COVID-19 Cluster Linked to Aerosol Transmission of SARS-CoV-2 via Floor Drains

Background Recently, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission through exposure to aerosols has been suggested. Therefore, we investigated the possibility of aerosol SARS-CoV-2 transmission within an apartment complex where residents reported testing positive for SARS-CoV-2 despite having no direct contact with other SARS-CoV-2-infected people. Methods Information on symptom onset and exposure history of the patients was collected by global positioning system (GPS) tracking to investigate possible points of contact or spread. Samples collected from patients and from various areas of the complex were analyzed using RNA sequencing. Phylogenetic analysis was also performed. Results Of 19 people with confirmed SARS-CoV-2 infection, 5 reported no direct contact with other residents and were from apartments in the same vertical line. Eight environmental samples tested positive for the virus. Phylogenetic analyses revealed that 3 of the positive cases and 1 environmental sample belonged to the B.1.497 lineage. Additionally, 3 clinical specimens and 1 environmental sample from each floor of the complex had the same amino acid substitution in the ORF1ab region. Conclusions SARS-CoV-2 transmission possibly occurs between different floors of an apartment building through aerosol transmission via nonfunctioning drain traps. Molecular phylogenetic analysis can be performed to investigate transmission route and may help with unclear epidemiological evidence of transmission. Our study suggests SARS-CoV-2 transmission possibly occurs between different floors of an apartment building through aerosol transmission via nonfunctioning drain traps.