airplane travel and covid

• COVID-19 travel advice

Considering travel during the pandemic? Take precautions to protect yourself from COVID-19.

A coronavirus disease 2019 (COVID-19) vaccine can prevent you from getting COVID-19 or from becoming seriously ill due to COVID-19 . But even if you're vaccinated, it's still a good idea to take precautions to protect yourself and others while traveling during the COVID-19 pandemic.

If you've had all recommended COVID-19 vaccine doses, including boosters, you're less likely to become seriously ill or spread COVID-19 . You can then travel more safely within the U.S. and internationally. But international travel can still increase your risk of getting new COVID-19 variants.

The Centers for Disease Control and Prevention (CDC) recommends that you should avoid travel until you've had all recommended COVID-19 vaccine and booster doses.

Before you travel

As you think about making travel plans, consider these questions:

• Have you been vaccinated against COVID-19 ? If you haven't, get vaccinated. If the vaccine requires two doses, wait two weeks after getting your second vaccine dose to travel. If the vaccine requires one dose, wait two weeks after getting the vaccine to travel. It takes time for your body to build protection after any vaccination.
• Have you had any booster doses? Having all recommended COVID-19 vaccine doses, including boosters, increases your protection from serious illness.
• Are you at increased risk for severe illness? Anyone can get COVID-19 . But older adults and people of any age with certain medical conditions are at increased risk for severe illness from COVID-19 .
• Do you live with someone who's at increased risk for severe illness? If you get infected while traveling, you can spread the COVID-19 virus to the people you live with when you return, even if you don't have symptoms.
• Does your home or destination have requirements or restrictions for travelers? Even if you've had all recommended vaccine doses, you must follow local, state and federal testing and travel rules.

Check local requirements, restrictions and situations

Some state, local and territorial governments have requirements, such as requiring people to wear masks, get tested, be vaccinated or stay isolated for a period of time after arrival. Before you go, check for requirements at your destination and anywhere you might stop along the way.

Keep in mind these can change often and quickly depending on local conditions. It's also important to understand that the COVID-19 situation, such as the level of spread and presence of variants, varies in each country. Check back for updates as your trip gets closer.

Travel and testing

For vaccinated people.

If you have been fully vaccinated, the CDC states that you don't need to get tested before or after your trip within the U.S. or stay home (quarantine) after you return.

If you're planning to travel internationally outside the U.S., the CDC states you don't need to get tested before your trip unless it's required at your destination. Before arriving to the U.S., you need a negative test within the last day before your arrival or a record of recovery from COVID-19 in the last three months.

After you arrive in the U.S., the CDC recommends getting tested with a viral test 3 to 5 days after your trip. If you're traveling to the U.S. and you aren't a citizen, you need to be fully vaccinated and have proof of vaccination.

You don't need to quarantine when you arrive in the U.S. But check for any symptoms. Stay at home if you develop symptoms.

For unvaccinated people

Testing before and after travel can lower the risk of spreading the virus that causes COVID-19 . If you haven't been vaccinated, the CDC recommends getting a viral test within three days before your trip. Delay travel if you're waiting for test results. Keep a copy of your results with you when you travel.

Repeat the test 3 to 5 days after your trip. Stay home for five days after travel.

If at any point you test positive for the virus that causes COVID-19 , stay home. Stay at home and away from others if you develop symptoms. Follow public health recommendations.

Stay safe when you travel

In the U.S., you must wear a face mask on planes, buses, trains and other forms of public transportation. The mask must fit snugly and cover both your mouth and nose.

Follow these steps to protect yourself and others when you travel:

• Get vaccinated.
• Keep distance between yourself and others (within about 6 feet, or 2 meters) when you're in indoor public spaces if you're not fully vaccinated. This is especially important if you have a higher risk of serious illness.
• Avoid contact with anyone who is sick or has symptoms.
• Avoid crowds and indoor places that have poor air flow (ventilation).
• Don't touch frequently touched surfaces, such as handrails, elevator buttons and kiosks. If you must touch these surfaces, use hand sanitizer or wash your hands afterward.
• Wear a face mask in indoor public spaces. The CDC recommends wearing the most protective mask possible that you'll wear regularly and that fits. If you are in an area with a high number of new COVID-19 cases, wear a mask in indoor public places and outdoors in crowded areas or when you're in close contact with people who aren't vaccinated.
• Avoid touching your eyes, nose and mouth.
• Cover coughs and sneezes.
• Wash your hands often with soap and water for at least 20 seconds.
• If soap and water aren't available, use a hand sanitizer that contains at least 60% alcohol. Cover all surfaces of your hands and rub your hands together until they feel dry.
• Don't eat or drink on public transportation. That way you can keep your mask on the whole time.

Because of the high air flow and air filter efficiency on airplanes, most viruses such as the COVID-19 virus don't spread easily on flights. Wearing masks on planes has likely helped lower the risk of getting the COVID-19 virus on flights too.

However, air travel involves spending time in security lines and airport terminals, which can bring you in close contact with other people. Getting vaccinated and wearing a mask when traveling can help protect you from COVID-19 while traveling.

The Transportation Security Administration (TSA) has increased cleaning and disinfecting of surfaces and equipment, including bins, at screening checkpoints. TSA has also made changes to the screening process:

• Travelers must wear masks during screening. However, TSA employees may ask travelers to adjust masks for identification purposes.
• Travelers should keep a distance of 6 feet apart from other travelers when possible.
• Instead of handing boarding passes to TSA officers, travelers should place passes (paper or electronic) directly on the scanner and then hold them up for inspection.
• Each traveler may have one container of hand sanitizer up to 12 ounces (about 350 milliliters) in a carry-on bag. These containers will need to be taken out for screening.
• Personal items such as keys, wallets and phones should be placed in carry-on bags instead of bins. This reduces the handling of these items during screening.
• Food items should be carried in a plastic bag and placed in a bin for screening. Separating food from carry-on bags lessens the likelihood that screeners will need to open bags for inspection.

Be sure to wash your hands with soap and water for at least 20 seconds directly before and after going through screening.

Public transportation

If you travel by bus or train and you aren't vaccinated, be aware that sitting or standing within 6 feet (2 meters) of others for a long period can put you at higher risk of getting or spreading COVID-19 . Follow the precautions described above for protecting yourself during travel.

Even if you fly, you may need transportation once you arrive at your destination. You can search car rental options and their cleaning policies on the internet. If you plan to stay at a hotel, check into shuttle service availability.

If you'll be using public transportation and you aren't vaccinated, continue physical distancing and wearing a mask after reaching your destination.

Hotels and other lodging

The hotel industry knows that travelers are concerned about COVID-19 and safety. Check any major hotel's website for information about how it's protecting guests and staff. Some best practices include:

• Enhanced cleaning procedures
• Physical distancing recommendations indoors for people who aren't vaccinated
• Mask-wearing and regular hand-washing by staff
• Mask-wearing indoors for guests in public places in areas that have high cases of COVID-19
• Vaccine recommendations for staff
• Isolation and testing guidelines for staff who've been exposed to COVID-19
• Contactless payment
• Set of rules in case a guest becomes ill, such as closing the room for cleaning and disinfecting
• Indoor air quality measures, such as regular system and air filter maintenance, and suggestions to add air cleaners that can filter viruses and bacteria from the air

Vacation rentals, too, are enhancing their cleaning procedures. They're committed to following public health guidelines, such as using masks and gloves when cleaning, and building in a waiting period between guests.

Make a packing list

When it's time to pack for your trip, grab any medications you may need on your trip and these essential safe-travel supplies:

• Alcohol-based hand sanitizer (at least 60% alcohol)
• Disinfectant wipes (at least 70% alcohol)
• Thermometer

Considerations for people at increased risk

Anyone can get very ill from the virus that causes COVID-19 . But older adults and people of any age with certain medical conditions are at increased risk for severe illness. This may include people with cancer, serious heart problems and a weakened immune system. Getting the recommended COVID-19 vaccine and booster doses can help lower your risk of being severely ill from COVID-19 .

Travel increases your chance of getting and spreading COVID-19 . If you're unvaccinated, staying home is the best way to protect yourself and others from COVID-19 . If you must travel and aren't vaccinated, talk with your health care provider and ask about any additional precautions you may need to take.

Remember safety first

Even the most detailed and organized plans may need to be set aside when someone gets ill. Stay home if you or any of your travel companions:

• Have signs or symptoms, are sick or think you have COVID-19
• Are waiting for results of a COVID-19 test
• Have been diagnosed with COVID-19
• Have had close contact with someone with COVID-19 in the past five days and you're not up to date with your COVID-19 vaccines

If you've had close contact with someone with COVID-19 , get tested after at least five days. Wait to travel until you have a negative test. Wear a mask if you travel up to 10 days after you've had close contact with someone with COVID-19 .

• How to protect yourself and others. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/prevent-getting-sick/prevention.html. Accessed Feb. 4, 2022.
• Domestic travel during COVID-19. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/travelers/travel-during-covid19.html. Accessed Feb. 4, 2022.
• Requirement for face masks on public transportation conveyances and at transportation hubs. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/travelers/face-masks-public-transportation.html. Accessed Feb. 4, 2022.
• International travel. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/travelers/international-travel/index.html. Accessed Feb. 4, 2022.
• U.S citizens, U.S. nationals, U.S. lawful permanent residents, and immigrants: Travel to and from the United States. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/travelers/international-travel-during-covid19.html. Accessed Feb. 4, 2022.
• Non-US. citizen, non-U.S. immigrants: Air travel to the United States. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/travelers/noncitizens-US-air-travel.html. Accessed Feb. 4, 2022.
• People with certain medical conditions. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-medical-conditions.html. Accessed Feb. 4, 2022.
• Stay up to date with your vaccines. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/stay-up-to-date.html. Accessed Feb. 4, 2022.
• Pack smart. Centers for Disease Control and Prevention. https://wwwnc.cdc.gov/travel/page/pack-smart. Accessed Feb. 4, 2022.
• Travel: Frequently asked questions. Centers for Disease Control and Prevention. https://www.cdc.gov/coronavirus/2019-ncov/travelers/faqs.html. Accessed Feb. 7, 2022.
• Coronavirus (COVID-19) information. Transportation Security Administration. https://www.tsa.gov/coronavirus. Accessed Feb. 7, 2022.
• WHO advice for international traffic in relation to the SARS-CoV-2 Omicron variant (B.1.1.529). World Health Organization. https://www.who.int/news-room/articles-detail/who-advice-for-international-traffic-in-relation-to-the-sars-cov-2-omicron-variant. Accessed Feb. 7, 2022.
• VRHP/VRMA Cleaning guidelines for COVID-19. Vacation Rental Management Association. https://www.vrma.org/page/vrhp/vrma-cleaning-guidelines-for-covid-19. Accessed Feb. 7, 2022.
• Safe stay. American Hotel & Lodging Association. https://www.ahla.com/safestay. Accessed Feb. 7, 2022.
• Khatib AN, et al. COVID-19 transmission and the safety of air travel during the pandemic: A scoping review. Current Opinion in Infectious Diseases. 2021; doi:10.1097/QCO.0000000000000771.

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U.S. travel resources

• Check CDC recommendations for travel within the U.S.
• Review testing requirements for travel to the U.S.
• Look up restrictions at your destination .
• Review airport security measures .

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What is COVID-19?

Who can get covid-19, can i travel if i recently had covid-19, what can travelers do to prevent covid-19, more information.

CDC Respiratory Virus Guidance has been updated. The content of this page will be updated soon.

Coronavirus disease 2019 (COVID-19) is a respiratory illness caused by the virus SARS-CoV-2. The virus spreads mainly from person to person through respiratory droplets and small particles produced when an infected person coughs, sneezes, or talks. The virus spreads easily in crowded or poorly ventilated indoor settings.

People with COVID-19 have reported a wide range of symptoms   – ranging from no or mild symptoms to severe illness. Symptoms may appear 2–14 days after exposure to the virus. Possible symptoms include fever, chills, cough, shortness of breath, fatigue, muscle aches, headache, new loss of taste and smell, sore throat, runny nose, nausea, vomiting, or diarrhea.

Anyone can get COVID-19. However, some people are more likely than others to get very sick if they get COVID-19. These include people who are older, are  immunocompromised , or have certain  disabilities , or have  underlying health conditions .  Vaccination, past infection, and timely access to testing and treatment can help protect you from getting very sick from COVID-19.

Yes, you can travel once you have ended isolation . Check CDC guidance for additional precautions, including testing and wearing a mask around others. If you recently had COVID-19 and are recommended to wear a mask, do not travel on public transportation such as airplanes, buses, and trains if you are unable to wear a mask whenever around others.

Get  up to date  with your COVID-19 vaccines before you travel and take steps to protect yourself and others . Consider wearing a mask in crowded or poorly ventilated indoor areas, including on public transportation and in transportation hubs. Take additional precautions if you were recently exposed to a person with COVID-19. Don’t travel while sick.

If you have a  weakened immune system  or  are at increased risk for severe disease talk to a healthcare professional before you decide to travel.  If you travel, take multiple prevention steps to provide additional layers of protection from COVID-19, even if you are up to date with your COVID-19 vaccines. These include improving ventilation and spending more time outdoors, avoiding sick people, getting tested for COVID-19 if you develop symptoms, staying home if you have or think you have COVID-19, and seeking treatment if you have COVID-19.

Consider getting travel insurance in case you need medical care abroad .

Consider getting a COVID-19 test if you:

• Develop COVID-19 symptoms before, during, or after travel.
• Will be traveling to visit someone who is at higher risk of getting very sick from COVID-19.
• Were in a situation with a greater risk of exposure during travel (e.g., in an indoor, crowded space like an airport terminal while not wearing a mask).

If you traveled and feel sick, particularly if you have a fever, talk to a healthcare professional, and tell them about your recent travel.

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I Just Tested Positive for COVID. Should I Get on the Plane Anyway?

This is an ethical dilemma many of us are now facing: Is it OK to fly when I’ve got COVID? Outside’s travel expert weighs in.

Heading out the door? Read this article on the Outside app available now on iOS devices for members! >","name":"in-content-cta","type":"link"}}'>Download the app .

I’m about to go on spring break, and if I test positive for COVID before flying home, I can’t afford to isolate for five days in a place or miss extra work. It seems like everyone is coughing and sneezing on planes these days, and folks are opting to fly anyway. As much as I want to be a conscientious traveler, why should I pay another thousand bucks to stay in a hotel and quarantine for five days when nobody else appears to be doing that? —Weary of the Pandemic

You’re right. Most Americans are tired of dealing with pandemic rules and regulations—including the government. On January 30, President Biden announced that, as of May 11, the administration would officially shift away from treating COVID as a national public-health crisis and instead begin to manage it more like the flu or other seasonal respiratory disease. But does that mean we should be flying if we’re infected?

If you travel, even infrequently, and haven’t yet grappled with this question, chances are you will. I found myself in the throes of such a predicament right before the holidays. I was on assignment in Antarctica on a 100-passenger cruise ship, and although cruises were considered a hotbed for the coronavirus in the early days of the pandemic, almost two years later, any fear of catching the virus had faded from my mind. I should have known better and read the obvious signs: namely, being welcomed aboard by masked staff.

In hindsight, I probably should have taken a COVID test before flying home to New Jersey for Christmas to see my virus-phobic mom and immune-compromised aunt. But I’d been vaccinated, did not feel sick, and assumed that if anyone on the ship had gotten sick, we would have been alerted.

On the ten-hour leg of my flight from Buenos Aires to Houston, I sat next to a lovely elderly couple from the cruise, both of whom were vigilant about keeping on their N95 masks. Two days after I returned, I received an email from a passenger I’d befriended, who reported that at least a dozen people on the cruise had come down with COVID—including the couple I sat next to on the plane.

“Yes, I felt like an asshole,” a friend of mine who recently flew home when she thought she might have COVID admits. “Yes, I worried that I could’ve infected someone with a weak immune system. But people are coughing and sniffling on planes and in airports all the time.”

Thankfully, I tested negative, but the incident made me realize how easily I could have unknowingly gotten my family sick, perhaps with serious consequences. It also made me consider what the travel repercussions of testing positive might have been: missing Christmas with my family and having to quarantine alone in Ushuaia, Argentina, for at least five days (as recommended by the Centers for Disease Control and Prevention).

When I mentioned the situation to a friend, she admitted she’d recently taken a flight to Oahu, even though she knew she had COVID. “It’s so unethical, but I honestly was adamant about this trip,” she confided. “I needed a vacation, and I felt totally fine. I wore a mask, obviously.”

With Relaxed COVID Requirements, Many Sick Travelers Have Opted to Fly

We all have our reasons for traveling while sick. For better or for worse, sidestepping COVID guidelines has become much easier for travelers. For more than a year, providing timely proof of a negative COVID test ahead of your flight was a pricey, stressful hassle. So, as a road warrior, I was relieved when the CDC dropped this mandate for domestic travel last June. (Regulations for international travel have largely followed suit, with very few nations still requiring testing or proof of vaccination for inbound passengers; a full list of country-specific entry requirements can be found here .)

Quarantining while traveling has also been a costly and inconvenient part of the pandemic, as anyone who has been required to do it can attest. Now given the choice of traveling with COVID or hunkering down and isolating, which could cost thousands of dollars in hotel fees, room-service meals, missed work, and child care, many choose to fly infected with the coronavirus. And there are no rules stopping them from boarding a plane.

Last August, Ellen (not her real name) started to feel a tickle in her throat on the final day of her weeklong trip to Kauai. “I thought, Oh shit, I cannot get COVID right now,” she recalls. Her first vacation since pandemic travel restrictions had relaxed was, it turns out, anything but relaxing: The town of Hanalei felt super crowded. Restaurants averaged two-hour waits for dinner. And everything, from her Airbnb to meals, was expensive.

In this transitional period of the pandemic, many people are already treating COVID like the flu or a cold, says Henry Wu, director of the Emory TravelWell Center in Atlanta.

“By the last day of the trip, I started feeling run-down, and I really wanted to get home,” she says. “I didn’t want to be isolated in a last-minute, overpriced hotel room for five more days on the island and deal with flight-change costs. Not to mention my partner and I were due back at work.”

Ellen decided not to test before her flight back to the mainland, rationalizing that germs were everywhere and other passengers on her flight likely had COVID, too. She took extra precautions to assuage her guilt, double-masking with N95’s and sanitizing her hands more frequently than she normally would. But by the time she got home from the red-eye flight, she had a fever and sore throat, and when she finally took a COVID test, it was positive. Her partner, who had been around her unmasked at the height of contagion, never got sick.

“Yes, I felt like an asshole,” she admits. “Yes, I worried that I could’ve infected someone with a weak immune system. But people are coughing and sniffling on planes and in airports all the time.”

Amid the height of cold and flu season, it can seem like everyone traveling has a sniffle and the majority of people aren’t letting any illness—a common cold, COVID, or RSV among the top three this year and difficult to discern, based on symptoms—cancel big plans. In mid-January, Jamie DeLancey flew from Denver to San Francisco to watch the 49ers play in the NFL’s wild-card championship game, with what he assumed was a bad cold. He’d come down with COVID before and this felt different, so he did not test, noting that he hasn’t found such tests to be reliable. While he wore a mask on his flights, he didn’t wear one at the game.

In this transitional period of the pandemic, many people are already treating it like the flu or a cold, says Henry Wu, director of the Emory TravelWell Center in Atlanta. “In a way, that’s a logical rationale if you’re vaccinated and unlikely to get sick,” he says. “But that’s not the reality for some people who are elderly or immune-compromised. In many ways, things haven’t changed. If you’re sick and in contact with them, you could put them in the hospital.”

The CDC continues to advise avoiding travel if you are sick with or have tested positive for COVID, and isolating for at least five days after your positive test if you’re either asymptomatic or your symptoms first appear; following these guidelines, you should test again on day six and then wear a high-quality mask, such as an N95, when outdoors between days six and ten if you are around others, including on a plane. Whether the masses of travelers adhere to these is another thing altogether, as we’ve all seen play out on airlines.

How to Avoid Frustration, Fees, and Questionable Choices if You Get COVID Before or During a Trip

When Ross Holbrook flew from Denver to San José del Cabo, Mexico, with his wife and two young daughters last May, he watched his seatmate chug a bottle of DayQuil cold medicine. Holbrook was vaccinated and wearing a mask, but on day three of their family vacation, he tested positive for COVID; by day eight, his wife and one of the girls were also positive. Their Airbnb had a pool, so they made the best of things, but due to the mandatory quarantine rules in effect at the time, the family estimates they spent nearly $3,000 extending their car and Airbnb rentals. “We did consider driving home,” he says, but that idea was abandoned as impractical.

Five extra days in a destination like Mexico or Hawaii can cost a small fortune, not to mention difficult to find a room at the height of spring break or summer travel. What if you can’t afford to isolate and stay extra days in a place if you get COVID? Should you put off travel completely? Not necessarily, but you should have a COVID game plan that protects others, says Richard Martinello, the medical director of infection prevention at Yale New Haven Health in Connecticut.

“We all have busy lives, but as part of society, we have responsibilities not to put others in harm’s way, like not driving drunk,” he says. “Putting yourself in prolonged close contact with fellow travelers when you are knowingly sick, whether with COVID or any other contagious virus, is irresponsible. You never know who you’re sitting next to on a plane. If they’re immune-compromised, even a cold could push them over the edge to serious illness.”

Martinello acknowledges that the average traveler can’t afford to miss five additional days from work and home, so if you must travel sick, he suggests driving rather than flying or another form of public transportation. That said, if a partner or friend will be driving with you, they should be aware that you’re sick, he says, so they are consenting and can test and isolate appropriately.

Stuck somewhere like Hawaii, where flying home is the only option? Take every precaution to limit contagion spread. Wear an N95 mask. Paper surgical masks are the next best option, and homemade cloth masks even have some value in preventing the spread of germs, he says. You can also request to be moved next to an empty seat.

Check Your Airline’s COVID Policies

Several airlines, including Delta and United, continue to waive change fees for travelers looking to rebook due to COVID. Hawaiian Airlines will allow a one-time ticket change (with the difference in fares charged) for the same circumstances. Purchasing travel insurance for a flight also covers most COVID cancellations and rebookings.

Such thoughtful policies have prompted some travelers to make the morally conscious decision when illness sets in. Carmino DeMecurio was one of those people. He was booked to fly from New York City to Fort Lauderdale, Florida, for a business trip on January 19, but tested positive for COVID on January 16. He canceled the entire trip and said Delta immediately issued him an e-credit for a future flight. He was able to call in remotely for his meeting. “It wasn’t ideal to be the only person on a screen, but out of respect for others, it seemed like the right decision,” he says.

Consider Getting Travel Insurance

While airlines can be accommodating, quarantine lodging accommodations can be the real zinger for travelers. According to a spokesperson for the American Hotel and Lodging Association, it’s up to individual hotels to decide whether to offer a discounted rate if a guest must extend a stay due to quarantine. If you’ve splurged on a big trip, or you’re traveling far from home, trip insurance might be a smart investment. Allianz Travel Insurance recently added an Epidemic Coverage Endorsement to some of its plans. Under this new policy, if you have proof—a PCR test or a physician’s note—that you’ve tested positive for COVID during a trip, you can be reimbursed for unused, prepaid, nonrefundable trip costs, as well as additional accommodation and transportation costs incurred, depending on which situation applies.

Allianz’s OneTrip Basic policy, for example, offers up to $10,000 in trip cancellation and trip-interruption benefits per insured person, while the OneTrip Prime , the company’s most comprehensive policy, covers up to $100,000 in trip cancellation and up to $150,000 in trip-interruption benefits, with the option to tack on what’s called a Cancel Anytime upgrade, an option that reimburses travelers for up to 80 percent of prepaid, nonrefundable expenses for a trip that must be canceled for almost any reason not already covered by the policy.

According to an Allianz spokesperson, travelers can typically expect to pay 5 to 6 percent of the cost of their vacation for a standard travel-insurance policy. Actual prices will fluctuate based on a traveler’s age, state of residence, primary destination, length of stay, and total cost of their trip. For example, a 34-year-old from California traveling to Africa for a $9,700 three-week safari would pay $443 for a policy.

So should you travel with COVID if you come down with it on your upcoming spring-break trip? That depends on how prepared you are with a contingency plan, an adequate insurance policy, and the risk you’re willing to take when it comes to your personal health and the health of others, as you can still be hospitalized and even die from the virus. Not least is the ethical consideration of it all. Martinello advises travelers to follow the simple golden rule of “do unto others as you would have them do unto you.” And if you don’t trust your fellow air passengers—which, as this article reflects, are generally as eager to get away or get home as you are—do everyone a favor and wear a mask.

Any number of concerns are on our radar as we plan our next trip, from serious issues like how destinations are working to mitigate tourists’ environmental impact to inconveniences like months-long passport wait times. In this column, our travel expert Jen Murphy will be addressing your questions about how to navigate the world. Check out her previous  column, on how to avoid bed bugs during your next hotel stay, here . 

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Friendly skies? Study charts Covid-19 odds for plane flights

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What are the chances you will contract Covid-19 on a plane flight? A study led by MIT scholars offers a calculation of that for the period from June 2020 through February 2021. While the conditions that applied at that stage of the Covid-19 pandemic differ from those of today, the study offers a method that could be adapted as the pandemic evolves.

The study estimates that from mid-2020 through early 2021, the probability of getting Covid-19 on an airplane surpassed 1 in 1,000 on a totally full flight lasting two hours at the height of the early pandemic, roughly December 2020 and January 2021. It dropped to about 1 in 6,000 on a half-full two-hour flight when the pandemic was at its least severe, in the summer of 2020. The overall risk of transmission from June 2020 through February 2021 was about 1 in 2,000, with a mean of 1 in 1,400 and a median of 1 in 2,250.

To be clear, current conditions differ from the study’s setting. Masks are no longer required for U.S. domestic passengers; in the study’s time period, airlines were commonly leaving middle seats open, which they are no longer doing; and newer Covid-19 variants are more contagious than the virus was during the study period. While those factors may increase the current risk, most people have received Covid-19 vaccinations since February 2021, which could serve to lower today’s risk — though the precise impact of those vaccines against new variants is uncertain.

Still, the study does provide a general estimate about air travel safety with regard to Covid-19 transmission, and a methodology that can be applied to future studies. Some U.S. carriers at the time stated that onboard transmission was “virtually nonexistent” and “nearly nonexistent,” but as the research shows, there was a discernible risk. On the other hand, passengers were not exactly facing coin-flip odds of catching the virus in flight, either.

“The aim is to set out the facts,” says Arnold Barnett, a management professor at MIT and aviation risk expert, who is co-author of a recent paper detailing the study’s results. “Some people might say, ‘Oh, that doesn’t sound like very much.’ But if we at least tell people what the risk is, they can make judgments.”

As Barnett also observes, a round-trip flight with a change of planes and two two-hour segments in each direction counts as four flights in this accounting, so a 1 in 1,000 probability, per flight, would lead to approximately a 1 in 250 chance for such a trip as a whole.

All told, given about 204 million U.S. domestic airline passengers from June 2020 through February 2021, the researchers estimate that about 100,000 cases of Covid-19 were transmitted on flights during that time.

The paper, “ Covid-19 infection risk on U.S. domestic airlines ,” appears in advance online form this month in the journal Health Care Management Science . The authors are Barnett, who is the George Eastman Professor of Management Science in the MIT Sloan School of Management; and Keith Fleming, a student from MIT Sloan’s master’s program in business analytics.

Barnett is a longtime expert in airline safety who has analyzed the long-term reduction in aviation crashes in recent decades, among other topics. The current study about transmission of the Covid-19 virus was spurred by an airline policy change from early in the pandemic — Delta Air Lines started leaving open the middle seats on domestic flights, in order to de-densify its planes, a practice that some other airlines followed for a while. (Delta and all other airlines are no longer using this policy.)

To conduct the study, Barnett and Fleming amalgamated public health statistics about Covid-19 prevalence, data from peer-reviewed studies about Covid-19 contagion mechanisms, data about the spread of viruses on airlines generally and the spread of Covid-19 on international airlines, and some available industry data about seat-occupancy rates on U.S. domestic jet flights. They then estimated transmission risks on U.S. domestic airlines through extensive modeling.

The researchers used a two-hour flight for their estimates because that is about the average duration of a domestic flight in the U.S. As their airplane settings, the scholars used a Boeing 737 and Airbus A320, workhorse planes in the U.S. with a single aisle, three seats on either side, and typical capacities of about 175 passengers. Most such planes do have high-functioning HEPA air-purification systems, which help reduce the transmission risk of airborne illnesses.

Using the prevalence of Covid-19 in the U.S. as a starting point, and integrating airborne transmission data, Barnett and Fleming modeled what would likely happen on flights filled with a wide variety of passenger loads. The modeling includes a series of adjustments to make the passenger profile as realistic as possible. For instance, airline passengers are a bit more affluent than the U.S. population as a whole, and Covid-19 has affected more affluent populations slightly less than other social groups, so those things are quantified in the study, among other factors.

Ultimately Barnett and Fleming did find a notable dropoff in transmission risk when planes have fewer people on them — whether having fewer passengers is due to lack of demand, or because airlines were leaving middle seats open. While it is true that leaving middle seats open does not eliminate all proximity with all other passengers, it does reduce the extent of close proximity with others, and thus appears to lower the overall transmission risk. 

“The [medical] literature suggests the proximity matters,” Barnett says.

As Barnett readily notes, pandemic circumstances and airline policies keep evolving, meaning that their estimates for the 2020-2021 period in the study may not translate precisely to the summer of 2022. Even despite the availability of vaccines, he believes the reduced amount of masking, the more-crowded flights, and easy transmissibility of current variants all mean that risks could have increased.

“If we were to do an estimate of the chances of infection now, it could be considerably higher,” Barnett says.

Still, he adds, the approach used in this paper could readily be adapted to updated studies about in-flight transmission risks, for Covid-19 or other viruses.

“Modeling like that presented here could help in assessing the changed situation, much as the general approach might help in connection with a future pandemic,” Barnett and Fleming write in the paper.

Open access funding making the paper free for readers was provided by MIT Libraries.

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Coronavirus Updates

Cdc says travel is safe for fully vaccinated people, but opposes nonessential trips.

Rachel Treisman

The Centers for Disease Control and Prevention updated its domestic travel guidance for fully vaccinated people on Friday, lifting certain requirements while continuing to advise mitigation measures like mask-wearing and hand-washing. Angus Mordant/Bloomberg via Getty Images hide caption

The Centers for Disease Control and Prevention updated its domestic travel guidance for fully vaccinated people on Friday, lifting certain requirements while continuing to advise mitigation measures like mask-wearing and hand-washing.

The Centers for Disease Control and Prevention has updated its domestic travel guidance for fully vaccinated people, lifting certain testing and self-quarantine requirements and recommending precautions like wearing a mask and avoiding crowds. But health officials continue to discourage nonessential travel, citing a sustained rise in cases and hospitalizations.

The CDC updated its website on Friday to reflect the latest scientific evidence, writing that "people who are fully vaccinated with an FDA-authorized vaccine can travel safely within the United States."

The announcement comes less than a month after the CDC first released updated guidance about gatherings for fully vaccinated people, which it described as a "first step" toward returning to everyday activities.

Air Travel Is Opening Up Again, But That Doesn't Mean The Pandemic Is Over

The CDC considers someone fully vaccinated two weeks after they receive the last dose of vaccine. Those individuals will no longer need to get tested before or after travel unless their destination requires it, and do not need to self-quarantine upon return.

The new guidance means, for example, that fully vaccinated grandparents can fly to visit their healthy grandkids without getting a COVID-19 test or self-quarantining as long as they follow other recommended measures while traveling, according to CDC Director Rochelle Walensky.

Those measures include wearing a mask over their nose and mouth, staying 6 feet from others and washing their hands frequently. Masks are required on all planes traveling into, within or out of the U.S., under an executive order issued by President Biden.

But Walensky, speaking at a White House COVID-19 Response Team briefing on Friday, nonetheless discouraged all nonessential travel, citing a continued increase in the seven-day average of cases and hospitalizations.

"While we believe that fully vaccinated people can travel at low risk to themselves, CDC is not recommending travel at this time due to the rising number of cases," Walensky said.

CDC Director Fears 'Impending Doom' If U.S. Opens Too Quickly

She said that while vaccinated people can do more things safely, most Americans are not yet fully vaccinated. Those who are not must have a negative test 1-3 days before they travel under CDC guidance. They must either get tested 3-5 days after they return and self-quarantine for 7 days, or self-quarantine for 10 days with no test.

Walensky said on Monday that there is more travel occurring now than throughout the pandemic, including the winter holidays. She acknowledged that people have been looking to get away over spring break or take advantage of what they perceive as a "relative paucity in cases," and she said the country was seeing an uptick in cases as a result.

"The thing that's different this time is that we actually have it in our power to be done with the scale of the vaccination," she said. "And that will be so much slower if we have another surge to deal with as well."

The U.S. is already seeing an uptick in domestic travel, and many Americans are looking to book trips in the coming months in what experts described to NPR as a sign of "clear pent up demand for travel."

As the country's supply of COVID-19 doses has grown, so has Biden's goal for the number of shots in arms during his first 100 days, doubling the target to 200 million by the end of this month. Many states have already expanded eligibility to all adults or are set to do so in the coming weeks, well ahead of the president's May 1 deadline.

According to NPR's vaccine tracker , 16.9% of the U.S. population is fully vaccinated, and 30% has had at least one dose. Researchers estimate that 70% to 85% of the country would need to have immunity for COVID-19 to stop spreading through communities.

International travel restrictions remain

The CDC is not lifting travel restrictions barring the entry of most non-U.S. citizens from places including China, Brazil, South Africa and parts of Europe. It will continue to require airline passengers entering the U.S. to get a test within three days of their departure and show proof of a negative result before boarding.

The travel industry has been pushing for some of these restrictions to end. A group of 26 organizations sent a letter to White House COVID-19 czar Jeffrey Zients urging the federal government "to partner with us to develop, by May 1, 2021, a risk-based, data-driven roadmap to rescind inbound international travel restrictions."

While Some Spring Breakers Swarm Beaches, Many Stay Home, Dreaming Of Summer Travel

"To be clear, at this time, we do not support removal or easing of core public health protections, such as the universal mask mandate, inbound international testing requirement, physical distancing or other measures that have made travel safer and reduced transmission of the virus," they wrote. "However, the data and science demonstrate that the right public health measures are now in place to effectively mitigate risk and allow for the safe removal of entry restrictions."

Travel and tourism have taken a considerable hit because of the pandemic with industry groups noting that overseas travel to the U.S. declined by 81% in 2020, causing billions of dollars in losses. Without lifting international travel bans, the U.S. Travel Association estimates that some 1.1 million American jobs will not be restored and billions in spending will be lost by the end of the year.

"Fortunately, enough progress has been made on the health front that a rebound for domestic leisure travel looks possible this year, but that alone won't get the job done," Roger Dow, the association's president and CEO, said in a statement . "A full travel recovery will depend on reopening international markets, and we must also contend with the challenge of reviving business travel."

Fauci Expects Surge In Vaccinations To Keep A 4th Coronavirus Wave At Bay

• COVID-19 vaccine
• Centers for Disease Control and Prevention

Should I mask for my flight? What to know about COVID and traveling.

There’s no quicker way to ruin a vacation than getting sick, and travelers should be wary of catching a respiratory virus during their journeys.

It could end up as just the common cold, or be something more serious like the flu or COVID -19. 

Since the winter season began, the Centers for Disease Control and Prevention has noticed “elevated and increasing (though not dramatically)” COVID-19 activity in the U.S., the agency said in late December. Particularly, travelers should be aware of the latest most widely circulating COVID-19 variant, JN.1.

“JN.1’s continued growth suggests that the variant is either more transmissible or better at evading our immune systems than other circulating variants,” the agency said.

Travelers are always at a higher risk of catching COVID-19 since they’re moving quickly through multiple places. The CDC’s Traveler-Based SARS-CoV-2 Genomic Surveillance – which collects samples from international travelers arriving from more than 25 countries at major U.S. airports – found a 32.9% positivity rate for pooled samples the week of Jan. 1. The following week showed a slight decline with a positivity rate of 27.8%. The most common variant found in these travelers was JN.1.  

Learn more: Best travel insurance

Here’s what to know if you’re traveling soon and wondering about your risk of COVID-19 and how to stay safe:

Are COVID cases rising?

Coronavirus cases were recently on the rise, but have been declining as of about two weeks ago. 

For a while, the JN.1 variant was spreading rapidly. In December, the CDC said hospital admissions for COVID-19 increased by more than 50% . The week ending on Jan. 9 saw 34,876 new COVID-19 hospital admissions in the U.S. – the highest since a year ago on Jan. 24, 2023. 

However, the most recently released data of the week ending Jan. 20 reported a 14% decline in hospital admissions and a 1.2% decline in test positivity. 

The states with the highest rates of new hospitalizations last week were New York, Massachusetts, New Jersey, West Virginia, Connecticut and Arkansas. 

The states and territories that saw the highest week-over-week increase in COVID-19 hospitalization rates were Puerto Rico, with 36.3% more hospitalizations last week than the week before, and New Mexico, which had 24% more. Alaska also had a 13.9% rate increase. 

From Reviewed: We tried the Lucira COVID-19 and flu test — Here's what to know about the at-home kit

What are the masking rules in air travel?

Federal law no longer requires passengers to wear face masks on domestic flights as of Spring 2022, so it’s up to individuals to mask. Since then, nearly all international destinations have also dropped their own mandates requiring masks in planes and airports. If you do want to mask up, some airlines like Southwest Airlines can provide one. 

Is the air quality safe inside a plane?

For the most part, yes. Airplane ventilation systems are effective at making the onboard air as clean as an operating room , Leonard Marcus, director of the Aviation Public Health Initiative at Harvard University, told USA TODAY in April 2022. 

When a plane is in flight, its ventilation system draws in air from outside and discharges half of the “used” air back outside while filtering the rest, so air is constantly moving inside the plane, helping to greatly reduce transmission risks. It may not feel like it, but the air inside a plane is being exchanged at a rate of about 10 times more than in typical office buildings. 

I measured CO2 levels on a plane: It showed me when I was most likely exposed to COVID

A 2020 study in the Journal of the American Medical Association found that the risk of catching COVID-19 during air travel is low, thanks to the continuous exchange of air and the flow from top to bottom. 

When grounded, the plane has to use an onboard auxiliary power unit to operate the ventilation system and also pump in air from an outside air compressor. 

Most aircraft also use high-efficiency particulate air, or HEPA, filters that catch at least 99.97% of dust, pollen, mold, bacteria and the tiniest of particles, including COVID-19.

Should I wear a mask while traveling?

Although airlines said their cleaning processes meet CDC guidelines and passengers are usually given sanitizing wipes when they board a plane, experts agree that masks add an extra layer of protection against contracting COVID-19 during air travel. Outbreaks on planes can still happen when some passengers are infected.

The CDC recommends people wear a high-quality mask like an N95 when in crowded or tight spaces, like on the airport jetway to board a plane, or if travelers are passing through a destination with high levels of respiratory illnesses. 

Passengers exposed to someone with COVID-19 within 10 days or feeling under the weather, should mask, cancel or rebook their flight. 

Wearing a mask while traveling is also just a good gesture to fellow passengers. “Wearing a mask during travel can also help protect others who cannot avoid being in crowded places when they are traveling,” said the CDC. 

Kathleen Wong is a travel reporter for USA TODAY based in Hawaii. You can reach her at [email protected] .

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What to Know About the C.D.C. Guidelines on Vaccinated Travel

In updated recommendations, the federal health agency said both domestic and international travel was low risk for fully vaccinated Americans. But travel remains far from simple.

• Share full article

By Ceylan Yeginsu

The Centers for Disease Control and Prevention updated its guidance for fully vaccinated Americans in April, saying that traveling both domestically and internationally was low risk.

The long-awaited recommendations were issued by federal health officials after a series of studies found that vaccines administered in the United States were robustly effective in preventing infections in real-life conditions.

One is considered fully vaccinated two weeks after receiving the single dose of the Johnson & Johnson vaccine, or two weeks after receiving the second dose of the Pfizer-BioNTech or Moderna shots.

If you decide to travel, you might still have some questions. Here are the answers.

Will I still need to wear a mask and socially distance while traveling?

Yes. Under federal law, masks must be worn at airports in the United States, onboard domestic flights and in all transport hubs. The C.D.C. says that as long as coronavirus measures are taken in these scenarios, including mask wearing, fully vaccinated Americans can travel domestically without having to take a test or quarantine, although the agency warns that some states and territories may keep their local travel restrictions and recommendations in place.

For those wishing to travel internationally, a coronavirus test will not be required before departure from the United States unless mandated by the government of their destination. Vaccinated travelers are still required to get tested three days before travel by air into the United States, and are advised to take a test three to five days after their return, but will not need to self-quarantine.

Can I go abroad?

Yes, but only to countries that will have you.

More than half the world’s countries have reopened to tourists from the United States, including the countries of the European Union , which on June 18 added the United States to its “safe list” of countries, meaning that American travelers can now visit. While the European Union aims to take a coordinated approach to travel this summer, member states will be allowed to set their own requirements for travelers from individual countries based on their own epidemiological criteria, which means they may require testing or vaccination.

Some places like Turkey, Croatia and Montenegro had already been welcoming Americans with negative test results. Greece joined that growing list in May, ahead of most European countries, opening to fully vaccinated tourists and other foreigners with a negative test.

Many Caribbean nations have reopened to American tourists, but each has its own coronavirus protocols and entry requirements.

Here’s a full list of countries Americans can currently travel to.

What about domestic travel? Is it free and clear to cross state borders?

If you are fully vaccinated, the C.D.C. says you can travel freely within the United States and that you do not need to get tested, or self-quarantine, before or after traveling. But some states and local governments may choose to keep travel restrictions in place, including testing, quarantine and stay-at-home orders. Hawaii , for instance, still has travel restrictions in place.

Before you travel across state lines, check the current rules at your destination.

How are they going to check that I’m fully vaccinated?

Right now, the best way to prove that you have been vaccinated is to show your vaccine card .

Digital vaccine and health certificates showing that people have been vaccinated or tested are in various stages of development around the world and are expected, eventually, to be widely used to speed up travel.

The subject of “ vaccine passports ” is currently one of the most hotly debated topics within the travel industry, with questions over the equity of their use and concerns over health and data privacy.

In early April, Gov. Ron DeSantis of Florida issued an executive order that would ban local governments and state businesses from requiring proof of vaccination for services.

And in March, the European Union endorsed its own vaccine certificate , which some countries are already using, with more expected to adopt it by July 1.

But what about my kids? What’s the guidance on traveling with unvaccinated people?

The C.D.C. advises people against travel unless they have been vaccinated. If you must travel, the agency recommends testing one to three days before a trip and following all coronavirus guidance at your destination.

In May, the F.D.A. expanded its emergency use authorization of the Pfizer-BioNTech coronavirus vaccine to include adolescents between 12 and 15 years of age.

All air passengers aged two and older coming into the United States, including fully vaccinated people, are required to have a negative Covid-19 test result taken no more than three days before they board their flight.

What is my moral obligation to the places I visit where most people are not vaccinated?

The United States inoculation rollout has been among the fastest in the world, but there is a stark gap between its rapid rollout and the vaccination programs in different countries. Some nations have yet to report a single dose being administered.

Many countries are currently seeing a surge in new cases and are implementing strict coronavirus protocols, including mask mandates in public spaces, capacity limits at restaurants and tourist sites and other lockdown restrictions.

It is important to check coronavirus case rates, measures and medical infrastructure before traveling to your destination and not to let your guard down when you get there. Even though you are fully vaccinated, you may still be able to transmit the disease to local communities who have not yet been inoculated.

You can track coronavirus vaccination rollouts around the world here.

Follow New York Times Travel on Instagram , Twitter and Facebook . And sign up for our weekly Travel Dispatch newsletter to receive expert tips on traveling smarter and inspiration for your next vacation.

Ceylan Yeginsu is a London-based reporter. She joined The Times in 2013, and was previously a correspondent in Turkey covering politics, the migrant crisis, the Kurdish conflict, and the rise of Islamic State extremism in Syria and the region. More about Ceylan Yeginsu

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Air travel and COVID-19 prevention in the pandemic and peri-pandemic period: A narrative review

Michel bielecki.

a University of Zürich Centre for Travel Medicine, WHO Collaborating Centre for Travellers' Health, Epidemiology Biostatistics and Prevention Institute, Hirschengraben 84, CH-8001, Zürich, Switzerland

Dipti Patel

b National Travel Health Network and Centre, UCLH NHS Foundation Trust, 250 Euston Road London, NW1 2PG, United Kingdom

Jochen Hinkelbein

c Department of Anaesthesiology and Intensive Care Medicine, University Hospital and Medical Faculty, Cologne, Germany

d Space Medicine Group, European Society of Aerospace Medicine (ESAM), Cologne, Germany

e German Society of Aerospace Medicine (DGLRM), Munich, Germany

Matthieu Komorowski

f Space Medicine Group, European Society of Aerospace Medicine (ESAM), Cologne, Germany Department of Surgery & Cancer, Imperial College Healthcare NHS Trust, St Mary's Campus, Praed St, Paddington, London, W2 1NY, UK

g Intensive Care Unit, Charing Cross Hospital, Imperial College Healthcare NHS Trust, Fulham Palace Road, London, W6 8RF, UK

John Kester

h Independent Researcher and Expert on Tourism, Former Director of Statistics, Trends and Policy at the United Nations World Tourism Organization (UNWTO), Spain

Shahul Ebrahim

k Faculty of Medicine, University of Sciences, Techniques, and Technology, Bamako, Mali

Alfonso J. Rodriguez-Morales

i Public Health and Infection Research Group, Faculty of Health Sciences, Universidad Tecnológica de Pereira, Pereira, Risaralda, Colombia

j Grupo de Investigación, Biomedicina, Faculty of Medicine, Fundación Universitaria Autónoma de Las Américas, Pereira, Risaralda, Colombia

Ziad A. Memish

l Alfaisal University, Riyadh, Saudi Arabia

m Hubert Department of Global Health, Rollins School of Public Health, Emory University, Atlanta, GA, USA

Patricia Schlagenhauf

Air travel during the COVID-19 pandemic is challenging for travellers, airlines, airports, health authorities, and governments. We reviewed multiple aspects of COVID peri-pandemic air travel, including data on traveller numbers, peri-flight prevention, and testing recommendations and in-flight SARS-CoV-2 transmission, photo-epidemiology of mask use, the pausing of air travel to mass gathering events, and quarantine measures and their effectiveness.

Flights are reduced by 43% compared to 2019. Hygiene measures, mask use, and distancing are effective, while temperature screening has been shown to be unreliable. Although the risk of in-flight transmission is considered to be very low, estimated at one case per 27 million travellers, confirmed in-flight cases have been published. Some models exist and predict minimal risk but fail to consider human behavior and airline procedures variations. Despite aircraft high-efficiency filtering, there is some evidence that passengers within two rows of an index case are at higher risk. Air travel to mass gatherings should be avoided. Antigen testing is useful but impaired by time lag to results. Widespread application of solutions such as saliva-based, rapid testing or even detection with the help of “sniffer dogs” might be the way forward. The “traffic light system” for traveling, recently introduced by the Council of the European Union is a first step towards normalization of air travel. Quarantine of travellers may delay introduction or re-introduction of the virus, or may delay the peak of transmission, but the effect is small and there is limited evidence. New protocols detailing on-arrival, rapid testing and tracing are indicated to ensure that restricted movement is pragmatically implemented. Guidelines from airlines are non-transparent. Most airlines disinfect their flights and enforce wearing masks and social distancing to a certain degree. A layered approach of non-pharmaceutical interventions, screening and testing procedures, implementation and adherence to distancing, hygiene measures and mask use at airports, in-flight and throughout the entire journey together with pragmatic post-flight testing and tracing are all effective measures that can be implemented.

Ongoing research and systematic review are indicated to provide evidence on the utility of preventive measures and to help answer the question “is it safe to fly?“.

1. Introduction

COVID-19 has changed traveller numbers, destinations and flight patterns and the situation remains in constant flux. Travellers must comply with protective measures as considered appropriate by the country of departure, the country of arrival and the transporter, in particular airlines. There is confusion with regard to the risk of transmission of SARS-CoV-2. On one hand there is the risk of infection in-flight or at airports, which airlines address with measures such as the use of filters, monitoring and testing of passengers. On the other hand, governments try to limit the risk of transporting infectious passengers from abroad or within a country with measures such as travel bans and quarantines.

Despite large numbers of studies, there is still only scant evidence evaluating protective measures for air travel or indeed for everyday life. How useful are masks, hand sanitisers, thermo screening, pre-flight testing, seat distancing and air filtration systems respectively? Which measures are scientifically proven to have a benefit, and which are merely there to show that an effort is being made? There is a lack of unanimity throughout the world with respect to the definition of risk areas and thresholds for restricted travel as well as to the necessity, effectiveness, duration and implementation of quarantine measures. Airlines are struggling to be compliant with COVID-19 prevention guidelines while somehow retaining at least partial flight services. Travellers are struggling with the decision “Should I stay, or should I go?“. This narrative review aims to assess the status quo of air travel measures in the context of COVID-19 as of October 2020 and to examine their scientific basis if appropriate.

As a group, we divided up topics related to air-travel in the pandemic period and did a rapid narrative review on each of the assigned sub-topics. For identification of relevant publications, a standardized search strategy was used. The PubMed, Scopus and Web of Sciences databases were searched by using the search terms “In-flight”, “flight”, “transmission”; “SARS-CoV-2″, “airborne”, “respiratory”, “aviation”, “COVID”, “COVID-19”, “Corona”, “aircraft” in various combinations with the terms “cabin”, “transmission”, “social distancing”, “quarantine” and testing”. Additionally, cited publications in the original hits were screened and included if relevant, with no restrictions on language and years. IATA, flightradar24 and Forwardkeys were sources of information on air transport volumes. We checked official websites, did an airline survey by email or contacted airlines via social media to evaluate pre-flight and in-flight measures/precautions/recommendations adapted by airlines.

3.1. Travel numbers

Air travel numbers have significantly declined. The International Air Transport Association (IATA) reported worldwide passenger departures totalling 4.5 billion on 39 million scheduled flights in 2019 (117 per flight on average). Revenue Passenger Kilometers (RPKs) flown were 8.7 trillion in 2019 (with 1911 km per departure on average).

For 2020 IATA foresees a substantial reduction in numbers, with passenger departures projected at 2.2 billion (−51.6%), flights at 23 million (−40.6%) and RPKs at 3.9 trillion (−54.7%) (with 1749 km per passenger on average) [ 1 ], [ Table 1 ]. Data refers to international flights (between countries and territories) as well as domestic flights (within countries and territories). Based on mode of transport, 58% of international overnight visitors reached their destination by air in 2018 according to the World Tourism Organization (UNWTO) [ 2 ]. As for international travel, the vast majority of flights are within the same world region, rather than flights between regions.

IATA, worldwide airline industry.

Source: compiled from International Air Transport Association (IATA) Airline Industry Economic Performance - June 2020 – Report & Data tables https://www.iata.org/en/publications/economics/?Search=&EconomicsL1=149&EconomicsL2=150 * Departures refer to legs flown, so # of round trips is half for direct flights, and a third or less for indirect flights.

Domestic air travel is rather concentrated in the large populous countries such as the US, China, India, Indonesia, Japan, the Russian Federation and Brazil.

Commercial flights (including cargo, but excluding private flights, some business jet flights, most helicopter, ambulance, military and drone flights) are tracked flights in virtual real-time by Flightradar24 and offer insight in flight evolution over time. The year 2020 started with growth in January in commercial flights. In February there was a moderate decrease because of the disruption of traffic within and to/from China. With the lockdowns increasingly being installed in many countries, flights were 55% down in the final week of March 2020 compared to the same period of 2019 [ 3 ]. In April 2020, flights were 74% below the same month in 2019, but showed early signs of a turning point at the very end of the month [ 4 ]. This slow recovery continued with flights down 71% in May [ 5 ], 62% in June [ 6 ], 50% in July [ 7 ], 45% in August [ 8 ], 43% in September and 42% in October 2020 [ 9 ]. At the height of the pandemic, a majority of countries closed borders for inbound and/or outbound travel with traffic limited to repatriation of travellers and essential travel, or sometimes for all travel. In some cases, mandatory quarantine was ordered. Rising numbers at the end of August and throughout September have seen European countries adapt recommendations and restrictions with changes being implemented at short notice. At the start of October, at the time of writing, a second wave of COVID-19 is moving through Europe necessitating multiple travel restrictions.

Domestic travel has been overall less restricted. The travel analytics company, Forwardkeys, based on its latest analysis, expects domestic air travel in China to have fully recovered by the start of September 2020. This is highly significant, because it is the first time, since the start of the COVID-19 outbreak, that a major segment of the aviation market, anywhere in the world, has returned to pre-pandemic levels [ 10 ].

The most resilient travel flows and the projected quickest to recover include the following [ 10 ]:

• • Nearby destinations, domestic or neighboring countries
• • Late bookings and private transport
• • Visiting family, friends and relatives (VFR)
• • Essential business travel, such as visiting clients, and providers. Meetings on the other hand are predicted to be held virtually when at all possible.

3.2. Quarantine measures and travel bans

COVID-19 has changed how we travel; travel advisories and travel bans as well as quarantine or self-isolation when entering a country are now commonplace. For the international traveller, the variable and broad border measures now mean that they not only need to consider disease risk, but also need to take into account the need for quarantine at their destination, on their return, or both. Travel restrictions and quarantine are often the first response against emerging infectious disease threats [ 11 ]. They are used as public health tools to combat the international spread of COVID-19, although their utility is yet to be determined. The rationale for the implementation of quarantine is complex, based on a combination of factors such as economy, political agenda, and changing knowledge and epidemiology. Differing national and international guidance, evolving evidence, and the potential for recommendations to change rapidly make travel a lot more complex [ Table 2 ].

Some Factors that may be considered when making quarantine decisions.

3.3. Travel advisories and bans

International travel advisories have been introduced, but where is the evidence that such bans are effective? While the direct effect of such advisories is difficult to quantify, travel advisories during the SARS epidemic in 2003 did result in a significant reduction in travel, but these were considered to be too late and too small to influence the global spread of SARS had there not been such effective control of the epidemics within affected areas [ 12 ].

Similarly, travel bans have been introduced in response to other emerging infectious disease threats, but the evidence relating to their impact has been inconsistent [ 13 ]. An analysis of the 2009 H1N1 pandemic showed that the decline in air travel to and from Mexico was too small to have an impact, and stricter restrictions would have led to delays of about two weeks even with early intervention [ 14 ]. Border closure were, however, shown to be effective in controlling the 1918–19 influenza pandemic in various Pacific islands [ 15 ], and theoretically might be helpful in small island nations with low traveller numbers [ 16 ], but a systematic review of the effectiveness of travel restrictions in containing the spread of influenza showed that in general, travel restrictions had only limited effect, and the degree of impact was dependant on multiple factors ranging from the extent and timing of the restrictions, the epidemic size, to virus transmissibility and travel patterns.

The review concluded that only extensive travel restrictions had any meaningful effect on reducing the magnitude of epidemics, and on their own, might delay the spread and peak of pandemics by a few weeks or months but the evidence for containment of influenza within a defined geographical area was lacking [ 17 ].

In the case of COVID-19, the evidence reveals a similar picture; some research has indicated a negligible effect of travel bans [ 18 ], and other studies have suggested a delay in disease spread and case numbers, albeit with a recognition that complete travel bans are unlikely to be sustainable in the longer term [ 19 , 20 ]. Yet, the current situation and patchwork of bans and quarantine measures is unprecedented in scale.

3.4. Quarantine recommendations, their usefulness and risks

Quarantine (the restriction of asymptomatic healthy people who may have had exposure to an infectious disease) after travel is one of the oldest, public health tools known. Adopted widely in the fourteenth century to stop the spread of plague, quarantine has subsequently been used with varying degrees of success following international travel.

Following the 2003 SARS outbreak, an assortment of quarantine approaches was used in five severely affected countries/regions. While measures were highly effective in reducing onward transmission of SARS by containment of imported cases on arrival, implementation of quarantine was resource intensive, involved coordination of multiple sectors of society, frequently required new legislative actions or authorities, and was highly dependent on effective communication [ 21 , 22 ].

In the context of COVID-19, a Cochrane review found that quarantine is important in reducing incidence and mortality, and early implementation combined with other public health measures is important to ensure effectiveness. They also concluded that the quarantine of travellers from a country with a declared outbreak may delay its introduction or re-introduction, or may delay the peak of transmission, or both, but the effect was small, and their confidence in the results was low or very low due to the limitations in the evidence available [ 23 ].

As of 3rd September, an estimated 156 countries or territories have introduced some form of traveller quarantine measures [ 24 ], and in the absence of any international consensus this means that approaches to quarantine and how it is implemented (voluntary/mandated, home/government facility, individual/group etc) will vary from country to country; likely based on a combination of factors, including epidemiology, culture, local context, economic imperatives and political factors. However, any decision to introduce quarantine measures is not without risk, requires adequate resourcing, and needs to account for the potential negative effects, which are increasingly being reported [ 25 ].

As of October 9th, the Council of the European Union introduced a “ traffic light system ” based on infection rate per 100′000 people. The European Centre for Disease Prevention and Control (ECDC) will publish a map weekly categorizing EU regions into different zones for which different rules will apply. This is being complicated by countries being able to additionally set their own rules. A common testing regime has still not been set out making the framework difficult to work and further adding uncertainty to travel as nations are only required to provide information on new restrictions 24 h before enforcement [ 26 ].

3.5. Pre-flight passenger screening

COVID-19 has led to unprecedented lockdowns and reduction of air travel globally, fuelled by fear of trans -border introduction of the virus and onboard transmissions. The fear is not ungrounded as past instances with SARS-COV have shown that superspreader events can lead to hundreds of new infections. Transmission mainly occurs in the symptomatic phase of the illness [ 27 , 28 ]. However, many infections in SARS-CoV-2 are also associated with contact to asymptomatic or presymptomatic patients [ 29 , 30 ].

In essence, flying will be safer and superspreading events diminished by optimizing screening procedures, minimizing the risk of allowing pre- or asymptomatic patients to board, and consequent implementation and adherence to simple hygiene measures that prevent the spread of diseases.

Various strategies have been introduced to detect SARS-CoV-2 carriers including temperature screening, which is currently advised by IATA [ 31 ]. A recent paper has shown the lack of utility of temperature screening in the identification of young infected persons. Another option is demanding negative PCR tests before letting passengers board, a strategy Swiss Airlines is partly pursuing by allowing mask free travel with a medical certificate and a negative PCR test [ 32 ]. Certain destination countries also require a negative PCR test at point of entry [ 33 ].

Simple measures, such as allowing only passengers to enter airports, regular disinfection of surfaces, and mandatory PPE for staff and handing out packs containing disinfectants and masks, have been introduced at various airports around the world [ 34 ].

3.6. Temperature screening

Temperature screenings have been introduced worldwide in an effort to reduce transmissions. The installation of thermoscanners can be quite costly. During the SARS pandemic, Canada spent around 5.7 million dollars on the installation of such scanners, yet failed to detect a single case [ 35 , 36 ]. Initial data speculated that only around 45% of travelers would be detected by temperature screenings [ 37 ], recent data suggests that number is much lower, as amongst young people a vast majority never develops fever [ 38 ], suggesting that fever measurements are not an adequate screening method for airports.

3.7. COVID-19 tests

There are three main ways to establish infection with SARS-CoV-2; nucleic acid tests to detect the presence of RNA, either via RT-PCR or LAMP. Antigen testing for the presence of a viral antigen, usually a surface protein. Antibody tests to detect prior infection using ELISA or LFA assays.

For diagnostic testing the gold standard currently is naso-/oropharyngeal swabbing with subsequent RT-qPCR analysis. The sensitivity varies greatly based on who performs the test and how it is being performed (only NP, OP + NP, only OP) in addition to viral RNA concentrations varying across the respiratory tract. A previous study in which both OP and NP specimen were collected in previously SARS-CoV-2 positively confirmed patients showed discordant results in 38% of the cases [ 39 ]. Due to the invasive nature of the test, prolonged positivity post recovery and variability of the results based on who performs them this makes it a poor tool for screening.

The immune response against SARS-CoV-2 does not reflect infectivity of the individual, especially since in most cases the immediate IgM response is absent or not measurable [ 40 ]. , In addition commercial ELISA kits are costly and LFA assays lack the required sensitivity making them poor candidates for screening purposes.

The most promising candidates are thus antigen based testing and saliva tests.

Saliva tests have a similar sensitivity to PCR tests of 91% [ 41 ], and most importantly are non-invasive and can be considered for self-testing. Colorimetric tests such as New England Biolabs tests seem especially promising as they allow testing with minimal amounts of equipment and results can be obtained within half an hour. Antigen tests such as Abbotts Rapid test are another option, as they provide immediate results and have a very high specificity. However, they still rely on nasopharyngeal swabbing [ 42 ] and have faced scrutiny in the past over low sensitivity of their tests [ 43 ].

Recently, Finland and other countries are training dogs to detect SARS-CoV-2 positive patients. In a pilot study by Jendrny et al. tracheobronchial secretions and saliva were collected from positive hospitalized patients. The study was double blinded (dog, handler and observer) and the dogs were able to find positive samples with a sensitivity of 82% and specificity of 96.5% - most notably there was no significant difference between saliva and tracheal secretions (85% vs 87% hitrates). While the specificity of rapid COVID-19 Antigen tests is higher (99.5%), the sensitivity of dogs is much superior to those of antigen based tests (56.2%) [ 44 , 45 ]. A limitation of the study is that only samples from hospitalized patients were used. A follow up study with samples from different time points of a patient is needed since especially pre-/asymptomatic patients’ samples are of interest. Nonetheless certain airports, such as the one in Helsinki [ 46 ] have already started using dogs to detect SARS-CoV-2 in travelers with satisfying results and a “sensitivity of almost 100%“.

As of October 10th, more than 90 countries require arriving air passengers to be in possession of a negative COVID-19 PCR result from a test taken within a prescribed number of days prior to arriving in the respective country. The usefulness of this measure needs evaluation. More than 30 additional countries require a negative COVID-19 PCR test result to be exempt from quarantine or other restrictions. Although antigen testing may be more readily available, only PCR test results are accepted by these countries. More than 60 countries require COVID-19 testing upon arrival in the respective country, some regardless of whether the traveller already had a negative COVID-19 test result prior to arrival [ 47 ].

3.8. Physical distancing on planes, use of masks, hand sanitisation and air filtration systems

In recent time, transmission of COVID-19 during airplane travel has gained enormous importance for re-establishing worldwide travel activities. Since air travellers spend extended periods in enclosed spaces where physical distancing is difficult or impossible, there is a theoretical risk of spread of infectious diseases during the flight. Although there is sparse knowledge on COVID-19, recent evidence is available for other (SARS-like) viruses and their dissemination during airplane travel. However, comparisons are difficult to make since the kinetics of viruses are different due to their size, aerosol-linked movement in the aircraft cabin as well as their infectivity. Recent studies in previous years have focused on other infectious diseases such as the Zika virus [ 48 ], yellow fever [ 49 ], the influenza virus [ 50 , 51 ], Ebola [ 52 ], SARS [ 27 , 53 ], and others [ 54 ] but differences with COVID-19 precludes firm conclusions.

3.9. Aircraft cabin

The cabin of a typical aircrafts [ Fig. 1 ] is usually provided with a high airflow of many cubic meters per minute, which replaces the air onboard the cabin every two to 3 minutes. Air filtration in various implementations has become a critical intervention in managing the spread of COVID-19. Recent evidence has shown that severe acute respiratory syndrome (SARS-CoV-2) can remain airborne longer and travel farther than anticipated earlier in the COVID-19 pandemic, and high-efficiency particulate Air/Arrestance (HEPA) filters have been recommended [ 55 ]. In a typical aircraft, the recirculated air is passed through HEPA filters, which are required to remove over 99.97% of particles characterized by aero-diameter of 0.3 μm or larger [ 56 ]. In practice, however, they were found just as efficient at 0.01 μm, which is much smaller than the 0.125 μm size of the virus that causes COVID-19 [ 56 , 57 ]. Altogether, high airflow and use of HEPA filters onboard planes make it unlikely to catch the virus from someone who is not in the immediate vicinity.

Sample airflow, A320.

3.10. Social distancing, hygienic procedures and inflight transmission

Social distancing during the whole time at an airport as well as during boarding, sitting and de-boarding of the aircraft is of utmost importance to prevent the spread of SARS-CoV-2. Whereas the in-flight transmission of symptomatic COVID-19 patients is comparatively easy to identify due to clinical symptoms and is an established screening procedure [ 58 , 59 ], the evidence for the transmission of the virus from asymptomatic passengers on an aircraft is inconclusive. Only sparse data are available yet [ 60 ].

In-flight transmission has been long-standing described for multiple infectious agents, especially bacterial and viral respiratory pathogens [ 61 ], such as tuberculosis [ [62] , [63] , [64] ], influenza [ 65 , 66 ], measles [ 67 ], and coronaviruses, such as the Severe Acute Respiratory Syndrome coronavirus (SARS-CoV) [ 27 , 61 , [68] , [69] , [70] , [71] , [72] ].

During a flight from Singapore to Hangzhou International Airport in Zhejiang, China, in January 2020, a commercial aircraft carrying 335 passengers and crew members, 16 patients, not using face masks, were exposed and infected with SARS-CoV-2. The median age of those infected was 37 years, and no fatal outcomes were reported in these series, although 10 of these cases were symptomatic [ 73 ].

Two more instances of inflight transmissions were reported. One during a domestic flight between Sydney and Perth with 11 infectious cases during the flight. 6 were seated mid cabin and 5 aft cabin. They noticed a significantly greater risk of transmission in secondary infections in mid cabin vs aft cabin seats (11/112 vs 0/101 passengers) as well as window seats 7/28 vs non-window seats (4/83) [ 74 ].

The second flight was a long haul flight between London Heathrow, and Hanoi during which one primary case seated in business class led to 15 secondary infections. 12/15 passengers were seated in business class, 3/15 in economy class. The authors concluded that seating proximity (<2 seats away) was associated with the highest risk of transmission [ 75 ].

Preliminary data from the U.S. Department of Defense using Boeing 777–200 and 767–300 air frames was released to shed light on aerosol behavior and virus reduction during a flight using mannequins. The study showed a minimum 99.7% reduction of virus aerosols. The authors concluded that the infection risk is thus 1 infection per 54 h of flight and zero infections during a 12-h flight. This contrasts the cases we described in this article in which several instances of inflight transmissions are reported. While the risk of transmission is probably low, such models are based on sitting mannequins and do not take into account human interactions, differences in airflow throughout the flight, possible infections during boarding or deboarding or even differences in seating arrangements during which infection risk also seems to differ. Further studies are necessary to evaluate elements in human behavior and heightened infection risk, as well as particularities and differences in airline safety protocols which could account for the differences in infection observed between flights [ Table 3 ].

Published cases of inflight transmission of COVID-19 with known index cases.

As a consequence of the risk, the recommendation of face masks on board has been extended internationally during this period of transition from the pandemic to the peri-pandemic era. In a study of the repatriation of Israeli citizens from Japan, who had been passengers on the Diamond Princess cruise ship, no case of in-flight transmission of SARS-CoV-2 in the 14-h flight was shown, likely due to use of face masks on board [ 76 ].

The risk of transmission of droplet-mediated infections on an aircraft depends on proximity to an index case and on other factors, such as movement of passengers and crew, fomites, and contact among passengers in the departure gate [ 68 , 77 ].

Considering the difficulty of airborne infection transmission in-flight because of HEPA filters used in aircraft ventilation systems, contact with contaminated surfaces or infected persons when boarding, moving, or disembarking from the aircraft may play a critical role in inflight transmission of infectious diseases [ 27 , 61 ]. Whilst seated, Hoehl et al. characterized high risk only passengers seated within two rows of an index case [ 68 ].

Real-world data bodes well for flying too. Worldwide, there have been a few reports of individual transmissions linked to flights, but no superspreading-type events. Australia, through its exhaustive contact tracing system, did not identify any case of on-board transmission, even for people who travelled whilst contagious [ 78 ]. Bae and colleagues analysed 310 passengers who boarded an evacuation flight from Milan, Italy, to South Korea. N95 respirators were provided, and passengers were kept 2 m apart for physical/social distancing before boarding. After an 11-h flight, 299 asymptomatic passengers arrived in South Korea and were immediately quarantined for 2 weeks [ 79 ]. Only one passenger became infected after the flight [ 79 ].

Barnett estimated the risk of catching the virus during a full 2-h flight to be around 1 in 4300. The risk drops to 1 in 7700 if airlines leave the middle seat empty [ 80 ]. This is further confirmed by recent data suggesting that following strict measures with the risk of infection with SARS-CoV-2 on flights remains extremely low (44 transmissions in 1.2 billion travellers). Even when taking underreporting into account, those figures are very promising.

The International Air Transport Association (IATA) supported wearing of face coverings for passengers and crew while on board aircraft, but did not support mandating social distancing measures that would leave ‘middle seats’ empty, based mainly on an economical argument. Airlines for Europe (A4E) stated that „leaving middle seats free (…) is not viable for the air transport industry given it would reduce the maximum number of passengers onboard to between 50 and 66% of aircraft capacity. Due to high operating and other fixed costs, airlines require planes to be at least 77% full in order to “ break even .“

The odds of dying of a case contracted in flight are estimated at between 1 in 400,000 to 1 in 600,000 depending on age and risk factors, which is comparable to the risk for a standard 2-hour exposure on the ground [ 80 ]. Finally, the risk of infection is also increased during travel to and from the airport, as public transportation and ridesharing can increase the risk of getting exposed to the virus [ 81 ].

3.11. Mass gatherings

Mass gatherings (MGs) are watched cautiously by public health experts because of its three important public health implications [ 82 ]. First, MG related adverse health events and medical emergencies can compromise the public health response capacity of the host country. Second, MGs can accelerate disease outbreaks to epidemic levels in the host country. Third, MG related travel can accelerate the global seeding of pathogens with epidemic potential and may cause silent or explosive outbreaks globally. Air travel is particularly implied as a risk factor for the 2nd and 3rd outcome, and most notably for the 3rd.

Increasing access to air travel is the most critical enabler of international mass gatherings such as the Hajj and the Olympics Games. However, air travel is also becoming increasingly relevant for other mostly domestic or regional MGs such as the Khumb Mela in India, Arbaeen in Iraq, and the Shiite pilgrimage to Qom in Iran. About three quarters of Olympics participants and Hajj pilgrims use air travel to reach their MG destination [ 82 , 83 ]. It was in light of this fact that following the World Health Organization declaration of a public health emergency of international significance (PHEIC) on COVID-19, the authors advocated for the suspension of the of the year-around Umrah pilgrimage in Saudi Arabia, the trend setter for future MG cancellations [ 82 ]. Subsequent declaration of COVID-19 as a pandemic strengthened the call for the cancellation of MGs. MGs including the annual international Hajj pilgrimage, the Olympics Games 2020 in Japan, the Miami Beach Arts Fair, California's spring Coachella Valley Music and Arts Festival, and Canada's national music awards (the Junos) have been cancelled or postponed.

Due to airborne routes of disease transmission, respiratory diseases are the most common and consistent public health risk during mass gatherings [ 83 ]. When transmission occurs from innate surfaces and from human secretions, high density occupation in common spaces, high density crowding in event venues, and high frequency use of shared toilet facilities add to the complexity of transmission for both air travel and mass gatherings.

There is no known short-cut to hosting a true mass gathering amid a respiratory disease pandemic of high transmission potential, mortality, and poorly understood natural history such as COVID-19. During such uncertainties, the overwhelming public health recommendation have been to cancel the event [ 84 , 85 ].

Communities that held MG events prior to COVID-19 PHEIC such as the Qom pilgrimage in Iran and a conference in Boston have resulted in extensive COVID-19 transmission [ 86 , 87 ].

Cases also increased to epidemic levels in areas that hosted multiple events as in the State of South Dakota in the USA. The scaled down Hajj 2020 [ 88 ] with 1000 domestic pilgrims in Mecca (1200 square kms) do not meet the definition of a mass gathering (an event that strains the planning and response resources of the health system in the community where it takes place) as the downsizing afforded nearly 27 square meters of personal space to each pilgrim in the most potentially crowded pilgrim ritual area, the Grand Mosque.

As mitigation fatigue increases among the population, providers of travel health services will be faced with interest from their patients about participation in fly-in mass gatherings.

Attendance in religious MGs are highly sensitive events to many people and lifelong wishes of many, and interest in religious MGs may be amplified at times of uncertainty such as a pandemic.

However, in the absence of a vaccine or specific pharmaceutical intervention, participation in mass gathering during an active pandemic (with a respiratory virus that sustains among asymptomatic carriers) may not be encouraged. By providing a full list of implications of participation in MGs during respiratory disease pandemics (such as lock down for an extended period of time if exposed, challenges with medical evacuations if ill, the cost of evacuation for a pandemic disease acquired at a mass gathering), providers of travel health services can play an important role to help their patients to make informed decisions about MG attendance.

3.12. Measuring mitigation compliance: photo-epidemiology to measure face covering use

The success of modified air-travel amid a pandemic requires review of traveller compliance with prevention interventions, and ultimately of the utility of such interventions in reducing air-travel related risk of transmission. Participation compliance in individualized surveys or assessments is likely to be suboptimal in travel settings due to privacy issues, time factors, and crowded settings. One innovative epidemiologic surveillance approach has been the use of photo-epidemiology methods were systematically obtained sequential photographs of the crowd and analysed manually or using face recognition systems. Photo-epidemiology has its origins in wildlife surveillance, but Elachola & Ebrahim studied its utility to monitor face mask use for prevention of respiratory viruses and umbrella use for sun protection during the 2009 and 2013 Hajj mass gathering [ 89 , 90 ]. Those reports remain as the first ever reported estimates of face mask and umbrella use during mass gatherings. Elachola and Ebrahim applied this method at airports for the first time early during the COVID-19 outbreak and reported face mask use among travellers observed at airports in Asia, Europe and USA [ 91 ]. At the height of COVID -19 lockdowns photo-epidemiology methods were also applied to monitor population face covering use in most frequented venues such as supermarkets [ 92 ]. The findings from these two studies generally corresponded to the disparities observed in implementation of face covering advisories, historic population exposure to face covering advisories.

The above experiences underscore the utility of photo-epidemiology to monitor face covering use among travellers. Photo-epidemiology studies can be tailored to specific flights as it can be conducted at departure lounges, arrival gates, and inside the cabin. Thus, photos taken at multiple points of a flight can also ascertain pre-boarding and post embarkation variation in face covering use, all of which affect airborne transmission of SARS-COV-2. While photo-epidemiology helps to address self-report bias of individualized surveys, this method may not be suitable for stratified analysis by age, gender and other characteristics of the surveyed population. Yet, photo-epidemiology remains the only available tool to measure population level prevalence of compliance of face coverings.

3.13. Preparedness for compounding transmission risk and uncertainties to air travellers due to emergencies during pandemic

The crash of the Air India COVID-19 related repatriation flight carrying Indian emigrant workers from Dubai to Kozhikode airport on August 7, 2020 underscores how disease transmission risk from air travel could be compounded during pandemics. The 199 persons on board this flight had pre-flight COVID-19 negative tests but were exposed to rescue workers, security and government officials, and volunteers who rushed to the scene at the crash site. Given the COVID-19 status of the formal and informal responders were unknown and the airport was located in a high transmission area designated as ‘hotspot’, all rescued passengers and responders were quarantined and subjected to COVID-19 testing. The entire District Government Office, and airport emergency staff were quarantined, compromising the capacity of government and airport function in addition to adding to the COVID-19 response burden in the airport vicinity.

While the full extent of accident-attributable transmission primary and secondary transmission of SARS-COVI-2 is still being studied, the incident underscores the fragilities of risk aversion during air travel with implications for international assistance. Both airlines and airport management systems should have protocols in place that anticipate and prepare the ground staff for emergencies during pandemics. Plans should assure COVID-19 free status of all airport and responder staff, triage plans, a maintenance pool of vetted volunteers from the community oriented to disease mitigation concepts who could improve emergency response capacity, and surplus personal protection equipment in place. Advisories to travellers should include mention of emergencies including potential quarantine of survivors and such advance warning can help improve travellers’ coping capabilities during an unanticipated crisis.

3.14. Pre- and in-flight measures by airline

The International Air Transport Association sets forth rules for safe flying [ 93 ]. The implementation of said rules varies greatly based on the airline. While all airlines enforce masks on the flight, there are many differences in pre-flight and in-flight measures ( Table 4 ).

Preflight-Measures of the 20 biggest airlines by size as of October 15th.

Information on measures taken by airlines can be very difficult to find. With some airlines such as Emirates or Air China, all information is transparently visible on their webpage making it easy for the traveller to comprehend what is awaiting him at the airport or during the flight. Others, unfortunately display the information in a very chaotic way, or are very vague about the measures they are taking, or do not display the measures at all and are also reluctant to provide concise answers when contacted.

There are significant differences in pre-flight measures of airlines. Some, like the Lufthansa group or Emirates encourage or enforce pre-flight testing for their passengers. GoIndiGo on the other hand created an app that requires passengers to complete e questionnaires on their health status multiple times before the flight, which is essentially a telemedicine application.

Most airlines disinfect their plane before and after every flight. Some, like Aeroflot or the Emirates also disinfect sanitary facilities inflight during long flights. Air China varies the frequency based on an internal risk evaluation. Others, like Easyjet or Ryanair only seem to disinfect their flights once a day, claiming that this suffices for a full 24 h.

A vast majority of airlines have reduced the food they are serving to prepackaged food or own food only. Turkish Airlines has a shift-based eating system only allowing certain groups of passengers to eat at once. All airlines seem to allow drinking during the flight, and all airlines enforce wearing a mask, or in the case of Aeroflot also gloves inflight.

All airlines we looked at are using HEPA filters. Some, like Turkish Airlines have especially designated isolation seats in case someone becomes symptomatic inflight.

There was little information available on which airlines use passenger locater forms, with some airlines such as Lufthansa stating openly that it is a data protection issue, and others such as Goindigo making it mandartory via their app.

A report [ 98 ] report published by Faculty and Scientists at the Harvard T.H. Chan School of Public Health provides a comprehensive and thorough summary on common practices and recommendations concerning SARS-CoV-2 transmission during travel. They propose a layered approach for reduction of SARS-CoV-2 transmission (Education and Awareness; Screening; Physical and Engineering Controls; Process Management, and PPE) by means of NPIs (Non-Pharmaceutical Interventions) and suggests a reduction of risk to minimal levels can be achieved by utilizing standard control measures (social distancing, wearing masks, disinfecting of surfaces, screenings, testing and a strict enforcement of those measures) that are effective in other circumstances. Such an approach can mitigate the transmission risk of SARS-CoV-2 to passengers and crew members. We summarized those findings along with our recommendations in Fig. 2 .

Mitigation measures × for prevention of SARS-CoV-2 transmission while traveling from home to the end destination.

Also including NPIs: Non-Pharmaceutical Intervention Layering Non-Pharmaceutical Interventions (NPIs) can mitigate risk of SARS-CoV-2 transmission for Passengers and crew members during air travel (figure derived from the report “Assessment of Risks of SARS-CoV-2 Transmission During Air Travel and Non-Pharmaceutical Interventions to Reduce Risk Phase One Report: Gate-to-Gate Travel Onboard Aircraft Prepared by Faculty and Scientists at the Harvard T.H. Chan School of Public Health).

4. Limitations

Our paper is a rapid, narrative review of the status quo (as of October 2020) of air-travel in the pandemic and peri-pandemic period. It is limited because it is not a systematic review and also because of the rapidly evolving numbers of publications that may have an impact on precautions related to air travel and SARS-CoV-2 transmission.

5. Conclusions

In the pandemic and peri-pandemic periods, a substantial reduction in air travel numbers is apparent with a decrease (−51.6%) in passenger departures. Trends show that the most resilient and fastest travel flows for recovery are domestic flights and neighboring country travel, last minute travel, visiting friends and relatives and essential business travel.

Systematic reviews show that in general, travel restrictions have only limited effect in containing infection, and the degree of impact depends on multiple factors ranging from the extent and timing of the restrictions, the epidemic size, to virus transmissibility and travel patterns. Quarantine of travellers from a country with a declared outbreak may delay introduction or re-introduction of the virus, or may delay the peak of transmission, or both, but the effect is small and there are limitations to the evidence available.

Temperature screening is ineffective. A combined approach of telemedicine (i.e. patients have to fill out self-assessment form prior to flight) and facilities at airports performing both systematic rapid tests, possibly a combination of saliva and antigen could be a viable future strategy at airports. Going forward, on arrival based saliva testing might thus be the best way to reduce the number of persons who have to quarantine after arrival. Hand hygiene and physical distancing from the point of entering an airport until leaving an airport as well as continuous face coverings are key elements of preventing SARS-CoV-2 transmission. Despite high air turnaround and high efficiency filtering used in aircrafts, there is some evidence that passengers within two rows of an index case are at higher risk. A retrospective analysis shows, however, that when stringent hygiene measures are enforced inflight, transmission rates of SARS-CoV-2 are likely to be very low, as little as one case per 27 million travellers, even with positive cases aboard. Guidelines from airlines are difficult to research. Most airlines disinfect their flights and enforce wearing masks and social distancing to a certain degree. Information on other precautions are lacking, not transparent and confusing to interpret. A layered approach of non-pharmaceutical interventions (including masks and sanitisers) for the entire journey (, home to airport to final destination) is indicated. While the guidelines set out by IATA are straight forward, a common platform for contact tracing, telemedicine approaches by preflight questionnaires and COVID-19 test results is lacking. What is necessary is a unified front with all stakeholders, further validation of existing rapid tests and an expert committee to systematically evaluate preventive strategies so that recommendations for safe air-travel are evidence based.

Author contributions

PS: concept and design. MB: figures and tables and airline survey. All authors contributed to evidence building and paper writing, review and revisions.

Declaration of competing interest

MB is involved in a start-up that 3-D prints components for virus tests including tests for SARS-CoV-2.

All other authors declare no conflicts of interest.

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Is it safe to fly right now? What to know about air travel and COVID-19

Airports are preparing for a crush of passengers as holiday air travel in 2021 is expected to approach pre-pandemic levels.

More than 6 million people are expected to fly between Dec. 23 and Jan. 2., with airlines projected to see a 184% increase in passengers from 2020, according to AAA , which called it a "dramatic bounce-back."

"With vaccines widely available, conditions are much different and many people feel a greater level of comfort with travel," said Paula Twidale, senior vice president of AAA Travel, in a statement.

Holiday bookings for Christmas and the New Year's holiday have been coming in "very, very strong," Ed Bastian, the CEO of Delta Air Lines, told CNBC. United has been flying its largest schedule since the start of the pandemic, adding more than 200 daily domestic flights to meet the increased demand.

More than 2 million people passed through Transportation Security Administration checkpoints on Dec. 16, 2021 — more than double the passenger volume on the same day in 2020.

But the rapid spread of the omicron variant may have many people wondering: Is it safe to fly right now?

'Very low' risk

There's not a one-size-fits-all answer to that question — it all depends on a person's risk tolerance and their own risk factors for severe disease, said Dr. Amesh Adalja, a senior scholar at the Johns Hopkins University Center for Health Security in Baltimore and a spokesman for the Infectious Diseases Society of America.

Masks are required on planes and at airports, and as long as people are complying, there's not a major risk from flying, he noted.

"Transmission on a plane of COVID-19 is not very common because of the (air) circulation and because of the mask wearing," Adalja told TODAY.

"(But) there's always going to be some level of COVID risk with any activity you do, whether it's flying, riding the bus or going to the post office... for most people, I think it's an acceptable risk."

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The more vaccinated passengers and crew are on a plane, the safer air travel is, Adalja added, so he was a fan of airlines mandating vaccinations as a condition of employment, the way United Airlines has .

Masking and vaccines are the best tools we have against both the omicron and delta variants, he said.

The Centers for Disease Control and Prevention urged people to delay travel until they were fully vaccinated. If that's not possible, they should get tested one to three days before their trip.

Given the high quality of cabin air and the various safety measures in place, there is "very low" risk of contracting COVID-19 on board a plane, according to the International Air Transport Association , which represents airlines around the world.

What studies have found:

United Airlines and the Department of Defense teamed up on a six-month study that found the risk of contracting COVID-19 on commercial flights was low when passengers wore masks for the entirety of the flight. The highest risk was associated with sitting in the same row, or a row in front of or behind, an infected person. This study didn't take into account the risk associated with being in a crowded airport or boarding a flight.

Researchers have said factors that may prevent transmission on planes include the airflow in the cabin from the ceiling to the floor and all passengers wearing face coverings.

But if everyone took off their masks at the same time for a one-hour in-flight meal service, the average infection probability increased by 59%, a study published in the Journal of Travel Medicine in May 2021 found.

Health & Wellness Current COVID-19 boosters are enough to fight the omicron variant, Fauci says

Still, most viruses don’t spread easily on flights because of how air circulates and is filtered on planes, the CDC noted.

Carriers like American Airlines have been touting the use of high-efficiency particulate air (HEPA) filters on board that capture “at least 99.97% of airborne microbes by circulating the cabin air once every 2 to 4 minutes.”

Airlines have also implemented enhanced cleanings and traveler health acknowledgments during check-in.

A paper by Arnold Barnett, a statistics professor at the MIT Sloan School of Management in Cambridge, Massachusetts, looked at the probability of an air traveler contracting COVID-19 from a nearby passenger while sitting in economy class on a two-hour domestic U.S. flight. He assumed everyone was wearing masks.

Barnett calculated the risk at 1 in 4,300 for full flights, which went down to 1 in 7,700 when middle seats were kept empty.

It's not clear that two hours spent on a plane involved a higher COVID-19 infection risk than two hours doing any other everyday activities during the pandemic, Barnett concluded in the study.

"You don't get sick on airplanes any more than anywhere else," wrote Joseph Allen, an assistant professor of exposure assessment science at Harvard T.H. Chan School of Public Health in Boston, in The Washington Post . "The required aircraft systems do a really good job of controlling airborne bacteria and viruses."

Danger on the ground

Experts have been more worried about coronavirus spread before flights.

“My concern has really been in the airports funneling people through hallways and jet ways and metal detectors,” said Dr. Michael Mina, an epidemiologist at Harvard T. H. Chan School of Public Health, during a briefing in 2020. “The whole process of airports… and squishing people together. We know that this virus can be airborne and it can linger for a little bit.”

Any part of the trip where you can’t social distance is more risky since the virus transmits most efficiently when people are in close contact together, including at the airport food court and standing at the gate before boarding, Adalja added. He also believed people’s behavior at the destination was usually riskier than the journey itself.

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If you plan to fly soon, Adalja recommended taking all the usual precautions during the trip: Wash your hands frequently, wear a face covering as required, avoid the crowded parts of the airport and try to stay 6 feet apart from everybody. Always have hand sanitizer with you.

Some studies have found the window seat may be best to avoid getting sick because it offers the least contact with other passengers, but Adalja was skeptical. It all depends on who's sitting beside you since it’s usually 10-15 minutes of close proximity — not fleeting contact — that transmits the new coronavirus virus, he said.

If you’re more likely to get the severe form of COVID-19, consider if it's worth the risk to fly. Don't fly if you're sick or have been in contact with someone who is sick. These are all important things to keep in mind during the holiday travel season.

This article was updated in December 2021 to include the most recent research and statistics.

A. Pawlowski is a TODAY health reporter focusing on health news and features. Previously, she was a writer, producer and editor at CNN.

CDC Recommendation for Masks and Travel

For Immediate Release: Tuesday, May 3, 2022 Contact: Media Relations (404) 639-3286

At this time, CDC recommends that everyone aged 2 and older – including passengers and workers – properly wear a well-fitting mask or respirator over the nose and mouth in indoor areas of public transportation (such as airplanes, trains, etc.) and transportation hubs (such as airports, stations, etc.). When people properly wear a well-fitting mask or respirator, they protect themselves and those around them, and help keep travel and public transportation safer for everyone. Wearing a well-fitting mask or respirator is most beneficial in crowded or poorly ventilated locations, such as airport jetways. We also encourage operators of public transportation and transportation hubs to support mask wearing by all people, including employees.

This public health recommendation is based on the currently available data, including an understanding of domestic and global epidemiology, circulating variants and their impact on disease severity and vaccine effectiveness, current trends in COVID-19 Community Levels within the United States, and projections of COVID-19 trends in the coming months.

Along with staying up to date with COVID-19 vaccines, avoiding crowds, wearing a well-fitting mask or respirator is one of multiple prevention steps that people can take to protect themselves and others in travel and transportation settings.

For more information about safer travel during the pandemic, see Domestic Travel During COVID-19 | CDC  and International Travel | CDC.

The following can be attributed to CDC Director Rochelle P. Walensky, MD, MPH: 

CDC continues to recommend that all people—passengers and workers, alike—properly wear a well-fitting mask or respirator in indoor public transportation conveyances and transportation hubs to provide protection for themselves and other travelers in these high volume, mixed population settings. We now have a range of tools we need to protect ourselves from the impact of COVID-19, including access to high-quality masks and respirators for all who need them.

Additionally, it is important for all of us to protect not only ourselves, but also to be considerate of others at increased risk for severe COVID-19 and those who are not yet able to be vaccinated. Wearing a mask in indoor public transportation settings will provide protection for the individual and the community.

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It seems like all my friends got COVID this summer, and many think they got it on a plane. But that’s as anecdotal as data gets. What does, you know, science have to say?

I talked to Arnold Barnett, a professor of statistics at the Massachusetts Institute of Technology, who co-wrote a recent paper that modeled the risk of contracting COVID while flying early in the pandemic. He and his student combed through the available data and built a complex mathematical model to determine the risk of getting infected onboard. Yet they ran into limitations, because no organized effort was made by the U.S. or any country to systematically contact trace COVID transmissions onboard aircraft.

“Nobody is screened. Nobody is asked if they’ve come down with COVID,” he explains. “There was no attempt made to figure out where people got it. We have so little data.”

That’s right, of all the billions spent combating the virus, supplying at-home testing kits and bailing out the airlines , little to none of it was spent answering the basic question of where and how people actually contracted the disease in the first place. Models like Barnett’s, while helpful, offer only best guesses.

“If we had actual data from the United States, then maybe we wouldn’t have needed a model,” he says.

One systematic attempt to contact trace on a flight that landed in Vietnam found that, of the 16 passengers who tested positive, 12 were in business class, where the one symptomatic case was found. In other words, a bunch of high-price ticket holders at the front of the plane got sick from the same person.

Yet this study from Vietnam's National Institute of Hygiene and Epidemiology was performed in March 2020. Think of what could have happened if we had kept collecting data throughout the pandemic.

Unknown unknowns

Cast your mind back to fall 2020. The first COVID wave had passed and would-be travelers were wondering: Is it safe to fly home for the holidays ?

The Centers for Disease Control and Prevention, based on a bizarre study commissioned by many federal agencies involving mannequins coughing at one another, suggested that “most viruses and other germs do not spread easily on flights because of how air circulates and is filtered on airplanes.”

You may remember that study. You may not know (as I didn’t, until recently) that the researchers who performed it received so much criticism that they appended a disclaimer, suggesting the study’s findings “were not designed to provide actionable information about viral risk during flight, safe flight times or seating capacity.”

The CDC has removed its messaging and references to the study, while airlines such as United Airlines continue to cite it as evidence of air travel safety.

The United Airlines website still mentions the problematic study.

I was writing about all this in 2020, trying to parse these confusing messages, and I used the mannequin study as evidence that flying wasn’t as dangerous as we originally thought.

Turns out I was wrong, but never even learned I was wrong until years later.

The real problem isn’t one poorly interpreted study. It’s that we still don’t know the rate at which people contracted (and died from) COVID after getting on a plane. Were 1% of COVID cases caused by air travel? Or 10%? More?

We have no idea, and that could have major ramifications down the road.

Flying into the unknown

Barnett’s model spit out a nice round number, suggesting the odds of contracting COVID on a full two-hour flight were about 1 in 1,000 at the beginning of the pandemic. But he believes the risks have probably increased significantly since then.

“Omicron BA.5 is a lot more contagious than the earlier versions," Barnett says. "And now people by and large are not wearing masks on airplanes.”

Thankfully, vaccines and treatments have reduced the mortality rate of COVID, so the risks are more manageable. But what if a new variant emerges that — knock on wood — evades vaccines altogether? Or (no, really, knock on wood) causes serious illness in young people or children? We will all want a real answer to simple questions: How bad is COVID transmission on planes? Is any one airline safer than another ?

Maddeningly, bafflingly, head-scratchingly, we still don’t know for sure.

“All models are wrong, some are useful,” Barnett says with a wry grin.

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⚠   The COVID-19 Public Health Emergency expired as of May 11, 2023. This site will no longer be updated and will remain online for historical purposes only.

For current COVID-19 guidance, please visit the Centers for Disease Control and Prevention (CDC) .

International travel is critical to connecting families and friends, to fueling small and large businesses, and to promoting the open exchange of ideas and culture. The international air travel policy follows the science and both enhances the safety of Americans here at home and the safety of international air travel.

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On March 10, 2023, CDC  removed  the requirement for air passengers from China, Hong Kong or Macau to show a negative COVID-19 test or documentation of recovery before boarding a flight to the United States.

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As of 12:01am EDT on May 12, 2023, noncitizen nonimmigrant air passengers will no longer need to show proof of being fully vaccinated with an accepted COVID-19 vaccine to board a flight to the United States. See  here  for more information.

While masks are no longer required on flights, The CDC still recommends wearing them. 

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Masked passengers sit on one of the first flights between Amsterdam, Netherlands, and Burgas, Bulgaria since COVID-19 shutdowns earlier in 2020. Masks can help mitigate the chance that passengers will get infected (or infect other travelers) in spite of the highly effective HEPA air filters used on most commerical planes.

• CORONAVIRUS COVERAGE

How clean is the air on planes?

High-tech filters and low-tech masks: How technology and personal responsibility might make flying safer than you think.

The coronavirus pandemic has reminded us that having access to clean air is a global health priority. While industrial pollution has dominated headlines for decades, COVID-19 brings the conversation indoors. The quality of indoor air—which way it flows, how much it does or doesn’t allow for pathogens to disperse or disappear—can make the difference between staying well or getting infected. Among the interiors repeatedly named as potential hot zones for infections (churches, nursing homes, and cruise ships) airplane cabins are a focal point of anxiety.

So it’s a surprise to find that the air inside a plane is cleaner than you might think. Thanks to HEPA filters and efficient circulation on commercial aircrafts, the air you breathe in flight—though not necessarily entirely virus-free—is much cleaner than the air in restaurants, bars, stores, or your best friend’s living room. Here’s why you don’t need to fear the air up there.

How airplane air gets cleaned

Most, but not all, commercial aircraft are equipped with HEPA (High Efficiency Particulate Air) filters. That means that, on HEPA-equipped planes, the airflow “mirrors the laminar airflow of an operating room with no or minimal crossover of air streams,” says Dr. Bjoern Becker of the Lufthansa Group of airlines. “Air is pumped from the ceiling into the cabin at a speed of about a yard per second and sucked out again below the window seats.”

About 40 percent of a cabin’s air gets filtered through this HEPA system; the remaining 60 percent is fresh and piped in from outside the plane. “Cabin air is completely changed every three minutes, on average, while the aircraft is cruising,” says Becker. (Lufthansa has a video showing how HEPA filters work .)

(Related: Here’s how coronavirus spreads on a plane.)

Officially, certified HEPA filters “ block and capture 99.97 percent of airborne particles over 0.3 micron in size, ” says Tony Julian, an air-purifying expert with RGF Environmental Group. The efficiency of these filters, perhaps counterintuitively, increases for even smaller particles. So while the exhaled globs that carry SARS-CoV-2 can be quite small, HEPA filters effectively remove the vast majority from the air.

A masked passenger stands on a flight between Vancouver, Canada, and Sydney, Australia in the spring of 2020. Mandatory mask wearing on planes has been strictly enforced by some airlines.

“Typically the number of particles in the air are [sic] really low, the plane is almost a clean room, because there’s so much ventilation, and very few sources of particulate generation within a plane,” says Liam Bates, CEO and co-founder of Kaiterra, an air-quality monitor manufacturer. “[Planes] are actually safer than virtually any other confined space.”

HEPA filters aren’t on older planes or tiny aircraft, which have less effective filtration systems. But even the best filters can’t catch every onboard virus particle, and there are ways airlines, their employees, and passengers can influence their effectiveness.

How reliable are filters?

HEPA’s 99.97 percent filtration effectiveness sounds reassuring, and airline execs count on that. But the biggest problem with those systems, says Bates, is that the “filter only guarantees the quality of the air that has passed through it. If the air that someone breathes in has not gone through that filter, then those numbers don’t matter.”

That’s why, in addition to good filters, airline cabins also need good passengers. This means everyone onboard should wear a mask.

That’s both because of masks’ proven protective qualities and the fact that HEPA filters and rapid-air circulation don’t work at max effectiveness until the plane is airborne. This means that the sometimes-interminable period between grabbing your seat and takeoff (or between landing and disembarking) is when you’re most likely to inhale a cloud of air from a person infected with COVID-19. That stale, warm air you occasionally notice when a plane is on the ground sitting at the gate or idling might mean there’s little circulation through those filters.

As with most technology, “HEPA filters should be inspected regularly and replaced as needed,” says Julian. Holes in the filters or problems with seals, for example, will compromise their effectiveness. Each HEPA manufacturer recommends the maintenance schedule for their products, and most airlines change them more frequently. Even if an airline changed filters less often than recommended, the International Air Transport Association says air flow through the filters might be reduced but their particle-trapping capacity would not. Contrary to what you might think, dirty filters can operate more effectively than clean ones .

Why masking is essential

When we cough, sneeze, and talk, microscopic (and, sometimes, visible) droplets of saliva escape our mouths. Gravity causes the big ones to fall to the ground (or an armrest) quickly, but the smaller ones can hang in the air. The SARS-CoV-2 science is evolving, but there’s now some evidence suggesting that the virus inside those tiny droplets is infectious .

A worker in protective gear disinfects an Israir Airlines plane at the Ben Gurion International Airport in Tel Aviv, Israel on August 17, 2020.

Wearing a mask the whole time you’re on a plane keeps some of that airborne saliva—and any virus it has—to yourself. There’s evidence that mask wearing both protects those around you and reduces the chance that you’ll get infected yourself. Think of sporting a mask like stowing your laptop during take-off: it minimizes the chance that air turbulence will cause anyone to get hit in the face with something harmful.

In the U.S. there’s no law requiring air passengers to wear masks. Each U.S. airline has implemented its own mask rules (here are American ’s, Delta ’s, and United ’s). There are multiple reports of airlines strictly enforcing them ( Delta banned more than a hundred barefaced rebels and has returned to the gate to kick passengers off), as well as ignoring them, or putting the onus on passengers to police those sitting around them. But there are also stories of people flying without masks (or masks worn incorrectly), and of flight crews not making people follow the rules.

How screening might help—or not

U.S. airports and airlines are implementing new screening measures to help keep potentially infectious passengers from making it onto passenger planes. Some rely on the honesty and ethical behavior of passengers, such as airlines that, during check in, ask passengers to certify that they have been free of COVID-19 symptoms for the past 14 days.

Even if everyone who boards a flight is truthful, other passengers still remain at risk because some 40 percent of COVID patients are asymptomatic and many individuals in the disease’s early stages exhibit no symptoms at all. Some airlines, including Qatar Airways , are making masks and face shields mandatory for passengers and crew. The mask protects others and the face shield helps protect you (especially from the virus entering your eyes).

(Related: If you must travel now, here’s how to make it safer .)

Abundant screening measures indicate that airports and airlines are taking COVID-19 seriously, but experts say such measures aren’t always based on scientific facts. “Passenger temperature screenings make us feel like we are doing something tangible to prevent the spread, however, based on the scientific data to date, it is neither efficient nor effective at identifying COVID-19 patients or reducing the spread,” says Dr. Daniel Fagbuyi, an Obama-Administration appointee to the National Biodefense Science Board with experience handling pandemics. Temperature checks with thermometer guns miss 30 percent of people with fevers.

Related: views from the airplane window seat

Ways to keep yourself safer in flight

The biggest risk when flying just might be the airport, boarding, and take off/landing experience. People in close indoor proximity, perhaps not wearing masks, could spell infection. Keeping that six feet (or more) of social distance while getting to your gate, into your seat, or deplaning is probably more important than anything else you can do (except covering your face).

If you must fly, choose an airline that enforces its own protective rules. At a minimum, you’ll be less stressed that you’ll have to be a mask enforcer. As of mid-August 2020, it seems that Alaska Airlines is being the most vigilant of U.S. carriers about mask wearing.

While Delta , Alaska, Hawaiian and Jet Blue are, for now, keeping middle seats empty, any resulting COVID protection is likely from fewer people on board, not whether a stranger is sitting a few inches rather than a foot from you. A much-talked about Massachusetts Institute of Technology study released August 18, 2020 found that leaving the middle seat empty on flights decreased a given passengers’ risk of contracting COVID-19 by a factor of 1.8, but it is not yet peer-reviewed.

On board, minimize contact with surfaces and wash your hands well before touching your face (including your mask). There’s no need to fly in a HAZMAT suit, however, says Dr. Ken Perry , an emergency physician in Charleston, South Carolina. “People would be much better off being fastidious with their mask use rather than worrying about gloves and other devices.”

Scientists no longer think that touching objects and then touching your eyes, nose, and mouth with dirty hands is the primary source of COVID-19 transmission. However, a recent report involving inflight transmission suggests an asymptomatic person spread the disease via surfaces in the toilet .

Airlines have upped their cleaning regimes, including disinfecting planes with electrostatic sprayers . And with just-announced emergency approval from the U.S. Environmental Protection Agency, American Airlines will start treating high-touch areas (seat backs, tray tables) with SurfaceWise2, a coating said to kill coronavirus for up to seven days .

In flight, Fagbuyi recommends keeping your mask on as much as possible. That means avoiding eating and drinking while airborne. Cleaning your hands with sanitizer onboard is fine, Fagbuyi says, but “wash your hands with soap and water once you get off” the plane, and especially before removing your mask.

And though it might be uncomfortable, Dr. Joyce Sanchez, medical director of the Travel Health Clinic at Froedtert and the Medical College of Wisconsin , says masking up doesn’t affect your oxygen or carbon-dioxide levels. “The overwhelming majority of people, including those with chronic lung and heart problems, can safely wear them,” she says.

Turns out the best way to make the skies friendlier right now is to cover up your smile.

Related Topics

• PUBLIC HEALTH
• SCIENCE AND TECHNOLOGY

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This chart shows how global air travel is faring

Air travel has picked up this year following COVID-19 disruptions in 2020 and 2021. Image:  Unsplash/Avery Cocozziello

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Stay up to date:, pandemic preparedness and response.

• Air travel has picked up this year following COVID-19 disruptions in 2020 and 2021.
• However, weekly seat capacity on commercial passenger airlines is still some way below 2019 levels.
• There are also regional differences in how airlines have recovered following the pandemic.

As international travel was brought to an abrupt halt in 2020 at the onset of the Covid-19 pandemic, the aviation industry suffered “the worst year in history for air travel demand”. While 2021 was still mired by travel restrictions, turbulence gradually eased in 2022 as more and more passengers returned to the skies.

According to data from OAG , weekly seat capacity on commercial passenger airlines averaged 90.7 million so far this year, up from 61 million during the same period in 2020 but still some way below the 2019 level of 110.9 million. The gap is gradually closing, however, and global capacity exceeded 100 million for the first time since the pandemic hit for a couple of weeks this summer.

There are significant regional differences in how far passenger airlines have recovered from the Covid-19 shock. While capacity remains far below pre-pandemic levels in large parts of Asia, especially in terms of international flights, capacity in North America is very close to 2019 levels.

As other sectors proceed to decarbonize, the aviation sector could account for a much higher share of global greenhouse gas emissions by mid-century than its 2%-3% share today.

Sustainable aviation fuels (SAF) can reduce the life-cycle carbon footprint of aviation fuel by up to 80%, but they currently make up less than 0.1% of total aviation fuel consumption. Enabling a shift from fossil fuels to SAFs will require a significant increase in production, which is a costly investment.

The Forum’s Clean Skies for Tomorrow (CST) Coalition is a global initiative driving the transition to sustainable aviation fuels as part of the aviation industry’s ambitious efforts to achieve carbon-neutral flying.

The coalition brings together government leaders, climate experts and CEOs from aviation, energy, finance and other sectors who agree on the urgent need to help the aviation industry reach net-zero carbon emissions by 2050.

The coalition aims to advance the commercial scale of viable production of sustainable low-carbon aviation fuels (bio and synthetic) for broad adoption in the industry by 2030. Initiatives include a mechanism for aggregating demand for carbon-neutral flying, a co-investment vehicle and geographically specific value-chain industry blueprints.

Learn more about the Clean Skies for Tomorrow Coalition's impact and contact us to find out how you can get involved.

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Airlines will now be required to give automatic cash refunds for canceled and delayed flights

FILE - Passenger drop off their baggage at United Airlines in C Terminal at George Bush Intercontinental Airport, Thursday, Dec. 21, 2023, in Houston. The Biden administration issued final rules Wednesday, April 24, 2024, to require airlines to automatically issue cash refunds for things like delayed flights and to better disclose fees for baggage or canceling a reservation. (Brett Coomer/Houston Chronicle via AP, File)

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The Biden administration issued final rules Wednesday to require airlines to automatically issue cash refunds for things like delayed flights and to better disclose fees for baggage or canceling a reservation.

The Transportation Department said airlines will be required to provide automatic cash refunds within a few days for canceled flights and “significant” delays.

Under current regulations, airlines decide how long a delay must last before triggering refunds. The administration is removing that wiggle room by defining a significant delay as lasting at least three hours for domestic flights and six hours for international ones.

Airlines still will be allowed to offer another flight or a travel credit instead, but consumers can reject the offer.

The rule will also apply to refunds of checked-bag fees if the bag isn’t delivered within 12 hours for domestic flights or 15 to 30 hours for international flights. And it will apply to fees for things such as seat selection or an internet connection if the airline fails to provide the service.

Complaints about refunds skyrocketed during the COVID-19 pandemic, as airlines canceled flights and, even when they didn’t, many people didn’t feel safe sharing a plane cabin with other passengers.

Airlines for America, a trade group for large U.S. carriers, noted that refund complaints to the Transportation Department have fallen sharply since mid-2020. A spokesperson for the group said airlines “offer a range of options — including fully refundable fares — to increase accessibility to air travel and to help customers make ticket selections that best fit their needs.”

The group said the 11 largest U.S. airlines issued $43 billion in customer refunds from 2020 through 2023.

The Transportation Department issued a separate rule requiring airlines and ticket agents to disclose upfront what they charge for checked and carry-on bags and canceling or changing a reservation. On airline websites, the fees must be shown the first time customers see a price and schedule.

The rule will also oblige airlines to tell passengers they have a guaranteed seat they are not required to pay extra for, although it does not bar airlines from charging people to choose specific seats. Many airlines now charge extra for certain spots, including exit-row seats and those near the front of the cabin.

The agency said the rule will save consumers more than $500 million a year.

Airlines for America said its members “offer transparency and vast choice to consumers” from their first search.

The new rules will take effect over the next two years. They are part of a broad administration attack on what President Joe Biden calls “junk fees.” Last week, Transportation Secretary Pete Buttigieg announced that his department will let state officials in 15 states help enforce federal airline consumer protection laws .

Watch CBS News

New airline rules will make it easier to get refunds for canceled flights. Here's what to know.

By Megan Cerullo

Edited By Aimee Picchi

Updated on: April 25, 2024 / 12:56 PM EDT / CBS News

New consumer protection rules will soon entitle airline passengers to automatic refunds when flights are canceled or significantly delayed, while also requiring airlines to reveal  junk fees  upfront.

In total, the new rules could save travelers $500 million annually, Department of Transportation Secretary Pete Buttigieg said Wednesday, describing the regulations as "the biggest expansion of passenger rights in the department's history."

They take aim at some of the most common complaints against airlines, such as delays and difficulties getting refunds. Airlines will also have to disclose all possible fees, such as added costs for seat selection, when advertising a fare.

The regulations are likely to effect in October, officials said. Here's what to know about the new rules and what they mean for you.

You'll get an automatic refund for delayed or canceled flights

The first rule mandates that airlines promptly refund customers when flights are meaningfully disrupted or delayed. Airlines will have to refund customers the full ticket prices, including airline-imposed fees, as well as government taxes and fees.

In theory, passengers are already entitled to such refunds, but in practice airlines don't always provide them, Buttigieg noted. He said the new rule benefits infrequent fliers in particular, who may be less familiar with their rights. 

This rule will save customers the hassle of dealing with a chatbot or completing a cumbersome claims process to receive refunds they're entitled to anyway when flights don't take off as scheduled.

Airlines often offer customers compensation in the form of vouchers or miles with values that are less than the flight's original cost. And passengers often must engage with customer service agents or chatbots to secure refunds, which can lead them to give up on the process altogether, according to Buttigieg.

How long of a delay will qualify for a refund? 

The new rule defines what constitutes a "significantly changed" flight: a delay of at least three hours for a domestic flight, and at least six hours for an international flight. That was previously left to the discretion of the airline. 

The rule says passengers will get automatic refunds in those cases as long as they don't accept alternative transportation or travel credits offered by the airline.  

Passengers will also be entitled to refunds for other significant flight changes, according to the Department of Transportation. 

These changes include flights whose departure or arrival airports change, that add connections or downgrade passengers to a different level of service. If a flight requires a passenger with a disability to make a connection at an airport or on a flight that is less accommodating, that also qualifies for a refund.

How long will it take to get a refund?

Airlines will have seven days to automatically refund passengers who purchased their tickets with a credit card, and 20 calendar days for other payment methods, the Transportation Department said.

"No more defaulting to vouchers or credits when consumers may not even realize they're entitled to cash," Buttigieg said. 

Can I get a refund for delayed bags? 

Yes, checked bag delays are also covered. 

When bags aren't delivered within 12 hours of a domestic flight's arrival at its gate, passengers will get a refund for their checked bag fee.   On international flights, bags that don't arrive within 15 to 30 hours, depending on a flight's length, are covered by the rule. 

What other refunds will be available? 

Airlines must also refund the costs of services customers paid for but then didn't receive on the flight, such as wifi, seat selection or in-flight entertainment, the Transportation Department said.

For instance, if passengers buy wifi access but it doesn't work properly, they are entitled to a refund for the service.

What is happening with surprise fees? 

Transportation officials also announced a second rule on Wednesday that targets "junk" or surprise fees, which are charges that aren't typically disclosed to a consumer ahead of purchase. 

Under the rule, airlines must disclose all fees the first time that airfare is advertised on an airline's site. Hyperlinks don't count, according to the agency.

The rule is designed to protect consumers against confusion caused by "drip pricing"  by requiring airlines to disclose how much these additional fees will cost up front. That includes amounts airlines charge consumers to check bags, carry on bags, select seats, and change or cancel flights.

The rule is designed to help make it easier for passengers to estimate the full cost of flying so they can make an informed purchase.

Are seats guaranteed if I buy a ticket?

Under the second rule, airlines will also have to make clear to customers that if they buy a ticket, they're guaranteed a seat — even if they don't fork over additional money to choose where on the plane that seat is located. 

How will I know I'm seeing the actual flight price?

The second rule also bars airlines from advertising artificially low prices that don't factor in mandatory fees. 

The Transportation Department said this will end "discount bait-and-switch tactics" that dangle deceptive discounts to convince travelers to buy tickets.

What do airlines say about the new rules?

Airlines for America, a trade group for large U.S. carriers, noted that refund complaints to the Transportation Department have fallen sharply since mid-2020. 

A spokesperson for the group said airlines "offer a range of options — including fully refundable fares — to increase accessibility to air travel and to help customers make ticket selections that best fit their needs."

The group said the 11 largest U.S. airlines issued $43 billion in customer refunds from 2020 through 2023.

While Buttigieg said airlines aren't "enthusiastic" about being held to a higher standard, he believes the new rules will build passenger confidence in companies and ultimately benefit the industry as a whole.

Buttigieg also said he hopes the new rules will push carriers to improve the consumer experience. For example, if an airline knows it will automatically owe customers refunds for canceled flights, it might invest more in precise scheduling, and ultimately reduce the number of cancellations overall. 

—With reporting by the Associated Press.

Megan Cerullo is a New York-based reporter for CBS MoneyWatch covering small business, workplace, health care, consumer spending and personal finance topics. She regularly appears on CBS News 24/7 to discuss her reporting.

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This Is the Best Airport in the World, According to a New Ranking

By Hannah Towey

Hamad International Airport (HIA) in Qatar was just named the best airport in the world in the 2024 Skytrax awards, knocking 12-time winner Singapore Changi Airport down to second place.

The annual ranking is based on customer satisfaction surveys of over 500 airports, evaluating factors such as cleanliness, friendliness of airport staff, the ease of getting to and from the airport, terminal design, dining options, and more.

Hamad International Airport first opened in 2014, replacing the adjacent Doha International Airport as Qatar's main aviation hub. The airport is operated by Qatar Airways, which is consistently ranked one of the best international airlines in the Condé Nast Traveler Reader's Choice Awards , and is the only airport designed specifically for the Airbus A380 plane. This year marks the third time the airport has won the prestigious industry award.

So, what exactly sets the airport apart from the competition? One of its newest—and most ambitious—features is the “Orchard,” a 6,000-square-meter indoor tropical garden with 65 retail and dining venues launched in 2022 as part of a multi-year expansion project. Home to over 300 trees and 25,000 plants from sustainable forests around the world, it's one of the airport's many green initiatives that includes a waste management program that recycles 3,979 tons of organic compost per year to be used as fertilizer.

“Throughout our young history, we have continued to showcase our commitment to environmental sustainability–from improving carbon efficiency to reducing greenhouse gas emissions and managing wastewater," Michael McMillan, the airport's vice president of facilities management said in a 2022 news release . “Sustainability has proudly been at the forefront of what we do since our inception.”

Over the past couple years, the airport has also added a brand-new airport hotel, Oryx Garden Hotel, as well as four new airport lounges, including the glamorous Louis Vuitton Lounge . In addition to Louis Vuitton, the airport's massive retail center Qatar Duty Free has an entire “street” called Viale del Lusso devoted to luxury shops like Dolce&Gabbana, Jimmy Choo, and Valentino. It perhaps comes at no surprise then that the airport also won Skytrax's 2024 award for the world’s best airport shopping.

The Louis Vuitton Lounge by Yannick Alléno in Doha's Hamad International Airport.

Chef Yannick Alléno highlights local ingredients, French favorites, and international fare.

The airport served over 45 million passengers in 2023, a 31% increase compared to the previous year, surpassing the previous record set during the FIFA World Cup. HIA has also added new international airline partners, including Vistara, Iberia, Xiamen Airlines, Garuda Indonesia, and Japan Airlines, and serves over 250 destinations. The airport's rapid growth shows now signs of stopping: the second phase of the expansion, scheduled to begin in 2023, aims to expand the airport's capacity to over 70 million annual passengers.

“Our continuous investment in our facilities and pioneering initiatives in retail and hospitality within a single expansive terminal has made this achievement possible," Badr Mohammed Al-Meer, the CEO of Qatar Airways Group, said in a news release . "We have introduced a diverse range of experiences at the airport, including ‘Souq Al Matar’, which brings Qatari hospitality and culture closer to travelers; ‘Orchard’, the ideal place for relaxation and rejuvenation between flights; and an array of high-end lounges.”

Other standout winners in the 2024 Skytrax airport awards include Seoul's Incheon Airport, the world’s most family friendly airport; Tokyo's Haneda Airport, the world’s cleanest airport; and the Istanbul Airport, for the world’s best airport dining experience.

Below, see the world's best airports , according to the 2024 Skytrax World Airport Awards. How many have you been to?

The World’s Top 20 Airports for 2024

• Doha Hamad Airport
• Singapore Changi Airport
• Seoul Incheon Airport
• Tokyo Haneda Airport
• Tokyo Narita Airport
• Paris Charles de Gaulle Airport
• Dubai Airport
• Munich Airport
• Zurich Airport
• Istanbul Airport
• Hong Kong Airport
• Rome Fiumicino Airport
• Vienna Airport
• Helsinki-Vantaa
• Madrid-Barajas
• Centrair Nagoya Airport
• Vancouver Airport
• Kansai Airport
• Melbourne Airport
• Copenhagen Airport

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What fliers need to know about new refund rules for airlines

Starting in about six months, u.s. airlines will have to offer customers cash refunds before vouchers.

New federal rules for airlines will go into effect later this year, giving travelers a better picture of the full cost of flights before they book — and getting them an easier refund if things go awry.

After a process that lasted more than a year, the Biden administration announced the rules on passenger protections Wednesday.

“This is a big day for America’s flying public,” Transportation Secretary Pete Buttigieg said in a news conference at Reagan National Airport.

While the trade group Airlines for America said its members “abide by — and frequently exceed — DOT regulations regarding consumer protections,” consumer advocates praised the administration’s move.

“These rules are not only critical but also common sense,” said William McGee, senior fellow for aviation and travel at the American Economic Liberties Project, who spoke at Wednesday’s event.

Most new rules go into effect in the fall

At the event Wednesday, Buttigieg said that “the bulk of these protections” will go into effect in about six months. Others will start in a year.

That means refund rules that get customers automatic cash refunds when airlines cancel or significantly change flights won’t be in place during the busy summer travel season. But they should be set in time for the Thanksgiving and winter holiday season rush.

Buttigieg said that the department expects airlines to take some time to develop the processes to return cash to travelers, but added that he doesn’t want them to drag their feet.

“They don’t have to wait the number of months that it’ll technically take for this to go into effect,” Buttigieg said Wednesday. “They could and should be doing this right now.”

You should get refunds without having to ask

Instead of first offering a voucher or credit, airlines “must automatically issue refunds without passengers having to explicitly request them or jump through hoops,” the Transportation Department says. The refunds need to be issued within seven business days for credit card purchases and 20 calendar days when bought through other methods.

However a traveler originally paid is the way the refund needs to be issued, the rule says, whether that’s by credit card or airline miles . Other types of compensation are allowed only if a passenger chooses one of those alternatives.

“No more defaulting to vouchers or credits when consumers may not even realize that they were entitled to cash,” Buttigieg said.

You can still choose to be rebooked

If travelers’ flights have been canceled or significantly changed, they can still continue with their trip. Passengers are only eligible for a refund if they have declined to accept alternative transportation.

Airlines will have to pay for delayed bags and broken WiFi

There are many ways for a trip to go awry, and the new rules cover more than just a late or canceled flight.

If a checked bag isn’t delivered within 12 hours of a domestic flight arriving at the gate, or within 15 to 30 hours of an international flight arriving, depending on how long that flight is, passengers will be entitled to a refund of their checked-bag fee. They will need to file a mishandled baggage report.

Refunds will also be given if passengers pay for a service such as WiFi, seat selection or in-flight entertainment and the airline fails to provide.

‘Significant’ changes will be the same for all airlines

Automatic cash refunds are due to passengers if their flight experiences a “significant change.” But what does that mean? Previously, the definition could vary from airline to airline.

The new rules provide some consistency. A change is considered significant if a departure or arrival is different by more than three hours for domestic flights or six hours for international trips.

Other changes considered significant: the departure or arrival is from a different airport; there are more connections; passengers are downgraded to a lower class; or service or flights are on planes that are less accessible for a person with a disability.

No more hidden fees for bags and seat selection

The rule on extra fees — what the Biden administration refers to as “surprise junk fees in air travel” — will require airlines and online travel booking sites to disclose up front the fees for a checked bag, carry-on bag, reservation change and reservation cancellation. Those fees must be clearly noted and not shown through a hyperlink, the rule says.

Consumers must also be informed that they don’t have to pay for a seat assignment to travel and that a seat will be provided without an additional price.

“Healthy competition requires that, as a consumer, you comparison shop, which means knowing the real price of a trip before and not after you buy,” Buttigieg said. “Airlines will now be required to show you these costs up front, so you have all the information you need to decide what travel option is best for you.”

Travelers can either search without providing their personal information to see standard fees or, after entering their information, see more tailored fees that might apply given their military status, frequent-flier membership or credit card use.

“The final rule puts an end to the bait-and-switch tactics some airlines use to disguise the true cost of discounted flights,” the Transportation Department said in a news release. “Prior to the rule, some airlines were offering deceptive discounts that consumers may have believed applied to the full fare that was being advertised but only applied to a small portion of the ticket price.”

You will still have to report complaints

Buttigieg said the main way for the department to find out about a violation of the rules is when people submit complaints through the site flightrights.gov . But he said he hopes that by making refunds automatic, there will be less need for complaints — and more flexibility for employees to perform audits or spot-checks of airline compliance.

Europe-style compensation is still not in the rules

Some travelers heading to or from Europe who experience delays under certain circumstances are entitled to compensation worth more than $600. That kind of system does not exist for domestic flights in the United States, but Buttigieg said it is on the agenda.

“On compensation, we continue to develop that — and to be clear, with this rule on the books, that does not stop or slow the progress that we’re driving in terms of a compensation rule,” he said.

More on air travel

Leave flying to the pros: Think you could land a plane in an emergency? Experts say you’re wrong . Here’s what you should actually do if something goes awry during a flight .

Pet peeves: Why do “gate lice” line up early for a flight ? Psychologists explained for us. Another move that annoys airline workers: abusing the flight attendant call button . For more on how to behave on a flight, check out our 52 definitive rules of flying .

Plane mess: Stories about extremely disgusting airplanes have been grossing out travelers. The question of plane cleanups became the subject of a recent debate after a flight attendant allegedly told a pregnant passenger to pick up the popcorn spilled by her toddler.

Frequent flying: Airline status isn’t what it used to be, but at least there are some good movies and TV shows to watch in the air. And somewhere out there, experts are trying to make airline food taste good.

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International tourist figures still millions below pre-COVID levels as slow recovery continues

For two years, Marcela Ribeiro worked three jobs to save for her dream holiday to Australia.

Like millions of people across the globe, the 35-year-old from Brazil had long wanted to explore the country's world-famous destinations, specifically the Great Barrier Reef, World Heritage-listed rainforest and sandy beaches. 

"I worked really, really hard, many jobs, to get here," Ms Ribeiro said.  

"The flights were very expensive, so I have to watch everything I spend. I can't afford to eat out in the restaurants every day." 

It's been a similar story for William Grbava from Canada and Amelia Mondido from the Philippines, who last week arrived in Australia for a holiday. 

"It's expensive here, much more than we were expecting. We have only been able to factor in a short stop in Sydney," Mr Grbava said. 

"We just had a beer and a pizza in Circular Quay for $50.

 "What I really wanted to do was drive up the coast to Brisbane, through Byron Bay and those beautiful towns. That's what I did when I was younger. But with the cost of fuel and car rental, it wasn't possible." 

Industry yet to recover to pre-COVID levels 

It's been more than four years since Australia's borders suddenly closed to the rest of the world and became one of the most isolated destinations on the globe. 

COVID-19 wreaked havoc across the country's economy, but nowhere was the pain as instant or more devastating as in the tourism industry. 

In 2019, 8.7 million tourists visited Australia from overseas in an industry that was worth $166 billion. 

New figures from Tourism Research Australia show there were only 6.6 million international visitors last year, a deficit of more than 2 million compared to 2019 levels.  

Victoria experienced the largest loss in international visits at 33 per cent, followed by Queensland at 24 per cent and New South Wales at 22 per cent. 

Nationally, Chinese visitor numbers — which made up the bulk of visitors to Australia pre-pandemic — slumped to 507,000 last year, down from 1.3 million in 2019. 

Figures for the month of February show more than 850,000 people visited Australia, an increase of 257,000 for the same time in 2023, but 7.5 per cent less than pre-COVID levels. 

Gui Lohmann from Griffith University's Institute for Tourism said there were a number of reasons for the slow return of international visitors. 

"The airfares are significantly high and we are under an inflationary situation with labour and food costs," Professor Lohmann said. 

"It could be challenging for Australia to reach above 8 million international visitors in the scenario we are in at the moment." 

Professor Lohmann said cost-of-living pressures were also at play in the return of international tourists, as was a "reset" in European thinking.  

"Many Europeans believe a long-haul trip is quite damaging to the environment and they're also flying less generally," he said. 

"Their domestic airline routes no longer exist [and] have been replaced by train trips." 

He said China's ongoing economic problems, the war in Ukraine and United States' election were also having an impact.  

"It's a much more complicated world we are facing after the pandemic," he said. 

A long road to recovery 

Oxford Economics has forecast it could take until 2025-26 before Australian tourism returned to pre-pandemic levels. 

Tourism Australia, a government agency that promotes holidays, said the strongest markets since borders reopened had been New Zealand, the United States and the United Kingdom. 

"We always knew that the recovery of international travel to Australia would take time, and we have continued to see the steady return of international visitors to our shores," a spokeswoman said. 

Maneka Jayasinghe, a tourism expert at Charles Darwin University, said affordability was a key factor in attracting visitors Down Under.  

She said the state and federal governments should consider subsidising travel to Australia. 

"Measures to reduce costs, such as discounted hotel prices, tourism package deals and food vouchers could be of importance to encourage visitors to Australia," Dr Jayasinghe said. 

"Tourism operators were badly hit during COVID so may not be in a financially viable position to provide further perks to visitors, especially the small-scale operators in smaller states and territories and those operating in remote areas." 

She said re-establishing links with traditional tourism markets, including Japan, was also a potential solution. 

"Countries with a rapidly growing middle class, such as India, could have high potential to grow. Some of the south-east Asian countries, such as Vietnam and Indonesia, could also be attractive due to their proximity to Australia." 

Dutch tourists Tim Erentsen and Laleh Maleki estimated it would cost them around $16,000 for their three-week holiday in Australia, where they are visiting Sydney, the Whitsundays and Cairns. 

"It has been expensive, especially the flights," Mr Erentsen said. 

Ms Maleki said the couple had travelled extensively throughout Europe and the US and the cost of hotels and food in Australia was comparable. 

"We thought if we were coming all this way and spending the money to get here, we should stay a bit longer, which is adding to the cost," Ms Maleki said. 

But despite that extra cost, she said the trip had been worth it. 

"We love the nature, it feels very safe here. The food is so good and the people are very friendly." 

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Opportunities for industry leaders as new travelers take to the skies

Travel fell sharply during the COVID-19 pandemic—airline revenues dropped by 60 percent in 2020, and air travel and tourism are not expected to return to 2019 levels before 2024. 1 “ Back to the future? Airline sector poised for change post-COVID-19 ,” McKinsey, April 2, 2021; “ What will it take to go from ‘travel shock’ to surge? ” McKinsey, November 23, 2021. While this downturn is worrisome, it is likely to be temporary. McKinsey’s latest survey of more than 5,500 air travelers around the world shows that the aviation industry faces an even bigger challenge: sustainability.

The survey results indicate emerging trends in passenger priorities:

About the survey

We asked about 5,500 people in 13 countries, half of them women, to answer 36 questions in July 2021. Each had taken one or more flights in the previous 12 months. More than 25 percent took at least half of their flights for business reasons; 5 percent had taken more than eight flights in the previous 24 months. They ranged in age from 18 to over 75 and hailed from the US and Canada, the UK, Sweden, Spain, Poland, Germany, Saudi Arabia, India, China, Japan, Australia, and Brazil.

Topics included concerns about climate change and carbon emissions, carbon reduction measures, and factors influencing tourism stays and activities.

We compared the results to those of a survey asking the same questions that we conducted in July 2019.

• Most passengers understand that aviation has a significant impact on the environment. Emissions are now the top concern of respondents in 11 of the 13 countries polled, up from four in the 2019 survey. More than half of respondents said they’re “really worried” about climate change, and that aviation should become carbon neutral in the future.
• Travelers continue to prioritize price and connections over sustainability in booking decisions, for now. This may be partly because no airline has built a business system or brand promise on sustainability. Also, some consumers may currently be less concerned about their own impact because they’re flying less frequently in the pandemic. That said, almost 40 percent of travelers globally are now willing to pay at least two percent more for carbon-neutral tickets, or about $20 for a $1,000 round-trip, and 36 percent plan to fly less to reduce their climate impact.
• Attitudes and preferences vary widely among countries and customer segments. Around 60 percent of travelers in Spain are willing to pay more for carbon-neutral flights, for example, compared to nine percent in India and two percent in Japan.

This article outlines steps that airlines, airports, and their suppliers could take to respond to changing attitudes and preferences. The survey findings suggest that airlines may need to begin with gaining a deeper understanding of changes across heterogenous customer segments and geographies. With those insights in hand, they could tailor their communications, products, and services to differentiate their brands, build awareness among each passenger segment, and better connect with customers.

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The survey findings point to fundamental and ongoing changes in consumer behavior.

After a decade of steady growth in passenger traffic, air travel was hit hard by the pandemic. International air travel immediately fell by almost 100 percent, and overall bookings declined by more than 60 percent for 2020, according to Airports Council International. At the time of writing, revenue passenger miles have returned to close to pre-pandemic levels in the United States, but still lag behind in other markets. 2 “COVID-19: October 2021 traffic data,” International Air Transport Association (IATA), December 8, 2021. In its October 2021 report, before the Omicron variant emerged, the International Air Transport Association (IATA) forecast that the industry’s losses would be around $52 billion in 2021 and $12 billion in 2022. 3 “Economic performance of the airline industry,” IATA, October 4, 2021.

Furthermore, travelers’ preferences and behaviors have changed sharply during the pandemic, particularly around health and safety requirements. An Ipsos survey for the World Economic Forum found that, on average, three in four adults across 28 countries agreed that COVID-19 vaccine passports should be required of travelers to enter their country and that they would be effective in making travel and large events safe. 4 “Global public backs COVID-19 vaccine passports for international travel,” Ipsos, April 28, 2021. And a 2021 survey by Expedia Group found that people buying plane tickets now care more about health, safety, and flexibility than previously. But, there is also renewed interest in travel as nearly one in five travelers expected travel to be the thing they spent the most on in 2021, one in three had larger travel budgets for the year, and many were looking for new experiences such as once-in-a-lifetime trips. 5 “New research: How travelers are making decisions for the second half of 2021,” Skift, August 26, 2021.

Comparing McKinsey’s 2019 and 2021 survey results, sustainability remains a priority as respondents show similar levels of concern about climate change, continue to believe that aviation must become carbon neutral, and want their governments to step in to reduce airline emissions. Some changes were more striking. The share of respondents who say they plan to fly less to minimize their environmental impact rose five percentage points to 36 percent. In 2021 half of all respondents said they want to fly less after the pandemic. Changes in opinion varied across markets. Passengers in the UK, US, and Saudi Arabia, for example, were more likely to feel “flygskam,” (shame about flying) while those in Spain, Poland, and Australia felt significantly less guilty about flying.

It is worth tracking these trends in each market and demographic, because passengers’ experiences and opinions are increasingly relevant: passengers spend far more time online, increasingly trust each other’s recommendations more than traditional marketing, and can reshape brand perceptions faster than ever. 6 “ Understanding the ever-evolving, always-surprising consumer ,” McKinsey, August 31, 2021. In some markets consumers may reward airlines that meet rising demands for environmental sustainability—and punish those who fall behind.

The Australian airline Qantas may be acting on a similar belief. In November 2021, it announced a new “green tier” in its loyalty program. The initiative, based on feedback from passengers, is “designed to encourage, and recognize the airline’s 13 million frequent flyers for doing things like offsetting their flights, staying in eco-hotels, walking to work, and installing solar panels at home”. Qantas states that it is one of the largest private-sector buyers of Australian carbon credits, and it will use program funds to support more conservation and environmental projects. 7 “Qantas frequent flyers to be rewarded for being sustainable,” Qantas media release, November 26,, 2021. “A look at how people around the world view climate change,” Pew Research April 18, 2019. Washington Post-Kaiser Family Foundation climate change survey, July 9 to August 5, 2019.

Given these shifting trends, it may be helpful for all industry stakeholders to maintain a deep and up-to-date understanding of consumer segments in each market that they serve. Three main findings about today’s travelers emerged from the 2021 survey:

Finding 1: Most travelers now have concerns about climate change and carbon emissions—and many are prepared to act on these concerns

Concern about carbon emissions from aviation did not rise much during the pandemic, probably in part because air travel declined so sharply. About 56 percent of respondents said they were worried about climate change, and 54 percent said aviation should “definitely become carbon neutral” in the future.

While these numbers have increased only one or two percentage points since 2019, the share of respondents who rank CO 2 emissions as their top concern about aviation—ahead of concerns such as noise pollution and mass tourism—rose by nine percentage points to 34 percent. More than 30 percent of respondents have paid to offset their CO2 emissions from air travel.

Finding 2: Price and connections still matter much more than emissions to most travelers

Of the nine major factors travelers consider when booking a flight, carbon emissions consistently rank as sixth-most important across customer segments. This may be partly because most airline marketing centers around low cost or superior service, and pricing and revenue management are targeted at price and best connection. Most booking websites allow prospective travelers to sort by price and number of connections, for example, but not by carbon footprint. Google Flights has made a first step, showing average CO2 emissions per flight and improving transparency for travelers.

Travelers might begin to make different choices if emissions featured more prominently in the booking process—particularly if more airlines offered CO 2 reduction measures that delivered genuine environmental impact.

Finding 3: Attitudes vary widely by demographics and geography

Beliefs about the seriousness of climate change, and how to respond to it, vary across demographics and geographies (exhibit). Although younger people are generally more aware of the predicted consequences of climate change, older cohorts have become more concerned about climate change since the 2019 survey. In some countries, large majorities see climate change as a major threat, while that represents a minority view in other countries.

The survey shows that frequent travelers feel slightly more shame about flying than other respondents—37 percent compared to 30 percent—but show a much lower intention to reduce their air travel to minimize their climate impact, at 19 percent compared to 38 percent.

According to Pew Research, more than 80 percent of people in Greece, Spain, France, and South Korea believe climate change is a major threat, compared to around 40 percent of those in Russia, Nigeria, and Israel. 8 “A look at how people around the world view climate change,” Pew Research April 18, 2019. According to 2019 polling by the Washington Post and Kaiser Family Foundation, more than three-quarters of Americans believe it represents a major problem or a crisis—but fewer than half are willing to pay to help address it. 9 Washington Post-Kaiser Family Foundation climate change survey, July 9 to August 5, 2019.

These numbers may change quickly in the next few years as discussions about climate change become less abstract as oceans rise and storms, forest fires, and droughts become more severe. Instead of being one topic of concern among many, millions more people around the world may come to see climate change as today’s greatest challenge.

This shift seems to be apparent in government action, especially in mature economies. The US, for example, announced its intention to exit the Paris Agreement in June 2017 but pledged to rejoin in April 2021. 10 “Climate change: US formally withdraws from Paris agreement,” BBC, November 4, 2020; “President Biden sets 2030 greenhouse gas pollution reduction target,” White House fact sheet, April 22, 2021. And in September, the White House set a goal for the country to produce 3 billion gallons of sustainable aircraft fuel annually by 2030—up from about 4.5 million gallons produced in the US in 2020—which would cut carbon emissions from flying by 20 percent compared with taking no action. 11 “Biden administration advances the future of sustainable fuels in American aviation,” White House fact sheet, September 9, 2021.

Taking stock of the pandemic’s impact on global aviation

How the industry can be cleared for takeoff.

Travelers’ attitudes and behaviors appear to be in flux, and will likely continue to change. Depending on the world’s progress in preventing and treating COVID-19, the industry will likely take at least a couple of years to recover from the downdrafts caused by the pandemic.

In this unique moment in aviation history, airlines may be able to communicate in new ways to inspire passengers to join the fight against climate change. Based on McKinsey’s experience in aviation and other industries around the world, there may be an opportunity for carriers to make it “easy to do good”. When following such an approach, experience shows that customers are drawn to straightforward language, demonstrations of what the industry is doing in this area, and the tangible benefits of those efforts. The most compelling stories are positive and connect with customers’ emotional needs.

As in the early days of travel advertising, airlines could reinforce the idea that the journey is the destination—that “getting there is half the fun.” By inviting customers to get involved in creating a greener future and own the solution, they could forge new partnerships and deepen loyalty.

Actual progress will be essential; organizations that talk about sustainability without demonstrating action may quickly be held to account. Simply keeping pace with trends or regulatory requirements will offer no advantages. Airlines that move boldly, such as by replacing rather than modifying a loyalty program with some kind of “planet-positive” scheme, will stand out from competitors.

The survey results and McKinsey’s work in the industry lead us to believe that the market is ready for a forward-thinking airline to chart a route to a cleaner future for the industry. Leading airlines that build a business strategy and brand promise on sustainability will likely attract a growing share of business and leisure travelers, fresh capital and talent, and new allies across the industry, government, and society at large.

In the years ahead, more customers will be willing to pay for sustainability, particularly if airlines can engage them with interesting approaches, such as gamification in frequent flyer programs, opt-out rather than opt-in offsets, “green fast lanes” for check-ins and security control, and customized emission-reduction offers. Decarbonization could become the standard to reach and maintain next-tier levels in loyalty programs. Passengers will be able to join the global decarbonization team and transform flight shame into flight pride.

Like many private flyers, corporate customers will look for ways to mitigate their CO 2 footprint. Passenger and cargo airlines could craft attractive decarbonization programs to engage the rising numbers of corporates aiming to significantly reduce their scope 3 emissions from air transport.

No single set of approaches will be effective in every geography or with every passenger segment. But airlines with a deep understanding of their customers’ changing needs and desires will continue to outperform those that don’t. Such organizations could recruit more of their passengers to the decarbonization team while protecting their brands, the future of aviation, and the planet itself.

Mishal Ahmad is a manager in McKinsey’s New Jersey office, Frederik Franz is a senior associate in the Berlin office, Tomas Nauclér is a senior partner the Stockholm office, and Daniel Riefer is an associate partner in the Munich office.

The authors would like to thank Joost Krämer for his contributions to this article.

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