Fear of Flying Is a COVID-Era Conundrum

By Victoria Knight, Kaiser Health News reporter. Originally published at Kaiser Health News.

The holidays are approaching just as COVID-19 case rates nationwide are increasing at a record-breaking pace, leading to dire warnings from public health experts.

The Centers for Disease Control and Prevention has issued cautions and updated guidelines related to family gatherings. Dr. Anthony Fauci, a White House coronavirus adviser and director of the National Institute of Allergy and Infectious Diseases, said in interviews that his kids won’t be coming home for Thanksgiving because of coronavirus risks. “Relatives getting on a plane, being exposed in an airport,” he told CBS News. “And then walking in the door and saying ‘Happy Thanksgiving’ — that you have to be concerned about.”

Are Americans listening? Maybe not. Especially as airlines, reeling from major revenue blows since the pandemic took hold in March, tell passengers they can travel with peace of mind and sweeten the deal with special holiday fares.

The airlines argue more is now known about the virus and recent industry-sponsored studies show flying is just as safe as regular daily activities. They also tout policies such as mask mandates and enhanced cleaning to protect travelers from the coronavirus.

Time for a reality check.

Americans who do choose to fly will be subject to evolving COVID safety policies that vary by airline, a result of the continuing lack of a unified federal strategy. Under the Trump administration, government agencies such as the Federal Aviation Administration and the Centers for Disease Control and Prevention have failed to issue and enforce any national directives for air travel.

And, though President-elect Joe Biden has signaled he will take a more robust federal approach to addressing COVID-19, which may result in such actions, the Trump administration remains in charge during the upcoming holiday season.

Here’s what you need to know before you book.

Airlines Say It’s Safe to Fly During the Pandemic. Is it?

The airline industry pins its safety clearance to a study funded by its leading trade group, Airlines for America, and conducted by Harvard University researchers, as well as one headed by the Department of Defense, with assistance from United Airlines.

Both reports modeled disease transmission on a plane, assuming all individuals were masked and the airplane’s highly effective air filtration systems were working. The Harvard report concluded the risk of in-flight COVID-19 transmission was “below that of other routine activities during the pandemic, such as grocery shopping or eating out,” while the DOD study concluded an individual would need to, hypothetically, sit for 54 straight hours on an airplane to catch COVID-19 from another passenger.

But these studies’ assumptions have limitations.

Despite airlines’ ramped-up enforcement of mask-wearing, reports of noncompliance among passengers continue. Most airlines say passengers who outright refuse to wear masks will not only be refused boarding, but will also be putting their future travel privileges at risk. Recent press reports indicate Delta has placed hundreds of these passengers on a no-fly list. Some passengers may still try to skirt around the rule by removing their mask to eat or drink for an extended time on the flight, and flight attendants may or may not feel they can stop them.

And though public health experts agree that airplanes do have highly effective filtration systems spaced throughout the cabin that filter and circulate the air every couple of minutes, if someone who unknowingly has COVID-19 takes off their mask to eat or drink, there is still time for viral particles to reach others seated nearby before they get sucked up by the filter.

Public health experts said comparing time on an airplane with time at the grocery store is apples and oranges.

Even if you wear a mask in both places, said Dr. Henry Wu, director of Emory TravelWell Center and associate professor of infectious diseases at Emory University School of Medicine, the duration of contact in both locales can be very different.

“If it’s a long flight and you are in that situation for several hours, then you are accumulating exposure over time. So a one-hour flight is 1/10 the risk of a 10-hour flight,” said Wu. “Whereas most people don’t spend more than an hour in the grocery store.”

Also, both studies analyzed only one aspect of a travel itinerary — risk on board the aircraft. Neither considered the related risks involved in air travel, such as getting to the airport or waiting in security lines. And public health experts say those activities pose opportunities for COVID exposure.

“Between when you arrive in the airport and you get into a plane seat, there is a lot of interaction that happens,” said Lisa Lee, a former CDC official and associate vice president for research and innovation at Virginia Tech.

And while Wu said he agrees that an airplane cabin is likely safer than other environments, with high rates of COVID-19 in communities across the U.S., “there is no doubt people are flying when they’re sick, whether they know it or not.”

Another data point touted by the airline industry has been that out of the estimated 1.2 billion people who have flown so far in 2020, only 44 cases of COVID-19 have been associated with air travel, according to data from the International Air Transport Association, a worldwide trade group.

But this number reflects only case reports published in the academic literature and isn’t likely capturing the true picture of how many COVID cases are associated with flights, experts said.

“It’s very difficult to prove, if you get sick after a trip, where exactly you got exposed,” said Wu.

The low count could also stem from systemic contact-tracing inconsistencies after a person with COVID-19 has traveled on a flight. In a recent case, a woman infected with the coronavirus died during a flight and fellow passengers weren’t notified of their exposure.

That may be due to the decentralized public health system the U.S. has in place, said Lee, the former CDC official, since contact tracing is done through state and local health departments. The CDC will step in to help with contact tracing only if there is interstate travel, which is likely during a flight — but, during the pandemic, the agency has “been less consistently effective than in the past,” said Lee.

“Let’s say there is a case of COVID on a flight. The question is, who is supposed to deal with that? The state that [the flight] started in? That it ended in? The CDC? It’s not clear,” said Lee.

Is Now the Time to Fly?

Most airlines have implemented safety measures beyond requiring masks, such as asking passengers to fill out health questionnaires, enhancing cleaning on planes, reducing interactions between crew members and passengers, and installing plexiglass stations and touchless check-in at service desks.

But many have also stepped back from other efforts, such as pledging to block middle seats. United relaxed its social distancing policy for allowing empty middle seats between customers at the end of May, though there were complaints from customers before then about flights being full. American Airlines stopped blocking middle seats in July. Other airlines plan to fill seats after the Thanksgiving holiday, with Southwest stopping the practice of blocking middle seats starting Dec. 1, and JetBlue planning to increase capacity to 85% on Dec. 2. In January, Alaska Airlines plans to stop blocking middle seats and JetBlue will fly at full capacity. Delta announced this week that it will continue to block the middle seat until March 30.

This policy change is a result of airlines’ lack of cash on hand, said Robert Mann, an aviation analyst. It also reflects a rising demand from consumers who feel increasingly comfortable traveling again, especially as holiday gatherings beckon.

“It was easy to keep middle seats empty when there wasn’t much demand,” said Mann.

Now, they’re instead hoping that new COVID-era services will calm passengers’ fears.

American, United, Alaskan and Hawaiian, among others, offer some form of preflight COVID test for customers traveling to Hawaii or specific foreign destinations that also require a negative test or quarantine upon arrival. JetBlue recently partnered with a company to offer at-home COVID tests that give rapid results for those traveling to Aruba.

Airlines are likely to expand their preflight COVID testing options in the next couple of months. “This is the new dimension of airline competition,” said Mann.

But is it a new dimension of travel safety?

Emory’s Wu said there is certainly a risk of catching the coronavirus if you travel by plane, and travelers should have a higher threshold in making the decision to travel home for the holidays than they would in years past.

After all, COVID case rates are surging nationwide.

“I think the less folks crowding the airports, the less movement in general around the country, will help us control the epidemic,” said Wu. “We are worried things will get worse with the colder weather.”

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About Lambert Strether

Readers, I have had a correspondent characterize my views as realistic cynical. Let me briefly explain them. I believe in universal programs that provide concrete material benefits, especially to the working class. Medicare for All is the prime example, but tuition-free college and a Post Office Bank also fall under this heading. So do a Jobs Guarantee and a Debt Jubilee. Clearly, neither liberal Democrats nor conservative Republicans can deliver on such programs, because the two are different flavors of neoliberalism (“Because markets”). I don’t much care about the “ism” that delivers the benefits, although whichever one does have to put common humanity first, as opposed to markets. Could be a second FDR saving capitalism, democratic socialism leashing and collaring it, or communism razing it. I don’t much care, as long as the benefits are delivered. To me, the key issue — and this is why Medicare for All is always first with me — is the tens of thousands of excess “deaths from despair,” as described by the Case-Deaton study, and other recent studies. That enormous body count makes Medicare for All, at the very least, a moral and strategic imperative. And that level of suffering and organic damage makes the concerns of identity politics — even the worthy fight to help the refugees Bush, Obama, and Clinton’s wars created — bright shiny objects by comparison. Hence my frustration with the news flow — currently in my view the swirling intersection of two, separate Shock Doctrine campaigns, one by the Administration, and the other by out-of-power liberals and their allies in the State and in the press — a news flow that constantly forces me to focus on matters that I regard as of secondary importance to the excess deaths. What kind of political economy is it that halts or even reverses the increases in life expectancy that civilized societies have achieved? I am also very hopeful that the continuing destruction of both party establishments will open the space for voices supporting programs similar to those I have listed; let’s call such voices “the left.” Volatility creates opportunity, especially if the Democrat establishment, which puts markets first and opposes all such programs, isn’t allowed to get back into the saddle. Eyes on the prize! I love the tactical level, and secretly love even the horse race, since I’ve been blogging about it daily for fourteen years, but everything I write has this perspective at the back of it.

31 comments

  1. Terence Dodge

    Magical thinking with money as a incentive, depending on incubation period which I assumes varies by individual first week in December should show results.

    Reply
  2. PlutoniumKun

    To add another element of concern, the physical movement of people will spread the disease and potentially mix different strains.

    In Ireland, the genetic evidence is that the first wave was almost entirely due to school groups on ski breaks in north Italy/Austria in February. I was told by one doctor that something of the order of 60% of cases recently in Ireland are traceable to a strain that arose in Spain over the summer, and was most likely brought back directly by holidaymakers or indirectly via the UK.

    In other words, restricting long distance travel and/or enforcing proper quarantine on people who do travel (as is common in Asia) would have greatly reduced the incidence and potentially saved many lives (not to mention the economic disruption). A key factor in preventing Covids spread in China seemed to have been strongly enforced travel restrictions between affected and unaffected areas.

    As for the physical act of flying, I strongly suspect that the number of cases caught on aircraft are seriously undercounted. Its very difficult to prove without genetic testing of the strain if someone who has been travelling caught it on the aircraft or before/after the journey.

    Shorter version – its madness to allow unrestricted movement for Thanksgiving. Its very hard to see any outcome but an even fiercer surge of cases coming up to Christmas.

    Reply
  3. Watt4Bob

    Human beings are behaving so badly as concerns Covid safety compliance that the results of ‘studies‘ in no way provide enough realistic advice to provide confidence in decision making around safe air travel.

    IOW, everything going “as planned” quickly turns to “OH NO!” when a belligerent fellow passenger decides to exercise their “RIGHT” not to wear a mask mid-flight.

    I’m seeing this sort of behavior in public places, and at my workplace, where at least I can leave the area…

    Reply
  4. TimH

    For me, the MAX aircraft invokes fear of flying. Otherwise, it’s fear of COVID.

    I expect air travel will build up slowly in US due to antics of TSA and CBP with security theatre on one hand, and the ever-increasing collection of biometrics on the other.

    Reply
  5. Louis Fyne

    I am guilty. Took a discretionary 3-hr round-trip flight with the fam.

    No problems whatsoever except for longer lines due to less staffing and 100% filled plane (and one dude hacking a pneumonia-, or flu-, like cough at the gates—gave that dude lots of room).

    I’d definitely fly again and tempted as flights to many locations are very low—-but I’m not in a high-risk group and my odds of survival should I get covid are very high (unless I’m the outlier).

    But totally bewildered by FAA/airlines/local government don’t at least institute temp. checks at the terminal door.

    My local gym has more safeguards than the two very major airports I flew through.

    Reply
    1. d

      temp checks are more of a feel good thing than any thing that really does good, with lots of people with the virus…but absolutely no symptoms of any sort.
      and even the tests for the virus seems to have bad negative and positive tests. course the test only good at a particular time, 20 minutes later maybe a different story

      Reply
  6. cocomaan

    I am doing some work for a client in Jamaica yesterday and for giggles looked at a flight from PA to Ocho Rios. Round trip $272.

    I then did one from PA to Las Vegas over the holidays. Round trip $230.

    So while people may be traveling by plane, I don’t think it’s going to be at such a rate that we have to worry too much yet. Last time I saw tickets this cheap was right after 9/11, if that.

    Reply
  7. Ella

    You have to be an idiot to fly right now. But again the majority of people at are idiots.

    It’s going to be a long winter for sure.

    Reply
  8. Joe Well

    Is it true that they are still serving meals and snacks on planes or else allowing passengers to consume whatever they brought on board? In that case, the mask requirement has a gaping hole by design, doesn’t it?

    Reply
    1. Thistlebreath

      Same perfect illogic of “you got to be going to our movie theaters again” when most of theater operators’ profit comes from tasty snacks to be consumed while watching the big screen.

      Best howler I heard was that people will quickly move aside their mask, pack in a mouthful of popcorn or whatever and then whip it back on. In the dark. With nobody else watching. You betcha, to lapse into Minnesotan.

      Reply
  9. Joe Well

    I am torn, actually, distraught. I really want to move from Boston to an international location that is warm and has low Covid rates where I can at least take my laptop outdoors (Bermuda and Chiapas, Mexico the leading candidates since Thailand and Vietnam still closed) and stay there until April at least. I agree that in theory air travel should be safe, I just don’t trust the airlines, their staff, the TSA, or the other passengers, especially if I have to get a connecting flight somewhere in Red America.

    I had hoped to carry on some kind of life doing outdoor winter activities but most people here have decided to pretend that the pandemic has ended and are meeting up inside people’s houses, including friends of friends, or, complete strangers.

    The state has effectively set the tone by allowing indoor dining which I shouldn’t have to explain is insane, while at the same time cancelling the huge calendar of outdoor events that local governments typically sponsor every month of the year.

    Let me be clear that “progressives” in my social circle have been among the worst offenders starting with the BLM mass demonstrations (many of them really just giant parties) in June that broke the back of the social distancing consensus.

    My mental health is not doing well right now.

    Reply
    1. drumlin woodchuckles

      I hear backs and forths about the BLMers practicing or not practicing Safe Six and Mask Up during their marches. Is there enough video of enough marches to where the issue could really be studied by watching a large enough amount of BLM protest march videos?

      And did BLMers then have after-march parties or meetups or millarounds? Are there videos? Could they be studied to ascertain the amount of Safe Six and Mask Up being practiced or not practiced?

      Because if it is true that a large percent of BLMers were in fact perpetrating corona-spreading behavior, than neither they nor their Allies have any moral standing to say a single thing whatsoever about the Motorcycle Rally at Sturgis , South Dakota. Or any of Trump’s grand rallies.

      So it would be nice to know what percent of BLM activities were pro-health and what percent were pro-disease . . . . in order to be able to actually analyze whether BLM actually did or didn’t actually do things which actually broke virus-containment discipline throughout the society.

      Reply
      1. d

        doubtful that those who favor the motorcycle thing in Sturgis, or favored any sort of group gathering of any sort indoors have much creditability as far as being safe. any group gathering of almost any size indoors is a virus invite.

        and after Sturgis get together there were lots of folks that got the virus

        its groups. in doors

        Reply
  10. carl

    Too many unknowns, no real standards from government, no contact tracing after the flight, airlines have a financial incentive to minimize risks, still too much emphasis on droplet transmission. One part of flying missing from the article is the boarding/unboarding process, where passengers tend to crowd up.

    Reply
  11. Michael Fiorillo

    My daughter recently returned to NYC by jet from Florida – I know, don’t get me started – and the plane was 2/3rds filled with Hasids, virtually none of whom wore masks, despite the constant and impotent entreaties of the flight attendants. When given forms attesting to the fact they were coming from a quarantine state, they brazenly lied, said they’d been elsewhere than Florida, and discarded them.

    Totally disgusting, contemptuous (if maybe outlying) behavior, and something to keep in mind if you’re considering spending hours in a tin can with other US humans.

    Reply
    1. drumlin woodchuckles

      One wonders if these Hasids were Trump supporters.

      Seriously, though, at the moral level what we should do is this . . . . give everyone who wants a No Mask Exemption because Freedom a No Mask Exemption. We should take their names, addresses, all numbers, etc., and put them on a list of people who will be forbidden any medical treatment whatsoever if they get Covid. Because Consequences to go with that Freedom.

      Reply
      1. Michael Fiorillo

        Not completely sure if they are Trump supporters, but 100% certain they are ignorant religious fanatics who have no regard whatsoever for the non-Them.

        Reply
      2. Jean Bidet

        Your proposed response is problematic. While I empathize with the sentiment, it would take us down a path leading to forbidding medical treatment for all sorts of moral risks that ultimately impose a cost on society ranging from eating processed (including fast) foods, to drinking, smoking, and other drug use, to not wearing seat belts, helmets, or using car seats, practicing safe sex, etc., etc. What about denying all social benefits to those who drop out of the schooling our tax dollars provide in order to make them functional adults and productive members of society? Even though I can see the logic, I’m not at all certain there is anything “moral” about this sort of response.

        Reply
  12. rtah100

    I drove from Devon to Turin for a morning meeting (with an unexpected bonus lunch) rather than fly. My colleague flew but I could not face bring herded through environments and stood/seated next to other humans I could not control. I preferred to take my chances with the matrix of six different sets of national quarantine rules and live off bulk bought croissants and bananas for 2,000 miles. Subsequently the case studies of Irish and Vietnamese air travel cases were published….

    Reply
  13. Upstater

    Back in September, my locality was under 1% for months. At the same time Aruba opened for tourists from the northeastern US, providing you had a negative PCR test in the past 72 hours or taking one on arrival and quarantining until results). Late fall is a particularly dismal season in upstate NY, so we booked award tickets on American Airlines through Charlotte for this week. MISTAKE #1.

    Well, now local positive rates are over 6% and nationally they are a moonshot.

    The flight from Charlotte had a 1.5 hour delay at the gate, AFTER fully boarding. There were 2 guys in front of us who brought their Starbucks cups on board and proceeded to have many, many unmasked cell phone calls. The coffee was either stone cold or empty. I asked the flight attendant to ask them to mask up and she made a general announcement. They were now below the nose maskers.

    It is a 3.5 hour flight. Half way through I personally asked the guys to maskmup. MISTAKE #2. One then went whining to the flight attendant saying I was “bothering” him, playing the role of victims. She came and offered to reseat me (we were in first class).

    When we arrived in Aruba, I told the AH to get rid of his Biden-Harris hoodie and get a MAGA hat and wear a Trump mask on his chin.

    DON’T FLY.

    Reply
    1. drumlin woodchuckles

      The following might be an interesting bit of social performance satire . . . . carry hundreds of MAGA hats around with you and give one to every no-masker you see.

      But don’t do this if you aren’t strong enough and trained enough to knock someone unconscious within one or two seconds. Because someone will get belligerent enough to require such treatment, and if you can’t dish it out, don’t put yourself in a position to risk taking it.

      Reply
  14. Wukchumni

    I’ve been Jong’ian since 9/11 with just 3 domestic flights under my belt-and the claim is that I was merely training for Covid.

    Can’t really miss something you don’t do, can you?

    Reply
  15. Stephen The Tech Critic

    I noticed that PlutoniumKun touches on this a bit in his comment above, but let me state this more clearly:

    The big problem with this analysis is that it’s focused on the *individual*. “What is *my* risk of getting COVID-19 on the airplane?” This kind of thinking essentially ascribes equal weight to an incidence transmission no matter who “I” got it from. If instead the analysis consider the risk to the *collective*, then we must acknowledge that some incidents of transmission are much more consequential than others.

    Transmissions that occur on airlines flights and in or around airports are probably *most* consequential to the *collective* because they connect parts within The Great Social Network (speaking of physically proximal contacts here, not the Silicon Valley imitations) that had been further separated. Unfortunately, busy Thanksgiving travel will probably be like stepping-on-the-gas in terms of the wider pandemic.

    Reply
  16. Kurt Sperry

    My family home is in Italy but I ain’t getting on a plane there until I’m vaccinated (and I want everyone with higher risks and comorbidities seen to first). I know people who have been flying and I’ve seen numbers suggesting it isn’t crazily unsafe but the very thought of it terrifies me.

    Reply
  17. David

    This made me chuckle :

    “Also, both studies analyzed only one aspect of a travel itinerary — risk on board the aircraft. Neither considered the related risks involved in air travel, such as getting to the airport or waiting in security lines. And public health experts say those activities pose opportunities for COVID exposure.”

    You don’t say? Has the reporter ever travelled on an aeroplane? These risks, in queues for check-in, queues for security, queues for food and drink, queues in shops, queues for boarding, airport buses, airport trains inter-terminal transfers, toilets, are exactly the risks that are cumulatively the most important. Not least because you meet and mingle with people from, potentially, everywhere the world. Sorry, but anyone who flies by plane at the moment and doesn’t absolutely have to needs more than their nose and throat examined.

    Reply
  18. Grayce

    Time to reflect on just what it means to be “The home of the free/”
    Are we simply free to do as we wish, to follow our whims? Are we free to disregard each other’s air to breathe when we share spaces? Are we free to risk our own health even if it is tied to so many more? Are we free to mature into a caring, gentler nation? (borrowed from Bush, the elder’s “kinder, gentler nation.”)
    Are we “in this together”?

    Reply
  19. rowlf

    Have a lot of airport personnel and flight attendants gotten sick? One would expect security checkpoint workers, passport control, ticket agents and flight attendants to have the most exposure to becoming infected.

    Reply
  20. ChrisFromGeorgia

    Isn’t there a huge whole in pre-flight testing, unless it is administered right at the gate, just prior to boarding?

    TSA lines full of travelers, the crowded airport main concourse, the ride to the airport on a congested transit system, etc.

    Reply

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