Background: Multiple instances of flight-associated SARS-CoV-2 transmission during long-haul flights have been reported during the COVID-19 pandemic. However, comprehensive investigations of passenger risk behaviours, before, during, and after the flight, are scarce. Methods: To investigate suspected SARS-CoV-2 transmission during a flight from United Arab Emirates to Australia in July 2020, systematic, repeated PCR-testing of passengers in hotel quarantine was linked to whole genome sequencing. Epidemiological analyses of in-depth interviews covering behaviours during the flight and activities pre- and post-boarding were used to identify risk factors for infection. Results: Seventeen of the 95 passengers from four different travel origins had PCR-confirmed infection yielding indistinguishable genomic sequences. Two of the 17 passengers were symptomatic within two days of the flight, had travelled together, and classified as co-primary cases. Seven secondary cases were seated within 2-rows of the co-primary cases, but five economy passengers seated further away, and three business class passengers were also infected (attack rate = 16% [15/93]). In multivariable analysis, being seated within 2-rows of a primary case (OR 7.16; 95% CI 1.66–30.85) and spending more than an hour in the arrival airport (OR 4.96; 95% CI 1.04–23.60) were independent predictors of secondary infection, suggesting travel-associated SARS-CoV-2 transmission may have occurred both during and after the flight. Self-reported increased hand hygiene, wearing gloves, frequent aisle walking and using the bathroom on the plane did not independently affect the risk of SARS-CoV-2 acquisition. Conclusions: This investigation identified substantial in-flight transmission among passengers seated both within and beyond two-rows of the primary cases, the standard applied to contact tracing on flights. Infection of passengers in separate cabin classes also suggests transmission occurred outside the cabin environment, likely at the arrival airport. Recognising that transmission may occur pre- and post- boarding may inform contact tracing advice and improve efforts to prevent future travel-associated outbreaks.
Objective: To characterise Long COVID in a highly vaccinated population infected by Omicron. Design: Follow-up survey of persons testing positive for SARS-CoV-2 in Western Australia, 16 July-3 August 2022. Setting: Community Participants: 22,744 persons with COVID-19 who had agreed to participate in research at the time of diagnosis were texted a survey link 90 days later; non-responders were telephoned. Post stratification weights were applied to responses from 11,697 (51.4%) participants, 94.0% of whom had received >= 3 vaccine doses. Main outcome measures: Prevalence of Long COVID - defined as reporting new or ongoing COVID-19 illness-related symptoms or health issues 90 days post diagnosis; associated health care utilisation, reductions in work/study and risk factors were assessed using log-binomial regression. Results: 18.2% (n=2,130) of respondents met case definition for Long COVID. Female sex, being 50-69 years of age, pre-existing health issues, residing in a rural or remote area, and receiving fewer vaccine doses were significant independent predictors of Long COVID (p < 0.05). Persons with Long COVID reported a median of 6 symptoms, most commonly fatigue (70.6%) and difficulty concentrating (59.6%); 38.2% consulted a GP and 1.6% reported hospitalisation in the month prior to the survey due to ongoing symptoms. Of 1,778 respondents with Long COVID who were working/studying before their COVID-19 diagnosis, 17.9% reported reducing/discontinuing work/study. Conclusion: 90 days post Omicron infection, almost 1 in 5 respondents reported Long COVID symptoms; 1 in 15 of all persons with COVID-19 sought healthcare for associated health concerns >=2 months after the acute illness.
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