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Video: How to stay healthy in flight

  1. Transcript of: How to stay healthy in flight

    MATT LAUER, co-host: This morning on TODAY'S HEALTH , killing germs in flight. Roughly two million Americans fly every day. And many leave the plane with a handful of new germs. What can you do to avoid that? Michelle Higgins is the "Practical Traveler" columnist for The New York Times , and TODAY contributor Dr. Roshini Raj , assistant professor of medicine at NYU Langone Medical Center . Hey, ladies. Good morning to both of you.

    Ms. MICHELLE HIGGINS (Practical Traveler Columnist, New York Times): Hi .

    Dr. ROSHINI RAJ (TODAY Contributor): Hello.

    MEREDITH VIEIRA, co-host: Hm.

    LAUER: We have brought our personal germ factory with us because Meredith is not...

    VIEIRA: I have a little cold.

    LAUER: ...feeling well.

    Dr. RAJ: Oh.

    LAUER: What are -- what are we talking about here when we travel? I mean, is it the -- are we talking about surfaces or the air that we're breathing?

    Ms. HIGGINS: The main concern is the surfaces because there are so many common shared surfaces on the planes, from the tray tables to the overhead bins that you're sharing to, you know, the bathroom door handle. You've got, you know, usually more than 100 people in this cramped space, and you're sharing all these common touch points, and...

    LAUER: Because a lot of people talk about the air. They say, OK, you know, if the guy in 16B -- or, in this case, the lady in 16B -- has a cold or the flu, she's exhaling and they can only recirculate that air so much and filter it so much. Is that another way to get sick?

    Ms. HIGGINS: Unless it's the passenger sitting directly next to you that's hacking...

    LAUER: Right.

    Ms. HIGGINS: ...you know, that's not as much of a concern. It's more about when you touch something, you know, the tray table or whatever that's been contaminated and then you touch your face or nose or eyes.

    Dr. RAJ: They actually filter the air pretty well. You know, ironically the air in planes sometimes in filtered better than in many office buildings that we work in.

    VIEIRA: Really?

    LAUER: Right.

    Dr. RAJ: So the air is really not a concern, as Michelle said.

    LAUER: So, Doctor, when we're talking about surfaces, are we talking about the typical household, you know, common cold , or are we talking about things that are more serious?

    Dr. RAJ: Well, we're talking about everything. So absolutely, you know, the common cold , the flu virus can survive for several days on hard surfaces like that tray table. But we're also talking about gastrointestinal viruses, you know, things that can cause food poisoning, diarrhea, things like that, or even, you know, MRSA , which is that really dangerous bug that people can get on their skin.

    LAUER: Isn't it true they swab, you know, tray tables and 2/3 of them had that?

    Dr. RAJ: Right. I found a study where Dr. Gerba ...

    LAUER: Yeah.

    Dr. RAJ: ...from University of Arizona swabbed tray tables and the, you know, bathroom door handles and the faucets and all the places that we're touching on a plane, right? And they found all of those things. Norovirus showed up. Mm-hmm.

    LAUER: Now...

    VIEIRA: So they never sanitize these planes when you get off and before people get on again?

    Ms. HIGGINS: Well, the airlines do do a good job of trying to deep cleanse the plane, is what they say. Every 30 days , American for instance, washes all the, you know, seat covers and, you know, scrubs the bathrooms. They also, you know, turn over the planes in between flights and pick up. But, you know, you're on -- depending on how long your flight is, you're cramped in with about 100 passengers.

    LAUER: Yeah, right.

    Ms. HIGGINS: So...

    Dr. RAJ: Yeah, every 30 days is not that often.

    VIEIRA: No. In a bathroom?

    LAUER: No, when you've got people flying.

    VIEIRA: Disgusting.

    LAUER: Now, you know, she makes fun of me. And, ladies, stick up for me here. I get on a plane, I take one of these little Wet Ones sanitary anti-bacterial wipes, and I tend to wipe my armrest. And if they've got one of those, you know, controllers for the lights and things -- that. And sometimes I'll even do the headrest. Is that crazy?

    VIEIRA: Oh my God.

    LAUER: Or is that very smart?

    VIEIRA: My God.

    Ms. HIGGINS: That's a good way to actually protect yourself from germs. Yeah.

    Dr. RAJ:

    LAUER: So very smart?

    Ms. HIGGINS: Well...

    LAUER: Would you go as far...

    VIEIRA: No, no.

    LAUER: ...as very smart?

    Ms. HIGGINS: Really, I...

    VIEIRA: That sounds neurotic.

    Ms. HIGGINS: You know, you might get some side glances from your fellow passenger...

    VIEIRA: Neurotic.

    Ms. HIGGINS: ...but, you know, to cleanse...

    VIEIRA: Neurotic.

    Ms. HIGGINS: ...your environment of germs, that's one of the ways to do it.

    Dr. RAJ: Right. But the best way is to wash your hands frequently because, you know, you can clean off some surfaces. You're probably not going to get every square inch. And what we tend to do is we touch our mouths a lot. We don't realize it but we might do this, we might, you know, rub our nose.

    VIEIRA: Exactly.

    Dr. RAJ: So you really need to make sure your hands are clean more than anything else.

    LAUER: What about some of the products, Michelle , that people are coming out with? You're not necessarily pitching these products or anything like that, but people are being somewhat inventive about this.

    Ms. HIGGINS: Right. So I think because of concerns of, you know, H1N1 and, you know, bedbugs and, you know...

    VIEIRA: Yeah.

    Ms. HIGGINS: ...all these things that people have been picking up while they're traveling, there're new products that have come out. Now, like the Purell , for instance, and the Wet Ones that you can -- those are probably two of the ones that will actually help you. Face masks...

    VIEIRA: Do you wear this?

    LAUER: You need this. Put that on. Put that on.

    VIEIRA: No, you wear this.

    LAUER: Stick that on. No, put it on.

    Ms. HIGGINS: ...generally are more about if the -- yes, the sick person is usually the one to wear that because that's a courtesy to your fellow passenger...

    VIEIRA: He has me wear this every day.

    Ms. HIGGINS: ...so they won't contaminate. But, you know, if you're really worried about a hacking seatmate next to you, that might help.

    LAUER: Right. So bottom line though, if you are nervous about it, take precaution. Nothing better than washing your hands...

    Ms. HIGGINS: Right.

    LAUER: ...but also be incredibly smart, almost brilliant, and wipe down your armrest with...


    LAUER: ...an anti-bacterial wipe.

    Ms. HIGGINS: That's right .

    LAUER: All right, ladies, thank you very much . Appreciate it.

    Ms. HIGGINS: Thank you.

    Dr. RAJ: Thank you.

    VIEIRA: Thank you, ladies, very much.

    LAUER: It's all right. It's all right. We're back in a moment. This is TODAY on NBC .

    VIEIRA: Oh my gosh.

    Ms. HIGGINS: I didn't do the bedbug...

updated 3/4/2011 10:22:48 AM ET 2011-03-04T15:22:48

Hearing about a recent IndependentTraveler.com staff discussion concerning the world's longest flights made me remember my first true long-haul flight to Sydney, Australia, for the 2000 Summer Olympics. About six hours into the 15-hour flight, I was feeling strong and confident. I clearly remember thinking, "Six hours down, nine to go. No sweat, I got this."

Four long, boring hours later, it was a different story; you could have poured me into a bucket. "Five hours to go? I don't got this."

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But get there I did. Unfortunately, that meant I had to get back, as well, a flight on which I made a serious tactical error, which led to misery for me and entertainment for my friends on the flight — about which I will tell more in due course.

However, not all long-haul flights have to be miserable; on one direct flight from Tokyo to New York, I was nearing the end of a book I was enjoying immensely, and remember distinctly thinking, "No, no, just a little more time!" when the pilot told us over the in-flight public address system that we had started our final descent. Here are 10 tips for preventing boredom, dehydration, deep-vein thrombosis, sleep deprivation and more so you can confidently say "I got this" the next time you are imprisoned in a metal tube for an entire waking day of your life.

1. Upgrade
When traveling long-haul, you have no better friend on the planet than your frequent flier miles. On the Tokyo-Newark flight I was disappointed to see come to an end, I enlisted the help of my travel agent to find flights on which I could burn up all of my Continental miles to upgrade my entire trip. It meant catching puddle jumpers to my final destination in Japan (Gifu), but a couple of short extra flights were a small price to pay for 27 hours of first-class legroom, fully reclining chairs, edible meals, entertainment and breathing space.

If you stop reading at this point in the article, you almost need to know nothing more than this — by hook or crook, try to get an upgrade. (Even Dr. Timothy Hosea, from whom you will hear below, offered this as his first and most important suggestion.)

2. Escape
You will want to have a rock-solid plan for frittering away several hours of your flight, and I don't mean working; staring at spreadsheets and writing proposals may burn up hours, but it does not make them vanish. You want these hours to disappear almost without a trace. Think headphones and Hollywood blockbusters. Getting a lot of work done is fine — rarely do you have 15 consecutive hours without a phone or e-mail, so I encourage bringing some work — but work will fail you when you get to the brutal middle hours of this ordeal. Headphones and Hollywood; don't stray from this.

Spring for the airline's headphones, pay for and watch every movie, swipe your card for the DirectTV, bring your iPad crammed with your favorite flicks — whatever it takes.

3. Don't carry on too much stuff
While checked baggage fees are inspiring travelers to carry on more and more stuff, on a long-haul flight this could burn you; anything that is under the seat in front of you just means less legroom and a more cramped living space for 15 or 16 hours. Don't bring so much on that you compete for your own sleeping space.

4. Bring your go-to gear
When it comes to surviving flights, I am not a gear guy. I can't be bothered to lug around neck pillows, eye masks, earplugs, noise-canceling headphones, etc — except on a long-haul flight. As I note above, your total carry-on haul should be limited, but you may want to consider some of these relatively small survival tools. Your body and brain will thank you for every small comfort you can provide, and the inconvenience of packing and carrying these around is dwarfed by the misery of 15 hours in flight with crying children, pilot announcements, engine noise and a major crick in your neck. Gear up.

5. Board relatively rested
Don't count on a long-haul flight as a good place to catch up on sleep — it's not. As attractive and intuitive as it seems to get on a long-haul flight extremely tired, hoping to sleep the whole way, you are in for a world of hurt if you can't sleep for any reason. You will be on the plane long enough to catch a few winks even if you are somewhat rested, and my advice is to take it when it comes; if your eyes start to droop, get out the eye covers and earplugs, and go with it. If you throw away a solid two-hour nap on a few extra rounds of Angry Birds, you might well be angry at yourself later.

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6. Secure your stuff
A long-haul flight gives unscrupulous travelers all the more time to size up the location of your wallet, wait until you fall asleep and make a move on your luggage. Secure your valuables deep inside your bags where it would take a TSA-ray machine to find them. Consider keeping items such as your passport, credit cards and cash in a money belt under your clothes.

7. Consider a sleep aid
If you are planning to use sleep aids (including "natural" methods such as melatonin, or drugs such as Ambien), try them before you fly with them. A few years ago a friend gave me an Ambien pill for a red-eye flight from Honolulu to New York City, and the drug acted more like a stimulant than a sleep aid. I was awake the entire flight, and felt wretched to boot. These types of drugs can vary greatly in how they affect individuals, so you will want to try them at home before you rely on them on the plane.

Dr. Timothy Hosea, team physician and Chair of the Sports Medicine and Research Committee for the United States national rowing teams, sometimes prescribes sleep aids for his athletes, but notes, "If you feel you need a sleep aid but haven't used those drugs before, you should probably try taking Tylenol PM or Benadryl. A prescription is fine with your doctor's approval, but don't experiment on a long flight; (the plane won't) stop for you!"

Dr. Hosea also says that, as the team doctor, he does not take any medication while flying with the squad in case someone needs care. "I bring a book, watch the movies and try to let the flight pass," he says. His approach is appropriate for other travelers who need to have their wits about them, such as folks flying with children, for example. If someone could potentially need you to be 100 percent during the flight, you should forgo any sleep medication. For more information, see Sleeping on Planes.

8. Use SeatGuru
On the flight back from Sydney mentioned above, I called ahead to get my seat reassigned to an exit row — big mistake. Unbeknownst to me, the exit row seat I chose was a window seat at one of the big, thick exit doors, which encroached on my leg area such that I had to sit sideways in the seat for the entire flight. It was also more like an "exit aisle," located right at a restroom, so there was endless and noisy foot traffic the entire flight. I was lucky that the rest of the row was empty, but it wasn't much help; the armrests did not go up, so I couldn't lie across the three seats in the aisle.

Needless to say, mine would have been a "yellow" or even "red" seat on the SeatGuru seating chart if it had existed in 2000 (the site was launched the following year). Eventually I went around the aircraft collecting all the unused pillows and blankets I could find, piled them up in each of the three seats, and created a workable (but in truth not very comfortable) platform across all three seats — and got a very few winks of sleep during the flight. I guess it was fairly comical, as friends all took pictures of me during the flight for their amusement. Glad you had a fun flight, guys.

Before you choose, also think hard about your usual preference of exit vs. aisle seat; it may be different on a long-haul flight than on a shorter flight. If you usually choose an aisle seat, consider whether you want your long, Ambien-enhanced sleep to be interrupted by an aisle mate; similarly, if you usually choose a window, you could get trapped in there by a snoring person in a prescription drug-induced stupor.

9. Ask about seats at the gate
Failing the ability to choose great seats before your flight, try again at the gate. If the flight is not full, the gate agent may be able to see an empty row, or put you and a traveling partner in a "window and aisle" configuration that reduces the likelihood of having someone sit in the middle seat, thereby getting you a seat and a half, at least.

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10. Take care of your health
Hydration: If you think hydration is a concern on a cross-country flight, try tripling or quadrupling your time in the air; you might as well spend 15 hours lying on the desert floor. Which is a good comparison, and you should stock up and behave accordingly. Imagine you are going to walk from Flagstaff to Winona, Ariz. How much water would you bring? Expect to drink about that much on a 16-hour flight.

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Dr. Hosea recommends drinking "electrolyte solutions, Gatorade being the best known, instead of solely water." Hosea says that maintaining electrolyte balance is important, and that you don't want to become completely diluted with water, particularly for older folks or people with other medical problems. "The combination of dehydration and stasis is really the issue with blood clots," he explains.

Deep vein thrombosis: DVT, the formation of blood clots in deep veins, is a known (if occasionally overstated) risk of longer flights. According to the National Institute of Health, the risk of developing DVT on flights up to four hours is small, but increases as travel time increases. The NIH's tips include walking up and down the aisles of the plane; moving, flexing and stretching your legs to encourage blood flow, especially in your calves; wearing loose and comfortable clothing; drinking plenty of fluids; and avoiding alcohol. Also, if you're at increased risk for DVT, your doctor may recommend wearing compression stockings while traveling or taking a blood-thinning medicine before you fly.

Dr. Hosea notes that the combination of being immobile along with the effects of dehydration increases the risk of DVT on long flights. He strongly recommends the following to the teams during long trips:

  • Hydrate very well the night before the flight, preferably with electrolyte drinks.
  • Don't drink alcohol the night before the flight.
  • Avoid diuretics such as coffee, soft drinks and even chocolate (all of which contain caffeine).
  • If you have no issue with ulcers, take a baby aspirin the night before and day of your flight.
  • Dress comfortably in loose-fitting clothes — no skinny jeans or anything that could impede blood flow or cause your ankles to swell.
  • Get an aisle seat or exit row so you can get up and walk around whenever possible.

Susan Francia, an Olympic gold medalist in rowing, has taken to wearing compression socks on long flights to competitions, although she has stopped short of wearing a full body suit. (Hosea discounts the need for the body suit as well: "You are really worried only about your ankles and calves.") Francia has noticed a positive effect from the compression socks, which Hosea notes can be simple "support hose."

"I did notice that my ankles were smaller," Francia says, "probably because they were mashed into old lady socks!"

Colds, the flu, bacteria, etc.: As I wrote in Avoiding the Airplane Cold, it isn't "air quality" that is of concern when you are flying, or recycled air, or anything of the sort — it is your body's compromised ability to deal with normal bacteria and viruses that puts you in danger of getting sick after a flight.

That is not to say that the general environment on a plane doesn't add to your risk of getting sick. Recent studies have found that the water coming out of aircraft sink faucets is often rife with bacteria from sitting in murky holding bins; that the seats, pillows and blankets on planes are more germ-ridden than your laundry basket; that your tray table is probably dirtier than your own bathroom floor; and that the seatback pockets — well, you don't even want to know, apparently.

Francia recalls a flight on the way to the Rowing World Championships last year where she considered wearing a face mask; the entire U.S. rowing team had contracted the swine flu on a World Cup trip earlier that summer, and she was being cautious. Francia asked a flight attendant what she thought. "Good idea, but it won't help," was the verdict. There is just too much stuff all around you to win that war. In the end, your best strategy is to bring along some bacteria-killing wipes, clean up your seat area as best you can and relax; there's not much more you can do.

Let's face it: electrolytes, compression socks, movie after movie and aspirin don't change the fact that you are stuck inside a metal can for a whole day. Just keep reminding yourself that this too shall pass — although I recommend saving your "I got this" until the wheels touch the ground.


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