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However, there is a complete lack of knowledge of its possible transmission through exhalations of e-cigarette aerosol (ECA), which is also a respiratory activity. E-cigarettes have become widely popular among smokers seeking a much safer way of nicotine consumption than smoking. Due to restrictive lockdown measures taken during the COVID-19 pandemic, many smokers and vapers (e-cigarette users) were confined to shared indoor spaces, making it necessary to assess the risk of SARS-CoV-2 virus aerial transmission through their exhalations. We summarize inferred knowledge of respiratory particles emission and transport through ECA, as well as a theoretical framework for explaining the visibility of exhaled ECA, which has safety implications and is absent in other respiratory activities (apart from smoking). We also summarize and briefly discuss the effects of new SARS-CoV-2 variants, vaccination rates, and environmental factors that may influence the spread of COVID-19. To estimate the risk of SARS-CoV-2 virus aerial transmission associated with vaping exhalations, we adapt a theoretical risk model that has been used to analyze the risks associated with other respiratory activities in shared indoor spaces. We consider home and restaurant scenarios, with natural and mechanical ventilation, with occupants wearing and not wearing face masks. We consider as \u201ccontrol case\u201d or baseline risk scenario an indoor space (home and restaurant) where respiratory droplets and droplet nuclei are uniformly distributed and aerial contagion risk might originate exclusively from occupants exclusively rest breathing, assuming this to be the only (unavoidable) respiratory activity they all carry on. If an infected occupant uses an e-cigarette in a home or restaurant scenarios, bystanders not wearing face masks exposed to the resulting ECA expirations face a <jats:inline-formula><jats:alternatives><jats:tex-math>$$1\\,\\%$$<\/jats:tex-math><mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\">\n                  <mml:mrow>\n                    <mml:mn>1<\/mml:mn>\n                    <mml:mspace\/>\n                    <mml:mo>%<\/mml:mo>\n                  <\/mml:mrow>\n                <\/mml:math><\/jats:alternatives><\/jats:inline-formula> increase of risk of contagion with respect the control case. This relative added risk with respect to the control case becomes <jats:inline-formula><jats:alternatives><jats:tex-math>$$5-17 \\%$$<\/jats:tex-math><mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\">\n                  <mml:mrow>\n                    <mml:mn>5<\/mml:mn>\n                    <mml:mo>-<\/mml:mo>\n                    <mml:mn>17<\/mml:mn>\n                    <mml:mo>%<\/mml:mo>\n                  <\/mml:mrow>\n                <\/mml:math><\/jats:alternatives><\/jats:inline-formula> for high-intensity vaping, <jats:inline-formula><jats:alternatives><jats:tex-math>$$44-176 \\%$$<\/jats:tex-math><mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\">\n                  <mml:mrow>\n                    <mml:mn>44<\/mml:mn>\n                    <mml:mo>-<\/mml:mo>\n                    <mml:mn>176<\/mml:mn>\n                    <mml:mo>%<\/mml:mo>\n                  <\/mml:mrow>\n                <\/mml:math><\/jats:alternatives><\/jats:inline-formula>, and over <jats:inline-formula><jats:alternatives><jats:tex-math>$$260 \\%$$<\/jats:tex-math><mml:math xmlns:mml=\"http:\/\/www.w3.org\/1998\/Math\/MathML\">\n                  <mml:mrow>\n                    <mml:mn>260<\/mml:mn>\n                    <mml:mo>%<\/mml:mo>\n                  <\/mml:mrow>\n                <\/mml:math><\/jats:alternatives><\/jats:inline-formula> for speaking for various periods or coughing (all without vaping). Infectious emissions are significantly modified by mechanical ventilation, face mask usage, vaccination, and environmental factors, but given the lack of empiric evidence, we assume as a working hypothesis that all basic parameters of respiratory activities are equally (or roughly equally) affected by these factors. Hence, the relative risk percentages with respect to the control state should remain roughly the same under a wide range of varying conditions. By avoiding direct exposure to the visible exhaled vaping jet, wearers of commonly used face masks are well protected from respiratory droplets and droplet nuclei directly emitted by mask-less vapers. Compared to the control case of an already existing (unavoidable) risk from continuous breathing, vaping emissions in shared indoor spaces pose just a negligible additional risk of COVID-19 contagion. We consider that it is not necessary to take additional preventive measures beyond those already prescribed (1.5 m separation and wearing face masks) in order to protect bystanders from this contagion.<\/jats:p>","DOI":"10.1007\/s11356-022-20499-1","type":"journal-article","created":{"date-parts":[[2022,6,27]],"date-time":"2022-06-27T02:02:37Z","timestamp":1656295357000},"page":"83020-83044","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Analytic modeling and risk assessment of aerial transmission of SARS-CoV-2 virus through vaping expirations in shared micro-environments"],"prefix":"10.1007","volume":"29","author":[{"given":"Roberto A.","family":"Sussman","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eliana","family":"Golberstein","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8450-5721","authenticated-orcid":false,"given":"Riccardo","family":"Polosa","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2022,6,27]]},"reference":[{"issue":"4","key":"20499_CR1","first-page":"563","volume":"29","author":"Z Ai","year":"2019","unstructured":"Ai Z, Hashimoto K, Melikov AK (2019) Airborne transmission between room occupants during short-term events: measurement and evaluation. 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EG is currently employed by Myriad Pharmaceuticals, an independent company that manufactures e-liquids and vaping devices in New Zealand. She also provides consultancy work on research and development, regulatory affairs support, and formulation to several independent vaping companies in the Pacific Region. In the past, she has worked for several pharmaceutical companies, including GlaxoSmithKline and Genomma Lab. She is also a member of the standards committee of the VTANZ and UKVIA. RP is full tenured professor of Internal Medicine at the University of Catania (Italy) and Medical Director of the Institute for Internal Medicine and Clinical Immunology at the same University. In relation to his recent work in the area of respiratory diseases, clinical immunology, and tobacco control, RP has received lecture fees and research funding from Pfizer, GlaxoSmithKline, CV Therapeutics, NeuroSearch A\/S, Sandoz, MSD, Boehringer Ingelheim, Novartis, Duska Therapeutics, and Forest Laboratories. Lecture fees from a number of European EC industry and trade associations (including FIVAPE in France and FIESEL in Italy) were directly donated to vaper advocacy no-profit organizations. RP has also received grants from European Commission initiatives (U-BIOPRED and AIRPROM) and from the Integral Rheumatology & Immunology Specialists Network (IRIS) initiative. He has also served as a consultant for Pfizer, Global Health Alliance for treatment of tobacco dependence, CV Therapeutics, Boehringer Ingelheim, Novartis, Duska Therapeutics, ECITA (Electronic Cigarette Industry Trade Association, in the UK), Arbi Group Srl., and Health Diplomats. RP has served on the Medical and Scientific Advisory Board of Cordex Pharma, Inc., CV Therapeutics, Duska Therapeutics Inc, Pfizer, and PharmaCielo. RP is also founder of the Center for Tobacco prevention and treatment (CPCT) at the University of Catania and of the Center of Excellence for the acceleration of Harm Reduction (CoEHAR) at the same University, which has received support from Foundation for a Smoke Free World to conduct 8 independent investigator-initiated research projects on harm reduction. RP is also currently involved in the following pro bono activities: scientific advisor for LIAF, Lega Italiana Anti Fumo (Italian acronym for Italian Anti-Smoking League), the Consumer Advocates for Smoke-free Alternatives (CASAA) and the International Network of Nicotine Consumers Organizations (INNCO); Chair of the European Technical Committee for standardization on \u201cRequirements and test methods for emissions of electronic cigarettes\u201d (CEN\/TC 437; WG4).","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"Not applicable.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics approval and consent to participate"}},{"value":"Not applicable.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Consent for publication"}}]}}