Air Travel, COVID-19 Transmission & Prevention: Lessons from a Flight to the Caribbean

I recently flew from Montreal to the Caribbean with Air Transat, an airline co-founded by current Québec Premier Legault, and soon to be bought, at a bargain price, thanks to the pandemic, by Air Canada.

These days, not many people dare flying. There is lots of social and political pressure against it, even if it is (still?) permitted.

An article by the leading Québec media group (TVA, Journal de Montréal, Journal de Québec, etc.) depicts people travelling to Mexico for the winter holidays as irresponsible. The article generated numerous highly critical commentaries by readers, who are in lockdown in Québec, towards those having opted for travelling.

https://www.tvanouvelles.ca/2020/12/28/des-quebecois-sur-le-party-dans-le-sud

https://twitter.com/search?q=sur%20le%20party%20dans%20le%20sud&src=typed_query

Regarding political pressure, Ms Valérie Plante, the mayor of Montreal, which is the hotspot of the pandemic in Canada, voiced her preoccupations. 

“One must absolutely ensure that rules are respected at their return. The 14 day quarantine is absolutely necessary. One should not spare any effort.”

The article reminds readers of the penalties if quarantine regulations are not respected: fines of up to 750 000$ (yes you read it well) and jail time of up to 6 months (enough time to ensure you get COVID maybe?) if you are caught transgressing! They are described in this other article, in English.

Canada’s prime minister Justin Trudeau also warned the population: “It’s not the time to take vacations abroad … Do what you have to do … Stay home … Protect your family, the frontline workers, the medical doctors, the nurses, the elderly.”

https://www.lapresse.ca/covid-19/2020-12-23/deuxieme-vague-de-la-covid-19/justin-trudeau-deconseille-fortement-aux-canadiens-de-voyager.php

In my opinion, protecting Canadians, especially the elderly, is something Canada does very poorly, with thousands having already died, and people continuing to unnecessarily die, especially in nursing homes.

Canada continues to scrupulously deny its citizens, including nursing home residents, any forms of prevention (except a few who got vaccinated) and early treatment for C19, even with the mounting and now pretty overwhelming evidence of the effectiveness of such prophylaxis and outpatient treatments.

A suggestion to Trudeau: you may want to refrain from giving lessons in this area. Canada’s record is, and continues to be, terrible. You sound like Andrew Cuomo taking pride in protecting the elderly in nursing homes in NY State!

The key argument advanced to discourage Canadians from traveling is that the situation could be much worse in the destination country. But is it true? Favorite destinations for Quebecers are Cuba and the Dominican Republic.

In Cuba, there have been so far 143 deaths attributed to C19, for a population of 11.3 million inhabitants. That’s a mortality of 13 per million inhabitants.

In the Dominican Republic, there there have been 2,404 deaths attributed to C19, for a population of 10.9 million, i.e. a mortality of 220 per million inhabitants.

https://www.worldometers.info/coronavirus/

Let’s compare to Montreal. So far, there have been 3,826 deaths, for a population of 2.014 million inhabitants. That’s a per capita mortality rate 1,890 per million inhabitants.

https://ici.radio-canada.ca/info/2020/coronavirus-covid-19-pandemie-cas-carte-maladie-symptomes-propagation/index-en.html

Yep, you are discouraged to go to countries where COVID mortality is respectively … 146 times or 8 times lower!

Of course, not all destinations in the South are doing as well in fighting the pandemic, but for sure, there is hypocrisy from the authorities when they claim that staying in Montreal is safer than travelling to the South, as the data tend to show the very contrary.

But let’s get back to air travel, and more precisely C19 prevention.

At the airport, check-in was uneventful. There are not many flights these days, so the Trudeau airport (named after the father of the current PM, after lots of controversy) was very far from being crowded. 

Social distancing was observed in the lines. People wearing masks, etc. Uneventful.

What was surprising is that no questions were asked regarding symptoms. That was the case at the check in, at security and prior to boarding. There was a temperature control done at security, but nothing else.

No negative C19 test were required to check in or embark the flight.

Boarding could have been better, especially in light of the better process used to disembark, when occupants of each row are asked to leave one by one, starting logically from the front. Such a process was not implemented for boarding.

We were told the plane had been cleaned and disinfected, and it looked really clean. Maybe there were some nasty chemicals in the air, but my impression was that cleanliness was irreproachable. 

The plane was at, or near, capacity, so that 6 feet distancing was nowhere to be seen onboard. Not even 6 inches distancing!

I had selected a safety exit seat, and had only one person directly next to me. He was not showing any symptoms, not even the slightest cough, which made me comfortable. I was lucky.

Among the passengers, some were coughing of course, as this is winter time. Could some of these passengers have the beginning of C19? Maybe.

There are media articles about people flying to the Caribbean for partying. The crowd on that particular plane was not of that type. Just people flying, mostly in family.

From my seat, I could only see maybe some 20 people, and I did not see anyone not wearing a mask. People were quiet, following the rules. It looked like it was going to be uneventful.

Onboard personnel were very nice, but seemingly a bit nervous. They were wearing surgical masks and gloves. They did not wear protective glasses / goggles. They were in constant close contact with the passengers. There was no bubble inside the plane.

Each passenger received a little pack with mask and also some hand sanitizer – a tiny quantity that was very hard to get out of its packaging. People were not advised to use it, and probably few did.

On board, the air circulation was very present, and one knows that air circulation and filtration, with HEPA filters, are key for making flying reasonably safe.

The plane took off. It was very quiet in the plane. This was a morning flight of just about 4 hours. I really thought things were going to continue to be uneventful for the next hours.

But, to my surprise, despite the short flight, passengers were offered a meal and drinks, and that started a sequence of activities conducive of virus spread.

First came the meals, with pretty terrible options: the traditional Quebec poutine dish, pizza and grilled cheese. Very few resisted the temptation. 

Drinks were also offered onboard, including alcoholic drinks.  

This meant lots of work for the cabin crew, who had not choice but to be in constant contact with passengers.

Passengers were informed that they were allowed to remove their masks to eat and drink.

The majority of passengers opted to take the meals and removed their masks. So if someone was contagious, it’s very likely he/she did spread the virus to nearby passengers.

That was totally avoidable.

In my opinion, for such a short flight, the meals were totally unnecessary. And bottles of water could have been offered on demand only. But that’s not what the airline did. 

Unlike with some other airlines, there was no specification for the masks to be worn by passengers. 

One could see a wide variety of masks. Most were not N95s or surgical masks, but rather cloth masks, either from stores or home-made.

Except for N95s, masks are known to be little effective in protecting the person wearing it. Their usefulness resides rather in not contaminating others. 

But if a majority of passengers remove their mask for say 30 minutes, to have their meal, there will be lots of virus in the air in case one or several passengers are contagious!

I may have been the only one in the plane wearing a N95. I did not remove it a second. I did not eat the poutine or the pizza or even the grilled cheese. I did not drink anything during the flight. I had a very pleasant flight despite not having any food or drink.

More the flight was progressing, the worse things became, as following the food and the drinks, for many, but not me, it was obviously time to go to the bathroom.

I was not far from a bathroom and what I witnessed was a pretty bad play.

The bathroom was minuscule, and there was a constant flow of people getting in and out. That lasted probably 2 hours, and there were other bathrooms on the flight with the same bad play in action. I even saw several people using the bathroom twice, despite the short flight.

Sometimes, the line of people in front of the bathroom was getting a bit long to my taste. The warnings by the crew to not forming such lines had were not respected by the lining passengers.

If a person in the flight was contagious, with the low quality masks being used by most, and the contacts with surfaces, it’s pretty certain that the virus would have found its way in that bathroom. People seemed unaware of the risks.

The cabin personnel had not given any warning to discourage using the bathrooms. They however intervened on several occasions to clean / sanitize them. But with their poor masks, they were exposing themselves even further to possible infections, just to do their job.

If the airline had not offered meals and drinks, there would have been a much lower usage of the bathrooms, many fewer contacts, and fewer risks of transmission. I was really surprised this had not been properly thought through beforehand.

Infections and outbreaks are far from being uncommon on flights. Just in a recent 12 day period, there have been 101 domestic flights in Canada and 90 international flights to/from Canada with cases or outbreaks, according to official statistics.

https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection/latest-travel-health-advice/exposure-flights-cruise-ships-mass-gatherings.html

Such statistics could likely be much improved by taking additional measures, such as suspending food and drinks, and educating passengers as to how to best behave to keep the flight as safe as possible.

Such additional measures, especially on short flights, would not create any significant discomfort for passengers, and would improve safety. 

They would actually make flights much more attractive, as many want to travel but stay on the fence, because of the above mentioned social and political pressure, but also because of the real risks associated with flying.

Key beneficiaries of additional measures would be the flight crew, who are exposing themselves to a higher risk, because the many flights they work on, and the fact that they are constantly in close contact with many passengers.

I personally wore a N95 mask, and found it barely less comfortable than a surgical mask. N95 masks are the only ones that provide you reasonable protection. I only wear such mask when in a situation I consider at high risk.

We are now 10 months in the pandemic and such masks should be available, and maybe compulsory, for flying, as social distancing is impossible to be respected on board.

In our webinar with Professor Paul Marik about C19 prevention and early treatment, he mentioned he wore a N95 mask for flying. This is very solid and credible advice.

The other thing he did, which is also very solid and credible advice, is Ivermectin prophylaxis, something we covered in a previous article, and which may be the best way to protect those flying, especially the airline personnel who are at high risk of repeated exposures to the virus.

The activity on the plane subsided finally when the descent started. 

Disembarking was row by row, starting from the front, and felt very safe.

At the airport, prior to customs, there was distancing enforced in the lines of passengers. A temperature check and some COVID testing were performed on passengers.

Of course, if infections had occurred on board, such tests would not detect them.

There were hand sanitizer dispensers available, but their usage was optional.

All the airport personnel were wearing masks, and so were all the people waiting for passengers outside the airport.

My journey was not totally complete. To reach my destination, a road drive was needed. I opted for a taxi. The driver had a surgical mask. I requested we drove with the windows full open, to reduce the risk of transmission — something that you obviously can’t do in Canada during winter time.

The drive felt safe and was very likely safe too.

The journey was completed. I had taken extra measures and felt safe. No symptoms whatsoever now 4 days following the journey.  I will continue to be vigilant of course.

At my destination, I remain highly responsible, respect social distancing and other rules and do everything to avoid being contaminated. I don’t want to catch that disease.

But well … I also am glad to go the beach, to get some sun (and Vitamin D), to breath the fresh air and to enjoy the sea.

I am in a place where, unlike Canada, prophylaxis and early treatment for COVID-19 are being practiced. There is even an internationally known medical doctor who has successfully treated thousands of patients in such a way. 

All the required medicines, prohibited or discouraged against in Canada, needed for prophylaxis and early treatment, are available here. They are typically cheap generic drugs, listed as essential by the World Health Organization. 

In the unlikely case I catch the disease, I am probably in a much better place than in Canada to receive the proper care, the proper treatment, within days of the first symptoms, thereby avoiding a severe form of the disease requiring hospitalization.

To me, from this experience, it’s clear to me that much more could be done by the authorities and airlines to avoid spreading C19 in planes.

If you decide to travel, my suggestion would be to take all the extra measures you can, to avoid infection, and chose a destination that is safe and that offers proper medical care in case you need it.

Fortunately, it’s still permitted to travel to the Caribbean and other destinations during this pandemic, at least from Canada.

And talking about Canada, when you fly back, please don’t forget the risk of a 750,000$ fine or of 6 months jail time you may face if transgressing the quarantine rules!

And also don’t forget that you will probably be at much higher risk of developing the disease and maybe even dying from it in Canada than in the country you visited.