Probability and estimated risk of SARS-CoV-2 transmission in the air travel system

BACKGROUND: As an emerging virus, SARS-CoV-2 and the risk of transmission during air travel is of high interest. This paper is a retrospective estimate of the probability of an infectious passenger in the air travel system transmitting the SARS-CoV-2 virus to a fellow passenger. METHODS: Literature was reviewed from May–September 2020 to identify COVID-19 cases related to air travel. The studies were limited to publicly available literature for passengers; studies of flight crews were not reviewed. A novel quantitative approach was developed to estimate air travel transmission risk that considers secondary cases, the overall passenger population, and correction factors for asymptomatic transmission and underreporting. RESULTS: There were at least 2866 index infectious passengers documented to have passed through the air travel system in a 1.4 billion passenger population. Using correction factors, the global risk of transmission during air travel is estimated at 1:1.7 million; acknowledging that assumptions exist around case detection rate and mass screenings. Uncertainty in the correction factors and a 95% credible interval indicate risk ranges from 1 case for every 712,000 travelers to 1 case for every 8 million travelers. CONCLUSION: The risk of COVID-19 transmission on an aircraft is low, even with infectious persons onboard.