My Patients Ask — Is it safe on an airplane and how can I avoid getting COVID when flying?

This is a great question and I love the answer provided by my friends at They have lots of great and trustworthy information on COVID.

The risk of contracting COVID-19 during air travel is low according to an article in the Journal of the American Medical Association (Pombal, JAMA 2020) authored by medical experts from the aviation industry.

The reason given is that modern airplanes circulate a mix of fresh air and air recycled through HEPA filters and the airflow comes down from above and exits through outlets in the floor.

This does not mean that there is no risk when flying and, regardless of aircraft ventilation, your risk is certainly higher should an infectious person be seated near or next to you, and airlines differ in their policies regarding filling middle seats.

In addition, although face masks are required to be worn by passengers and crew aboard all airlines, this is not being consistently enforced.

A study that measured the in-flight flow of aerosols, simulating aerosols released from a single, infected person seated in the middle seat of a Boeing 777, found that passengers seated immediately to the left or the right of the infected passenger, followed by those seated in the rows directly behind, or in front of the infected passenger, had the greatest risk of potentially infectious aerosols (1 micron in size) reaching their breathing space (Kinahan, medRxiv 2020 — preprint).

Previous research found that choosing a window seat and remaining seated throughout the flight may help to reduce your overall exposure to others.

On observed flights, passengers in window seats had an average of 12 contacts vs. 58 for those in middle seats and 64 for those in aisle seats.

The same study estimated that should an airline flight attendant have an infectious respiratory illness (such as flu or SARS), the risk of middle and aisle seat passengers becoming infected was higher (4% to 5%) than those sitting in a window seat (1% or less) (Hertzber, Proc Natl Acad Sci U.S.A. 2018).

Cases of COVID-19 spread have been documented or strongly suspected on long-duration flights, including a case in which at least four people (all seated within four rows of one another) were infected during an 18-hour flight from Dubai to Auckland, New Zealand in September 2020, despite it being less than one-quarter full.

However, not all passengers were wearing masks, nor did the airline require them in the lobby before boarding (Swadi, Emerging Inf Dis 2020).

However, there are steps you can take to help you stay safe and protect others:

  • Don’t travel if you feel unwell
  • Limit carry-on baggage
  • Wear a mask (an N95 respirator, if you have one, will protect you and others more than a face mask)
  • Seek flights that require mask-wearing on airlines known to enforce the rule. (Some airlines also require, on certain international flights, passengers to be COVID tested within 48 hours of boarding).
  • Point the overhead air nozzle straight at your head and keep it on full
  • Choose a window seat
  • Stay seated if possible
  • Follow crew instructions
  • Wash or sanitize your hands frequently
  • Avoid touching your face

The use of a face shield is not listed among the suggested steps, but having one available to wear would seem prudent should a passenger be seated to your left or right.

Limiting conversation with strangers would also seem wise.

In addition, results of computer airline cabin simulation (Wang, preprint in medRxiv 2020) highlighted the following:

  • Be aware that risk increases with the duration of the flight, with the risk of infection being about four to eight times higher on a 12-hour flight than on a 2-hour flight.
  • Due to spacing, the risk of infection is about one-third lower in Business Class than Economy Class.
  • A 1-hour meal service on a 12-hour flight increases the probability of infection by 59%. If there is a meal service, try to stagger your meal time so you are wearing mask those around you have their masks off.
  • As noted above, mask wearing is critical. In fact, if all passenger were to wear a high-efficiency mask (versus no mask), the probability of infections is reduced by about 73%, while the wearing of low-efficiency masks reduces the probability by 32%.

This blog was accurate as of the day of posting. However, as the COVID-19 pandemic rapidly evolves and the scientific community’s understanding of the novel coronavirus and the COVID vaccine develops, the information above may have changed since it was last updated. While I aim to keep all of my blogs on COVID and the COVID vaccine up to date, please visit online resources provided by the CDC, WHO, and your local public health department to stay informed on the latest news.

© Copyright WLL, INC. 2021. This blog provides a wide variety of general health information only and is not intended to be a substitute for professional medical advice, diagnosis, or treatment from your regular physician. If you are concerned about your health, take what you learn from this blog and meet with your personal doctor to discuss your concerns.


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