Monday, July 6, 2020
Last month I made my first roundtrip, domestic airline flight following 90+ days of lockdown and gradual easing of travel restrictions. I scheduled this quick trip cautiously, for family-related reasons, and with a goal of returning to my Pennsylvania home well in advance of any return to work with students in my law school. I'm not a timid flyer, but I did my best to try to minimize risk factors, including selection of an airline that advertised "vacant" middle seats, masking requirements, and updated standards for cleaning the airplane and social distancing. I am writing here because an individual on the return leg of my flight in my same row (but across the aisle) became seriously ill during the flight. This post is about my growing concern about what it means to respond to the potential for a communicable illness while traveling, especially but not exclusively in the time of COVID-19.
When the individual became ill (seeming to lose consciousness and vomiting-- more ill than what I associate with "mere" air sickness), the flight attendants responded to his needs with plastic bags and napkins. On the positive side, they kept everything low key and talked to the individual softly. I think it was another, closer passenger who summoned them and everyone tried to respect the privacy of the individual. Eventually, the ill passenger was moved to the rear of the plane. Shortly after that, all passengers were informed the seatbelt signs had been activated and everyone should stay in their seats for the remainder of the flight. There were no further announcements and nothing said about the ill passenger specifically. When the flight arrived at its regular destination, I did not see the individual leave the plane.
What does it mean for any state health department or CDC program official to say they will follow a plan for contact tracing? Each step of the process needs clarity, including that first step of identifying the ill traveler and other potentially affected travelers, right?
I received a traditional customer satisfaction "survey" form from the airline the morning of my return via email, asking me to describe the flight. This made me realize that I should be talking directly to the airline about this specific incident. Was the individual in question experiencing a communicable illness, especially COVID-19? I made a short, emailed report to the airline less than 12 hours after the end of the flight, and made a follow up inquiry and a second report by telephone and email. The most I have learned is that the airline is "researching" whether there is any record of the incident or illness on board that flight. Taking a week (or more?) to determine whether the crew made a report is not reassuring. At a minimum, shouldn't there be a record of that plane being taken out of service for some period of time for cleaning?
The Pennsylvania governor, for reasons unrelated to my account above, has recently asked all residents returning from the departure state in question (and certain other states experiencing surges in COVID-19) to self-quarantine for 14 days. That makes sense. Even though I had been exceptionally careful during my time out-of-state, the airline incident was a stark reminder that travel, even with the lessons learned during the last several months, involves factors that are completly outside the control of any of the passengers. "Being careful" on an individual basis may not be enough and when something happens that involves risk to others, we need clear lines for any investigation and communication.
Everyday we are learning new things about how to deal with communicable illnesses, including ones that may be life-threatening. I think what I'm realizing is that as individuals and consumers, we cannot be passive about these steps.
I contacted the CDC and was told there is a process for "contact investigations" by the CDC, but that triggering such an investigation cannot be done easily, at least not if you are a mere passenger. They recommended I contact the health department in the state where my plane landed. Here is what CDC sent me by email: https://www.cdc.gov/quarantine/contact-investigation.html
Weaknesses clearly exist in the protocols. The airline and CDC have been quick to warn me that they cannot give any information about the "patient." I'm not asking to know the patient's identity in any way. But shouldn't any potentially affected traveler be entitled to know:
a. Whether there was a report of the illness made by the crew to the airline and/or other authorities.
b. The result of any investigation, especially in terms of public health implications.
c. Whether a specific, communicable illness or disease was identified.
d. Whether there are specific steps that should be taken by passengers in light of the history.
Shouldn't the CDC want to know whether others on that plane have experienced similar symptoms? (Thankfully, I have not, but although I was in the line of sight of his seat, there were others between us, and in front and behind him, who were much closer.) I have realized that short of contacting every passenger on the plane, it might be difficult for some airlines to help with "contact" tracing. They may be relying on a manifest rather than a chart for assigned seats. Certainly, no one asked me or other, closer passengers on the flight for contact information. I hope the ill individual has recovered fully and quickly, and that for his sake this was a temporary illness. I'm being calm, even as I'm frustrated. I'm frustrated not just for myself, but for the larger public. The passengers on this plane included all ages, including older individuals. Earlier during my trip, I overheard one older traveler say to another, "I just want to live long enough to see my grandchildren again."