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Assessment of SARS-CoV-2 Transmission on an International Flight and Among a Tourist Group

Our take —

This is a case series, simply describing COVID-19 infection among passengers of a mid-length (280-minute) commercial flight, and interpretations of the findings should be limited as such. Overall, 7/24 members of a single tourist group tested positive, and 13 of the other 71 passengers that could be reached were tested for antibodies because they were sitting within 2 rows of a case or symptomatic; among those, an additional 2/13 cases were identified. Several major limitations make it impossible to draw any meaningful temporal conclusions between boarding the flight and infection with COVID-19 and other asymptomatic cases may have been missed.

Study design

Case Series

Study population and setting

The study describes COVID-19 infection among passengers of a 280-minute commercial flight that travelled from Tel Aviv, Israel to Frankfurt, Germany on March 9, 2020. 24 of the 102 passengers were members of a tourist group. A week earlier, the tourist group had contact with an individual who later tested positive for COVID-19. However, at the time of the flight, none had been diagnosed with COVID-19 and no protective measures (e.g., masks) were taken before or during the flight by the tourist group. After arrival at Frankfurt airport, a medical evaluation was conducted of the tourist group including collection of a throat swab specimen for COVID-19 testing. About 4-5 weeks later, all passengers were contacted by phone for interviews to assess symptoms, and a COVID-19 antibody test was offered to those passengers who sat within 2 rows of confirmed cases or who reported being symptomatic.

Summary of Main Findings

7 of the 24 members (29.1%) of the tourist group tested positive for COVID-19. However, only 4 were symptomatic during the flight; 2 were pre-symptomatic and 1 remained asymptomatic. 71 of the other 78 passengers who had been on the flight completed the phone interviews, and 13 of them provided serum samples within 6-9 weeks of the flight. COVID-19 antibodies were confirmed in 2 of the 13 individuals who provided serum samples.

Study Strengths

Indeterminate and positive results were verified using a plaque reduction neutralization test.

Limitations

No information was obtained on the airplane crew, and very few passengers outside of the tourist group had an antibody test (13 out of 78). No way to establish causality between boarding the flight and acquiring COVID-19, as all antibody tests were conducted after the flight.

Value added

Describes COVID-19 infection among passengers on an international commercial flight.

This review was posted on: 2 September 2020