Identifying airborne transmission as the dominant route for the spread of COVID-19

TLDR

Various mitigation measures such as social distancing and face covering have been implemented, but their effectiveness depends on understanding virus transmission, which remains uncertain. The authors analyzed trends and mitigation measures in Wuhan, Italy, and New York City from January 23 to May 9, 2020, showing that mitigation impacts are discernible from pandemic trends. The study demonstrates that airborne transmission is the dominant, highly virulent route of COVID‑19 spread, and that mandated face covering alone markedly reduced infections—by over 78,000 in Italy and 66,000 in New York City—while other measures such as social distancing alone are insufficient, underscoring masks combined with other interventions as the most effective strategy.

Abstract

Various mitigation measures have been implemented to fight the coronavirus disease 2019 (COVID-19) pandemic, including widely adopted social distancing and mandated face covering. However, assessing the effectiveness of those intervention practices hinges on the understanding of virus transmission, which remains uncertain. Here we show that airborne transmission is highly virulent and represents the dominant route to spread the disease. By analyzing the trend and mitigation measures in Wuhan, China, Italy, and New York City, from January 23 to May 9, 2020, we illustrate that the impacts of mitigation measures are discernable from the trends of the pandemic. Our analysis reveals that the difference with and without mandated face covering represents the determinant in shaping the pandemic trends in the three epicenters. This protective measure alone significantly reduced the number of infections, that is, by over 78,000 in Italy from April 6 to May 9 and over 66,000 in New York City from April 17 to May 9. Other mitigation measures, such as social distancing implemented in the United States, are insufficient by themselves in protecting the public. We conclude that wearing of face masks in public corresponds to the most effective means to prevent interhuman transmission, and this inexpensive practice, in conjunction with simultaneous social distancing, quarantine, and contact tracing, represents the most likely fighting opportunity to stop the COVID-19 pandemic. Our work also highlights the fact that sound science is essential in decision-making for the current and future public health pandemics.