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Why flying while sick can make you feel worse

Respiratory illnesses can make it painfully difficult to equalize pressure in your ears and sinuses

(iStock/Washington Post Illustration)

As cuffing season meets coughing season and airport crowds are reaching pre-pandemic levels, more travelers are likely getting on a plane when they’re not feeling 100 percent.

The coronavirus, the flu and RSV are all circulating at such high levels that hospitals are overwhelmed. Health experts warn it’s best not to fly if you have any symptoms (and not just for selfless reasons). Not only do you risk getting the passengers around you ill, but the environment on board could make you feel even worse.

“Many of the conditions on aircraft can exacerbate your symptoms when you have a respiratory illness,” said Henry Wu, an associate professor of medicine at Emory University and director of the Emory TravelWell Center.

Here’s how flying while sick could affect you and your fellow fliers — and what experts say you should do about it.

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Flying can make congestion, sore throat and dizziness feel worse

Respiratory illnesses affect your sinuses and Eustachian tubes, which connect your middle ear to your throat. Both are air-filled chambers, so when you’re on a plane, the pressure inside needs to equalize with the cabin pressure after takeoff and upon landing.

When you’re sick, however, the passages for drainage from those tubes become inflamed and narrow, making equalizing pressures more difficult, said Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security at the Bloomberg School of Public Health.

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“If you’ve got inflammation blocking your means of equalizing the pressure, that’s going to hurt,” he said.

That pain can continue even after your flight as inflammation prevents the pressure from equalizing, Adalja added. It can also lead to trouble hearing, vertigo, and in rare cases, damage to the eardrum, Wu said.

Aircraft cabins also have low humidity, which can exacerbate irritation of your mucus membranes and worsen a sore throat, Wu said.

It can also be a challenge to stay hydrated while flying, especially when you’re sick, leading to lightheadedness or feeling faint, he added.

How to know if you’re too sick to fly

Wu recommended travelers with any respiratory symptoms or fever get tested for coronavirus and the flu, and consider delaying their trip, even if you suspect it is only a common cold.

“It may be difficult to discern the common cold from the more serious respiratory infections like covid or flu or RSV, which is particularly dangerous for infants,” he said.

With the risk of spreading the sickness and exacerbating your symptoms, Wu said it’s better for travelers to be conservative about flying with an illness “for their own comfort and health as well as everyone else’s.” He added he has even seen airlines restrict travelers from boarding if they are visibly ill.

Adalja said anyone feeling shortness of breath before a flight — whether due to a severe respiratory illness or a chronic condition — should not travel, as lower oxygen levels in the air could impair your ability to oxygenate your blood. Most importantly, consult your doctor if you feel ill before a flight because each individual’s risk factors are different, Adalja said.

Jeffrey A. Linder, a professor of medicine at Northwestern University, said the “calculus has changed” in recent years to reduce the need to travel while ill, thanks to the ability to quickly test for the coronavirus and the proliferation of remote work.

“If you can’t get your symptoms under control with over-the-counter medicines, you should try to avoid flying,” Linder said.

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How to manage your symptoms on a flight

If you must travel while sick, there are a few ways to prevent your symptoms from getting worse.

The most important factor is keeping your nasal and middle ear passages as open as possible, especially during takeoff and descent, Linder said. He recommended taking an oral decongestant like 12-hour Sudafed a few hours before flying, followed by a nasal decongestant spray 30 minutes before flying and 30 minutes before descending (nasal decongestant sprays should only be used for up to three days in a row).

Adalja also recommended the Valsalva maneuver — holding your nose and blowing out — as well as using saline spray to ensure your passages are as clear of mucus as possible before flying.

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It’s also important to stay hydrated and wear a high-quality mask if you absolutely have to be flying while sick, Wu noted. Wearing a mask can have the added benefit of maintaining higher humidity in your oral and nasal passages, he added.

Above all, Wu recommended that travelers stay home if they feel sick, even if there are no longer coronavirus test requirements in place or mandatory masking on planes.

“It’s still a kind of a transitional period in this pandemic where a lot of folks are still figuring out how to navigate the return of influenza, as well as rising covid numbers again this winter,” he said. “The most we can do is just to everyone take their own precautions, whether you’re sick or not, to try to keep the aircraft and airports as safe as possible for everybody.”

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