Effect of Relative Humidity in Air on the Transmission of Respiratory Viruses (2021)

Viral respiratory infections have plagued mankind over its known history. Unfortunately, there has been a lack of meaningful progress in preventing the spread of viral respiratory infections globally. The central dogma appears to be that viruses are the villains. This framing focuses on a viral load balance (VLB) in the air. It follows that physical dilution through various means have been the primary focus of attempts to reduce the spread of infections. The problem of obesity provides a good example of how paradigm blindness can slow down progress in a field. Obesity has been framed as an energy balance disorder that blames overeating and lack of exercise for weight gain. Reframing obesity as a disorder of fat metabolism and storage caused by the quantity and quality of carbohydrates in the diet, referred to as the carbohydrate-insulin model (CIM), opened an alternative line of questioning with a testable hypothesis. Similarly, we postulate an alternative way to frame the spread of viral respiratory infections that would lead to new insights and potentially new ways to prevent infections. It has long been recognized that viral respiratory infections show a pronounced seasonal variation, referred to as seasonal forging, such that they increase in the winter but decrease or virtually disappear in the summer. In temperate regions, people spend over 90% of their time indoors. This is, therefore, where most respiratory infections are expected to occur. Evidence has been accumulating for decades on the strong correlation between variations in indoor relative humidity (RH) and variations in infection rates. Within a RH Goldilocks zone of 40%-60%, encapsulated viruses like influenza and SARS are optimally inactivated outside the infected host. Below 40% and above 80%, viruses can survive for extended periods in the air or on surfaces. This may explain in part the seasonality of infections as the indoor level of RH in winter is typically about 20% and above 40% in summer in temperate regions. However, the mechanism for the inactivation at midrange RH (in summer) is not well understood. This paper offers a hypothesis that could explain these observations. We have demonstrated that H 2 O 2 and other reactive oxygen species (ROS) are formed spontaneously at the water-air interface of pure water microdroplets. Using only water and a nebulizing gas in the presence of oxygen, we have demonstrated the significant disinfectant potential of pure water microdroplets caused by the activity of H 2 O 2 and other ROS. We postulate that spontaneous H 2 O 2 and ROS formation in viruses containing exhaled microdroplets have a similar virucidal effect at mid-range RH. The droplet evaporation rate is sufficient to concentrate the solutes and provide enough time for reactions to occur at significantly higher rates than in bulk solutions. The concentration of H 2 O 2 has also been shown to be positively correlated to RH. In addition, several other ROS/RNS may be present or formed through interactions with H 2 O 2 that may act as even more effective virucide disinfectants to inactivate the virus. Below RH 40% evaporation happens too rapidly for these reactions to make an impact before the droplet is desiccated, and above RH 80% the solutes remain too diluted. Rapid inactivation of viruses at midrange RH may therefore play a greater role in preventing infections than physical dilution of virus load in the air through excessive mechanical ventilation. Similar to obesity, we suggest that a new paradigm that considers virus infectivity outside the host rather than the virus load balance in the air alone could greatly contribute to our understanding of respiratory infections. The proposed new “Relative Humidity Infectivity” RHI paradigm could explain the causal mechanisms underlying seasonal respiratory infections. This can point to better prevention strategies that avoid further distortion of our indoor environment and create conditions within which humans can thrive and be optimally protected. We need more focus on testing the various hypotheses and more data to determine which of the two paradigms will lead us in the right direction or how to use the best of both in an optimal combination. The stakes cannot be higher, and the potential for eradicating future viral respiratory pandemics with nature-based solutions may be right under our noses, literally.