The aviation industry takes health emergencies seriously and works in conjunction with all relevant authorities to contain the spread of a virus as much as possible.

The World Health Organization (WHO) has declared the coronavirus (recently given the title COVID-19) outbreak a Public Health Emergency of International Concern (PHEIC) but is not advising any restrictions on travel or trade.

At present (March 10), more than 4000 deaths have been reported, including some fatalities outside of China, and the number infected runs into the hundreds of thousands. Cases have been reported worldwide.

Alarmist headlines have screamed about the spread of the disease, with parts of China effectively shut down. Wuhan—the center of the outbreak is the most notable city in isolation—but China has also closed off all of the major cities in Hubei province, a number of temples, the Forbidden City and part of the Great Wall.

Even so, the coronavirus needs to be put in perspective. As far as is currently known, it is not as lethal as SARS (Severe Acute Respiratory Syndrome), which killed almost 10% of people who contracted it.

Nor is it as contagious as measles, which spreads quickly and is still widespread in many parts of the world, such as Eastern Europe, Asia-Pacific and Africa. And though hundreds of people have died, this doesn’t compare with the 1,000 every week that fall victim to the flu in the United States.

The detail of how it is being spread is still an evolving story, but close proximity to someone who is unwell with the virus seems to be the main concern as opposed to casual airborne contamination

“The genetic profile of the virus was worked out very quickly, and immediately shared worldwide so a diagnostic test for coronavirus could be put in place,” says Dr David Powell, IATA’s Medical Advisor.

“The detail of how it is being spread is still an evolving story, but close proximity to someone who is unwell with the virus seems to be the main concern as opposed to casual airborne contamination.

“We are learning about the virus all the time, but the spread has been predominantly from contact with someone who is unwell at the time.”

Almost sterile
Global disease outbreaks inevitably lead many to question to the role of aviation. But the industry takes health emergencies seriously and works in conjunction with all relevant authorities to contain the spread of a virus as much as possible.

Two areas in particular become the focal point of media and public concern. The first is getting the virus from an infected person on a flight. This is only likely if a passenger is in close proximity to someone who is currently unwell.

“Many people don’t realize, but the risk of contracting a virus on board a flight is probably lower than in many confined spaces because modern aircraft have cabin air filtration systems equipped with HEPA (high efficiency particulate air) filters,” says Powell. “These filters have a similar performance to those used to keep the air clean in hospital operating rooms and industrial clean rooms.”

HEPA filters capture more than 99.97% of the airborne microbes and because a cabin air system delivers approximately 50% outside air and 50% filtered, recirculated air, it means the supplied air is essentially sterile, and the risk to be avoided is therefore direct spread from one person to another.

Viruses are far more likely to be passed on through touching a surface recently touched by contaminated hands. The trays at security checkpoints are an example of a potential pathway for such transmission.  

A second focal point is the effectiveness of temperature scanning at airports. One deficiency of this as a screen is that passengers could “cheat” the scan by taking medicines prior to landing to lower body temperature. 

“However, thermal scanning is of some use,” informs Powell. “WHO has acknowledged that some early cases of coronavirus were picked up in this way. But it only works if somebody is already unwell rather than going to become unwell, so it needs to be accompanied by advice on what to do if symptoms develop later.

“What we need is a more coordinated, harmonized and evidence-based approach to entry and exit controls,” he adds.

Learning from past pandemics
Aviation is experienced in outbreaks and understands the value of collaboration. International coordination has been in place for years and is key to an effective response.

Powell is in regular contact with counterparts at WHO, the US Centers for Disease Control and Prevention (CDC) and ICAO, for example. There is also IATA’s Medical Advisory Group, which comprises medical directors from 10 airlines. 

Cooperative efforts were enhanced after the SARS outbreak in 2003. WHO, with IATA input, developed the International Health Regulations (IHR), which came into force in 2005. One year later, ICAO launched the Cooperative Arrangement for the Prevention and Management of Public Health Events in Civil Aviation (CAPSCA) to coordinate the industry’s response to public health risks by bringing together organizations at all levels. 

International collaboration developed further during the influenza pandemic of 2009 and more recently during the two Ebola virus outbreaks in Africa. Guidance materials for maintenance crew, cabin crew, cleaning crew, cargo and baggage handlers and passenger agents developed by IATA are widely available. They show what cabin crew should do when dealing with a suspected case of communicable disease on board a flight, for example, and also instruct cleaning crew in how to disinfect an aircraft as part of normal cleaning routines.

Key advice
Passengers on a flight should:

•    Wash hands carefully on a regular basis, or use a hand sanitizer
•    Avoid touching other people
•    Avoid touching face with hands
•    Cover coughs and sneezes, and then wash hands
•    Avoid traveling if becoming unwell. Passengers only need to wear masks on a flight if they start to feel unwell. It is not recommended for cabin crew to wear masks. Masks become damp and act as potential reservoirs of infection. Respiratory infections tend to be spread more efficiently by touch than by exhaled air, which is why frequent handwashing is essential.

Impact on the industry

IATA has announced (Feb 20) that its initial assessment of the impact of the Novel Coronavirus 2019 outbreak (COVID-19) shows a potential 13% full-year loss of passenger demand for carriers in the Asia-Pacific region. 

History also provide some pointers.

SARS has been the most serious epidemic from a traffic point of view. In May 2003, the monthly revenue passenger kilometers (RPKs) of Asia-Pacific airlines were about 35% lower than pre-crisis levels. That year, Asia-Pacific airlines lost 8% of annual RPKs and $6 billion in revenues. It took nine months for traffic to return to pre-crisis levels.The industry is resilient, and the effect of the coronavirus will be temporary but airlines are calling for government support during a challenging period.

Ebola update
In July 2019, WHO declared that the Ebola Virus Disease (EVD) outbreak in Democratic Republic of Congo (DRC) is a Public Health Emergency of International Concern.

Known EVD cases run into the thousands with an overall case fatality ratio of two-thirds. WHO's current risk assessment for travel and transport is not recommending any travel restrictions or entry screening at airports.