Heterogeneity of Airborne Virus Transmission in the Built Environment: A Narrative Review

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Published: Aug 19, 2026
DOI: https://doi.org/10.20411/pai.v11i2.1049
Keywords:
SARS-CoV-2, Respiratory Particles, Superemitter, Ventilation

Main Article Content

Yizhi Zhang
Department of Civil and Environmental Engineering, Virginia Tech, Blacksburg, Virginia
Kathryn C. Krupinsky
Department of Microbiology and Immunology, University of Michigan, Ann Arbor, Michigan
Adam S. Lauring
Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan
Linsey C. Marr
Department of Civil and Environmental Engineering, Virginia Tech, Blacksburg, Virginia

Abstract

The COVID-19 pandemic accelerated recognition of airborne transmission of respiratory infections. Despite improved mechanistic understanding, our ability to predict the risk of infection in a given scenario remains limited owing, in part, to high heterogeneity in factors involved in transmission. The goal of this work is to quantify variability in factors that control risk of airborne virus transmission in the built environment. Using SARS-CoV-2 as a model, we conducted a narrative review on transmission via inhalable respiratory particles (<100 µm). We divided transmission into three key processes: emission of virus in respiratory particles from an infected individual (the source) into the air; transport and decay of virus in the environment; and deposition and infection in a new host (the receiver). Among the source-related factors, we found large variabilities spanning seven or more orders of magnitude. For example, the rate of respiratory emissions from an infected individual ranges from 1 to > 107 particles/s, depending in part on the type of respiratory activity and individual physiological factors. Unexplained inter-individual variations, such as those defining “superemitters,” introduce additional uncertainties. We also found considerable variability in the physical and biological decay of virus-laden particles, as they move from the source to the receiver. The air exchange rate, which controls physical loss of particles by ventilation, ranges from 0.01 to > 20 air changes per hour in typical buildings. Lastly, upon inhalation, the efficiency and site of virus deposition vary with the physiological state of the receiver. Their immunological status further influences whether infection is established. Overall, we found the largest variability in the rate of particle emissions and viral load of respiratory fluid. These two factors determine the amount of virus released into the air by an infected person, which is a critical indicator of the potential for onward transmission. Predicting the risk of infection in a specific scenario remains challenging due to the combined effects of variability in key determinants.

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Vol. 11 No. 2 (2026): Volume 11, Number 2
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Reviews
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