Should You Worry About Getting Sick From a Plane Flight?

Should You Worry About Getting Sick From a Plane Flight?

Is there anything air travelers despise more than a flight delay? Perhaps sitting in a dirty airplane or next to someone who is coughing, sneezing or worse.

Flight attendants and passengers have experienced (and often documented) all kinds of affronts to personal health and hygiene in the tight quarters of an airline cabin — from blood on the tray table latch to dirty diapers in the seat back pocket to a barefoot woman who picks her feet and toes.

Now, imagine the complex choreography involved in cleaning an airplane like a Boeing 737 with more than 160 seats in just the few minutes between the plane’s arrival at the gate and its departure. It’s a grueling task, and the stakes are high. After all, this has been a winter with “widespread flu activity,” according to the Centers for Disease Control and Prevention. And last month, two people with measles flew into O’Hare International Airport in Chicago.

While infectious disease doctors say a passenger’s greatest health risk on an airplane may come from exposure to fellow travelers, the risk of spreading some diseases can increase if surfaces in airline cabins and bathrooms are not adequately cleaned.

Airlines typically hire outside companies to perform “quick turns” (the cleaning between flights) and overnight cleaning, as well as deep cleaning, which occurs about once a month.

Airlines do track passenger satisfaction with cleanliness, and they survey and inspect the cleaning that the contractors do on their behalf.

A number of airlines, including Delta, JetBlue and Southwest, declined to provide an executive to discuss cleanliness on their planes. But a trade group that represents numerous carriers in the United States, Airlines for America, said through a spokeswoman, Alison McAfee, “The safety, security and well-being of our passengers and crew is always our highest priority, and airlines know that the cleanliness of the aircraft and cabin components is important to customers.”

Michael Taylor, the travel practice lead for J. D. Power, said the company’s airline satisfaction study had found “a significant upward trend in passenger perception and satisfaction with cabin cleanliness and restroom cleanliness” over the last three years. That improvement was helped by the airlines’ aggressive introduction of new airplanes, he said, which “really helps drive up the cleanliness score simply because the condition of the actual aircraft is newer.”

Current and former cabin cleaners interviewed by The New York Times describe a work environment where pay is at or near the minimum wage, morale is low and turnover is high. The Service Employees International Union has been working with cabin cleaners in campaigns to improve benefits, working conditions and win unionization.

Sameer Yousef, a lead cabin cleaner for ABM, one of the companies hired by airlines, oversees a team of four that cleans United airplanes at San Francisco International Airport. On average, he said, his team cleans everything from the galley, floor, lavatories, seats and windows on more than a dozen airplanes every workday. “To clean, we need 10 to 15 minutes, but they give us seven or six,” or even less time for quick turns, he said. “It’s a very big pressure for us. They don’t give us more people to help.”

Mr. Yousef said the job is hard. “We have problems with our backs. All day, you’re bent doing seat pockets, doing the seatbelts. You go down and look under the seats and go up, jumping in the overhead.”

Cabin cleaners are also responsible for conducting periodic security sweeps in the airplanes, but Mr. Yousef said that he and his team are not given flashlights or mirrors for the task. He uses the flashlight on his own mobile phone.

A report in 2015 by the Government Accountability Office detailed the “limited time” cleaners have before passengers for the next flight begin boarding, and noted that cleaners might need to request more time for “additional cleaning necessary to decontaminate the aircraft.” Cleaners told the G.A.O. that “after incidents when a traveler became ill during a flight, the cabin crew does not always notify them of potentially infectious bodily fluids that had contaminated the aircraft.” The report concluded that the United States lacks “a comprehensive national aviation-preparedness plan aimed at preventing and containing the spread of diseases through air travel.”

Michael Ostendorf, a senior vice president for aviation operations at ABM, said that the company cleans a variety of airplanes for United, American, Delta, Southwest and other airlines and that a typical turn time should be 10 to 15 minutes.

“Now, during an operation that could change, it could get better, or it could get worse depending on the airline’s on-time performance for that day,” he said. Both overnight and deep cleans are more extensive in terms of the time and crew allocated. He said federal rules prohibited him from discussing the equipment ABM provides to cabin cleaners for security sweeps.

Robert W. Mann Jr., an aviation consultant based in Port Washington, N.Y., said that a clean or dirty cabin is the first thing passengers take note of and that it colors their entire experience. “When customers perceive cleanliness problems they conflate that with a perception that an airline might not be maintaining its airplanes, which is not a good thing,” Mr. Mann said. But he noted that modern cabin designs are easier to clean because they don’t have as many “grooves and recesses that tend to just collect dirt.”

Still, many frequent fliers have taken cleaning matters into their own hands. Karla Schaus, a blogger in Toronto and owner of Studio Beauty Company, describes herself as a “germophobe” and has tweeted about dirty conditions in airports and airplanes.

“There’s such a high turnover,” she said. “So that’s the one thing I always am worried about when flying. I try my hardest not to imagine how many people had sat in those seats.”

Ms. Schaus says she buys medical-grade hand sanitizers and recently started carrying a travel package of disinfectant wipes after observing other airline passengers wiping down the seat and surfaces that they touch.

“You just feel like you’ve done your job in protecting yourself as much as you can,” she said of her new wiping protocol. “So if you are touching the seatbelt, or you’re touching the tray table, then you at least know that you yourself have seen it cleaned.” When someone asks for a wipe, Ms. Schaus said, she is happy to share.

She said she also uses the air vent to keep “fresh(ish)” air on her throughout the flight. “Over the years, I’ve asked to switch seats because of unclean conditions” or when seated next to a sick passenger, she said. “In my opinion, germs don’t discriminate. Whether in first class, business class or coach, upgrades don’t guarantee cleanliness.”

Dr. Phyllis Kozarsky, a professor of infectious diseases and medical director of Emory University School of Medicine’s TravelWell clinic, said airlines had created an “incredible disincentive” for travelers to alter their travel plans when they are sick by charging high change fees, “so the people who are sick fly.”

Ms. McAfee, of Airlines for America, said that passengers’ ability to change or cancel depends on the situation and that passengers should contact their airline because this is often handled on a “case-by-case basis.”

Mauro Guillén, a professor of management at the Wharton School, who says he takes an international flight each month, gives some airlines mixed reviews for not cleaning the bathrooms during those long-haul flights.

“I do wash my hands very frequently especially when I’m traveling,” he said. He said he preferred soap and water because his hands get very dry if he uses hand sanitizer too much on extended flights. What’s more, he said, frigid cabin temperatures adversely affect passenger health.

Dr. Martin Cetron, the director of the division of global migration and quarantine for the C.D.C., said the greatest risk for the spread of infectious disease on airplanes was from passengers, not the environment.

“In general, given the millions of people that are flying, the number of associated infections from the aircraft environment itself is relatively small in comparison to the constant volume of travel,” he said.

Respiratory diseases, like flu, are of concern in an airplane setting, he said. Measles and tuberculosis are especially worrisome because they “have the ability to float and sustain in the air for a long period of time.”

Dr. Cetron said passengers who clean their immediate environment on an airplane may get “some incremental benefit,” provided it’s not a substitute for measures that provide “huge protective benefits” like basic hand hygiene, getting vaccines and staying home when sick. “So if you’re choosing to wipe your surface instead of being vaccinated against measles or flu, I think your efforts are misplaced.”