Flight-Associated Transmission of Severe Acute Respiratory Syndrome Coronavirus 2 Corroborated by Whole-Genome Sequencing

Abstract

19 had tested positive for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) by PCR. All 6 passengers had disembarked from cruise ships that had recently docked in Sydney. In the subsequent 2 weeks, several other cases of SARS-CoV-2 infection were identified among passengers on that flight. Although the role of cruise ships in SARS-CoV-2 transmission is well documented (1), information regarding potential flight-associated transmission of SARS-CoV-2 (2,3) is limited. We investigated SARS-CoV-2 transmission associated with a 5-hour domestic flight by analyzing epidemiologic and whole-genome sequencing (WGS) data. Ethics approval was not required for this investigation, conducted as part of the public health response to the SARS-CoV-2 outbreak under the Western Australia Public Health Act 2016. Methods Public Health Response to Coronavirus Disease in Australia In Australia, coronavirus disease (COVID-19) is an urgently notifiable disease (4); laboratory-confirmed cases and close contacts are investigated and managed according to national guidelines produced by the Communicable Disease Network of Australia (4). Details for flights with SARS-CoV-2 infectious persons on board are published at https://www. healthywa.wa.gov.au/coronavirus. Airlines are responsible for the management of crew and are notified of potential in-flight exposure by the National Incident Room (https://www.health.gov.au/initiatives-and-programs/national-incident-room).

Air travel in a COVID-19 world: Commercial airline passengers’ health concerns and attitudes towards infection prevention and disease control measures

“…35 While IATA suggests that risk of in-cabin COVID-19 transmission is low 13 , COVID-19 has spread globally because of the movement of infected individuals by air travel. [9][10][11][12] Moreover, the IATA COVID-19 survey concluded that 36% of respondents would at least wait six months before considering traveling by air, with an additional 14% indicating they would not travel before a year or more from the moment the pandemic shows a true global decline and 5%…”

“…7 SARS-CoV-2 spread worldwide and was declared a global pandemic 8 in less than 3 months, driven principally by the movement of infected individuals by air. [9][10][11][12] The emergence of COVID-19 and its associated travel bans have reduced international passenger traffic. As of 8 October 2020, 1.2 billion passengers have travelled worldwide 13 , compared to the over 4.5 billion in 2019.…”

Reprint of: Air travel and COVID-19 prevention in the pandemic and peri-pandemic period: A narrative review

“…6 were seated mid cabin and 5 aft cabin. They noticed a significantly greater risk of transmission in secondary infections in mid cabin vs aft cabin seats (11/112 vs 0/101 passengers) as well as window seats 7/28 vs non-window seats (4/83) [ 74 ].…”

COVID-19 pandemic management and the rheumatology patient

“…In addition, multiple cases have been identified associated with airplane travel, where social distancing is not feasible, including two flights prior to recommendations for universal masking where genomic sequencing was not performed, and a more recent publication identifying identical viral strains between two passengers and two flight staff with incubation periods suggesting exposure to staff during the flight ( 63 , 64 , 65 ). A contact investigation out of Australia identified 29 cases linked to a flight where mask use was infrequent with passengers from a known cruise ship outbreak resulting in multiple secondary cases identified by a distinct genetic cluster ( 66 ). Secondary cases were clustered in the mid cabin but were dispersed over nine rows ( 66 ).…”

“…A contact investigation out of Australia identified 29 cases linked to a flight where mask use was infrequent with passengers from a known cruise ship outbreak resulting in multiple secondary cases identified by a distinct genetic cluster ( 66 ). Secondary cases were clustered in the mid cabin but were dispersed over nine rows ( 66 ).…”