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Getting Sick on Planes: Research and Mitigation Strategies For Those Who Still Take COVID Precautions Or are Immunocompromised
- jennifer96117
- Apr 25
- 6 min read
How far does COVID spread on airplanes, anyway? Where are you most at risk? Does where you sit on a plane matter?
Water is wet, the sky is blue, and the best way to prevent COVID-19 on an airplane is to wear a fit-tested N95. After all, airborne transmission accounts for 92.2% of cases. But are there any other mitigations you could take? How far does COVID spread on airplanes, anyway? Where are you most at risk? Does where you sit on a plane matter?
Many of us are still reluctant to fly, and for good reason. Despite IATA’s (International Air Transport Association) claim that the risk of getting COVID while flying is “very low”, there have been multiple studies over the years that prove otherwise. Below, I will discuss the biggest risks of getting sick on a plane, provide an overview of the studies I could find, explain what they mean, and offer a few precautionary recommendations.
Note: I am not a scientist or doctor. My recommendations are not medical advice. They are simply things that have worked best for me.
COVID Transmission At the Airport - Biggest Risks
Security Check
Unfortunately, in most countries, you have to remove your mask for them to verify your identity. There are clear N95 masks available, but whether or not they will let you through without pulling down your mask relies solely on the gate agent in most cases. The best option is to hold your breath while pulling the mask down and then breathe out while putting it back in place. Make sure you immediately check your seal as well.
Food Court/Eating
Air travel, from the time you leave your car to the time you leave the airport after the plane lands, is often long and arduous. Even with short flights, it can be difficult not to skip meals while travelling. That makes the allure of the post-security food courts and restaurants so enticing. If you have a chronic illness or blood sugar issues, skipping meals can be harmful at best and an emergency at worst.
3. Lines, So Anywhere in an Airport
There’s a reason why I feel like I need ten showers after I leave the airport. It is gross in there, and you are often packed in like sardines. So many germs and body odor. Eww.
COVID Transmission On the Plane - Biggest Risks
On the Tarmac
The cabin air systems on modern commercial aircraft are actually quite effective. They exchange air 20-30 times an hour and filter recirculated air through HEPA filters comparable to those used in hospitals. However, when boarding a plane, the plane is turned off, and so is the air circulation. This is also when you are most likely to be around other passengers as they walk past you to get to their seats.
2. Within Two to Three Rows of an Infected Person
According to this study:
“Passengers seated within two rows of the index case had a 4.41-fold higher attack rate compared with those farther away”.
Think of it this way: if an infected passenger is in seat 12F, the highest-risk zone extends roughly from rows 10 through 14. Passengers in rows 15 and beyond face substantially lower exposure. The airborne nature of transmission means that viral particles circulate not just laterally (across a row) but also forward and backward along the cabin.
However, this doesn’t mean that cases outside of these two to three rows are nonexistent. According to this study:
“The particulates in a cabin were found to be transported across more than three rows of seats, and the particle concentration decayed by approximately one order of magnitude every three rows. Meanwhile, a certain number of particles could still be detected in the eleventh row of a B767 aircraft cabin mockup when the particles were released in the second row, and the particle concentration decayed by about 37% every row”.
Obviously, with so many asymptomatic cases, it is impossible to know who is infected. This is why precautions are so important.
3. Longer Flights
Obviously, the longer the flight, the more you are exposed and the greater the risk of infection. You are also more likely to take off your mask the longer you are on the plane, especially if you need to eat. This study actually measured the mean risk of passengers within seven rows of an infected person on flights of multiple durations. For typical flight lengths on an Airbus A320 (0.9 hours), “mean risk for COVID-19 due to inhalation of aerosolised SARS-CoV-2 particles were estimated to be in the range of 1/1800”. Typical flight lengths on a Boeing 787-8 (8.7 hours), meanwhile, had a range of 1/120. At the time of the study:
“The expected number of flights to result in at least 1 case of COVID-19 due to transmission of aerosols containing the SARS-CoV-2 virus from a ‘regular’ virus shedding passenger was estimated to range from 2 to 44 cruise flights of durations typical for the aircraft types in the study. In case of cruise flights with longer durations, the expected number of flights ranged from 2 to 19.”
4. Near the Bathroom
I find that passengers tend to go to the bathroom at certain times during the flight, leading to a line. If your seat is near the bathroom, you will likely be forced to sit among the crowd waiting outside the bathroom door, increasing your risk. Unfortunately, since most bathrooms are at the back of the plane, this could negate this study, which suggests that the back rows of the plane have less transmission.
Recommendations
Book your flight when COVID-19 is normally low in your area and in the area you are travelling to. Consider booking during less peak times, when the plane is likely to be less full. As a rule of thumb, airlines like to increase prices during popular times, so look for something cheaper. Consider flights really early in the morning, when the airport opens, or “red-eye” flights late at night, close to when the airport closes. If you have a chronic illness, make sure you keep in mind how early or late flights may affect your body. If you need to take a flight during peak times to avoid a crash, please do so. Consider direct flights to limit your time at the airports.
If you live in the USA, consider getting CLEAR and/or TSA PreCheck to avoid long lines.
Pick a seat strategically. The further away from other passengers you are, the better, so if you can afford it, consider first class or premium seats. If not, don’t worry. According to this article and this article, the best place to sit is in the middle of the plane, where people are less likely to idle around, and in a window seat. Avoid areas where people crowd around you, like the very front of the plane or the bathrooms.
Make sure you wear an N95 mask that is fit-tested! Bring as many as you can, and keep some in your carry-on.
Bring HOCL spray for other germs. Use it to wipe down your seat and anywhere you may touch.
Wear a mask with a Sip Valve. Search ahead to find restaurants with smoothies or milkshakes that are available after you clear security (you can usually find this on Google maps). This way, you can satiate your hunger without having to take off your mask to eat solid foods.
In an emergency, I will take my AirFanta with me, find the least crowded restaurant, and eat there with the AirFanta pointed directly at my face. Please note that electronics with batteries are required to be in your carry-on, so make sure you have space for them. You can also use this spreadsheet to see what airports have outdoor areas where you can eat.
Keep the air vent on the plane pointed at you at all times. This increases the amount of filtered air you are breathing in.
When you return home or to your accommodation, consider using a nasal rinse or CPC mouthwash.
Flying while mitigating risk is absolutely doable. The important thing is making informed decisions by understanding your personal risk factors, choosing your flights and seats strategically, and taking precautions that match your comfort level.
Ready to plan your next trip? I can help you book flights with research-backed strategies in mind. I create trips tailored specifically to your comfort level and health needs, no guesswork required!
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NOTE: I cannot actually drink coffee or any caffeinated beverage due to my POTS, so you will not actually be buying me coffee. Money will most likely go to treats for my dog, instead.
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