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BACKGROUND: While risk of outdoor transmission of respiratory viral infections is hypothesized to be low, there is limited data of SARS-CoV-2 transmission in outdoor compared to indoor settings. METHODS: We conducted a systematic review of peer-reviewed papers indexed in PubMed, EMBASE and Web of Science and pre-prints in Europe PMC through August 12 th, 2020 that described cases of human transmission of SARS-CoV-2. Reports of other respiratory virus transmission were included for reference. RESULTS: Five identified studies found that a low proportion of reported global SARS-CoV-2 infections have occurred outdoors (<10%) and the odds of indoor transmission was very high compared to outdoors (18.7 times; 95% CI 6.0, 57.9). Five studies described influenza transmission outdoors and two described adenovirus transmission outdoors. There was high heterogeneity in study quality and individual definitions of outdoor settings which limited our ability to draw conclusions about outdoor transmission risks. In general, factors such as duration and frequency of personal contact, lack of personal protective equipment and occasional indoor gathering during a largely outdoor experience were associated with outdoor reports of infection. CONCLUSION: Existing evidence supports the wide-held belief that the the risk of SARS-CoV-2 transmission is lower outdoors but there are significant gaps in our understanding of specific pathways.
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Outdoor Transmission of SARS-CoV-2 and Other Respiratory Viruses, a Systematic Review
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