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Background: In COVID-19, transfer of infectious respiratory materials through cough, respiration and air conditioning is considered critical for disease transmission but the interplay of droplet and aerosol physics, physiology and environmental factors is not fully understood, potentially hindering effective source control. We studied transport modes of respiratory secretions and derived effective strategies for exposure minimization. Methods: Computer simulations and real-world experiments were used. Computational modeling integrated an intensive care setting, multi-physics, and physiology. Patient-focused airflow management and air purification strategies for exposure prevention were examined computationally and validated by submicron particle exhalation imaging. Findings: Ejected respiratory materials exhibited four transport modes: long-distance ballistic, short-distance ballistic, \'jet rider\', and aerosol modes. Interaction with the air flow induced by air conditioning contaminated an entire hospital room rapidly. Different than droplets or aerosols, \'jet rider\' particles travelled with the turbulent air jet initially, but fell out in reduced air velocity, were not well eliminated by air conditioning and exposed locations and persons at larger distance and longer time than larger droplets or aerosols; the size of jet rider particles predisposes them to preferential capture in the nasal mucosa, the primordial COVID-19 infection site. \'Cough shields\' captured large droplets but induced lateral dispersion of aerosols and jet riders. An air purification device alone had limited efficacy. A \'Shield and Sink\' approach combining \'cough shields\' with \'virus sinks\' reduced exposure of bystanders from all droplet sizes in modeling, with supportive evidence in particle imaging. Interpretation: \'Jet riders\' have characteristics of highly efficient respiratory infection vectors and may play a role in Covid19 transmission inside rooms. Exposure to all droplet types can be minimized by source control through an easily implemented \'Shield and Sink\' strategy.
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?:doi
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10.1101/2020.12.08.20233056
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document_parses/pdf_json/b058f6f655dd2f11f0ae236f36217e888d710252.json
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Minimizing exposure to respiratory droplets, \'jet riders\' and aerosols in air-conditioned hospital rooms by a \'Shield-and-Sink\' strategy
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