On Monday, a Florida judge voided the U.S. mandate for public transit, which includes planes, trains, and buses. Several airlines immediately announced they dropped masks. And, in true pandemic fashion, an intense debate about masks ensued. There are health equity
I remember when planes used to have smoking sections. Why won't airline companies at the very least offer us the choice mask/non-mask sections? I think that's fair. Anyone know anyone in the industry? Please ask them. We'd also probably get a lot more corroborating data that might at least sway some naysayers.
Totally agree - complicated and a sizeable cost, but allows for individual options re: individual assessment of vulnerability and risk plus opportunity for data collection as you point out. Question: is there a body data out there re: air travel-associated transmission aside from individual reports?
Love your stuff! Just an FYI on the "legal precedent." This was a decision of the lowest federal court (district court). Technically it has zero precedential value. If the appealed and the Federal Circuit Court of Appeals affirms or reverses, that has precedential value in the states in that circuit. That is all of the District Courts must follow their Appeals Court's decisions. Different Circuits can even come out differently and only the Supreme Court can decide (if they so choose) which Circuit is correct.
That said the reasoning of why the Court came to its conclusion can have persuasive value should a similar issue come up again.
I had a prof once who said that District Court judges were not expected to "get it right" that's what the appeals courts were for. Kind of glib, but there are a lot of District Court judges of varying abilities.
So, we need policies that protect people until the plane is in flight and some guarantee that the people around us do not have Covid. It seems like it would just be easier to wear a mask at all times rather put together some patchwork thing that half the people would ignore. I still have not figured out why wearing a mask is such a big deal. I personally will take $$ and travel some other way.
We flew home from Windhoek, Namibia to Maui, Hawaii exactly 20 days ago. The flight path was a total of 4 planes totaling around 30 flight hours. We had to test negative (which we both did) on a PCR test in Namibia before being allowed to board a plane to the US.
In our business class cabin (Qatar Airways), masks were optional because we are 6ft or more apart from the other passengers and we had private cubicles with doors. The flight attendant told me staff had to wear masks but passengers in business class don't. We wore our N95 the whole time except when eating.
By the time we landed in Seattle, my wife was showing mild symptoms. We thought nothing of it because of the nature of long haul travel. While on the final leg to Hawaii, she was having full blown symptoms (runny nose, headache & nausea). She tested positive immediately two times.
By some miracle, I don't have Covid. I've tested negative 4 times in 20 days even though we've been living together and operating as per usual. She's at the tail end and recovering now but yes, she contracted it on one of the flights back 100%. If not on the flight, then it could be one of the 4 crowded and/or poorly ventilated airports (Windhoek, Johannesburg, Doha or Seattle)
The Johannesburg -> Doha flight is 8 hours and the Doha -> Seattle flight is 14.5 hours back to back. She did take her mask off when eating and drinking because it's not possible to not eat on such long flights. When she was not eating, she was wearing her N95 mask in her cubicle with the door always shut.
That's a tough situation and the reason I have not considered long flights. I guess the best I would be able to do would be to aim the filtered air jets at my face while eating to make it almost impossible to breath in uncleaned air. It's easy for me to say what I would have done because I wasn't there. But I in theory would have tipped my mask up just long enough to deliver fork to mouth--with aforementioned air jet pointed at me. Not fun, but I'd try that.
I literally read this on an international flight with an unmasked guy 3 rows behind me coughing throughtout the 7.5 hour flight. I had my mask on and 1 of my 2 air vent nozzles aimed towards him to keep his air flow at bay!
The most important place to point the clean ultrafiltered air is directly at your face in order to keep anything else from getting into what you breath.
Dr Jetelina I just read a column by David Leonhardt of the NYT today quoting epidemiologist M Osterholm of U of Minnesota saying that Public health advice has been off the mark about masks and that the public has been given a sense of a level of protection that is not warranted. It further says that the risks of Covid-19, including the vulnerable, equates to severe influenza. In fairness, the NYT piece is attempting to look at the issue of “mandates” from all angles. But I’d like to know if you can comment. Thanks.
A Common Ground for Masks and No Masks – Is This Possible (and desirable)?
As usual, excellent review of dropping the mask requirements on planes, trains, etc. You underscore the strong scientific evidence supporting masks. Unfortunately, this is undermined by strong public and political opposition to mask requirements. Sadly, strong opinions on both sides in these divisive times does not bode well for a resolution any time soon.
Perhaps a common ground can be found modeled after remedies that were established, beginning in the 1970s, when airlines began to create separate cabins for smokers and non-smokers. Similarly, partitions (with reverse airflow) can be created in airplanes for those who choose to wear masks and for those who choose not to do so. And for many years, trains had smoker and non-smoker cars. In 1990, the FAA ruled out all smoking in air travel.
In these troubled times, finding a common ground in this fashion has the potential of being a winnable battle as opposed to either side demanding total victory resulting in endless public health policy flip-flops based on CDC guidance, executive actions, judicial rulings and overturned judicial rulings resulting in public confusion and further polarization.
Separate cabins for those choosing to mask-up and those choosing to mask-down might be a good place to start. This could be the starting point for more civil conversation about masks or even vaccination and maybe serve as a model for other polarized public policy areas.
Maybe this would work and maybe not. But then again, I’m an optimist. And you know the difference between an optimist and a pessimist. It’s simple – the pessimist has better data!!!
Related thoughts:
1. Ventilation/filtration systems. You mentioned that planes have great filtration/ventilation systems. Do you know if this is based on upgrades during the pandemic? Prior to pandemic, concerns were raised by the Association of Flight Attendants, CWA, AFL-CIO in 2018 about air quality. https://www.afacwa.org/aircraft_air_quality . Are all aircraft equipped with HEPA filters/are they required? Are they regularly inspected and changed – regulations? Are filters installed properly to create “smart air flow” (i.e. away from your face)?
2. Boarding and Taxiing: You pointed out that ventilation systems do not operate during boarding and taxiing – is this something simple that can be changed?
3. Airline Resistance. Airlines opposed masking requirements. And clearly, they would oppose the expense and logistical issues associated with creating separate cabins for masking and not masking. Airlines received substantial government bailout funds that enabled them to survive the pandemic. What needs to be done to overcome this resistance should the dual cabin approach be considered.
In closing, thanks again for your much valued information, professional opinion and bottom line.
Not going to happen. Nobody cares and nobody is going to pay for it. If I have to take a flight, it will be with half-face respirator with P100 filters. And no, I will not be eating on the plane.
Smoking sections of planes weren't very separate - and a lot of non-smokers suffered breathing in the cigarette smoke on flights, though distance helped to a degree. At least 10 or 15 rows away was required to make a difference. To actually make a difference, there would need to physically be a barrier - not just a partial curtain, which may not be safe and certainly would be costly to add. I believe airlines stopped having any smoking on board because of multiple lawsuits by flight attendents who developed lung cancer from workplace exposure. If airlines could be convinced to do so, they could probably sell mask only individual flights, say once a day on busy routes, once a week on less busy routes - there are a lot of people who would choose that, but seems unlikely unless required.
I agree - curtains would not be enough. Some barrier would be needed to block air flow coupled with reverse airflow. It would be costly to fabricate plus would probably need to be moveable in smaller capacity aircraft to accommodate fluctuations in mask seating demand. Larger seat capacity airplanes may be able to have semi-fixed barriers based on a mask seating demand analysis for different markets/routes (e.g. poisson distribution). Cost is not a trivial issue, but the level of government bailout for airlines in pandemic was not trivial either - where is leverage or incentive? Other thoughts or ideas? Or, is this idea a non-starter?
I like your idea about separate mask-only flights, especially if seats were not more expensive. That idea may fly for major hubs. Maybe flip the idea - have designated flights where masks are optional/not required.
Thank you for enlightening data and analysis. Some of the studies were conducted early in the pandemic. Presumably risk factors would increase with the more highly transmissible Delta and Omicron variants.
Another convincing reason, if any were necessary, is the most recent data here in Oregon shows that new reported cases are going back up and the test positivity rate has shot upward. In fact most of the indices are moving in the wrong direction.
The cases that you reference showing that masks prevent spread on planes, do you know what type of masks were worn? We travel to Germany often and N95 / medical grade masks are required, no cloth masks allowed. I’m curious if that research is based on any mask quality or medical grade.
Also, what do you think our goal should be as a society when we make these decisions? Is it zero spread? Is it waiting until the vaccine is available for all ages? It seems like some experts want a zero risk tolerance so I’m curious your perspective here.
Thank you for this article! It was perfect timining for my parents (who don't trust me!). If you ever need a follow-up topic, their next question was "what happens to our immune system if we always mask in public going forward".
I have a similar question. Even putting all other viruses aside, isn’t there some societal benefit to microdosing from time to time to keep our immunity strong against Covid?
I was also pondering, while standing in a very long security line, why the additional security burdens added after 9/11 (like taking off shoes, not getting to bring water, etc. etc.) are accepted by seemingly everyone as requirements of flying. I have no idea the answer, but it feels like more lives could be saved with covid precautions than airport security precautions given how unlikely it is for security to find someone with a weapon and how likely covid testing and masking could prevent spread of some infections.
And then there are cruiseships — the concerns raised in your post, raised by orders of magnitude:
- megaships with up to 7000 passengers, 2300 crew
- 7 days of “cohabitation”
- eating 3 meals/day in the same (interior) restaurant(s)
- boisterous entertainments
- close queueing (on/off ship) takes hours
- filtration mitigation is unknown, masking unpopular
- no contact tracing following cruise
- possible asymptomatic spread aboard and throughout ports of call
Granted, folks who cruise are taking their own chances, but they are imposing their choices on communities where and when they disembark, and on their home communities when they return.
The large-scale return of this industry this summer should be instructive.
Thank you for this post. We have a trip with our toddler in a few weeks and with increased rates and mask mandate lifted we are rethinking it. My parents sent us personalized air filters. Do they really work? What things would you consider to take your kids on a 5 hour flight?
Had a long exchange with an airline pilot about plane ventilation system. Upshot was that plane has 2 ventilation systems, one used when plane is on ground, which pulls ground air into the plane, another used when plane is in air. Both do frequent air changes and run air through HEPA filtration system. I wouldn't expect the in-flight ventilation system to keep CO2 levels down, just to keep air relatively pure.
I didn't ask him about air during boarding itself, dunno whether ground-air ventilation system is supposed to be on during boarding.
They can run on "shore power" or on APU. I noticed that halfway thru boarding, the air flow out the seat vent about doubled. Maybe switching from shore to APU?
I remember when planes used to have smoking sections. Why won't airline companies at the very least offer us the choice mask/non-mask sections? I think that's fair. Anyone know anyone in the industry? Please ask them. We'd also probably get a lot more corroborating data that might at least sway some naysayers.
Totally agree - complicated and a sizeable cost, but allows for individual options re: individual assessment of vulnerability and risk plus opportunity for data collection as you point out. Question: is there a body data out there re: air travel-associated transmission aside from individual reports?
Just returned from the Boston Marathon on JetBlue. Thrilled to be seated next to 2 med students wearing N-95 like me!
Love your stuff! Just an FYI on the "legal precedent." This was a decision of the lowest federal court (district court). Technically it has zero precedential value. If the appealed and the Federal Circuit Court of Appeals affirms or reverses, that has precedential value in the states in that circuit. That is all of the District Courts must follow their Appeals Court's decisions. Different Circuits can even come out differently and only the Supreme Court can decide (if they so choose) which Circuit is correct.
That said the reasoning of why the Court came to its conclusion can have persuasive value should a similar issue come up again.
I had a prof once who said that District Court judges were not expected to "get it right" that's what the appeals courts were for. Kind of glib, but there are a lot of District Court judges of varying abilities.
this is super interesting! thanks for clarifying
So, we need policies that protect people until the plane is in flight and some guarantee that the people around us do not have Covid. It seems like it would just be easier to wear a mask at all times rather put together some patchwork thing that half the people would ignore. I still have not figured out why wearing a mask is such a big deal. I personally will take $$ and travel some other way.
We flew home from Windhoek, Namibia to Maui, Hawaii exactly 20 days ago. The flight path was a total of 4 planes totaling around 30 flight hours. We had to test negative (which we both did) on a PCR test in Namibia before being allowed to board a plane to the US.
In our business class cabin (Qatar Airways), masks were optional because we are 6ft or more apart from the other passengers and we had private cubicles with doors. The flight attendant told me staff had to wear masks but passengers in business class don't. We wore our N95 the whole time except when eating.
By the time we landed in Seattle, my wife was showing mild symptoms. We thought nothing of it because of the nature of long haul travel. While on the final leg to Hawaii, she was having full blown symptoms (runny nose, headache & nausea). She tested positive immediately two times.
By some miracle, I don't have Covid. I've tested negative 4 times in 20 days even though we've been living together and operating as per usual. She's at the tail end and recovering now but yes, she contracted it on one of the flights back 100%. If not on the flight, then it could be one of the 4 crowded and/or poorly ventilated airports (Windhoek, Johannesburg, Doha or Seattle)
Thank you for confirming this fact.
Did she N95 mask the entire time from door to door or did she eat/drink on the plane/not mask in the business class cabin?
The Johannesburg -> Doha flight is 8 hours and the Doha -> Seattle flight is 14.5 hours back to back. She did take her mask off when eating and drinking because it's not possible to not eat on such long flights. When she was not eating, she was wearing her N95 mask in her cubicle with the door always shut.
That's a tough situation and the reason I have not considered long flights. I guess the best I would be able to do would be to aim the filtered air jets at my face while eating to make it almost impossible to breath in uncleaned air. It's easy for me to say what I would have done because I wasn't there. But I in theory would have tipped my mask up just long enough to deliver fork to mouth--with aforementioned air jet pointed at me. Not fun, but I'd try that.
I literally read this on an international flight with an unmasked guy 3 rows behind me coughing throughtout the 7.5 hour flight. I had my mask on and 1 of my 2 air vent nozzles aimed towards him to keep his air flow at bay!
The most important place to point the clean ultrafiltered air is directly at your face in order to keep anything else from getting into what you breath.
I did. I had 2 nozzles, one was pointing back and one down!
Smart.
Dr Jetelina I just read a column by David Leonhardt of the NYT today quoting epidemiologist M Osterholm of U of Minnesota saying that Public health advice has been off the mark about masks and that the public has been given a sense of a level of protection that is not warranted. It further says that the risks of Covid-19, including the vulnerable, equates to severe influenza. In fairness, the NYT piece is attempting to look at the issue of “mandates” from all angles. But I’d like to know if you can comment. Thanks.
A Common Ground for Masks and No Masks – Is This Possible (and desirable)?
As usual, excellent review of dropping the mask requirements on planes, trains, etc. You underscore the strong scientific evidence supporting masks. Unfortunately, this is undermined by strong public and political opposition to mask requirements. Sadly, strong opinions on both sides in these divisive times does not bode well for a resolution any time soon.
Perhaps a common ground can be found modeled after remedies that were established, beginning in the 1970s, when airlines began to create separate cabins for smokers and non-smokers. Similarly, partitions (with reverse airflow) can be created in airplanes for those who choose to wear masks and for those who choose not to do so. And for many years, trains had smoker and non-smoker cars. In 1990, the FAA ruled out all smoking in air travel.
In these troubled times, finding a common ground in this fashion has the potential of being a winnable battle as opposed to either side demanding total victory resulting in endless public health policy flip-flops based on CDC guidance, executive actions, judicial rulings and overturned judicial rulings resulting in public confusion and further polarization.
Separate cabins for those choosing to mask-up and those choosing to mask-down might be a good place to start. This could be the starting point for more civil conversation about masks or even vaccination and maybe serve as a model for other polarized public policy areas.
Maybe this would work and maybe not. But then again, I’m an optimist. And you know the difference between an optimist and a pessimist. It’s simple – the pessimist has better data!!!
Related thoughts:
1. Ventilation/filtration systems. You mentioned that planes have great filtration/ventilation systems. Do you know if this is based on upgrades during the pandemic? Prior to pandemic, concerns were raised by the Association of Flight Attendants, CWA, AFL-CIO in 2018 about air quality. https://www.afacwa.org/aircraft_air_quality . Are all aircraft equipped with HEPA filters/are they required? Are they regularly inspected and changed – regulations? Are filters installed properly to create “smart air flow” (i.e. away from your face)?
2. Boarding and Taxiing: You pointed out that ventilation systems do not operate during boarding and taxiing – is this something simple that can be changed?
3. Airline Resistance. Airlines opposed masking requirements. And clearly, they would oppose the expense and logistical issues associated with creating separate cabins for masking and not masking. Airlines received substantial government bailout funds that enabled them to survive the pandemic. What needs to be done to overcome this resistance should the dual cabin approach be considered.
In closing, thanks again for your much valued information, professional opinion and bottom line.
Alan
Not going to happen. Nobody cares and nobody is going to pay for it. If I have to take a flight, it will be with half-face respirator with P100 filters. And no, I will not be eating on the plane.
Smoking sections of planes weren't very separate - and a lot of non-smokers suffered breathing in the cigarette smoke on flights, though distance helped to a degree. At least 10 or 15 rows away was required to make a difference. To actually make a difference, there would need to physically be a barrier - not just a partial curtain, which may not be safe and certainly would be costly to add. I believe airlines stopped having any smoking on board because of multiple lawsuits by flight attendents who developed lung cancer from workplace exposure. If airlines could be convinced to do so, they could probably sell mask only individual flights, say once a day on busy routes, once a week on less busy routes - there are a lot of people who would choose that, but seems unlikely unless required.
I agree - curtains would not be enough. Some barrier would be needed to block air flow coupled with reverse airflow. It would be costly to fabricate plus would probably need to be moveable in smaller capacity aircraft to accommodate fluctuations in mask seating demand. Larger seat capacity airplanes may be able to have semi-fixed barriers based on a mask seating demand analysis for different markets/routes (e.g. poisson distribution). Cost is not a trivial issue, but the level of government bailout for airlines in pandemic was not trivial either - where is leverage or incentive? Other thoughts or ideas? Or, is this idea a non-starter?
I like your idea about separate mask-only flights, especially if seats were not more expensive. That idea may fly for major hubs. Maybe flip the idea - have designated flights where masks are optional/not required.
Thank you for enlightening data and analysis. Some of the studies were conducted early in the pandemic. Presumably risk factors would increase with the more highly transmissible Delta and Omicron variants.
Very, very useful information. Convincing case for continuing mask useage.
Another convincing reason, if any were necessary, is the most recent data here in Oregon shows that new reported cases are going back up and the test positivity rate has shot upward. In fact most of the indices are moving in the wrong direction.
The cases that you reference showing that masks prevent spread on planes, do you know what type of masks were worn? We travel to Germany often and N95 / medical grade masks are required, no cloth masks allowed. I’m curious if that research is based on any mask quality or medical grade.
Also, what do you think our goal should be as a society when we make these decisions? Is it zero spread? Is it waiting until the vaccine is available for all ages? It seems like some experts want a zero risk tolerance so I’m curious your perspective here.
Thank you for this article! It was perfect timining for my parents (who don't trust me!). If you ever need a follow-up topic, their next question was "what happens to our immune system if we always mask in public going forward".
I have a similar question. Even putting all other viruses aside, isn’t there some societal benefit to microdosing from time to time to keep our immunity strong against Covid?
In on Delta wi-fi right now-about 50% of the plane is masked :) Interesting to see this as it is very relevant to my current life situation!
I was also pondering, while standing in a very long security line, why the additional security burdens added after 9/11 (like taking off shoes, not getting to bring water, etc. etc.) are accepted by seemingly everyone as requirements of flying. I have no idea the answer, but it feels like more lives could be saved with covid precautions than airport security precautions given how unlikely it is for security to find someone with a weapon and how likely covid testing and masking could prevent spread of some infections.
This is a good point. Much of the screening is purely performative.
Another timely post, thank you Dr Jetelina.
And then there are cruiseships — the concerns raised in your post, raised by orders of magnitude:
- megaships with up to 7000 passengers, 2300 crew
- 7 days of “cohabitation”
- eating 3 meals/day in the same (interior) restaurant(s)
- boisterous entertainments
- close queueing (on/off ship) takes hours
- filtration mitigation is unknown, masking unpopular
- no contact tracing following cruise
- possible asymptomatic spread aboard and throughout ports of call
Granted, folks who cruise are taking their own chances, but they are imposing their choices on communities where and when they disembark, and on their home communities when they return.
The large-scale return of this industry this summer should be instructive.
Thank you for this post. We have a trip with our toddler in a few weeks and with increased rates and mask mandate lifted we are rethinking it. My parents sent us personalized air filters. Do they really work? What things would you consider to take your kids on a 5 hour flight?
No so sure about aircraft ventilation claims. CO2 on last flight was steady 1700. Delta Boeing 737-900. Fairly modern airplane.
Was up to 2400 during boarding...
All this CO2 experimenting is making me feel left out. Now I need to try my next flight
Aranet4 is the way to go...
Had a long exchange with an airline pilot about plane ventilation system. Upshot was that plane has 2 ventilation systems, one used when plane is on ground, which pulls ground air into the plane, another used when plane is in air. Both do frequent air changes and run air through HEPA filtration system. I wouldn't expect the in-flight ventilation system to keep CO2 levels down, just to keep air relatively pure.
I didn't ask him about air during boarding itself, dunno whether ground-air ventilation system is supposed to be on during boarding.
They can run on "shore power" or on APU. I noticed that halfway thru boarding, the air flow out the seat vent about doubled. Maybe switching from shore to APU?