Is it Safe to Fly on Commercial Airlines?

I have been asked this more than once. And, I don’t actually know the answer, because I don’t know of any good studies that address this question. There is little debate that in some cases, there do appear to be infections that can be traced back to flights. But, I have no idea how many and exactly what any particular person’s risk is. However, this doesn’t help people who have to make decisions about travel in the next couple of months, so I will at least share with you what my own decision is and why.

Personally, I will not be flying for at least the next six months. Why?

1. Cases of new COVID infections are increasing in the majority of the US states and in many of the countries that I might be attracted to as tourist destinations and that others might be likely to travel to for business.
2. I believe that cases are going to continue to increase over this fall and winter, and in fact, may be worse than anything we have seen so far. Why? We are seeing a confluence of new epidemiologic risk factors – more K-12 schools opening every week with in-person classes, colleges and universities holding classes in-person, the resumption of sports, the re-opening of bars, more and more examples of large gatherings in defiance of public health recommendations (and many infections from extended family get togethers, neighborhood bbqs, weddings, etc.), the movement of gatherings indoors due to air quality in the western US or due to colder weather, the upcoming cold and flu season, the projections that at least 90 percent of Americans remain vulnerable to infection and the increasing evidence that the D614G mutation, which is more contagious, is likely the predominant SARS-CoV-2 strain in the US and Europe.
3. The reason that 1 and 2 above are so important to my analysis is that the greater the number of cases in the community, the greater the odds that you will encounter one or more infected persons during your travel – the taxi or ride-sharing service to the airport or from the airport to your final destination, the shuttle bus or train between terminals or to or from parking lots, the hotel you will be staying at, etc.
4. In my personal observations, it seems that people may be more likely to stay home from work sick than they are to cancel travel plans. I recall vividly a flight last year where the person across the aisle and one row back was coughing incessantly during the flight. Two days later, guess what? Yes, I had a nasty cold with an annoying and persistent cough!
5. While airplanes do generally seem to have excellent air circulation, air exchanges and filtration, that is during flight. Probably all of us can remember boarding flights when it was hot outside and desperately fiddling with the air flow control valve above your head trying to get some cold air only to find out that the engines are not on fully and the air conditioning system will not turn fully on until beginning the take-off process.
6. When up in the air, people will be taking their masks off to drink, snack and eat meals. There is also the issue of someone taking their mask off and then falling asleep or someone taking it off and refusing to put it back on. Are the flight attendants going to awaken the passenger in order to have them put their mask back on? Are flight attendants going to insist that a passenger wear their mask if they refuse? Certainly, we have seen many businesses that require the wearing of masks, but do not enforce it in the store.
7. One must consider all the associated activities with any event. So, while the actual flight may or may not be safe, does the airport require everyone to wear masks at all times? Is there physical distancing at security? At baggage claim? At the taxi or ride-sharing stand? At the gate? During the boarding process?
8. During the time I practiced medicine, I had patients get ill while out of state. Arranging care under those circumstances can be less than optimal, but generally doable. On the other hand, I have had patients get ill over seas and this is far more complicated.
9. Lastly, given my concerns about significant increases in cases this fall and winter, one does have to consider the actions various states may take (travel restrictions or quarantining requirements) and restrictions the US or other countries might put in place that might require you to quarantine or might interfere with your ability to travel.

So, for all these reasons, I do not intend to travel for at least the next six months. Others might come to different conclusions, and of course, that is their prerogative. It is merely my hope that these factors may be helpful to you as you think through the risk/benefits of travel for you and your loved ones and make your own decisions in the next few months. If you do decide to travel, be extra careful about your adherence to all the safety precautions we have been promoting to reduce your chance of being infected. And, if you do become ill before your flight, please do everyone a favor and stay home!