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The summer months are fast approaching, and that may mean an opportunity for travel for those who feel comfortable doing so — or who may be itching for a change of scenery after two years of an isolating pandemic. However, the recent lifting of mask mandates on public transportation like airplanes may leave you feeling like it’s riskier than ever to leave home.
Here are answers to all of your questions about the recent changes, plus what experts recommend you do to evaluate your risk and stay safe.
What Are the Current Mask Mandates on Public Transit?
In April, the Transportation Security Administration announced that mask mandates would no longer be required on planes. Some pilots even shared this updated mid-flight, leading to the jubilation of several passengers (who consequently shed their masks) and to the distress of others concerned about COVID-19 transmission for the high-risk, reports USA Today.
The announcement came after a federal judge voided the previous masking order from the U.S. Centers for Disease Control and Prevention (CDC). However, the CDC still encourages masking in indoor public transit settings for those aged 2 years or older. Indoor areas of public transportation may include airplanes, trains, buses, and ferries, or transportation hubs like airports, stations, or seaports.
This recommendation from the CDC is based on currently available data about circulating variants and their impact on disease severity and vaccine effectiveness, domestic and global epidemiology, and current trends in COVID-19 community levels in the United States (plus projections of COVID-19 trends in the coming months).
Private transportation companies like Uber and Lyft also announced that they would lift the mask mandate shortly after the ruling, but masking may still be required in certain cities under local laws. For instance, the New York City Taxi & Limousine Commission, which regulates these types of trips, noted that masks are still required in all for-hire vehicles and taxis on Twitter in April.
Local laws may also apply to subway services — for instance, in New York City, it’s also still mandatory to wear masks at indoor train stations and on subways and buses, per the Metropolitan Transportation Authority.
How Risky Is Travel for the Immunocompromised?
If you’re worried about the risk these changes pose, you’re not alone.
“I’ve had a number of patients, especially as they start traveling, express concerns,” says rheumatologist Jiha Lee, MD, a Clinical Assistant Professor at Michigan Medicine. “I’ve also had a number of patients who have traveled, come back, and inadvertently developed infections.”
Throughout the pandemic, we’ve learned more about just how effective masks are in protecting against COVID-19. In a March 2022 study published in the Journal of the Royal Society Interface, researchers used modeling to determine that an unmasked person who speaks can spread infected droplets one meter (a little over three feet).
Meanwhile, if the same person coughs, the drops can spread up to three meters (nearly 10 feet) — and sneezing increases that distance to seven meters (nearly 23 feet). However, the researchers found that wearing a surgical mask or FFP2 mask (a respiratory mask similar to N95 masks) can reduce the risk of infection to an extent that it’s practically negligible, even from only one meter away.
“Masks have, by now, been shown to really help limit the transmission of the SARS-CoV-2 virus, including all of the variants we have seen,” says David Aronoff, MD, Chair of the Department of Medicine at Indiana University School of Medicine. “When people stop wearing masks, the impact of that on the pandemic depends on how much virus is spreading in the community at the time and how busy the pandemic is in a given location.”
In the United States, there have been reduced levels of disease recently, but the frequency of people diagnosed with COVID-19 is starting to increase. That’s important to consider, because many cases of COVID-19 are not being publicly reported due to the use of at-home rapid tests.
“We are largely underestimating the burden of disease, but we’re seeing increases in the United States, which means there’s definitely still a lot of COVID activity,” says Dr. Aronoff. “My concern for immunocompromised patients is that there absolutely could be people who have COVID and are contagious on public transportation like buses, trains, and airplanes. It’s really prudent for people to wear masks in those settings — which I would still recommend, particularly for people who are immunocompromised.”
Does It Make a Difference if You Still Wear a Mask — But Nobody Else Does?
You may feel a sense of hopelessness if you’re surrounded by unmasked passengers, but keep in mind that wearing your own mask can still provide you with an extra level of protection.
“Wearing a mask helps incrementally as a suite of things that people can do to limit disease transmission,” says Dr. Aronoff. “Every effort to reduce transmission can help and can be the difference between getting infected or not getting infected. I am an advocate for doing simple things that can cumulatively reduce the likelihood that someone is the unlucky victim of this potentially fatal disease.”
One way to easily increase the effectiveness of masking is to choose a well-fitted, quality mask. Some masks are better than others: For instance, N95 and KN95 masks are more protective masks that provide two-way protection, so you’re both less likely to transmit and contract the SARS-CoV-2 virus when wearing one. (Less effective masks include neck gaiters or bandanas, which offer very little protection, per a 2020 study in Science Advances.) Learn more about how N95 masks reduce risk for those who are immunocompromised or high-risk for COVID-19.
Meanwhile, for air travel, the plane itself will help reduce transmission through rigorous air exchange, in which fresh air is brought into the airplane and exchanged very frequently through HEPA filters.
“On an airplane, the ventilation is really quite good, and that helps reduce the risk of disease transmission,” says Dr. Aronoff.
Other mitigation efforts will also help: Make sure you’re up-to-date on your vaccines (most importantly) and keep your distance from other passengers in areas like the boarding gate or the luggage claim.
And no matter what method of transportation you take, you can further reduce your risk by traveling during off-peak times to avoid crowds or open windows to improve ventilation if that’s an option — say, in a taxi — per the CDC.
What Other Steps Should I Take Before a Trip?
Before you travel, touch base with your doctor and make sure you’ve received your COVID-19 vaccines and boosters if you’re eligible.
“If someone is moderately or severely immunocompromised, and the concern is that they may not mount a good response to vaccines or they’re not eligible for getting vaccines, they should talk to their licensed health care professional about preventive strategies like the use of Evusheld,” says Dr. Aronoff.
Evusheld is a monoclonal antibody treatment that can be used to prevent COVID-19 or reduce the severity of COVID-19, similarly to getting immunized. (Learn more about Evusheld for immunocompromised patients.)
When it comes to travel risks, Dr. Lee says that she’s most concerned about patients who are on rituximab (an immunosuppressive drug used to treat inflammatory types of arthritis) or CellCept (an immunosuppressive drug used to prevent rejection after organ transplants). These individuals, in particular, may not have mounted a fully protective response to the COVID-19 vaccine, even if they have received all recommended doses.
“For those individuals, I certainly recommend they follow the traditional guidelines that we had in terms of masking and social distancing as much as they can and to ensure their travel companions are fully vaccinated and taking similar precautions,” says Dr. Lee.
And of course, you’ll need to understand what your contingency plans are for seeking care if you do get sick while traveling. You should make sure that you have plenty of your regular medication for travel, in case you need to be isolated and can’t return home when you expected.
Before you leave, also look up the local rates of infection in your destination — you can use the CDC’s COVID Data Tracker to do so.
Your health care professional can help you weigh the risks and benefits to your travel. They may also be able to help you work through logistics like making sure you have access to testing before you leave or once you arrive at your destination (if you become exposed to someone with COVID-19 or develop symptoms). Learn about the local resources available and have a point of contact in the area you’re traveling to.
When it comes to how risky travel is as an immunocompromised individual, there’s no one blanket answer that can apply to all. Your risk will be determined largely by your own underlying conditions, vaccination status, and the external factors of your trip.
“There are a number of things to consider, like your vaccination status and the type of travel in terms of accommodation, mode of transportation, or activities,” says Dr. Lee. “Based on your disease and immunocompromised status, your doctors can help better assess the risks and come up with plans to stay informed and minimize those risks.”
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Fischer EP, et al. Low-cost measurement of face mask efficacy for filtering expelled droplets during speech. Science Advances. September 2, 2020. https://doi.org/10.1126/sciadv.abd3083.
Interview with David Aronoff, MD, Chair of the Department of Medicine at Indiana University School of Medicine
Interview with rheumatologist Jiha Lee, MD, a Clinical Assistant Professor at Michigan Medicine
“Masks are still required in all taxis and for-hire vehicles.” NYC TLC. Twitter. April 19, 2022. https://twitter.com/nyctaxi/status/1516434021944807424.
‘More fearful than I was’: At-risk immunocompromised Americans decry lifting of travel mask mandate. USA TODAY. April 20, 2022. https://www.usatoday.com/story/news/health/2022/04/20/immunocompromised-americans-fear-travel-mask-mandate-removal/7372643001/.
MTA service during the coronavirus pandemic. MTA. April 26, 2022. https://new.mta.info/coronavirus.
Wearing Masks in Travel and Public Transportation Settings. COVID-19. U.S. Centers for Disease Control and Prevention. May 3, 2022. https://www.cdc.gov/coronavirus/2019-ncov/travelers/masks-public-transportation.html.
Wang J, et al. Modelling the direct virus exposure risk associated with respiratory events. Journal of the Royal Society Interface. January 12, 2022. doi: https://doi.org/10.1098/rsif.2021.0819.