With SARS threat, is flying safe?
Air filters, disinfectants attempt to keep airplanes free from virus   Image: Medical Staff Takes Body Temperature Of Passengers At Hong Kong Airport
A medical staff member takes the temperature of a passenger at the Hong Kong International Airport. Airport officials have begun checking the temperatures of all outbound travelers in an effort to prevent the spread of SARS.
By Linda Carroll
April 18 —  It was not long ago that airline passengers were scrutinizing their fellow travelers, looking out for anyone who showed even the slightest sign of being a potential terrorist. But these days, nervous air travelers are worrying about a smaller, but still deadly threat: the SARS virus.
  IN EARLY April, an American Airlines flight was grounded and temporarily quarantined in San Jose, Calif., while public health officials determined whether several individuals on board were sick with severe acute respiratory syndrome, or SARS. A little more than a week later, the health department in Hong Kong asked passengers on seven separate Lufthansa flights to check in with health officials because a traveler on those trips was infected with the virus.
       With such a highly contagious bug potentially on board, travelers may wonder exactly how safe it is to fly these days.
       Some public worry is justified because too little currently is known about the virus for scientists to say with certainty that flying is safe. But people can take comfort in the fact that newer airplanes have strong filters against viruses and airlines operating in affected countries have implemented policies to keep travel as harmless as possible.
       While there have been reports in Asia of people falling ill with SARS after sharing flights with an infected individual, there haven’t been many, says Dr. Mark Rosen, chief of the division of pulmonary and critical care medicine at the Beth Israel Medical Center in New York City.

       That small number indicates the risk is probably very low because there have been a large number of passengers exposed to travelers who were infected with the virus, he adds.
       Still, some experts say the low infection rate among air travelers could simply be due to luck. It’s possible that the numbers would be different if a so-called “super-spreader” were on board, says Dr. Richard Olds, professor and chairman of the department of medicine at the Medical College of Wisconsin in Milwaukee.
       “Some people with SARS are highly infectious,” Olds explains. In other diseases, such as tuberculosis, wide variation in infectiousness occurs depending on the location of the infection, he said.
       With SARS, someone with an infection in the deep tissue of the lungs may not spread the disease as easily as an individual who has in infection in the upper air ways where a lot of air comes out at high pressure, Olds says.
 fact file 
Timeline for SARS
1 / 6
Nov. 16, 2002
The first case of severe acute respiratory syndrome, SARS, occurs in China’s southern province of Guangdong.
Mid-February 2003
China’s government reports 305 cases of atypical pneumonia and five deaths in Guangdong province.
Feb. 10
The World Health Organization, WHO, learns that the cases of atypical pneumonia began in November in China.
Feb. 14
Chinese authorities say the disease is under control.
Feb. 21
A professor, who treated patients in Guangdong province, travels to the Metropole Hotel in Hong Kong. He infects 12 other guests who spread the disease by travel to Vietnam, Canada and the United States.
2 / 6
Feb. 26
Doctors in Hong Kong report the first cases of what they called SARS.
Feb. 28
Cases of SARS appear in Vietnam, similar to those in Hong Kong.
March 12
The WHO issues a global health alert stating that a new, unrecognizable, flu-like disease may spread to health-care workers.
March 14
Canada reports its first case of SARS.
March 15
The WHO issues an emergency travel advisory, saying SARS is spreading worldwide. At the time, the agency did not restrict travel to any parts of the world. Instead, it warned travelers to be aware of the illness’ symptoms and to inform airport personnel if someone on their plane had those symptoms.
3 / 6
March 18
Doctors in Germany say they have found signs of a paramyxovirus in blood samples from one SARS patient. Scientists in Hong Kong confirm the findings in samples of two other patients. Paramyxovirus is a family of viruses that includes a pathogen causing measles. Scientists say the paramyxovirus theory makes sense, since pneumonia can be a complication of measles.
March 20
Hong Kong health officials link the global spread of SARS with the guest in a local hotel. Epidemiologists trace the illness back to the Chinese professor who stayed at Hong Kong's Metropole Hotel.
March 21
The Chinese government asks WHO for help investigating the outbreak in Guangdong province. A team of WHO experts travels to the region.
March 23
Scarborough Grace Hospital in Toronto closes temporarily because of SARS. The chief of Hong Kong's Hospital Authority is admitted to hospital with pneumonia-like symptoms. Doctors are not sure if he caught SARS.
March 24
CDC scientists say they have strong evidence that a type of coronavirus, which also causes the common cold and infects animals, may be responsible for SARS.
4 / 6
March 26
Ontario declares a public health emergency and orders thousands of people to quarantine themselves in their homes.
March 27
Passengers on international flights sitting near those with SARS come down with the disease, prompting WHO to tell Canada, Hong Kong and Singapore to screen passengers on flights.
March 31
Hong Kong’s health department issues an isolation order, requiring residents of an apartment block to stay inside until April 9 to stop the spread of SARS.
April 3
The CDC warns against all non-essential travel to Hong Kong, China, Singapore and Hanoi. Hong Kong relocates the citizens of an infected apartment block to isolation camps.
April 4
President Bush issues an executive order allowing the quarantine of healthy people suspected of being infected with SARS but who do not yet have symptoms.
5 / 6
April 7
The WHO recommends people consider postponing all non-essential travel to Hong Kong or Guangdong province. The WHO sends a team to Guangdong province to investigate the outbreak’s origins.
April 8
Doctors in China say there are more SARS cases than the government is reporting. Hong Kong reports 40 new cases a day for three days in a row. The CDC reports receiving a record number of phone calls from the U.S. public about SARS.
April 9
The WHO says China may be withholding information about SARS.
April 14
Canadian scientists sequence the DNA of the coronavirus believed to cause SARS
April 16
Scientists in the Netherlands confirm that a new form of coronavirus, other types of which cause the common cold, is the cause of SARS.
6 / 6
April 17
Hong Kong officials report that SARS spread through a leaky sewage system in an apartment complex where a quarter of the territory's 1,300 cases were identified.
April 18
China responds to criticism about how it is handling the SARS epidemic by being more open about cases.

Sources: Centers for Disease Control and Prevention and World Health Organization
Printable version

       Although the United States may have been spared a super-spreader, the disease is not under control throughout the world, with total cases now at more than 3,200. With air transmission not completely ruled out and the anecdotal experience of travelers saying they often catch respiratory illnesses after flying, it is no wonder people are worried.
       But, the experts say, it’s more likely that passengers caught their viruses in the airport or the city they’ve just visited than on the plane.
       Newer jets, experts remind us, are equipped with sophisticated air cleaning systems that employ stringent filters to screen out spores, bacteria and viruses.
       “We do several things to minimize disease spread on our airplanes,” says Dave Space, a research scientist for cabin air quality at the Boeing Company. “First, we design air flow patterns that minimize flow between the fore [front] and aft [back] parts of the plane.”

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       When the ventilation system is turned on, passengers get a mix of outside and recycled cabin air that’s been run through a HEPA, or a high-efficiency particulate air filter, Space says. HEPA filters remove extremely small particles, such as viruses and dust.
       In theory, filtration is a great way to clean up the air. But, despite the fact that aircraft manufacturers recommend that ventilation systems be running constantly while passengers are on board, often, when planes are sitting on the tarmac awaiting permission to take off, the system is turned off, experts say.
       “The real issue is when a plane is on the tarmac for an extended period of time,” Wisconsin’s Olds says. “At an airport like LaGuardia, you might sit on the tarmac for hours.”
       Even if the air is clean, passengers should remember that virus particles coughed or sneezed onto surfaces, like armrests and tray tables, may keep their potency for hours afterwards.
       Currently, airlines follow guidelines issued by the Centers for Disease Control and Prevention that call for extra disinfection if it turns out a SARS infected traveler was on board, says Diana Cronan, a spokesperson for the Air Transport Association, the trade association of U.S. airlines.
Sign up for our health e-newsletter        But, at the moment, the CDC does not recommend any special disinfection procedures. So, if a SARS infected person is on board, but not recognized, virus particles could be left behind on surfaces, experts say.
       “You could sit down in the very seat that a SARS infected person sat on,” says Dr. John A. Zaia, chairman of the department of virology at the Beckman Research Institute at the City of Hope in Duarte, Calif. “The arm rests might be contaminated. If you touch that and then rub your nose or eyes, that is potentially a risk.”
       For this reason, experts suggest frequent hand washing with either soap and water or an alcohol-based hand rub.
       When it comes to travel to Asian countries, the CDC and many infectious disease experts are currently recommending travelers postpone trips, if they can.
       But new safety measures taken by airlines and airports may lessen the risk for those travelers who must fly to affected countries.
       The Hong Kong Airport Authority, for example, has begun to take the body temperature of all outbound passengers to prevent the spread of SARS.
       Singapore Airlines has made airplane cleanup more stringent when flights originate from certain cities.
       Now, a plane flying between Singapore and Hong Kong will be disinfected prior to leaving Singapore and again prior to leaving Hong Kong, says James Boyd, an airline spokesperson. All hard surfaces, including overhead bins, guard rails, tray tables, video monitors and telephones are cleaned, he adds.
       The airline also has trained staff to spot symptoms that might help identify passengers who are infected with SARS, Boyd says. Any passenger who appears to have SARS symptoms will be referred to a doctor, he says.

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       The airport at Singapore also has changed its procedures, Boyd says. “Elevator buttons, water coolers doors and push plates are being disinfected hourly,” he adds. “And the handles for the moving sidewalks are cleaned after the arrival of a plane from a SARS affected country.”
       Public health officials in the United States also meet airplanes coming from affected countries and provide passengers with information sheets about SARS symptoms and the importance of contacting a doctor, if necessary.
       Ultimately, the risk of contracting SARS on a plane trip is probably small, experts say, especially if the trip isn’t to Asia.
       “If the travel is in the United States, South America or Europe, I wouldn’t lose any sleep worrying about SARS, Beth Israel’s Rosen says. “Of course you don’t know for sure, but life is full of uncertainty. If you want a guarantee of being safe, stay home and close the door.”

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