‘A smoking gun’: Infectious coronavirus retrieved from hospital air

Infection of cells by floating virus could be key to understanding community transmission

Covid-19: Doctors in Johannesburg how how to play an intubox over a patient to help curb the spread of viral droplets during intubation. Photograph: Michele Spatari/AFP/Getty

Covid-19: Doctors in Johannesburg how how to play an intubox over a patient to help curb the spread of viral droplets during intubation. Photograph: Michele Spatari/AFP/Getty

 

Sceptics of the notion that coronavirus spreads through the air, including many expert advisers to the World Health Organisation, have held out for one missing piece of evidence: proof that floating respiratory droplets called aerosols contain live virus and not just fragments of genetic material.

Now a team of virologists and aerosol scientists has produced exactly that: confirmation of infectious virus in the air.

“This is what people have been clamouring for,” Linsey Marr says, an expert in airborne spread of viruses who is not involved in the work. “It’s unambiguous evidence that there is infectious virus in aerosols.”

A research team at the University of Florida succeeded in isolating live virus from aerosols collected up to 5m from patients hospitalised with Covid-19 – farther than the 2m recommended in social-distancing guidelines.

The findings, posted online last week, have not yet been vetted by peer review but have already caused a stir among scientists. “If this isn’t a smoking gun, then I don’t know what is,” Marr tweeted last week.

But some experts say it is still not clear that the amount of virus recovered is sufficient to cause infection.

The research was exacting. Aerosols are minute by definition, measuring only up to 5 micrometres across; evaporation can make them even smaller. Attempts to capture these delicate droplets usually damage the virus they contain.

“It’s very hard to sample biological material from the air and have it be viable,” Shelly Miller says, an environmental engineer at the University of Colorado Boulder who studies air quality and airborne diseases. “We have to be clever about sampling biological material so that it is more similar to how you might inhale it.”

In the new study, researchers devised a sampler that uses pure water vapour to enlarge the aerosols enough that they can be collected easily from the air. Rather than leave these aerosols sitting, the equipment immediately transfers them into a liquid rich with salts, sugar and protein, which preserves the pathogen.

“I’m impressed,” Robyn Schofield says, an atmospheric chemist at Melbourne University, in Australia, who measures aerosols over the ocean. “It’s a very clever measurement technique.”

As editor of the journal Atmospheric Measurement Techniques, Schofield is familiar with the options available but says she has not seen any that could match the new one.

The researchers had previously used this method to sample air from hospital rooms. But in those attempts, other floating respiratory viruses grew faster, making it difficult to isolate the coronavirus.

This time, the team collected air samples from a room in a ward dedicated to Covid-19 patients at the University of Florida Health Shands Hospital. Neither patient in the room was subject to medical procedures known to generate aerosols, which the WHO and others have contended are the primary source of airborne virus in a hospital setting.

The team used two samplers, one just over 2m from the patients and the other about 5m from them. The scientists were able to collect virus at both distances and then to show that the virus they had plucked from the air could infect cells in a lab dish. The genome sequence of the isolated virus was identical to that from a swab of a newly admitted symptomatic patient in the room.

The room had six air changes per hour and was fitted with efficient filters, ultraviolet irradiation and other safety measures to inactivate the virus before the air was reintroduced into the room.

That may explain why the researchers found only 74 virus particles per litre of air, John Lednicky says, the team’s lead virologist at the University of Florida. Indoor spaces without good ventilation – such as schools – might accumulate much more airborne virus, he says.

But other experts say it is difficult to extrapolate from the findings to estimate an individual’s infection risk.

“I’m just not sure that these numbers are high enough to cause an infection in somebody,” Angela Rasmussen says, a virologist at Columbia University in New York. “The only conclusion I can take from this paper is you can culture viable virus out of the air,” she says. “But that’s not a small thing.”

Several experts note that the distance at which the team found the virus is much farther than the 2m recommended for physical distancing.

“We know that, indoors, those distance rules don’t matter any more,” Schofield says. It takes about five minutes for small aerosols to traverse the room even in still air, she adds.

The findings should also push people to heed precautions for airborne transmission like improved ventilation, Seema Lakdawala says, a respiratory virus expert at the University of Pittsburgh. “We all know that this virus can transmit by all these modes, but we’re only focusing on a small subset,” Lakdawala says.

She and other experts note one strange aspect of the new study. The team reports finding just as much viral RNA as they did infectious virus, but other methods generally found about 100 times more genetic matter.

“When you do nasal swabs or clinical samples, there is a lot more RNA than infectious virus,” Lakdawala says.

Lednicky has received emails and phone calls from researchers worldwide asking about that finding. He says he will check his numbers again to be sure.

But ultimately, he adds, the exact figures may not matter. “We can grow the virus from air – I think that should be the important take-home lesson,” he says. – New York Times

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