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Glenn D. Braunstein, M.D.

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Plane Sense for Hectic Seasonal Air Travel

Posted: 11/21/2011 6:18 pm

An estimated 23.2 million air travelers will brave the airport traffic, long security lines and checked baggage fees to cram into packed planes so they can share turkey and pumpkin pie with loved ones during the 12-day period surrounding Thanksgiving.

Millions of these travelers -- and others who join in the robust, end-of-year holiday season -- also will pick up unwanted souvenirs: the seemingly inevitable cold that results from that many bodies in close quarters and from touching the same surfaces as hundreds of others.

Sure, everyone has a pet peeve about air travel these days, and there's plenty to gripe about: limited and bad-tasting food, cramped seats, hefty fees, lunk-headed passengers lugging gigantic carry-on bags to hog overhead storage. The upside of these annoyances is that they're fast forgotten once you sniff that homemade stuffing.

In the meantime, no one wants to get sick while traveling or immediately thereafter, especially because your desk gets buried in work while you're even briefly away. So many aspects of air travel, however, increase the prospects of picking up an illness. So try these tips to protect your health from check-in to baggage claim -- and be thankful you did what you could.

Terminal Tips
Watch your feet. By now, it's routine to kick off those shoes in the security line. Experienced travelers especially seem to jump out of their dogs as they race through TSA procedures; many wear flip flops for speed and efficiency.

That's a lot of bare feet padding around on floors and carpets that are only as clean as you can expect them to be -- given the thousands of toes jamming across them daily. Wear socks. It won't endear you to the fashion-conscious and you might not be the coolest Zori dude. But sweaty feet easily pick up bacterial or fungal infections.

Watch your hands. Airports serve armies on the go. That's why they're such a popular location for movies like Contagion. While I think the chances of the typical Thanksgiving trip becoming blockbuster fodder are slim, picking up unwanted germs is easy. Walls, railings, faucets, door handles and other surfaces get mauled. Touching those germy spots, then your face, mouth or eyes is an easy way to transmit infections. Wash your hands often; bring along hand sanitizer and wipes. This strategy works in the airport and airborne, where you may share a much-trafficked restroom, not to mention heavily used seats and tray tables. I won't even warn you about what unsanitary stuff gets stashed in the seat pocket in front of you. Just click here.

Up in the Air
If you feel that just about every time you get on a plane, you get off with a cold -- it's not your imagination. A 2004 study in the Journal of Environmental Health Research found adults are up to 113 times more likely to have a cold after flying compared to ground-level transmission rates. That's a lot of coughing and sneezing. The study found, on average, 20 percent of passengers reported colds five to seven days after their flight.

This needn't be inevitable and some measures may help: turning off the overhead air vent was once thought to prevent colds. Counter-intuitively, this study and others found that recirculated air in the cabin makes no difference. Older planes bring only fresh air into the cabin, while newer planes recirculate up to 50 percent of the air to improve fuel efficiency.

Either way, the number of passengers reporting respiratory symptoms was the same. So, if you enjoy the blast of air from the overhead vent, open it without any additional worry about catching something.

What does matter? First, the low humidity of the cabin air makes a difference. Fatigue plays a role, as well as the sheer number of people crammed into such small, constrained space. This can prompt a higher than normal viral load in aircraft cabins, in which there is a much lower rate of outside air ventilation per person to dilute down the exposure.

What to Do About It?
Moisturize. While the recirculated air doesn't seem to make a difference, the higher viral load seems to play a role, as does the dessication effect of low humidity. The dryness of the plane's air compromises a key natural defense: mucus, which kept in motion by tiny, hair-like cilia, moves bacteria and viruses away from the nose and throat to the stomach, where acids destroy them. Dry air thickens the mucus and degrades its protective properties. Tote a saline nasal spray and use it before, during and after the flight to help keep those membranes moist and functioning; consider a good post-flight rinse.

Hydrate. Keeping well-hydrated also helps combat the plane's dryness. But don't guzzle cocktails or coffee. Alcohol and caffeine both are dehydrating.

Disinfect. When the plane is packed, it may not be possible to switch seats to avoid a coughing, sneezing fit of that miserably ill fellow passenger. You can carry disinfecting wipes to give a quick cleaning to the arm rests and flight tray. Repeat this wipe down before exiting the plane as a courtesy to the next passenger. And remember the hand sanitizer -- we touch our faces more often than we realize.

Also Consider:
Prevent deep vein thrombosis. Sitting still for long periods can increase risk of deep vein thrombosis or blood clots in the legs. This is especially true for: those older than 60; the obese; pregnant women; travelers with a history of blood clots, heart disease, recent surgery on a lower extremity, varicose veins, or who are taking estrogen hormone therapy including oral contraceptives; and smokers. Compression hose have been shown to help, as does exercise. While the flight crew will not take kindly to anyone relentlessly pacing the main aisles, go to the lavatory -- especially on long flights -- to stretch your legs. (If you hydrate properly, you'll have to do this anyway.) In-seat exercises also can help. Try "foot pumps," putting your feet flat, then lifting your heels high, keeping the balls of your feet on the floor. Or do ankle circles, neck rolls and knee lifts.

Manage anxiety. Anxiety can strike even those without a fear of flying. Terror alerts, stressful security procedures, the mad dash to the airport, crowded spaces -- any of these is enough to put even the best travelers on edge. Listen to music, bring light reading or indulge in the in-flight entertainment to relax. Fatigue can add to anxiety and neither helps the immune system. And, if you are crossing several time zones you might find it useful to follow some of my earlier tips for beating jet lag.

Bon voyage and enjoy your time with those distant friends and families. Try not to overeat or booze it up when you reach your destination. The point of the time away is to provide you with a festive respite -- yes, with some rest and relaxation mixed in with the holiday hurly burly. Stay healthy because the season will be gray and glum if you're not.