Superspreading Events Without Superspreaders: Using High Attack Rate Events to Estimate N o for Airborne Transmission of COVID-19

We study transmission of COVID-19 using five well-documented case studies : a Washington state church choir, a Korean call center, a Korean exercise class, and two different Chinese bus trips. In all cases the likely index patients were pre-symptomatic or mildly symptomatic, which is when infective patients are most likely to interact with large groups of people. An estimate of N 0 , the characteristic number of COVID-19 virions needed to induce infection in each case, is found using a simple physical model of airborne transmission. We find that the N 0 values are similar for five COVID-19 superspreading cases (~300-2,000 viral copies) and of the same order as influenza A. Consistent with the recent results of Goyal et al , these results suggest that viral loads relevant to infection from presymptomatic or mildly symptomatic individuals may fall into a narrow range, and that exceptionally high viral loads are not required to induce a superspreading event [1,2] . Rather, t he accumulation of infective aerosols exhaled by a typical pre-symptomatic or mildly symptomatic patient in a confined, crowdedspace (amplified by poor ventilation, particularly activity like exercise or singing, or lack of masks) for exposure times as short as one hour are sufficient. We calculate that talking and breathing release ~460 N 0 and ~10 N 0 (quanta)/hour, respectively, providing a basis to estimate the risks of everyday activities. Finally, we provide a calculation which motivates the observation that fomites appear to account for a smallpercentage of total COVID-19 infection events.