Connor Reed, a 25-year-old from Llandudno in North Wales, was working at a school in the Chinese city of Wuhan when he began to feel “a bit sniffly”. He would soon face a painful ordeal and become the first known British man to catch the coronavirus. It was 25 November, 2019, when he first felt unwell. He told Sky News: “I was feeling like I just had a normal cold and the problem with this virus is it progresses in stages. It started with a cold.”
It’s possible that Connor’s cold was unconnected with the virus and he just happened to catch it several days before he was struck by coronavirus. For a while he continued to work and was feeling relatively normal, but just as the cold was tailing-off, in early December, he was struck by flu. “I woke up and I was just feeling really bad. I was coughing a lot and subsequently I lost my voice.
“One of my Irish friends mentioned that hot whisky and honey really helps with symptoms. So, that’s what I tried and honestly, it did help. It really did. But in no way am I condoning that whisky and honey will cure the virus. I mean, it definitely doesn’t.”
At this point, in early December, Connor decided he wasn’t going to go back to work for a while. He had a fever and he didn’t want to pass the illness onto his colleagues. Despite living in what was the epicentre of the virus, as yet, the local authorities were unaware that Wuhan in China was incubating a nasty new disease that would spread across the globe.
“I was feeling achy,” says Connor “I just wanted to curl up into a ball and I had ear problems and sinus problems where it felt like there was a balloon being blown up in my face. And that was probably the worst symptom. It really bothered me. “I also had a raking cough. It was terrible. And it was happening so much, I lost my voice. Sometimes, I couldn’t make any sound at all. Sometimes, I sounded like a frog.”
For most people who catch the virus, it won’t get any worse than this, it may not even get that bad, but for Connor the scariest part was still to come. He actually felt like he was recovering from the flu and was feeling optimistic about going back to work when one morning he woke up struggling to breathe.
“It scared me because breathing is a necessity of life, like if you have the flu, you really feel like you’re going to die, but you’re really not. But when your lungs get affected, that’s where it scared me. And I couldn’t take a full breath. And the breaths I did take, it sounded like I was breathing through a bag. It was very crackly, and I could only take half breaths. If I walked to the kitchen, for instance, I’d be breathing really shallow and really fast.”
Connor continued drinking hot water to try and clear it up but, a day later when things didn’t improve, he went to hospital. On 5 December he had a day of blood tests, x-rays and breathing tests. The next day, two weeks after he’d first caught the cold, the results came back that he had pneumonia.
He said: “At no point was I thinking that I’m going to die. I mean, it wasn’t that serious. I’m a young person. I don’t smoke. I don’t drink. It really didn’t affect me as bad as if I was elderly or I had pre-existing health problems.” Connor recovered from his illness and a few weeks later doctors realised he had suffered from the virus that was now spreading across the province, which would become known as COVID-19.
Wuhan is still under quarantine. Connor recalls getting an alert on his phone at 3am announcing the quarantine for the city. “Luckily, I was awake to read that text message. So, I bolted out of the house and went to the 24-hour supermarket downstairs. I knew that it was going to be bad and I knew that shops were going be sold out.”
He stocked up. But weeks later the city continues to maintain strict rules. Connor said: “As more and more new cases came, and it started spreading, the government sanctioned harsher penalties and a lot harsher quarantine. For instance, at the moment, one person is allowed to leave their house every three days, and that’s just to purchase necessities.”
He said when going out there is “no atmosphere”, and very few people on the streets. “If you go to a shop, there are some shops that are open that have blocked the door off. You tell them what you want. They put it into a bag and then they pass the bag to you on a long stick just to avoid personal contact.”
Connor said the national government had dealt with the crisis well and learned lessons from previous outbreaks such as SARS. He believes the numbers for infected people that the authorities are releasing are accurate.
He added: “There are not many Western countries that can build a hospital in 10 days. China is one of the most efficient countries at getting stuff done. In regard to this outbreak, they’ve got it done. They had to. They had to take the drastic measures, that many other countries wouldn’t have taken.”
Have things gotten plane confusing for you? With the COVID-19 coronavirus outbreak occurring, are you having trouble deciding whether to cancel or postpone your air travel plans?
It seems like a fair number of people are trying to make such decisions right now. Social media certainly has had its share of “should I stay or should I go” clashes of opinions and discussions. For example, @scottbudman tweeted out these recommendations:
And someone here is worried about more than hot farts:
Then there was this question to Florian Krammer, PhD, a Professor at the Department of Microbiology Icahn School of Medicine at Mount Sinai:
On the flip side, if you don’t like lines and crowds at the airport, this may seem like a great time to fly, with an emphasis on the word seem. According to Rick Clough reporting for Bloomberg, commercial air traffic is on track to drop by 8.9% this year, which would be the biggest decline since 1978 and in fact only the fourth year that air travel has fell in that time frame. Declines also have occurred in 1991, 2001 after the 9/11 terrorist attacks, and 2009 amidst the recession and the H1N1 flu pandemic. Cecile Daurat and Justin Bachman have written for Bloomberg that the airline industry stands to lose up to $113 billion in sales and that some airlines are already cutting back on available flights. Who knows? Maybe you can even find a seat on the plane that has a free seat next to it, so that you can actually do things like see your feet while sitting.
So what should you do? Well, as you’ll see in a bit, there are clearer-cut situations in which air travel is not advisable and canceling or postponing makes sense. However, for some other situations, the answer is a bit more complicated and evolving. The SARS-CoV2 outbreak and accompanying travel recommendations are evolving and serious situations. The SARS-CoV2 seems to be significantly more contagious and more virulent than the flu virus. But it is not yet clear exactly how much more. Its reported case fatality rate has been in the 1.5% to 3.8% range, nowhere near that of the original SARS virus. But things continue to change as more info emerges. There is still much to learn about SARS-CoV2 and its spread. So caution but not panic is worthwhile. Moreover, you’ve got to weigh different factors, risks, and benefits.
If your destination has some major travel warnings or restrictions, then the answer may be easy. For example, China and Iran fall into the category of “widespread sustained (ongoing) transmission and restrictions on entry to the United States.” That means that you shouldn’t consider traveling to these countries unless you absolutely have to do so. South Korea and Italy are listed as having “widespread sustained (ongoing) transmission,” which also means that postponing travel to these countries is a good idea. There’s a warning about Japan as well, if you are an older adult or someone with a chronic medical condition.
As things are changing fairly rapidly, check this website often. Bookmark the site. Treat it like you would Cristiano Ronaldo’s Instagram feed. Follow it. Learn it. Absorb it.
A second thing to do is double-check whether the meeting, the gathering, or whatever you’re going to may be canceled. Recently meetings have been like primary candidates in a political race: “it’s going to happen, it’s going to happen, no problems, oh, time to shut things down.” Last minute cancellations have been occurring, so you don’t want to be stuck with a ticket and no place to go, just like what may be going on, or perhaps not going on, here:
So what do you do if your destination doesn’t have a major warning and your event still seems on track? Air travel certainly isn’t the same as staying in your apartment or house surrounded by mounds and mounds of toilet paper rolls. The only way to completely avoid the possibility of infection is to completely avoid contact with people or any of the objects or surfaces that they touch. This is may not be practical. Life is never risk-free. So there will be risks with any activity, especially ones that involve larger numbers of people.
But let’s be clear what the real risks may be. For example, how much of a risk is the recycled air in airplanes? Well, the air does go through HEPA filters. HEPA stands for “high efficiency particulate air [filter]” and is supposed to filter out at least 99.97% of microbes, dust, pollen, mold, and any airborne particles that are 0.3 microns (µm) in size. The filter may even be more efficient at filtering particles that are smaller or larger than 0.3 µm, such as French fries.
Assuming that the HEPA filter is working properly then you may not have to worry so much about the air nozzle overhead that’s creating a mini-tornado on your face. Plus, SARS-CoV2 can only travel so far in the air. It’s not as if they have little wings. Viruses don’t drink Red Bull. Instead, they hitch rides on respiratory droplets that come out of an infected person through coughing, sneezing, spitting, or the like. These droplets can travel up to three to six feet from the person.
What may be of greater concern is the close proximity between passengers on the plane. Over the past decade or so, passengers haven’t exactly been declaring, “wow, what do I do with all this legroom? There’s just too much legroom here in economy seating.” In fact, Stephanie Robertson has written for the New York Times about “Fighting the Incredible Shrinking Airline Seat” and how airplane seat sizes have been shrinking since since the U.S. airline industry underwent deregulation in the 1970’s. Maintaining a three to six foot distance from other passengers may be tough even if you were to have excessive and obvious heated flatulence. So yes, if the person next to you is infectious, you could get exposed.
Then there are the various surfaces on the plane. You are probably more likely to catch respiratory viruses like coronaviruses and flu viruses through touching things that have been contaminated with the virus. That includes body parts like hands or surfaces like seat belt buckles and Baby Yoda figurines that have been touched by someone infectious. Quite a few of the surfaces in an airplane cabin would be considered “high touch,” meaning that different people touch them frequently. These include tray tables, seats, seat belts, video monitors, and that crypt-like pocket in the back of the seat in front of you. People shove who knows what in those pockets, including magazines, wrapping papers, used tissues, and maybe even a doughnut.
That’s why limiting what you touch, washing your hands thoroughly and frequently, and not touching your face with unwashed hands will be more important than holding your breath for the entire duration of the six hour or so flight. (By the way, you can only hold your breath for a few minutes before you pass out, so don’t even try it.) Of course, not touching your face is easier said than done, as I described previously for Forbes. Your face can feel like a gigantic planet with a massive gravitational pull on your fingers. Therefore, try keeping your hands occupied like putting them in your pockets, typing on a computer, or flashing gang signs to yourself.
Hand sanitizer can help but make sure you use it properly. Use enough sanitizer to cover all parts of your hands. Then massage your hands together as if they were the main characters in a romance novel. Keep up the rubbing until they become dry. Recite the alphabet while doing this so that you know that you’ve gone long enough, because isn’t that what lovers in a romance novel do?
Washing your hands with soap and water, if done properly, is always better than just using hand sanitizer. However, airplane bathrooms may be areas of really high touch, in more ways than one. A lot can go on in a bathroom and a decent percentage of it is not good, from a microbe standpoint, that is. The words “airplane bathroom” and “luxurious” usually don’t go together. While in a cramped airplane bathroom, it can be difficult to limit your touching, especially when turbulence makes it feel like you are an ingredient in a smoothie being made.
Therefore, definitely wash your hands thoroughly at the end of an adventure in an airplane bathroom. This may not be the easiest thing with the design of the bathroom sink. Many such bathrooms don’t have automatic sensor-driven faucets. Instead you’ve got to continuously hold down those little faucet handles, and keep pushing that lever that allows the sink to drain. After drying your hands with a paper towel, try not to touch other used items when throwing the towel away in the garbage. This can be tough when the garbage container lid slams back shut like gator’s mouth. When you are leaving the bathroom, use a paper towel to handle the door knob so that you don’t just re-contaminate your hands.
Pay attention to how everything in the cabin is maintained and cleaned. As a customer, consider it a right to know what safety and disinfection procedures are in place during and between flights. According to the World Health Organization (WHO), the new coronavirus may be able to survive on surfaces for “a few hours or up to several days.” That means what happened in the cabin during the flights before yours may stay in the cabin. Therefore, before a flight, consider inquiring about the specifics of an airline’s cleaning policies. After all, scrimping and saving on such things may be one way some airlines try to cut costs, unless customers shine more of a light on such practices.
Another question that is coming up is whether flights will be canceled or grounded due to the outbreak, leaving you stranded. That will depend on where you are flying, how the outbreak proceeds, and what the governments and the airlines plan on doing. It is difficult to predict what may happen. Therefore, follow closely official CDC announcements and the news, the real news that is and not what Uncle Joey or Aunt Marmy are saying on Facebook.
Stick with airlines that have more flexible cancellation and change policies. Beware of the airlines that say, “oh, you can change your flight but it will require this massive fee and a body part.” If you have already booked a flight and the airline has instituted a new more flexible change policy, see if you can benefit from that policy too. For example:
Consider purchasing travel insurance or a Cancel for Any Reason (CFAR) policy to cover you in case plans have to change. As always, read the fine print of such policies, which may not always be so fine.
Also, look into alternatives to air travel. Even if you do end up taking a flight, it is helpful to know how you may get back if your return flight ends up getting canceled. Make sure that the options are viable. After all, find a bicycle and pedal like mad may not work if you are going from San Francisco to New York City.
Ultimately, it’s difficult to make blanket recommendations about air travel. (Oh, by the way, make sure that airline blankets are properly cleaned before using them.) In general, this doesn’t seem to be the best time to schedule optional travel. There’s still a fair amount of uncertainty. So if you can easily cancel your air travel, then you may want to do so.
If your travel isn’t completely optional, try to identify alternatives such as video-conferencing or sending a gigantic cake. Cutting down air travel not only may decrease your risk of getting sick but also reduce the risk of you carrying the virus to others who may be of even greater risk for bad health outcomes if they have other diseases or are older. It ain’t a bad thing for the environment either.
If you are over 65 years of age or have a chronic medical condition like lung disease, have a very low threshold for canceling your air travel. You may be at risk for worse health outcomes if you get infected. Check with your doctor before considering such travel. If you are a little kid, enjoy smearing things on your face, and don’t quite understand boundaries yet, you may not want to travel either because you won’t be able to maintain the necessary aforementioned infection control precautions. Besides if you are a kid, you are probably less likely to have essential work travel.
If canceling or postponing your air travel is difficult to do and you do end up having to travel by air, no need to be paranoid. “Be paranoid” is rarely the recommendation for any situation. Just take the precautions mentioned above, which are probably precautions that you should always take when traveling by plane regardless of whether a novel virus is circulating.
So, again, right now, you should avoid the locations that the CDC website warns you to avoid and consider canceling or postponing all non-essential air travel if it is reasonably feasible to do so. You also may want to avoid air travel if you are in a higher risk group such those over 65 years of age or with a chronic medical condition.
Of course, lots of air travel doesn’t quite fall into these categories, which makes decision making more difficult. As with all difficult decisions, your decision on whether to cancel your flight plans is personal, depending on your risk tolerance and needs. Yes, being confined close together with others in a cabin for several hours does have its risks. Yes, you are depending on others to keep surfaces clean and disinfected. Yes, you don’t know exactly what will happen in the ensuing weeks. But there are things that you can do to reduce the accompanying risks. Realize that nothing has no risk.
Be aware of the real risks and not what so-and-so with ten followers on Twitter is trying to get you to believe. Don’t listen to some of the panicky chatter out there or anyone who tells you that there is one definitive answer for everyone, such as all air travel should be canceled immediately or that no one should be concerned about air travel at all. Keep in mind the expertise and agendas of anyone who may be giving advice. Follow closely announcements from trusted sources. If you can follow what a celebrity is doing with his or her hair each day on social media, you can frequently check websites like the CDC’s. In other words, just stay appropriately grounded when making your decision of whether to fly.
I am a writer, journalist, professor, systems modeler, computational and digital health expert, avocado-eater, and entrepreneur, not always in that order. Currently, I am a Professor of Health Policy and Management at the City University of New York (CUNY), Executive Director of PHICOR (@PHICORteam), Associate Professor at the Johns Hopkins Carey Business School, and founder and CEO of Symsilico. My previous positions include serving as Executive Director of the Global Obesity Prevention Center (GOPC) at Johns Hopkins University, Associate Professor of International Health at the Johns Hopkins Bloomberg School of Public Health, Associate Professor of Medicine and Biomedical Informatics at the University of Pittsburgh, and Senior Manager at Quintiles Transnational, working in biotechnology equity research at Montgomery Securities, and co-founding a biotechnology/bioinformatics company. My work involves developing computational approaches, models, and tools to help health and healthcare decision makers in all continents (except for Antarctica) and has been supported by a wide variety of sponsors such as the Bill and Melinda Gates Foundation, the NIH, AHRQ, CDC, UNICEF, USAID and the Global Fund. I have authored over 200 scientific publications and three books. Follow me on Twitter (@bruce_y_lee) but don’t ask me if I know martial arts.