Table 1.
Summary data on peer-reviewed or public health publication of flights with suspected or possible in-flight SARS-CoV-2 transmission from January 2020 to 21 September 2020
| Arrival date | Origin–destination transmission levels | Flight # origin–destination aircraft type total Pax | Number Pax likely infected pre-departure | In-Flight transmissions level of likelihood | Quarantine and testing protocols on arrival | Seat location of secondary cases | Masking-result | Comments | |
|---|---|---|---|---|---|---|---|---|---|
| Mass transmission events (>1 secondary case) | |||||||||
| A 2 | 19-March | Large outbreak on Ruby Princess cruise ship. Almost no local transmission in Australia on date of flight with disembarked passengers | QF 577 Sydney-Perth A330. 28 Pax in business; 213 in economy |
13 PCR+ symptomatic index cases came directly from the Ruby Princess. 9 classified as infectious during flight | 11 certain transmissions no other plausible exposures | After initial index cases identified, other PAX notified to quarantine. Testing only of those coming forward. 11 Ruby Princess index cases had the same strain not previously recorded (A2-RP) by WGS | Secondary cases all within 12 rows in the mid-cabin 3 secondary cases more than 2 rows away from a primary case | Rare—mass transmission | Proven by WGS. Likely underestimate as no systematic post-arrival testing of asymptomatic flight Pax. Unique sequence likely originated on ship. US passengers on flight had just arrived in Sydney. 5 other primary cases on flight from other ships had different sequences. |
| B 3 | 2-March | Only 23 total UK and 16 total Vietnam cases prior to flight date. | VN54 London-Hanoi B787 21 Pax in business; 180 in economy |
1 PCR+ highly symptomatic index case in Business Class on arrival, contact of a known case (exposed while in Italy) | 15 highly likely transmissions. 12 in Business Class (62% attack rate), 2 economy, 1 economy cabin flight attendant. | All Pax home quarantined, tested on D3, D5 and D13. 15 secondary cases PCR+ by D5. |
11/12 Business class secondary cases within 2 rows of index case. Economy cases 15 rows distant | Optional—mass transmission | No investigation of in-flight movements. No other cases symptomatic on arrival. Only 4 cases remained asymptomatic throughout |
| C 4 | 10-March | Early onset of outbreak in Toronto and Boston visited by index cases. | CX811 Boston-Hong Kong B777 Unknown Pax# in 274 seats |
2 Pax (couple) symptomatic on arrival day | 2 highly likely transmissions to flight attendants tested after contact tracing of index cases | No arrival quarantine or testing in place. Index cases PCR+ D5 when hospitalized. | Index couple in adjacent business class seats served directly by 1 flight attendant. | Optional—mass transmission | Proven by WGS. 2 index cases and 2 flight attendants identical whole genome sequences, not seen before in Hong Kong |
| D | 20-June wars.vote4.hk/en/cases |
All infected Pax originated in Pakistan during peak of transmission. | EK380 Dubai-Hong Kong B777 Unknown Pax# in 360 seats |
27 PCR+ all asymptomatic on arrival | 2 likely transmissions; PCR+ on D14 | Observed quarantine with testing of all Pax on D0 and D14 | 1 sitting in Row 40 with 5 index cases; 1 in isolated location | Mandatory—mass transmission. Meals served. | Secondary cases both PCR negative D0 and had passed temperature and symptom screening in Dubai. Pre-flight transmission possible |
| Chartered Evacuation Flights: Hundreds of flights totalling >200 000 Pax, little published data to date | |||||||||
| E 6 | 31-March | From Italy at peak 1st wave transmission | Evacuation Milan-Seoul B747 299 Pax |
6 PCR+ on arrival Seoul. 11 symptomatics denied boarding | 1 likely transmission. | All Pax quarantined and tested on D0 and 14. 6 PCR+ asymptomatics on D0; 1 on D14 | No index cases within 6 rows; shared specific lavatory with an index case | Mandatory – 1 likely transmission. Secondary case masked except during meals and in lavatory | Secondary case quarantined alone for 3 weeks pre-departure, private ground transport, screening/pre-boarding/distancing outside airport terminal by Korean CDC. |
| F 6 | 3-April | Italy at peak of 1st wave transmission | Evacuation Milan-Seoul 205 Pax |
3 PCR+ on arrival in Seoul. | 1 possible transmission. | All Pax quarantined and tested on D0 and 14. 3+ on D0; 1+ on D14 | Mandatory (except during meals)—1 possible transmission. | No pre-departure or in-flight detail on 1 possible case. Pre-departure as above. | |
| G 7 | 20-February | Diamond Princess Pax | Evacuation Tokyo-Tel Aviv Galaxy 6000. 11 Pax 3 crew |
2 asymptomatic PCR+ on arrival | No transmission | All Pax quarantined and tested 6 times over 14 days. 0 additional positive at D14. | Index cases were seated in back rows behind everyone else. | Mandatory (crew FFP2, Pax surgical except during 2 meals)—no transmission | Small cabin, ventilation different from large aircraft |
| H | 17-February | Diamond Princess Pax | Evacuation Tokyo-Travis AFB California B747 300 Pax |
14 PCR+ asymptomatic diagnosed pre-departure | No post-arrival data available | All other Pax quarantined on Air Force bases and tested once | PCR+ positives seated in separate area of aircraft | Mandatory | Post-arrival testing not yet published. |
| I | 20-March | Costa Luminosa Pax | Evacuation Marseille-Atlanta | 3 known PCR+ enroute; 10 other Pax obviously ill (media reports) | No post-arrival data available | Asymptomatics continued on domestic flights. Disposition of symptomatics and known PCR+ unknown | 3 PCR+ separated from others enroute after test results became known | Optional | Post-arrival testing not yet published |
| Published Flights with Possible Single Transmissions | |||||||||
| J 8 | 24-January | 15 index cases infected in Wuhan prior to 19-January departure or during group tours with others from Wuhan. 0 cases in Singapore that week. Case #16 from Hangzhou. | Singapore—Hangzhou B787 335 Pax |
16 PCR+ Pax on first testing D2 | 1 possible transmission. PCR+ D2 | Quarantine and PCR at D2, D12 for all Pax | 1 possible case spent 1 hour seated between 4 index cases | Mandatory—1 possible transmission. Possible secondary case took off mask to talk for 1 hour | Possible transmission to #16 on flight with an incubation period of just 2 days. From China not Wuhan but no others in his Singapore tour group positive |
| K 9 | 9-March | 14 cases/day in Israel. 100 cases/day Germany. | Tel-Aviv-Frankfurt B737 102 Pax |
7/24 in same tour group visiting Israel. PCR+ on arrival. Group had contact with confirmed COVID case prior to flight. | 1 unproven transmission. 1 non-tour group member self-reported PCR+ test at D4; not tested at D0 and had IgG at 7 weeks. Another non-group member IgG+ at 9 weeks (no previous testing) |
No quarantine for non-tour group members | Proposed in-flight cases seated in same or row between index cases | Optional—1 unproven transmission | Authors denote as likely transmission. Few details on epidemiologic background of Pax |
| L | 30-March | #12 spent 2 months in New York at outbreak peak prior to flight. <10 daily cases in Taiwan. | CI 11 JFK-Taipei 340 Pax |
11 symptomatic Pax PCR+ on arrival | No proven transmission. Possible case #12 PCR+ D15 developed symptoms D7. | Negative PCR at D14 in all other Pax | Unknown | Mandatory—no likely transmissions | In-flight transmission cannot be ruled out but high-risk pre-flight exposure |
| Published High-Risk Flights with no Evidence of Transmission | |||||||||
| M 10 | 22-January | Peak of Wuhan outbreak | Wuhan-Toronto 350 Pax | 2 PCR + (couple) 1 symptomatic/1 asymptomatic on flight. | No transmission | Home quarantine of Pax within 2 rows with 14 days close monitoring for symptoms by public health | Optional—no transmissions. | No post-arrival PCR testing of asymptomatic Pax or Pax within 2 rows of couple. | |
| N-R | 16, 21, 23-June and 3,4-July (5 flights) wars.vote4.hk/en/cases |
Almost all Pax originated in Pakistan during peak of transmission. | EK380 Dubai-Hong Kong B777. Unknown Pax# per flight. 360 seats available per flight |
10, 19, 13, 9, 7 PCR+ on arrival. 0, 1, 4, 1, 0 symptomatic on arrival; rest asymptomatic. | No transmissions on any of the 5 flights | Observed quarantine with testing on D0 and D14 | Not applicable | Mandatory—no transmission was documented with robust testing of all Pax at D14. Meals served. | All Pax had passed temperature and symptom screening in Dubai 4 hours earlier |
Abbreviations: WGS = whole genome sequencing; Pax = passengers; Pax# = number of passengers. D0 = flight arrival date; D2 = two days post-arrival, etc.