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Letters

Lack of COVID-19 transmission on an international flight

Kevin L. Schwartz, Michelle Murti, Michael Finkelstein, Jerome A. Leis, Alanna Fitzgerald-Husek, Laura Bourns, Hamidah Meghani, Andrea Saunders, Vanessa Allen and Barbara Yaffe
CMAJ April 14, 2020 192 (15) E410; DOI: https://doi.org/10.1503/cmaj.75015
Kevin L. Schwartz
Infectious disease physician, Public Health Ontario, Toronto, Ont.
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Michelle Murti
Public health physician, Public Health Ontario, Toronto, Ont.
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Michael Finkelstein
Associate medical officer of health, Toronto Public Health, Toronto, Ont.
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Jerome A. Leis
Infectious disease physician, Sunnybrook Hospital, Toronto, Ont.
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Alanna Fitzgerald-Husek
Associate medical officer of health, York Region Public Health, Newmarket, Ont.
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Laura Bourns
Associate medical officer of health, Region of Peel Public Health, Mississauga, Ont.
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Hamidah Meghani
Medical officer of health, Halton Region Health Department, Oakville, Ont.
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Andrea Saunders
Communicable diseases specialist, Public Health Ontario, Toronto, Ont.
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Vanessa Allen
Chief, Medical Microbiology, Public Health Ontario, Toronto, Ont.
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Barbara Yaffe
Associate chief medical officer of health, Ontario Ministry of Health, Toronto, Ont.
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In response to the CMAJ news article, “Communication, transparency key as Canada faces new coronavirus threat,”1 we would like to share the public health response to the first Canadian cases of coronavirus disease 2019 (COVID-19). Case details have been published.2 The patients travelled from Wuhan to Guangzhou, then Guangzhou to Toronto, Canada, arriving on Jan. 22, 2020. The index patient was symptomatic with dry cough during the flight. His wife developed cough on Jan. 23. Both sets of throat and nasopharyngeal swabs collected were positive for COVID-19.

There were approximately 350 passengers on board the airplane. The public was notified through the media that the index case was symptomatic during the 15-hour flight. Close contacts included 25 individuals sitting within 2 m of the index case during the flight, flight crew members, and 1 close contact on arrival in Toronto. Close contacts received active daily contact monitoring by local public health officials for 14 days from the flight’s arrival in Toronto. Passengers and crew members who were not from Ontario were referred to their home jurisdictions for follow-up. On Jan. 29, 1 close contact developed symptoms of cough; however, nasopharyngeal and throat swabs were negative for COVID-19. Non-close-contact passengers were advised to self-monitor and contact public health if they became symptomatic; 5 of these passengers became symptomatic, were tested and found by nasopharyngeal and throat swabs to be negative for COVID-19.

The United States Centers for Disease Control and Prevention recommend contact tracing 2 rows in front and behind symptomatic cases with respiratory infections owing to an elevated risk within close contact.3 However, for both severe acute respiratory syndrome–associated coronavirus (SARS-CoV) and influenza, approximately 50% of airplane transmission occurred beyond these rows.4

Studies of airplane transmission are commonly biased by contacts sharing exposure risks before boarding the aircraft.5 In our investigation, transmission may have been mitigated by mild symptoms and masking during the flight. However, the lack of secondary cases after prolonged air travel exposure supports droplet transmission, not airborne, as the likely route of spread of the COVID-19.

Footnotes

  • Competing interests: None declared.

References

  1. ↵
    1. Glauser W
    . Communication, transparency key as Canada faces new coronavirus threat. CMAJ 2020;192:E171–2.
    OpenUrlFREE Full Text
  2. ↵
    1. Silverstein WK,
    2. Stroud L,
    3. Cleghorn GE,
    4. et al
    . First imported case of 2019 novel coronavirus to Canada presenting as mild pneumonia. Lancet 2020 Feb. 13 [Epub ahead of print]. doi: 10.1016/S0140-6736(20)30370-6.
    OpenUrlCrossRef
  3. ↵
    Protecting travelers’ health from airport to community: investigating contagious diseases on flights. Atlanta: Centers for Disease Control and Prevention; reviewed 2019 Apr. 3. Available: www.cdc.gov/quarantine/contact-investigation.html (accessed 2020 Feb. 6).
  4. ↵
    1. Hertzberg VS,
    2. Weiss H
    . On the 2-row rule for infectious disease transmission on aircraft. Ann Glob Health 2016;82:819–23.
    OpenUrl
  5. ↵
    1. Leitmeyer K,
    2. Adlhoch C
    . Review article: Influenza transmission on aircraft — a systematic literature review. Epidemiology 2016;27:743–51.
    OpenUrl
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Canadian Medical Association Journal: 192 (15)
CMAJ
Vol. 192, Issue 15
14 Apr 2020
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Lack of COVID-19 transmission on an international flight
Kevin L. Schwartz, Michelle Murti, Michael Finkelstein, Jerome A. Leis, Alanna Fitzgerald-Husek, Laura Bourns, Hamidah Meghani, Andrea Saunders, Vanessa Allen, Barbara Yaffe
CMAJ Apr 2020, 192 (15) E410; DOI: 10.1503/cmaj.75015

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Lack of COVID-19 transmission on an international flight
Kevin L. Schwartz, Michelle Murti, Michael Finkelstein, Jerome A. Leis, Alanna Fitzgerald-Husek, Laura Bourns, Hamidah Meghani, Andrea Saunders, Vanessa Allen, Barbara Yaffe
CMAJ Apr 2020, 192 (15) E410; DOI: 10.1503/cmaj.75015
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