This is the first part of a two part article series; after you’re read this please be sure to click on to the second part which provides 19 ways to minimize your risk of infection when flying.
As shown above, air passenger numbers are slowly but steadily increasing in the US again. Southwest says it expects to be back to operating its full schedule by the end of the year once more – perhaps the biggest unknown there being nothing to do with the virus and everything to do with the still-grounded 737 MAX.
Meanwhile, countries all around the world are relaxing their travel bans and quarantine requirements. It may be possible, in the next month or two, to start to travel to many/most other countries, and to be able to enjoy more or less a normal vacation experience after getting there.
The safety of air travel is increasingly a consideration. Just because we can travel doesn’t mean we should. How safe is it to fly, and how can we shift the odds in our favor?
Earlier this week the International Civil Aviation Organization issued a series of guidelines on how flights should be operated to minimize the risk of Covid-19 infection. We noticed that the guidelines were very weak on any type of assurance of safety, and with most of the input coming from industry organizations such as IATA (the international airline lobbying group) we were not surprised the weak and vague guidelines issued. The guidelines contain an abundance of vague terms rather than hard specific requirements – phrases such as “wherever possible” betray the reality of these guidelines – they are a compromise between absolute safety and essential commercial requirements to profitably and efficiently provide air travel services.
There’s a focus on cheap easily implemented measures – requiring passengers to wear masks (although the unofficial airline policy often seems to be “you should wear a mask but if you don’t want to, we won’t insist”), more cabin cleaning, whatever that means, and the almost entirely useless temperature checks of passengers prior to boarding. Expensive but effective measures like keeping middle seats free were not recommended, clearly on grounds of profit/cost rather than for public health reasons.
Unfortunately, the virus doesn’t give a free pass to the need for airlines to be profitable, and just as relentlessly hunts down its victims in a commercial environment as it does anywhere else.
Some airlines have been quite strident in their assurances that it is safe to travel, even on full planes with every middle seat taken. “There have been no proven cases of Covid-19 infections being acquired on planes” is a statement that has been offered up in the earlier days of the virus pandemic, and maybe it might have been true then, but probably not so much now. We note that a medical advisor for IATA is now saying
The risk of transmission of COVID-19 from passenger-to-passenger onboard an aircraft appears already to be very low, based on our communications with a large number of major airlines during January through March 2020, and a more detailed IATA examination of contact tracing of 1,100 passengers [during the same period] who were confirmed for COVID-19 after air travel.
One has to wonder, of course, what “very low” actually means. Back in January – March the incidence of the virus was very low, everywhere, in all circumstances and situations.
It is of course very difficult to be able to exactly establish where one gets an infection. But we know four things :
1. In general, we have noticed ourselves, and many other people we know have experienced the same, that whenever we go on a long-haul flight, no matter what the time of year, there’s probably one chance in two that within a week or so we’ll have come down with a cough or cold. Was that acquired as a result of a 10+ hour flight? We can’t “prove” it was, but statistically, after hundreds of such flights over the years, we notice the clear correlation between “long flight” and “catching a cough/cold”.
If we’re at risk of catching a cough or cold after a flight, it seems likely we’d also be at risk of catching other respiratory type viral infections such as Covid-19.
2. We were speaking with a physician who is also a professor at the leading teaching hospital in Singapore about this matter, and she has personal knowledge of a person who did catch the Covid-19 virus, almost certainly on a flight from Europe to Singapore. This was established through Singapore’s contact tracing program – one person was discovered to have the virus on the flight, and the contact tracing program checked with people on the same flight and one of the people was a relative of a colleague of hers and he was found to have the virus too.
3. There are several studies pointing to what seems to be an elevated level of virus infections among flight attendants. This probably points to an increased risk of infection in their workplace – ie, on planes.
On 10 April, a story circulated about 100 American Airlines flight attendants having tested positive for the disease. At the time, there were 510,000 cases in total in the country, a rate of 1544 per million. AA has just over 26,000 flight attendants, and so this represents an infection rate 2 1/2 times greater than the general population. Considering also that probably not all flight attendants were tested, and not all flight attendants would be actively working as flight numbers shrank down, and some flight attendants might have already had the disease and recovered, the real rate is probably even higher again.
But keeping it simply to the 2 1/2 times greater than normal number, that seems to be a strong indicator of elevated risk of catching the virus on a flight. Sure, flight attendants fly a lot more than we do, and by moving around during a flight, have a higher risk of catching the virus. We accept all those points, however, we’d ask the airline executives who say “there have been no proven examples of people catching the virus on a plane” to take back their statements.
4. There have been a number of studies, over the years, of the risk of catching an airborne infection on a plane. The conclusions have varied, but they all show there is some element of elevated risk, with the risk level dropping off rapidly with distance between the infected person and other people on the flight. You’re not likely to catch an infection from someone ten or twenty rows away from you. This 2018 study concluded that the most significant increase in risk was associated with people one or two seats on either side, and one row ahead or behind. That could potentially be eight people. Other studies have shown a greater virus spread.
The above image, taken from this study, shows how one person infected 20 others with SARS during a three hour flight from Hong Kong to Beijing. This was an outlier outcome, but just because it is rare does not mean it does not exist. It has been speculated that maybe there was an air circulation problem on that particular plane – perhaps there was. But that is not altogether reassuring – what is to say there mightn’t be a similar problem on your next flight?
The major reason for citing this is to show a proven “worst case” scenario to keep in mind when airline executives try and assure you there is no measurable risk at all.
The Risk of Flying Depends on Several Things
Not all flights have the same risk associated with them. There are six major considerations, two easy/obvious ones, another one that is self-explanatory, and three more subtle ones :
- Longer flights have slightly more risk than shorter flights.
- Crowded flights have more risk than less-full flights.
- Planes with adjustable overhead air vents (called “gaspers” in the trade) that you can angle to blow air on your face are safer than planes that don’t have these.
There’s also a harder-to-quantify unknown factor. Your fellow passengers and the possibility you’re seated close to someone with the Covid-19 infection at present. At one extreme, if you’re flying on a domestic flights between two cities in New Zealand (a country that hasn’t had a new infection for 14 days and may have eliminated the virus presence entirely, and which requires international arriving visitors to quarantine for 14 days) you’re probably under very low threat from your fellow passengers. At the other extreme, if you’re flying in Chile at present ( a country with a very high rate/million (about 250) of new cases being reported every day at present), then you’d be understandably anxious as each additional person boarded the plane.
It becomes harder to guess the risk from other passengers when you’re on an international flight, particularly to or from a hub, meaning there are lots of people from many different countries/cities funneling through the hub and your flight. This was vividly demonstrated earlier this week when a Qatar Airways flight from Doha to Athens landed in Athens and 12 of its 91 passengers tested positive for the virus. Note – these 12 people who tested positive are not people who contracted the virus during the flight – they are people who boarded the plane in Doha already with the virus. It is not yet known how many of the other 79 passengers will end up with the virus, too.
There are two other considerations as well. Your own susceptibility to the virus and risk level, plus your tolerance for accepting risk.
If you’re in a higher risk category – older, overweight, diabetic, heart/lung problems – then you are more likely to get a viable infection from a smaller number of virus particles, and the infection is more likely to be severe rather than mild. There is a lot of difference between one chance in ten of getting an extremely mild infection that you don’t even notice, and one chance in ten of getting a severe infection you will probably die from.
A younger person in good health living on their own can also make a decision with little impact elsewhere, but if you are living with your parents and grandparents in a higher density home environment, you need to consider not just your personal risk but the risk of infecting others around you.
The Risk of Travel in General
It is important to understand that the risk of flying is only one part of a broader picture – the risk of an overall travel experience.
When you travel, you unavoidably tend to find yourself needing to accept less social distancing and greater risks – on all forms of transport, not just planes, when checking in and out of hotels, eating meals, attending functions or meetings, or visiting leisure attractions.
You need to consider all these different risk factors, and the level of virus activity in the places you’re visiting – and recheck those numbers immediately before travel because numbers can suddenly start climbing with no advance warning.
The Riskiest Time on Your Flight
When the plane is calmly cruising along for however much time it takes, things are fairly stable in the plane, and there are nice protective airflows going from the top of the cabin to the bottom, helping to minimize virus transmission. Plus you’ve hopefully cleaned your immediate touch-surfaces and environment. This is a relatively low risk time.
Risks increase when people walk past your seat, especially if you have an aisle seat, and when flight attendants do their food and drink services.
The riskiest time of all is during the boarding and disembarking, before and after the flight. There are two reasons for this. The first is that the cabin air flow changes. Instead of a nice controlled environment with relatively high rates of directed air flow, the air flow rates massively reduce. Making this worse is the second reason – you’ve people moving around everywhere, messing up the air flow further, and, quite literally, “getting in your face”.
Board your flight as late as possible. Remember, while you are not supposed to board before your boarding group/row number is called, you don’t have to board at the time your row is called. Wait until pretty much everyone is on board, and the gate staff are starting to say things like “this is a final call for anyone on flight —“.
As for getting off the plane, if you’re near the back of the plane, and especially if you’re not in an aisle seat, we suggest you wait, seated, until the plane has largely emptied, then get up and leave. If you’re near the front (a much better place to be) get off the plane as quickly as you can.
Don’t Rely on the Airline to Help You
We read about airlines providing wipes and masks and perhaps other sanitary materials to their passengers. But we also see, in the tiny print, “while supplies last” and other disclaimers. For example “Guests are provided with a complimentary sanitizing wipe while supplies last” quoted in this article.
So bring plenty of your own products with you. The TSA are now allowing people to have up to 12 ounces of sanitizer with them when going through security. There’s no need to have a full 12 ounce bottle, but certainly have more than a tiny travel sized one or two ounce bottle.
We also suggest you have a few spare disposable masks with you in case you encounter nearby passengers without masks.
We see a lot of people with some type of wipes, using them to clean surfaces. But we never really know exactly what type of wipes they are, or how well they might work. We’ve seen “anti-bacterial” wipes being used, but remember, Covid-19 is a virus, not a bacteria. What might be effective for controlling bacteria might not be effective for controlling viruses.
Our simple approach is to use hand sanitizer for everything. It seems to be more readily available again now, and more reasonably priced. Simply slather plenty of hand sanitizer on all touch surfaces – you don’t even need a cloth or tissue. Just squirt some onto your hand or the surface, and use your hand to wipe it over. Use a regular tissue if you wish.
Very important – do not wipe the sanitizer off. Leave the surface wet and let it slowly evaporate. The longer the surface has sanitizer on it, the more time for the sanitizer to kill the virus.
Doing this reduces the number of different cleaning products you need to travel with.
What You Can Do to Minimize Your Risk
Please keep reading now for the second part of this two-part article. This provides 19 specific suggestions for how to minimize your risk of catching the virus when flying, plus provides additional information on other possible virus-avoidance ideas.