Aerosol transmission, an indispensable route of COVID-19 spread: case study of a department-store cluster.

Patients with COVID-19 have revealed a massive outbreak around the world, leading to widespread concerns in global scope. Figuring out the transmission route of COVID-19 is necessary to control further spread. We analyzed the data of 43 patients in Baodi Department Store (China) to supplement the transmission route and epidemiological characteristics of COVID-19 in a cluster outbreak. Incubation median was estimated to endure 5.95 days (2-13 days). Almost 76.3% of patients sought medical attention immediately uponillness onset. The median period ofillness onsetto hospitalization and confirmation were 3.96 days (0-14) and 5.58 days (1-21), respectively. Patients with different cluster case could demonstrate unique epidemiological characteristics due to the particularity of outbreak sites. SRAS-CoV-2 can be released into the surrounding air through patient's respiratory tract activities, and can exist for a long time for long-distance transportation. SRAS-CoV-2 RNA can be detected in aerosol in different sites, including isolation ward, general ward, outdoor, toilet, hallway, and crowded public area. Environmental factors influencing were analyzed and indicated that the SARS-CoV-2 transportation in aerosol was dependent on temperature, air humidity, ventilation rate and inactivating chemicals (ozone) content. As for the infection route of case numbers 2 to 6, 10, 13, 16, 17, 18, 20 and 23, we believe that aerosol transmission played a significant role in analyzing their exposure history and environmental conditions in Baodi Department Store. Aerosol transmission could occur in some cluster cases when the environmental factors are suitable, and it is an indispensable route of COVID-19 spread.