Patricia Yarberry Allen, M.D. is a Gynecologist, Director of the New York Menopause Center, Clinical Assistant Professor of Obstetrics and Gynecology at Weill Cornell Medical College, and Assistant Attending Obstetrician and Gynecologist at New York-Presbyterian Hospital. She is a board certified fellow of the American College of Obstetrics and Gynecology. Dr. Allen is also a member of the Faculty Advisory Board and the Women’s Health Director of The Weill Cornell Community Clinic (WCCC). Dr. Allen was the recipient of the 2014 American Medical Women’s Association Presidential Award.

I am traveling this weekend to join the family from across the country who will gather in the Midwest to celebrate my brilliant father-in-law’s 90th birthday. Adult children and grandchildren and great-grandchildren will be present. 

I imagine the photographs of this event will look nothing like the recently released images of Queen Elizabeth, Charles, William and George. ( In our family, Harry and Archie would have been included in the photograph as well.)

I will be traveling, as usual, on a commercial flight. As it is flu and virus season, I expect many of my fellow passengers will be coughing and sneezing without covering their mouth and nose with Kleenex, or will be sick with a respiratory virus, or are infectious but do not know it yet. This is what keeps me up at night. As part of my training to become a board certified physician, I did a year’s fellowship in infectious disease and I became a slight germaphobe after this special training. I tell you this to both explain and share my airline travel routine. After all, you fellow travelers are also at risk for the diseases found in the cabins of airplanes.

Infectious diseases are one of the leading causes of death worldwide and respiratory infections occur in up to 20% of all travelers. Viral pathogens are the most common cause of respiratory infection in travelers. February is the peak season for influenza infections.  I hope each of you has received your annual flu shot by now. If not, please get it. At this point in the season, CDC estimates indicate that there have been 13 million influenza illnesses, 120,000 hospitalizations, and 6,000 flu-related deaths. Influenza is thought to be transmitted primarily by droplets settling within 3-6 feet; however, the airborne route has been implicated in special situations. 

Now, we have to contend with the new respiratory virus that has affected the travel decisions of many people. It is the novel Coronavirus, 2019-nCoV.  Much is unknown about how this virus spreads. According to the CDC:

“Current knowledge is largely based on what is known about similar coronaviruses. Coronaviruses are a large family of viruses that are common in many different species of animals including camels, cattle, cats and bats.  Rarely, animal Coronaviruses can infect and then spread between people such as with MERs, SARs and now with 2019-nCoV.

Most often, spread from person to person happens among close contacts (about 6 feet). Person to person spread is thought to occur mainly via respiratory droplets produced when an infected person coughs or sneezes, similar to how influenza and other respiratory pathogens spread. These droplets can land in mouths, noses or eyes of people who are nearby or possibly be inhaled into the lungs. Typically, as with most respiratory viruses, people are thought to be most contagious when they are most symptomatic. With 2019-n CoV, however, there have been reports of spread from an infected person with no symptoms to a close contact.

It’s currently unclear if a person can get 2019-n CoV by touching a surface or object that has the virus on it and then touching their own mouth, nose or possibly their eyes.” [Source: CDC]

According to the World Health Organization (WHO), as of February 2nd, there were at least 16,514 confirmed cases with 360 deaths in China and at least 16,660 confirmed cases worldwide. One death in the Philippines is the only one outside of China. 

My Air Travel Routine for Avoiding a Respiratory Infection in 2020.

I always prepare for airline travel as though I am going to battle with the black plague. This weekend’s trip will be no different. However, Amazon, now sells a kit with washable airline seat covers. I own two of these since it does me no good if I avoid a respiratory infection and The Husband gets it and infects me in my own bed. Here is a photo of the Seat Sitters seat covers. I found out about these from a patient who gifted me with them. It is perhaps my best gift ever. (Apologies to The Husband)
Packing list for this flight, which is only one and a half hours:

1. Non-latex gloves
2. Clorox wipes
3. Hand sanitizer
4. White cotton gloves
5. Disposable reusable airline seat cover
6. N-95 face masks to prevent airborne infectious agents  
7. Boroleum ointment to insert into the nasal openings using small Q-tips, not potentially dirty hands. (I think Boroleum traps viruses that pass under my mask and prevents them from taking up residence in my sinuses. It moisturizes the nasal mucosa, preventing easy access for germs. There is no scientific evidence to support my belief.)
8. Moisturizer for hands
9. A disposable scrub gown worn as part of Personal Protective Equipment (PPE)
10. Glasses to protect my eyes

Routine on the plane:

1. After I board the plane, I put on a pair of disposable latex-free gloves and start to work with the Clorox wipes, cleaning every surface in sight including the call button and those for air and light along with the window shade.
2. Cover the seat with those amazing airplane seat covers mentioned above.
3. Remove and discard the first pair of latex-free gloves.
4. Put on a disposable gown over my coat.
5. After settling in I finish my pre-flight routine for short flights:
   1. Purell for hands followed by a moisturizer.
   2. Put on white cotton gloves.
   3. Place N-95 face mask around the nose and mouth and secure.

Rules that I follow:

1. Avoid touching eyes, nasal opening or mouth with hands. These are the areas of entry for infectious agents.
2. Never ever touch those filthy back of the seat magazine pouches. You do not want to know what has been cultured from those places.
3. Airplane lavatory survival: remove white cotton gloves. Replace these with a new pair of nonlatex gloves. Before leaving the lavatory, remove and discard gloves and scrub hands with soap and water for 30 seconds. Use Kleenex to open the bathroom door. Discard Kleenex. Return to seat and replace white cotton gloves.
4. No eating or drinking. I am wearing a mask after all.

I always bring extra masks and many small containers of Purel and Kleenex to give to the lucky passengers who are willing to make eye contact with me. At this point, I know that I am not a pretty sight but my preparation for air travel and adherence to this pre-flight checklist has worked well so far. While many of you just hope to land on a runway at the end of your flight experience, I urge you to set your sights higher: land without any infectious disease to take with you to your destination and to pass on to unsuspecting friends and family.

I must admit that I tried to talk The Husband into making the twelve-hour drive to his home so that I could avoid the February flu season with potential Coronaviruses lurking on the plane, but I was unsuccessful. Sigh.

Wish us well as we travel to celebrate the birthday of the leader of the clan who has been a wonderful example to his children and grandchildren and has made the lives of others so much better!

Dr. Pat