Each week we answer pressing coronavirus questions. For this week's installment, we're focusing on flying.
Since the coronavirus began its spread around the world, the number of people flying has nosedived. In the U.S., for example, the number of flyers has dropped more than 90% since the beginning of March. TSA screened 234,928 travelers on Thursday, compared with 2,611,324 people on the same weekday a year earlier.
With some countries and states are starting to allow businesses to reopen and lifting stay-at-home orders, people are wondering about the risks of flying.
The Centers for Disease Control and Prevention guidance urges avoiding travel as much as possible, "especially if your trip is not essential .... Don't travel if you are sick or travel with someone who is sick." Travel increases your chances of getting and spreading COVID-19, the CDC states.
Dr. Mark Gendreau, chief medical officer at Beverly Hospital in Massachusetts and a professor of emergency medicine at Tufts University, agrees: Even as some restrictions start to lift, he believes that it's still not a great time to take a flight for, say, a beach vacation.
"If you're going for a vacation, it might be a good idea to postpone it for a little longer and by a little longer I would say another couple of months. We still have a lot of [viral] activity out there," he says.
Here are answers to some of the commonly asked questions about flying.
What do I need to think about before making a decision to fly — or not?
Determine whether the trip is necessary — and worth the risk and hassle.
"It's up to individual travelers to decide what is really urgent and necessary," says Dr. Henry Wu, a professor of infectious disease medicine at Emory University and director of its TravelWell Center. "While traveling in an aircraft, you may be around people from all over the world, whether on the plane or at the airport. There will always be some risk at this point, and it's going to be very difficult to determine how high."
He says personal protective measures like face coverings, hand hygiene and keeping social distance all help to reduce the transmission rate of the virus — but cautions that these measures don't eliminate risk entirely.
To determine whether it's smart to fly, suggests Wu, start with a self-assessment: "Your medical background, your age and whether or not you have risk factors for severe complications."
Second, evaluate the importance of the trip. In certain instances – say if you want to visit a dying family member or greet a new grandchild – you may feel strongly that you should go. Other situations may be discretionary.
Third, evaluate your own tolerance for risk and inconvenience. Some states and countries require a 14-day quarantine period for arriving visitors – Hawaii, for example, requires all arriving plane passengers to stay home or in their lodging for 14 days after arriving and monitor their health, with a possible $5,000 fine or year in prison for violators.
The CDC continues to advise a 14-day quarantine when you get home from international travel.
"I think everyone has to sort of do a little soul-searching to see what their risk tolerance is and the importance of the trip and their ability to take protective measures," Wu says.
How stressful will it be?
Airplanes are confined spaces. Someone seated near you on the plane could start sneezing or coughing uncontrollably — which could cause you anxiety. Make sure you are prepared for the mental stress of an environment that is not fully within your control during a global pandemic.
The last time this reporter flew was in early March. It was not a relaxing experience: I was crammed in a full plane, highly aware of any stray cough or sneeze (including my own) and with no way to know if someone sitting near me might be carrying the virus. It was a relief to land.
Gendreau says that your risk within a confined space like an airplane comes down to three factors: the duration of your exposure, your proximity to the source of the exposure and how infectious that source is.
While there's no way to eliminate that risk, there are steps you can take to reduce your chance of picking up an illness on board.
If I do fly, do I need to wear a mask?
While there's still much that isn't known about COVID-19, the virus is believed to spread primarily through respiratory droplets produced when an infected person coughs or sneezes, according to the CDC. Masks can protect you from spraying your fellow passengers with droplets if you cough or sneeze and can also protect your mouth and nose from the droplets of others.
All major U.S. airlines, and some overseas, now require employees and passengers to wear face coverings during flights except when eating or drinking. Very young children are exempted as are those with medical conditions that prevent wearing a face covering.
Your mask should cover your nose and mouth and not be too loose, Wu says. Be sure your hands are clean when putting the mask on and taking it off, and always wash or sanitize your hands after removing your mask.
Can you practice social distancing on a plane?
As airlines have cut flights, some planes in recent weeks have been quite full. After an outcry from the public, airlines are now taking steps to promise travelers they'll have more space: Many do not seating passengers in middle seats on any flights, and if space allows, are seating passengers every other row. Bethany Long Newman flew on American from Chicago to Charleston, W.Va. in late April. On her flight from Chicago to Charlotte, "Everyone had their own row, and they put an empty row in between people."
But the situation was more haphazard on her next flight, aboard a smaller plane from Charlotte to Charleston: "When we boarded, there was a flight attendant that just said, 'You can sit wherever you want." Newman and her two family members family took a seat, but then someone sat down directly behind them, spurring Newman and her family to move elsewhere.
Wu says it's easier to stay spread apart now, with fewer people flying, but that will be more challenging if and when travel picks up.
United Airlines says that beginning next week until the end of June, it will aim to inform passengers 24 hours before departure if their flight will be more than 70% full. Customers can opt to rebook on a different flight or receive a travel credit.
What's the safest seat to select?
People sitting on the aisle are more likely to be in contact with other passengers and crew members as they walk down the aisle or take something out of the overhead bins.
"If it's a crowded flight," Gendreau says, "you can't go up those aisles without accidentally touching someone who's just seated there."
Those passengers by the window are also less likely to get up during the flight to use the bathroom or move around – activities that can also expose you to other people and surfaces.
Gendreau says in this era of not-so-crowded flights, he'd go for a window or middle seat instead of an aisle.
Wu's pick? "Wherever is the most distant from others."
Do I need to bring hand sanitizer? And when should I use it?
"Hand gel: don't leave home without it," says Gendreau. He says the germiest places on airplanes are often the bathroom faucet handle, the slider that locks the lavatory door and the magazine pockets and tray tables.
If you use the lavatory, use sanitizer gel on your hands after you return to your seat, to remove germs from surfaces like the door lock.
Wu says it's important to stay aware of what you're touching: "If you touch anything that may not be clean, which is virtually everything that's not on yourself, be mindful of that," he says, and sanitize your hands when needed.
He says that in general, it's not a bad idea to carry around a pen to touch elevator buttons and the like, instead of using your fingers. Though then you need to be aware that you're carrying around a dirty pen.
Should I do any pre-emptive wiping?
Wipe down surfaces in your area.
Airlines have stepped up their cleaning procedures of aircraft cabins, disinfecting them with fogging machines that spray disinfectant. Staff come through again with cleaning supplies to clean cabin surfaces like seat belts, window shades, tray tables and seat-back screens.
Your airline might provide disinfecting wipes and hand sanitizer as you board, but you may want to bring your own in case it doesn't. Gendreau hasn't flown since the arrival of COVID-19, but he was already in habit of bringing wipes and sanitizer gel.
"I'd just clean my seat back tray, my gasper [air vent], my seat belt. Then I'd wipe down where the magazine stuff was," he said. "Then I'd dispose of that wipe, take out my gel and sanitize my hands."
When you use hand sanitizer, use several drops and rub for at least 20 seconds.
What if my face gets itchy?
Don't touch it.
Sanitize your hands, put on your mask and adjust it so it's comfortable — and then leave it alone.
"If I've got an itchy eye or something, it's my forearm that's getting it unless I sanitize my hand," says Gendreau.
How effective are cabin air filters?
"The good news is that airline aircraft air circulation is very good," says Wu, "and it is constantly being filtered and circulated."
Most aircraft used by U.S. airlines use high-efficiency particulate air (HEPA) filtration systems. "This type of air filter can theoretically remove at least 99.97% of dust, pollen, mold, bacteria and any airborne particles with a size of 0.3 microns," the U.S. Environmental Protection Agency says. "Particles that are larger or smaller are trapped with even higher efficiency."
The CDC says, "Because of how air circulates and is filtered on airplanes, most viruses and other germs do not spread easily."
But those air filters are not going to protect you from a sneeze that lands right on you.
"My main concern would be my individual row, as well as the two rows in front and back — that's roughly your six-foot radius," Wu says. "Even if the air is well-circulated and filtered, if somebody is just really coughing or sneezing within vicinity, it certainly does increase the chance of some exposure or contamination of the area around you."
What preventive measures can I take if someone starts coughing or sneezing a lot?
If someone is hacking nearby, hopefully they're wearing a mask. If they're sitting close to you, you might want to move seats if possible.
If you can't, Gendreau says, try to convert your mask into one that seals more tightly against your face. He suggests a technique demonstrated by a former Apple engineer, in which three rubber bands are stretched over top of a mask to create a seal over the mouth and nose.
Gendreau would also reach up and turn on the adjustable air duct above your head, known as a gasper. He recommends turning it to a medium flow and angling it so the air current is directed slightly in front of your face. He says that by turning the gasper on, you might be able to add some turbulence to the air in your space. Modeling studies have shown, he says, that opening the gasper for additional air flow "does create some extra turbulence in your personal air space and that might create enough turbulence where the particle doesn't sort of land on your mask or on your arm."
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