In-flight Transmission Cluster of COVID-19: A Retrospective Case Series

Abstract

Objectives: No data were available about in-flight transmission of SARS-CoV-2. Here, we report an in-flight transmission cluster of COVID-19 and describe the clinical characteristics of these patients.Methods: After a flight, laboratory-confirmed COVID-19 was reported in 12 patients. Ten patients were admitted to the designated hospital. Data were collected from 25 th January to 28 th February 2020. Clinical information was retrospectively collected.Results: All patients are passengers without flight attendants. The median age was 33 years, and 70% were females. None was admitted to intensive care unit, and no patients succumbed through 28 th February. The median incubation period was 3.0 days and from illness onset to hospital admission was 2 days. The most common symptom was fever. Two patients were asymptomatic and negative for chest CT scan throughout the disease courses. On admission, initial RT-PCR were positive in 9 patients, however initial chest CT were positive in only half patients. The median lung "total severity score" of chest CT was 6. Notably, "Crazy-Paving" pattern, pleural effusion, and ground-glass nodules were also seen.

Occurrence and transmission potential of asymptomatic and presymptomatic SARS-CoV-2 infections: A living systematic review and meta-analysis

“…In nine studies that reported on close contacts of infected individuals and aggregated data from clusters of both asymptomatic and symptomatic people with SARS-CoV-2 the summary estimate was 14% (95% CI 8%-23%, prediction interval 2%-53%) [36,47,60,62,66,72,105,108,111]. We included 12 studies (n = 675 people) that reported on outbreak investigations arising from a single symptomatic person or from the country's first imported cases of people with COVID-19 [32,43,48,58,61,68,71,90,94,95,97,100]. Four of the outbreaks involved nursing homes [58,68,71,94] and four involved occupational settings [43,61,90,95].…”

Two metres or one: what is the evidence for physical distancing in covid-19?

“…27 Other indoor case clusters have been reported within fitness gyms, boxing matches, call centres, and churches, where people might sing, pant, or talk loudly. 28 -30 Interestingly, there have been few reports of outbreaks on aeroplanes, 31 which may reflect current low volume of passengers, lack of contact tracing, or relatively low risk because speaking is limited. Although publication bias is likely (events linked to outbreaks are more likely to be reported than events where no outbreak occurred), well documented stories of outbreaks demand a scientific explanation.…”

The epidemiology of reverse transmission of COVID-19 in Gansu Province, China

“…Using the same approach has proven effective in controlling virus transmission in China over the last 6 weeks in combating the COVID-19 outbreak [21]. It has been reported that it may be possible for COVID-19 to be transmitted during flights, which has prompted the mandatory wearing of N95 facemasks for crew and passengers on any incoming flights to China, and when known positive COVID-19 cases are onboard, isolation in a screened-off section of the aircraft and the wearing of fully protective gowns, face masks and goggles [26]. Thus, during the repatriation flight and during the short interval in China prior to swab testing, stringent quarantine precautions were used, making infection during the repatriation flight and upon return to China unlikely.…”