How safe is air travel during Covid -19 (Corona) Pandemic?
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How safe is air travel during Covid -19 (Corona) Pandemic?


1. How is Corona virus transmitted?

Corona virus is transmitted via droplets (>5μm) and aerosols (usually <5μm). Both are produced during talking, sneezing, coughing, or singing by an infected person and pose a risk of infection transmission through direct contact, airborne, and fomites. Droplets are particles that travel a shorter distance, settle rapidly on a surface, and remain in the air for shorter periods of time than aerosols. Aerosols particles travel a larger distance and can remain suspended in the air for a longer time. 


 Source: BMC Infect Dis 19, 101 (2019) 

2. How safe are you during your air travel in Corona times? 

Most of us would cringe at the thought of air travel and have a lot of anxiety pertaining to the safety aspects during Covid -19. Though we cannot exclude the risk altogether, it may be safer than you think. The risk of contracting COVID-19 onboard flight is very low when compared with other public indoor environments, such as restaurants, workplaces, trains and buses, based on published reports. Since Covid-19 outbreak, less than 50 cases (inclusive of confirmed, probable and potential cases) are reported in which transmission is thought to be associated with a flight journey. Conclusive data reflects one case for every 27 million travelers!

3. Why should there be a lower risk of infection transmission during air travel as compared to other modes of transportation?

Unlike other modes of transport, combination of seating arrangement and characteristics of airflow in-flight mitigate the risk

Seating position: In flight, you sit facing forward rather facing other passengers, minimizing the chances of breathing in, the expelled air, of co-travelers.
Seat backs: High seat backs act as a physical barrier to COVID-19 spread.

4. How can air travel be safe if you are sitting next to a fellow passenger who may be infected?

1. First of all, global health screening and departure biosafety measures concerning air travel minimize the chances of an infected passenger sitting next to you. 
2. Because of the forward seating arrangement, fewer chances of face to face interaction.
3. The downward flow of cabin air (from ceiling to floor) mitigates the forward and backward spread, and on top of it, air is fully renewed with fresh air every 2-3 minutes.
4. Individual overhead ventilation helps in directing the airflow downward than sideways.
5. Wearing masks further reduces the chances of transmission from person sitting next to you.
6. Face coverings are designed to contain respiratory droplets before they can be expelled into the air.
7. Use of HEPA (high-efficiency particulate air) filters.
8. Some airlines leave middle seats unsold, creating a bit more space between passengers.   

Source: https://www.iata.org/en/youandiata/travelers/health/low-risk-transmission/ 

5. Should you trust on board air quality?

The air quality on a commercial flight is quite reliable. The air handling system in commercial flights works against the viruses spread in cabin. Good air quality in flights can be understood by:

1. High airflow rate in cabin: Unfavourable to spread of virus droplets unlike in other modes of transport. The airflow in airliners is much faster than normal indoor buildings.

2. Direction of airflow flow rate: Air enters the cabin from overhead inlets, flows downwards in circular pattern towards floor outlets for exit. Air entry and exit occurs at the same seat row or nearby rows, giving less room for forward and backward airflow  between rows. Infected salivary droplets fall on floor and don’t spread down the aisle. This typical air movement curtails the virus roll out between rows.

Source: Pombal R et al. Risk of COVID-19 During Air Travel. JAMA. 2020;324(17):1798.

3. Rate of air exchangeOnce air leaves the cabin, about half is thrown outside, and half is filtered through HEPA (high-efficiency particulate air) filters, of the same types used in hospitals or operating rooms, before being mixed with fresh outside air and entering the cabin again. High air exchange rate combined with HEPA filters which remove 99.97% viruses, bacteria, and fungi, keep air quality high in flight and moreover, cabin air is refreshed 20 times per hour when compared with just 12 times in a ground building.

4. Separate Ventilation sections for about every 7 rows of seats: Reduce the sharing of breathing air with all the passengers in a flight but only with our immediate co-passengers. Passengers seated within two rows of an infectious person are most at risk.

Video : https://youtu.be/s2x-x9FjI0A



6. Which is the safest place to sit in a flight?

According to the WHO, contact with an infected person on a plane is defined as being seated within two rows of one another. However, researchers at The New England Journal of Medicine found that a three-row rule was more accurate. Staying in your seat reduces the chances of coming into contact with the virus. Till now window seats were considered safest but a detailed analysis of passengers on a Qantas flight in March concludes that the risk of catching the coronavirus is more on a window seat in the middle of the aircraft in an economy class.

7. What are the risk reduction strategies adopted by airports and airline authorities?

1. Screening and/Inquiry about symptoms.
2. Enhanced cleaning and disinfection measures.
3. Use of physical barriers and sanitization in airports.
4. Use of face coverings or masks.
5. Physical distancing in airports and during boarding and deplaning. 
6. Contactless boarding/baggage processing and deplaning. 
7. Adjustment of food and beverage service to reduce contact.
8. Control of access to aisles and bathrooms to minimize contact.
9. Limiting exposure of crew members to infection.
10. Facilitation of contact tracing. 

8. What precautions should you take at your level for safer air travel?

1. Avoid travel if you are unwell or have co-morbid conditions.
2. Wear a mask or face covering (as specified by airliners) and carry surface and hand sanitizers.
3. Practise hand hygiene and clean hands after touching any surface.
4. Follow respiratory etiquette.
5. Avoid touching the eyes, nose, or mouth.
6. Cut short in-flight movement.
7. Avoid removing the mask at any time.
8. Maintain Social distance wherever applicable.

References:

1. Tellier, R., Li, Y., Cowling, B.J. et al. Recognition of aerosol transmission of infectious agents: a commentary. BMC Infect Dis 19, 101 (2019)
2. Pombal R, Hosegood I, Powell D. Risk of COVID-19 During Air Travel. JAMA. 2020;324(17):1798. doi:10.1001/jama.2020.19108
3. Air travel in the time of COVID-19. The Lancet Infectious Diseases Volume 20, Issue 9, P993, September 01,2020
4. Covid -19 transmission up in air.The Lancet Respiratory Medicine
5. Travel during the COVID-19 Pandemic
6. WHO Travel Advice
7. Restoring Aviation During COVID-19
8. IATA Comment on Studies Regarding Onboard Transmission of COVID-19
9. COVID-19 Aviation Health Safety Protocol: Guidance for the management of airline passengers in relation to the COVID-19 pandemic
10. Here’s how coronavirus spreads on a plane—and the safest place to sit
11. How Safe is Air Travel?


 

About Author
Dr. Neerja Shastri (MBBS, MD Physiology)\\<br />Currently working as Professor Physiology is an expert in basic and advanced pulmonary function tests. She has also been training medical and paramedicals in obstructive airway diseases and Pulmonary Function Tests at various scientific platforms .Formerly she has worked in Chest Research Foundation Pune and have headed international Clinical Trials and Spirometry QA operations with active involvement in National /international Clinical and academic research.
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Dr. L●●l S●●●●●a
Dr. L●●l S●●●●●a General Medicine
Good informative artical I fully agree with you and your cullge.
Nov 9, 2020Like
Dr. S●●●●h P●●●l
Dr. S●●●●h P●●●l Occupational Medicine
Nice article
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Dr. S●●●●●●●●●●n K●●●●●●i
Dr. S●●●●●●●●●●n K●●●●●●i Family Medicine
Good information for safe Air Travel
Dec 12, 2020Like