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Ruuskanen O, Dollner H, Luoto R, Valtonen M, Heinonen OJ, Waris M. Contraction of Respiratory Viral Infection During air Travel: An Under-Recognized Health Risk for Athletes. SPORTS MEDICINE - OPEN 2024; 10:60. [PMID: 38776030 PMCID: PMC11111432 DOI: 10.1186/s40798-024-00725-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 05/09/2024] [Indexed: 05/25/2024]
Abstract
Air travel has an important role in the spread of viral acute respiratory infections (ARIs). Aircraft offer an ideal setting for the transmission of ARI because of a closed environment, crowded conditions, and close-contact setting. Numerous studies have shown that influenza and COVID-19 spread readily in an aircraft with one virus-positive symptomatic or asymptomatic index case. The numbers of secondary cases differ markedly in different studies most probably because of the wide variation of the infectiousness of the infector as well as the susceptibility of the infectees. The primary risk factor is sitting within two rows of an infectious passenger. Elite athletes travel frequently and are thus prone to contracting an ARI during travel. It is anecdotally known in the sport and exercise medicine community that athletes often contract ARI during air travel. The degree to which athletes are infected in an aircraft by respiratory viruses is unclear. Two recent studies suggest that 8% of Team Finland members traveling to major winter sports events contracted the common cold most probably during air travel. Further prospective clinical studies with viral diagnostics are needed to understand the transmission dynamics and to develop effective and socially acceptable preventive measures during air travel.
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Affiliation(s)
- Olli Ruuskanen
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, PL 52, 20521, Turku, Finland
| | - Henrik Dollner
- Department of Clinical and Molecular Medicine, Children's Clinic, St. Olavs University Hospital, Norwegian University of Science and Technology, Trondheim, Norway
| | - Raakel Luoto
- Department of Paediatrics and Adolescent Medicine, Turku University Hospital and University of Turku, PL 52, 20521, Turku, Finland
| | | | - Olli J Heinonen
- Paavo Nurmi Centre and Unit for Health and Physical Activity, University of Turku, Turku, Finland
| | - Matti Waris
- Institute of Biomedicine, University of Turku and Department of Clinical Virology, Turku University Hospital, Kiinamyllynkatu 10, 20520, Turku, Finland.
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Hakmi H, Moreno J, Petrone P, Sohail AH, Burbano G, Sbayi S. Crossing borders to change lives: Surgical mission amidst the COVID-19 pandemic. Cir Esp 2023; 101:594-598. [PMID: 36410642 DOI: 10.1016/j.cireng.2022.11.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 08/31/2022] [Accepted: 10/15/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION During the COVID pandemic, elective global surgical missions were temporarily halted for the safety of patients and travelling healthcare providers. We discuss our experience during our first surgical mission amidst the pandemic. We report a safe and successful treatment of the patients, detailing our precautionary steps and outcomes. METHODS Retrospective manual chart review and data collection of patients' charts was conducted after IRB approval. We entail our experience and safety steps followed during screening, operating and postoperative care to minimize exposure and improve outcomes during a surgical mission in an outpatient setting during the pandemic. The surgical mission was from February 8 to February 12, 2022. RESULTS A total of 60 patients who were screened. 33 patients underwent surgical intervention. One patient required postoperative hospitalization for a biliary duct leak. No patient or healthcare provider tested positive for COVID at the end of the mission. The average age of patients was 46.9 years. The average operative time was 116 min, and all patients had local nerve blocks. It included 45 health work providers. CONCLUSIONS It is safe to perform outpatient international surgery during the pandemic while following pre-selected precautions.
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Affiliation(s)
- Hazim Hakmi
- NYU Langone Hospital-Long Island, Mineola, New York, USA
| | - Johnny Moreno
- Centro Clínico Quirúrgico Ambulatorio "Blanca's House Ecuador - Hospital del Día", Guayaquil, Ecuador
| | | | - Amir H Sohail
- NYU Langone Hospital-Long Island, Mineola, New York, USA
| | - Galo Burbano
- Centro Clínico Quirúrgico Ambulatorio "Blanca's House Ecuador - Hospital del Día", Guayaquil, Ecuador
| | - Samer Sbayi
- Stony Brook University Hospital, Stony Brook, New York, USA
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Rafferty AC, Bofkin K, Hughes W, Souter S, Hosegood I, Hall RN, Furuya-Kanamori L, Liu B, Drane M, Regan T, Halder M, Kelaher C, Kirk MD. Does 2x2 airplane passenger contact tracing for infectious respiratory pathogens work? A systematic review of the evidence. PLoS One 2023; 18:e0264294. [PMID: 36730309 PMCID: PMC9894495 DOI: 10.1371/journal.pone.0264294] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 01/18/2023] [Indexed: 02/03/2023] Open
Abstract
We critically appraised the literature regarding in-flight transmission of a range of respiratory infections to provide an evidence base for public health policies for contact tracing passengers, given the limited pathogen-specific data for SARS-CoV-2 currently available. Using PubMed, Web of Science, and other databases including preprints, we systematically reviewed evidence of in-flight transmission of infectious respiratory illnesses. A meta-analysis was conducted where total numbers of persons on board a specific flight was known, to calculate a pooled Attack Rate (AR) for a range of pathogens. The quality of the evidence provided was assessed using a bias assessment tool developed for in-flight transmission investigations of influenza which was modelled on the PRISMA statement and the Newcastle-Ottawa scale. We identified 103 publications detailing 165 flight investigations. Overall, 43.7% (72/165) of investigations provided evidence for in-flight transmission. H1N1 influenza A virus had the highest reported pooled attack rate per 100 persons (AR = 1.17), followed by SARS-CoV-2 (AR = 0.54) and SARS-CoV (AR = 0.32), Mycobacterium tuberculosis (TB, AR = 0.25), and measles virus (AR = 0.09). There was high heterogeneity in estimates between studies, except for TB. Of the 72 investigations that provided evidence for in-flight transmission, 27 investigations were assessed as having a high level of evidence, 23 as medium, and 22 as low. One third of the investigations that reported on proximity of cases showed transmission occurring beyond the 2x2 seating area. We suggest that for emerging pathogens, in the absence of pathogen-specific evidence, the 2x2 system should not be used for contact tracing. Instead, alternate contact tracing protocols and close contact definitions for enclosed areas, such as the same cabin on an aircraft or other forms of transport, should be considered as part of a whole of journey approach.
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Affiliation(s)
- Anna C. Rafferty
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australian Capital Territory, Australia
- National Incident Centre, The Australian Government Department of Health, Canberra, Australian Capital Territory, Australia
| | - Kelly Bofkin
- Qantas Airways Limited, Mascot, New South Wales, Australia
- Virgin Australia Airlines, South Brisbane, Queensland, Australia
| | - Whitney Hughes
- Qantas Airways Limited, Mascot, New South Wales, Australia
| | - Sara Souter
- Qantas Airways Limited, Mascot, New South Wales, Australia
- Virgin Australia Airlines, South Brisbane, Queensland, Australia
| | - Ian Hosegood
- Qantas Airways Limited, Mascot, New South Wales, Australia
| | - Robyn N. Hall
- National Incident Centre, The Australian Government Department of Health, Canberra, Australian Capital Territory, Australia
| | - Luis Furuya-Kanamori
- UQ Centre for Clinical Research, Faculty of Medicine, The University of Queensland, Herston, Queensland, Australia
| | - Bette Liu
- School of Population Health, University of New South Wales, Kensington, New South Wales, Australia
| | | | - Toby Regan
- New Zealand Ministry of Health, Wellington, New Zealand
| | - Molly Halder
- New Zealand Ministry of Health, Wellington, New Zealand
| | - Catherine Kelaher
- National Incident Centre, The Australian Government Department of Health, Canberra, Australian Capital Territory, Australia
| | - Martyn D. Kirk
- National Centre for Epidemiology and Population Health, The Australian National University, Canberra, Australian Capital Territory, Australia
- National Incident Centre, The Australian Government Department of Health, Canberra, Australian Capital Territory, Australia
- * E-mail:
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Jones DL, Rhymes JM, Wade MJ, Kevill JL, Malham SK, Grimsley JMS, Rimmer C, Weightman AJ, Farkas K. Suitability of aircraft wastewater for pathogen detection and public health surveillance. THE SCIENCE OF THE TOTAL ENVIRONMENT 2023; 856:159162. [PMID: 36202356 PMCID: PMC9528016 DOI: 10.1016/j.scitotenv.2022.159162] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 05/08/2022] [Revised: 09/25/2022] [Accepted: 09/28/2022] [Indexed: 06/16/2023]
Abstract
International air travel is now widely recognised as one of the primary mechanisms responsible for the transnational movement and global spread of SARS-CoV-2. Monitoring the viral load and novel lineages within human-derived wastewater collected from aircraft and at air transport hubs has been proposed as an effective way to monitor the importation frequency of viral pathogens. The success of this approach, however, is highly dependent on the bathroom and defecation habits of air passengers during their journey. In this study of UK adults (n = 2103), we quantified the likelihood of defecation prior to departure, on the aircraft and upon arrival on both short- and long-haul flights. The results were then used to assess the likelihood of capturing the signal from infected individuals at UK travel hubs. To obtain a representative cross-section of the population, the survey was stratified by geographical region, gender, age, parenting status, and social class. We found that an individual's likelihood to defecate on short-haul flights (< 6 h in duration) was low (< 13 % of the total), but was higher on long-haul flights (< 36 %; > 6 h in duration). This behaviour pattern was higher among males and younger age groups. The maximum likelihood of defecation was prior to departure (< 39 %). Based on known SARS-CoV-2 faecal shedding rates (30-60 %) and an equal probability of infected individuals being on short- (71 % of inbound flights) and long-haul flights (29 %), we estimate that aircraft wastewater is likely to capture ca. 8-14 % of SARS-CoV-2 cases entering the UK. Monte Carlo simulations predicted that SARS-CoV-2 would be present in wastewater on 14 % of short-haul flights and 62 % of long-haul flights under current pandemic conditions. We conclude that aircraft wastewater alone is insufficient to effectively monitor all the transboundary entries of faecal-borne pathogens but can form part of a wider strategy for public heath surveillance at national borders.
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Affiliation(s)
- Davey L Jones
- Centre for Environmental Biotechnology, Bangor University, Bangor, Gwynedd LL57 2UW, UK; Food Futures Institute, Murdoch University, Murdoch, WA 6105, Australia.
| | - Jennifer M Rhymes
- Centre for Environmental Biotechnology, Bangor University, Bangor, Gwynedd LL57 2UW, UK; UK Centre for Ecology and Hydrology, Bangor, Gwynedd LL57 2UW, UK
| | - Matthew J Wade
- Newcastle University, School of Engineering, Cassie Building, Newcastle-upon-Tyne NE1 7RU, UK; UK Health Security Agency, Environmental Monitoring for Health Protection, Windsor House, London SW1H 0TL, UK
| | - Jessica L Kevill
- Centre for Environmental Biotechnology, Bangor University, Bangor, Gwynedd LL57 2UW, UK
| | - Shelagh K Malham
- School of Ocean Sciences, Bangor University, Menai Bridge, Anglesey LL59 5AB, UK
| | - Jasmine M S Grimsley
- UK Health Security Agency, Environmental Monitoring for Health Protection, Windsor House, London SW1H 0TL, UK; The London Data Company, London EC2N 2AT, UK
| | - Charlotte Rimmer
- Centre for Environmental Biotechnology, Bangor University, Bangor, Gwynedd LL57 2UW, UK
| | - Andrew J Weightman
- Microbiomes, Microbes and Informatics Group, School of Biosciences, Cardiff University, Cardiff CF10 3AX, UK
| | - Kata Farkas
- Centre for Environmental Biotechnology, Bangor University, Bangor, Gwynedd LL57 2UW, UK; The London Data Company, London EC2N 2AT, UK
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Bennett JS, Mahmoud S, Dietrich W, Jones B, Hosni M. Evaluating vacant middle seats and masks as Coronavirus exposure reduction strategies in aircraft cabins using particle tracer experiments and computational fluid dynamics simulations. ENGINEERING REPORTS : OPEN ACCESS 2022; 5:e12582. [PMID: 36718395 PMCID: PMC9878082 DOI: 10.1002/eng2.12582] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Revised: 09/29/2022] [Accepted: 10/01/2022] [Indexed: 06/18/2023]
Abstract
Aircraft cabins have high-performance ventilation systems, yet typically hold many persons in close proximity for long durations. The current study estimated airborne virus exposure and infection reductions when middle seats are vacant compared to full occupancy and when passengers wear surgical masks in aircraft. Tracer particle data reported by U.S. Transportation Command (TRANSCOM) and CFD simulations reported by Boeing were used along with NIOSH data, to build nonlinear regression models with particle exposure and distance from particle source as variables. These models that estimate exposure at given distances from the viral source were applied to evaluate exposure reductions from vacant middle seats. Reductions averaged 54% for the seat row where an infectious passenger is located and 36% for a 24-row cabin containing one infectious passenger, with middle seats vacant. Analysis of the TRANSCOM data showed that universal masking (surgical masks) reduced exposures by 62% and showed masking and physical distancing provide further reductions when practiced together. For a notional scenario involving 10 infectious passengers, compared with no intervention, masking, distancing, and both would prevent 6.2, 3.8, and 7.6 secondary infections, respectively, using the Wells-Riley equation. These results suggest distancing alone, masking alone, and these practiced together reduce SARS CoV-2 exposure risk in increasing order of effectiveness, when an infectious passenger is present.
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Affiliation(s)
- James S. Bennett
- Division of Field Studies and EngineeringNational Institute for Occupational Safety and Health, CDCCincinnatiOhioUSA
| | - Seif Mahmoud
- Division of Field Studies and EngineeringNational Institute for Occupational Safety and Health, CDCCincinnatiOhioUSA
| | - Watts Dietrich
- Division of Field Studies and EngineeringNational Institute for Occupational Safety and Health, CDCCincinnatiOhioUSA
- University of CincinnatiCincinnatiOhioUSA
| | - Byron Jones
- Department of Mechanical and Nuclear EngineeringKansas State UniversityManhattanKansasUSA
| | - Mohammad Hosni
- Department of Mechanical and Nuclear EngineeringKansas State UniversityManhattanKansasUSA
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6
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Ngeh S, Vogt F, Sikazwe CT, Levy A, Pingault NM, Smith DW, Effler PV. Travel-associated SARS-CoV-2 transmission documented with whole genome sequencing following a long-haul international flight. J Travel Med 2022; 29:6582210. [PMID: 35532195 PMCID: PMC9129214 DOI: 10.1093/jtm/taac057] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Revised: 04/29/2022] [Indexed: 11/14/2022]
Abstract
BACKGROUND Multiple instances of flight-associated severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) transmission during long-haul flights have been reported during the COVID-19 pandemic. However, comprehensive investigations of passenger risk behaviours, before, during and after the flight, are scarce. METHODS To investigate suspected SARS-CoV-2 transmission during a flight from United Arab Emirates to Australia in July 2020, systematic, repeated polymerase chain reaction (PCR) testing of passengers in hotel quarantine was linked to whole genome sequencing. Epidemiological analyses of in-depth interviews covering behaviours during the flight and activities pre- and post-boarding were used to identify risk factors for infection. RESULTS Seventeen of the 95 passengers from four different travel origins had PCR-confirmed infection yielding indistinguishable genomic sequences. Two of the 17 passengers were symptomatic within 2 days of the flight, and classified as co-primary cases. Seven secondary cases were seated within two rows of the co-primary cases, but five economy passengers seated further away and three business class passengers were also infected (attack rate = 16% [15/93]). In multivariable analysis, being seated within two rows of a primary case [odds ratio (OR) 7.16; 95% confidence interval (CI) 1.66-30.85] and spending more than an hour in the arrival airport (OR 4.96; 95% CI 1.04-23.60) were independent predictors of secondary infection, suggesting travel-associated SARS-CoV-2 transmission likely occurred both during and after the flight. Self-reported increased hand hygiene, frequent aisle walking and using the bathroom on the plane did not independently affect the risk of SARS-CoV-2 acquisition. CONCLUSIONS This investigation identified substantial in-flight transmission among passengers seated both within and beyond two rows of the primary cases. Infection of passengers in separate cabin classes also suggests transmission occurred outside the cabin environment, likely at the arrival airport. Recognizing that transmission may occur pre- and post-boarding may inform contact tracing advice and improve efforts to prevent future travel-associated outbreaks.
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Affiliation(s)
- Sera Ngeh
- Communicable Disease Control Directorate, Department of Health Western Australia, PO Box 6172, Perth Business Centre, Perth, WA 6849, Australia.,National Centre for Epidemiology and Population Health, Australian National University, 62 Mills Road, Acton, Canberra ACT 2601, Australia
| | - Florian Vogt
- Communicable Disease Control Directorate, Department of Health Western Australia, PO Box 6172, Perth Business Centre, Perth, WA 6849, Australia.,National Centre for Epidemiology and Population Health, Australian National University, 62 Mills Road, Acton, Canberra ACT 2601, Australia.,Global Health Program, The Kirby Institute, Level 6, Wallace Wurth Building, High Street, University of New South Wales, Sydney, Kensington NSW 2052, Australia
| | - Chisha T Sikazwe
- Department of Microbiology, PathWest Laboratory Medicine Western Australia, QE2 Medical Centre, Locked Bay 2009, Nedlands, WA, 6909, Australia.,School of Biomedical Sciences, University of Western Australia, 35 Stirling Highway, Perth, WA 6009, Australia
| | - Avram Levy
- Department of Microbiology, PathWest Laboratory Medicine Western Australia, QE2 Medical Centre, Locked Bay 2009, Nedlands, WA, 6909, Australia.,School of Biomedical Sciences, University of Western Australia, 35 Stirling Highway, Perth, WA 6009, Australia
| | - Nevada M Pingault
- Communicable Disease Control Directorate, Department of Health Western Australia, PO Box 6172, Perth Business Centre, Perth, WA 6849, Australia
| | - David W Smith
- Department of Microbiology, PathWest Laboratory Medicine Western Australia, QE2 Medical Centre, Locked Bay 2009, Nedlands, WA, 6909, Australia.,School of Medicine, University of Western Australia, 35 Stirling Highway, Perth, WA 6009, Australia
| | - Paul V Effler
- Communicable Disease Control Directorate, Department of Health Western Australia, PO Box 6172, Perth Business Centre, Perth, WA 6849, Australia.,School of Medicine, University of Western Australia, 35 Stirling Highway, Perth, WA 6009, Australia
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Menon NG, Mohapatra S. The COVID-19 pandemic: Virus transmission and risk assessment. CURRENT OPINION IN ENVIRONMENTAL SCIENCE & HEALTH 2022; 28:100373. [PMID: 35669052 PMCID: PMC9156429 DOI: 10.1016/j.coesh.2022.100373] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
The coronaviruses are the largest known RNA viruses of which SASR-CoV-2 has been spreading continuously due to its repeated mutation triggered by several environmental factors. Multiple human interventions and lessons learned from the SARS 2002 outbreak helped reduce its spread considerably, and thus, the virus was contained but the emerging mutations burdened the medical facility leading to many deaths in the world. As per the world health organization (WHO) droplet mode transmission is the most common mode of SASR-CoV-2 transmission to which environmental factors including temperature and humidity play a major role. This article highlights the responsibility of environmental causes that would affect the distribution and fate of the virus. Recent development in the risk assessment models is also covered in this article.
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Affiliation(s)
- N Gayathri Menon
- Centre for Research in Nanotechnology and Science (CRNTS), Indian Institute of Technology Bombay, India
| | - Sanjeeb Mohapatra
- NUS Environmental Research Institute, National University of Singapore, 1 Create Way, Create Tower, #15-02, Singapore 138602, Singapore
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8
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Wang Q, Gu J, An T. The emission and dynamics of droplets from human expiratory activities and COVID-19 transmission in public transport system: A review. BUILDING AND ENVIRONMENT 2022; 219:109224. [PMID: 35645454 PMCID: PMC9126829 DOI: 10.1016/j.buildenv.2022.109224] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Revised: 05/03/2022] [Accepted: 05/20/2022] [Indexed: 06/15/2023]
Abstract
The public transport system, containing a large number of passengers in enclosed and confined spaces, provides suitable conditions for the spread of respiratory diseases. Understanding how diseases are transmitted in public transport environment is of vital importance to public health. However, this is a highly multidisciplinary matter and the related physical processes including the emissions of respiratory droplets, the droplet dynamics and transport pathways, and subsequently, the infection risk in public transport, are poorly understood. To better grasp the complex processes involved, a synthesis of current knowledge is required. Therefore, we conducted a review on the behaviors of respiratory droplets in public transport system, covering a wide scope from the emission profiles of expiratory droplets, the droplet dynamics and transport, to the transmission of COVID-19 in public transport. The literature was searched using related keywords in Web of Science and PubMed and screened for suitability. The droplet size is a key parameter in determining the deposition and evaporation, which together with the exhaled air velocity largely determines the horizontal travel distance. The potential transmission route and transmission rate in public transport as well as the factors influencing the virus-laden droplet behaviors and virus viability (such as ventilation system, wearing personal protective equipment, air temperature and relative humidity) were also discussed. The review also suggests that future studies should address the uncertainties in droplet emission profiles associated with the measurement techniques, and preferably build a database based on a unified testing protocol. Further investigations based on field measurements and modeling studies into the influence of different ventilation systems on the transmission rate in public transport are also needed, which would provide scientific basis for controlling the transmission of diseases.
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Affiliation(s)
- Qiaoqiao Wang
- Institute for Environmental and Climate Research, Jinan University, 511443, Guangzhou, China
- Guangdong-Hong Kong-Macau Joint Laboratory of Collaborative Innovation for Environmental Quality, 511443, Guangzhou, China
| | - Jianwei Gu
- Guangdong-Hong Kong-Macao Joint Laboratory for Contaminants Exposure and Health, Guangdong Key Laboratory of Environmental Catalysis and Health Risk Control, Institute of Environmental Health and Pollution Control, Guangdong University of Technology, 510006, Guangzhou, China
- Guangzhou Key Laboratory of Environmental Catalysis and Pollution Control, Guangdong Technology Research Center for Photocatalytic Technology Integration and Equipment Engineering, School of Environmental Science and Engineering, Guangdong University of Technology, 510006, Guangzhou, China
| | - Taicheng An
- Guangdong-Hong Kong-Macao Joint Laboratory for Contaminants Exposure and Health, Guangdong Key Laboratory of Environmental Catalysis and Health Risk Control, Institute of Environmental Health and Pollution Control, Guangdong University of Technology, 510006, Guangzhou, China
- Guangzhou Key Laboratory of Environmental Catalysis and Pollution Control, Guangdong Technology Research Center for Photocatalytic Technology Integration and Equipment Engineering, School of Environmental Science and Engineering, Guangdong University of Technology, 510006, Guangzhou, China
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Wang F, You R, Zhang T, Chen Q. Recent progress on studies of airborne infectious disease transmission, air quality, and thermal comfort in the airliner cabin air environment. INDOOR AIR 2022; 32:e13032. [PMID: 35481932 PMCID: PMC9111434 DOI: 10.1111/ina.13032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/05/2022] [Revised: 03/03/2022] [Accepted: 03/17/2022] [Indexed: 05/08/2023]
Abstract
Airborne transmission of infectious diseases through air travel has become a major concern, especially during the COVID-19 pandemic. The flying public and crew members have long demanded better air quality and thermal comfort in commercial airliner cabins. This paper reviewed studies related to the airliner cabin air environment that have been published in scientific journals since 2000, to understand the state-of-the-art in cabin air environment design and the efforts made to improve this environment. In this critical review, this paper discusses the challenges and opportunities in studying the cabin air environment. The literature review concluded that current environmental control systems for airliner cabins have done little to stop the airborne transmission of infectious diseases. There were no reports of significant air quality problems in cabins, although passengers and crew members have complained of some health-related issues. The air temperature in cabins needs to be better controlled, and therefore, better thermal comfort models for airliners should be developed. Low humidity is a major complaint from passengers and crew members. Gaspers are used by passengers to adjust thermal comfort, but they do not improve air quality. Various personalized and displacement ventilation systems have been developed to improve air quality and thermal comfort. Air cleaning technologies need to be further developed. Good tools are available for designing a better cabin air environment.
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Affiliation(s)
- Feng Wang
- Tianjin Key Laboratory of Indoor Air Environmental Quality ControlSchool of Environmental Science and EngineeringTianjin UniversityTianjinChina
- Department of Building Environment and Energy EngineeringThe Hong Kong Polytechnic UniversityKowloon, Hong Kong SARChina
| | - Ruoyu You
- Department of Building Environment and Energy EngineeringThe Hong Kong Polytechnic UniversityKowloon, Hong Kong SARChina
| | - Tengfei Zhang
- Tianjin Key Laboratory of Indoor Air Environmental Quality ControlSchool of Environmental Science and EngineeringTianjin UniversityTianjinChina
| | - Qingyan Chen
- Department of Building Environment and Energy EngineeringThe Hong Kong Polytechnic UniversityKowloon, Hong Kong SARChina
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10
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Guo Q, Wang J, Estill J, Lan H, Zhang J, Wu S, Yao J, Yan X, Chen Y. Risk of COVID-19 Transmission Aboard Aircraft: An Epidemiological Analysis Based on the National Health Information Platform. Int J Infect Dis 2022; 118:270-276. [PMID: 35331931 PMCID: PMC8935959 DOI: 10.1016/j.ijid.2022.03.024] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2021] [Revised: 02/23/2022] [Accepted: 03/15/2022] [Indexed: 12/26/2022] Open
Abstract
Objectives This study aims to investigate the risk of COVID-19 transmission on aircraft. Methods We obtained data on all international flights to Lanzhou, China, from June 1, 2020, to August 1, 2020, through the Gansu Province National Health Information Platform and the official website of the Gansu Provincial Center for Disease Control and Prevention. We then performed the statistical analysis. Results Three international flights arrived in Lanzhou. The flights had a total of 700 passengers, of whom 405 (57.9%) were male, and 80 (11.4%) were children under the age of 14 years. Twenty-seven (3.9%) passengers were confirmed to have COVID-19. Confirmed patients were primarily male (17, 65.4%) with a median age of 27.0 years. Most confirmed cases were seated in the middle rows of economy class or near public facility areas such as restrooms and galleys. The prevalence of COVID-19 did not differ between passengers sitting in the window, aisle, or middle seats. However, compared with passengers sitting in the same row up to 2 rows behind a confirmed case, passengers seated in the 2 rows in front of a confirmed case were at a slightly higher risk of being infected. Conclusions COVID-19 may be transmitted during a passenger flight, although there is still no direct evidence.
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Affiliation(s)
- Qiangqiang Guo
- School of Public Health, Lanzhou University, Lanzhou, China; Lanzhou University Institute of Health Data Science, Lanzhou, China; Lanzhou University, an Affiliate of the Cochrane China Network, Lanzhou, China; WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou, China
| | - Jianjian Wang
- School of Public Health, Lanzhou University, Lanzhou, China; Lanzhou University Institute of Health Data Science, Lanzhou, China; Lanzhou University, an Affiliate of the Cochrane China Network, Lanzhou, China; WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou, China
| | - Janne Estill
- Institute of Global Health, University of Geneva, Geneva, Switzerland; Institute of Mathematical Statistics and Actuarial Science, University of Bern, Bern, Switzerland
| | - Hui Lan
- School of Public Health, Lanzhou University, Lanzhou, China; Lanzhou University Institute of Health Data Science, Lanzhou, China; Lanzhou University, an Affiliate of the Cochrane China Network, Lanzhou, China; WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou, China
| | - Juanjuan Zhang
- School of Public Health, Lanzhou University, Lanzhou, China; Lanzhou University Institute of Health Data Science, Lanzhou, China; Lanzhou University, an Affiliate of the Cochrane China Network, Lanzhou, China; WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou, China
| | - Shouyuan Wu
- School of Public Health, Lanzhou University, Lanzhou, China; Lanzhou University Institute of Health Data Science, Lanzhou, China; Lanzhou University, an Affiliate of the Cochrane China Network, Lanzhou, China; WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou, China
| | - Jingwen Yao
- Health Statistics Information Center of Health Commission of Gansu Province, Lanzhou, China
| | - Xuanchen Yan
- Health Statistics Information Center of Health Commission of Gansu Province, Lanzhou, China.
| | - Yaolong Chen
- School of Public Health, Lanzhou University, Lanzhou, China; Lanzhou University Institute of Health Data Science, Lanzhou, China; Lanzhou University, an Affiliate of the Cochrane China Network, Lanzhou, China; WHO Collaborating Centre for Guideline Implementation and Knowledge Translation, Lanzhou, China.
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Wells CR, Pandey A, Fitzpatrick MC, Crystal WS, Singer BH, Moghadas SM, Galvani AP, Townsend JP. Quarantine and testing strategies to ameliorate transmission due to travel during the COVID-19 pandemic: a modelling study. THE LANCET REGIONAL HEALTH. EUROPE 2022; 14:100304. [PMID: 35036981 PMCID: PMC8743228 DOI: 10.1016/j.lanepe.2021.100304] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Numerous countries have imposed strict travel restrictions during the COVID-19 pandemic, contributing to a large socioeconomic burden. The long quarantines that have been applied to contacts of cases may be excessive for travel policy. METHODS We developed an approach to evaluate imminent countrywide COVID-19 infections after 0-14-day quarantine and testing. We identified the minimum travel quarantine duration such that the infection rate within the destination country did not increase compared to a travel ban, defining this minimum quarantine as "sufficient." FINDINGS We present a generalised analytical framework and a specific case study of the epidemic situation on November 21, 2021, for application to 26 European countries. For most origin-destination country pairs, a three-day or shorter quarantine with RT-PCR or antigen testing on exit suffices. Adaptation to the European Union traffic-light risk stratification provided a simplified policy tool. Our analytical approach provides guidance for travel policy during all phases of pandemic diseases. INTERPRETATION For nearly half of origin-destination country pairs analysed, travel can be permitted in the absence of quarantine and testing. For the majority of pairs requiring controls, a short quarantine with testing could be as effective as a complete travel ban. The estimated travel quarantine durations are substantially shorter than those specified for traced contacts. FUNDING EasyJet (JPT and APG), the Elihu endowment (JPT), the Burnett and Stender families' endowment (APG), the Notsew Orm Sands Foundation (JPT and APG), the National Institutes of Health (MCF), Canadian Institutes of Health Research (SMM) and Natural Sciences and Engineering Research Council of Canada EIDM-MfPH (SMM).
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Affiliation(s)
- Chad R. Wells
- Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health, New Haven, Connecticut, 06520, USA
| | - Abhishek Pandey
- Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health, New Haven, Connecticut, 06520, USA
| | - Meagan C. Fitzpatrick
- Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health, New Haven, Connecticut, 06520, USA
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, 21201, USA
| | - William S. Crystal
- Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health, New Haven, Connecticut, 06520, USA
| | - Burton H. Singer
- Emerging Pathogens Institute, University of Florida, P.O. Box 100009, Gainesville, FL, 32610, USA
| | - Seyed M. Moghadas
- Agent-Based Modelling Laboratory, York University, Toronto, Ontario, Canada
| | - Alison P. Galvani
- Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health, New Haven, Connecticut, 06520, USA
- Department of Ecology and Evolutionary Biology, Yale University, New Haven, Connecticut, 06525, USA
| | - Jeffrey P. Townsend
- Department of Ecology and Evolutionary Biology, Yale University, New Haven, Connecticut, 06525, USA
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut, 06510, USA
- Program in Computational Biology and Bioinformatics, Yale University, New Haven, Connecticut, 06511, USA
- Program in Microbiology, Yale University, New Haven, Connecticut, 06511, USA
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Wells CR, Pandey A, Fitzpatrick MC, Crystal WS, Singer BH, Moghadas SM, Galvani AP, Townsend JP. Quarantine and testing strategies to ameliorate transmission due to travel during the COVID-19 pandemic: a modelling study. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2021:2021.04.25.21256082. [PMID: 34729563 PMCID: PMC8562544 DOI: 10.1101/2021.04.25.21256082] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND Numerous countries imposed strict travel restrictions, contributing to the large socioeconomic burden during the COVID-19 pandemic. The long quarantines that apply to contacts of cases may be excessive for travel policy. METHODS We developed an approach to evaluate imminent countrywide COVID-19 infections after 0-14-day quarantine and testing. We identified the minimum travel quarantine duration such that the infection rate within the destination country did not increase compared to a travel ban, defining this minimum quarantine as "sufficient." FINDINGS We present a generalised analytical framework and a specific case study of the epidemic situation on November 21, 2021, for application to 26 European countries. For most origin-destination country pairs, a three-day or shorter quarantine with RT-PCR or antigen testing on exit suffices. Adaptation to the European Union traffic-light risk stratification provided a simplified policy tool. Our analytical approach provides guidance for travel policy during all phases of pandemic diseases. INTERPRETATION For nearly half of origin-destination country pairs analysed, travel can be permitted in the absence of quarantine and testing. For the majority of pairs requiring controls, a short quarantine with testing could be as effective as a complete travel ban. The estimated travel quarantine durations are substantially shorter than those specified for traced contacts. FUNDING EasyJet (JPT and APG), the Elihu endowment (JPT), the Burnett and Stender families' endowment (APG), the Notsew Orm Sands Foundation (JPT and APG), the National Institutes of Health (MCF), Canadian Institutes of Health Research (SMM) and Natural Sciences and Engineering Research Council of Canada EIDM-MfPH (SMM).
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Affiliation(s)
- Chad R. Wells
- Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health, New Haven, Connecticut 06520, USA
| | - Abhishek Pandey
- Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health, New Haven, Connecticut 06520, USA
| | - Meagan C. Fitzpatrick
- Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health, New Haven, Connecticut 06520, USA
- Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland, 21201, USA
| | - William S. Crystal
- Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health, New Haven, Connecticut 06520, USA
| | - Burton H. Singer
- Emerging Pathogens Institute, University of Florida, P.O. Box 100009, Gainesville, FL 32610, USA
| | | | - Alison P. Galvani
- Center for Infectious Disease Modeling and Analysis (CIDMA), Yale School of Public Health, New Haven, Connecticut 06520, USA
- Agent-Based Modelling Laboratory, York University, Toronto, Ontario, Canada
- Department of Ecology and Evolutionary Biology, Yale University, New Haven, Connecticut 06525, USA
| | - Jeffrey P. Townsend
- Department of Ecology and Evolutionary Biology, Yale University, New Haven, Connecticut 06525, USA
- Department of Biostatistics, Yale School of Public Health, New Haven, Connecticut 06510, USA
- Program in Computational Biology and Bioinformatics, Yale University, New Haven, Connecticut 06511, USA
- Program in Microbiology, Yale University, New Haven, Connecticut 06511, USA
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Zhong Y, Wang K, Zhu Y, Lyu D, Yu Y, Li S, Yao K. Ocular manifestations in COVID-19 patients: A systematic review and meta-analysis. Travel Med Infect Dis 2021; 44:102191. [PMID: 34763068 PMCID: PMC8574127 DOI: 10.1016/j.tmaid.2021.102191] [Citation(s) in RCA: 33] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2020] [Revised: 07/09/2021] [Accepted: 10/26/2021] [Indexed: 01/08/2023]
Abstract
Introduction With the accumulating evidence of ocular manifestations of the 2019 novel coronavirus disease (COVID-19), the study aimed to systematically summarize the ocular manifestations in COVID-19 patients. Methods The PubMed, EMBASE, Web of Science databases were searched through June 2021. Studies that provided clinical characteristics and outcomes and reported on the ocular manifestations or conjunctival swab RT-PCR tests among COVID-19 patients were included. Results A total of 30 studies involving 5,717 patients were identified. Ocular manifestations including conjunctival hyperemia (7.6%, 95% confidence interval [CI] 1.8–8.9%), conjunctival discharge (4.8%, 95% CI 1.8–8.9%), epiphora (6.9%, 95% CI 2.8–12.8%), and foreign body sensation (6.9%, 95% CI 2.4–13.0%) were observed. The positive rate of conjunctival swab tests was 3.9% (95% CI 0.2–6.4%). Severe cases of COVID-19 were associated with an increased risk of developing ocular complications (odds ratio [OR] = 2.77, 95% CI 1.75–4.40). Conclusions Despite their relatively low incidence rate in COVID-19 patients, ocular manifestations may be non-specific and present as the initial symptoms of infection. The presence of SARS-CoV-2 in the conjunctival swabs implicates the eye as a potential source of infection. Early diagnosis and proper eye protection would help prevent viral transmission.
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Affiliation(s)
- Yueyang Zhong
- Eye Center of the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Kai Wang
- Eye Center of the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Yanan Zhu
- Eye Center of the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Danni Lyu
- Eye Center of the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Yinhui Yu
- Eye Center of the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Su Li
- Eye Center of the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China
| | - Ke Yao
- Eye Center of the Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang Province, China.
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Khatib AN, McGuinness S, Wilder-Smith A. COVID-19 transmission and the safety of air travel during the pandemic: a scoping review. Curr Opin Infect Dis 2021; 34:415-422. [PMID: 34524196 DOI: 10.1097/qco.0000000000000771] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE OF REVIEW To examine the literature assessing safety of air travel relating to coronavirus disease 2019 (COVID-19) transmission from January 2020 to May 2021. The COVID-19 pandemic has had an unprecedented impact on air travel and global mobility, and various efforts are being implemented to determine a safe way forward. As the pandemic evolves, so do the challenges that force various stakeholders, including the aviation industry, health authorities, and governments, to reassess and adapt their practices to ensure the safety of travellers. RECENT FINDINGS The literature was reviewed for multiple aspects of air travel safety during the COVID-19 pandemic. Recurring themes that surfaced included the pivotal role of commercial air travel in the geographic spread of COVID-19, the efficacy of travel restrictions and quarantines, inflight transmission risk and the role of preventive measures, the utility of pre and post flight testing, the development of effective vaccines and subsequent challenges of vaccine passports, and the ongoing threat of novel highly transmissible variants. SUMMARY Much uncertainty lies ahead within the domains of these findings, and ongoing research, discourse and review will be necessary to navigate and determine the future direction and safety of air travel. Recovery will be slow, necessitating innovative, multipronged and collaborative solutions.
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Affiliation(s)
- Aisha N Khatib
- Department of Family & Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Sarah McGuinness
- School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia
- Department of Infectious Diseases, Alfred Health, Melbourne, Victoria, Australia
| | - Annelies Wilder-Smith
- Institute of Preventive and Social Medicine, University of Bern, Switzerland
- Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
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