President’s Corner July 2020
SARS-CoV-2 Basics for Aviation Professionals: Lessons Growing from the COVID-19 Pandemic
At the time of this writing, the pandemic of SARS-CoV-2 , a new Coronavirus causing COVID-19, is gripping the world media. The healthcare and aviation industries play very key roles in the global attempt to prevent a pandemic. Aviation allows rapid travel around the world both of people and the diseases they may harbor. Global public health organizations seek to limit the spread and work with transportation industries to restrict travel and screen persons meeting high-risk criteria. Quarantine, both of those in endemic areas and those traveling from areas or with symptoms, is a very serious measure implemented to contain the disease. Isolation of individuals with confirmed or suspected COVID-19 and the required contact tracing for further possible exposures and cases adds an extra burden for the individuals involved, their family and friends and the healthcare system.
Several reputable sources have provided information to help reduce the risk of spreading the disease. The Centers for Disease Control and the World Health Organization have excellent sites that are updated with the most current information for travelers, aviation personnel, health care providers and the general public. The Air Line Pilots Association, International also has a comprehensive collection of references and resources designed for aircrew traveling internationally.
The International Civil Aviation Organization has published a COVID-19 Response and Recovery Platform. Communications with accurate facts are essential in balancing media hype with actual facts. ICAO’s Council Aviation Recovery Taskforce has “Take-Off Guidance for Air Travel during the COVID-19 Public Health Crisis” which emphasizes the safe Public Health Corridor of clean aircraft, clean airports, clean crew and clean cargo. I continue to meet virtually several hours each week with 40 world health and aviation industry experts to update guidance as new facts become available. All aspects of aviation are considered including commercial airline, private and business travel, medical evacuation, repatriation, cargo and air navigations services (ATC). The goal is to develop an international standard that is easily accessible by all operators and facilitates a return to air travel by building traveler and public health authorities’ confidence in the safety of flying. Another useful resource for aviation professionals is the International Air Transport Association’s COVID page. IATA coordinates closely with ICAO and researches cases of potential transmission of COVID-19 during airline travel. To date, the evidence is reassuring.
What is known is that SARS-CoV-2 can be spread from human to human through airborne respiratory droplets, aerosols and contaminated surfaces. Spread is more likely with close contacts (less than 2 meters for greater than 15 minutes) who are symptomatic, but spread from asymptomatic (disease without symptoms) or pre-symptomatic (infected just prior developing symptoms) individuals is also possible. This type of asymptomatic spread may be the cause of new “hotspots” of disease activity.
Based on previous coronaviruses and other pandemic responses, there are definite steps a person can take to reduce the risk of exposure and infection. The key preventive step is handwashing with warm soapy water for at least 20 seconds frequently during the day or use of a 70% isopropyl alcohol solution. Avoiding persons with flu-like symptoms and coughs is ideal, but maintaining a 2-meter distance from all others will reduce the risk. Wearing a mask/facial covering can reduce the distribution of airborne viral particles and the risk of infecting others. Certain types of masks will add a layer of protection for the individual wearer to reduce the chances of acquiring the disease. Coughing into a handkerchief or a sleeve rather than into hands also reduces the risk. Cleaning and sanitizing potentially contaminated surfaces with effective agents also reduces the risk. In areas where the infection is widespread, avoiding crowded public gathering places is prudent. Many states have public health orders mandating these recommendations, but the federal government has yet to do so, either for the public or for the aviation industry. To date, there is no vaccine nor antiviral medication for SARS-CoV-2 although active work and clinical trials are proceeding worldwide.
Testing is an important component of public health measures to control the disease. This space does not permit a detailed discussion of testing. At this time, testing for viral particles can show evidence of current or past infection, although some tests are not specific enough to document infection with SARS-CoV-2 versus other Coronaviruses. Antibody testing, presumably demonstrating past exposure to SARS-CoV-2, is currently fraught with sensitivity and specificity issues. Even if we were confident in the accuracy of the results of antibody testing, we cannot make statements about immunity to further SARS-CoV-2 exposure or the duration of any presumed immunity at this time. The WHO does not recommend use of so-called “immunity passports” based on confirmed presence of antibodies, nor do countries of the world accept these results as a basis for bypassing public health regulations.
One aspect that is often overlooked in this pandemic is the mental health toll associated with COVID-19 fears and policies. Lives have been disrupted in many ways, from daily lifestyle, challenges with financial obligations, interacting with schools, employers and vendors, the uncertainty of future employment, travel restrictions, inability to see or care for loved ones and the rise of domestic violence and addictive behaviors to name a few. The ICAO Mental Health and the Aerospace Medical Association’s Working Groups are meeting regularly to develop strategies to help aviation professionals cope with these stressors. I strongly encourage reaching out to peer support groups, employee assistance programs or mental health professionals if you are faced with threats to your mental wellbeing. The FAA and EASA actively endorse these practices as healthy for aviation professionals and best for the safety of the air space system.
More will become known as there is a global effort of infectious disease and public health officials working around the clock to gather more data, conduct research and communicate policy recommendations to governments and the airline industry. The extraordinary steps being taken worldwide in the interim will slow the spread of the disease and hopefully lower the case mortality rate. A site I find useful for unbiased, scientifically validated information is the Centre of Evidence-Based Medicine at the University of Oxford in the UK. The scientific facts are critical in understanding the disease. Rumors, social media posts, premature publication of unreviewed “studies” and politicization of policies creates confusion, inappropriate action and increases the burden of disease. Ultimately, the hope of preventing and possibly eliminating COVID-19 lies with the development, distribution and widespread use of a safe, effective vaccine generating sustained immunity based on solid scientific evidence.
In conclusion, I recommend:
- Wash hands frequently for at least 20 seconds with soap and warm water or 70% isopropyl alcohol
- Avoid close contact with people. Stay two meters or more away if possible
- Use a mask or facial covering when distancing from others is not always possible
- Practice good cough/sneeze hygiene. Cover nose and mouth with a cloth or disposable tissue or use the sleeve of a shirt, not hands, to cough into.
- Wipe down potentially contaminated surfaces with effective cleaners and sanitizing agents
- Report potential symptoms of COVID-19 and get tested if you have symptoms
- Follow public health authority recommendations
- Evaluate the facts from reputable scientific sources
- Incorporate healthy physical and mental wellness practices in daily life
- Get a flu shot! – Nearly 70,000 Americans died of the flu last year for which a vaccine is available
We all do preventive maintenance on our aircraft. Let’s do the same for ourselves.
Fly Safely, Stay Healthy!