Flying and Covid Best Practices
January 26, 2024 3:58 PM   Subscribe

Flying immunocompromised…what’s the deal with Covid in airports and airplanes these days?

After posting about amputation as an option for an awful foot injury I not only applied to the ExoSym program, but got in! I’m super nervous but mostly excited.

Anyway, this is our first time traveling since the beginning of Covid and I’m immunocompromised. I really don’t want me or Mr. Fish to get Covid and could use some best traveling practices to stay safe. We are both vaxxed and boosted and with the current booster.

We’re flying to SeaTac from Boston on an early morning flight and have seats near the front, first row behind a partition near a bathroom on the other side. I have a window and am planning on wearing a 3M cup N95 and a surgical mask over it. I’m going to try to avoid the bathroom but that might be hard. Mr. Fish is going to wear an Aura N95.

Fortunately, due to my crappy foot we get a ride to the gate and plan on not dawdling in the terminal too much either.

What else can we do to keep Covid free since no one really masks too much anymore?
posted by floweredfish to Health & Fitness (34 answers total) 6 users marked this as a favorite
Good question. I have to go to SeaTac airport pretty often for work and there’s rarely a mask in sight. 🙃 I think if you’re vaxxed to the max and keep your N95 or equivalent on as much as possible you’ll be doing about as much as you can, though a cross-country flight is a long time to stay perfectly masked. But that’s what I’d attempt, maybe sneaking some sips of water to avoid dehydration.
posted by Suedeltica at 4:04 PM on January 26

I'm no expert, but masking is probably most important, and it sounds like you have that covered. Washing hands, too. Eating could be avoided but it is a long flight. Anecdotally, I have flown several times cross-country since covid started and have never gotten covid as a result. I use N95 masks, and wash my hands frequently. But I have eaten on planes, and drink water. In 2023, I actually forgot to put my mask back on for awhile after eating - very few people wear them still - but put it back on when I realized it. You should be ok.
posted by j810c at 4:08 PM on January 26

Best answer: My strategy (which, knock wood, has worked so far) has been to keep the mask on (my go-to is a headloop KN95) at all times in the airport. Unfortunately the TSA will make you pull it down when they check your ID; I hold my breath for this and pop the mask back on as soon as they've matched my face to my ID. Check to see if SeaTac and/or Boston have pet relief areas after security; some airports have ones that are outdoors so if you need to eat or drink at the airport you can duck outside without having to go through security again.

As soon as I board the plane I turn the little fan thingie over my seat as high as it will go. The mask stays on as long as we're on the ground. Once we're airborne, if I need to eat or drink anything I hold my breath, pull the mask down for the bite or sip, and then put it back on. I only do this while the plane is in the air because I read somewhere that planes actually have pretty good air exchange but only while airborne. The little fan thingie stays on all flight; if you get cold like I do you'll want to wear a nice warm hoodie onto the plane. I also carry individually wrapped disinfectant wipes and wipe down the tray table and armrests and seatbelt buckle; this is probably overkill but it makes me feel better.

Someone I follow online said that she chugs Pedialyte before flying and doesn't take the mask off at all (except presumably for the TSA check). I've also seen recommendations online for using nasal sprays and/or mouthwash after leaving a zone of possible exposure. I haven't done any of these things but they could be additional mitigations to look into.
posted by Fish, fish, are you doing your duty? at 4:22 PM on January 26 [5 favorites]

I choose foods I can eat with my hands - protein bar, trail mix, a burrito. I lower my mask while holding my breath, take a bite, and put my mask back on to chew & swallow. Same procedure for taking sips of water. It’s laborious and I don’t know how effective it is, but at least it feels safer to me than taking off the mask for 10 minutes to eat.
posted by umber vowel at 4:22 PM on January 26 [1 favorite]

Best answer: I'm immunocompromised and started always flying first class. It's much less crowded and you're sharing a bathroom with a lot fewer people. It's pricey, but if you can manage it, I think it's worth it.
posted by FencingGal at 4:25 PM on January 26 [7 favorites]

As an extra layer of protection, you could use a nasal spray that contains iota-carageenan, like Betadine's Cold Defense. There was a study a few years ago that showed that prophylactic use of carageenan nasal sprays can reduce the chance of infection taking hold if used before & after exposure. If it were me flying, I would use it twice daily for a couple of days after the flight as well.

If you don't think you can get through the flight without being able to drink anything, you can get airtight valves for masks that permit a straw through.
posted by burntflowers at 4:27 PM on January 26 [3 favorites]

Best answer: You should be able to pre-board because of your foot which is great so you won't have to hang out in the huddle of people waiting to board. If that doesn't work, consider boarding last if you don't need to worry about getting your carry-on to go in the cabin.

Second turning on the overhead fan to the max. Air flow in the cabin goes top to bottom, not front to back so mostly the air you will breathing will be already filtered before it gets to you. It is much safer than being a movie theater. (Not that you would, but just it a reminder that it is less risky than it feels.)
posted by metahawk at 4:31 PM on January 26

planning on wearing a 3M cup N95 and a surgical mask over it.

Why a surgical mask? If I'm not mistaken that's not supposed to add any benefit over an n95, and potentially might interfere with fit.

If you're very worried you could consider a p100 respirator. The actual breathing can be more comfortable than in an n95, the respirator itself may or may not be, and you will definitely get looks and possibly comments, but you don't have to care.
posted by trig at 4:32 PM on January 26 [9 favorites]

Also if you're worried about bathrooms you could plan to go early in the flight, possibly even during boarding.
posted by trig at 4:59 PM on January 26

Best answer: BOS to SEA is 6.5 hours. I don't know the exact nature of your health issues, but you can probably make it, albeit uncomfortably, without eating or drinking at all so you can stay masked the whole time. That's what I would try to do.
posted by praemunire at 5:01 PM on January 26 [5 favorites]

Best answer: Because of the way air circulation works in most planes, it is generally less risky than you might think. The key times to keep your mask on is during take off and landing, and especially while everyone gets on and off. Once a plane is at altitude you’re getting freshly filtered air that hasn’t had a whole plane full of people breathing in it, for the most part. Of course, if you are seated next to someone infectious, especially if they are unmasked, that’s cause for concern. Also since you are immunocompromised you will want to keep masking as much as you can. But you can probably relax a bit and do stuff like drink water and use the bathrooms once the seatbelt sign is off. I would be more concerned about the airport than the plane, honestly.

I’ve flown with the n95 and surgical mask on top before, it worked pretty well. I have glasses and the surgical mask kind of tucks underneath them and helps keep the n95 in place when I’m doing stuff like scrunching my face into the window or the tray table. Also if I touch something gross and haven’t had the chance to really wash my hands I can touch the surgical mask without making the n95 gross and then swap the surgical mask for a fresh one asap. If you have invested in a mask fitter or other gadget though, there is no real point to the surgical mask.
posted by Mizu at 5:47 PM on January 26 [4 favorites]

The immunocompromised folks I know who have absolutely needed to fly recently have gone with P100 masks plus nasal spray (Covixyl seems to be the option of choice for most folks if they don’t want to or can’t access Enovid) , and minimizing time in the actual airport by arriving somewhat last minute, not checking bags or having someone else who can claim the bags while they wait outside, etc.
posted by Stacey at 5:50 PM on January 26 [4 favorites]

I made a similar trip with an immunocompromised individual (SEA to east coast). Our plan was very similar to yours, but I'd note we got in touch with "TSA Cares" who provided us with someone to streamline the security process.
posted by whisk(e)y neat at 5:51 PM on January 26

Additional anecdata for you - Immunocompromised too and I have to travel cross country fairly frequently. I haven’t caught Covid or anything else on my trips since starting back up in 2021 - the only precaution I take is to wear a KN95 religiously in the terminal, on the plane, and in other large population areas.

Of course this year I finally got my first covid case ever in my own home from my husband who had caught it locally….
posted by Tandem Affinity at 5:57 PM on January 26

Doesn't solve the eating issue, but I know people who swear by SIP drinking valves.
posted by joyceanmachine at 5:59 PM on January 26 [2 favorites]

(No advice about travel, though I will be in the air westbound this weekend myself. But so stoked to hear about your ExoSym -- it seems like a really cool solution. I hope it goes well!!)
posted by wenestvedt at 6:33 PM on January 26 [6 favorites]

Best answer: Congrats on the ExoSym (I go later this year for mine!)!
posted by Sassyfras at 8:26 PM on January 26 [3 favorites]

You should be able to pre-board because of your foot which is great so you won't have to hang out in the huddle of people waiting to board.

This is actually worse. Until takeoff, the airplane has worse air quality than the queue to board.
posted by Candleman at 9:58 PM on January 26 [6 favorites]

I think you’re already taking the right precautions by masking. I’m not immuno compromised but my job which requires a lot of talking in order to make money makes it so I try really hard to avoid getting sick since I can’t talk with a caugh. I’ve said this on here before but from the start of Covid to about early 2023 I was vaccinated with all boosters and ALWAYS wore masks inside. Traveled on planes and wore masks…usually a kn95. In that period of time I didn’t get sick…no Covid and no cold or flu. Then in 2023 I slowly stopped masking (I still masked on planes). Summer of 2023 I caught my 1st cold. Early fall I got the most recent Covid booster. In October I attended an outdoor concert with a friend…no masks worn. Both of us ended up with Covid. So the main thing I feel is the game changer…the mask. If you’re diligent about it I think you’ll be all good. I also carry sanitizer everywhere. I use it regularly. Hope this helps.
posted by ljs30 at 10:25 PM on January 26 [1 favorite]

Best answer: I'd maybe bring some variety of unscented wipes for the seat tray and surfaces.
posted by sebastienbailard at 2:02 AM on January 27 [1 favorite]

I fly with a small portable air purifier.
You could also look into small far uvc devices but those are probably not cool for an enclosed space like a plane as you don't want to be within 50 cm of a far uvc emitter- still if you need to be in rooms where COVID exposure is possible...

I don't understand avoiding the bathroom, you can go to the bathroom! Just keep that mask on. :)
posted by stray at 4:14 AM on January 27

Best answer: Another vote for Enovid (use 2x per nostril 4-5x a day after the flight for a day or two) and the SIP valve, which works really well. Buy a big smoothie as your meal for the flight, add protein powder.

Also, second the rec for a portable filter, especially for the hotel room and other meetings.

So psyched for you!
posted by Dashy at 5:06 AM on January 27 [1 favorite]

I wouldn't worry about using the bathroom. The main risk of catching covid is from someone breathing/coughing/sneezing on you. Just Keep your mask on in the bathroom and wash your hands after as you normally would.
posted by wisekaren at 6:25 AM on January 27 [1 favorite]

Best answer: You might consider getting an inexpensive CO2 monitor if you don't have one already. The Vitalight for $40 is quite good. Of course a high-quality mask is your primary defense, but the CO2 monitor can tell you when the air is stale (full of others' exhaled breaths) or fresh. It can help you to estimate risk in the moments you need to remove the mask, and which spaces to avoid.

I've generally found that a large space like an airport terminal is pretty low risk (CO2 level is close to outside air: ~400ppm), but it depends on the air handling of the building, so space is not a guarantee. In my local grocery store the level is typically ~900ppm despite the high-ceilinged, large airy feel of the place. That's not terrible, but there are lower levels in the small classrooms at the school where I teach, because of the air handling.

As far as I understand it (and from reports on twitter of people on airplanes), air quality is generally pretty good when the plane is in flight: air circulation is turned on and the HEPA filters are also working (the latter represents an unmeasureable improvement to the observed CO2 level, when considering airborne viral particles). But, when the plane is on the ground, it is not standard to run the air handling, and the CO2 levels can rise a lot (3000-5000ppm!)

Sorry if you already are aware of all of this!
posted by pjenks at 6:44 AM on January 27 [3 favorites]

Very good recommendations here. Anecdata - we just returned from travel to Hawaii from the east coast. We wore masks throughout the airport and in the plane. We removed our masks briefly to eat, and used hand sanitizer after using the bathroom (and washed our hands). Very few people were masked, planes were packed as were the airports but we remained healthy. I'm going to investigate the current recommendations for nasal sprays and may add that to our next travel. I hope you have a great trip and stay healthy!
posted by bluesky43 at 8:11 AM on January 27

Huh, TIL
Corticosteroid (steroid) nasal sprays are widely available in the U.S. They’re often used for treating conditions like allergies and nasal polyps, but some researchers are exploring their potential as a treatment for COVID. It’s thought that they can help control inflammation while stopping the virus from entering your respiratory system.
It references a Cleveland Clinic study of 70,000 patients with mild to moderate Covid. “ As of now, there aren’t any ongoing clinical trials that are studying steroid nasal sprays for COVID. But since early data is positive, we may see some clinical trials in the future. ”

posted by TWinbrook8 at 10:14 AM on January 27

Adding to the count of people who have flown many times and not gotten COVID afaik, which I credit to good mask hygiene (and presumably some luck as well). I’ve only flown so far on 1-2 hour flights, short enough that I felt fine leaving the mask on and skipping drinks and food. That’s certain to be a heavier lift from Boston to SeaTac but you’re better positioned than I am to evaluate whether it’s achievable and worthwhile, how much of a bummer it would be to get Covid under your circumstances, etc.

Should this not actually be direct, and should you plan to connect, I second pet relief areas as indicating relatively safe places to unmask (including the area indoors near them, which I think may get more fresh air). I bring a CO2 monitor and let that be my guide about how much of others’ air I’ll be rebreathing in any given space.
posted by eirias at 12:05 PM on January 27

I just got back from Sicily, and to get there, I had to fly BOS-->ATL-->Palermo. (And then reversed on the way back.) So all told, six flights, and about 24 hours (each direction) of airplane travel.

Very few people were wearing masks, both in the air and at the airports.

On one of flights (a shorter one, thankfully), I was in front of two acutely ill people without masks. Both coughing every 15-30 seconds and of course, not covering their mouths. It was very uncool. I think you should count on other flyers not being careful and taking essentially zero precautions.

(Another piece of anecdata: I have a friend who missed a flight because he tested positive for Covid, but his wife who was exposed in the same way, traveled unmasked. Now at her destination, she's feeling ill and unbelievably, is considering flying back. So I have zero faith that people are even considering others when they're making travel decisions these days.)

I used N95 masks the entire way, including while sleeping. I did take my mask down to eat a meal on the long flights in both directions.

Importantly, I also used Enovid nasal spray every three hours: two sprays in each nostril.

It's been long enough since I returned to be able to say for sure that I did not get Covid on my flights.
posted by yellowcandy at 12:54 PM on January 27 [1 favorite]

it is not standard to run the air handling, and the CO2 levels can rise a lot (3000-5000ppm!)

Part of why I travel with a CO2 meter is to keep an eye on whether the air handlers are working well. Planes, in flight, tend to be fairly good, but I've had some that were 2500ppm for extended periods of time. In those cases, I'd do things like postpone snacks until landing.
posted by Candleman at 3:46 PM on January 27

Fit testing, either DIY or with a kit, is important to confirm that the mask does fit properly. An elastomeric P100 is likely better than an N95. Eye protection may be worthwhile, won't hurt so why not? A PAPR would be best, ones by Cleanspace have been reported to be fine on the airplane.
posted by Sophont at 5:48 PM on January 27 [1 favorite]

I've flown a couple times a year since 2021 and have not caught COVID or anything else from my travels. I wear an N95 on the plane and a KF94 in the airport (it's a bit more comfortable and I tend to arrive early), except when eating and drinking. It all feels like sort of a tiger-repelling rock situation but I certainly wouldn't do any less than that. I recently bought a portable HEPA air purifier for my office and I am thinking about bringing it on the plane for my next trip.
posted by misskaz at 6:52 AM on January 28

Just got back from the US and flew LHR -> ATL (7-10 hours), then a very short domestic flight, plus the reverse 10 days later.

I wore an N95 the entire time on both flights and in the airport, not removing to eat or drink. There was one person wearing a mask in my cabin on the way, and one person behind me that coughed a lot.

On the way back the flight was a lot emptier, and no one in my class wore a mask. One woman coughed without covering her mouth in the airport rather frequently, but she was in a different class and on a different flight.

Like yellowcandy, I've been back long enough to say that I did not get Covid on my flights either.
posted by Ms. Moonlight at 10:29 AM on January 28

Response by poster: Thanks all!

Here’s the plan:
- We have TSA pre check so we don’t have to deal with a big security line
- Because of my foot we get a ride from security to the gate
- We are going to try to board last
- We are flying first class (we had crazy points from pandemic shopping)
- It’s an early morning flight so it will be the plane’s first use of the day
- The flight time is very conducive to nap taking, so we are both planning on not taking our N95s off the whole time except at TSA check
- Going to wipe those tray tables down
- When we get there, Mr. Fish has volunteered as tribute to get the luggage while I get air
- I’m looking into the Enovid

Wish me luck!
posted by floweredfish at 2:38 PM on January 29 [3 favorites]

Whelp... after almost 4 years of avoiding it with significant flights in the past year, I tested positive for it yesterday - seemingly most likely on the return flight or airport (which was Friday, 1/26). With about 100K miles under my belt, an always mask, always wipe, always sanitize, rarely shake hands, never share food, and so forth - I finally got nailed by it. I'm not sure where I went lapse, but I'd probably just chalk it up to - no matter how prepared you are - there is still risk.
posted by Nanukthedog at 5:39 AM on January 31 [1 favorite]

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