Medical Examiner

We Might Be Masking on Planes for a Good Long While

Even if you’re eager to take your mask off in other settings, planes are a little different.

A flight attendant wearing a surgical mask walks down the center aisle of a plane, collecting trash from passengers
Photo by Lukas Souza on Unsplash

You make sure your checked bag is under the weight limit. You arrive at the airport early, and you go through security. You send off a text to a loved one, preparing to put your cellphone in airplane mode. And you wear your mask.

Masks have become a regular part of our flying routine, another little inconvenience we deal with in exchange for quickly(ish) getting from one geographical location to another. After weeks of sustained drops in cases and hospitalizations (but still high daily deaths), many states are now moving to remove the mask mandates that govern stores and venues. One mask mandate that remains in place is the federal requirement to wear a mask in all forms of transportation shared with others. This includes public transportation like buses, subways, and Amtrak trains, as well as planes. The requirement, made by the Transportation Security Administration, is set to expire on March 18, though it is expected to be extended.*

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Should masks on planes be here to stay, like other quirks of plane transportation, even after the pandemic wanes? Or by extending the mandate, are we witnessing masks becoming just another annoying and nonsensical part of flying?

While we can reasonably debate if masking on planes should at some point become a thing of the past, or if we’ll be masking up on planes routinely during COVID and flu seasons, it’s clear that removing mask mandates on planes right now is a bad idea.

A plane is not just a regular shared space. Planes connect people from different parts of the country with different metrics for cases, hospitalizations, and deaths and different vaccination rates. As we saw this past summer, as the South was hit with a summer wave, other regions of the country fared better or didn’t see surges until later. In the air, you can’t take into account local metrics like you would with a local mandate. The only metrics that matter are the ones that apply nationwide. When those are truly low enough to take off masks, we will probably have reached the end of this pandemic.

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Yes, planes are pretty clean, thanks to their air filtration systems. A 2020 study that tested planes’ air quality found that they do have the lowest amount of particulate matter (i.e., have better air quality) compared with other commonly used spaces like stores, restaurants, and offices. But good ventilation is one layer of protection; it won’t necessarily protect you if a person in your row is breathing out coronavirus particles, for example.

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Research bears this out. A study that looked a flight in Japan from March 2020 found that those who reported wearing a mask throughout the flight were less likely to test positive than those who reported not wearing a mask (those who reported wearing a mask most of the time were also less likely to test positive compared with those who didn’t wear a mask), and those within two rows of the infected person were more likely to test positive compared with other passengers. Another study used computational fluid dynamics to model the transmission of the virus on two flights from early in the pandemic and found that when everyone is wearing a mask on flights, the rate of infection is much lower than when people are not wearing masks. This study found that if the infected person wore a surgical mask, infection would drop from 12 people to two people, and if everyone on board wore a mask, it would drop from two to one. The latter might seem like a marginal benefit to require mandatory masking, but with asymptomatic disease, you don’t know who is infected. And without a vaccine mandate on planes, it’s impossible to tell who might be more likely to be a carrier of the virus.

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All this might sound rather cumbersome after two years of the pandemic, in a period when infection rates are declining in many parts of the country. While I can sympathize with the argument that masking can be uncomfortable in our daily lives, and that we shouldn’t require masks when it is safe to remove them, flying is something that most passengers do not do on a regular basis. It is also an activity where we might be seated, without knowing it, in close, extended contact with someone who is high-risk or someone going to visit an elderly relative or an otherwise vulnerable relative. Flying isn’t just done for leisure; people use it to move, to see family in emergencies, to do essential travel. Higher-risk people who are avoiding indoor dining and movie theaters might need to, say, travel to visit a loved one in the hospital.

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This is all enough evidence for flight attendants—who have to wear masks and put up with the aggressive behavior of passengers who do not want to wear them—to broadly voice their expectation of an extended mask mandate. Both the Association of Flight Attendants, a union that represents more than 50,000 flight attendants across the U.S., and the Association of Professional Flight Attendants, which represents flight attendants at American Airlines, expects TSA will renew the mandate, citing the fact that many people are still vulnerable, including those who are not eligible to get the vaccine.*

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The travel mandate is in place for now, but it could expire in the future. If that happens, I hope it is at a point when it is clear by the metrics that the pandemic is waning (though unfortunately, as we know from the current lifting of mandates—again, deaths are still a concern right now—it may not be the case).

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At that point, we’ll then be left to make the choice for ourselves. I will continue to wear a mask on domestic flights especially during periods of seasonal virus outbreaks (we know that high-quality masks can also help protect us against flu) and perhaps, in a post-pandemic future, be more relaxed on longer-haul flights.

But the days of masks being a personal protective choice rather than a population health measure are way ahead of us. Until then, bring your mask on board.

Correction, March 3, 2022: This piece originally mischaracterized the Association of Flight Attendants’ stance on the mask mandate. The organization is not urging TSA to renew the mandate; it expects TSA to do so.

Correction, March 2, 2022: This piece originally misidentified the Transportation Security Administration as the Transportation Safety Administration.

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