Public Health

6 things doctors wish patients knew about flying during the pandemic

Sara Berg, MS , News Editor

Being crammed in an airplane with strangers for hours might seem like a flying petri dish during the COVID-19 pandemic. But as the holidays near and COVID-19 cases continue to rise, many people are still contemplating booking a flight to visit family. While there are risks associated with flying, air travel may be safer than most think. To help clear up any confusion, physicians share further insight for patients on whether it is safe to fly.

What doctors wish patients knew

Keep patients up-to-date on how to safely navigate the pandemic with insights from physician colleagues in this special edition of AMA Moving Medicine.

Since travel may increase a person’s chance of getting and spreading COVID-19, Centers for Disease Control and Prevention (CDC) guidance on celebrating the holidays notes that “postponing travel and staying home is the best way to protect yourself and others this year.” However, if someone chooses to travel, there are ways to make it safer.

Three members of the Aerospace Medical Association—a member organization of the AMA House of Delegates—took time to help clear up any misinformation. They are:

Here is what they had to say about flying during the COVID-19 pandemic.

As winter approaches and case counts continue to rise, options for traveling may be limited. However, if you do decide to travel, it is important to look at the trip as a whole and consider all factors involved.

“When we think of flying, we also need to think in terms of the whole trip as an end to end process,” said Dr. Pombal. “It is in fact a journey that starts the moment you walk out the door to get into a vehicle—car, train or bus—that will take you to the airport, through airport procedures, flying itself, all the way to the activities you are going to engage in once you get to your destination.”

“You cannot dissociate the risk from all those steps,” he said.

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During air travel, the risk of COVID-19 is lower than from an office building, classroom, supermarket or commuter train, says the JAMA Patient Page, “Risk of COVID-19 During Air Travel,” co-written by Dr. Pombal.

“To date, the number of confirmed cases of COVID-19 transmission to airline passengers around the world is small,” said Dr. Pombal, adding that there have been only about “60 cases over a period in 2020 during which a total of over 1.2 billion passengers have travelled by air.”

“The odds of being on a plane with a person with actively transmissible COVID—both positive and in the window where they are significantly shedding as identified by the research—are quite low,” said Drs. Shoor and Ortega. However, “the best portion of the discussions and agreements revolve around the flexibility of response because one size doesn’t fit all.”

“To match that, discussions have set forth a pattern of communication to express and share those similarities and differences as each flight has a takeoff and a landing location with different authorities,” they said.

“As this progresses, we will see areas ramp up and others go away, so you have to reevaluate the way you think about how you travel,” said Dr. Shoor.

“In general, air enters the cabin from overhead inlets and flows downwards towards floor-level outlets,” said Dr. Pombal. “Air enters and leaves the cabin at approximately the same seat row or immediately adjacent rows.”

“The airflow in today's aircrafts have been measured at three times the amount mandated for infection control rooms in hospitals,” said Drs. Shoor and Ortega. “It takes the ventilation system of a plane about six minutes to reduce the number of viral particulates in the air by 99.9%.

“This fact alone reduces risk significantly compared to office buildings, restaurants or homes,” they added.

“The approach that airports and airlines are taking to protect passengers and their staff is like the multiple layers that you wear to protect you from the cold,” said Dr. Pombal. “On the plane, air flow, recycling and filtering, as well as masks or face coverings, will help to reduce the likelihood of transmission.”

Additionally, the Collaborative Arrangement for the Prevention and Management of Public Health Events in Civil Aviation (CAPSCA) “brings together international, regional, national and local organizations to work together to improve preparedness planning and response to public health events, such as COVID, that affect the aviation sector,” said Drs. Shoor and Ortega. “From CAPSCA’s meetings, a variety of interventions were created to be used by airlines, airports, and other control agencies.”

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Those “include travel bans, screening, quarantine, testing, distancing, processes during flight, and other engineering actions,” they added.

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“The wearing of masks or of a face covering to fully cover your mouth and nose is widely considered as a key element to effectively reduce transmission while traveling,” said Dr. Pombal. “Before you travel, check the airline’s and the destination’s requirements.”

Wearing a mask “can reduce the amount of particulates, especially in a cough,” said Drs. Shoor and Ortega. “If you are significantly shedding, then a mask will reduce your transmissivity. However, you shouldn't be flying if you are sick.” 

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Sitting down “reduces the chances of random physical contact and disturbs less the cabin ventilation pattern that tends to prevent air from flowing lengthwise along the cabin,” said Dr. Pombal. “It may also optimize the use of the seatback in front as a barrier.”

The CDC offers further guidance on travel during the COVID-19 pandemic.