• Jinjun Zhang, Fei Qin, Xinyan Qin, Jianren Li, Sijia Tian, Jing Lou, Xuqin Kang, Huixin Lian, Shengmei Niu, Wenzhong Zhang, and Yuguo Chen.
• Beijing Emergency Medical Center, Beijing, China.
• Ann. Med. 2021 Dec 1; 53 (1): 156915751569-1575.

ObjectivesTo explore the potential of SARS-CoV-2 spread during air travel and the risk of in-flight transmission.MethodsWe enrolled all passengers and crew suspected of being infected with SARS-CoV-2, who bounded for Beijing on international flights. We specified the characteristics of all confirmed cases of COVID-19 infection and utilised Wells-Riley equation to estimate the infectivity of COVID-19 during air travel.ResultsWe screened 4492 passengers and crew with suspected COVID-19 infection, verified 161 confirmed cases (mean age 28.6 years), and traced two confirmed cases who may have been infected in the aircraft. The estimated infectivity was 375 quanta/h (range 274-476), while the effective infectivity was only 4 quanta/h (range 2-5). The risk of per-person infection during a 13 h air travel in economy class was 0.56‰ (95% CI 0.41‰-0.72‰).ConclusionWe found that the universal use of face masks on the flight, together with the plane's ventilation system, significantly decreased the infectivity of COVID-19.KEY MESSAGESThe COVID-19 pandemic is changing the lifestyle in the world, especially air travel which has the potential to spread SARS-CoV-2.The universal use of face masks on the flight, together with the plane's ventilation system, significantly decreased the infectivity of COVID-19 on an aircraft.Our findings suggest that the risk of infection in aircraft was negligible.

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