Dose-response Relation Deduced for Coronaviruses From Coronavirus Disease 2019, Severe Acute Respiratory Syndrome, and Middle East Respiratory Syndrome: Meta-analysis Results and its Application for Infection Risk Assessment of Aerosol Transmission

BACKGROUND: A comprehensive understanding of the transmission routes of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is of great importance to effectively control the spread of coronavirus disease 2019 (COVID-19). However, the fundamental dose-response relation is missing for evaluation of the infection risk. METHODS: We developed a simple framework to integrate the a priori dose-response relation for SARS-CoV-2 based on mice experiments, the recent data on infection risk from a meta-analysis, and respiratory virus shedding in exhaled breath to shed light on the dose-response relation for humans. The aerosol transmission infection risk was evaluated based on the dose-response model for a typical indoor environment. RESULTS: The developed dose-response relation is an exponential function with a constant k in the range of about 6.4 × 10(4) to 9.8 × 10(5) virus copies, which means that the infection risk caused by 1 virus copy in viral shedding is on the order of 10(–6) to 10(–5). The median infection risk via aerosol transmission with 1-hour exposure (10(–6) to 10(–4)) was significantly lower than the risk caused by close contact (10(–1)) in a room with an area of 10 to 400 m(2) with 1 infected individual in it and with a typical ventilation rate of 1 air change per hour. CONCLUSIONS: The infection risk caused by aerosol transmission was significantly lower than the risk caused by close contact. It is still necessary to be cautious for the potential aerosol transmission risk in small rooms with prolonged exposure duration.