Abstract
The epidemic of severe acute respiratory syndrome (SARS) had a significant effect on global society in the early 2000s and the potential of its resurgence exists. Studies on the modes of transmission of SARS are limited though a number of outbreak studies have revealed the possible airborne route. To develop more specific and effective control strategies, we conducted a detailed mechanism-based investigation that explored the role of fomite transmission in the well-known Ward 8A outbreak. We considered three hypothetical transmission routes, i.e., the long-range airborne, fomite and combined routes, in 1,744 scenarios with combinations of some important parameters. A multi-agent model was used to predict the infection risk distributions of the three hypothetical routes. Model selection was carried out for different scenarios to compare the distributions of infection risk with that of the reported attack rates and select the hypotheses with the best fitness. Our results reveal that under the assumed conditions, the SARS coronavirus was most possible to have spread via the combined long-range airborne and fomite routes, and that the fomite route played a non-negligible role in the transmission.
Highlights
The severe acute respiratory syndrome coronavirus (SARS-CoV) was a substantial global threat associated with significant morbidity and mortality in the early 2000s [1]
Due to the small temperature differences between zones, two-way airflow occurred at each inner opening in the ward [35], so some virus-containing airborne droplets spread to other cubicles by airflow
The difference between infection risks (Fig 3B) in the source and adjacent cubicles was very large (1:0.43 in this scenario), which was inconsistent with the small difference (1:0.80) in the reported attack rate distribution (Fig 3A)
Summary
The severe acute respiratory syndrome coronavirus (SARS-CoV) was a substantial global threat associated with significant morbidity and mortality in the early 2000s [1]. Since its emergence in November 2002, the SARS-CoV had induced 8,096 cases, including 774 deaths, in 37 countries within 8 months [2]. Understanding of the relative importance of the three routes is limited, so the recommended infection control measures (standard, contact, droplet and airborne precautions [12, 17]) have been vague and unfocused.
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