how to survive a long-haul flight — 2020/coronovirus update
In 2018 I wrote this summary of what I learned from watching several dozen “what I take on a flight” videos on YouTube. Mostly what people said then was: choose a good seat and bring your own entertainment. Also: wipes and hydration.
I fly more now than I did then; I’m now solidly in the 99th percentile of frequent fliers. And I’ve continued to watch “what to take on a flight” YouTube videos, not so much because I need more advice but because it’s a pleasant distraction from real life, to watching twenty-something white women YouTubers show me what products they buy.
And then… coronavirus.
Look, I’m clearly a public health nerd. I have a Ph.D. in health behavior. I spent 8 years of my professional life as a director of wellness education on a college campus, including through the H1N1 pandemic. I dig infectious disease prevention.
So I switched from YouTube to Google Scholar, as I looked for evidence-based ways to reduce disease transmission on planes.
Here’s what I learned:
Above all, if you have symptoms of a respiratory infection, don’t get on the plane.
I’m sorry. I know you wanted to go to that wedding or vacation destination or conference, and maybe it’s just a regular cold, right? Well. Were you tested for SARS-CoV2? No? Then don’t get on the plane for sure. But if you were tested and it came back negative… still don’t get on a plane. Someone with greater vulnerability than you could catch your cold and that leaves that person at even greater risk for COVID-19. Don’t do it. Don’t be that asshole coughing on the seat pocket and tray table and touching the armrests and seatbelt buckle. Don’t be that asshole. Stay home until you’re not trailing germs in your wake.
If you don’t have symptoms, do a cost-benefit analysis
of whether you want to put yourself in an enclosed space with a crowd. Slowing down transmission matters a lot, and a great way for all of us to do that is to choose not to put ourselves in dense crowds. (If you’re in a high risk group — if you’re older or have diabetes, high blood pressure, cancer, or cardiovascular disease, for example, or if you smoke — the balance of costs and benefits is going to be pretty lopsided for you.)
It’s not like you’re looking forward to flying, but sometimes you need to fly for work. Sometimes you need to fly for personal reasons — a family member is unwell or there’s a funeral or a wedding or a new baby to meet or anything else. And sometimes you simply want to fly for a vacation, and god knows we all need some joy in our lives. If you’re symptom-free, it’s possible to fly, even now, in a way that minimizes the likelihood that you’ll get COVID-19 or that you’ll unknowingly spread the virus (since you can have it and be infectious without having serious symptoms).
One thing I want to make sure you know: don’t worry, it’s not the recirculated air. Infections are transmitted on planes through vastly more mundane — and more controllable — modes. It’s really about inanimate surfaces, touching surfaces that were touched by someone who had the virus. Surface → hand → mucus membranes (eyes, nose, mouth). It’s really that simple.
So let’s get to it. How do I fly safer? Here’s what I do, based on the research I read:
Step 0: I Wear Long Sleeves. As I choose my outfit for the flight, I make sure I have long sleeves. You’ll see why soon.
Step 1: I Wash My Hands 3 Times. First, before I leave home, to begin with a clean slate. Once I’m in public spaces and unavoidably touching surfaces, I keep my hands below my collar bones, until I get to the far side of security. (People suck at following “negative advice” — e.g., “don’t do x” — but they’re great with “positive advice” — e.g., “do y”— hence, keep my hands below my collar bones, not “keep my hands away from my face.”) When I’m through security and at the gate, I wash my hands a second time. And finally, I wash my hands again before I board the plane. I want unambiguously clean hands when I get on that plane.
Step 2: I Participate in Community Health. This isn’t just about me not getting COVID-19, it’s about being a part of the solution, to protect those who are most vulnerable. For all I know, the next person who sits in my seat has asthma or diabetes or cancer or cardiovascular disease, and that person needs a clean seat. Maybe you have one or more of those conditions, and you’re next in that seat. Don’t you hope the last person who sat there did a quick little wipe down?
Alcohol-based wipes. Antibacterial wipes are not what you’re looking for here — SARS-CoV2, the virus that causes COVID-19, is not a bacterium. You need alcohol-based wipes, because alcohol breaks down the “envelop” in which the virus resides. These kinds of wipes are hard to find in travel-friendly containers and sizes, I know, and as I write this they’re largely out of stock everywhere as people panic-buy stuff. But as you prepare for your flight, find some. I like these, but anything that says on the label that lists ethanol as the active ingredient, with at least 60% (gentler varieties often say 62%) You can also get a big tub of them and put a few in a zip-top plastic baggie, for carry-on convenience.
What do I wipe down?
Seatbelt buckle. Tray table. Headrest. Arm rests. Seat pocket.
And when I’m done, I put that used wipe is an empty plastic zip top bag I brought for that purpose. Then I wipe my hands with a second wipe or with hand sanitizer.
A Note on Hand Sanitizer
There’s a lot of research on the efficacy of hand sanitizer and… turns out I’ve been using hand sanitizer wrong my whole life. Using hand sanitizer correctly is like washing hands correctly. It matters that I keep scrubbing my hands until they are dry. 20 seconds is a decent benchmark, just like with washing your hands, if only because it takes that long for alcohol to do its antiviral job, but since I’ve been learning to do it correctly I find it takes at least 30.
Also, although it can be effective if your hands are dirty, sanitizer less effective if your hands are wet — like if you just blew your nose and your hands are a little, you know, snotty, you need to wipe the snot off first, then use the hand sanitizer.
Finally, the same active-ingredient caveat for wipes applies to hand sanitizer. “Alcohol-free” is not what you want. Ethanol should be the active ingredient, and it should be least 60%.
Hand washing should generally be your first choice, over hand sanitizer, but on a plane, that’s not always a practical option. (At the airport, handwashing is usually the better plan.)
Step 3: I Stay In My Seat. This has to come with all the caveats — getting up to walk around on a plane has benefits but the research says (and common sense agrees) that if I stay in my seat, I reduce my exposure to other people’s germs, and I expose fewer people to mine. I mean, duh.
Step 4. When I Must Leave My Seat, I Don’t Touch Surfaces. I say this as someone with a balance disorder, who needs to hold onto something while walking in an unstable environment like a plane. I don’t touch the tops of other people seats or the overhead bins with my hands, while walking to the bathroom. I don’t grab the seat in front of me when I stand up. I use my wrists or my knuckles, covered by my sleeves. See? Long sleeves! And then, in an abundance of caution, I keep my hands below my collar bones until I can sanitize my hands (thoroughly, until they’re dry.)
Step 5: I Cough and Sneeze Into My Elbow. Like Dracula pulling his cape across his face. See again! Long Sleeves!
Step 6: I Wash My Hands When I Get Off the Plane. Because of course I do. I didn’t get my bag out of the overhead bin without touching any surfaces, and moving through the plane exposed me to all those people. Hands below my collar bones as I deplane, then handwash.
And that’s really all there is to it.
One other thing: Vitamin C. Look, vitamin c is not really a thing, unless you’re actually LOW on vitamin C, which, if you’re reading this, you almost for sure are not. In terms of keeping your immune system fully functional, it’s more important that you get enough sleep and even that you stay hydrated (“pee pale!” as my sister’s voice teachers would tell you) than that you supplement C. The evidence for zinc to shorten infections is stronger — to shorten, when taken at the first symptoms, but not to prevent. And there’s no evidence for SARS-CoV2.
If you’re really invested in preventing infection and you want to buy something, buy saline nasal spray. The air on a plane is drier than the air anywhere on the surface of the Earth, so your nasal passages will dry out, which leaves you more vulnerable to infection. Moisten those nasal cavities, friend.
Arritey. That’s what I do, based on the evidence. Organizations that hire me are doing their part to slow the spread by canceling the biggest events, so my flying will probably be cut in half this year. Cool. The work I do matters, but if doing my work puts others in harm’s way, then I’d rather we all stay home. And if I’m on the road, I want to practice all the harm reduction in my power. I hope you will, too.