Travel health: Flying during the Covid-19 pandemic

Air travel has become one of the pandemic’s talking points. Dr Jane Wilson-Howarth takes us through her recent journey to Nepal and analyses the health risks

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In March, we returned to Nepal. Foreign holidays were then illegal but travel for work was permitted. Navigating the rules set by the airline proved fiercer than those of the Nepali government. The challenge travellers face is that each airline and country potentially sets different rules and requirements. Entering the Netherlands by air, for example, one has to arrange a test that is certified by a clinic within 24 hours of boarding an aircraft (the solution is to fly into Belgium where there is no such rule, and take a train to your Dutch destination).

Rapid self-administered tests exist. Lateral flow testing is being done in UK schools and by vaccinators; for these people self-swab, then drip a solution from their swab into a device that looks like a pregnancy test. This gives a result in 20-30 minutes but reliability is operator-dependant and these are not normally accepted for travel. Similarly, blood testing to assess immunity or past COVID-19 exposure is not useful for travellers.

Fortunately, most countries allow a longer timeframe for pre-travel testing than the Dutch. Just under 72 hours before we were due to fly from Heathrow, we had an on-line consultation through Nomad Travel Pharmacy. We took our own throat and nose swabs under the watchful eye of the Nomad clinician and then a courier took our samples for analysis. The results of this gold standard PCR (Polymerase Chain Reaction) test came through in plenty of time for our flights.

The airbus we boarded for our flight to Doha was about 70% full, yet passengers were not distanced as much as they could have been. Then on the Doha to Kathmandu leg, the plane was completely full, and seats were more cram-packed.

Departures sign (Shutterstock)

Departures sign (Shutterstock)

I found myself analysing the risks as we travelled. The biggest challenges seemed to be on the ground, during boarding and while disembarking. Maintaining social distance while queuing through security and passport control proved impossible. Everyone was wearing a mask but people often made physical contact while we queued so it was reassuring to know that fellow travellers had tested negative for COVID-19.

Passengers can’t control when to board and often have little choice in where to sit but it is worth trying to avoid seats, especially isle seats, close to the toilets. It is impossible to visit the toilet and properly hand-wash without touching potentially contaminated surfaces and this is especially true on-board, particularly when the soap runs out. And exiting a loo without touching door handles is also impossible. This is a crucial time for generous use of hand sanitiser.

Once everyone is settled in their seats, the plane’s HEPA filters should remove most virus particles from the cabin air but perhaps the most important tip for minimising the risk of picking up COVID-19 (or any other infection) is to analyse what you do with your hands. What do you touch? Do you rub your eyes? How often do you adjust your mask? Have you used someone else’s pen? Do you rest your hands on potentially contaminated surfaces? Will you sanitise your tray table?

We were careful. Five days after arriving in Kathmandu we arranged another PCR test and, once we received the negative result, we emerged from quarantine.

Dr Jane’s Nepal memoir A Glimpse of Eternal Snows is now available on Audible. For more information visit

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