Navigating the risks of flying during COVID-19: a review for safe air travel

Abstract

Rationale for Review: With air travel restarting, there has been much discourse about the safety of flying during the pandemic. In Travel Medicine, risk assessment includes estimating baseline risk to the traveller, recognizing factors that may modify that risk, considering the role of interventions to decrease that risk, and accounting for a traveller’s perception and tolerance of risk. The goals of this review are: to identify the in-flight transmission risks of commercial air travel, to provide recommendations about the risks of flying during the pandemic, and to propose strategies to mitigate the spread of COVID-19. Key Findings: The airline industry has taken a layered approach to increase passenger safety through effective onboard ventilation, extended ventilation at the gate, boarding and deplaning strategies, improved aircraft disinfection, and pre-flight screening such as temperature checks and COVID-19 testing. Proximity to an index case may contribute to the risk of transmission more than the seat type or location. The use of face masks has significantly reduced onboard transmission and mandatory inflight mask wearing policies are being enforced. Innovations such as digital health passports may help standardize screening entry requirements at airports and borders, allowing for a safer return to travel. Recommendations: In-flight transmission of SARS-CoV-2 is a real risk, which may be minimized by combining mitigation strategies and infection prevention measures including: mandatory masking onboard, minimizing unmasked time while eating, turning on gasper airflow inflight, frequent hand sanitizing, disinfecting high touch surfaces, promoting distancing while boarding and deplaning, limiting onboard passenger movement, implementing effective pre-flight screening measures and enhancing contact tracing capability. Assessing risk is a cornerstone of travel medicine. It is important to evaluate the multiple factors contributing to the cumulative risk of an individual traveller during the COVID-19 pandemic and to employ a multi-pronged approach to reduce that risk.

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

“…Although self-inoculation of the nasal mucosa by contaminated hands is a well-documented mode of influenza virus transmission [ 25 ], aerosols or droplets represent the primary source of direct transmission from influenza (or other respiratory) virus-infected persons [ 24 ]. Therefore, we contextualized the findings from this systematic review to the current growing evidence on COVID-19 transmission/prevention concerns, which include the prospect of common practices (i.e., wearing facemasks) to control and prevent SARS-CoV-2 transmission in confined air travel-related spaces [ 10 , 17 ].…”

“…It is, however, reassuring that despite over 1.2 billion passengers traveling since the beginning of 2020, only 44 cases of COVID-19 reported by the International Air Transport Association (IATA) as of 8 October 2020 have been associated with a flight journey [ 16 ]. As discussed below, cabin ventilation and air filtration together—perhaps this was not the case in Moser et al’s study [ 14 ]—ensure that the air aboard modern aircraft is very safe [ 17 ]. Likewise, wearing facemasks—which theoretically amplify the air quality in cabins—is necessarily interrupted by meal (or beverage) intake during a flight.…”

“…Screening of air travelers at entry points from designated/recognized areas of a severe respiratory syndrome by observation, questionnaires, and body temperature assessment in combination with personal protective measures are the most recommended mitigation measures [ 8 , 10 , 17 ]. However, most recommendations have unknown efficacy because of scarce or lacking scientific evidence and rely on studies developed in settings other than aircraft.…”

A scoping review of global vaccine certificate solutions for COVID-19

“…CommonPass, a product of the Commons Project is one example which have been trialed out by United Airlines and Cathay Paci c Airways for showing COVID-19 test results and has been presented to over 37 governments. In the near future, it will integrate vaccine certi cates 40 . Germany, Indonesia, Italy, Israel, Colombia, Argentina, and the U.S. have considered implementing health passports like CommonPass 41 .…”

Impact of Immediate and Preferential Relaxation of Social and Travel Restrictions for Vaccinated People on the Spreading Dynamics of COVID-19 : a Model-Based Analysis

“…For air travel, each window/aisle seater case will infect the middle seater, while each middle seater case will infect both the window and aisle. Even though the ventilation in an aircraft is good [S4], normal travel involves conversation and occasional physical contact between neighbouring passengers. Furthermore, each infected passenger will likely infect two others (nearest neighbours) in the airport seating area.…”