Unfortunately taking a flight does carry risk of Covid infection, due to the close proximity you’ll spend indoors with many people. And it’s not just the flight, but also the process of getting to and from the airports.

However, as this pandemic wanes on, many people will need to fly for one reason or another.

Therefore this article will look at risks of getting Covid when flying – and steps you can take to mitigate this risk.

Airplane Risks & Mitigation Steps

Focusing on the plane aspect first, these are the 3 potential routes of infection while flying:

Route #1 – Objects (aka “fomites”) – Droplets expelled by passengers, containing coronavirus, landing on surfaces, which you then accidentally transfer from your hands to your mouth/nose/eyes.

Route #2 – Droplets – expelled by passengers you’re in close proximity to, which go directly into your mouth/nose/eyes

Route #3 – Microdroplets/Airborne – Breathing, talking, coughs and sneezes can eject micro-droplets into the air. This risk doesn’t require the infected passenger to be seated super close to you, as airborne particles could travel around the plane. This route of transmission has been questioned in the past, so we’ll revisit some of the research on this later.

Image source: BMC Infectious Diseases paper – link

For routes (1) and (2), it’s likely “adequate” to wear a properly fitting face covering (such as fabric or surgical mask) and glasses. They will:

  • Mitigate (1) by blocking/reducing your ability to unconsciously put your finger or other objects into your mouth, nose or eyes.
  • Mitigate (2) by forming a physical barrier that the droplets will land on, and not pass through.

Route of entry (3) requires a proper respirator (rather than mask) to mitigate:

Things to look out for with your respirator choice:

  • ✅ It should be rated at N95 standard (USA) or FFP2/P2 standard (Europe), or better. Better = N99/N100 (USA) or FFP3/P3 (Europe)
  • ✅ It *must* fit your face in such a way that there aren’t gaps left anywhere. Unfortunately some respirators fit terribly, and if they leave air gaps, they’re effectively useless.
  • ✅ The straps *must* allow you to create a tight seal. Respirators that only loop around the ears are hard to tighten sufficiently.
  • ✅ Once on and tightened, test the fit by blowing out your mouth, and checking if any air leaks around the edges.
  • ✅ If you have facial hair, you *must* shave around the region at which the respirator touches your face. Otherwise your facial hair affect the quality of the seal.

Getting the right respirator and making sure it fits will be super important to your overall risk mitigation strategy. As it will form the first line of defence between your airways and the environment outside.

For more details on respirators, including sources for evidence that respirators can block particles the size of the coronavirus, please see this article I wrote.

What else to consider?

Glasses vs Goggles?

As we mentioned, a possible route of entry for the coronavirus is the eyes.

Glasses should be sufficient to block the majority of droplets from entering your eyes.

However, if you want to make absolutely sure that nothing is getting in, then you’ll need glasses with a seal around the eyes – such as goggles.

As I was preparing to take the photo above, I realized 1) how ridiculous it looks/feels trying to wear full face goggles as well as a respirator 2) that there’s not enough room for the goggles to sit comfortably with the respirator.

It’s crucial your eye protection doesn’t interfere with the fit of your respirator. In the example image above (left side), I’d either need smaller goggles, or a smaller respirator to make it work.

Gloves? Optional, but not necessary

Routes #1, #2 and #3 above can all be mitigated without the use of gloves. As the virus can’t be contracted through your sealed skin (thankfully!)

After the flight and once you’re in a “safe space”, you can remove your mask/respirator, carefully wash your hands, and continue on with your affairs.

The 2 potential benefits I could see of wearing gloves are:

  1. You could remove them, and have relatively clean hands, without having to instantly wash them.
  2. They might help deter you from putting your hands on your face whilst wearing a mask/respirator. As the texture of gloves will feel noticeably unusual.

Other passengers wearing face coverings?

In a situation where no-one on the airplane is wearing face coverings, there’s a lot of potential droplets being exhaled onto objects and into the air.

However in the current climate most, if not all airlines are making face coverings mandatory. Which is great.

Assuming compliance is good, and the rules get enforced, this should help decrease your risk.

Face covering fail – via Twitter

Airplane filtration systems

Intuitively, airplanes are risky because you’re stuck in a metal box with hundreds of strangers for hours at a time.

That being said, it’s worth acknowledging the steps the airplanes take to filter the air inside the cabin.

According to the CDC (source), the majority of newer airplanes recirculate cabin air, mixed with outside air, through HEPA air filters, which are capable of filtering particles down to the size of the coronavirus. With the cabin air getting passed through these filters 20-30x per hour.

Whilst this isn’t perfect, it’s a lot better than re-circulating the same stale air the whole time, and should hopefully reduce some of the risk.

Food & Drink?

Ideally you would put on your respirator prior to arrival at the airport, and not take it off until you’re safely at your destination.

Obviously taking off your respirator at any point along the way (even if you later put it back on) is going to be a potential risk.

For shorter flights, it should be possible to leave it on the whole time, because you can survive for a while without food and water.

However for longer flights, you could theoretically survive without food, but you’re probably going to need water to avoid dehydration.

The best idea I’ve come up with (so far 🙄) is to pack a straw, so that you can slurp up a drink quickly without having to fully remove your respirator. Of course, this isn’t perfect, as it will create a temporary gap.

If you need to eat however, then I can’t see an easy way to do so without taking your respirator off.

Travel to and from the airport

We’ve covered the strategy for reducing your risk whilst on the flight. Once you’re seated, it’s quite a controlled environment.

As long as you trust your respirator and follow protocol (no touching your face or removing the respirator), you’ve probably done all you can to reduce your risk.

Which then leaves the periods before and after your flight to consider.

At a high level, what you need to do is:

  • ❌ Avoid getting into crowded situations you don’t have to.
  • ❌ Avoid unnecessary public transport. If you can get friends or family you trust to drop you off/pick you up from the airport – that avoids taxis/buses/trains.
  • ✅ Generally keep your respirator on as much as possible, and maintain good hand hygiene. For example, whilst the airplane filters the air 20-30x per hour, the HVAC/AC system within the airport quite likely does not.

Past studies on airplane infections?

There isn’t a lot of information available on airplane infections. I’d imagine this is, in part, due to the difficulty in pinpointing specific infection location. Given the time from contracting the virus to symptom onset ranges from 2 to 15 days1 – it leaves a wide window of opportunity.

Papers I’ve located on possible airplane Covid-19 infections are:

  • Analysis of 830 flights (130,000 people) flying in to Beijing airport, which identified 161 total confirmed Covid cases, with just 2 potential cases of airplane transmission. They attributed the universal use of face-masks and airplane air filtration systems as preventing infections whilst flying2. Flights were 5h to 10h in duration, so not short flights. Hard to gauge what this means without additional comparable studies, but it’s a nice data point to have.
  • Case report of a 50 year old who “probably” caught Covid on a flight from the Central African Republic to Paris3. This occurred in late February, before airplanes started taking precautions, and the man in question did not wear a respirator.

Roundup

Hopefully the above helps you in your pre-flight preparations. If there’s something you think I’ve missed, or warrants more discussion, please let me know in the comments.

See Post Sources Below:

  1. The Incubation Period of Coronavirus Disease 2019 (COVID-19) From Publicly Reported Confirmed Cases: Estimation and Application – Lauer et al. (May 2020)
  2. Transmission of SARS-CoV-2 on Aircraft – Zhang et al. (June 1 2020)
  3. Probable aircraft transmission of Covid-19 in-flight from the Central African Republic to France – Eldin et al. (May 2020)
John Alexander

Posted by John Alexander

Note: Not a Medical Doctor or PhD. I'm a researcher and writer, with a focus on the subjects of health and longevity. My intent is to write about scientific research in an accessible, understandable way. If you believe something I've stated needs a reference, and I haven't done so, please let me know in the comments. Follow on: Twitter

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Klaus h Larsen
Klaus h Larsen
21 days ago

you may want to change out the image of the mask and straw as that type of mask does not filter outgoing respirations.

Andrea
Andrea
2 months ago

Any thoughts about using a faceshield in combination with a respirator? I’m considering that rather than glasses.

mhorn
mhorn
Reply to  John Alexander
1 month ago

We have an upcoming 2.5 hr flight. I found this article to be the most thorough and easy to understand of all the hits on my search. Thank you! We will be wearing face shields and N95 masks from the time we enter the airport until we land and are in our “safe place”.

mhorn
mhorn
Reply to  Andrea
1 month ago

yes

Last edited 1 month ago by mhorn