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What were the historical reasons for the resistance to recognizing airborne transmission during the COVID ?19 pandemic?

Jimenez, Jose L.; Marr, Linsey C.; Randall, Katherine; Ewing, Edward Thomas; Tufekci, Zeynep; Greenhalgh, Trish; Tellier, Raymond; Tang, Julian W.; Li, Yuguo; Morawska, Lidia; Mesiano?Crookston, Jonathan; Fisman, David; Hegarty, Orla; Dancer, Stephanie J.; Bluyssen, Philomena M.; Buonanno, Giorgio; Loomans, Marcel G. L. C.; Bahnfleth, William P.; Yao, Maosheng; Sekhar, Chandra; Wargocki, Pawel; Melikov, Arsen K.; Prather, Kimberly A.


Jose L. Jimenez

Linsey C. Marr

Katherine Randall

Edward Thomas Ewing

Zeynep Tufekci

Trish Greenhalgh

Raymond Tellier

Julian W. Tang

Yuguo Li

Lidia Morawska

Jonathan Mesiano?Crookston

David Fisman

Orla Hegarty

Philomena M. Bluyssen

Giorgio Buonanno

Marcel G. L. C. Loomans

William P. Bahnfleth

Maosheng Yao

Chandra Sekhar

Pawel Wargocki

Arsen K. Melikov

Kimberly A. Prather


The question of whether SARS?CoV?2 is mainly transmitted by droplets or aerosols has been highly controversial. We sought to explain this controversy through a historical analysis of transmission research in other diseases. For most of human history, the dominant paradigm was that many diseases were carried by the air, often over long distances and in a phantasmagorical way. This miasmatic paradigm was challenged in the mid to late 19th century with the rise of germ theory, and as diseases such as cholera, puerperal fever, and malaria were found to actually transmit in other ways. Motivated by his views on the importance of contact/droplet infection, and the resistance he encountered from the remaining influence of miasma theory, prominent public health official Charles Chapin in 1910 helped initiate a successful paradigm shift, deeming airborne transmission most unlikely. This new paradigm became dominant. However, the lack of understanding of aerosols led to systematic errors in the interpretation of research evidence on transmission pathways. For the next five decades, airborne transmission was considered of negligible or minor importance for all major respiratory diseases, until a demonstration of airborne transmission of tuberculosis (which had been mistakenly thought to be transmitted by droplets) in 1962. The contact/droplet paradigm remained dominant, and only a few diseases were widely accepted as airborne before COVID?19: those that were clearly transmitted to people not in the same room. The acceleration of interdisciplinary research inspired by the COVID?19 pandemic has shown that airborne transmission is a major mode of transmission for this disease, and is likely to be significant for many respiratory infectious diseases.


Jimenez, J. L., Marr, L. C., Randall, K., Ewing, E. T., Tufekci, Z., Greenhalgh, T., …Prather, K. A. (2022). What were the historical reasons for the resistance to recognizing airborne transmission during the COVID ‐19 pandemic?. Indoor Air, 32(8), Article e13070.

Journal Article Type Review
Acceptance Date May 30, 2022
Online Publication Date Aug 21, 2022
Publication Date 2022-08
Deposit Date Aug 30, 2022
Publicly Available Date Aug 30, 2022
Journal Indoor Air
Print ISSN 0905-6947
Publisher Wiley
Peer Reviewed Peer Reviewed
Volume 32
Issue 8
Article Number e13070
Keywords airborne transmission, disease transmission, droplet transmission, history
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What were the historical reasons for the resistance to recognizing airborne transmission during the COVID ?19 pandemic? (996 Kb)

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Copyright Statement
This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.

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