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Ambient carbon dioxide concentration correlates with SARS-CoV-2 aerostability and infection risk

Haddrell et al., Nature Communications, doi:10.1038/s41467-024-47777-5 (date from preprint)
Aug 2023  
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27th treatment shown to reduce risk in November 2021
 
*, now with p = 0.0000000046 from 14 studies.
No treatment is 100% effective. Protocols combine treatments. * >10% efficacy, ≥3 studies.
4,300+ studies for 77 treatments. c19early.org
In Vitro study showing that elevated ambient CO2 levels, such as those found in poorly ventilated indoor spaces, can significantly increase the airborne stability and infectivity of SARS-CoV-2 by preventing respiratory droplets from reaching a high alkaline pH that normally helps inactivate the virus. This effect was more pronounced than changes in humidity and suggests that higher indoor CO2 concentrations could increase COVID-19 transmission risk.
Kreutzberger et al. showed that SARS-CoV-2 requires an acidic pH to enter and infect cells. High ambient CO2 levels could potentially increase the acidity of the respiratory mucosa by impairing the alkalinization of the airway surface liquid, creating conditions more favorable for SARS-CoV-2 infection. However, further research is needed to directly confirm the effect of CO2 on mucosal pH in real-world settings.
3 preclinical studies support the efficacy of alkalinization for COVID-19:
Haddrell et al., 10 Aug 2023, peer-reviewed, 11 authors.
In Vitro studies are an important part of preclinical research, however results may be very different in vivo.
This PaperAlkalinizationAll
Ambient carbon dioxide concentration correlates with SARS-CoV-2 aerostability and infection risk
Allen Haddrell, Henry Oswin, Mara Otero-Fernandez, Joshua F Robinson, Tristan Cogan, Robert Alexander, Jamie F S Mann, Darryl Hill, Adam Finn, Andrew D Davidson, Jonathan P Reid
Nature Communications, doi:10.1038/s41467-024-47777-5
An improved understanding of the underlying physicochemical properties of respiratory aerosol that influence viral infectivity may open new avenues to mitigate the transmission of respiratory diseases such as COVID-19. Previous studies have shown that an increase in the pH of respiratory aerosols following generation due to changes in the gas-particle partitioning of pH buffering bicarbonate ions and carbon dioxide is a significant factor in reducing SARS-CoV-2 infectivity. We show here that a significant increase in SARS-CoV-2 aerostability results from a moderate increase in the atmospheric carbon dioxide concentration (e.g. 800 ppm), an effect that is more marked than that observed for changes in relative humidity. We model the likelihood of COVID-19 transmission on the ambient concentration of CO 2 , concluding that even this moderate increase in CO 2 concentration results in a significant increase in overall risk. These observations confirm the critical importance of ventilation and maintaining low CO 2 concentrations in indoor environments for mitigating disease transmission. Moreover, the correlation of increased CO 2 concentration with viral aerostability need to be better understood when considering the consequences of increases in ambient CO 2 levels in our atmosphere. The inhalation of respiratory aerosol containing the severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has been identified as an important route of transmission in the spread of coronavirus disease 2019 (COVID-19) 1 . As for all respiratory viral infections, a sufficient viral dose must be delivered to the respiratory system of an uninfected individual for disease transmission to occur. For COVID-19, this equates to inhalation of a sufficient quantity of aerosolized/ inhalable and infectious SARS-CoV-2 viral particles. The minimal infectious dose is a function of many parameters, such as mucosal immunity 2 , prior infection 3 , and immunization status 4 . Regardless of the infectious dose required, the cumulative viral load of the air inhaled will necessarily correlate with the overall risk. Thus, understanding how environmental factors affect the aerosolized viral load over time will contribute to the assessment of the risk of transmission. At their core, many of the non-pharmaceutical interventions implemented to mitigate the risk of COVID-19 transmission are centered on the removal of infectious aerosolized virus from a given space. The aerosolized viral load may be altered physically by lowering
Reporting summary Further information on research design is available in the Nature Portfolio Reporting Summary linked to this article. Author contributions Competing interests The authors declare no competing interests. Additional information Supplementary information The online version contains supplementary material available at https://doi.org/10.1038/s41467-024-47777-5. Correspondence and requests for materials should be addressed to Allen Haddrell, Andrew D. Davidson or Jonathan P. Reid. Peer review information Nature Communications thanks the anonymous reviewer(s) for their contribution to the peer review of this work. A peer review file is available. Reprints and permissions information is available at http://www.nature.com/reprints Publisher's note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence..
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