The emergence of novel pathogens is a product of our time- the development of formerly untouched wilds along with the development of mass transit and air travel beckons us to consider the consequences of global connectivity and industrialization. The emergence and rapid worldwide dissemination of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has brought inquiries about the complexities of pathogen transmission to public attention. Here, we conduct preliminary characterization studies of SARS-CoV-2 aerosol efficiency and stability, revealing its efficient aerosolization and remarkable persistence in respirable aerosol with negligible loss of infectious fraction over time, as well as in vivo exhaled droplet size modulation and heightened emission of respirable particles correlating with peak viral replication. Our results indicate aerosol transmission of SARS-CoV-2 as a potential route of infection and highlight the need for use of aerosol safeguards to prevent transmission. We additionally produce a robust non-human primate (NHP) acute infection model of SARS-CoV-2 utilizing two different exposure modalities and species of NHP and propose a new persistent disease model utilizing aerosol exposure techniques to produce long-lasting signs of disease reminiscent of post-COVID syndrome. Lastly, we demonstrate a probable long-term consequence of disease consisting of frequent, minor indications of pulmonary scarring in infected NHPs which are not fully established at 28 days post-exposure and lack signs of robust regenerative activity. We establish correlations between the functionality of alveolar macrophage populations after infection and the development of this scarring to propose modulation of either alveolar macrophage functionality or the inflammatory pulmonary environment as new treatment targets to prevent long-term consequences of SARS-CoV-2 infection.
