Two decades ago on a midwinter flight from New York to Chile en route to Antarctica, more than a dozen fellow travelers and I came down with bronchitis. When the Antarctic voyage got under way, so many people were sick that the ship’s doctor nearly ran out of antibiotics.
Since that trip, I have diligently followed a preventive routine whenever I fly.
* I prepare far enough in advance to be
sure I am well rested and minimally stressed when I leave.
* Just before the flight I take echinacea and 1,000 milligrams of vitamin C. (The immunity-boosting powers of these supplements are still much debated, but they seem to work for me.)
* During the flight I drink lots of water — but no alcohol and minimal caffeine — to keep protective membranes well hydrated.
* I wash my hands often and keep them away from my eyes and nose.
Though I can cite no studies that endorse my routine, I have never again become ill from flying — and I fly dozens of times a year, sometimes halfway around the world. The regimen has also protected a former head of the Federal Aviation Agency, who would get pneumonia when he flew from New York to Colorado or Australia to visit his sons.
I also take precautions to prevent blood clots, which is a special concern because I am short. In addition to staying well hydrated, I always book an aisle seat so I can get up easily and walk around at least once an hour. On very long flights, I wear compression stockings.
Each year nearly 2 billion people travel aboard commercial airlines. Yet as two experts in emergency medicine noted in February in The Lancet, “Many passengers are unaware of health implications associated with commercial air travel.”
Data on in-flight medical problems are limited, and no one keeps track of how many people become sick from flights after they leave the airplane. But the experts, Danielle Silverman of Georgetown University Hospital in Washington, and Mark Gendreau of the Lahey Clinic Medical Center in Burlington, Massachusetts, maintain that flight risks to health are rising because “the age of travelers is increasing, and long-haul aircrafts, such as the Airbus A380 and Boeing 777LR, are capable of extending flight times to 18-20 hours.”
Older passengers are more likely to have health problems that can be aggravated by air travel, especially on long flights. Infectious diseases known to have been spread to people of all ages by air travel include influenza, severe acute respiratory syndrome (or SARS) and tuberculosis, not to mention the common cold.
Several factors can affect the health of airline passengers, including changes in cabin pressure that reduce oxygen supply; immobility and dehydration that raise the risk of blood clots for all passengers, not just those in the tighter space of economy class; exposure to passengers with infectious diseases; and jet lag when crossing multiple time zones. Flight crews also face chronic exposure to cosmic radiation, which is a hazard for pregnant women as well.
Some commercial airlines have taken steps to minimize health risks and their consequences, like offering passengers plenty of water during flights and recommending exercises that keep blood from pooling in the legs. All flights carry emergency medical kits, and most now also have an automatic defibrillator to rescue passengers whose hearts develop an erratic rhythm, which can be fatal within minutes.
But the bulk of any protection may depend on you, the passenger. If you have a chronic health problem, the Lancet authors suggest a preflight medical assessment to determine whether it is safe for you to fly and what precautions you should take if you do fly.
Airline cabins are commonly pressurized to altitudes of 1,524m to 2,438m above sea level. Healthy people have no problem at such altitudes, but those with underlying heart or respiratory disease who may already have low levels of oxygen in their blood can develop symptoms of mountain sickness — fatigue, headache, light-headedness and nausea. Those passengers may need supplementary oxygen when flying, the doctors wrote.
Even healthy passengers may develop mild abdominal cramps and ear problems as gas in body cavities expands with rising altitudes. The doctors warned against flying too soon after surgery, and they cautioned scuba divers against flying within 12 hours of a dive (24 hours for those who do several dives a day), lest they develop decompression sickness.
The risk of blood clots starts to rise four hours into a flight and peaks on flights of more than eight hours. Flying business class offers no protection, despite the expanded leg room, research has shown. The more flights taken within two weeks, the greater the risk. Passengers who are obese, have cancer, recently had surgery, take oral contraceptives or have conditions that raise their susceptibility to blood clots (including genetic conditions like factor V Leiden) are at particular risk of flight-induced clots. Many may benefit from blood thinners when flying.
On long flights, the less that passengers move about the cabin and the less water they consume, the greater the risk. Wearing compression stockings and exercising the calf muscle during the flight can lower the risk.
While exposure to cosmic radiation is not considered a problem even for frequent air travelers unless they are pregnant, anyone can develop jet lag from abrupt changes in multiple time zones. After a westward flight, it can take a day to adjust for every time zone crossed; after an eastward flight, a day and a half.
Although controlling exposure to sunlight is the best way to limit jet lag, it can be challenging for some travelers, so the doctors recommend taking melatonin (0.5 to 5 milligrams). When flying eastward, try to get morning light (wear sunglasses only in the afternoon) and take melatonin at the desired bedtime. When flying westward, get afternoon light (wear sunglasses only in the morning) and take melatonin in the morning. And in either direction, be sure to stay well hydrated.
To prevent contagious illnesses, the most important measure is to be sure all your immunizations are up to date, including annual flu shots. The Lancet authors noted that the “risk of onboard transmission of infection is mainly restricted to individuals with either close personal contact or seated within two rows” of an infected passenger.
But since there may be no way to know who sitting near you might be infectious, my regimen should not hurt and may very well protect you.
On April 26, The Lancet published a letter from two doctors at Taichung-based China Medical University Hospital (CMUH) warning that “Taiwan’s Health Care System is on the Brink of Collapse.” The authors said that “Years of policy inaction and mismanagement of resources have led to the National Health Insurance system operating under unsustainable conditions.” The pushback was immediate. Errors in the paper were quickly identified and publicized, to discredit the authors (the hospital apologized). CNA reported that CMUH said the letter described Taiwan in 2021 as having 62 nurses per 10,000 people, when the correct number was 78 nurses per 10,000
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