The Risk of Aircraft-Acquired SARS-CoV-2 Transmission during Commercial Flights: A Systematic Review

Diana Zhao, Stephanie Cheng, Fuchiang R. Tsui, Maya B. Mathur and Chih-Hung Jason Wang ()
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Diana Zhao: Center for Policy, Outcomes and Prevention, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 94305, USA
Stephanie Cheng: Center for Policy, Outcomes and Prevention, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 94305, USA
Fuchiang R. Tsui: Department of Anesthesiology and Critical Care Medicine, Children’s Hospital of Philadelphia, Philadelphia, PA 19146, USA
Maya B. Mathur: Quantitative Sciences Unit, Department of Pediatrics, Stanford University, Stanford, CA 94305, USA
Chih-Hung Jason Wang: Center for Policy, Outcomes and Prevention, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA 94305, USA

IJERPH, 2024, vol. 21, issue 6, 1-11

Abstract: The aircraft-acquired transmission of SARS-CoV-2 poses a public health risk. Following PRISMA guidelines, we conducted a systematic review and analysis of articles, published prior to vaccines being available, from 24 January 2020 to 20 April 2021 to identify factors important for transmission. Articles were included if they mentioned index cases and identifiable flight duration, and excluded if they discussed non-commercial aircraft, airflow or transmission models, cases without flight data, or that were unable to determine in-flight transmission. From the 15 articles selected for in-depth review, 50 total flights were analyzed by flight duration both as a categorical variable—short (<3 h), medium (3–6 h), or long flights (>6 h)—and as a continuous variable with case counts modeled by negative binomial regression. Compared to short flights without masking, medium and long flights without masking were associated with 4.66-fold increase (95% CI: [1.01, 21.52]; p < 0.0001) and 25.93-fold increase in incidence rates (95% CI: [4.1, 164]; p < 0.0001), respectively; long flights with enforced masking had no transmission reported. A 1 h increase in flight duration was associated with 1.53-fold (95% CI: [1.19, 1.66]; p < 0.001) increase in the incidence rate ratio (IRR) of cases. Masking should be considered for long flights.

Keywords: risk of aircraft-acquired SARS-CoV-2 transmission; COVID-19 risk on flights; coronavirus transmission on airplanes (search for similar items in EconPapers)
JEL-codes: I I1 I3 Q Q5 (search for similar items in EconPapers)
Date: 2024
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