safer than smoking. It is important to asses its safety under preventive and containment measures undertaken during the COVID-19 pandemic. Methods. We develop a theoretical risk model to assess the contagion risk by aerial transmission of the SARS-CoV-2 virus carried by e–cigarette aerosol (ECA) in shared indoor spaces, a home and restaurant scenarios, with natural and mechanical ventilation, with and without face masks. We also provide the theoretical elements to explain the visibility of exhaled ECA, which has important safety implications. Results. In a home or restaurant scenarios bystanders exposed to ECA expirations by an infectious vaper (and not wearing face masks) face a 1% increase of risk of contagion with respect to a “control case” scenario defined by exclusively rest breathing without vaping. This relative added risk becomes 5 - 17% for high intensity vaping, 44 - 176% and over 260% for speaking for various periods or coughing (all without vaping). Mechanical ventilation significantly decrease infective emissions but keep the same proportionality in risk percentages. Face masks of common usage effectively protect wearers from respiratory droplets and droplet nuclei possibly emitted by mask-less vapers as long as they avoid direct exposure to the visible exhaled vaping jet. Conclusions. Vaping emissions in shared indoor spaces involve only a minuscule added risk of COVID-19 contagion with respect to the already existing (unavoidable) risk from continuous breathing, significantly less than speaking or coughing. Protection of bystanders from this contagion does not require extra preventive measures besides those already recommended (1.5 meters separation and wearing face masks).

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Modeling aerial transmission of pathogens (including the SARS-CoV-2 virus) through aerosol emissions from e-cigarettes

Cited by 3 publications

References 147 publications

Aerial Transmission of the SARS-CoV-2 Virus through Environmental E-Cigarette Aerosols: Implications for Public Policies

Aerial Transmission of the SARS-CoV-2 Virus through Environmental E-Cigarette Aerosols: Implications for Public Policies

Prediction of potential passive exposure from commercial electronic nicotine delivery systems using exhaled breath analysis and computational fluid dynamic techniques

Analytic modeling and risk assessment of aerial transmission of SARS-CoV-2 virus through vaping expirations in shared micro-environments

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