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Current state of knowledge, 29th November https://www.dhs.gov/sites/default/files/publications/mql_sars-cov-2_-_cleared_for_public_release_20201117.pdf US hospitalisations https://gis.cdc.gov/grasp/COVIDNet/COVID19_3.html Infection Human infectious dose, SARS-CoV-2, unknown by all exposure routes However Based on human exposure to other coronaviruses and animals exposure the dose at which 50% of humans become infected is 10 to 1,000 plaque-forming units (PFU) UK, human exposure trials in January 2021 to identify the infectious dose of SARS-CoV-2 Golden Syrian hamsters Exposure to 56,000 PFU via the intranasal route developed clinical symptoms Immunosuppressed, severe clinical symptoms (including death) after exposure to 100-10,000 PFU We need to know Human infectious dose; by aerosol surface contact (fomite) fecal-oral routes other potential routes of exposure Most appropriate animal model(s) to estimate the human infectious dose for SARS-CoV-2 Does exposure dose determine disease severity? Transmission Exhaled breath may emit 105-107 genome copies per person per hour 100, 000 to 10,000,000 Droplets Aerosols Fomites Close = a combined total of 15 minutes within 6 feet of an infected person in a 24-hour period Infectious for 1-3 days prior to symptom onset, 40% Asymptomatics, 12% Five days after symptom onset Asymptomatic individuals can transmit disease as soon as 2 days after infection Asymptomatic children may have substantially lower levels of virus in their upper respiratory tracts than symptomatic children In the US, symptomatic index cases resulted in transmission to approximately 53% of household members SARS-CoV-2 may be spread by conversation and exhalation Most transmission indoors, offices, restaurants, bars, gyms Clusters are often associated with large indoor gatherings Undetected cases play a major role in transmission Most cases are not reported Individuals who have clinically recovered but test positive for COVID-19 are unlikely to be infectious We need to know Relative contribution of different routes of transmission (e.g., fomites, aerosols, droplets) How common is transmission from bodily fluids like semen, urine, and feces? How infectious are young children compared to adults? What is the emission rate of infectious SARS-CoV-2 particles while breathing, talking, coughing, singing, or exercising taking into account variation in viral load in the upper and lower respiratory tract?

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