Arkansas Democrat-Gazette

Are you ready to fly yet?

- KACEY ERNST AND PALOMA BEAMER THE CONVERSATI­ON Kacey Ernst is Associate Professor of Epidemiolo­gy and Biostatist­ics at the University of Arizona, where Paloma Beamer is Associate Professor of Environmen­tal Health Sciences.

We don’t know about you, but we’re ready to travel. And that typically means flying. We have been thinking through this issue as parents and as an exposure scientist and infectious disease epidemiolo­gist. While we’ve decided that we’re not going to fly right now, we will walk you through our thought process on what to consider and how to minimize your risks.

Why the fear of flying?

The primary concern with flying— or traveling by bus or train—is sitting within six feet of an infected person. Even asymptomat­ic people can transmit. Your risk of infection directly correspond­s to your dose of exposure, which is determined by the duration of time exposed and the amount of virus-contaminat­ed droplets in the air.

A secondary concern is contact with contaminat­ed surfaces. When an infected person contaminat­es a shared armrest, airport restroom handle, seat tray or other item, the virus can survive for hours though it degrades over time. If you touch that surface and then touch your mouth or nose, you put yourself at risk of infection.

While there is no way to make air travel 100 percent safe, there are ways to make it safer. It’s important to think through the particular­s for each trip.

One approach to decision-making is to use what occupation­al health experts call the hierarchy of controls. This approach focuses on strategies to control exposures close to the source and minimizes how much you have to rely on individual human behavior to control exposure. It’s important to remember you may be infectious, and everyone around you may also be infectious.

The best way to control exposure is to eliminate the hazard. Since we cannot eliminate the new coronaviru­s, ask yourself if you can eliminate the trip. Think extra hard if you are older or have pre-existing conditions, or if you are going to visit someone in that position.

If you are healthy and those you visit are healthy, think about ways to substitute the hazard. Is it possible to drive? This would allow you to have more control over minimizing your exposures, particular­ly if the distance is less than a day of travel.

If you choose to fly, check out airlines’ policies on seating and boarding. Some are minimizing capacity and spacing passengers by not using middle seats and having empty rows. Others are boarding from the back of the plane. Some that were criticized for filling their planes to capacity have announced plans to allow customers to cancel their flights if the flight goes over 70 percent passenger seating capacity.

Federal and state guidance is changing constantly, so make sure you look up the most recent informatio­n from government agencies and the airlines and airport you are using for additional advice, and current policies or restrictio­ns.

While this may sound counterint­uitive, consider booking multiple shorter flights. This will decrease the likelihood of having to use the lavatory and the duration of exposure to an infectious person on the plane.

After you book, select a window seat if possible. If you consider the sixfoot radius circle around you, having a wall on one side would directly reduce the number of people you are exposed to during the flight in half, not to mention all the people going up and down the aisle.

Also, check out your airline to see if engineerin­g controls are designed or put into practice to isolate hazards. These include ventilatio­n systems, onboard barriers and electrosta­tic disinfecta­nt sprays on flights.

When the ventilatio­n system on planes is operating, planes have a very high ratio of outside fresh air to recirculat­ed air, about 10 times higher than most commercial buildings. Plus most planes’ ventilatio­n systems have HEPA filters. These are at least 99.9 percent effective at removing particles that are 0.3 microns in diameter and more efficient at removing both smaller and larger particles.

From checking in to going through security to boarding, you will be touching many surfaces. To minimize risk:

■ Bring hand wipes to disinfect surfaces such as your seat belt and personal belongings, like your passport. If you cannot find hand wipes, bring a small washcloth soaked in a bleach solution in a zip bag. This would probably freak TSA out less than a personal spray bottle, and viruses are not likely to grow on a cloth with a bleach solution. More bleach is not better and can be unsafe. You only need one tablespoon in four cups of water to be effective.

■ Bring plastic zip bags for personal items that others may handle, such as your ID. Bring extra bags so you can put these things in a new bag after you get the chance to disinfect them.

■ Wash your hands or use hand sanitizer as often as you can. While soap and water is most effective, hand sanitizer is helpful after you wash to get any parts you may have missed.

■ Once you get to your window seat, stay put.

■ Wear a mask. If you have an N95 respirator, consider using it, but others can also provide protection. We do not recommend purchasing N95 until health-care workers have an adequate supply. Technicall­y, it should also be tested to make sure you have a good fit. We do not recommend the use of gloves, as that can lead to a false sense of security and has been associated with reduced hand hygiene practices.

If you are thinking about flying with kids, there are special considerat­ions. Getting a young child to adhere to wearing a mask and maintainin­g good hygiene behaviors at home is hard enough; it may be impossible to do so when flying. Children under 2 should not wear a mask.

Each day, we are all constantly faced with decisions about personal comfort with risk. Arming yourself with specific knowledge about your airport and airline, and maximizing your use of protective measures that you have control over can reduce your risk.

A good analogy might be that every time you get in the car to drive somewhere there is risk of an accident, but there is a big difference between driving the speed limit with your seat belt on and driving blindfolde­d at 60 miles an hour through the middle of town.

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