[Flying and COVID-19: options to reduce the risk of transmission]

With air travel continuing after the SARS-CoV-2 pandemic as before, is there a risk of in-flight-transmission? We found 18 papers describing a total number of 306 index patients on 150 flights, 79 infected passengers and four infected cabin crew. Infection transmission within the aircraft cabin depends on flight occupancy, proximity to the index patient, duration of flight and the prevailing virus variant. A negative PCR-test has a sensitivity of 95 %, around 5 % of travelers will get a false negative result. Airborne transmission of virus-containing saliva droplets (aerosols) is considered the most important infection mechanism; infection via contaminated surfaces is less common. Strict distancing, with an empty middle seat, is essential. The risk of in-flight transmission can be further minimized by mandatory masking, restricting passenger movements, restricting meals and beverages, frequent hand sanitizing and complying to rules while boarding or at disembarkation.