key: cord-0800652-qzdvun3r
authors: Grobusch, Martin P.; Schaumburg, Frieder; de Frey, Albie
title: Air travel and COVID-19 prevention: Fasten your seat belts, turbulence ahead
date: 2020-11-20
journal: Travel Med Infect Dis
DOI: 10.1016/j.tmaid.2020.101927
sha: 0593664ffef26eea41dc4c887d99a62cfc6496aa
doc_id: 800652
cord_uid: qzdvun3r

nan

It is widely accepted that the epidemiological curve of COVID-19 can only be flattened in a team action, taking into account all factors that could contribute to the spread of the virus. At the same time, individual sectors (e.g. entertainment and sporting industries, hospitality business, education, aviation) lobby, even take legal action, to be excluded from tough lockdown measures by showing that they do not contribute significantly to the spread of SARS-CoV-2. Therefore, balanced evidence-based decision-making becomes more and more fundamental to justify any restrictions of both private and professional life.

In this issue of TMAID, in their rapid narrative review, Michel Bielecki and colleagues summarise the current (as of October 2020) literature on COVID-19 prevention during and around air travel [1] . A little after that, about a (supersonic) flight's time back and forth from Europe to Australia later, Aisha Khatib et al. reported their findings on the same topic [2] ; this illustrates the urgency of the matter as airlines struggle to remain operational and to re- SARS-CoV-2 spread across the globe as a stowaway on commercial aircraft well before the dimension of the problem was obvious and well-recognised [5] . Consequently, air-travel restrictions may curb its global spread to (from the virus' perspective) uncharted territories [6] . Yet, in relation to another respiratory virus, influenza, as Khatib and colleagues point J o u r n a l P r e -p r o o f out: "…. that only extensive travel restrictions had any meaningful effect on reducing the magnitude of epidemics, and on their own, might delay the spread and peak of pandemics by a few weeks or months but the evidence for containment of influenza within a defined geographical area was lacking" [2] . On an individual level, in-flight transmission has been well-documented and without doubt contributes to the spread of COVID-19. However, as a COVID-19 pandemic era variant of the time-honoured bon mot that the most dangerous part of air travel is the way to the airport, the multiple occasions of virus transmission prior to boarding and after disembarking emerge as more critical regarding the scale and dimension of COVID-19 transmission amongst individuals. Whereas it has been shown before that, not surprisingly, airports could be formidable hubs for microbial passengers travelling in packs of zillions [7] , it begs the question whether a traveller's presence in an airport terminal poses a significantly bigger risk to the individual or public health and society than being in a shopping mall?

In the MMWR of 13 November 2020, the CDC reports on the cessation of the screening of inbound international travellers to the USA, concluding that temperature and symptom screening at airports detected few COVID-19 cases at considerable cost, yielding one single identified case per 85,000 travellers screened. As potential reasons for the low yield, multiple factors including an overall low COVID-19 prevalence in travellers; the relatively long incubation period; and an illness presenting with a broad spectrum in terms of asymptomatic infections; afebrile cases, range of severity, and non-specific symptoms commonly shared with other 'flu-like' infections; as well as travellers who might be in denial of their symptoms or even take steps to lower the odds of their illness being detected [8] . Every crisis also comes with opportunities. Innovative tools are increasingly being used in aviation that will also be valuable in containing future pandemics such as photoepidemiology to assess mask use, mobile applications for contact tracing [9] , antiviral materials and coatings for the decontamination of inanimate surfaces [10] .

A common denominator as a baseline to determine risk versus benefit has always been, and will always be, a major challenge in deciding on the in-or exclusion of an intervention in the heterogenic population that defines 'a traveller'. Trying to plot a way for safe airline travel in the vast expanse that is the SARS-CoV-2 pandemic, is no different. Given the complexity of the task, it is difficult, if not impossible to provide clear-cut, undisputable evidence for or against the effectivity, efficacy and effectiveness of many current interventions. All taken together; undeniably, with the often subjective interests of various stakeholders involved, we have to brace ourselves for some further delays prior to departure, frustration on the runway and in-flight turbulence on our way towards a 'new normal' in post-pandemic air travel.

J o u r n a l P r e -p r o o f

Air travel and COVID-19 prevention in the pandemic and peri-pandemic period: a narrative review

Navigating the risks of flying during COVID-19: A review for safe air travel

International Civil Aviation Organization Council Aviation Recovery Task Force (CART)

Worldwide COVID-19 spreading explained: traveling numbers as a primary driver for the pandemic

Travel restrictions and SARS-CoV-2 transmission: an effective distance approach to estimate impact

Airport door handles and the global spread of anti-microbial resistant bacteria: a cross-sectional study

Automated and partly automated contact tracing: a systematic review to inform the control of COVID-19

Antimicrobial Nanomaterials and Coatings: Current Mechanisms and Future Perspectives to Control the Spread of Viruses Including SARS-CoV-2