Dear Emily:
How should I think about flying with my kids? They are 5 and 1. The 1-year-old can’t mask. Help.
This is a generic version of a question I get all the time. People are wondering about flying right now, and they’re also wondering about the fall. My brother is getting married in October — should we go? We have a trip planned for Christmas — should we cancel? Should we drive instead of fly to see my mom? It’s 14 hours in the car.
In most of these cases, there are really many questions. It’s not just about flying; it’s about weddings and trips and family. But I want to focus today on the particular flying issue.
Let me start by stating the obvious, which is that the situation is evolving. No activity is perfectly risky or perfectly safe, and if case rates are higher at the time, it will be riskier to do anything. Your decisions about flying are probably, at least to some extent, going to be linked to the virus situation (either at home, where you are going, or in between). And because this feels unpredictable, I’d caution against trying to decide about, say, a Christmas trip. This is tricky because of planning, etc., but to the extent that you can make choices that preserve flexibility, I would.
But let’s imagine you need to make this choice now — vacation is next week.
It may be good to start by considering what you are worried about. The child-centered question above voices the concern about unvaccinated and possibly unmasked children. For healthy vaccinated adults, the concern is of a mild breakthrough case. In both of these groups, the serious illness risks are extremely small, but there are worries about spreading (say, to immune-compromised people or to kids if they aren’t traveling with you) and also practical concerns. If I travel and my kids get COVID, they can’t go to child care for two weeks, for example.
Putting it differently: If you were two vaccinated healthy adults without children at home who could adapt to working from home for a couple of weeks in the quite unlikely case of a breakthrough infection, the answer to this question is that it’s fine. If your situation is more complicated, read on.
(If you are an unvaccinated adult, I would not travel at the moment and I would prioritize getting vaccinated.)
Are airplanes risky?
Not very. It’s easy to have this idea that airplanes are full of recycled air and if someone in the very front of the plane has COVID and coughs, it will get to you at the back. In fact, the air filtration systems in planes are extremely good. This has meant that airplanes themselves do not seem to be major COVID spread locations.
The most recent systematic data comes from this study of 18 Europe-U.K. flights last fall. There were 55 infectious and symptomatic passengers on these flights. They had 2,221 close contacts based on the flight alone (that is, people who were otherwise unrelated but were on the flight with them). Among these, there were five possible cases identified (0.22%).
By comparison, this same set of 55 infectious people were traveling together with another 92 people; these were close contacts for reasons beyond the flight. Among that group, 13% of them became infected. Effectively, the in-flight risks were orders of magnitude lower than the risks from non-flight contact.
Among those who were infected by an on-flight contact, nearly all were sitting within a seat or two of the infectious person. The idea that proximity matters is supported too by an investigation of a single outbreak in which a number of business-class passengers were infected on a long-haul flight. Sitting near the infectious person was associated with a much greater chance of being infected.
Given the millions and millions of people who have flown during the pandemic, it may be frustrating to think that our best data appears to rely on a sample of 18 flights. However, there is also some information contained in the absence of more discussion. If spread on airplanes — especially significant outbreaks — were common, we would likely hear more about them.
A fair question is how much Delta changes things, and, as usual, we do not know. But the logic about media coverage stands. Despite quite a lot of flying this summer, airplanes have not been pointed to as a major spread source, and the logic for why not (i.e. good filtration) holds.
This is probably the most actionable portion of today’s writing, since I think it makes clear that if your concern is the airplane, you can put that aside. It’s not likely to be better to drive 14 hours, stopping at various random rest stops and eating locations. If you’re going, take the flight.
Is travel risky?
The airplanes themselves take up a lot of space in people’s minds, but the other parts of travel are likely to be the bigger risks. In particular, we often travel to see other people. To the questions I get about flying to a wedding, the fact is that the wedding and wedding-related drinking activities are a much bigger COVID risk than the airplane part.
My kid is too young to mask. Does this rule out plane travel?
No. Yes, it is possible that their risk of infection is slightly higher than if they could mask (though probably lower than the risk to adults, just due to susceptibility), but these differences are small. And, see below, kids are low-risk.
But really, how do I think about this?
In my mind, the framework is not dissimilar to that for schools, which I wrote about last week. The probability of infection on airplanes or while traveling is small but not zero. And it’s hard to think about this small probability on top of the other small probabilities, to multiply them all out.
It may be easier to think about it by asking yourself a version of the question “What if there was a (say) 20% chance the kids would get COVID? Would we take the trip, knowing what we know about illness risks in children and any other logistical issues?” And to ask what the cutoff would be at which you’d be comfortable taking the trip. If it’s zero, do not travel. If it’s 20%, I think you’re safe to assume the actual risks are below that.
In a sense, I think this applies to many of the choices vaccinated adults will be making for themselves and their children over the next few months. Someone asked me about an indoor fundraiser: should she go, given unvaccinated kids at home? When I probed further, she told me that, basically, there was no risk she was comfortable with. If you recognize your degree of risk tolerance, it influences the decision.
A final word
Flying is not going to be a lot of fun! I was on a train the other day for the first time since the pandemic began, and every time someone coughed I jumped in a panicky way. I anticipate that flying will have this same feel, probably worse. This isn’t a reason to not do it, just something to be aware of. To be fair, flying with children is always a bit of chaos. If you do it now, just expect anxious chaos.