Dynamics of respiratory virus spread indoors suggest a holistic approach for exposure risk mitigation

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic represented a time of mixed messaging around the relevance of various respiratory virus transmission pathways, with debate extending from the regional health authorities to individual subject matter experts around the world. Globally, the non-pharmaceutical interventions (NPIs) for dealing with the pandemic virus were, fortunately, based on the potential risk posed by each of the transmission pathways (direct droplet transmission, transmission by aerosolized virus, and indirect transmission via surfaces/hands or re-aerosolization of infectious virus from contaminated environmental surfaces). These NPIs were very effective in limiting transmission of SARS-CoV-2 and other respiratory viruses. We believe that there are numerous interdependencies between the various virus transmission pathways, indicating the need for a more holistic consideration of the importance of all transmission pathways and the corresponding need for targeted NPIs during virus outbreaks and pandemics.