Image: Airline workers
Roberto Candia  /  AP file
To help keep sick travelers from flying, some airlines have opted to waive change fees for passengers who postpone their trips. In most cases, passengers must fax the airline a doctor’s note to dodge the change fee.
By contributor
updated 11/20/2009 3:47:06 PM ET 2009-11-20T20:47:06

As outbreaks of the H1N1 virus inject more frazzle into already-frayed travelers, airlines and their approach to sick passengers are being scrutinized.

The airlines say they are listening to fliers’ concerns and, in several cases, reacting. Some are even specifically looking for swine flu.

Earlier this month, a woman traveling home to Hawaii was ordered by flight attendants to leave a United Airlines plane set to depart Tampa, Fla. The passenger, Mitra Mostoufi, had become suddenly nauseous after taking restless-leg medicine and requested an airsickness bag.

According to Mostoufi, one flight attendant responded: “You’re a health risk,” while another told Mostoufi she might have swine flu and, therefore, had to exit. Although United Airlines suspected Mostoufi carried H1N1, still another United employee tried to rebook Mostoufi on an American Airlines flight, Mostoufi said. She reached Honolulu the next day aboard a United plane.

Flight crews are responsible for determining when passengers are visibly too ill to fly — to protect the “safety and health of all travelers onboard” — and the airline was within its rights to bump Mostoufi, according to United spokesman Rahsaan Johnson.

Should flight attendants, however, have the authority — or be expected — to diagnose swine flu?

‘From H1N1 to heart attacks’
At US Airways, “all employees have information on how to help passengers displaying symptoms of any medical issue, from H1N1 to heart attacks,” said spokesperson Valerie Wunder. “We follow the procedures and protocols as advised by the [U.S. Centers for Disease Control and Prevention], who lists the symptoms of H1N1.”

Problem is, six of the 10 swine flu symptoms listed by the CDC are outwardly silent: sore throat, fever, body aches, headache, chills and fatigue. (The other symptoms may include a cough, runny nose and, sometimes, diarrhea and vomiting). Will flight attendants start feeling passengers’ foreheads as they simultaneously scan their ticket stubs?

“On every flight I work, people are coughing, sneezing, and not covering their mouths — including a few crew members,” said United Airlines flight attendant Susan Fogwell. “Since I’m not a doctor, I have absolutely no clue whether someone has H1N1, a cold, allergies, or whatever.”

“We are not — not — in the job of diagnosing passengers at all,” said Paul Flaningan, a spokesman for Southwest Airlines. “We treat all communicable diseases basically the same ... Whether it’s someone at our gate or someone in flight who feels like they’re coming down with something, we do have procedures in place. (That includes round-the-clock communication with medical advisors on the ground). But to spend time to try and diagnose between standard flu and swine flu, we don’t do that.”

“This is a tough one,” acknowledged Dr. Mitchell Weinstein, an infectious disease physician in Chicago and a medical expert at “But I don’t think we need to make it more complex than it has to be ... If a flight crew witnesses someone who obviously has these symptoms, then they should be barred from flight. This does not mean that they need to be master diagnosticians, but I think it is worth erring on the side of the conservative.”

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Affordability trumps social responsibility
“Ideally, sick people should stay off planes,” said organizational behavior consultant Mary Federico, a New Yorker who has “suffered the consequences” of jetting with contagious seatmates. “But it’s unrealistic to expect that to happen ... There is little or no flexibility with flights. Availability and cost and penalties are issues.”

Two recent travel surveys found that travelers’ wallet worries trump social responsibility.

Interactive: Is it a cold, the swine flu — or something else?

According to an early November poll conducted by the Consumer Travel Alliance, almost 73 percent of the passengers questioned said they would fly with swine flu rather than pay airline rebooking fees (which can cost as much as $250). posed the same query in late October and, according to the Web site, 51 percent of its respondents said they, too, would lug their bags and their H1N1 germs onto scheduled flights rather than pony up change fees.

What’s more, most passengers check in online or at an airport kiosk and “gate agents barely look at a passenger — they only grab your boarding pass,” said JoAnne Kochneff, who owns Travel by Gagnon in Grand Rapids, Mich. “Their job is to board the aircraft as quickly as possible ... When would it come to the attention of the airline that someone might be suffering from H1N1?”

As of mid-November, all but four states were reporting “widespread influenza activity” and nearly 4,000 Americans had died from the H1N1 virus, according to the CDC. When a swine flu carrier touches and deposits the virus on an airline arm rest, seat back, seatbelt clasp or tray table, those germs can survive for as long as eight hours — remaining contagious for the next passengers who occupy that seat. Airlines — like buses, trains and escalator rails — are ideal swine flu transporters. Swine flu events

Consequently, many commercial jets are armed with extra germ-fighting kits this autumn. United Airlines equips its crews with masks, gloves, Lysol wipes and packets of alcohol hand wipes, and Fogwell said she spends more time sanitizing the galleys and the public-address phones. Continental Airlines stocks its planes with a limited number of masks and gloves as do American and Southwest airlines.

But keeping flu-ish passengers on the ground is still the best way to keep planes H1N1 free.

Fees waived — with a note from your doctor
To keep sick travelers from flying, United, Continental, Northwest and AirTran Airways all have opted to waive change fees for passengers who postpone their trips due to illness. In most cases, the customers must fax the airline a doctor’s note to dodge the change fee.

“If a passenger has H1N1, we don’t want them to travel any more than they don’t want to travel,” said AirTran spokesman Christopher White. “It’s best for them and best for us that they don’t fly.”

For people who possess non-refundable American Airlines or US Airways tickets, however, change and cancellation fees will still be applied if those customers reschedule their trips due to swine flu, according to spokespersons at both airlines.

“I can understand that the airlines are concerned about bogus medical excuses — they may worry some of the flying public will try to take advantage of the H1N1 scare and use their ‘flu’ as a way to circumvent an airline change or cancellation fee,” said Ann Lombardi, a travel agent at Atlanta’s “The Trip Chicks.” “I know, too, that the airlines are struggling financially and may be reluctant to initiate laxer rules ... But something has got to give. And the ball is in the airline’s court.” Flu activity around the country

For her frequent cross-country flights, writer Katherine Brodsky packs two strategies to evade the pandemic germ of the day. One tactic borders on the divine. The other approaches the impossible.

“Whenever I hear someone coughing and sneezing as they are boarding the plane, I say a little prayer so they don’t sit next to me. I’m not religious but (I pray) just in case it works,” said Brodsky, who splits her time between New York and Vancouver. Her other ploy? “I try to breathe less!

“But I have some sympathy too,” she added, “since often (ill passengers) have no real alternative. It’s not like you can call up an airline and say, ‘I’m feeling a little sick this morning. Would you mind getting me on a flight a week later and paying for my hotel while I recover?’ ”

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Video: Flying while sick

  1. Closed captioning of: Flying while sick

    >> health directors and vaccine manufacturers.

    >>> well, deciding whether you're going to fly sick, especially with the holidays looming, poses a real issue for travelers. because in canada a woman claimed she was forced to fly while sick with h1n1 . she says she wanted to change her flight, she would have, but she would have been forced to pay nearly $700 in change fees to do so. meanwhile, in tampa, florida, a woman and her daughter were taken off a united airlines flight to hawaii because the crew suspected the mom might have been ill with h1n1 or swine flu . i'm joined now by a doctor of omny health care in orlando, florida. she says airlines need to create more lenient cancellation policies for h1n1 . i'm also joined by assistant general counsel for the air transport of america. stephanie, what do you want the airlines to do?

    >> i would like to see them waive the cancellation fees. i am on the front line of this war of the flu pandemic that currently exists that we haven't had since 1976 . i'm diagnosing it every day. i see how contagious it can be. i'm working hard on prevention and vaccination of the flu pandemic . and i think that if we citizens are being responsible by trying to cancel their flights, but they're being stuck with these fees, they're going to be less likely to not fly, therefore choosing their pocketbooks over their health.

    >> katherine , we have been pounding it into people. don't go to work sick. keep your kids home if they're sick. don't get on airplanes if they're sick. yet by trying to really say to people airplanes are still a safe place to be. but if the airlines don't help out economically, this is real concern that people are going to get on planes ill.

    >> well, it's a concern any time people have to change their plans because of illness. there are often financial considerations. whether or not you go to work when you're sick, if you don't have paid sick leave . whether you keep your child home from school, if you don't have alternative child care arrangements. or whether you take a trip that you've planned and paid for. a lot depends on what kinds of arrangements you have. purchase travel insurance , for example.

    >> katherine , the average person is not going to purchase travel insurance going from coast to coast . i want to put up some of the airlines and what they are -- say that they're doing. united will waive some fees with a doctor's note. american says, you know, the $150 fee may still apply. but if you look at this list, there is really no consistency among the carriers. why can't everyone get on the same page and say, look, until springtime we are going to be fluid and we are going to try to keep everything, frankly, safe and keep this country moving?

    >> i think the airlines have been flexible and have adopted flexible poliiepolicies. they are carrier by carrier. they're different for different carriers. that's in large part because of the system we have in this country where there's not government regulation of the fares and the policies that airlines impose.

    >> i would say the same thing. there's enough government and registrationlation in regulation in a lot of things. wall street comes to mind. you expect corporations to step up to the plate and do the right thing. stephanie, is that argument good enough for you?

    >> absolutely. i think that by the airlines taking a leadership role in saying, look, we understand this is a huge public safety issue, we want to help out our consumers and our flight attendants who are exposed, for that matter, and say, look, let's take this unique flu season we haven't had in years and take a fresh look at our policies. and i think that this could be a win/win for them. they can show that they're being caring during these tough times. and gain loyalty in the future for these customers. let's face it. there's competition out there. people are watching what they do now.

    >> wow. you're sounding like a real customer. a customer-based idea. smart. thank you so much. and katherine andrus, thanks to you, too.

    >>> he's making a list and


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