King lives in Berkeley, but he grew up in Greeneville, Tenn., a “beautiful but economically depressed” town known for its abundant churches and as the home of President Andrew Johnson. King’s paternal grandmother, Jean, was an important influence on his childhood there, a high school guidance counselor who hosted holiday dinners and baked the bread for communion, a “remarkable person with a lot of life.”
Now, Jean McAmis was in her late 90s, suffering from dementia, living in hospice care and suddenly refusing to eat or drink.
“My first thought was, ‘OK, how can I get out there?’” says King. But traveling home from the Bay Area requires a seven-hour flight, and the idea of bringing the coronavirus to his parents was horrifying. “My dad took the lead and said, ‘We don’t want you to do that. We don’t want you to put yourself at risk.’”
For Bay Area residents with relatives nearby, hanging out during the pandemic comes with extra precautions: masked strolls, hugs on hold and backyard dinners with people spaced 6 feet apart. But for those with loved ones a plane ride away, deciding whether and how to visit involves a more confounding set of calculations. It means considering the threat of infection while flying versus the pain of missing funerals, births and graduations. It means navigating how soon to see loved ones upon arrival and weighing the possibility of exposing vulnerable family to the virus against the idea of not seeing each other until a vaccine is complete.
“Everybody is going to draw the line differently,” says UC Berkeley infectious disease expert John Swartzberg. “It’s not a right or wrong, it’s where you can live your life.”
The threat of coronavirus infection during air travel starts well before the plane leaves the tarmac. There’s riding to the airport via Uber or BART, waiting at security, using a public restroom, buying a snack and walking down the jetway to board — a process that brings you into contact with strangers and the surfaces they touch every step of the way. None is particularly dangerous on its own, but each adds to the overall chance of exposure.
“Flying is an accumulation of a bunch of things that in general imply higher risk,” says Dr. Bob Wachter, chairman of UCSF’s Department of Medicine. “It is staying in fairly close contact with a whole lot of people you don’t know, it is doing that indoors, it is doing that for long periods of time.”
That is especially true of the flight itself. On an empty plane the risk is minimal, but the more people aboard, the less ability there is to maintain a safe distance and the higher the likelihood that someone might be transmitting virus.
“You don’t want somebody within 6 feet of you, which means you don’t want anybody in your row or you don’t want anybody in front of you or behind you,” Swartzberg says. “Lots of luck.”
Airports and airlines are taking measures to mitigate the risk. At San Francisco International Airport, physical distancing markers and sanitizer stations have been installed throughout the terminals, and 300 face masks are given out daily. On planes, airlines have implemented new cleaning procedures and boarding protocols. They’ve limited capacity and suspended food and beverage service to minimize contact between crew and passengers. Implementation of those policies varies substantially, however. JetBlue Airways and Delta Air Lines have blocked middle seats, and Southwest has lowered capacity by a third. United hasn’t cut the number of tickets available, but prioritizes the selection of window and aisle seats and notifies fliers 24 hours before departure if more than 70% of tickets are sold. The airline also asks people to complete a self-assessment during check-in and confirm they haven’t experienced COVID symptoms or had close contact with someone who is infected in the past 14 days.
The airlines also have begun requiring face masks, which Wachter deems the single most important safety measure.
“To me, all of the other things are worth about 20% and universal mask wearing is worth about 80%,” he says.
But as elsewhere, masking has been a point of contention in the friendly skies. Social media posts from recent trips show bare-faced passengers and report flight attendants seemingly doing little enforcement.
Wachter has heard the same from friends who’ve traveled.
“I thought that was scary as hell,” he says. “The safety risks of getting sick and dying from COVID on an airplane have to be orders of magnitude higher than the safety risks of dying because the plane crashes.”
On Monday, the industry seemed to acknowledge as much. Trade group Airlines for America announced that its seven member carriers — Alaska, American, Delta, Hawaiian, JetBlue, Southwest and United — would be “vigorously enforcing face covering policies.” JetBlue says it will deny boarding to anyone without a mask, and if a passenger removes their covering for more than a quick break during a flight, they can be reported to security once on the ground and lose flying privileges. As of June 18, United passengers who don’t comply with masking rules will be added to a restricted list and banned for a period of time.
Three people who flew recently on three separate Southwest flights told The Chronicle that everybody on board had been masked.
“If there’s universal masking I feel significantly more comfortable,” Wachter says.
But Swartzberg points out that getting on a plane during the pandemic isn’t just about accepting the risk of travel for yourself.
“It’s the other piece that people have a harder time grappling with,” he says. “I’m willing to take that risk if I get sick, but if I get sick, who am I going to infect? We all have this enormous responsibility, and flying brings it out.”
For those hoping to visit loved ones who are at higher risk of complications from COVID-19, that responsibility looms particularly large. The question of how to avoid bringing the virus to family is an agonizing one. Unless you can go for a month and quarantine for a full two weeks, “the answer is there is no good answer,” Wachter says.
Carry on: The fewer people who touch your luggage, the better. Skip a checked bag.
BYO-everything: To minimize interactions and enclosed spaces inside the airport, bring your own snacks and water bottle.
Sanitize: TSA is allowing up to 12 ounces of liquid hand sanitizer in carry-ons. Clean your hands every time you touch a public surface.
Use the bathroom: It’s best to avoid the tight quarters and high-touch surfaces of the airplane lavatory. Go before you fly.
Wipe down: Bring alcohol wipes and give your seat area a thorough cleaning.
Mask up: Wear a mask throughout your time in the airport and on board, and notify flight attendants if fellow passengers remove face coverings for long periods of time.
For most people, that’s out of the question, so the alternative is devising a strategy that feels safe enough. The average incubation period between exposure and onset of symptoms is five or six days, so for the first six days of a visit, experts advise behaving as if you’ve been infected on the flight — staying at a hotel, monitoring for symptoms, keeping more than 6 feet away from loved ones, seeing them outside and masking diligently in their presence.
If you’re visiting a family member at high risk of serious illness or death from COVID-19, Swartzberg suggests quarantining for at least 10 days to make sure symptoms don’t appear. If testing were widely available, he says, you could take tests on days four and seven and, with two negative results, feel reasonably assured you were virus-free.
If Wachter were going to visit his parents, ages 84 and 90, in Fort Lauderdale, for the first five days or so he would be extremely careful to maintain ample distance.
“I would not quarantine, but I would religiously stay at least 6 feet if not more away and I would wear a mask in their presence,” he says.
It’s not a perfect solution, especially if you’re hoping to enjoy a hug or to hold a baby, but “if you’re going to say I need my risk to be essentially zero, there’s no way you can do this,” Wachter says. “I think unfortunately you’re stuck with Zoom.”
Loring Pfeiffer’s parents were supposed to fly from Colorado to the Bay Area during the middle of the shelter-in-place order for the birth of her third child.
“We realized in March it wasn’t going to happen,” says the Santa Clara University lecturer. “Then I just felt really sad about not knowing when I would see them again.”
As the Bay Area began to reopen last month, Pfeiffer consulted the family doctor about the safest way for her parents to meet their grandson.
The doctor’s advice: drive. Even with stops for fuel and bathroom breaks, there’s no question that driving is safer than flying, says Wachter. “It’s shelter in non-place.”
Pfeiffer’s parents made the 18-hour trip in two days.
“It has been fantastic,” Pfeiffer says. “Grandparent love is a whole separate kind of love.”
Her husband’s folks are hitting the road next, driving from Kentucky to meet baby Wiley.
As much as the threat of exposure during air travel is an academic question for Wachter and Swartzberg, it’s also a personal dilemma. Swartzberg is missing his own grandkids, a plane ride away on the East Coast. He has no plans to see them in person soon.
“I’m 75 and my wife’s 71, and we’re at high risk,” he says. “We’re going to be amongst the last people to fly.”
Wachter has been contemplating a trip later this summer to his place in New Hampshire. He’ll watch the number of cases in the Bay Area and New England, keep tabs on airline mask enforcement and make his decision at the last minute.
There is no right choice. There’s just deciding how much risk you want to tolerate.
“It’s part of what makes this whole thing so unbelievably difficult and also extraordinarily interesting,” Wachter says. “You have this mixture of science meets politics meets human nature meets the economy all in one big stew, and every day you have to make a thousand decisions based on that.”
Last weekend, Kyle King got the call he had been dreading. His grandmother Jean had passed away in her sleep. Her death hasn’t changed the danger of flying, but it has made the decision not to go home all the more heart-wrenching. For now, King is staying in California, waiting for a window when travel feels safer and the pandemic’s threat isn’t so pressing.
When that happens, Jean’s loved-ones will gather together in Greeneville. And they’ll give her the goodbye she deserves.
Sarah Feldberg is The San Francisco Chronicle assistant features editor. Email: firstname.lastname@example.org Twitter: @sarahfeldberg