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Better buckle up, passengers.

A new report published by the Centers for Disease Control and Prevention (CDC) has suggested the novel coronavirus can be spread on airplanes by asymptomatic carriers.

In the study, featured in the peer-reviewed journal Emerging Infections Diseases, researchers examined evidence of in-flight transmission of COVID-19 by asymptomatic patients, as prior data was inconclusive. In-flight transmission by those symptomatic for COVID-19, meanwhile, has been well established.

A new report published by the Centers for Disease Control and Prevention (CDC) has suggested the novel coronavirus can be spread on airplanes by asymptomatic carriers.
(iStock)

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The studied evacuation flight flew from Milan, Italy, to South Korea in late March on an 11-hour trip; 310 passengers were initially scheduled to board, but 11 were denied entry after showing symptoms for COVID-19. Both on the ground and in the high skies, the flight crew followed strict infection control procedures by the Korea Centers for Disease Control and Prevention (KCDC).

In the high skies, all passengers wore N95 respirator masks, except while eating and using the restroom. After arriving in South Korea, the 299 passengers were quarantined for 2 weeks at a government quarantine facility, in complete isolation from one another, where they were frequently examined for symptoms of COVID-19.

On April 2, the first day of the quarantine, six passengers tested positive for COVID-19 and were hospitalized. Two weeks later, the six passengers showed no symptoms of the viral disease and were said to be asymptomatic.

This figure shows the location of the 6 asymptomatic patients and the subsequently infected patient on the late March flight. 
(Centers for Disease Control and Prevention)

On April 15, the 14th day of the quarantine, however, a woman who initially tested negative after deplaning tested positive for the coronavirus. The traveler wore the N95 mask throughout the flight, except while using the restroom, which was shared by nearby passengers – including someone who was asymptomatic. The woman who tested positive for COVID-19 on April 15 was seated three rows behind the asymptomatic passenger.

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To that end, the researchers suspect that the woman’s infection was likely transmitted by in-flight contact.

Ten crew members and eight medical staffers from the KCDC were also quarantined at the facility for two weeks and tested for COVID-19 on days 1 and 14 of quarantine; all of the 18 people tested negative for the coronavirus both times.

The researchers also reviewed data from another evacuation flight, which traveled from Milan to South Korea on April 3 under the same strict infection control procedures as guided by the KCDC.
(iStock)

In further investigation, the researchers reviewed data from another evacuation flight, which traveled from Milan to South Korea on April 3 under the same strict infection control procedures as guided by the KCDC.

During that trip, three passengers were asymptomatic for COVID-19 and one passenger who tested negative on Day 1 of quarantine similarly tested positive on Day 14 of quarantine.

“On the basis of an epidemiologic investigation, the authors and KCDC suspect that this infection was also transmitted by inflight contact,” the authors said.

The authors concluded that it remains unclear exactly how the virus was transmitted on the airplanes, suggesting that contaminated surfaces or infected persons may have a “critical role” in the in-flight transmission of infectious disease and that further research was needed.

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“Our findings suggest the following strategies for the prevention of SARS-CoV-2 transmission on an aircraft,” they wrote. “First, masks should be worn during the flight. Second, because contact with contaminated surfaces increases the risk for transmission of SARS-CoV-2 among passengers, hand hygiene is necessary to prevent infections,” they wrote.

“Third, physical distance should be maintained before boarding and after disembarking from the aircraft.”

In close, the authors urged that “stringent global regulations for the prevention of COVID-19 transmission on aircraft” could help prevent such public health emergencies in the future.

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