Hand‐Hygiene Mitigation Strategies Against Global Disease Spreading through the Air Transportation Network

Abstract

The risk for a global transmission of flu-type viruses is strengthened by the physical contact between humans and accelerated through individual mobility patterns. The Air Transportation System plays a critical role in such transmissions because it is responsible for fast and long-range human travel, while its building components-the airports-are crowded, confined areas with usually poor hygiene. Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO) consider hand hygiene as the most efficient and cost-effective way to limit disease propagation. Results from clinical studies reveal the effect of hand washing on individual transmissibility of infectious diseases. However, its potential as a mitigation strategy against the global risk for a pandemic has not been fully explored. Here, we use epidemiological modeling and data-driven simulations to elucidate the role of individual engagement with hand hygiene inside airports in conjunction with human travel on the global spread of epidemics. We find that, by increasing travelers engagement with hand hygiene at all airports, a potential pandemic can be inhibited by 24% to 69%. In addition, we identify 10 airports at the core of a cost-optimal deployment of the hand-washing mitigation strategy. Increasing hand-washing rate at only those 10 influential locations, the risk of a pandemic could potentially drop by up to 37%. Our results provide evidence for the effectiveness of hand hygiene in airports on the global spread of infections that could shape the way public-health policy is implemented with respect to the overall objective of mitigating potential population health crises.

The accelerated infectious disease risk in the Anthropocene: more outbreaks and wider global spread

“…While such a proposal may sound like "pie in the sky" at the moment, rapid advances in diagnostic techniques, such as translational proteomics, may soon allow us to identify infected hosts using simple breathalyzer, saliva, or urine tests (Athlin et al, 2017;Nakhleh et al, 2017;Tao et al, 2019;Zainabadi et al, 2019). Furthermore, hygienic measures, such as the enforcement of handwashing and the wearing of facemasks in public transport hubs, complete and regular disinfection of important traffic hubs and vehicles (including the air and all surfaces), and much better vector control should become mandatory global standards of public health (e.g., Grout and Speakman, 2019;Nicolaides et al, 2019, reviewed in Huizer et al, 2015, especially in the most central of traffic hubs, such as the world's most connected airports (Guimerà et al, 2005;Bajardi et al, 2011). Such measures would certainly help to decrease the mobility of infected hosts and thus the transmission and global spread of diseases.…”

Hand hygiene and facemask use to prevent droplet transmitted viral diseases during air travel: a systematic literature review

“…Despite our extensive literature searching on the topic, we were able to summarize the results of only four recently published studies that tried to investigate the potential of practices, such as facemask use or hand hygiene, in limiting the transmission of in uenza virus-laden droplets and aerosols in aircrafts. While the results from three studies [Caley et al, 2007;Gupta et al, 2012;Nicolaides et al, 2020] were probabilistic concerning the rst practice, the case-control study by Zhang et al [2013] provided substantial evidence about the risk of not wearing a facemask in a con ned space such as the airplane cabin during a ight. Less convincing are the results from these studies concerning the hand washing of passengers in airport/aircraft settings [Caley et al, 2007;Gupta et al, 2012;Nicolaides et al, 2020].…”

“…While the results from three studies [Caley et al, 2007;Gupta et al, 2012;Nicolaides et al, 2020] were probabilistic concerning the rst practice, the case-control study by Zhang et al [2013] provided substantial evidence about the risk of not wearing a facemask in a con ned space such as the airplane cabin during a ight. Less convincing are the results from these studies concerning the hand washing of passengers in airport/aircraft settings [Caley et al, 2007;Gupta et al, 2012;Nicolaides et al, 2020]. Again in the study by Zhang et al [2013], passengers in both case and control groups appeared to be equally compliant in hand hygiene, with 100% of passengers stating to have washed hands after using toilet, which may be a receptacle of viruscontaminated fomites [Morawska, 2006].…”

“…Two studies evaluated hand hygiene as a mitigation strategy [Nicolaides et al, 2020;Zhang et al, 2013]. In the study by Nicolaides et al…”

Clinical, Molecular and Epidemiological Characterization of the SARS-CoV2 Virus and the Coronavirus Disease 2019 (COVID-19): A Comprehensive Literature Review

“…Increasing the level of hand cleanliness to 60% in places with a high concentration of people, like all airports in the world would have a reduction of 69% in the impact of a potential disease spreading[211].The specific recommendations from WHO are social distancing and hand washing. About rational use of masks, WHO recommends: "If the person is healthy, only need to wear a mask if he/she is taking care of a person with suspected SARS-CoV-2 infection".…”