The CDC shared that two separate passengers on two separate flights likely caught Coronavirus after asymptomatic passengers used the toilet or had in-flight contact. These would be the first noted in-flight transmissions.
Keep your mask on in the toilet
The scientists from Soonchunhyang University in Seoul, report that the first passenger sat three rows behind the infected passenger and likely became infected while using the toilet, the only time she removed her mask. The scientists concluded the “most plausible explanation for the transmission to a passenger on the aircraft is she became infected by an asymptomatic but infected passenger while using an onboard toilet”.
After an 11-hour flight, 299 asymptomatic passengers arrived in South Korea and were immediately quarantined for 2 weeks at a government quarantine facility in which the passengers were completely isolated from one another. Medical staff examined them twice daily for elevated body temperature and symptoms of COVID-19. Asymptomatic patients were those who were asymptomatic when they tested positive and did not develop symptoms within 14 days after testing. Among the 299 passengers, 6 had a confirmed positive result for SARS-CoV-2 on quarantine day 1 and were transferred immediately to the hospital. At 14 days after the positive test, the 6 patients reported no symptoms and were categorized as asymptomatic.
On quarantine day 14, a 28-year-old woman who had no underlying disease had a confirmed positive test result for COVID-19. On the flight from Milan, Italy, to South Korea, she wore an N95 mask, except when she used a toilet. The toilet was shared by passengers sitting nearby, including an asymptomatic patient. She was seated 3 rows away from the asymptomatic patient. Given that she did not go outside and had self-quarantined for 3 weeks alone at her home in Italy before the flight and did not use public transportation to get to the airport, it is highly likely that her infection was transmitted in the flight via indirect contact with an asymptomatic patient.
The scientists also looked at 205 passengers flying the same route on April 3rd. Three were asymptomatic, only testing positive on the first day of quarantine. Another passenger swabbed negative on day one, but positive on day 14.
To reinforce our results, we performed an external validation using a different dataset. Another evacuation flight of 205 passengers from Milan, Italy, to South Korea on April 3, 2020, was also conducted by KCDC under strict infection control procedures. Among the passengers on this flight were 3 asymptomatic patients who tested positive on quarantine day 1 and 1 patient who tested negative on quarantine day 1 and positive on quarantine day 14. On the basis of an epidemiologic investigation, the authors and KCDC suspect that this infection was also transmitted by inflight contact.
Wear your mask at all times and understand the importance of hand hygiene and social distancing when boarding and deplaning.
Considering the difficulty of airborne infection transmission inflight because of high-efficiency particulate-arresting filters used in aircraft ventilation systems, contact with contaminated surfaces or infected persons when boarding, moving, or disembarking from the aircraft may play a critical role in inflight transmission of infectious diseases
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