Paging Dr. Hamblin: Should I Fly?

Editor’s Note: Every Wednesday, James Hamblin takes questions from readers about health-related curiosities, concerns, and obsessions. Have one? Email him at paging.dr.hamblin@theatlantic.com.

Dear Dr. Hamblin,

I’m a healthy 76-year-old thinking about taking a nonstop flight from Las Vegas to Baltimore. I want to see my daughter and her family, including my grandkids, who have been fantastic about quarantining. I could self-isolate in their basement. For the flight, I have an N95 mask and gloves, and I could get a protective face shield. And as icing on the cake, I can wear a diaper to avoid public restrooms.

Should I get on that plane?

Anonymous

I think you should feel confident about getting on that plane.

The measures you’re taking should keep you safe. But more than anything else, the thoughtfulness you show in the planning here suggests you’ll do everything vigilantly. Our safety in confined indoor spaces like airplanes depends on the collective efforts of individuals, and you’re clearly not the type to just wear a mask around your chin or performatively wash your hands only if people are looking.

That said, I don’t think you need to wear a diaper. Every airport bathroom in the United States should have functional exhaust fans that expel any lingering, potentially infectious toilet plume after you flush. If you’re wearing a mask, the ordeal should be a low-risk proposition. The same goes for the flight itself: An airplane toilet shouldn’t aerosolize the virus any more than a typical toilet. But the surfaces in airplane bathrooms could very possibly be coated in the virus, because every part of the tiny room is touched regularly by many people. I’d operate under the same assumption in any bathroom right now, and wash my hands accordingly.

Read: Air travel is going to be very bad, for a very long time

What makes flying especially risky, at least theoretically, is the air on the flight. A plane involves many people in an enclosed space for prolonged periods. Mucus membranes in your nasal passages dry out on a plane, making them more prone to being colonized by a virus. But the air on a flight should be as safe as or safer than other enclosed spaces where people are spending prolonged periods together. Unlike many homes or offices, the air in a plane is constantly turning over, with outside air sucked into the cabin and old air pushed out. Any air that is recirculated is supposed to be run through a HEPA filter that can catch almost any virus.

The ventilation is probably not as good as if all the windows on the plane were open, but, well, that would cause it to crash and everyone inside to suffocate. Still, it’s better than sitting in a car with the air-conditioning going, recirculating air while everyone inside sits in the stew.

The air on planes can be an issue when their ventilation system is shut off, even temporarily, such as when they’re stuck on a tarmac for one of those always-unclear reasons. This situation is credited with one well-known influenza outbreak, in which 38 of 54 people on a plane were infected after sitting on a tarmac for three hours without air circulation. No such instances of cabinwide spread have been reported with the coronavirus, though there have been isolated reports of transmission, mostly to a single nearby passenger. The worst reported incident was in early March, when Vietnam’s health ministry linked a dozen cases to a long flight from London to Hanoi.

To be safe, planes shouldn’t sit idle with their ventilation system off for long. If yours is doing that, demand that it be turned back on. The air system is also typically turned off during boarding and deplaning, leading some airlines to get creative about new boarding patterns that minimize how long it takes. If a more efficient boarding process were always possible, I wish they’d done it a long time ago. In any case, I wouldn’t rush to be the first person to board the plane.

It may also help to turn on the personal fan above your head. At least, it can’t hurt. That air should be filtered, and on the off chance that someone sitting very close to you has the virus and is spreading it around, this fan might help dilute it and shoo away anything hanging in the air near you.

Overall, the air in a plane’s cabin should completely turn over every three minutes. When that sort of ventilation system is combined with people correctly wearing high-quality masks, and declining to travel if they are at all symptomatic or have had contact with people who are sick, the risk of an outbreak on a plane should be close to zero.

The main concern with air travel, then, is less about spreading the virus on the plane than about people spreading the virus once they arrive. The specific concern is transporting the virus from a hot spot to a place that has things under control, especially in the United States, where coronavirus cases are surging in most but not all states. Your plan to isolate for two weeks upon arrival is a good one. New York, Connecticut, and some other states are already requiring incoming travelers to do this; it should become standard policy. Self-isolating can be difficult to do, especially when you’re visiting family, but it’s very important. I think you could safely hang out in the backyard or on the porch, at a distance. It doesn’t need to be a hostage situation in which your relatives lower food down the stairs using a pulley system.

Read: I just flew. It was worse than I thought it would be.

That brings me back to the precautions you plan on taking. Unlike in many other countries, the U.S. currently has no restrictions on domestic travel. If you wanted to, you could start gallivanting around the country without anyone stopping you, even if you feel ill. But just because you can fly doesn’t mean you should. Staying safe while traveling is going to come down to basic conscientiousness. If everyone had the vigilance you show here, we’d be in a lot better place—as a country and as a world.

Before all of this, I used to wish people “safe travels” in a way that was kind of meaningless. Now it’s more of an earnest injunction to be mindful of not only your safety, but also the safety of everyone around you. Act as though you are contagious, even though you should be traveling only when you’re confident that you’re not. Safe travels.

“Paging Dr. Hamblin” is for informational purposes only, does not constitute medical advice, and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. By submitting a letter, you are agreeing to let The Atlantic use it—in part or in full—and we may edit it for length and/or clarity.

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