Abstract
International air travel has been highlighted as a concern since the beginning of the COVID-19 pandemic with respect to importation of cases. We summarise the available evidence for in-flight transmission of wild type SARS-CoV-2 during 2020, and for imported COVID-19 clusters to cause outbreaks. This paper provides a data baseline prior to the emergence of new mutations causing SARS-CoV-2 variants of concern, whose characteristics may increase the potential risk of in-flight transmission and imported outbreaks. The evidence on in-flight transmission of wild-type SARS-CoV-2 is limited, and is described in a small number of published reports. Most of the available evidence pertains to the early phase of the COVID-19 pandemic, during a period without non-pharmaceutical interventions such as distancing and in-flight mask wearing. There is considerable potential for outbreaks of COVID-19 from imported cases or clusters when public health guidance around quarantine of travellers and self-isolation of cases is not adhered to. Risks can be mitigated by measures such as: avoiding non-essential travel, targeted testing and quarantine of travellers from high incidence regions or regions of concern, managed quarantine processes, and protocols for rapid investigation and control of transmission from a possible variant of concern. Measures should be dynamically assessed and proportionate to the level of risk.Graphical abstract
Highlights
Under International Health Regulations (IHR) [1], nations should provide a public health response to the international spread of disease in ways that are commensurate with public health risks, and which avoid unnecessary interference with international traffic and trade.European Union guidance for a co-ordinated approach to travel restrictions through the COVID-19 pandemic aspires to an integrated method based on the epidemiological picture at a given time in the region of origin/We review the available evidence on the risk posed by air travel during the first phases of the COVID-19 pandemic, when wild-type SARS-COV 2 predominated internationally
We aimed to present the available evidence on in-flight transmission events, the nature of infection prevention and control (IPC) measures and the risk of outbreaks of COVID-19 in the destination countries
A small number of studies have shown evidence of inflight transmission of SARS-CoV-2 in the early phase of the COVID-19 pandemic, with higher attack rates associated with tour groups and with business class settings; and lower attack rates associated with adherence to inflight mask wearing
Summary
European Union guidance for a co-ordinated approach to travel restrictions through the COVID-19 pandemic aspires to an integrated method based on the epidemiological picture at a given time in the region of origin/. We review the available evidence on the risk posed by air travel during the first phases of the COVID-19 pandemic, when wild-type SARS-COV 2 predominated internationally. This provides a baseline for comparison as variants of concern (VOC) emerge. Published articles describe events; editorial commentary in academic journals draws on published evidence. This review can only provide a picture of events described and should be set in the context of substantial (albeit greatly reduced) numbers of
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