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Summer is high travel season, and every year around this time my patients ask about precautions to take while flying. Nothing is worse
than realizing that you've caught a cold -- or something worse -- on the first day of your vacation.
Perfect Storm
 In many ways, airplane travel forms a perfect storm
for germs to enter your body. The two major factors are extremely dry air and close proximity to others. Compounding this, travelers
from far-flung destinations carry a smorgasbord of viruses and bacteria, many of which can survive for short periods in the air and on
hard surfaces. These bugs are all vying for the chance to climb past your defenses and make a cozy home in your body.
Sounds pretty gross, you say? You're right! Below are seven proven ways to avoid nasty pathogens during plane travel.
1. Use a saline nasal spray 30-60 minutes before your flight.
Cold viruses regularly enter your nose and are carried along a layer of mucus, taking a harmless tour of your digestive system that
ends in your stomach. The problem occurs when the virus finds a dry, cracked area in your nasal passages -- that's a perfect spot for the
virus to dig in. Your goal is to keep your nasal passages moist, which poses a particular challenge on airplanes.
Most people don't realize exactly how dry an airplane cabin can be -- humidity can dip into the single digits on long flights,
drastically lower than the 20% humidity of most deserts, and far below the optimal 40 to 70% range. So, use that saline spray and
then...
2. Take the Water.
For prevention of a dry throat and nose stay hydrated. Flight attendants are very good with passing out water. Think of the flight as
a marathon and take the water. Avoid caffeine and alcohol -- they are diuretics and will dehydrate you further.
3. Keep Your Hands Off the Fomites.
There are many contaminated surfaces on planes. We physicians call them "fomites". As gross as you think the blankets and pillows on
airplanes may seem, the FAA actually found they aren't that bad since they are washed. However, hard surfaces touched by many passengers
-- think trays, overheads and seat belt buckles -- are very contaminated.
But the areas to worry about the most on airplanes are the galley water taps and lavatory faucets, where tests have found germs
associated with feces in 17% of airplanes tested. These germs cause not only colds and flu, but conditions like pink eye. This means you
must also...
4. Wash Your Hands.
Mother knew best: hand-washing is the best weapon by far against germs. Here is the all-star guide to hand washing: use soap and warm
water and rub hands together (the friction may be the reason hand washing really works) for 15-20 seconds -- the length of Happy Birthday
twice or your ABCs once. For those of you who want to be extra thorough, use an alcohol-based antibacterial hand gel upon returning to
your seat.
5. Don't Touch Your Eyes and Nose.
Many of us rub our eyes when we wake up. And many touch their eyes and noses when they talk without even realizing it. On an
airplane, this is a golden opportunity for germs to enter your system. It may be a hard habit to break, but with some practice it can be
done. If you're travelling with a friend, be on the lookout for each other.
6. Wipe Down Your Area.
Studies
have shown that wiping down hard surfaces eliminates pathogens if done correctly. Be sure to use an alcohol-based disposable
hand wipe to wipe your tray, overhead handle, armrests, and seat belt buckle before you touch them. Use a separate wipe for each
surface.
7. Stay Out of the Line of Fire.
We've all had to sit next to someone sneezing, wheezing or coughing up a lung. If you can't change seats, your only recourse is to
avoid touching anything in the line of fire. You might also avoid conversation and cover yourself with a jacket or airline blanket to
keep some of the germs away. Keep in mind that risk of infection is greatest on flights of more than eight hours, and within two rows of
an infected passenger.
Bonus Tip: Walk Around
This last tip is not about avoiding germs. Of all the questions I receive from patients about plane travel, concerns about DVT (deep vein thrombosis) tops
the list. DVT occurs when slow-moving blood forms a clot, usually in the lower leg or thigh. Small pieces of the clot can break off and
travel through the circulatory system toward the lungs, potentially blocking blood flow and causing breathing difficulty, chest pain, and
death. Certain things predispose you to DVT, including a recent immobility of your legs (bedrest, paralysis, a cast, etc.), active
cancer and leg swelling.
 Flights of five hours or longer elevate the risk of
DVT for everyone. Why? Blood pools in your leg veins when you are sitting in cramped quarters ("economy class syndrome") for long
periods.
To minimize your risk, book a seat in an exit row, a bulkhead seat, or an aisle seat. Walk up and down the aisle about once an hour --
if you are drinking more water and washing your hands, you'll need a few trips to the restroom anyway.
Another preventive tip is to spell the alphabet with your big toe to keep your blood moving. Consider taking a baby aspirin the morning of
your flight for prevention as well, since it can act as an anticoagulant and make it harder for your blood to form clots.
Here's wishing you a safe and illness-free vacation this summer!
 Sharon Orrange, MD
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