Potential airborne transmission of SARS-COV-2 through bathroom ventilation ducts associated with an outbreak in a residential building in Santander, Spain, 2020

During the COVID-19 pandemic, airborne transmission of SARS-CoV-2 via respiratory aerosols was a critical concern in indoor environments. In the city of Santander, Spain, an outbreak in a multi-family residential building during a period of low community transmission revealed vertical clustering of 15 cases in four homes. The building's design included single interior bathrooms without windows in each home, ventilated by a shared vertical bathroom duct system. Field measurements, computational fluid dynamics (CFD) simulations, and multi-zone airflow modeling were performed to evaluate vertical disease transmission potential in the Santander building. Epidemiological and genetic data combined with the field-collected data and modeling indicated that the most plausible transmission route was the bathroom vertical ventilation duct system, which facilitated movement of infectious aerosol between vertically connected homes. Additionally, operating the kitchen exhaust fan can augment the movement of aerosols between occupied spaces increasing the potential for infection. Recommendations for mitigating future risks include the installation of forced air exhaust fans with non-return flaps in bathroom ducts.