When I was hired as a flight attendant in the sixties, we wore hats and gloves. Today's flight attendants are wearing masks and gloves.

My gloves were white and considered glamorous at the time. Today, rubber gloves are worn to protect cabin crews from contagious diseases such as SARS and AIDS.

A BRA?

Under the stress of being exposed to deadly contagious diseases in their workplace, today's flight attendants, as always, joke around.

Their comments show how very resourceful flight attendants are: "If you don't have time to pick up a mask, wear one side of your bra. Padded bras are more protective!" "In a pinch, a shoulder pad will do."

TB, SARS

Since the publication of my first air-travel book eleven years ago, I have been advising my readers to wear a dampened, cotton handkerchief while in flight. Fold the handkerchief (or bandana) on the diagonal, place it over your nose and mouth, and secure it behind the ears.

• The handkerchief helps to block the spread of germs in crowded airplane cabins, and the dampness actually adds needed humidity to the airway passages, helping to offset the effects of the near-zero onboard humidity.

• Handkerchiefs are made of a variety of fabrics, weaves, blends, thicknesses, and pore sizes. All of these specifications affect, to varying degrees, the ability of the handkerchief to protect us from airborne diseases. However, when the cotton is dampened, the fibers swell, making them even more effective in blocking disease organisms.

• If you use a handkerchief, be sure to launder it in soap and hot water after every flight and travel with several handkerchiefs.

• If the same handkerchief is used on successive flights, be sure to wear the same side in as before to avoid inhaling filtered material.

At a medical convention in 1995, I surveyed a room full of physicians from the podium, and all of them agreed with me that wearing a handkerchief would significantly help passengers to avoid catching the flu, and even tuberculosis, when flying.

Tuberculosis is caused by a bacterium. SARS is now believed to be a virus. Viruses are smaller than bacteria, so today I cannot guarantee you that a dampened handkerchief offers adequate protection when flying.

NO GUARANTEES

I do not want to give passengers and crewmembers any false hope of protection by suggesting they wear a handkerchief, or even a mask when they fly. There are no guarantees here.

• Therefore, I suggest that passengers look into commercial masks with particular certifications for protection from the SARS virus, and follow the instructions for cleaning them -- and then still make every effort to move away from people who are coughing.

• You might also want to carry an extra mask and offer it to someone coughing into your biospace nearby your seat.

• If buying a maks, find out if the manufacturer claims it is efficacious for the size of the SARS virus. Hospital masks are supposed to protect from viruses, yet I visited a medical supplier and the masks they were selling did not guarantee protection from any viruses.

Many companies are now making claims about the protective value of their masks. I have no personal knowledge concerning the accuracy of these claims and because of the wide variety of choices in masks, I cannot offer a recommendation of any brand or model at this time, but I will continue to look into this.

PROTECT YOURSELF

• For the moment, however, I will say that all passengers on every flight should protect themselves by wearing a mask or handkerchief.

• Or you could wear both (the dampened hankie inside the mask). Many layers help, so you could also wear two handkerchiefs.

• The tightness of mask fit to the face is a key. Like any filter, if air can bypass it, it is no good no matter how efficient it is.

• It's a balance between how much you want to pay for a mask, how much protection you feel you need, how much extra bulk and weight you wish to carry on the airplane, and how difficult it is to breathe with a mask on your face. This is significant in the low-oxygen cabin environment. Make sure you are getting enough air.

AIRBORNE DISEASES

Airborne diseases spread when we cough, talk, laugh, and even simply exhale.

Airborne viruses that can be caught in airplane cabins include flu, measles, mumps, chicken pox, and SARS.

Airborne bacterial diseases that can be caught in airplane cabins include pneumonia, meningitis, and TB.

Incubation periods for viral and bacterial infections range from several days to several weeks.

At-risk passengers are those with impaired immune systems including the very old, the ill, the jetlagged, and the fatigued. Also at risk are the very young with only tiny lungs.

Of primary significance is the dose of contagious organisms. This is why passengers are more vulnerable on long flights, and also why sitting close to a contagious individual is more dangerous than merely breathing recirculated air.

Although the risk of infection increases with the duration of a flight, evidence shows that infections spread on the ground before all flights—short, long, domestic, international—because there is usually no fresh air at all on board until after takeoff.

• Don your handkerchief or mask before boarding. Even the long jetway, connecting the departure area to the aircraft, is a contagious, crowded space. But, at least it is on the ground and some fresh air seeps in. 

CABIN AIR

It is my belief that the airplane's main passenger cabin is the most dangerous public place for catching a contagious disease.

On most flights, the filtration system is not effective and the airflow circulates and recirculates the exhaled air of fellow travelers.

On top of this, the cabin is very dry, and dry air has been shown to increase the survival rate of viruses. Low relative humity also reduces the efficiency of the respiratory system cilia to filter out these biohazards.

And we can also blame sardine seating. People are jammed closer together with less ambient air in airplanes than they are in schools, in offices, even in discos. In those locations on the ground, ceiling heights are much higher than in airplanes. Lower ceilings translate to less circulating air per person.

Buses also have low ceilings, but there are not so many passengers and they have windows that can open.

Movie theatres have much higher ceilings and no sardine seats. Theatergoers wouldn't put up with sardine seats and neither should airline passengers have to.

SUGGESSTIONS FOR THE INDUSTRY

• Non-invasive technologies such as ultra-violet light must be used by the airlines to disinfect and disinsect aircraft cabins. Strong chemical disinfectants and pesticides that are now being used are unacceptable due to their toxicity. The residue of these chemicals makes a large percentage of the flying population ill and, consequently, even more vulnerable to catching contagious diseases.

• HEPA filtration needs to become standard on all airplanes though, so far, HEPA filters have been shown to remove viruses only in laboratory tests. Presently only some planes have HEPA filters, but they are serviced on time schedules rather than as needed. Airplane filters should be inspected and serviced before every flight and routine monitoring of cabin air contamination should be carried out on all planes. Presently no routine monitoring of cabin air, whatsoever, is being done.

• There is no way to eliminate all risk of contagious diseases spreading on aircraft because some people are carriers even without manifesting symptoms and some people fly when they are ill. Those who postpone flying when they are ill should not be charged a penalty by the airline. The airlines should trust the honesty of passengers and not require expensive and time-consuming doctor's visits as proof of illness.

• The FAA should require all airlines to record contact information for passengers, so that passengers can be quickly notified of fellow passengers who have come down with deadly diseases relatively soon after their flights.

FROM READERS

"I was flying some months ago, and it was extremely critical that I not get sick on that business trip. I wore a surgical mask the whole way through, and felt both ridiculous looking, and smart, all at the same time." -Reginald Steinhold

"I am happy to see that someone has written a book about all these air quality problems on planes. I have lived in Hawaii for 27 years and have flown to the Mainland many, many times. Only within the last 5-7 years have I gotten ill effects from flying—most notably a sinus infection almost every time I fly. I have definitely noticed the problem with airplane air—it's horrible. I will be taking your suggestions about using a damp cloth and perhaps asking for oxygen. I'm tired of getting sick. I look forward to reading your book." -Gary Hawley