Almost 10,000 people tested negative before flying. Just one was positive after landing, a study shows.
A study of Delta Air Lines passengers to Italy found that a mandatory PCR coronavirus test, performed within three days of the flight, weeded out the vast majority of travelers infected with Covid.
The study looked at data from the airline's program that enabled travelers to avoid quarantine in Italy if they had a negative molecular test within 72 hours and were given a rapid test at the Atlanta or New York airport before departure. Passengers had to undergo another quick test after landing in Italy.
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The study was conducted by the Mayo Clinic, Delta Air Lines, and the Georgia Department of Health. The article, published earlier this month, will appear in the Mayo Clinic Proceedings magazine.
Of 9,853 travelers who received a negative coronavirus test within 72 hours of departure, 0.05 percent - or five people - were found to have an active infection either immediately before or after the flight. The flights took place between December 2020 and May 2021; The study says the average infection prevalence rate in the community during this time was estimated to be 1.1 percent.
Four of these five passengers were detected by rapid antigen tests before boarding at the airport, which were confirmed by rapid molecular tests. They weren't allowed to fly.
That left one passenger who did not test positive until arriving in Italy.
“These data suggest that even at this higher level of active community infection, a single molecular test performed within 72 hours of departure can lower the rate of active infection on board a commercial aircraft to levels that can prices are several orders of magnitude lower than active community infection, "the study said." The addition of further measures, including universal masking at airports and on board aircraft, increasing the frequency of air exchange and improved cleaning, physical distancing During departure, the increase in vaccination rates for travelers and the exclusion of symptomatic persons, further increases safety. "
Delta said it covered the cost of the tests related to the flights but played no financial role in the study. Mayo Clinic worked with Delta to design the testing program as part of a longstanding partnership.
In an article on its news site, Delta said the results show "the feasibility of introducing a test protocol with a meaningful impact."
"We'll be living with Covid-19 variants for some time," said Henry Ting, the airline's chief health officer, in the article. "This real-world data - not simulation models - can be used by governments around the world as a blueprint to require vaccinations and testing instead of quarantines in order to reopen borders for international travel."
Many international destinations require testing before passengers leave, sometimes in addition to vaccination. But with the exception of flights to Hawaii, there are no mandates for tests in advance of domestic flights.
"Spending more than six hours in the confined space of an international flight is inherently more risky than an hour-long domestic flight," said lead author Aaron Tande, an infectious disease doctor on the Mayo Clinic in Rochester, Minnesota. He said there is greater discussion about whether testing is required for all flights as opposed to just those that are more at risk.
The study was conducted before the extremely contagious Delta variant became dominant in the United States and included many months when vaccines were not available to the general population.
Tande said the absolute numbers in the research could differ if repeated now, with the Delta variant in play, more people vaccinated and a different level of infection in the community. Still, he said, the results showed that testing would reduce the risk of infection on an airplane.
Tande said it was still clear that air traffic needed "multiple levels of mitigation". He said most reported cases of in-flight transmission occurred either before universal masking or when masks were neglected, which may include eating and drinking.
"It is very clear to me that you should have universal masking on flights," he said. "And then testing is another level to reduce the risk."
He said his ideal safe flight would take an extra step: everyone on board would be vaccinated, tested, and masked.
"Do I want to be on a vaccinated flight?" he said. "100 percent."
The study admits "important caveats" including the possibility that those who flew felt they were more likely to be a low risk of getting the virus, or that travelers with exposure may have chosen to stay home because they knew that they would be tested.
"This possibility can limit the generalizability of our results and recommendations to the total population of commercial air travelers," the study says.
Rapid antigen tests, which are less sensitive than molecular tests, could also have produced false negative results and enabled infected people to be screened. Tande said the study didn't track those 9,800+ passengers to see if any of them - including those on the flight with the person who tested positive - became infected.
The article states that the results show a "low yield" of additional rapid tests at the airport after a negative PCR test. According to the study, this suggests that "these additional tests, along with other containment measures (i.e. masking), are unlikely to increase safety, especially as vaccination rates are increasing rapidly".
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