There was a war taking place inside the cabin of Delta’s Airbus A321 as it sat on the tarmac at Logan.
A man with a device that resembled an insect fogger slowly walked down the aisle of the plane, carefully stopping at each row as the hand-held machine emitted a visible cloud of disinfectant. The device was sending out an electrostatic charge of a cleaning agent that clung to the surfaces that it touched. The electrostatic spraying was followed by a crew using high grade disinfectant to wipe down high touch points, such as seat belts, armrests, and tray tables.
The procedure is done between every flight. Where Delta Air Lines could once turn a plane around in half an hour, the cleaning procedures made necessary by the pandemic take twice as long.
“Our vision is this is not going to go away,” said Henry Kuykendall, Delta’s Northeast head of airport operations. “And if we wait for it to go away, that’s not a plan.”
But even with the extra measures that Delta and nearly every other US airline have launched since COVID-19, is it enough to convince passengers that it’s now safe to travel? Alaska Airlines, Delta, JetBlue and Southwest Airlines are keeping the middle or adjacent seats blocked off until at least September. Others are capping the number of passengers on each flight.
American Airlines and United Airlines are selling all seats in each plane again. But they are notifying passengers when their flight is more than 70 percent booked and offering the opportunity to choose a different flight.
Although few people have resumed flying since April, when passenger counts were down more than 90 percent over 2019, survey after survey has found that as much as they miss traveling, a majority of Americans are not yet ready to board a plane. A study released in late July found that 67 percent of respondents are not inclined to fly in the near future, with half of those saying they were “very uncomfortable” with the idea, according to the survey conducted by the business news website the Manifest.
And a vaccine may not be enough to help airlines out of their rut. Bloom Consulting found that 35 percent of Americans still won’t travel, even if a vaccine is available.
It’s not just the general public that has reservations about flying again. Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases, told Market Watch last week that he would not fly, primarily because, at 79, he places himself in a high risk group for contracting coronavirus.
The Globe reached out to 15 epidemiologists, COVID-19 researchers, and doctors across the country. All but two said they have no plans to get on a plane in the near future.
“I would fly only if it was extremely necessary,” said Dr. Daniel Fagbuyi, a biodefense and public health expert who was an Obama administration appointee to the National Biodefense Science Board. “If I did fly, you best believe I’m coming with my alcohol sanitizer, disinfectant for my seat and surfaces, gloves, goggles, and N95 mask, but that’s me. It’s all about risk tolerance and protecting one another.”
For Dr. Shira Doron, an infectious disease physician and hospital epidemiologist at Tufts Medical Center, the issue is proximity to other passengers. Without 6 feet of separation from other passengers Doron said she would be leery of a flight.
“Maintaining that distance is difficult not only on the plane, but in the airport as well,” she said. “If you’re traveling with your family and you could have a whole section or a whole row, that’s different than if you’re traveling alone and you get stuck in the middle or even right next to somebody. Masks help, but they help to varying degrees, particularly with non-medical-grade masks.”
Airlines, which are losing billions of dollars each quarter, have taken numerous steps to reduce the risks of passengers contracting the virus. Most are updating to touchless check-in and ticketing. Agents are behind plexiglass shields, and within the airport, seating is blocked off to ensure social distancing. JetBlue is testing disinfecting by UV light. Most airlines are now boarding from the rear, and just a few passengers at a time to reduce backups on the jetway. All airlines are also becoming increasingly strict about masks. Last week, American announced a no mask, no service policy. Delta said it has banned more than 120 mask scofflaws.
United demonstrated its cleaning protocols to the Globe last month at Logan, even showing the HEPA filter used in the plane’s ventilation system to catch 99.97 percent of airborne particles that contain dust, pollen, bacteria, including traces of the virus.
There is a common misconception that the air in a plane’s cabin is simply recirculated throughout a flight. In fact, it is refreshed 20 to 30 times per hour with a blend of fresh air that is constantly piped in and cabin air that continually goes through HEPA filters.
There are very few controlled scientific studies about the risks of contracting the disease on a plane, but at least one shows that it’s possible to get COVID-19 if there are infected passengers and a mask is worn incorrectly. On a Jan. 24 flight between Singapore and the Chinese city of Hangzhou in Zhejiang, a man contracted the virus after coming into contact with passengers who were positive. However he was found to be the only passenger, out of 335 on board, who became positive while in the air.
“The low rate of transmission during the flight may also be attributed to the design of and equipment in the aircraft,” the researchers from China wrote in the study posted on publisher Elsevier’s ScienceDirect site. “The air recirculation system, with the highly efficient particulate filter equipment and laminar nature of airflow, may have effectively prevented or restricted the transmission of the virus,” this study concluded.
Hundreds of flight attendants have contracted the disease, and several have died from it, but it is unclear how many of those were attributed to infections contracted in airplanes.
A majority of the doctors interviewed for this story said their worry wasn’t cabin air, but direct contact with other passengers or surfaces where the virus can lurk.
“Even if the airline is diligent about cleaning and air filtration, that can’t protect you from the person next to you taking off their mask and breathing on you,” said Brian Labus, assistant professor of the School of Public Health at the University of Nevada. “You can’t physically separate yourself from others, and close contact poses the greatest risk of infection.
United’s chief communications officer called blocking the middle seat “a PR strategy,” but early research has shown that keeping those seats empty may help make flying safer.
A statistical model compiled by Arnold Barnett, a management science professor at MIT, found that the chance of contracting COVID-19 as a passenger on a full flight is 1 in 4,300, compared to 1 in 7,700 on a flight with empty middle seats.
“The calculations here, however rudimentary, do suggest a measurable reduction in COVID-19 risk when middle seats on aircraft are deliberately kept open,” Bartlett wrote. “The question is whether relinquishing one third of seating capacity is too high a price to pay for the added precaution.”
Arnold’s research is not yet peer reviewed. But taking those numbers into account, the chance of dying from COVID-19 caught on an airplane is significantly higher than the likelihood of dying in a plane crash. At a 1 percent mortality rate, there is a 1 in 430,000 chance of dying from COVID-19 contracted on a full flight, according to Arnold’s research, and a 1 in 770,000 chance from a plane with the middle seats blocked off; by contrast, the risk of dying from a crash is roughly 1 in 34 million.
“I think it’s a stupid choice for airlines to be filling that middle seat,” said Dr. Howard Forman, a public health professor and emergency room radiologist at Yale who has been studying coronavirus. “Right now we should be doing everything we can to be minimizing risk, not increasing it.”
Officials from the Centers for Disease Control and Prevention and National Institute of Health specifically called out American Airlines for selling middle seats and flights at full capacity. A spokesman for American said the airline has adopted numerous safety measures.
“We have multiple layers of protection in place for those who fly with us, including required face coverings, enhanced cleaning procedures, and a pre-flight COVID-19 symptom checklist,” the spokesman, Ross Feinstein, said in an e-mail.
It’s understandable why airlines would make the move to fill those middle seats. United reported a $1.6 billion loss in its second quarter, American $2.1 billion, Delta lost $5.7 billion. Spirit Airlines, which is selling all seats, lost $144 million. The number of people flying is slowly creeping up, but not enough to turn those losses around. On July 23, more than 700,000 people passed through TSA check points, a fraction of the 2.7 million who passed through the same day a year earlier.
‘I think it’s a stupid choice for airlines to be filling that middle seat. Right now we should be doing everything we can to be minimizing risk, not increasing risk.’
Dr. Howard Forman, Yale University
The International Air Transport Association estimates that passenger traffic won’t rebound to pre-crisis levels until at least 2023, depending on when a vaccine is available.
But given that flying is a personal decision, there is no way to ultimately predict what those numbers will be. Airlines are getting stricter about masks and cleaning, but as hot spots flare, travelers may opt to stay closer to home.
Doron, the Tufts specialist, noted new data showing as many as 47 percent of US residents have risk factors for COVID-19.
“That’s a lot of people who potentially could get COVID and we still really don’t know why some people will appear to be healthy and wind up so sick,” Doron said. “Before they get on a plane, everybody needs to take into consideration their own risk. This isn’t going anywhere anytime soon.”