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Research Article

Exhaled aerosol increases with COVID-19 infection, age, and obesity

David A. Edwards, Dennis Ausiello, Jonathan Salzman, Tom Devlin, View ORCID ProfileRobert Langer, View ORCID ProfileBrandon J. Beddingfield, Alyssa C. Fears, Lara A. Doyle-Meyers, Rachel K. Redmann, Stephanie Z. Killeen, View ORCID ProfileNicholas J. Maness, and Chad J. Roy
  1. aJohn A. Paulson School of Engineering & Applied Sciences, Harvard University, Cambridge, MA 02138;
  2. bSensory Cloud, Boston, MA 02142;
  3. cCenter for Assessment Technology and Continuous Health (CATCH), Massachusetts General Hospital & Harvard Medical School, Boston, MA 02114;
  4. dDepartment of Chemical & Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139;
  5. eDivision of Microbiology, Tulane National Primate Research Center, Covington, LA 70118;
  6. fDepartment of Microbiology and Immunology, Tulane University School of Medicine, New Orleans, LA 70118

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PNAS February 23, 2021 118 (8) e2021830118; https://doi.org/10.1073/pnas.2021830118
David A. Edwards
aJohn A. Paulson School of Engineering & Applied Sciences, Harvard University, Cambridge, MA 02138;
bSensory Cloud, Boston, MA 02142;
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  • For correspondence: dedwards@seas.harvard.edu rlanger@mit.edu croy@tulane.edu
Dennis Ausiello
cCenter for Assessment Technology and Continuous Health (CATCH), Massachusetts General Hospital & Harvard Medical School, Boston, MA 02114;
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Jonathan Salzman
bSensory Cloud, Boston, MA 02142;
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Tom Devlin
bSensory Cloud, Boston, MA 02142;
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Robert Langer
dDepartment of Chemical & Biological Engineering, Massachusetts Institute of Technology, Cambridge, MA 02139;
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  • ORCID record for Robert Langer
  • For correspondence: dedwards@seas.harvard.edu rlanger@mit.edu croy@tulane.edu
Brandon J. Beddingfield
eDivision of Microbiology, Tulane National Primate Research Center, Covington, LA 70118;
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  • ORCID record for Brandon J. Beddingfield
Alyssa C. Fears
eDivision of Microbiology, Tulane National Primate Research Center, Covington, LA 70118;
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Lara A. Doyle-Meyers
eDivision of Microbiology, Tulane National Primate Research Center, Covington, LA 70118;
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Rachel K. Redmann
eDivision of Microbiology, Tulane National Primate Research Center, Covington, LA 70118;
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Stephanie Z. Killeen
eDivision of Microbiology, Tulane National Primate Research Center, Covington, LA 70118;
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Nicholas J. Maness
eDivision of Microbiology, Tulane National Primate Research Center, Covington, LA 70118;
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  • ORCID record for Nicholas J. Maness
Chad J. Roy
eDivision of Microbiology, Tulane National Primate Research Center, Covington, LA 70118;
fDepartment of Microbiology and Immunology, Tulane University School of Medicine, New Orleans, LA 70118
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  • For correspondence: dedwards@seas.harvard.edu rlanger@mit.edu croy@tulane.edu
  1. Contributed by Robert Langer, January 12, 2021 (sent for review October 26, 2020; reviewed by Justin Hanes and Melanie Ott)

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    Fig. 1.

    Exhaled breath particles of 74 essential workers at No Evil Foods and of 120 volunteers at Grand Rapids Community College. (A) All participants; (B) “superspreader” (of aerosol particles) participants (first decile); (C) “superspreader” (of aerosol particles) participants (second decile); and (D) “low spreader” participants. Data represent particle counts per liter of exhaled air (particle diameter larger than 300 nm) for each of the 194 individuals. Error bars represent SD sample calculations based on 3 to 12 exhaled aerosol count measurements, with each measurement an average of counts over a 5-s time interval.

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    Fig. 2.

    Exhaled breath particles as a function of BMI-years for volunteers reporting age and BMI (n = 146). Results of linear regression analysis are shown for the exhaled aerosol numbers from the superspreader and low spreader (of aerosol particles) subjects showing significant correlation, particularly for the superspreader subjects (r2 = 0.98).

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    Fig. 3.

    Exhaled breath particles and corresponding genomic SARS-CoV-2 viral RNA in experimentally infected (A) rhesus macaques (RM) and (B) African green monkeys (AGM). Both groups are segregated by species (n = 4; n = 8). The corresponding color-matched box-and-whisker plots of total exhaled breath particles represent iterative five 1-min sampling events to genomic viral RNA (color-matched circles) for each animal at each respective time point. Mean calculated correlation between time point-matched exhaled breath particle production and genomic viral RNA showed statistically significant correlations in 75% of the RM (RM01, r2 = 0.93, P < 0.03; RM02, r2 = 0.99, P < 0.004; RM04, r2 = 0.98, P < 0.0008) and 50% of the AGM (AGM02, r2 = 0.91, P < 0.04; AGM03, r2 = 0.97, P < 0.01).

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    Fig. 4.

    Exhaled breath particles and corresponding particle size distributions in experimentally infected (A) rhesus macaques (RM) and (B) African green monkeys (AGM); dpi, days postinfection.

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    Fig. 5.

    Exhaled breath particles and corresponding particle size distributions in rhesus macaques (n = 4) infected with Mtb. Total particle counts per liter of air sampled as a measure of production during 10 min of continuous mask sampling for (A) all exhaled aerosol particles of >0.5 μm and (B) all exhaled aerosol particles of >1.0 μm. The total number of particles increased with time postinfection (PI) (in A), with the fraction of particles larger than 1 μm increasing less significantly, reflecting a high submicron fraction (> 90%) from 3 wk PI.

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Exhaled aerosol increases with COVID-19 infection, age, and obesity
David A. Edwards, Dennis Ausiello, Jonathan Salzman, Tom Devlin, Robert Langer, Brandon J. Beddingfield, Alyssa C. Fears, Lara A. Doyle-Meyers, Rachel K. Redmann, Stephanie Z. Killeen, Nicholas J. Maness, Chad J. Roy
Proceedings of the National Academy of Sciences Feb 2021, 118 (8) e2021830118; DOI: 10.1073/pnas.2021830118

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Exhaled aerosol increases with COVID-19 infection, age, and obesity
David A. Edwards, Dennis Ausiello, Jonathan Salzman, Tom Devlin, Robert Langer, Brandon J. Beddingfield, Alyssa C. Fears, Lara A. Doyle-Meyers, Rachel K. Redmann, Stephanie Z. Killeen, Nicholas J. Maness, Chad J. Roy
Proceedings of the National Academy of Sciences Feb 2021, 118 (8) e2021830118; DOI: 10.1073/pnas.2021830118
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