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1.
Euro Surveill ; 27(21)2022 May.
Article in English | MEDLINE | ID: covidwho-1875326

ABSTRACT

BackgroundSARS-CoV-2 emergence was a threat for armed forces. A COVID-19 outbreak occurred on the French aircraft carrier Charles de Gaulle from mid-March to mid-April 2020.AimTo understand how the virus was introduced, circulated then stopped circulation, risk factors for infection and severity, and effectiveness of preventive measures.MethodsWe considered the entire crew as a cohort and collected personal, clinical, biological, and epidemiological data. We performed viral genome sequencing and searched for SARS-CoV-2 in the environment.ResultsThe attack rate was 65% (1,148/1,767); 1,568 (89%) were included. The male:female ratio was 6.9, and median age was 29 years (IQR: 24-36). We examined four clinical profiles: asymptomatic (13.0%), non-specific symptomatic (8.1%), specific symptomatic (76.3%), and severe (i.e. requiring oxygen therapy, 2.6%). Active smoking was not associated with severe COVID-19; age and obesity were risk factors. The instantaneous reproduction rate (Rt) and viral sequencing suggested several introductions of the virus with 4 of 5 introduced strains from within France, with an acceleration of Rt when lifting preventive measures. Physical distancing prevented infection (adjusted OR: 0.55; 95% CI: 0.40-0.76). Transmission may have stopped when the proportion of infected personnel was large enough to prevent circulation (65%; 95% CI: 62-68).ConclusionNon-specific clinical pictures of COVID-19 delayed detection of the outbreak. The lack of an isolation ward made it difficult to manage transmission; the outbreak spread until a protective threshold was reached. Physical distancing was effective when applied. Early surveillance with adapted prevention measures should prevent such an outbreak.


Subject(s)
COVID-19 , Adult , Aircraft , COVID-19/epidemiology , Disease Outbreaks , Female , Humans , Male , Retrospective Studies , SARS-CoV-2/genetics
3.
Int J Infect Dis ; 118: 270-276, 2022 May.
Article in English | MEDLINE | ID: covidwho-1751049

ABSTRACT

OBJECTIVES: This study aims to investigate the risk of COVID-19 transmission on aircraft. METHODS: We obtained data on all international flights to Lanzhou, China, from June 1, 2020, to August 1, 2020, through the Gansu Province National Health Information Platform and the official website of the Gansu Provincial Center for Disease Control and Prevention. We then performed the statistical analysis. RESULTS: Three international flights arrived in Lanzhou. The flights had a total of 700 passengers, of whom 405 (57.9%) were male, and 80 (11.4%) were children under the age of 14 years. Twenty-seven (3.9%) passengers were confirmed to have COVID-19. Confirmed patients were primarily male (17, 65.4%) with a median age of 27.0 years. Most confirmed cases were seated in the middle rows of economy class or near public facility areas such as restrooms and galleys. The prevalence of COVID-19 did not differ between passengers sitting in the window, aisle, or middle seats. However, compared with passengers sitting in the same row up to 2 rows behind a confirmed case, passengers seated in the 2 rows in front of a confirmed case were at a slightly higher risk of being infected. CONCLUSIONS: COVID-19 may be transmitted during a passenger flight, although there is still no direct evidence.


Subject(s)
COVID-19 , Adolescent , Adult , Aircraft , COVID-19/epidemiology , Child , China/epidemiology , Female , Humans , Male , Research Design
4.
Travel Med Infect Dis ; 47: 102313, 2022.
Article in English | MEDLINE | ID: covidwho-1740219

ABSTRACT

BACKGROUND: Despite commercial airlines mandating masks, there have been multiple documented events of COVID-19 superspreading on flights. Conventional models do not adequately explain superspreading patterns on flights, with infection spread wider than expected from proximity based on passenger seating. An important reason for this is that models typically do not consider the movement of passengers during the flight, boarding, or deplaning. Understanding the risks for each of these aspects could provide insight into effective mitigation measures. METHODS: We modeled infection risk from seating and fine-grained movement patterns - boarding, deplaning, and inflight movement. We estimated infection model parameters from a prior superspreading event. We validated the model and the impact of interventions using available data from three flights, including cabin layout and seat locations of infected and uninfected passengers, to suggest interventions to mitigate COVID-19 superspreading events during air travel. Specifically, we studied: 1) London to Hanoi with 201 passengers, including 13 secondary infections among passengers; 2) Singapore to Hangzhou with 321 passengers, including 12 to 14 secondary infections; 3) a non-superspreading event on a private jet in Japan with 9 passengers and no secondary infections. RESULTS: Our results show that the inclusion of passenger movement better explains the infection spread patterns than conventional models do. We also found that FFP2/N95 mask usage would have reduced infection by 95-100%, while cloth masks would have reduced it by only 40-80%. Results indicate that leaving the middle seat vacant is effective in reducing infection, and the effectiveness increases when combined with good quality masks. However, with a good mask, the risk is quite low even without the middle seats being empty. CONCLUSIONS: Our results suggest the need for more stringent guidelines to reduce aviation-related superspreading events of COVID-19.


Subject(s)
Air Travel , COVID-19 , Coinfection , Aircraft , COVID-19/epidemiology , COVID-19/prevention & control , Humans , Movement
5.
Sensors (Basel) ; 22(3)2022 Jan 22.
Article in English | MEDLINE | ID: covidwho-1686938

ABSTRACT

One of the causes of positioning inaccuracies in the Unmanned Aircraft System (UAS) is navigation error. In urban environment operations, multipaths could be the dominant contributor to navigation errors. This paper presents a study on how the operation environment affects the lateral (horizontal) navigation performance when a self-built UAS is going near different types of urban obstructions in real flight tests. Selected test sites are representative of urban environments, including open carparks, flight paths obstructed by buildings along one or both sides, changing sky access when flying towards corners formed by two buildings or dead ends, and buildings with reflective glass-clad surfaces. The data was analysed to obtain the horizontal position error between Global Positioning System (GPS) position and ground truth derived from Real Time Kinematics (RTK), with considerations for (1) horizontal position uncertainty estimate (EPH) reported by the GPS receiver, (2) no. of visible satellites, and (3) percentage of sky visible (or sky openness ratio, SOR) at various altitudes along the flight paths inside the aforementioned urban environments. The investigation showed that there is no direct correlation between the measured horizontal position error and the reported EPH; thus, the EPH could not be used for the purpose of monitoring navigation performance. The investigation further concluded that there is no universal correlation between the sky openness ratio (SOR) seen by the UAS and the resulting horizontal position error, and a more complex model would need to be considered to translate 3D urban models to expected horizontal navigation uncertainty for the UAS Traffic Management (UTM) airspace.


Subject(s)
Aircraft , Geographic Information Systems , Biomechanical Phenomena
6.
Sci Total Environ ; 820: 153171, 2022 May 10.
Article in English | MEDLINE | ID: covidwho-1629486

ABSTRACT

On the 26th of November 2021, the World Health Organization (WHO) designated the newly detected B.1.1.529 lineage of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) the Omicron Variant of Concern (VOC). The genome of the Omicron VOC contains more than 50 mutations, many of which have been associated with increased transmissibility, differing disease severity, and potential to evade immune responses developed for previous VOCs such as Alpha and Delta. In the days since the designation of B.1.1.529 as a VOC, infections with the lineage have been reported in countries around the globe and many countries have implemented travel restrictions and increased border controls in response. We putatively detected the Omicron variant in an aircraft wastewater sample from a flight arriving to Darwin, Australia from Johannesburg, South Africa on the 25th of November 2021 via positive results on the CDC N1, CDC N2, and del(69-70) RT-qPCR assays per guidance from the WHO. The Australian Northern Territory Health Department detected one passenger onboard the flight who was infected with SARS-CoV-2, which was determined to be the Omicron VOC by sequencing of a nasopharyngeal swab sample. Subsequent sequencing of the aircraft wastewater sample using the ARTIC V3 protocol with Nanopore and ATOPlex confirmed the presence of the Omicron variant with a consensus genome that clustered with the B.1.1.529 BA.1 sub-lineage. Our detection and confirmation of a single onboard Omicron infection via aircraft wastewater further bolsters the important role that aircraft wastewater can play as an independent and unintrusive surveillance point for infectious diseases, particularly coronavirus disease 2019.


Subject(s)
COVID-19 , SARS-CoV-2 , Aircraft , Australia , COVID-19/epidemiology , Humans , SARS-CoV-2/genetics , South Africa/epidemiology , Waste Water
7.
Indoor Air ; 32(1): e12979, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1629184

ABSTRACT

Commercial airliners have played an important role in spreading the SARS-CoV-2 virus worldwide. This study used computational fluid dynamics (CFD) to simulate the transmission of SARS-CoV-2 on a flight from London to Hanoi and another from Singapore to Hangzhou. The dispersion of droplets of different sizes generated by coughing, talking, and breathing activities in a cabin by an infected person was simulated by means of the Lagrangian method. The SARS-CoV-2 virus contained in expiratory droplets traveled with the cabin air distribution and was inhaled by other passengers. Infection was determined by counting the number of viral copies inhaled by each passenger. According to the results, our method correctly predicted 84% of the infected/uninfected cases on the first flight. The results also show that wearing masks and reducing conversation frequency between passengers could help to reduce the risk of exposure on the second flight.


Subject(s)
Air Microbiology , Air Pollution, Indoor , Aircraft , COVID-19 , COVID-19/transmission , Humans , Masks , SARS-CoV-2
9.
Scand J Trauma Resusc Emerg Med ; 30(1): 6, 2022 Jan 15.
Article in English | MEDLINE | ID: covidwho-1622251

ABSTRACT

BACKGROUND: The COVID-19 pandemic has placed exceptional demand on Intensive Care Units, necessitating the critical care transfer of patients on a regional and national scale. Performing these transfers required specialist expertise and involved moving patients over significant distances. Air Ambulance Kent Surrey Sussex created a designated critical care transfer team and was one of the first civilian air ambulances in the United Kingdom to move ventilated COVID-19 patients by air. We describe the practical set up of such a service and the key lessons learned from the first 50 transfers. METHODS: Retrospective review of air critical care transfer service set up and case review of first 50 transfers. RESULTS: We describe key elements of the critical care transfer service, including coordination and activation; case interrogation; workforce; training; equipment; aircraft modifications; human factors and clinical governance. A total of 50 missions are described between 18 December 2020 and 1 February 2021. 94% of the transfer missions were conducted by road. The mean age of these patients was 58 years (29-83). 30 (60%) were male and 20 (40%) were female. The mean total mission cycle (time of referral until the time team declared free at receiving hospital) was 264 min (range 149-440 min). The mean time spent at the referring hospital prior to leaving for the receiving unit was 72 min (31-158). The mean transfer transit time between referring and receiving units was 72 min (9-182). CONCLUSION: Critically ill COVID-19 patients have highly complex medical needs during transport. Critical care transfer of COVID-19-positive patients by civilian HEMS services, including air transfer, can be achieved safely with specific planning, protocols and precautions. Regional planning of COVID-19 critical care transfers is required to optimise the time available of critical care transfer teams.


Subject(s)
Air Ambulances , COVID-19 , Emergency Medical Services , Adult , Aged , Aged, 80 and over , Aircraft , Critical Care , Female , Humans , Male , Middle Aged , Pandemics , Retrospective Studies , SARS-CoV-2
10.
Medicine (Baltimore) ; 100(48): e27881, 2021 Dec 03.
Article in English | MEDLINE | ID: covidwho-1583961

ABSTRACT

ABSTRACT: In February 2021, an explosion of cases of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pneumonia overwhelmed the only hospital in Mayotte. To report a case series of patients with acute respiratory failure (ARF) due to SARS-CoV-2 who were evacuated by air from Mayotte to Reunion Island.This retrospective observational study evaluated all consecutive patients with ARF due to SARS-CoV-2 who were evacuated by air from Mayotte Hospital to the intensive care unit (ICU) of Félix Guyon University Hospital in Reunion Island between February 2, and March 5, 2021.A total of 43 patients with SARS-CoV-2 pneumonia were evacuated by air, for a total flight time of 2 hours and a total travel time of 6 hours. Of these, 38 patients (88.4%) with a median age of 55 (46-65) years presented with ARF and were hospitalized in our ICU. Fifteen patients were screened for the SARS-CoV-2 501Y.V2 variant, all of whom tested positive. Thirteen patients (34.2%) developed an episode of severe hypoxemia during air transport, and the median paO2/FiO2 ratio was lower on ICU admission (140 [102-192] mmHg) than on departure (165 [150-200], P = .022). Factors associated with severe hypoxemia during air transport was lack of treatment with curare (P = .012) and lack of invasive mechanical ventilation (P = .003). Nine patients (23.7%) received veno-venous extracorporeal membrane oxygenation support in our ICU. Seven deaths (18.4%) occurred in hospital.Emergency air evacuation of patients with ARF due to SARS-CoV-2 was associated with severe hypoxemia but remained feasible. In cases of ARF due to SARS-CoV-2 requiring emergency air evacuation, sedated patients receiving invasive mechanical ventilation and curare should be prioritized over nonintubated patients. It is noteworthy that patients with SARS-CoV-2 pneumonia related to the 501Y.V2 variant were very severe despite their young age.


Subject(s)
Air Ambulances , COVID-19/complications , Hypoxia/etiology , Respiratory Distress Syndrome , Respiratory Insufficiency , Transportation of Patients , Aged , Aircraft , COVID-19/diagnosis , Comoros , Curare , Humans , Middle Aged , Respiratory Distress Syndrome/etiology , Respiratory Distress Syndrome/therapy , Respiratory Insufficiency/etiology , Respiratory Insufficiency/therapy , Reunion/epidemiology , SARS-CoV-2
11.
Indoor Air ; 32(1): e12974, 2022 Jan.
Article in English | MEDLINE | ID: covidwho-1583526

ABSTRACT

Many laboratory experiments and model development activities have been underway to better estimate the risk of a person indoors becoming infected with COVID-19. The current paper focusses on the near-field (distances < about 5 m) transport and dispersion (T&D) of the virons, treating them as inert tracers. The premise is that the T&D process follows widely used basic analytical near-field formulations such as a slab model, a Gaussian plume model, or a diffusivity (K) model. A slab or Gaussian model is more appropriate for cloud sizes less than the distance scale of the turbulence, while a K model is more appropriate for cloud sizes larger than the distance scale. The proposed slab model is evaluated with observations from the TRANSCOM tracer experiment in Boeing 767 and 777 airplanes, which involved multiple release scenarios. Release rates of 1-µm plastic bead inert tracers were constant over 60 s from a mannequin's mouth and samplers were placed at about 40 nearby seat locations. A simple basic science near-field slab model is shown to agree with observations of maximum concentration and dose within a factor of two or three.


Subject(s)
Air Microbiology , Air Pollution, Indoor , Aircraft , COVID-19 , Aerosols , COVID-19/transmission , Humans , Models, Theoretical , SARS-CoV-2
13.
PLoS One ; 16(12): e0246916, 2021.
Article in English | MEDLINE | ID: covidwho-1546847

ABSTRACT

The COVID-19 pandemic has reintroduced questions regarding the potential risk of SARS-CoV-2 exposure amongst passengers on an aircraft. Quantifying risk with computational fluid dynamics models or contact tracing methods alone is challenging, as experimental results for inflight biological aerosols is lacking. Using fluorescent aerosol tracers and real time optical sensors, coupled with DNA-tagged tracers for aerosol deposition, we executed ground and inflight testing on Boeing 767 and 777 airframes. Analysis here represents tracer particles released from a simulated infected passenger, in multiple rows and seats, to determine the exposure risk via penetration into breathing zones in that row and numerous rows ahead and behind the index case. We present here conclusions from 118 releases of fluorescent tracer particles, with 40+ Instantaneous Biological Analyzer and Collector sensors placed in passenger breathing zones for real-time measurement of simulated virus particle penetration. Results from both airframes showed a minimum reduction of 99.54% of 1 µm aerosols from the index source to the breathing zone of a typical passenger seated directly next to the source. An average 99.97 to 99.98% reduction was measured for the breathing zones tested in the 767 and 777, respectively. Contamination of surfaces from aerosol sources was minimal, and DNA-tagged 3 µm tracer aerosol collection techniques agreed with fluorescent methodologies.


Subject(s)
Aircraft , Computer Simulation , Fluorescent Dyes/chemistry , /chemistry , COVID-19/pathology , COVID-19/prevention & control , COVID-19/virology , DNA/chemistry , DNA/metabolism , Humans , Masks , Microspheres , SARS-CoV-2/genetics , SARS-CoV-2/isolation & purification
14.
Air Med J ; 41(1): 68-72, 2022.
Article in English | MEDLINE | ID: covidwho-1536419

ABSTRACT

OBJECTIVE: COVID-19 may have contributed to an excess of out-of-hospital cardiac arrests (OOHCAs). This observational study identified changes in OOHCA epidemiology pre- and post-COVID-19 lockdown in a single UK helicopter emergency medical service (HEMS). METHODS: A retrospective, single-center (Essex & Herts Air Ambulance), observational study was undertaken with anonymized OOHCA data (demographics, etiology, and outcomes) from March 23, 2020, to June 23, 2020, and comparative data from March 23, 2019, to June 23, 2019. Supplementary data (total OOHCAs and patient outcomes) were provided by the East of England Ambulance Service National Health Service Trust. Data were analyzed using the Mann-Whitney U test and chi-square test; P < .05 was statistically significant. RESULTS: Of the HEMS activations during national lockdown, 33.6% were for OOHCAs compared with 25.8% during the reference time frame. The frequency of young and female OOHCAs demonstrated a statistically significant increase. Statistically significant variations in medical etiology and initial cardiac rhythm were identified. CONCLUSION: During the initial UK-wide lockdown, the OOHCA characteristics attended by 1 HEMS team were altered. The changes seen may be due to the pathophysiology of COVID-19 or an alteration in dispatch due to the demand placed on the wider ambulance service; this may require further consideration for any future lockdowns or pandemics.


Subject(s)
Air Ambulances , COVID-19 , Emergency Medical Services , Out-of-Hospital Cardiac Arrest , Aircraft , COVID-19/epidemiology , Communicable Disease Control , Female , Humans , Out-of-Hospital Cardiac Arrest/epidemiology , Out-of-Hospital Cardiac Arrest/therapy , Retrospective Studies , SARS-CoV-2 , State Medicine
15.
Environ Sci Pollut Res Int ; 29(16): 23407-23418, 2022 Apr.
Article in English | MEDLINE | ID: covidwho-1527495

ABSTRACT

This study aimed at investigating aircraft noise exposure levels, their annoyance, and potential health effects among communities living within airport catchment areas during the COVID-19 pandemic. Both field measurements and an online survey approach were used to investigate aircraft noise exposure levels, annoyance, and general health effects among residents living near Muscat International Airport (MCT) in Muscat, Oman, amid the COVID-19 period. The study found a drastic decline in aircraft noise levels due to the introduction of COVID-19 intervention measures such as lockdowns, social distancing, and closure of airports. In June 2020, during the COVID-19 pandemic, average daily aircraft noise levels of LAeq (39.9 dB(A)) and Lmax (49.7 dB(A)) was observed compared to the previous year (April-May 2019) of 58.5 and 76.8 dB(A), indicating aircraft noise reductions level of 32% and 35%, respectively. The results of the online social survey among 187 participants showed that most (58.8%) of the respondents did not feel that the level of noise produced by aircraft causes annoyance. During the day, the vast majority of the interviewees did not complain of any annoyance during the morning (45.5%), afternoon (39.6%), and evening (31%) with only < 4% of residents have reported a very high degree of annoyance of during COVID-19 pandemic period. Very few people (17%) did complain of experiencing general health problems while 29% did not know of any potential health effects that could be attributed to aircraft noise exposures. Aircraft noise annoyance complaints among the As-Seeb residents during the pre-COVID-19 pandemic periods were reported to be extremely high reaching about 84% compared to 41% during this current COVID-19 pandemic period. These findings support the need to develop future sustainable noise mitigation policies in order to help reduce noise exposures and improve human health during post-COVID-19 pandemic periods.


Subject(s)
COVID-19 , Noise, Transportation , Aircraft , COVID-19/epidemiology , Communicable Disease Control , Environmental Exposure , Humans , Noise, Transportation/adverse effects , Oman/epidemiology , Pandemics
16.
Air Med J ; 40(6): 395-398, 2021.
Article in English | MEDLINE | ID: covidwho-1525663

ABSTRACT

OBJECTIVE: Prehospital emergency anesthesia in the form of rapid sequence intubation (RSI) is a critical intervention delivered by advanced prehospital critical care teams. Our previous simulation study determined the feasibility of in-aircraft RSI. We now examine whether this feasibility is preserved in a simulated setting when clinicians wear personal protective equipment (PPE) for aerosol-generating procedures (AGPs) for in-aircraft, on-the-ground RSI. METHODS: Air Ambulance Kent Surrey Sussex is a helicopter emergency medical service that uses an AW169 cabin simulator. Wearing full AGP PPE (eye protection, FFP3 mask, gown, and gloves), 10 doctor-paramedic teams performed RSI in a standard "can intubate, can ventilate" scenario and a "can't intubate, can't oxygenate" (CICO) scenario. Prespecified timings were reported, and participant feedback was sought by questionnaire. RESULTS: RSI was most commonly performed by direct laryngoscopy and was successfully achieved in all scenarios. The time to completed endotracheal intubation (ETI) was fastest (287 seconds) in the standard scenario and slower (370 seconds, P = .01) in the CICO scenario. The time to ETI was not significantly delayed by wearing PPE in the standard (P = .19) or CICO variant (P = .97). Communication challenges, equipment complications, and PPE difficulties were reported, but ways to mitigate these were also reported. CONCLUSION: In-aircraft RSI (aircraft on the ground) while wearing PPE for AGPs had no significant impact on the time to successful completion of ETI in a simulated setting. Patient safety is paramount in civilian helicopter emergency medical services, but the adoption of in-aircraft RSI could confer significant patient benefit in terms of prehospital time savings, and further research is warranted.


Subject(s)
Anesthesia , COVID-19 , Emergency Medical Services , Aircraft , Feasibility Studies , Humans , Intubation, Intratracheal , Personal Protective Equipment , SARS-CoV-2
17.
Hypertension ; 79(2): 325-334, 2022 02.
Article in English | MEDLINE | ID: covidwho-1476907

ABSTRACT

In a cross-sectional analysis of a case-control study in 2015, we revealed the association between increased arterial stiffness (pulse wave velocity) and aircraft noise exposure. In June 2020, we evaluated the long-term effects, and the impact of a sudden decline in noise exposure during the coronavirus disease 2019 (COVID-19) lockdown, on blood pressure and pulse wave velocity, comparing 74 participants exposed to long-term day-evening-night aircraft noise level >60 dB and 75 unexposed individuals. During the 5-year follow-up, the prevalence of hypertension increased in the exposed (42% versus 59%, P=0.048) but not in the unexposed group. The decline in noise exposure since April 2020 was accompanied with a significant decrease of noise annoyance, 24-hour systolic (121.2 versus 117.9 mm Hg; P=0.034) and diastolic (75.1 versus 72.0 mm Hg; P=0.003) blood pressure, and pulse wave velocity (10.2 versus 8.8 m/s; P=0.001) in the exposed group. Less profound decreases of these parameters were noticed in the unexposed group. Significant between group differences were observed for declines in office and night-time diastolic blood pressure and pulse wave velocity. Importantly, the difference in the reduction of pulse wave velocity between exposed and unexposed participants remained significant after adjustment for covariates (-1.49 versus -0.35 m/s; P=0.017). The observed difference in insomnia prevalence between exposed and unexposed individuals at baseline was no more significant at follow-up. Thus, long-term aircraft noise exposure may increase the prevalence of hypertension and accelerate arterial stiffening. However, even short-term noise reduction, as experienced during the COVID-19 lockdown, may reverse those unfavorable effects.


Subject(s)
Aircraft , Blood Pressure/physiology , COVID-19 , Environmental Exposure , Noise, Transportation/adverse effects , Noise/adverse effects , Quarantine , Vascular Stiffness/physiology , Aged , Arteriosclerosis/epidemiology , Arteriosclerosis/etiology , Female , Harm Reduction , Humans , Hypertension/epidemiology , Hypertension/etiology , Life Style , Male , Middle Aged , Poland/epidemiology , Pulse Wave Analysis , Sleep Initiation and Maintenance Disorders/epidemiology , Sleep Initiation and Maintenance Disorders/etiology , Urban Health
19.
J Travel Med ; 28(7)2021 Oct 11.
Article in English | MEDLINE | ID: covidwho-1393299

ABSTRACT

RATIONALE FOR THE REVIEW: Air travel may be associated with viruses spread via infected passengers and potentially through in-flight transmission. Given the novelty of the Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, transmission associated with air travel is based on transmission dynamics of other respiratory viruses. Our objective was to provide a rapid summary and evaluation of relevant data on SARS-CoV-2 transmission aboard aircraft, report policy implications and to highlight research gaps requiring urgent attention. METHODS: We searched four electronic databases (1 February 2020-27 January 2021) and included studies on SARS-CoV-2 transmission aboard aircraft. We assessed study quality based on five criteria and reported important findings. KEY FINDINGS: We included 18 studies on in-flight SARS-CoV-2 transmission (130 unique flights) and 2 studies on wastewater from aircraft. The quality of evidence from most published studies was low. Two wastewater studies reported PCR-positive samples with high cycle threshold values (33-39). Index case definition was heterogeneous across studies. The proportion of contacts traced ranged from 0.68 to 100%. Authors traced 2800/19 729 passengers, 140/180 crew members and 8/8 medical staff. Altogether, 273 index cases were reported, with 64 secondary cases. Three studies, each investigating one flight, reported no secondary cases. Secondary attack rate among studies following up >80% of passengers and crew (including data on 10 flights) varied between 0 and 8.2%. The studies reported on the possibility of SARS-CoV-2 transmission from asymptomatic, pre-symptomatic and symptomatic individuals. Two studies performed viral cultures with 10 positive results. Genomic sequencing and phylogenetic analysis were performed in individuals from four flights. CONCLUSION: Current evidence suggests SARS-CoV-2 can be transmitted during aircraft travel, but published data do not permit any conclusive assessment of likelihood and extent. The variation in design and methodology restricts the comparison of findings across studies. Standardized guidelines for conducting and reporting future studies of transmission on aircraft should be developed.


Subject(s)
Air Travel , COVID-19 , Aircraft , Humans , Phylogeny , SARS-CoV-2 , Travel
20.
N Engl J Med ; 383(25): 2472-2473, 2020 12 17.
Article in English | MEDLINE | ID: covidwho-1387596
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