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呼吸、说话、咳嗽或打喷嚏:什么驱动了 SARS-CoV-2 的传播?

Breathing, speaking, coughing or sneezing: What drives transmission of SARS-CoV-2?

机构信息

From the, Laboratory of Chemical Physics, NIDDK, National Institutes of Health, Bethesda, MD, USA.

出版信息

J Intern Med. 2021 Nov;290(5):1010-1027. doi: 10.1111/joim.13326. Epub 2021 Jun 8.

Abstract

The SARS-CoV-2 virus is highly contagious, as demonstrated by numerous well-documented superspreading events. The infection commonly starts in the upper respiratory tract (URT) but can migrate to the lower respiratory tract (LRT) and other organs, often with severe consequences. Whereas LRT infection can lead to shedding of virus via breath and cough droplets, URT infection enables shedding via abundant speech droplets. Their viral load can be high in carriers with mild or no symptoms, an observation linked to the abundance of SARS-CoV-2-susceptible cells in the oral cavity epithelium. Expelled droplets rapidly lose water through evaporation, with the smaller ones transforming into long-lived aerosol. Although the largest speech droplets can carry more virions, they are few in number, fall to the ground rapidly and therefore play a relatively minor role in transmission. Of more concern is small speech aerosol, which can descend deep into the LRT and cause severe disease. However, since their total volume is small, the amount of virus they carry is low. Nevertheless, in closed environments with inadequate ventilation, they can accumulate, which elevates the risk of direct LRT infection. Of most concern is the large fraction of speech aerosol that is intermediate-sized because it remains suspended in air for minutes and can be transported over considerable distances by convective air currents. The abundance of this speech-generated aerosol, combined with its high viral load in pre- and asymptomatic individuals, strongly implicates airborne transmission of SARS-CoV-2 through speech as the primary contributor to its rapid spread.

摘要

SARS-CoV-2 病毒具有高度传染性,这一点已被大量有充分记录的超级传播事件所证明。这种感染通常始于上呼吸道(URT),但也可能迁移到下呼吸道(LRT)和其他器官,通常会带来严重后果。虽然 LRT 感染会导致通过呼吸和咳嗽飞沫释放病毒,但 URT 感染可以通过大量的言语飞沫释放病毒。在症状轻微或无症状的携带者中,其病毒载量可能很高,这一观察结果与口腔上皮中大量易感染 SARS-CoV-2 的细胞有关。排出的飞沫会迅速通过蒸发失去水分,较小的飞沫会转化为长寿命的气溶胶。虽然最大的言语飞沫可以携带更多的病毒,但数量很少,迅速降落到地面,因此在传播中作用相对较小。更值得关注的是小的言语气溶胶,它可以深入 LRT 并导致严重疾病。然而,由于它们的总体积较小,携带的病毒量也较低。尽管如此,在通风不足的封闭环境中,它们会积聚,从而增加直接 LRT 感染的风险。最令人担忧的是中间大小的言语气溶胶,因为它可以在空气中悬浮数分钟,并可以通过对流空气流被输送到相当远的距离。这种由言语产生的气溶胶的大量存在,加上其在有症状前和无症状个体中的高病毒载量,强烈表明通过言语传播的 SARS-CoV-2 是其快速传播的主要原因之一。

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