Host and viral determinants of airborne transmission of SARS-CoV-2 in the Syrian hamster

Reviewer #1 (Public Review):

In the submitted manuscript, Port et al. investigated the host and viral factors influencing the airborne transmission of SARS-CoV-2 Alpha and Delta variants of concern (VOC) using a Syrian hamster model. The authors analyzed the viral load profiles of the animal respiratory tracts and air samples from cages by quantifying gRNA, sgRNA, and infectious virus titers. They also assessed the breathing patterns, exhaled aerosol aerodynamic profile, and size distribution of airborne particles after SARS-CoV-2 Alpha and Delta infections. The data showed that male sex was associated with increased viral replication and virus shedding in the air. The relationship between co-infection with VOCs and the exposure pattern/timeframe was also tested. This study appears to be an expansion of a previous report (Port et al., 2022, Nature Microbiology). The experimental designs were rigorous, and the data were solid. These results will contribute to the understanding of the roles of host and virus factors in the airborne transmission of SARS-CoV-2 VOCs.

Reviewer #2 (Public Review):

This manuscript by Port and colleagues describes rigorous experiments that provide a wealth of virologic, respiratory physiology, and particle aerodynamic data pertaining to aerosol transmission of SARS-CoV-2 between infected Syrian hamsters. The data is particularly significant because infection is compared between alpha and delta variants, and because viral load is assessed via numerous assays (gRNA, sgRNA, TCID) and in tissues as well as the ambient environment of the cage. The paper will be of interest to a broad range of scientists including infectious diseases physicians, virologists, immunologists and potentially epidemiologists. The strength of evidence is relatively high but limited by unclear presentation in certain parts of the paper.

Important conclusions are that infectious virus is only detectable in air samples during a narrow window of time relative to tissue samples, that airway constriction increases dynamically over time during infection limiting production of fine aerosol droplets, that variants do not appear to exclude one another during simultaneous exposures and that exposures to virus via the aerosol route lead to lower viral loads relative to direct inoculation suggesting an exposure dose response relationship.

While the paper is valuable, I found certain elements of the data presentation to be unclear and overly complex.