Aboard Princess Diamond, a spray transmission case study


“We are getting surprises all the time,” said Dr. Conly. “This article seems interesting to me, but I have a lot of time left to get into a line of credibility, in my opinion.”

Dr. George Rutherford, a professor of epidemiology at the University of California, San Francisco, was equally skeptical. Outside of hospital settings, he said, “Big drops in my mind account for the vast majority of cases. Aerosol transmission: If it really works with that, it creates a lot of dissonance. Are there situations where it could happen? Yes, maybe , but it is a small amount “.

Dr. Tang and other scientists strongly disagree. “If I talk to an infectious person for 15 or 20 minutes and inhale some of their air,” said Dr. Tang, “isn’t that a much easier way to explain transmission than to touch an infected surface and touch the eyes? When talking about an outbreak, like in a restaurant, the latter seems like a devious way to explain the transmission. “

In the new analysis, a team led by Parham Azimi, an indoor air researcher at Harvard’s TH Chan School of Public Health, studied the outbreak at Princess Diamond, where physical spaces and infections were well documented. He ran more than 20,000 simulations of how the virus could have spread throughout the ship. Each simulation made a variety of assumptions, about factors such as patterns of social interaction (how long people spent in their cabins, on the terrace, or in the cafeteria, on average) and the amount of time the virus can live on surfaces. Each also factored into variable contributions of smaller floating droplets, broadly defined as 10 microns or smaller; and larger drops, which fall more quickly and infect surfaces or other people, by landing on your eyes, mouth or nose, for example.

Around 130 of those simulations replicated, to some extent, what actually happened on Princess Diamond as the outbreak progressed. By analyzing these more “realistic” scenarios, the research team calculated the most likely contributions for each transmission path. The researchers concluded that the smallest drops predominated and accounted for about 60 percent of new infections overall, both at close range, within a few meters of an infectious person, and at great distances.

“Many people have argued that airborne transmission is occurring, but no one had numbers for that,” said Dr. Azimi. “What is the contribution of these little drops? Is it 5 percent or 90 percent? In this document, we provide the first real estimates of what that number might be, at least for this cruise. “

The logic behind such a transmission is straightforward, experts said. When a person speaks, he emits a cloud of drops, the vast majority of which are small enough to remain suspended in the air for a few minutes or more. Through inhalation, that cloud of small droplets is more likely to reach a mucous membrane than the larger ones that are ballistically elevated.