10/15/20 COVID-19 Brief: Safer Air Travel – Sharing the Best Advice I’ve Seen Thus Far

Because travel can’t always be avoided, it is important that employees know that there are many things they can do to keep themselves safe. These tips can’t guarantee safe travel, but – practiced together – they will greatly reduce the risk of COVID-19 infection.

A Message on COVID-19 from WorkSTEPS Chief Medical Officer Dr. Ben Hoffman

Safer Air Travel – Sharing the Best Advice I’ve Seen Thus Far

A recent COVID-19 Brief focused on how to make essential business travel safer overall. In that article, I touched on air travel, but not too heavily. Since then, a number of people have asked what employees can do to reduce infection risk while flying.

In addition to my role as an advisor, I (and members of my family) have flown a number of times in recent months, so I’ve been reading about air travel and collecting tips that seem to make sense in light of what we know about COVID-19 and how its transmitted. In this article, I’ll share the most useful advice I’ve seen. And, if there’s a helpful tip you think I’ve missed, let us know.

Where is the Risk in Air Travel?

Before outlining specific tips, it’s helpful to understand where infection risks are highest in the air travel experience. That is, during what steps in the process of getting from Point A to Point B are passengers most exposed to risk? Here’s what I’ve learned:

  • Airplanes have good ventilation: Modern airplanes have powerful ventilation systems that pull in fresh air use HEPA filters to filter out fine particles. This is critical now that there is a general consensus on the role of airborne transmission. An excellent graphic in this WSJ article demonstrates how air flows inside modern aircraft to mitigate the spread of airborne particles.
  • Beware the sick seatmate: Strong ventilation won’t protect you if a passenger sitting next to you (either side or in back of you in particular) coughs or sneezes and releases particles that can land on you or on things that you may touch.
  • Beware Boarding and Deplaning: You know the scenes: A) a line of passengers waits for the guy in 17c to wrestle his huge roller bag into the overhead; and B) at the arrival gate, “bing” goes the bell and people rise, crowd into the aisle and struggle to retrieve their bags out of overhead bins. Those are risky times – people are close together, some are forcefully exhaling when they exert themselves, and there’s no way to distance yourself.
  • Beware Airport Crowding: Moving through airports is like a trip to Disney World, but without the fun. It’s just a series of cues at ticketing, security, Starbucks and boarding, and each cue is a new opportunity for close contact with someone who may be sick.

Reducing the Risk of Air Travel – Top Tips

Employees who must travel for business can take a number of steps to protect themselves from COVID-19. I’ve picked tips up from a lot of different places, including this recent article. Here are what I consider to be the top tips:

  • Book smart: Book travel on airlines with pre-flight screening procedures and open middle seat policies. Book during lower-volume travel times and select direct flights when possible. Every unique flight involves its own boarding and deplaning process, introducing more risk.
  • Wear a mask: Get a good quality mask and wear it from the time you enter the departure airport until you leave the destination airport.
  • Wear safety glasses: Subdue your vanity and put on some safety glasses as protection from droplets that can land in your eyes.
  • Direct air flow: Aim the overhead air nozzle straight at your head and keep it on full.
  • Watch your distance – everywhere: To the extent possible, keep your distance from other passengers throughout the terminal and during boarding and deplaning process.
  • Speak up: If someone seated near you is coughing or sneezing, alert the flight attendant. If someone standing or seated near you removes their mask, ask them to put it back on. If someone is breathing down your neck when they should be keeping their distance, kindly ask them to give you some space.
  • Sanitize: Keep your hands clean and wipe down your seat area with sanitary wipes. Wipe down arm rests, the air nozzle, tray tables…anything you might touch.
  • Don’t touch your face: Always good advice.

Because travel can’t always be avoided, it is important that employees know that there are many things they can do to keep themselves safe. The tips above can’t guarantee safe travel, but – practiced together – they will greatly reduce the risk of COVID-19 infection.

As noted earlier, if you have advice for air travel that you don’t see on my list and that you’d like to share with others, let us know.

Ben Hoffman, MD, MPH
Chief Medical Officer, WorkSTEPS

For more from Dr. Hoffman, connect with him on LinkedIn.


Area Reported Cases Deaths Recovered
Global 31,880,980 977,211 23,476,791
United States 7,105,855 205,851 4,360,093

Source: Scientific American

National: COVID-19 became the third biggest cause of deaths in the week of March 30 to April 4. COVID-19 trailed heart disease and cancer. It killed more people than stroke, chronic lower respiratory disease, Alzheimer’s, diabetes, kidney disease or influenza. In that week, close to 10,000 people died of the illness caused by the coronavirus. The flu led to 1,870 deaths (this  data includes pneumonia) over the same time frame. A spike in the week by week accounting came in mid-April, when COVID-19 cases became the leading cause of death. The disease returned to the third deadliest spot in the week of May 4 - 9 and has stayed there since.

In hotspot counties, particularly those in the South and West, percent positivity increased earliest in younger persons, followed by several weeks of increasing percent positivity among older age groups. An increase in the percentage of positive test results in older age groups is likely to result in more hospitalizations, severe illnesses, and deaths. There is an urgent need to address transmission among young adult populations, especially given recent increases in COVID-19 incidence among young adults. These data also demonstrate the urgency of healthcare preparedness in hotspot counties, which are likely to experience increases in COVID-19 cases and hospitalizations among older populations in the weeks after meeting hotspot criteria.

Global: On Monday, Dutch researchers reported the first death of an immunocompromised person reinfected with the coronavirus. On Tuesday, it was announced that eighteen members of Tunisia’s Parliament have tested positive for the virus following a full parliamentary session on October 2nd. China announced this week, in response to an outbreak, the country plans to test 9 Million people for COVID-19. According to China’s National Health Commission, the city’s entire population will be tested within five days the Associated Press reported.

A portrait of the Coronavirus: The first pictures of the coronavirus, taken just seven months ago, resembled barely discernible smudges. But scientists have since captured the virus and its structures in intimate, atomic detail, offering crucial insights into how it functions.

Vaccine updates: On Tuesday, the NIH paused Eli Lilly COVID-19 antibody trial because of safety concerns. The NIH said the trial’s independent data safety monitoring board (DSMB) stated that the study had reached a “predefined boundary for safety”, meaning that there was an overall difference between the study group and the placebo group. Both Eli Lilly and the NIH refer to a potential safety issue. The DSMB is a group of independent experts overseeing the trial to ensure the safety then recommended pausing the enrollment of new patients in the study. On Sunday, a Johnson & Johnson’s COVID-19 vaccine trial was also placed on pause citing safety concerns. Such pauses are common in large clinical trials and give time for an independent board of scientific experts to review the data and determine whether the event may have been related to the treatment or occurred by chance.

Convalescent plasma role in mortality, hospital stay: A study published last week found that convalescent plasma (CP) did not significantly reduce mortality but decreased inpatient stays in patients 65 and older. This study analyzed clinical outcomes for cohorts of CP and control patients. The study followed 241 adult COVID-19 patients—64 CP patients and 177 control patients admitted to three Rhode Island hospitals prior to May 31 through 28 days post-admission. The two patient cohorts were closely matched for symptoms, demographics, and pre-existing comorbidity scores. Data revealed no significant difference between CP and control groups for in-hospital mortality (12.5% vs 15.8%) or overall rate of hospital discharge. However, patients 65 years or greater who received CP showed an increased rate of hospital discharge compared with those in the control group and was even  pronounced in patients receiving high-titer antibody plasma. This suggests a possible increased benefit of CP for this age-group. 

NIH Clinical Trial Testing Hyperimmune Intravenous Immunoglobulin Plus Remdesivir to Treat COVID-19 Begins: A clinical trial to test the safety, tolerability and efficacy of a combination treatment regimen for coronavirus disease 2019 consisting of the antiviral Remdesivir plus a highly concentrated solution of antibodies that neutralize SARS-CoV-2, the virus that causes COVID-19, has begun. The study is taking place in hospitalized adults with COVID-19 in the United States, Mexico and 16 other countries on five continents. The National Institute of Allergy and Infectious Diseases, part of the National Institutes of Health, is sponsoring and funding the Phase 3 trial, called Inpatient Treatment with Anti-Coronavirus Immunoglobulin, or ITAC. (NIH, 10/8/2020)

Mitigation / Suppression:

Genomic evidence for reinfection with SARS-CoV-2: a case study. The degree of protective immunity conferred by infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is currently unknown. As such, the possibility of reinfection with SARS-CoV-2 is not well understood.  The researchers found that the genetic discordance of the two SARS-CoV-2 specimens was greater than could be accounted for by short-term in vivo evolution. These findings suggest that the patient was infected by SARS-CoV-2 on two separate occasions by a genetically distinct virus.

Deliberately allowing COVID-19 to spread in the hope of achieving so-called herd immunity is "unethical", an expert has warned. WHO Director-General Tedros Adhanom Ghebreyesus said the concept, which occurs when a large portion of a population becomes immune to a disease, "means allowing unnecessary infections, suffering and death".

NIH study to identify promising COVID-19 treatments: On Tuesday, the National Institute of Allergy and Infectious Diseases (NIAID), part of NIH, launched the Accelerating COVID-19 Therapeutic Innovations and Vaccines Big Effect Trial (ACTIV-5/BET). The study is designed to determine whether certain approved therapies or investigational drugs in late-stage development show potential and merit progression into larger clinical trials. The ACTIV-5/BET study aims to streamline the pathway to finding urgently needed COVID-19 treatments by repurposing either licensed or late-stage-development medicines, then testing them in a way that identifies the most promising therapies for progression to larger clinical studies.

Survival on Surfaces: While respiratory transmission is generally understood to be the primary driver of the COVID-19 pandemic, a study published in the journal Virology has raised new concerns for fomite transmission. Researchers from the Commonwealth Scientific and Industrial Research Organisation at the Australian Centre for Disease Preparedness analyzed the survival of SARS-CoV-2 virus on various surfaces under controlled laboratory conditions. They found wide variations in survival time based on surface type and temperature. Most notably, infectious virus survived on glass, stainless steel, and paper and polymer bank notes (i.e., paper currency) for at least 28 days at 20°C (68°F). In contrast, viable virus was detected on cotton cloth after only 14 days. As temperature increased, the survival time of infectious virus decreased. At 40°C (104°F), infectious virus lasted less than 24 hours on cotton and less than 48 hours on all other surfaces.

The term “herd immunity” is widely used but carries a variety of meanings. Some authors use it to describe the proportion immune among individuals in a population. Others use it with reference to a particular threshold proportion of immune individuals that should lead to a decline in incidence of infection. Still others use it to refer to a pattern of immunity that should protect a population from invasion of a new infection. A common implication of the term is that the risk of infection among susceptible individuals in a population is reduced by the presence and proximity of immune individuals (this is sometimes referred to as “indirect protection” or a “herd effect”). We provide brief historical, epidemiologic, theoretical, and pragmatic public health perspectives on this concept.

Sewage As a Possible Transmission Vehicle During a Coronavirus Disease 2019 Outbreak in a Densely populated Community: Guangzhou, China, April 2020 (Clinical Infectious Diseases) Our investigation has for the first time pointed to the possibility that SARS-CoV-2 might spread by sewage. This finding highlighted the importance of sewage management, especially in densely populated places with poor hygiene and sanitation measures, such as urban slums and other low-income communities in developing countries.

Prolonged COVID-19 symptoms in pregnant women: Most pregnant women with COVID-19 experience mild disease. However, a nationwide study revealed many have prolonged symptoms lasting weeks after infection. Researchers in this study followed 594 US women who tested positive for SARS-CoV-2 during pregnancy and reported symptoms at the time of testing. Symptoms and symptom duration for pregnant patients were gathered from March 22 to July 10. Only 27 (5%) of the women were hospitalized, with 11 (2%) admitted to the ICU. Primary first symptoms included cough (20%), sore throat (16%), body aches (12%), fever (12%), and loss of taste or smell (6%). The study found that almost half of the participants (48%) were still symptomatic after 3 weeks, with 60% reporting no symptoms after 4 weeks. For 25% of pregnant women, symptoms persisted for 8 weeks or longer. The median time for symptoms to resolve was 37 days.


Pandemic impact on American households: Researchers published a new poll reviewing financial toll on Americans by the coronavirus. They published findings of a survey of 3,500 respondents, conducted from July 1 - August 3. Of those surveyed 46% said they faced serious financial problems during the pandemic. That number shot up to 63% in households with a family member who contracted COVID-19. About 21% reported serious difficulties paying debt including credit card bills, and 19% reported having difficulty paying their housing.


COVID-19: China Medical Supply Chains and Broader Trade IssuesThis report aims to assess current developments and identify immediate and longer-range China trade issues for Congress. An area of particular concern to Congress is US shortages in medical supplies—including personal protective equipment (PPE) and pharmaceuticals—as the United States steps up efforts to contain COVID-19 with limited domestic stockpiles and insufficient US industrial capacity. Because of China’s role as a global supplier of PPE, medical devices, antibiotics, and active pharmaceutical ingredients, reduced exports from China have led to shortages of critical medical supplies in the United States. (CRS, 10/8/2020)

CDC releases Tips for Trick or Treating and Other Halloween Activities: Traditional Halloween activities are fun, but some can increase the risk of getting or spreading COVID-19 or flu. CDC has a new webpage that features new ways of trick or treating and other Halloween activities. When trick or treating or participating in other Halloween activities with people outside your household, wear a mask. You can make it fun by making your mask part of your costume, but when it comes to slowing the spread of COVID-19, a costume mask is not a substitute for a cloth mask. Also, do not wear a costume mask over a cloth mask. It can make breathing more difficult. 

The COVID-19 Pandemic and the $16 Trillion Virus (JAMA): The SARS-CoV-2 (severe acute respiratory syndrome coronavirus 2) pandemic is the greatest threat to prosperity and well-being the US has encountered since the Great Depression. This Viewpoint aggregates mortality, morbidity, mental health conditions, and direct economic losses to estimate the total cost of the pandemic in the US on the optimistic assumption that it will be substantially contained by the fall of 2021. These costs far exceed those associated with conventional recessions and the Iraq War, and are similar to those associated with global climate change. However, increased investment in testing and contact tracing could have economic benefits that are at least 30 times greater than the estimated costs of the investment in these approaches.

The Work From Home WorkSTEPS Medical Team:

Ben Hoffman, MD, MPH
Chief Medical Officer

Tony Nigliazzo, MD
Medical Director

Loraine Kanyare, MSN, MPH, RN
Director of Case Management

Robert L. Levitin, MD
Physician Consultant

Lynda Phillips, LVN
Nurse Case Manager

Codey Church, LVN
Nurse Case Manager

Kerry Womack, LVN
Nurse Case Manager

Chuck Reynolds
Strategic Communications Consultant

This Guidance (“Guidance”) is provided for informational and educational purposes only. It is not intended as Legal Advice or Medical Advice. Adherence to any recommendations included in this Guidance will not ensure successful diagnosis or treatment in every situation. Furthermore, the recommendations contained in this Guidance should not be interpreted as setting a standard of care or be deemed inclusive of all proper methods of care nor exclusive of other methods of care reasonably directed to obtaining the same results. The ultimate judgment regarding the propriety of any specific therapy must be made by the physician and the patient in light of all the circumstances presented by the individual patient, and the known variability and biological behavior of the medical condition. Similarly, this Guidance is based on current advice, comments, and guidance from the EEOC, CDC and the CMS made publicly available. The ultimate judgement regarding the propriety of any specific employment action must be made by the company and attorney in light of all of the circumstances presented by the company, state and federal rules existing at the time and the then current state of the National Pandemic. This Guidance and its conclusions and recommendations reflect the best available information at the time the Guidance was prepared. The results of future studies or changes in rules, regulations or laws may require revisions to the recommendations in this Guidance to reflect new data. WorkSTEPS does not warrant the accuracy or completeness of the Guidance and assumes no responsibility for any injury or damage to persons or property arising out of or related to any use of this Guidance or for any errors or omissions.

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Newsletter written by WorkSTEPS CMO Dr. Ben Hoffman and WorkSTEPS’ expert medical team.