Air Evacuation of Passengers with Potential SARS-CoV-2 Infection Under the Guidelines for Appropriate Infection Control and Prevention

Abstract

This report describes the air evacuation of 80 Koreans from Iran to Korea on March 19^th, 2020, with a direct transfer of passengers between airplanes in Dubai. The passengers were potentially infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) so, strict precautions were taken for the duration of the flight, and the passengers were screened before embarking from Dubai and disembarking at Incheon International Airport in Korea. Passengers with fever or symptoms of SARS-CoV-2 were assessed by a quarantine doctor, and if they were suspected of being infected with SARS-CoV-2, they were categorized as a "patient under investigation (PUI)". There was 1 passenger designated as a PUI before the departure from Dubai and another designated as a PUI upon arrival into Korea. The first PUI tested negative, but the second PUI tested positive for SARS-CoV-2. All those aboard the flight (passengers, aircrew, and medical staff) were screened for SARS-CoV-2 upon arrival into Korea and completed a mandatory 14-day medical quarantine. There were no additional cases of infection.

Keywords: COVID-19; SARS-CoV-2; air travel.

Figure 1

(A) The seat map for the Boeing 777-200 aircraft. The first-class seats in the front of aircraft had to be designated as a clean zone and the economy seats in the middle and rear were set as a contaminated zone to control infection on board. In addition, a clean zone and a contaminated zone were divided by using 2 curtain-type transparent vinyl doors, and a semi-contaminated zone was established between them. Asymptomatic passengers were seated in a zigzag form in 1 row to minimize the risk of droplet propagation from the rear seat, and symptomatic passengers were seated in front contaminated zone with sufficient space. The toilet for the patient under investigation (PUI) was set close to them. (B) The route for passengers to board the aircraft. The solid red arrow and the yellow dotted arrow indicates the boarding route of asymptomatic and symptomatic passenger, respectively. Asymptomatic passengers boarded first, and then symptomatic passengers boarded. (C) The route for passengers to disembark the aircraft. A different entrance was used when boarding. The solid red arrow and the yellow dotted arrow indicates the route for disembarking asymptomatic and symptomatic passenger, respectively. Asymptomatic passengers disembarked first, followed by symptomatic passengers.

Figure 2

Vinyl curtain doors. The doors were attached with a double-sided adhesive tape. The center contains a magnet, so when people push, the magnetic door opens, and closes automatically.

Figure 3

(A) Pre-transfer quarantine. Two quarantine officers collected pre-filled Health Status Questionnaires (HSQ) from the central aisle while simultaneously measuring body temperature. (B) The passenger who had respiratory symptoms in the last 14 days on the HSQ, or a fever of 37.5 degrees or higher were investigated by the quarantine doctor. (C) The personal care packages. Packages were distributed to each passenger it contained a personal hand sanitizer (50 mL), in-flight behavior guide, HSQ, a pen, and an extra face mask. (D) A safety guide to the use of the toilet. A guide to safe use of the toilet was prepared and pasted on the mirror (blue dotted line). The guide is as follows. Use a disposable toilet seat cover. After using the toilet, close the toilet lid and flush. Open the toilet lid again and pump the diluted sodium hypochlorite into the toilet 3 or 4 times. A bottle of hand sanitizer (yellow solid line) and a bottle of 1:1,000 diluted sodium hypochlorite (red dotted line) were installed.