In-flight transmission has been hypothesized but not substantiated sufficiently in a non–peer-reviewed report of a cluster of 10 flight-associated cases in China in February (N. Yang et al., unpub. First, we did not have genomic sequencing data available to support our hypothesis of in-flight transmission. We also eliminated change fees for First, Business, Premium Economy and Main Cabin tickets for all long-haul international flights originating in North or South America for tickets issued on or after November 19, 2020. We also thank the Civil Avian Administration, Immigration Bureau, Vietnam Airlines, and all passengers on flight VN54 for their cooperation and support. CLEVELAND, Ohio — Airlines say that the likelihood of in-flight transmission of COVID-19 is low. The forms can be printed, digital, or uploaded to the VeriFly app. "We conclude that the risk for on-board transmission of SARS-CoV-2 during long flights is real and has the potential to cause COVID-19 clusters of substantial size, even in business class–like settings with spacious seating arrangements well beyond the established distance used to define close contact on airplanes," the authors said. Opens another site in a new window that may not meet accessibility guidelines. Dinh), Ha Noi University of Public Health, Hanoi (L.N. Of the 15 persons with flight-associated cases, 12 (80%) had traveled in business class with case 1, and 2 travelers (cases 14 and 15) and 1 flight attendant (case 16) had been in economy class (Figure 1). Requirement for face masks on planes and in airports Second, long flights not only can lead to importation of COVID-19 cases but also can provide conditions for superspreader events. State, local, and territorial governments may have travel restrictions in … In Vietnam, for example, as a result of this investigation, national policy was changed toward mandatory testing at arrival irrespective of departure location and 14-day quarantine irrespective of test result or clinical signs/symptoms (41). During those three weeks, Emirates had five flights with seven or more infected passengers on each flight, for a total of 58 coronavirus-positive passengers flying on eight-hour trips. Importation and human-to-human transmission of a novel coronavirus in Vietnam. During the first 6 months of 2020, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) spread to almost all countries and infected »4 million persons worldwide (1). However, given the logistic and economic implications of such policies, developing a quick and reliable point-of-care test that covers the entire infectious period remains paramount. However, all persons with flight-associated cases departed from the United Kingdom (none transited from other countries); and until the departure date of flight VN54, only 23 COVID-19 cases had been recorded in the United Kingdom. A new case study from New Zealand ’s Ministry of Health finds that Covid-19 can spread on long-haul flights. Please use the form below to submit correspondence to the authors or contact them at the following address: Cong-Khanh Nguyen, Department of Communicable Diseases Control, National Institute of Hygiene and Epidemiology, 1 Yersin St, Hai Ba Trung District, Hanoi 100000, Vietnam. Get the VeriFly app Last, given the delay between arrival and confirmation of the probable index case, no environmental samples could be collected from the airplane. Our findings challenge these recommendations. Temporary changes to food and drink service, Domestic, short-haul international and select long-haul international flights, New international travel originating outside of North or South America. Among the 16 persons in whom SARS-CoV-2 infection was detected, 12 (75%) were passengers seated in business class along with the only symptomatic person (attack rate 62%). Among the 217 passengers and crew members on a direct flight from London to Hanoi in early March 2020, we identified a cluster of 16 laboratory-confirmed COVID-19 cases. Among passengers seated within 2 meters from case 1, which we approximated in business class to be <2 seats away, 11 (92%) were SARS-CoV-2–positive compared with 1 (13%) located >2 seats away (risk ratio 7.3, 95% CI 1.2–46.2) (Table 2). Travelers originating in the U.S. and taking an international roundtrip flight can order an at-home, virtually guided COVID-19 antigen test to take with them for their return flight back to the U.S. We thank healthcare workers from provincial Centers for Disease Control and local authorities from cities and provinces in Vietnam for their great work with case finding, contact tracing, disease control, and prevention measures. Whether these cases reflect unusually long incubation periods or symptoms caused by conditions other than COVID-19 is unknown. Her signs and symptoms (fever, sore throat, fatigue, and shortness of breath) progressed further after arrival, and she self-isolated at her private residence in Hanoi and had contact with household personnel only. Similar results with similar limitations have been reported from flights arriving in France (31,32) and Thailand (33) in January and February. Of note, the temporal sequence of symptom onset among cases in economy class and the crew member serving in economy class also allows for the possibility of a second in-flight transmission event, independent of the cluster in business class (Figure 2). What worried me more were the long flights to get there: about 17 hours from New York, with a layover required somewhere. We were able to quarantine, interview, and collect swab specimens for PCR testing from all passengers and crew members who remained in Vietnam. You're allowed to make a change to your trip once, and the change fee will be waived. Although Vietnam Airlines keeps business class passengers separated from economy class passengers during most procedures before and during the flight, contact with the 2 economy class cases might have occurred after arrival during immigration or at baggage claim. Susie Neilson. Staying home is the best way to protect yourself and others from getting sick. Transmission of SARS-CoV 2 During Long-Haul Flight. The IATA's Powell reports encouraging data about the risk of virus transmission on flights. You will be subject to the destination website's privacy policy when you follow the link. We’re making travel easier by giving you even more flexibility and the freedom to make your own choices when you fly with us. However, the conclusiveness and unambiguity of our in-depth epidemiologic upstream and downstream investigations coupled with extensive laboratory testing make us confident of our main findings. 17) (18). You can cancel your trip online and rebook later when you’re ready, including Basic Economy fares bought between March 1, 2020 and March 31, 2021. All travel for your new trip must be completed by March 31, 2022. The timing of last contact of the remaining 2 confirmed close contacts with their respective flight-associated cases suggests that infection of the flight-associated cases occurred at the same time and that time of infection coincided with the time of the flight (Appendix). First imported case of 2019 novel coronavirus in Canada, presenting as mild pneumonia. Opens another site in a new window that may not meet accessibility guidelines. This policy change eliminated the need for resource-intensive contact tracing of flight passengers altogether and enabled detection of another 106 cases among »5,000 passengers on 44 flights until all international flights were halted on March 28. They continued to reside in London until February 29, when case 1 started to experience a sore throat and cough while attending meetings and visiting entertainment hubs with friends. Tu, D.D. “The risk for on-board transmission of SARS-CoV-2 during long flights is real. We eliminated all change fees for First, Business, Premium Economy and Main Cabin tickets for all domestic and short-haul international flying for tickets issued on or after August 31, 2020. Plane trips and COVID risk: what you need to know. Covid-19 could lead to a surge in 'ultra-long haul' flights. This does not apply to children under 2 years old. Severe acute respiratory syndrome coronavirus 2 shedding by travelers, Vietnam, 2020. The 274 seats on the airplane were divided into business class (28 seats), premium economy class (35 seats), and economy class (211 seats); there were 4 toilets for business and premium economy classes and 5 for economy. All of these studies limited contact tracing to passengers within 2 rows of the index cases, which could explain why secondary flight-related transmission was not detected by those studies. The first case of coronavirus disease (COVID-19) in Vietnam was recorded on January 23, 2020; the patient was a visitor from Wuhan, China (9). Dr. Khanh is an epidemiologist at the Department of Communicable Diseases Control, National Institute of Hygiene and Epidemiology. Centers for Disease Control and Prevention. We subsequently launched an extensive epidemiologic investigation that involved testing and isolation/quarantine of all traceable passengers and crew members of the identified flight. Estimated effectiveness of symptom and risk screening to prevent the spread of COVID-19. Check Travel Restrictions. Similar intervals between arrival and positive SARS-CoV-2 test results among 3 case-pairs suggest a common exposure event rather than subsequent infection from one partner to the other. "The risk of transmission of COVID-19 from passenger-to … By March 10, all 16 (100%) of the flight crew and 168 (84%) of the passengers who remained in Vietnam had been traced; 33 (16%) passengers had already transited to other countries. Specifically, we defined suspected flight-associated COVID-19 cases as passengers or crew members on board flight VN54 landing in Hanoi on March 2 who reported fever and cough, with or without shortness of breath, during March 1–16. Our case investigations supplemented by information obtained from media reports indicated that she had traveled to Italy on February 18 with her sister, who was later confirmed to be SARS-CoV-2–positive in London, and back to London on February 20 to stay with her sister for another 2 nights. Among >1,300 close contacts of VN54 passengers and crew members, 5 confirmed cases were identified, 3 of whom were household personnel linked to case 1. We conclude that the risk for on-board transmission of SARS-CoV-2 during long flights is real and has the potential to cause COVID-19 clusters of substantial size, even in business class–like settings with spacious seating arrangements well beyond the established distance used to define close contact on airplanes. Any symptomatic person was isolated immediately until the test result was received. Our study has several limitations. At that time, 1,593 persons had tested negative for SARS-CoV-2 infection in Vietnam, and according to official policy at that time, another 10,089 contacts and travelers returning from COVID-19–affected areas overseas were under preemptive quarantine directly at the time of arrival. In January 2020, no secondary cases were detected after a 15-hour flight to Canada with a symptomatic person with COVID-19 on board (29), although contact tracing and monitoring were limited (30). The number of probable secondary cases detected in our study is on the upper end of hypothesized estimations for SARS-CoV-2 transmission on airplanes in the absence of face mask use, although the movement of aerosols and droplets in the specific conditions of a flight cabin remains poorly understood (27). Southwest Airlines ® is aware that government mandates have resulted in restrictions on air travel due to the ongoing COVID-19 pandemic. On the 2-row rule for infectious disease transmission on aircraft. Similarly, for case 4, who reported having visited India before the United Kingdom during his incubation period, the possibility of preflight transmission remains slim because by March 1, only 3 cases of COVID-19 had been reported in India, although testing in India was still limited (20–22). If you may be exempt because you have a disability that prevents you from safely wearing a mask as defined by the Americans with Disabilities Act (42 USC 12101 et. Emerg Infect Dis. No in-depth investigations among passengers on those flights were conducted, and no evidence indicated that transmission had occurred during the flights themselves. For example, airline crew often use business class toilets while on board, which might explain the case among the crew serving in economy class, for whom no other potential source of infection could be established. Of the 12 additional cases in business class, symptoms subsequently developed in 8 (67%); median symptom onset was 8.8 days (interquartile range 5.8–13.5) after arrival (Figure 2). Why airlines that can pivot to ultra-long-haul flights will succeed in the post-coronavirus era August 24, 2020 7.44am EDT Linus Bauer , City, University of London Combating the COVID-19 Epidemic: Experiences from Vietnam. Coronavirus travel questions: Your COVID-19 queries answered. Southwest stopped blocking middle seats on Dec. 1. Basic Economy fares bought on or after April 1, 2021 are non-refundable and non-changeable. Seating proximity was strongly associated with increased infection risk (risk ratio 7.3, 95% CI 1.2–46.2). COVID-19: Facemask use prevalence in international airports in Asia, Europe and the Americas, March 2020. 2019 Novel coronavirus (COVID-19) pandemic: built environment considerations to reduce transmission. Fourth, we had no data available on individual passenger use of face masks while on board, which would have enabled a more refined risk analysis. In-depth interviews were conducted with all persons with suspected or confirmed flight-associated cases; the specific focus was detecting any potential SARS-CoV-2 transmission events before and after the flight to investigate potential alternative scenarios for transmission other than during the flight. We acknowledge important contributions and guidelines from the following committee and institutions: Vietnam National Steering Committee for COVID-19 Prevention and Control, Ministry of Health, Ministry of Science and Technology, and National Institute of Hygiene and Epidemiology. Two meals were served, and flight attendants worked in 2 teams, 1 for the business and premium economy sections and 1 for the economy section. data, https://www.medrxiv.org/content/10.1101/2020.03.28.20040097v1.full.pdf). Our objectives were to estimate the probability that transmission of SARS-CoV-2 occurred on the flight in question and to identify risk factors associated with transmission. Read more about U.S. testing and other requirements Guidelines for preventing SARS-CoV-2 infection among air passengers should consider individual passengers’ risk for infection, the number of passengers traveling, and flight duration. Keep in mind, if you cannot show proof of a negative test or documentation of recovery, you cannot fly and won’t be allowed to board the plane. Although testing had not been implemented on a large scale nationwide at that time (19), community transmission in the United Kingdom was not yet widely established (20), making the presence of multiple persons on board incubating the illness unlikely. These kits must be ordered and delivered to a U.S. residence Our findings call for tightened screening and infection prevention measures by public health authorities, regulators, and the airline industry, especially in countries where substantial transmission is ongoing (37). Our investigation did not reveal strong evidence supporting potential SARS-CoV-2 exposure either before or after the flight for any of the additional persons with flight-associated cases other than having traveled on the same flight as case 1 (Appendix). At that time, importation of COVID-19 had been documented in association with 3 flights to Vietnam, including a cluster of 6 persons who had index cases and were evacuated from Wuhan; 6 secondary cases resulted from virus transmission in Vietnam (11). The risk of catching the coronavirus on an airplane, and ways to reduce that risk, have been well documented since SARS-CoV-2 started spreading across the … Delta Air Lines is the only carrier still limiting seat sales in economy class, a policy in effect through April 30. This finding also concurs with transmission patterns observed for influenza virus (38) and is generally in line with the mounting evidence that airborne transmission of SARS-CoV-2 is a major yet underrecognized transmission route (39,40). Here's how they're dealing with COVID-19 guidelines. If you’re traveling at this time, we’re here for you and are making temporary changes to the travel experience to prioritize your safety. You’re welcome to bring snacks and soft drinks on board to enjoy during your flight. If oxygen masks drop from an overhead compartment, remove your face covering before placing the oxygen mask over your nose and mouth. 2020;26(11):2617-2624. https://doi.org/10.3201/eid2611.203299. In the absence of genomic analysis, we were unable to completely rule out alternative transmission routes. CDC is not responsible for Section 508 compliance (accessibility) on other federal or private website. Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1. Transmission on flight VN54 was clustered in business class, where seats are already more widely spaced than in economy class, and infection spread much further than the existing 2-row (36) or 2 meters (37) rule recommended for COVID-19 prevention on airplanes and other public transport would have captured. Khanh N, Thai P, Quach H, et al. I recently rescheduled my trip to visit next week; here are the strategies I used that made me comfortable doing so: Choose a flight where everybody boarding has just had a negative Covid test. U.S. federal law requires that you wear a face covering from the time you enter the airport where your trip begins, on board your flight, and until you leave the airport where your trip ends. All successfully traced passengers and crew members were interviewed by use of a standard questionnaire, tested for SARS-CoV-2, and quarantined in designated facilities or at home. Furthermore, all persons with suspected or confirmed flight-associated cases were asked to identify persons with whom they had had close contact (<2 meter distance for >15 minutes) between arriving in Vietnam and the start of quarantine/isolation. A 27-year-old businesswoman from Vietnam, whom we identified as the probable index case (hereafter case 1), had been based in London since early February. These rules do not apply to children under 2, or if you have a disability that prevents you from wearing a face covering and meet the exemption requirements. Ages of affected persons ranged from 30 to 74 years (median 63.5 years); 9 (>50%) were male, and 12 (75%) were of British nationality (Table 1). The role of fomites and on-board surfaces such as tray tables and surfaces in toilets remains unknown. On March 1, she boarded flight VN54. General Information Travel restriction Customer notification: Taking care of you. If you haven't yet used that year-old flight credit, issued when the COVID-19 pandemic first brought travel to a standstill, there's a good chance it can still be redeemed for an airline ticket. Thai, T.-T. Nguyen), Australian National University, Canberra, Australian Capital Territory, Australia (H.-L. Quach, N.-A. On January 12, 2021, CDC announced an Order requiring all air passengers arriving to the US from a foreign country to get tested no more than 3 days before their flight departs and to present the negative result or documentation of having recovered from COVID-19 to the airline before boarding the flight. Transmission of the severe acute respiratory syndrome on aircraft. Times are tough for travellers. Potential transmission of SARS-CoV-2 on a flight from Singapore to Hangzhou, China: An epidemiological investigation. In early March, when much of the global community was just beginning to recognize the severity of the pandemic, we detected a cluster of COVID-19 cases among passengers arriving on the same flight from London, UK, to Hanoi, Vietnam, on March 2 (Vietnam Airlines flight 54 [VN54]). We defined cases of SARS-CoV-2 infection according to Vietnam Ministry of Health guidelines in place at the time of our investigation (12). There was an unexpected error. No evidence indicated that the regular air conditioning and exchange system on flight VN54 were malfunctioning. Epidemiologic and clinical timeline for passengers on Vietnam Airlines flight 54, from London, UK, to Hanoi, Vietnam, March 2, 2020, for whom SARS-CoV-2 infection was later confirmed. First, thermal imaging and self-declaration of symptoms have clear limitations, as demonstrated by case 1, who boarded the flight with symptoms and did not declare them before or after the flight. In particular, we investigated all possible exposures of all persons with flight-associated cases during their incubation period in relation to the timing of the flight, including locations where flight-associated cases may have crossed paths before and after the flight. Probable aircraft transmission of Covid-19 in-flight from the Central African Republic to France. Your face covering must be worn and visible at all times, including if you plan to sleep. This option is specifically for your return flight to the U.S. and is not valid for travel to and from China. *This is a narrow exception that includes a person with a disability who cannot wear a mask for reasons related to the disability. Operating hours for clubs that remain open may change based on flight schedules. On March 5, she sought care at a local hospital in Hanoi, where an oropharyngeal swab sample was taken and tested; SARS-CoV-2 infection was confirmed by real-time reverse transcription PCR on March 6. Transmission of COVID-19 virus by droplets and aerosols: A critical review on the unresolved dichotomy. It has been hypothesized that a combination of environmental factors on airplanes (humidity, temperature, air flow) can prolong the presence of SARS-CoV-2 in flight cabins (27). At that time, the use of face masks was not mandatory on airplanes or at airports (18). Contact with case 1 might also have occurred outside the airplane at the airport, in particular among business class passengers in the predeparture lounge area or during boarding. Flight VN54 departed London at 11:10 am local time on March 1, 2020, and arrived in Hanoi at 5:20 am local time on March 2; the nonstop flight lasted about 10 hours. Table of Contents – Volume 26, Number 11—November 2020. For the safety of everyone on board, some types of recreational / personal protection equipment are not allowed for use on our planes or in flight: The U.S. and countries around the world have imposed a range of travel restrictions and testing requirements due to COVID-19. First cases of coronavirus disease 2019 (COVID-19) in France: surveillance, investigations and control measures, January 2020. Two new studies published in a scientific journal raise questions about whether transmission of the coronavirus on lengthy commercial airline … Investigation Team. Affected persons were passengers, crew, and their close contacts. We’re limiting food and drink service in the Main Cabin based on flight length and destination. The new change fee policy also applies to AAdvantage® award tickets. It has been hypothesized that a combination of environmental factors on airplanes (humidity, temperature, air flow) can prolong the presence of SARS-CoV-2 in flight cabins (27). Face masks were neither recommended nor widely used on airplanes in early March, in particular not among travelers from Europe (24–26), who constituted the majority of passengers on flight VN54. Electronic or printed proof of a negative viral COVID-19 test (PCR or antigen) performed no more than 3 days before your flight departs. When you check-in you'll be asked to confirm you've been free of COVID-19 symptoms for the past 10 days. Guidelines, law, and governance: disconnects in the global control of airline-associated infectious diseases. Opens another site in a new window that may not meet accessibility guidelines. Saving Lives, Protecting People, National Institute of Hygiene and Epidemiology, Hanoi, Vietnam (N.C. Khanh, P.Q. If you buy Basic Economy fares you may now buy extras like upgrades, seats, priority boarding and same-day flight changes. Portable electronic air fresheners / purifiers. You’re allowed to change your origin and destination cities as part of this offer. Transmission and control of an emerging influenza pandemic in a small-world airline network. Transmission of SARS-CoV 2 During Long-Haul Flight. On March 7, three of her household personnel received positive SARS-CoV-2 results, as did a friend of hers, whom she had visited in London on February 29, on March 10. Change fees are waived for tickets bought on or before September 30, 2020, for travel March 1, 2020 – March 31, 2021. Third, our assessment of passengers’ preflight exposure to other confirmed cases relied on interviews only. Duong, L.T.Q. Keep in mind, you may owe any difference in ticket price if the fare of your new trip is higher when you rebook. She was seated in business class and continued to experience the sore throat and cough throughout the flight. 2These last authors contributed equally to this article. Hawaiian Airline’s latest information on travel updates, travel waivers, and flight suspensions related to the COVID-19. Comment submitted successfully, thank you for your feedback. Review article: influenza transmission on aircraft. While limited quantities of face coverings may be available at the gate, they will not be available for every customer on every flight. To identify factors associated with in-flight infection risks, we calculated risk ratios and 95% CIs. We consider local transmission after arrival in Vietnam unlikely. In September, two other international studies came … On airborne transmission and control of SARS-Cov-2. We traced 217 passengers and crew to their final destinations and interviewed, tested, and quarantined them. *Change fees apply if your original ticketed travel was before March 1, 2020, Basic Economy tickets with travel before March 1, 2020 are non-changeable. The odds will be lower for flights taken in parts of the globe with few cases and higher for long haul flights as "the ratio of proximity is a factor along with the existence of proximity," he says. Curbside check-in may not be available. These close contacts were also contacted, tested, and quarantined for 14 days. When Rwanda decided to reopen its borders on August 1, ... What to consider before taking an international flight during the coronavirus … Visit the Centers for Disease Control and Prevention (CDC) website for more information about the mask requirement. As long as COVID-19 presents a global pandemic threat in the absence of a good point-of-care test, better on-board infection prevention measures and arrival screening procedures are needed to make flying safe. To assess the role of in-flight transmission of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), we investigated a cluster of cases among passengers on a 10-hour commercial flight. None of the couples or individual cases traveled or stayed with another couple or individual case before the flight or after arrival in Vietnam. Flight-associated cases were considered to have very likely acquired infection on board VN54 and were hence classified as probable secondary cases in this analysis if the following 3 criteria were met: 1) they experienced signs/symptoms 2–14 days after arrival or if they were SARS-CoV-2 positive by PCR 2–14 days after arrival in the absence of signs/symptoms; 2) in-depth investigation did not reveal any potential exposure to SARS-CoV-2 before or after the flight during their incubation period; and 3) they had shared cabin space with the probable index case during the flight (14–17). A total of 16 crew members and 201 passengers were on board. He is a member of Rapid Response Team of Vietnam’s National Steering Committee for COVID-19 Prevention and Control. Quang). Show your documents to an American Airlines agent. Message not sent. Please enable JavaScript to fully experience this site. It is not meant to cover persons for whom mask-wearing may only be difficult. Opens another site in a new window that may not meet accessibility guidelines. Please note, making false claims of a disability or a health condition to obtain an exemption from wearing a face covering may result in denial of travel on American for the duration of the U.S. federal mask requirement. A study of a COVID-19 cluster with 16 infected flight passengers from Singapore in February 2020 identified only 1 instance of potential in-flight transmission (28). No more change fees for all domestic, short-haul international and select long-haul international flying on Premium Cabin, Premium Economy and Main Cabin fares. Linking to a non-federal website does not constitute an endorsement by CDC or any of its employees of the sponsors or the information and products presented on the website.
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