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Limited and contradictory evidence exists about transmission of COVID-19 particularly with reference to airborne transmission via aerosols, with most authorities believing it to be rare. Others point to growing scientific theoretical and experimental evidence, and circumstantial evidence suggesting airborne spread, and believe the precautionary principle – an approach to issues with “potential for causing harm when extensive scientific knowledge on the matter is lacking” should apply when considering PPE recommendations for health care workers (HCW).
Airborne transmission may be possible in circumstances where procedures that generate aerosols are performed.

Aerosol generating procedures (AGPs, see Table 1 in Section 3) include endotracheal intubation, bronchoscopy, open suctioning, administration of nebulized treatment, non-invasive ventilation, manual bag-mask ventilation, turning the patient to the prone position, disconnecting the patient from the ventilator, tracheostomy, insertion of intercostal catheter and cardiopulmonary resuscitation.
The additional possibility of exhaled aerosols transmitted over a short-range by an infectious individual during normal talking or coughing, particularly in crowded and inadequately ventilated spaces over a prolonged period of time, is theoretically plausible and some outbreak reports related to indoor crowded spaces have suggested the possibility of aerosol transmission combined with droplet transmission.

There are several documented occurrences in which SARS-CoV-2 appears to have been transmitted over long distances or times. These transmission events appear uncommon and have typically involved the presence of an infectious person producing respiratory droplets for an extended time (>30 minutes to multiple hours) in an enclosed space with inadequate ventilation. However, it is currently believed that most infections are spread through close contact and that airborne transmission is not the primary route of transmission. The risk of infection is known to be much lower outside where ventilation is better.
There have been no reports of faecal−oral transmission, urine, bloodborne or intrauterine transmission of the COVID-19 virus to date. Further studies are needed to determine whether it is possible to detect COVID-19 virus in air samples from patient rooms where no procedures or support treatments that generate aerosols are ongoing.
Coronaviruses can survive on surfaces for many hours but are readily inactivated by cleaning and disinfection.

  • Window for Transmission
  • Face Masks
  • General measures to limit COVID-19 transmission in the workplace
  • Infection control and prevention
  • PPE recommendations for Emergency Departments
  • PPE in specific clinical situations
  • General recommendations
  • Rational use of PPE in high-risk zones
  • Alignment with regional guidance
  • References
  • Resources
  • Section disclaimer