Carbon Dioxide Levels as a Key Indicator for Managing SARS-CoV-2 Airborne Transmission Risks Across 10 Indoor Scenarios.

Background The outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in December 2019 has led to a global pandemic through contact, droplets, and aerosolized particles. Aim This study aimed to quantify the airborne transmission risk of SARS-CoV-2 in various indoor environments. Methods Using indoor carbon dioxide (CO₂) levels, we estimated the probability of airborne transmission and the basic reproduction number (R₀) across 10 hypothetical indoor scenarios, including a college classroom, restaurant, classical music concert, live event, city bus, crowded train, hospital room, home, shogi match, and business meeting, using an analysis based on the modified Wells-Riley model. Results The relationship between airborne transmission rates and indoor CO₂ concentrations was visualized with and without the use of masks. Without masks, at an indoor CO₂ concentration of 1,000 ppm, airborne transmission rates were high in a home (100%), business meeting (100%), and hospital room (95%); however, they were moderate in a restaurant (55%), at a shogi match (22%), and at a live concert (21%); and low in a college classroom (1.7%), on a city bus (1.3%), at a classical music concert (1.0%), and on a crowded train (0.25%). In contrast, R₀ was high at a live event (42.3), in a restaurant (15.9), in a home (3.00), and in a hospital room (2.86), indicating a greater risk of cluster infections. An examination of reduced airborne infection risk through surgical mask use and improved ventilation across various scenarios revealed that mask-wearing was highly effective in hospital rooms, in restaurants, at shogi matches, and in live concerts. Ventilation was particularly useful in hospital rooms, in restaurants, and at shogi matches. Discussion and conclusion In all indoor scenarios, a positive linear relationship existed between airborne transmission risk and indoor CO₂ levels. The risk varied markedly across scenarios and was influenced by factors such as mask use, ventilation quality, conversation, and exposure duration. This model indicates that the risk of SARS-CoV-2 airborne transmission can be easily predicted using a CO₂ meter.