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Flying sick? 4 secrets for surviving your trip

Shiloh

Editor, Senior Moderator
Source: http://www.cnn.com/2008/TRAVEL/traveltips/05/29/flying.sick/index.html

updated 3:07 p.m. EDT, Thu May 29, 2008
Flying sick? 4 secrets for surviving your trip

By Christopher Elliott
Tribune Media Services

(Tribune Media Services) -- With a fever that soared to a mind-numbing 103 degrees and a chest rattling with acute bronchitis, Kathryn Clover's co-worker was in no shape to fly from Buenos Aires to Miami recently. But she boarded the plane anyway.

"She passed out on the first flight," remembers Clover, an operations manager for a nonprofit organization in Fort Lauderdale, Florida. "She was absolutely miserable for the long trip back. And I, in turn, was miserable because I was taking care of her and she was coughing on me -- and our surrounding passengers -- for 15 hours."

Why would anyone get on an aircraft while in the throes of a contagious, debilitating viral infection?

Maybe the question should be: Why not?

A lot of airlines won't waive their strict nonrefundability rules unless you can show them a death certificate. It's pretty much been that way since 9/11, and although the policies were relaxed somewhat in recent years, higher fuel prices and a softening economy have forced air carriers to take a hard line on refunds once again.

Here's what often happens when someone tries to call off a flight for the sake of their own health, and the welfare of other passengers.

On a recent trip from San Diego, California, to West Lafayette, Indiana, Candis Dorsch's husband developed a profuse nosebleed. "It wouldn't stop," she recalls. "It was obvious to us he could not fly without endangering himself, other passengers or the crew. It was obvious he needed medical attention."

But when Dorsch phoned Delta to explain the situation and ask if they could rebook the ticket, the carrier refused to waive any of her fees. "They told us we needed to board or our ticket would expire," she says.

Although there are no surveys on the number of sick people who fly because of the airlines' rigid rules, there's ample anecdotal evidence that airline passengers are boarding their flights whether they feel well or not. As a result, there's an odd kind of theater taking place at the boarding area. Sick passengers are showing up at the gate, either to plead with the airline to be allowed to fly later, or downplaying their symptoms, hoping gate agents won't notice their condition and permit them to fly.

Sometimes they're allowed to board, sometimes not.

It's a no-win situation. If sick passengers fly, they risk harming themselves -- passing out, as Clover's colleague did, or worse, dying, as a passenger on an American Airlines flight recently did. And if passengers are carrying an infectious disease, they could potentially spread a virus to people around them as well, which may be one of the reasons SARS made it to five countries within just a day several years ago.

If ill air travelers aren't allowed to board, they may be able to get the airline to waive their fees -- technically they've been denied boarding involuntarily -- but now they have to find their way home or to a hotel or a hospital. And they're already in the airport terminal, which is a public area, and who knows how many people they've already infected. Was that really worth the few hundred dollars the airline made?

To get an idea of how rigid airlines have become with their sick passengers, consider what happened to Kurtis Williams, an astronomer from Austin, Texas, who was scheduled to fly from Austin to San Jose, California, recently. "The evening before my return, I came down with the worst flu I've had in a long time," he says. "It hurt to move, it hurt to talk, and my fever was 104." So Williams phoned his carrier, US Airways, to tell it he was too sick to fly.

"In addition to the change fee, they also charged me the fare difference -- a cool $258," he says. "So it cost me $358 to do the right thing and wait a day to go home. My total fare ended up being only $25 cheaper than if I'd purchased a new, one-way ticket for the return trip home."

So what do you do if you're too sick to fly?
1. Don't give up

It may not be necessary to change your ticket or buy a new one. Despite what the offshore phone operators may tell you in barely understandable English, your airline has some compassion. Just not in that particular department, maybe. A doctor's note and a polite letter to the right department may encourage your airline to do the right thing. I also list the names of higher-level customer service managers on my Web site. Appeal your case to them, if necessary.

2. Show up and let 'em see you

If you plead your case at the gate, while you're coughing and wheezing and bleeding out the eyes, your airline might see things your way. Gate agents screen passengers to make sure they're airworthy, and can disqualify them for anything from smelling bad to being too drunk. You remember the TV show "Airline"? Well, if you're too sick and a gate agent makes that determination, chances are you'll be put on a future flight without having to pay extra. It might be worth the trip to the airport.

3. Argue your case

An airline lets itself off the hook when it can't fly because of what it calls a force majeure event -- something beyond its control. For example, if there's a thunderstorm that prevents it from operating its planes safely, it isn't obligated to compensate you for the delay or to pick up your hotel expenses. Why shouldn't the same standard apply to you? (Answer: it should, of course.) An airline shouldn't be able to apply one set of standards to itself and another to its passengers. And they know it.

4. Get help

In the unlikely event that you're staggering around the gate in a fever-induced delirium, while an airline employee insists you either board the plane or lose your fare, you can try a Hail-Mary strategy to convince them you should be allowed to fly once you're better. You can inform the passengers around you that you're ill and ask them if they want to breathe the same re-circulated air for the next five hours. I guarantee they will become forceful advocates for your cause.

Not all airlines are pigheaded when it comes to their sick customers. When Patricia Eachus' husband was sent to the emergency room recently, Hawaiian Airlines charged him a $100 cancellation fee to reschedule his flight, but promised a refund if she could send a doctor's note. She did.

"My next credit card billing had the $100 credit from Hawaiian Air," she says. "Also, when my husband checked in, Hawaiian marked his checked luggage as 'priority' so it would come off the plane in the first batch. It changed his seating to have an empty seat next to him. And it allowed him to board early, asking if there was anything else that they could do to make him more comfortable for the flight."

Ahh, don't you just love a happy ending?

(Christopher Elliott is the ombudsman for National Geographic Traveler magazine. This column originally appeared on MSNBC.com. You can read more travel tips on his blog, elliott.org or e-mail him at celliott@ngs.org).
 
Re: Flying sick? 4 secrets for surviving your trip

"... if there's a thunderstorm that prevents it from operating its planes safely, it isn't obligated to compensate you for the delay or to pick up your hotel expenses.
Why shouldn't the same standard apply to you?
(Answer: it should, of course.)
An airline shouldn't be able to apply one set of standards to itself and another to its passengers. And they know it."


If the above statements are true, than the refusing Comps breaks a law.
Maybe to fine them?

If the above need a trial, than maybe to add a national law of mandatory reinborsment of the XX% of the ticket because forcing the travel would mean an breach in the activated national biosecurity policy ...

BTW, don't do the 2., or 4. option - that means be a illness spreader.
Instead, when buying tickets in advance, don't pick a travel company which are not declared ticket reinborsment in their wroted terms.
 
Re: Flying sick? 4 secrets for surviving your trip

[Texts appeared on this week's edition of WHO Weekly Epidemiological Record vol 83 no 23. If someone want, could move this text in another thread or placed alone.]

[TB, WHO, UPDATES] Updated guidelines on tuberculosis and air travel

[Texts excerpted from Weekly Epidemiological Record, vol. 83, no. 23, (Download full text [pdf 207kb])]
There is a potential risk of transmission of tuberculosis (TB) and some other airborne or droplet-spread communicable diseases on board commercial aircraft, particularly during long fl ights.
Reported episodes of potential transmission of TB infection on board aircraft, the outbreak of severe acute respiratory syndrome (SARS) in 2003, and the emergence of multidrug-resistant TB (MDR-TB) and extensively drug-resistant TB (XDR-TB) raised considerable anxiety among travellers, public health authorities and airline companies, which reverberated in the media.

There is evidence that transmission of mycobacteria of the Mycobacterium tuberculosis complex may occur during long flights from an infectious source (a traveller with infectious pulmonary or laryngeal TB) to other passengers.

To date, no cases of active TB disease associated with air travel-related exposure during fl ight have been identified.

The risk of infection during air travel is related to the infectiousness of the person with TB, the susceptibility of those exposed, the duration of exposure, the proximity to the index case and the efficiency of cabin ventilation.

Susceptibility to infection and disease is increased in immunocompromised people and in infants and young children. There is currently little evidence to suggest that any particular strain of M. tuberculosis would be transmitted more readily than others.

The consequences of infection with drug-resistant strains are potentially more complex in terms of treatment, outcomes and cost.

The 3rd edition of Tuberculosis and air travel: guidelines for prevention and control(1) addresses the concerns about transmission of TB, including MDR-TB and XDR-TB, during air travel and provides information on:

(i) the transmission of TB on board commercial aircraft;

(ii) practical ways to reduce the risk of exposure to TB on board commercial aircraft;

(iii) the management of travellers with infectious TB associated with air travel;

(iv) procedures to follow and responsibilities of the parties involved when infectious TB is diagnosed in a patient who has a history of recent air travel, including contact identification and screening for possible interventions;

(v) the roles of WHO in the prevention and control of TB during air travel;

(vi) provisions relevant to TB in the revised International Health Regulations (IHR), which entered into force in June 2007; and

(vii) the specifi c roles and responsibilities of WHO and partner organizations when incidents involving the IHR occur.

Main changes in the 3rd edition of the guidelines, 2008
The updated edition of Tuberculosis and air travel: guidelines for prevention and control contains 6 main changes:

1. Revised case defi nitions for infectious, potentially infectious and non-infectious TB in the context of air travel.

2. Modified guidance on restriction of commercial air travel for patients with infectious TB, and a risk assessment for potentially infectious cases.

3. Elimination of cabin crew for consideration as close contacts of the index case, except under special circumstances.

4. Additional information and guidance on recommended roles and responsibilities when exposure to TB during air travel is suspected.

5. Proposed steps and procedures to follow during a contact investigation.

6. Additional information on the provisions of the IHR that are applicable or potentially applicable to TB associated with air travel, and the roles of WHO when incidents occur.

Case definitions for TB in the context of air travel
* Infectious TB
All cases of respiratory (pulmonary or laryngeal) TB who are sputum smear-positive and culture-positive (if culture is available).

* Potentially infectious TB
All cases of respiratory (pulmonary or laryngeal) TB who are sputum smear-negative and culture-positive (susceptible, MDR-TB or XDR-TB).

* Non-infectious TB
All cases of respiratory TB who have 2 consecutive negative sputum smear and negative culture (if culture is available) results.
Patients with MDR-TB or XDR-TB are considered non-infectious if there is evidence of a clinical response to treatment and 2 consecutive negative sputum culture results* have been obtained. (* After at least 6 weeks of incubation.)

Action recommended for each category
1. For cases of infectious TB, it is recommended that procedures for contact investigation begin, taking into consideration national contact investigation policies.

2. For cases of potentially infectious TB, additional information should be requested to conduct a risk assessment and determine whether a contact investigation should be considered.

3. For cases of non-infectious TB, no further action is required.

Specific recommendations
For travellers

* Pre-travel
1. People with infectious or potentially infectious TB should postpone all travel by commercial air transportation(2) of any flight duration until they become non-infectious.

For physicians
* Pre-travel
2. Physicians should inform all infectious and potentially infectious TB patients that they must not travel by air on any commercial flight of any duration until they have completed at least 2 weeks of adequate treatment and are sputum smear negative on at least 2 occasions (additional steps are required for MDR-TB and XDR-TB, see recommendation 3).

3. Physicians should inform all MDR-TB and XDR-TB patients that they must not travel on any commercial flight ? under any circumstances or on a flight of any duration ? until they are proven to be noninfectious (i.e. 2 consecutive negative sputum-culture results).

4. Physicians should immediately inform the relevant public health authority when they are aware that an infectious or potentially infectious TB patient intends to travel against medical advice.

5. Physicians should immediately inform the public health authority when they are aware that an infectious or potentially infectious TB patient may have exceptional circumstances requiring commercial air travel.

* Post-travel
6. Physicians should immediately inform the public health authority when an infectious or potentially infectious TB patient has a history of commercial air travel within the previous 3 months.

For public health authorities (see also requirements under IHR)
* Pre-travel
7. Public health authorities that are aware that a person with infectious TB is planning to travel via a commercial air carrier should inform the concerned airline and request that boarding be denied.

8. If an infectious or potentially infectious TB patient has exceptional circumstances that may require commercial air travel, public health authorities should ensure that the airline(s) involved and the national public health authorities at departure, arrival and any transit points have approved the commercial air travel and the procedures for travel.

* Post-travel
9. The public health authority should promptly contact the airline when an infectious or potentially infectious TB patient is known to have travelled on a commercial fl ight that may have been >8 hours within the preceding 3 months in order to obtain the information required for the initial risk assessment (i.e. confi rm that the passenger was on the fl ight and the total fl ight duration).

10. The public health authority of the country of diagnosis should carry out a risk assessment based on the specific conditions of the case. If the index case is considered to be infectious or potentially infectious, the public health authorities of all countries involved should be informed (i.e. countries where the fl ight(s) departed and landed).

11. If a contact investigation involves >1 country, national public health authorities of the involved countries should agree on their respective roles and responsibilities (including who will request the passenger manifests from airlines). International bodies such as WHO, the European Community, the European Centre for Disease Prevention and Control or others may provide assistance if requested.

12. The national public health authority that obtained the passenger information from the airline should contact counterpart public health authorities in the appropriate countries and provide them with the relevant information on the source case and the available contact information of all travellers identifi ed as potentially exposed (i.e. those passengers seated in the same row and in the 2 rows in front of and behind the index case) in their jurisdiction.

13. Public health authorities may follow national policies and guidelines regarding TB contact investigation involving potentially exposed travellers in their jurisdiction, in accordance with requirements under the IHR.

14. Public health authorities should be in communication with their national IHR focal point concerning any event that may involve the IHR, including events for which international contact tracing may be initiated, for assessment of any action that may be required under the IHR and for support in facilitating communication.

15. National and international public health authorities are encouraged to collaborate on research concerning TB and air travel.

For airline companies
* Pre-travel
16. Airline companies should deny boarding to any person who is known to have infectious or potentially infectious TB, as informed by the relevant public health authority.

17. Airline companies should, in the case of ground delays that last >30 minutes with passengers on board, ensure that the ventilation system is in operation.

18. Airline companies should ensure that all their aircraft that recirculate the cabin air are fi tted with a filtration system. New aircraft should be fi tted with 99.97% high-efficiency particulate air fi lters, or an alternative of at least this level of effi ciency. The filtration system should be maintained in accordance with the recommendations of the filter manufacturer.

19. Airline companies should ensure that cabin crews receive adequate training on potential exposure to communicable diseases, in fi rst aid and in applying universal precautions when there may be exposure to body fluids.

20. Airline companies should ensure that there are adequate emergency medical supplies aboard all aircraft (including gloves, surgical masks, biohazard disposal bags and disinfectant).

* Post-travel
21. Airline companies should cooperate with national public health authorities in providing as quickly as possible all available contact information requested for contact-tracing of travellers, in accordance with applicable legal requirements including the IHR.

These recommendations are expected to remain valid until 2013. In the intervening period, any updated information and guidance will be provided as necessary on the WHO web site at http://www.who.int/tb/publications/2008/WHO_HTM_TB_2008.399_eng.pdf

1) This publication (WHO/HTM/TB/2008.399) will be available from WHO Press, Geneva e-mail: bookorders@who.int; web access http://www.who.int/tb.

2) Excluding specially designated aircraft, e.g. air ambulance.
-
-----
 
Re: Flying sick? 4 secrets for surviving your trip

This is an ongoing problem.

Without some comprehensive aviation industry policy or international safety net of support for severely ill passengers, people will continue to board aircraft despite their illness. Not everyone has the resources to afford hundred(s) of dollars of airline change fees and money for unexpected overnight accommodations.
 
Re: Flying sick? 4 secrets for surviving your trip

Source: http://www.ajc.com/hp/content/health/stories/2008/12/21/spotlight_1221_4dot_3DOT.html

People shouldn?t fly when they?re sick, but they do
By ALISON YOUNG
Click-2-Listen
The Atlanta Journal-Constitution

Sunday, December 21, 2008

After her recent flight arrived in Atlanta, a 57-year-old woman told paramedics she had been throwing up and felt nauseated. A virus had been afflicting her family.

?Everyone in the family has this,? she said.

On any given day, passengers battling contagious illnesses of all kinds pass through Atlanta?s Hartsfield-Jackson International Airport. Some are so sick that paramedics are called to their aid. But airlines routinely let sick passengers fly and rarely comply with regulations requiring that they notify the Centers for Disease Control and Prevention of certain illnesses.

Airlines said it isn?t easy to know who is ill and what to report.

?People who are sick shouldn?t travel,? said Dr. Martin Cetron, director of the CDC?s division of global migration and quarantine. ?It?s not good for you and your illness. It?s certainly not good for your fellow passengers.?

But sick people travel anyway. In October and November alone, medics responded to at least 75 reports of people at the airport complaining of vomiting, nausea, diarrhea, fever, sore throat and coughs. Some had most of these symptoms at once, according to Atlanta Fire-Rescue Department records.

One passenger had been sick since she went to California nearly a week earlier, but she still flew to Atlanta, having bouts of vomiting and diarrhea aboard the plane. Another had been sick for two weeks while in Peru, possibly from malaria, she thought. Despite a fever, she flew into Atlanta.

Airline industry officials said their employees aren?t trained medical professionals. How are they to know someone has a fever, unless it?s very high? Besides, they said, an airplane is no more likely to spread disease than any other crowded place.

Airlines can deny boarding to passengers, though none would say how often they do it.

?If somebody arrives for a flight sniffling a bit, it?s not necessarily going to attract attention or suspicion,? said Katherine Andrus, assistant general counsel for the Air Transport Association.

Federal regulations require airlines to immediately notify health officials of any passenger or crew illness involving diarrhea or a two-day fever or any fever with a rash, swollen glands or jaundice before their flight reaches an airport.

The CDC has requested that airlines also report anybody who has a fever plus difficulty breathing, headache with stiff neck, reduced level of consciousness or unexplained bleeding. Such symptoms ?may indicate a serious, contagious illness,? the agency says.

While transmission of serious diseases aboard aircraft is believed to be rare, nobody knows how often colds, flu and the stomach bug norovirus are spread among passengers.

John Spengler, an environmental health professor at the Harvard School of Public Health, said close proximity for long periods of time gives airline travel special potential for spreading disease.

?Airlines have very good ventilation,? Spengler said, noting that recirculated air is repeatedly cleansed through HEPA filters on most planes. But there?s no getting around the tight confines of a coach class seat on a packed jet ?and the nasty sick person sitting next to you for hours.

CDC is concerned about identifying and stopping the spread of diseases ranging from measles, tuberculosis and bacterial meningitis, to SARS and rare hemorrhagic fevers like Ebola. Airline reporting is considered critical in responding to an influenza pandemic.

But airlines rarely report ill passengers so the CDC can assess them, said Cetron. ?Most of what we learn about is after the fact? such as from hospitals, he said.

CDC doesn?t even get a full reporting of all deaths aboard aircraft, Cetron said.

From January through mid-October, the CDC?s quarantine program received 1,607 reports nationwide of travelers who were sick or died aboard airplanes, ships or other modes of transportation; 100 reports involved the quarantine station at Hartsfield, which serves Georgia, Tennessee and the Carolinas. Most of the cases, after being assessed, didn?t require further CDC intervention.

Last December, a very ill, coughing woman with multi-drug resistant tuberculosis flew from India to Chicago, then to California. One person who flew with her later became TB-positive on tests, though CDC officials said the traveler had lived in a country with a high TB rate, making the source of exposure unclear.

Seven months earlier, Andrew Speaker of Atlanta, who had no outward symptoms or cough, was isolated by federal authorities in a highly publicized incident after he flew to Greece and back with drug-resistant TB. Tests found nobody caught the disease from Speaker.

In 2004, a 38-year-old businessman sick with Lassa fever ?a viral hemorrhagic illness ?flew from West Africa through London to Newark. He had been sick for three days and continued to have fever, chills, sore throat, diarrhea and back pain aboard his flights. The airline did not report the incident to CDC, Cetron said. Within hours of arrival in the United States, the man was hospitalized. He had a temperature of 103.6 degrees and died a few days later.

Again, no passengers were infected. But a few studies have documented cases where serious diseases have been spread aboard aircraft, including tuberculosis, influenza and SARS.

In most cases, the scientific articles involve a single incident. So how often are diseases spread aboard aircraft?

?You ask anybody who flies and they all feel that this environment is the cause,? said Harvard?s Spengler. ?But what proof do we have? Unfortunately, we don?t have much proof except for those case studies.?

Spengler is part of the multi-university Center of Excellence for Airliner Cabin Environment Research, which is examining how tiny droplets are spread in jets to devise better decontamination methods for aircraft surfaces.

While the scientific evidence is being gathered, Spengler, like other travel and health experts, takes his own protective measures. ?I?m fastidious about washing my hands,? he said. And he uses a paper towel to open the lavatory door.

If a traveler shows signs of being infectious, Spengler cranks up the air nozzle above his seat to blow filtered air in his direction. ?I?d rather have that little extra protection than not.?

WHAT YOU CAN DO

?You can?t control what people bring on an airplane, but you can have some control,? said Heidi Giles MacFarlane, vice president of global response services for MedAire, a firm that provides medical consulting to airlines.

Last year MedAire received more than 17,000 in-flight calls from the 74 global airlines it serves.

Travel and health experts advise:

? Don?t travel if you?re sick. Think about other passengers who are particularly vulnerable: People with immune systems weakened by disease, cancer treatment or transplants; very young children and the elderly.

? Tell your airline: Airlines will sometimes allow ill passengers to postpone or change their flight and waive any fees, but they do it on a case-by-case basis and may require a doctor?s note.

? Buy travel insurance. At the time you book your trip, purchase insurance that covers the cost of your ticket if you become ill or injured. For trips abroad, get travel insurance that will cover your medical evacuation back to the United States.

? Wash your hands. And do it properly: With soap and warm, running water for at least 20 seconds. Carry an alcohol-based hand sanitizer as a backup.

? Avoid touching surfaces. Not everyone washes their hands in the bathroom ? but they probably grabbed the door handle when they left. Use a paper towel to open the door. And avoid touching other surfaces that may harbor bacteria or viruses, such as airline tray tables and airport ticket counters.

? Ask for another seat. If another passenger is so ill that it makes you uncomfortable, speak up. Alert airline staff, especially before boarding. If the person is seated next to you, ask if you can be moved.

? Get a flu shot. With peak flu season approaching, it?s still not too late.

? Know the local diseases. If traveling to other countries, you may need other shots or medicines to protect you. The CDC has detailed advice at: wwwn.cdc.gov/travel/default.aspx

Inset:
SICK AT THE AIRPORT

Medics with the Atlanta Fire-Rescue Department respond to about 4,000 emergency calls a year involving people at Hartsfield-Jackson International Airport. The Atlanta Journal-Constitution used the Georgia Open Records Act to obtain the department's database of reports for 2007 and 2008. The reports don't give diagnoses, which often require lab work done elsewhere. Here are just a few:

* Sick pilot: In March, a 24-year-old pilot had been battling cold and flu symptoms, including a fever, for a day. He went to work anyway. After landing his plane in Atlanta, he fainted. A flight attendant told medics he was out for one to two minutes. The pilot and the airline were not identified in the data.
* Nasty cough: A 37-year-old man told medics in October he had body pain and was coughing up green sputum. He said he had caught malaria while working in Africa and that doctors had advised him to come back to the U.S. for treatment because his condition wasn't improving.
* High fever: A 29-year-old man who was suffering from a fever of 102.8, dizziness, nausea and vomiting told paramedics in July he had been diagnosed with a virus five days earlier and he was out of his medication.
* Fainting while waiting: While standing in line at a Delta counter, a 26-year-old man passed out in January, chipping his tooth on the counter as he fell. The man told medics he had been diagnosed with strep throat several days ago and said he still had a fever.
* Possible chickenpox: Customs officials called medics in August to check out a 4-year-old boy who had flown in from Nigeria with his mother, who said he might have chickenpox.
* Child with fever, seizure: A 2-year-old boy, described by a flight attendant as "very warm," had a seizure on board a plane that arrived in Atlanta in January.
* Maybe pneumonia: A 75-year-old man told medics in October he had been sick with a cough and fever for a few days and felt weak. His wife just got over pneumonia, he said.
 
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