Air quality

One’s first notion is to blame the air quality, because it is a cramped space.  The cabin air is without a doubt a significant cause of spreading germs on aircraft.  However, the aircraft manufacturers are aware of this risk and they have done three crafty things to reduce this source of germs and viruses:

1. They replace the air 20 times an hour, in comparison with an average office, where fresh air from outside replaces internal air just twelve times per hour.
2. The air is filtered with “high-efficiency” filters.
3. The air flow is not, as you might expect, from the front of the aircraft to the back, but it flows from ceiling to floor.

The result of the last factor means that if someone is diseased and sitting many rows from you, you are unlikely to breathe the air that contains their germs.  Unfortunately, it also means that if there is anyone within two rows of you with an illness, you are going to breathe the air that they have contaminated.  Again, and again, and again, and again.

The cabin air is typically as dry as a dessert, which also robs your body of some of its protective measures, and the stress of modern air travel also undermines your immune system.

You could ensure that you are getting all the vitamins your body needs, which many people find a help.  To hydrate your sinuses you could use a spray, but that smacks of eccentricity.  One might think that wear wearing a face-mask would protect you.  Not so, according to the British Health Protection Agency.  There is no objective evidence to suggest that they are a useful preventive measure.

If there is someone coughing or sneezing near you and there are empty seats on the plane, you could request that the cabin crew move you.

Lavatories

The aircraft lavatories may start out clean at the beginning of the flight, but by the time that dozens of people have used them, some with suspect personal hygiene, they become Contamination City.  Funny enough, unless someone has had an accident, the seat probably has fewer germs than your phone or your keyboard.  The danger areas are, perversely, the areas that you are most likely to touch: the door handle, lock, tap (faucet), washbasin, walls and the counter.

Never use water from the aircraft’s plumbing system for brushing your teeth.  As recently as 2004 the EPA found that, owing to faecal contamination, no aircraft water systems complied with the national drinking water regulations.  Owing to more stringent regulations this has improved, but on any day, a significant number of planes are carrying water that is unfit for human consumption.  Aircraft water systems need only be disinfected a minimum of four times a year.  Worse yet, if they find E. coli in the water, they can continue to operate the plane for up to 72 hours before restricting public access to the water.

Our suggestions:

• Use bottled water for brushing your teeth.
• Carry alcohol-based handwash and disinfect your hands after having used the lavatory facilities.
• Do not touch your face until after you have disinfected your hands.  Use moist towelettes to wash your face (either provided by the airline, or ones that you carry on board with you).

Your seat and space

According to the US government’s guidelines for cleaning and disinfecting aircraft possibly contaminated with influenza (http://www.flu.gov) the places that can carry infection and can infect subsequent travellers using the same seat are the following:

• Armrests
• The plastic/metal part of the seat back
• Tray tables
• Seat belt buckles
• Light and air controls, cabin crew call button and overhead compartment handles
• The adjacent walls, windows and window shades, and
• The individual video monitor.

With the quick turn-around of planes, particularly short-haul, it is unlikely that these surfaces have all been sterilised.  You can use antiseptic wipes to clean the surfaces yourself, but then you risk looking a bit over-the-top.  Perhaps a more discreet way to handle this would be to wipe just those surfaces that you will likely be in contact with whilst seated, and then use hand-disinfectant when you have had to touch the ventilation, lighting and other controls.

If you sit on an aisle then there is an additional risk you face – people with contaminated hands are likely to steady themselves on the corner of your headrest as they pass by.  If you are phobic about germs then you may do better to sit at the window.

If you need help with finding suitable disinfectants, the EPA maintains a list of approved sterilisers here: http://www.epa.gov/oppad001/chemregindex.htm  List G is probably a good place to start.

However scary this list may be, the simple fact is that few travellers contract any life-threatening ailment on board, and a few simple precautions can substantially reduce your risk of colds or flu.

Copyright DIY Travel Expert

Wisdom teeth that are hurting and need to be removed. The writer’s own experience of this is that being at altitude with an impacted wisdom tooth that needed pulling was extremely unpleasant. The dull ache that had developed earlier in my journey became a harsh pain fifteen minutes after take-off. The reason was that the cabin is only required to be pressurised to 8000 ft, so there is a significant pressure drop. (In a Boeing 767 the pressure corresponds to 6,900 ft and the Airbus A380, currently the “best”, maintains a cabin pressure equivalent to 5,000 ft).

Colds and flu. If your eustachian tube is blocked or your sinuses are congested then you are going to have a problem. Additionally, if three is a lot of liquid build-up in your inner ear then the pressure could lead to the rupture of your eardrum.  This is an immediate medical emergency.

Foot injuries. Ankle injuries in particular are unpleasant to travel with. If you have a sprained ankle and you are travelling in economy class, it is going to be very uncomfortable.

Upset stomach. This speaks for itself in terms of discomfort.

Also, there is the risk of being denied boarding if the airline deems you unfit to travel at time of check in or boarding. Boarding a flight home from London a few years back, I had a swollen foot and was limping. The check-in clerk looked at me with suspicion, but held his peace. It swelled even more during the flight and I took my shoe off, with some difficulty. A stewardess walked past and said, ‘You’re not going to get that back into your shoe! If they had spotted this at boarding, you wouldn’t have been allowed to travel without a medical certificate from your doctor”.

You can also clear your injury with the airline beforehand, or you may be denied boarding, depending on their assessment of your mobility. Bear in mind that the airline has to contend with regulations that require you to be fit enough to evacuate from the aircraft in an emergency. (The hazard of trying to clear it with the airline is that they could say “no”, in which case you are going to be grounded until such time as your condition as improved enough to convince a doctor that you can travel.) As a basic rule of thumb, if you are okay for going up and down stairs, you should be okay for flight. If you have a broken leg in a cast, though, the airline will in some cases allow you to fly but require that you book an extra seat.

What to do about it
Since we are covering conditions that arise while you are travelling, the time-honoured advice of “get it fixed before you leave home” is not going to work. If it happens when you are already in flight then your sole solution is to ask the cabin crew for help. If the condition has developed while you are away from home but before you board then there may be actions you can take. Since this is DIY Travel Expert, we naturally have some practical advice.

Toothpain: Get painkiller drugs from a pharmacist. If there is time to see a doctor, get suitable antibiotics (or get them from a chemist if you are visiting a country where pharmacists are allowed to prescribe medication). The antibiotic will help reduce the pressure by reducing the volume of fluid in the tooth or gum.

Colds, flu and sinus conditions: Use decongestants. You may find that a spray will give you faster relief than medication that you have to swallow. Sprays will not leave you feeling drowsy, and you could take a tipple, whereas if you have taken a decongestant pill the chances are that you will be advised strictly not to use alcohol.

Burst ear-drum: This is a medical emergency. Alert the cabin-crew immediately. The pilot may even have to turn the plane around. Or land at the nearest viable airport.

Sprains: The usual advice for treatment of sprains is “RICE” – Rest, apply Ice, Compression and Elevation. Rest is going to be achievable. You can ask the personnel for ice and a towel (dampen the towel first – you are trying to cool down inflammation, you do not want to make the situation worse by causing frostbite). For compression you should preferably purchase an elasticised bandage designed for the injured body-part, which avoids applying compression inappropriately. For instance, a knee-guard will not apply pressure to the kneecap. As an alternative, have the part bandaged by a trained person the first time, then copy the method exactly yourself thereafter. Elevation is going to be a problem if you are travelling in “coach”. Bear in mind that you still need to take precautions against deep-vein thrombosis, even if you have a minor injury.

Oxygen.  If you have any condition that leaves you short of breath on the ground, it is likely that it will be worse at altitude.  If you require oxygen then will not be allowed to take your own tank on board because home medical oxygen tanks are not FAA-certified.  The airlines will require 48 hours notice if you need oxygen and it will cost you $50-$75 per tank or trip.

Upset stomach. If this happens before boarding, get to a pharmacy (many major airports also have pharmacies) and get something to help the symptoms. This might also be the one occasion that you would like to request a seat close to the lavatory at check-in.

The cabin crew are trained in first-aid, so consult with them if you experience discomfort or any new or unusual symptoms.

For more on in-flight safety, see our article on in-flight safety – hazard awareness and deep vein thrombosis – protect yourself.

Note: The suggestions listed here are not a substitute for proper medical advice. You should determine their suitability in your situation, and you are always cautioned to seek advice from an approved professional.

As reported in the Boston Globe, Marty Salfen, senior vice president of the International Airline Passengers Association, states that “if you have any type of medical condition, see a doctor prior to getting on the plane.  And if you feel sick once you’re on board, contact the flight attendant.  Don’t wait until it’s virtually too late.”