Navigating the risks of flying during COVID-19: a review for safe air travel.

RATIONALE FOR REVIEW: With air travel restarting, there has been much discourse about the safety of flying during the pandemic. In travel medicine, risk assessment includes estimating baseline risk to the traveller, recognizing factors that may modify that risk, considering the role of interventions to decrease that risk and accounting for a traveller's perception and tolerance of risk. The goals of this review are to identify the in-flight transmission risks of commercial air travel, provide recommendations about the risks of flying during the pandemic and propose strategies to mitigate the spread of COVID-19. KEY FINDINGS: The airline industry has taken a layered approach to increase passenger safety through effective onboard ventilation, extended ventilation at the gate, boarding and deplaning strategies, improved aircraft disinfection and pre-flight screening such as temperature checks and COVID-19 testing. Proximity to an index case may contribute to the risk of transmission more than the seat type or location. The use of face masks has significantly reduced onboard transmission, and mandatory in-flight mask-wearing policies are being enforced. Innovations such as digital health passports may help standardize screening entry requirements at airports and borders, allowing for a safer return to travel. RECOMMENDATIONS: In-flight transmission of SARS-CoV-2 is a real risk, which may be minimized by combining mitigation strategies and infection prevention measures including mandatory masking onboard, minimizing unmasked time while eating, turning on gasper airflow in-flight, frequent hand sanitizing, disinfecting high touch surfaces, promoting distancing while boarding and deplaning, limiting onboard passenger movement, implementing effective pre-flight screening measures and enhancing contact tracing capability. Assessing risk is a cornerstone of travel medicine. It is important to evaluate the multiple factors contributing to the cumulative risk of an individual traveller during the COVID-19 pandemic and to employ a multi-pronged approach to reduce that risk.

Uncovering two phases of early intercontinental COVID-19 transmission dynamics.

BACKGROUND: The COVID-19 pandemic has posed an ongoing global crisis, but how the virus spread across the world remains poorly understood. This is of vital importance for informing current and future pandemic response strategies. METHODS: We performed two independent analyses, travel network-based epidemiological modelling and Bayesian phylogeographic inference, to investigate the intercontinental spread of COVID-19. RESULTS: Both approaches revealed two distinct phases of COVID-19 spread by the end of March 2020. In the first phase, COVID-19 largely circulated in China during mid-to-late January 2020 and was interrupted by containment measures in China. In the second and predominant phase extending from late February to mid-March, unrestricted movements between countries outside of China facilitated intercontinental spread, with Europe as a major source. Phylogenetic analyses also revealed that the dominant strains circulating in the USA were introduced from Europe. However, stringent restrictions on international travel across the world since late March have substantially reduced intercontinental transmission. CONCLUSIONS: Our analyses highlight that heterogeneities in international travel have shaped the spatiotemporal characteristics of the pandemic. Unrestricted travel caused a large number of COVID-19 exportations from Europe to other continents between late February and mid-March, which facilitated the COVID-19 pandemic. Targeted restrictions on international travel from countries with widespread community transmission, together with improved capacity in testing, genetic sequencing and contact tracing, can inform timely strategies for mitigating and containing ongoing and future waves of COVID-19 pandemic.

Global trends in air travel: implications for connectivity and resilience to infectious disease threats.

BACKGROUND: Increased connectivity via air travel can facilitate the geographic spread of infectious diseases. The number of travellers alone does not explain risk; passenger origin and destination will also influence risk of disease introduction and spread. We described trends in international air passenger numbers and connectivity between countries with different capacities to detect and respond to infectious disease threats. METHODS: We used the Fragile States Index (FSI) as an annual measure of country-level resilience and capacity to respond to infectious disease events. Countries are categorized as: Sustainable, Stable, Warning or Alert, in order of increasing fragility. We included data for 177 sovereign states for the years 2010 to 2019. Annual inbound and outbound international air passengers for each country were obtained for the same time period. We examined trends in FSI score, trends in worldwide air travel and the association between a state's FSI score and air travel. RESULTS: Among countries included in the FSI rankings, the total number of outbound passengers increased from 0.865 billion to 1.58 billion between 2010 and 2019. Increasing fragility was associated with a decrease in travel volumes, with a 2.5% (95% CI: 2.0-3.1%) reduction in passengers per 1-unit increase in FSI score. Overall, travel between countries of different FSI categories either increased or remained stable. CONCLUSIONS: The world's connectivity via air travel has increased dramatically over the past decade. There has been notable growth in travel from Warning and Stable countries, which comprise more than three-quarters of international air travel passengers. These countries may have suboptimal capacity to detect and respond to infectious disease threats that emerge within their borders.

Profilaxia do tromboembolismo venoso em viagens aéreas / Venous thromboembolism prophylaxis on flights

A aviação civil vem apresentando aumento progressivo do número de voos regulares nos últimos 10 anos e, em função disso, mais passageiros estão sendo transportados em viagens aéreas (VAs). Associado a isso, há um aumento das doenças relacionadas às VAs, especialmente naquelas de longa duração. Uma das complicações mais temidas dos voos é o tromboembolismo venoso (TEV), mas a sua real incidência é de difícil mensuração devido à falta de consenso sobre, por exemplo, quanto tempo após o pouso podemos considerar que o TEV possa estar relacionado à VA realizada ou mesmo quanto tempo de voo pode ser considerado como de longa duração. Muito tem se discutido sobre os mecanismos fisiopatológicos do TEV relacionado às VAs, quais passageiros são os de maior risco e quais medidas profiláticas podemos adotar com segurança e eficácia. O objetivo desta revisão é esclarecer esses pontos e as condutas consensuais atuais

Civil aviation has seen a steady increase in the number of scheduled flights over the last ten years and, as a result, more passengers are traveling by air. This has been associated with an increase in flight-related diseases, especially on long-haul flights. One of the most feared complications during flights is venous thromboembolism (VTE), but its true incidence is difficult to measure because of a lack of consensus on elements such as the definition of how long after landing a VTE can be considered to be related to a flight and even how long a flight must last to be considered of long duration. There has been much discussion of the pathophysiological mechanisms of flight-related VTE, of which passengers are at greatest risk, and of what prophylactic measures can be adopted safely and effectively. The purpose of this review is to clarify these points and describe current consensual conduct

Factores relacionados con las lumbalgias de los instructores de paracaidismo en el túnel de viento / Factors related to low back pain of instructors for skydiving in the wind tunnel

El Túnel de viento (WT) es un dispositivo que simula, gracias a una corriente vertical de aire, de 300 km/hora, la caída libre previa a la apertura del paracaídas. Se utiliza principalmente para el aprendizaje del paracaidismo militar de apertura manual. En su interior, un instructor ayuda y asesora al alumno en sus movimientos y posiciones. Nuestro objetivo es establecer la frecuencia de episodios de dolor lumbar en estos instructores e identificar factores relacionados. Material y método: Estudio retrospectivo en el que participaron 19 de los 23 Instructores de vuelo en activo de España. Hemos registrado el número de episodios de lumbalgia, antecedentes profesionales, actividad paracaidista y de actividad física. Además, grabamos las sesiones de trabajo de los instructores identificando las posturas, gestos y acciones compatibles con la producción de lumbalgias mecánicas. Resultados: El 78,9% de los Instructores han padecido dolor lumbar en el último año. No hemos encontrado diferencias significativas en la presencia de lumbalgias entre los grupos establecidos a partir del IMC, el número de saltos durante toda su trayectoria, las horas/semana en el WT y los años como instructor. Tampoco hay relaciones con la práctica de otras actividades físicas. Mediante la grabación en video se ha observado que, en el interior del WT, los instructores adoptan todas las posturas, gestos y movimientos relacionados con la producción del dolor lumbar inespecífico. Todas esas actividades actúan provocando sobrecargas musculares y articulares. Son hiperlordosis, actitudes cifóticas dorsales y lumbares, traslado de cargas, mantenimiento de contracciones isométricas y movimientos de torsión. Conclusiones: Existe una alta incidencia de dolor lumbar en los instructores del WT. Las actividades realizadas por estos profesionales son de riesgo para la producción de lumbalgias mecánicas; por lo que es necesario diseñar programas de prevención de este problema (AU)

Wind tunnel (WT) is a device that simulates, thanks to a vertical stream of air, 300 km/h, the free fall prior to the opening of the parachute. It is mainly used for learning the military manual opening parachuting. Inside, an instructor helps and assists the student in their movements and positions. Our objective is to establish the frequency of episodes of low back pain in these instructors and identify related factors. Material and method: Retrospective study involving 19 of the 23 WT instructors active in Spain. We have recorded the number of episodes of low back pain, professional background, paratrooper-activity and physical activity. In addition, we recorded instructors work sessions to identify postures, gestures and actions compatible with the production of mechanical low back pain. Results: 78.9% of instructors have suffered from back pain in the past year. We have not found significant differences in the presence of low back pain among the groups established from BMI, the number of hops throughout his career, hours per week in the WT and years as an instructor. There is no relationship with the practice of other physical activities. Using the video recording has been observed that, in the interior of the WT, instructors adopt all postures, gestures, and movements related to the production of non-specific low-back pain. All these activities act causing overloads muscle and joints. They are hyperlordosis, dorsal and lumbar kyphotic attitudes, transportation of cargos, maintenance of isometric contractions and twisting movements. Conclusions: There is a high incidence of low back pain in the WT instructors. The activities carried out by these professionals are risk for the production of mechanical back pain; therefore, it is necessary to create protocols of prevention of this problem (AU)

The challenges of disease risk ascertainment using accessible data sources for numbers of travelers.

BACKGROUND: Accessible travel has led to a rapid growth in international tourism, particularly to developing countries. With the increase, travel-associated morbidity and mortality has changed. Data on traveling populations are essential for policy makers to estimate infectious and noninfectious risks in travelers. Passenger flow statistics are compiled by the World Tourism Organization (WTO) and by official institutions of some countries. This study investigates sources of passenger flow statistics, methods of data collection, and compares datasets for consistency. METHODS: Four national datasets of departing travelers were compared to the United Nations' World Tourism Organization (WTO) data on passenger arrivals to eight destination countries. The ratio between arrivals and departures was calculated (main destination ratio [MDR]) to estimate the proportion of direct to indirect traveler arrivals. RESULTS: With few exceptions, arrival data exceeded that of departure data for all destinations. India is a primary destination for Australian residents where arrival and departure figures were similar (MDR 1.1), while visits to Cambodia and Turkey, with 3.6- and 3.8-fold higher arrivals, respectively, are part of multidestination trips. For UK residents, arrivals exceeded departures for all destinations except India where the reverse was true (MDR 0.8). A close correlation between arrivals and departures was noted for visits to South Africa while arrivals to Singapore and Cambodia were 7- and 10-fold higher, respectively. Arrivals by Finnish residents to destination countries were 1.4- to 1.6-fold higher than departures and 2.2-fold higher for Canadians visiting China. CONCLUSIONS: Different methodologies used to capture arrival and departure statistics result in different estimations of traveler numbers. Data from a single source does not provide a comprehensive picture of most tourism itineraries. Inbound statistics give a more accurate reflection of the total visits made by travelers from a source country.