How contagion occurs

Influenza, effective transmission only by coughing, stagnant air and close contact: results of a clinical study

A real-life study on infected and healthy people shows that proximity is not enough for contagion; coughing and room ventilation are decisive for the spread of the virus.

by Federico Mereta

Ragazza malata sdraiata a letto

4' min read

Translated by AI
Versione italiana

4' min read

Translated by AI
Versione italiana

How is influenza transmitted most effectively (for the virus, not for us)? Is it enough to be close to each other at the table or to be in the same room to 'pass on' the invisible enemy of health? As we in Italy are about to reach the peak of cases, with the dramatic numerical push imposed by the K variant, comes research that offers valuable information in this regard.

Because it indicates how care must always be taken not to crowd into confined spaces, but reveals how proximity alone is not enough to 'pass on' viruses, and at the same time puts other modes of transmission that are more 'fruitful' for the virus (and therefore dangerous for us) under the magnifying glass. Rather than physical proximity to the sick person, in fact, coughing, the environmental stagnation of the air itself and really close contact (in practice 'vis a vis') would be the basis of optimal viral transmission. An experiment conducted by researchers from the University of Maryland at College Park and the Baltimore School of Medicine, published in PLOS Pathogens, tells us how influenza viruses spread and, above all, how best to protect oneself, in addition to vaccination, of course.

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Coughing and air exchange

The research examined, in a real clinical study, the airborne transmission of influenza between naturally infected people, rather than intentionally infected in the laboratory, and uninfected people. It was coordinated by Donald Milton and Jianyu Lai, as reported in a University of Maryland memo. The experiment examined university students with influenza and healthy middle-aged adult volunteers, placed together in a hotel room. Basically, a real-life test.

Well, although it may seem strange, despite the close contacts none of the healthy participants contracted the infection. According to the experts, more than proximity there are certain variables to be taken into account. 'Our data suggest key factors that increase the probability of influenza transmission: coughing is one of the main ones,' is the comment of Lai, who analysed the data. What happened in the test? Although there was a high viral load in the nostrils, the students in the room only rarely coughed. So the amount of virus released into the environment was minimal. But that's not enough. Moving air would be the other key factor in the spread of viruses.

'The air in our study room was continuously stirred rapidly by a heater and a dehumidifier, thus diluting the small amounts of viruses present,' Lai said. Practical tip? Remember to open the windows often in the presence of flu symptoms. Finally, there is a further parameter that must be considered, age. According to experts, middle-aged adults tend to be less vulnerable to influenza than young adults, which probably contributed to the absence of infections.

An original study

For the record, the research was conducted on a quarantined floor of a hotel in the Baltimore area and involved five participants with confirmed flu symptoms and 11 healthy volunteers. Two groups were evaluated in 2023 and 2024. Participants lived on the hotel's isolated floor for a fortnight and followed daily routines designed to replicate real-life social interactions. These included informal conversations and physical activities such as yoga, stretching and dancing.

The infected participants also handled shared objects such as a pen, tablet and microphone, passed from one to the other. The researchers closely monitored symptoms and collected nasal swabs, saliva samples and blood samples daily to monitor infection and antibody development. They also measured viral exposure both in the air the participants breathed and in the room itself.

How to behave

The lack of transmission observed in this study provides valuable clues as to how people can reduce their risk during the flu season. Milton, also well known for his studies on Covid-19, resumes. 'Being in close, face-to-face contact with other people in closed environments, where the air doesn't move much, seems to be the riskiest thing, and it's something we all tend to do a lot,' the expert reports in the university note. Our results suggest that portable air purifiers that agitate the air as well as purifying it could be of great help. But if you are very close and someone is coughing, the best way to protect yourself is to wear a mask, especially the N95'.

"The study confirms that, in addition to vaccination, which often protects us from infection and almost always from the more serious forms and complications of influenza, compliance with general rules of hygiene are the most important tools for preventing the spread of viruses," comments Michele Conversano, Professor of Hygiene at the University of Bari - Taranto branch and President of Happy Ageing, Alliance for Active Ageing. A cough can transmit more than three thousand viral particles at a speed of up to 80 kilometres per hour, so the use of a mask can and must be a fundamental tool, as well as the constant ventilation of environments that does not allow the dangerous accumulation of viruses in confined spaces. These are simple rules and behaviours that, together with vaccination, can counteract contagions and diseases'.

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