Though the COVID-19 health crisis is abating in many countries, research into SARS-CoV-2, the virus that caused the global pandemic, is thankfully continuing. This is important given the potential for the virus to mutate and form a strain that could prove resistant to existing vaccinations and treatment protocols.
A new study into the virus has now established that traces of the SARS-CoV-2 coronavirus can be detected even from microscopically small fluid droplets exhaled during a very short time span. The new discovery, by a team of researchers at the University of Gothenburg in Sweden, came about mainly through the use of an advanced research instrument developed by scientists at the university.
The measurements were made with the research instrument Particles in Exhaled Air (PExA), developed at Occupational and Environmental Medicine at Gothenburg University’s Sahlgrenska Academy, and with a smaller handheld instrument called the Breath Explorer (BE).
The fact that infections spread through exhaled air is well known, but now the researchers show that a few breaths are sufficient for detecting traces of viruses in microscopically small fluid droplets (i.e. particles) exhaled from small airways, at least early in the course of COVID-19.
The study shows that aerosol particles with the ribonucleic acid (RNA) virus can be found early in the course of COVID-19. The particles detected can be very small, even less than five micrometers in diameter, and the particles with RNA virus can be captured in just a few breaths by the new instrument.
Of course, this immediately leads to conjecture about possibly replacing unpleasant nasal swab tests with convenient and easy breath tests. However, according to the researchers that would be extrapolating the findings too far. They explained that respiratory viruses such as SARS-CoV-2 are likely to be concentrated mainly in the nose and throat, and it is easiest to take samples from that mucous membrane to detect the infection, than from breath analyses.
Nevertheless, the method of taking measurement in exhaled air is a very promising way of studying how the virus affects the small respiratory airways and how this effect changes during the course of the disease. Among other things, the researchers are working on studies of post-COVID conditions using this method.
Methods for studying aerosol particles can be a good way of complementing established methods of measuring and monitoring COVID-19. In general, it can be said that the analysis of exhaled air has great potential for studying the spread of infection and where the virus is in the respiratory tract.
The idea of trying to measure viruses and signs of changes in the small respiratory passages using PExA originated early in 2020, when the pandemic was an established fact. One challenge has been recruiting study subjects early in the course of the disease, despite close collaboration with other research teams.
In an initial small study involving only 10 subjects conducted in the autumn of 2020, only one of the samples was positive. The researchers believe this resulted from conducting measurements too late in the course of the disease. In collaboration with Sahlgrenska University Hospital, which allowed parallel measurement in connection with employees taking polymerase chain reaction (PCR) tests on the hospital grounds, the study eventually evolved to include more subjects in an earlier stage of the disease. These measurements were conducted in the spring of 2021 on medical professionals who had just submitted positive PCR samples for COVID-19.
Three different techniques were used to collect the samples: 20 normal breaths; a technique in which participants briefly hold their breath after a very deep exhalation; and a technique in which the study subject coughed three times into the instrument.
The research shows unsurprisingly that coughing generated the most positive breath samples collected with PExA (8 of 25), followed by deep breathing (3 of 25) and regular breathing (2 of 25). Two positive aerosol samples from normal respiration were also generated when collected with the instrument Breath Explor, although these came from individuals who were separate from the PExA findings with normal respiration.
On the plus side, the quantity of aerosol particles needed for the test was about one 10-millionth of the amount from nasal swab samples needed to detect viral RNA in regular respiration with PCR analysis. The findings from the deep-breathing maneuver came as a surprise, as the amount of sample is minute. Fluid droplets that one exhales after deep breathing form largely in the small airways, where it is known that the virus can cause great damage.
As a result, it would be exciting to further study the findings in the exhaled air in relation to disease progression, said the team in a report on their study. When the study was initiated, the Alpha viral variant of SARS-CoV-2 was the dominant strain. This strain caused infections that often extended farther down into the lungs compared with the now dominant Omicron variant. New studies underway will help explain how the complement system in small respiratory passages is activated, whether the response looks different when viruses change, and the long-term effects on small respiratory passages in the case of post-COVID syndrome.
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