In-flight transmission cluster of COVID-19: a retrospective case series

Background: No data is available about in-flight transmission of SARS-CoV-2. Here, we report an in-flight transmission cluster of COVID-19 and describe the clinical characteristics of these patients. Methods: After a flight, laboratory-confirmed COVID-19 was reported in 12 patients. Ten patients were admitted to the designated hospital. Data was collected from 25th January to 28th February 2020. Clinical information was retrospectively collected. Results: All patients were passengers, and none were flight attendants. The median age was 33 years, and 70% were females. None was admitted to intensive care unit, and no patients died up to 28th February. The median incubation period was 3.0 days and time from onset of illness to hospital admission was 2 days. The most common symptom was fever. Two patients were asymptomatic and had normal chest CT scan during hospital stay. On admission, initial RT-PCR was positive in 9 patients, and initial chest CT was positive in half of the patients. The median lung ‘total severity score’ of chest CT was 6. ‘Crazy-paving’ pattern, pleural effusion, and ground-glass nodules were seen. Conclusion: There is potential for COVID-19 transmission in aeroplanes, but the symptoms were mild in our patients. Passengers and attendants must be protected during flights.