Coronavirus (COVID-19): Press Conference with Leonard Marcus, John Spengler, Edward Nardell, and Wendy Purcell, 02/11/21

You’re listening to a press conference from the Harvard School of Public Health with Leonard Marcus, founding co-director of the National Preparedness Leadership Initiative, a joint program of the Harvard School of Public Health and the Harvard Kennedy School. And John Spengler, the Akira Yamaguchi professor of Environmental Health and Human Habitation at the Harvard Chan School. And Edward Nardell, professor in the Department of Environmental, Health and Immunology and Infectious Diseases. And Wendy Purcell, research associate in the Department of Environmental Health at the Harvard Chan School. This call was recorded at 3:30 p.m. Eastern Time on Thursday, February 11th.


MODERATOR: Dr. Marcus, do you have any opening marks for us?

LEONARD MARCUS: Yes, Nicole, thank you very much and thanks to all of you for joining us today. So today we’re releasing the phase two report of the Aviation Public Health Initiative, assessment of risks of SARS-CoV-2 transmission during air travel and non-pharmaceutical interventions to reduce risk. This curb-to-curb travel through airports report examines disease transmission through the point of airport arrival, through check in and security and out to the plane. And on the other side, baggage claim and exit at your destination airport. This report complements our Phase one report that was issued in October 2020, the gate-to-gate report that examined the risks of disease transmission on board our aircraft. Both these reports can be found on the Harvard School of Public Health Aviation Public Health Initiative website. The project grew out of conversations three months into the COVID-19 crisis. I co-direct the National Preparedness Leadership Initiative and we research leaders in times of crisis. We have engaged with leaders in government and in the private sector who’ve been at the vanguard of the COVID-19 response. In the course of those conversations, we spoke with leaders of the COVID response in the aviation industry. We learned of their interest in developing an independent source for research and recommendations regarding the risks of disease transmission in the aviation environment. A team of world-renowned experts were assembled here at the Harvard School of Public Health, and the work began in July 2020. The research was funded by the aviation industry. Understanding the questions that would arrive, we negotiated an arrangement that provided us an independence in conducting our research and reaching our findings. Very importantly, the arrangement offered opportunities to work directly with the airlines, with manufacturers and with airport operators who are eager and ready to share with us the work they were doing regarding risk reduction and efforts to extend that work and the public health safety of the workforce and air travelers.

We also reached out to government agencies and aviation associations to engage in this research that they were conducting that would inform the work of our team. The team here is by intent and interdisciplinary group of scientists combining work in infectious disease, environmental health, epidemiology, social science and engineering. As is now the case, our frequent meetings and consultations to share data and refine our research were conducted over Zoom. With the exception of two airport field visits, many on the team have not met once and one another in person over the course of the project. We thank airlines for America for their support of the project. A4A gathered a consortium of manufacturers, airlines, airports, aviation associations and government agencies who together participated in the data collection and dissemination of report findings. We thank all of them for their active participation and encouragement of this work. Following our key messages to take from this report. As efforts to overcome the covid-19 crisis continue, there are risks of any activity in public spaces. We have found that the aviation industry has been applying its scientific and engineering prowess to explore and implement measures that reduce that risk as will be discussed by my colleagues. For people who need to fly, the combination of measures in the layered approach detailed as non-pharmaceutical interventions do significantly reduce risks. And of course, that combination includes the wearing of masks now, required by federal law. Take this strong message from the report. If you decide to fly, take responsibility for your health by wearing face masks to according to recent recommendations, maintain distance from others, maintain hygiene throughout your trip, and if you must eat or drink, do so quickly from under your mask and pay attention to what you can do to reduce your risks of acquiring or transmitting the disease. To be clear, we are not saying that it is safe to fly. There are risks and actions to reduce those risks. It’s important to remember that the status of the COVID-19 pandemic is changing and with that, scientific recommendations will continue to adjust in light of emerging evidence in this crisis. So as more is known, we encourage the industry, its workforce and air travelers to continue following the science in both the short term and the long term. The resilience of our society, the economy and the aviation industry will require that we that all of us together stop community spread of SARS-CoV-2, and with it, stop the prolongation of this crisis and with that, it’s my pleasure to introduce to you Dr. Jack Spengler.

JACK SPENGLER: Thank you, Dr. Marcus. And good afternoon, all. Reflecting on this phase 2 report and the distinction between phase one, gate to gate aircraft, similar function, very similar designs. So this engine and the machine, we could understand it, the ventilation system, we could understand the distribution of aerosols. We could understand then hence the risk. Think of airports, though. Airports have similar function. We’ve all been to airports, but they have very different designs. We have four hundred and fifty so-called primary airports in the United States. And these are airports defined as serving more than ten thousand passengers per year. And they range from the small regional hubs to the large or small regional terminal single airports to large international hubs, the largest of which in the United States is Atlanta. Before COVID, 50 million in planes a year or coming through that airport. And we were told by airport management that this past November 2020 during holiday season at Thanksgiving, they were at one hundred thousand passengers a day. That’s a third of their normal peak holiday season traffic. So as we took a look at airports, we say to some degree there’s a great advantage of airports. Most of them are large volume spaces, connected airways from entrance lobbies through security to concourse. These are all open spaces. So to some degree, individual passengers can choose their pathways. But yet we know we contact things. We know we contact when we depart to receive a ticket or get a baggage stub. We know we come face to face with counter people. We come face to face with security people. And there are times where there’s large volume now isn’t so large. We’re more constrained in space around gates, around baggage handling, busy times during security, going through security lines. So we’ve come to approach this by saying we’ve got to understand the potential of airports to implement good cleaning practices, disinfection practices, implement the layered approaches, reinforcing masking, reinforcing distancing. But what do they do during the times where there’s inevitably some crowding? Because it will occur, and it will occur more often as the traveling public comes back. And with an uptick, we’ll see what we have all experienced in the past, queuing around gates as we are anxious to board, piling up around the luggage racks and so forth. We couldn’t possibly model and assess every airport out there. So we took a generic approach to this. We took design specifications from standard operating guidelines and we applied our models that looked at a well-mixed environment, modified that for what you do in close proximity. Why just well mixed estimates aren’t sufficient to really understand the close proximity conditions and apply those models under different ventilation conditions, different ceiling heights, different densities, different durations that people might be in those environments to look at the risk implication for transmission. We extended that analysis to look at the transport systems, the ground transport systems that service airports. These are the shuttle busses. These are the trams that take us to the gates or take us between terminals or even those busses that we like to crowd into. They take us from the gate to the plane and plane back to the gate. Some of those capacities are one hundred people could be on those kinds of conveniences. So we wanted to really understand how an airport operators could manage ventilation, distancing duration and density to come up with achievable solutions. To keep the risk as low as possible. Now, I want to share some of this time with Professor Wendy Purcell, scholar with us here at Harvard that worked on this project and had a particular role among many, but one was to really inquire into the practices that airport operators were doing. Wendy?

WENDY PURCELL: Thanks so much, Jack. Yes, indeed. I think the first thing I wanted to say was just to express collectively our sincere thanks to all the airports that participated in our study. They actually invested a huge amount of time in completing what was a very comprehensive questionnaire. We had follow-up interviews with them. They shared their materials, practices, ideas, their concerns with us. And I think given all the other very pressing demands on their time, they were very generous. And so the extremely valuable insights that they shared with us have informed our research findings and indeed our recommendations. So I wanted to give everyone a sense of the volume of materials that we actually looked at. We reviewed around fifteen hundred pages of completed questionnaires, supplementary materials. We looked at five full COVID playbooks. We actually surveyed twenty-three airports in the US, two outside the US. We interviewed managers of six US airports and we actually, as you mentioned at the top, Lenny, went to two US airports for field visits. We also interviewed representatives of the Transportation Security Administration, TSA, the US Customs and Border Protection. We spoke with associations that represent the airport industry, specialists in virus testing, in ventilation systems, in indoor chemistry that relates to cleaning and disinfection, and we spoke with some airport architects as well. And so our aim really was to learn about the current practices related to the mitigation of SARS-CoV-2 transmission in airports and actually to gain some insights into the potential future innovations. So our sample of US airports reflects different areas of the country, different airport sizes with international and domestic facilities. And so we know that no two airports are the same. But we believe that this sample offers a substantive basis upon which to assess airport pandemic practices and provide recommendations that are relevant to reducing the risk of SARS-CoV-2 transmission.

So we sent our survey out in October 2020 and we took returns up through to the 21st of December. And we had a completion rate of 88.5% percent, with respect to the US airports. I think that gives you a real insight into their engagement with this project. So maybe just to give you some of our findings, the airports in this study are making concerted efforts to reduce the risk of SARS-CoV-2 transmission in the airport environment as it relates to this curb-to-curb traveler experience. They’re employing a whole range of different risk mitigation strategies for passengers, for employees, for their concessionaires, the contractors and visitors. And typically, these interventions fit with what we know about how the virus spreads. And they include enhanced cleaning and disinfection upgrades to ventilation and air handling means to encourage physical distancing and promoting the compliance with this critical face coverings and masks and actually using technology to support contactless procedures in certain circumstances. And collectively, these efforts are playing an important role in providing, as you mentioned, these layers of protection for risk mitigation that we think will restore traveler confidence.

So just to give you an insight, one of our airports talks about installing two miles of physical barriers, adding around 5,000 different floor decals and signs, about 500 hand sanitizer stations, they make announcements in two different languages every 10 to 15 minutes, they enhance their cleaning and disinfection regimes and they’ve reviewed and upgraded their ventilation and air handling. We also saw that innovation was strong, particularly in the adoption of contactless technologies. In fact, one of the airports mentioned it be almost possible to go curb to curb entirely contactless. So overall, what we saw were these airport mitigation strategies that showed a substantive grasp of the SARS-CoV-2 transmission with the interventions that they designed to reduce the spread by all known routes. They did have some concerns. The concerns, I think the top one, was the absence of a consistent and clear set of protocols across the industry and between local destination origin jurisdictions. They worried about maintaining physical distance, saying when passenger numbers go back up to pre-COVID levels and they had some concerns around tenant compliance with protocols and also a risk for employees outside work. One example that I want to raise really was one where the airport restaurants in some states were required to close to offer seated dining, and that’s even if they were properly spaced. And that was because of local or state rules. The airports therefore having to only allow food pick-up and delivery. But the unintended consequence of this policy meant that there was congestion then engaged in seated areas, mixing up passengers who’d unmask to eat or drink with those who were masked. I think this is an example of where one precautionary measure could potentially exacerbate overall risk. And so the airports were lobbying states to change these policies and the science would absolutely support their efforts. So despite the very complex conditions in which the operating, airports in this study made timely science based decisions to manage the COVID threat by adopting a layered approach to risk mitigation, we saw good and best practices across the industry and we saw this call for greater harmonization that will help them make focused investments and this consistency, then helping to support public confidence. So I want to say thank you to all those airports and they’ll hand over to my colleague, Professor Ed Nardell.

ED NARDELL: Thank you. Are we taking questions or making comments here?

JACK SPENGLER: Well, you joined late. You can make a few opening remarks, or we could have you ready for questions, but why don’t you share your involvement in the program, your background, and why it was so important to have this diverse set of disciplines involved?

ED NARDELL: Thank you, Jack. I may add, my name is Edward Nardell, I’m a physician. For some 30 years or more, I’ve been involved in airborne transmission of infectious agents, tuberculosis in particular. But more recently, obviously, COVID. I’ve also been involved in influenza transmission, have done a lot of fairly basic research on airborne transmission and mitigation strategies. So I’ve been involved in both phases of this project, on the airline, on the aircraft component and now on the on the airport component. And in particular, I am interested in the nature of transmission of the SARS-CoV-2 virus and also on various aspects of the architecture and engineering approaches to mitigation.

JACK SPENGLER: Back to you, Lenny.

MODERATOR: Actually, I can take it over for you for a little bit. Thank you all for your comments. The first question.

Q: Thank you so much for being here today. I really appreciate it. And I have a question about a test mandate. Given your research, what are your thoughts on having a test mandate for flying? I know the CDC is considering it, but do you think it is necessary?

LEONARD MARCUS: As you may know, if you’ve been following people here at the Harvard T.H. Chan School of Public Health, Michael Mina has been talking about creating tests that people can use at home, very reliable and efficacious, very, very low cost of the dollar to 50 cents rate so that people before they go to work, before they go to school, before they leave their home, they can take a test. The aspiration is that those tests will be available. The technology and the approval, the cost structure for those tests is not yet fully in place. And we are hoping that the tests will be available at that level in the near future. We’re not going to comment on the policy itself. However, from an aspiration perspective, eventually, yes, there has to be more widespread testing and something that we can be doing from our home very easily would be a big plus.

MODERATOR: Did you have a follow up?

Q: No, that was great. Thank you so much.

MODERATOR: Next question.

Q: Hi, all of you. Thank you for doing this today. I’m curious. I think you all said when we’re looking at the interior of the aircraft that it was a safer environment than being in a grocery store, in a bar or restaurant. And I’m curious if you could compare the general airport environment to that? Is it safer than a grocery store? Is it safer than being in a bar or restaurant?

JACK SPENGLER: So I just was the grocery store last night, so I was looking around and I thought, gee, these aisles go almost to the ceiling and block the airflow. If there’s good airflow that is trying to ventilate and mix down. And think of the comparison to airports, big open spaces. And if the ventilation system is designed right, it is forcing that conditioned air into that occupied zone without many obstructions. So, in fact, just on the sort of physical architecture, it is designed to probably be better for dilution, dispersion and removal of a plume that might have contaminated aerosols in it. Right. So from that point of view, without making the specific calculated comparison, we have I think the intuitive impression that it certainly would be certainly very different design than we find in in the shopping things. But the difference is you, as you well know, we find ourselves in congested areas, not just in line to check out where we still can have some spacing in a grocery store, but queuing around gates, killing around luggage carousels. You don’t have to, but oftentimes we do get close to each other and that’s where we really focused our attention. You need to really be assured that your ventilation system is delivering COVID-free air in those places at high enough quantities to dilute the possibility of any transmission, reduce it. And so we offer a guidelines to airport operators of how they should go out and make their own assessments. First, starting with a good audit of their ventilation system. Is it really performing? Many of these things get out of whack over time. Are they really performing? And then do they provide enough ventilation in those specific areas when people are there? In other settings, we’ve recommended for classrooms enhancing that air exchange up to four to six air changes per hour and keep some distance. And you’re in your really OK, under those circumstances, so long as people are wearing masks. That’s a caveat that you really want to maintain the reduction of the source term, because if you don’t, you still could be in the plume of someone who’s infectious. Long winded answer. But I think that’s as far as I think our comparisons can go at this time.

LEONARD MARCUS: Thank you for the question. And, Jack, I wonder if you could just give that what we found regarding canyons?

JACK SPENGLER: Yes. So as Wendy was saying, our conversations with airport management was very helpful because they were telling us that vendors were promoting devices to be installed in their air ducts, disinfection devices. They also were being promoted, these Plexiglas glass barriers that not only would go on a desk separating the counter people from customers but lining the queues that we would have to follow. So imagine yourself in a plastic canyon. And if that is not designed properly, it could be just like the aisles of a grocery store. Right. Breaking up that airflow. And if you have reduced dilution where people are, that’s where you have the higher risk. So we actually did with the help of our colleagues at the University of Maryland, Jelena Srebric, who is an expert in mechanical engineering but an expert in computational fluid dynamic modeling. And she could demonstrate the fact that you would have a higher exposure in those plastic canyons than you would have in an open space with a good ventilation system. So it’s counterintuitive. You might be separating people from droplets which mask already do, but you’re not necessarily improving dilution.

Q: Just to follow up briefly, it does seem from what you’re saying, that the places that we gather in an airport are not the big open spaces of the of the terminal, but around the baggage carousel where the ceilings are lower and people are crowding to try to see whether their comes up so they can get out of there quick or at the gate area where you can’t hear the announcements if you’re far away from when your flight might be boarding and when your roll is called that sort of thing. So the design of airports might be good for some space, but what can you also say that some of the practices that they carry out at the airports, although I have to say I flown in quite a while, but there are counterintuitive to try to protect people from the virus?

JACK SPENGLER: Well, of course, that wasn’t delivered by design. It was designed for a different purpose. But now you’re very right. In the time of COVID, we have to look at these spaces anew. And we in our discussions, one we’ve heard airport say this is why we want the technology to let people be spread out around a gate and notify on their cell phones, on their iPhones. It’s your time to board. So there are some more experimental airports are actually working on such systems, but it’s by design, both the Customs and Border Patrol TSA areas, they do have lower ceilings than most of other concourses lobbies in the airport, and that’s for security reasons to have cameras installed in the ceiling. So it’s those spaces that caught our attention and we applied our models to those spaces and we offer remedies for airports to consider. You can bring in supplemental air cleaning systems like we recommend for school classrooms in case you can induce more mixing, mechanical mixing in the system. Ed Nardell is an expert on ultraviolet germicide ultraviolet lamp structures. And those could be installed in these. That effectively would enhance the air cleaning. So there are solutions to these and we’re just saying be mindful of them and consider them, should your ventilation system not support the five, six air changes per hour when you need it.

MODERATOR: Do you have a comment you’d like to make?

ED NARDELL: I do. Relevant to the question asked, Jack mentioned quickly the need for the mask wearing. And, you know, one of the key parts of both of our reports is the multilayered approach. And the reason for that, particularly in airports, is because it of a mask removal in places where eating and drinking goes on. And that could be in the food court areas, but it also could be at the, you know, the boarding areas as well. And in all those areas, suddenly you’re losing one of the most important layers that we have. So then you become more dependent on the on the ventilation system, for example. And in that way, you mentioned restaurants and you mentioned a grocery store as well. People don’t take their masks off in grocery stores, but they do in restaurants. So what we have in an airport is a combination of a variety of different settings, much larger spaces, as we discussed, but also a variety of activities.

LEONARD MARCUS: And could you share your recommendations on if you need to eat or drink, what you ought to be doing in an airport or an aircraft cabin? I think that’s important.

ED NARDELL: Yeah. If everyone takes their masks off at the same time when food is passed around, then we’re all kind of vulnerable. And ideally, one would remove masks randomly so that only a few people or some portion of the population have their mask off at any one time. That probably happens to some degree in the airport, but on the airline, sort of on the airplane, rather, eating is more orchestrated and can be, especially on long flights and therefore a greater risk. Ideally, if I’m eating, I would hope people around me or have their masks on. And if somebody else is eating, I hope I have my mask on. If I’m nearby, then no one has been willing to try and actually formally orchestrate that. And I imagine it would be very difficult to do. But that is the concept is that the mask removal should be minimized and to some degree randomized, if that’s possible.

WENDY PURCELL: Just to point to the report as well, in the in the sort of layered approach, I think we’ve been very clear that all of the models that we’ve used to look at risk mitigation in different parts of the airport, whether it’s check-in or the shuttle or, as you said, the dining spaces. We’ve been able to show how you can adjust and tailor those different layers to the particular physical space density, the time you expect people. So all of those models are included in the report. So every facility manager can go and plug in their particular dimensions. You know, they can play with the density, they can play with things like the duration and come up with a solution which will mitigate risk by adjusting the layers to that particular circumstances. So I think that’s one of the real strengths of the layered approach is that you can adjust in accord to the particular dimensions and circumstances of your airport terminal.

MODERATOR: Are you all set?

Q: I think so.

MODERATOR: Next question.

Q: Hi, everybody. Nice to see you. Sense as you go around the country, there are a variety of different mask mandates in different states. What if you could talk a little bit about how airports are? Are they independent of what the state is doing with the mask mandate? Or does every airport basically have the same rules regarding mandates?

LEONARD MARCUS: A week ago Monday, different states and different local areas had different rules regarding masks. As of a week ago Monday, the federal government requires masks on all public transportation, including busses and trains and airports and airlines. So right now there is a federal mask mandate. And at least on paper, just like you have to wear your seatbelt, you have to wear your mask.

JACK SPENGLER: Can I prompt Wendy to respond to that, because the inquiries for many airports, this goes back a couple of months now, showed how they, regardless of what the national policy was or the state policy, they were pretty consistent, wouldn’t you say, Wendy?

WENDY PURCELL: Yeah, I mean, I think in the absence of that kind of national mandate, they really did move early into saying that we mandate mask wearing, particularly for the employees. They were very quick off the mark there. And I think then they moved into that that broader across our airport. Part of our collective responsibility is to keep you safe. So they put up lots of signage, physical signage, as well as announcements. And then a couple of the airports did some really interesting things. One of them established an ambassador’s scheme. So they have some of their staff, you know, kind of promoting mask wearing compliance by having these ambassadors that were supporting people to do the right thing and pull the mask off if it was slipped below the nose and so on. A couple of them have what they called wellbeing champions that were going out and sort of supporting. So I think as Jack said, they moved to say mask wearing is important before the national mandate and they were actually doing a lot of work to support compliance of mask wearing because it is a critical layer, I think, as Lenny said it right at the top.

LEONARD MARCUS: And we have to acknowledge one limitation because of COVID, we couldn’t go out and survey airports because we weren’t traveling. So we ask every family member friend who goes to an airport, so what did you see? And we have to acknowledge that it is a mixed bag from one part of the country to another. And we’re hoping the federal requirement will get us to the point where there’s more uniformity when it comes to mastering in the aviation system.

Q: How vulnerable is your study and its findings to the spread of a variant that might be 40 percent more infectious? It sounds like you’re giving airports fairly high marks for doing whatever they can in a risky situation, not recommending that people travel, nonetheless. But how might that change in March when the U.K. variant becomes if, as expected, it does become the dominant strain in the United States?


JACK SPENGLER: So I’m going to ask Ed to chime in on this, too, but, you know, it’s very likely, as we understand it, talking to our medical experts that the variant has been here a while already. But I think the good news is, particularly with the very recent implication of the barrier, that good mask fit well fitted mask. And if it takes two to make it fit, well, well fitted mask reduces that exposure substantially. And if people aren’t singing, shouting, yelling, putting out volumes, more of viral loads, that even that admission terms come way down. So all of these things work to keeping the system safe. Let’s put it that way. Or rephrase it, keeping risk of transmission low, particularly as community rates come down as well. Ed, something to add to that?

ED NARDELL: Yeah, you know, I think, as you know, we’ve all heard people like Mike Osterholm, who’s on the president’s task force, are describing a tsunami of potential risk offshore, just as we’re seeing the rates go down. And when that tsunami hit, UK rates doubled. So there certainly is a risk of increasing cases due to the variant. At the same time, as we know, we’re rolling out vaccine as rapidly as possible. I happen to get my second dose today. And we all know more and more people who have been vaccinated. Not enough, of course, and not fast enough, but it’s happening. So it is a bit of a race between the introduction of variants and the introduction of vaccine. And if we’re fortunate and we get the vaccine rolled out very quickly, at least the hope is that we can keep the numbers going down and that certainly won’t impact our recommendations much. And indeed, any small increases would not much impact our recommendations either. And I think what will impact our recommendations are on the positive side, particularly if we see lower and lower test rates in the coming months as more and more vaccine roll out.

Q: Thank you.

MODERATOR: Next question.

Q: Thanks very much for taking my call. My question also has to do with testing. I know you said you’re not going to comment on the proposals for domestic testing, but my read of your report, I mean, I read as much as I could. You guys come out pretty strongly in favor of the benefits of preflight antigen testing, at one point calling that it could serve a critical need. So is that a correct read, number one? Number two, care to handicap the odds at all of any kind of domestic testing requirement coming into place? And three, given the sponsorship of your study, did the airlines know that there was going to be a big heavy section on viral testing since they’re so vehemently against it? And did you present these findings to them and did you get any pushback? Thank you.

LEONARD MARCUS: Thank you for the question. Yes, I mean, as I said earlier, from an aspirational perspective, we think it would be a plus to see testing across the board, including for businesses for going to school. It’s right now aspirational. The reason we’re not making a policy statement is we don’t want to make a policy statement when the technology and the capability isn’t yet in place. The aviation industry did see the report before we put it out and our conclusions in the report, our own. Yes, there was discussion about testing, but you can see in the report that we come out in favor of testing in general. We’re not coming up with a policy recommendation because we simply don’t feel that the capabilities right now are in place that would make it inexpensive, very, very efficient, very, very reliable. We have actually been talking about this now for months with our colleague Michael Mina. And of course, Michael has been very outspoken about the need for this. And we would agree with him that this is a direction that we need to go. And I don’t know if any of our colleagues want to comment on that.

JACK SPENGLER: That’s well said. I mean, the implementation is we can’t begin to speak to implementation and to do this in any particular setting a school, setting, airlines and airports, offices, think of the logistics, the legal implications, the privacy sequestering of a positive person. These are complicated issues. And we weren’t in a position to address all of the complications.

ED NARDELL: I think some airlines are actually piloting limited amounts of preflight testing. And I know I feel much more comfortable, particularly in a long flight. If I had some assurance that no one on that flight is carrying detectable virus at the time you take off. But there are enormous logistics. It can be done at a small scale. The question is, what would it take to do it on a large scale? And that’s where we get into the unknowns from our perspective.

MODERATOR: Do you have any follow up questions?

Q: No. Thank you very much, I appreciate it.

MODERATOR: Next question.

Q: Thanks, Nicole, and thanks, everyone, for taking questions. I just wanted to say that on the comment on food and randomizing sort of eating and taking off masks, I’ve thought about that because I’ve even heard of individuals who will purposely eat the entire way through a plane ride, I see Wendy’s nodding, to avoid wearing a mask. So I don’t know if there is a way around that. Is there any way to enforce a time limit? I guess the answer is probably going to be that that’s something that the agencies and the regulatory bodies have to deal with, correct?

ED NARDELL: If I were making calls, and I’m not, I would say that reasonably short flights, with exceptions for people who absolutely have to eat diabetics or whatever, that really one should minimize removal for eating and drinking and certainly curtail that kind of behavior where people use eating and drinking as a way to not wear a mask. But, you know, the problem is that until we have federal regulations, which we do now have in part, they don’t say, you know, you have to wear it continuously. But you put the poor airline attendants in the position of being the policemen. And they really need the help of regulations to be able to turn to those regulations and not have to do battle on their own.

WENDY PURCELL: This was this was one of the areas where I think having that dialog with the airports operators themselves really gave us some insights into the way they were showing us pictures of these very large, very well ventilated, physically spaced dining areas, which they have to close off because of local and state mandate, which we understood, but forcing people that into these kinds of gated areas. And I think in our in our report, we talk about strongly discouraging eating. Both congested spaces and to support the science, the science would support the opportunity to unmask in those well-ventilated restaurant areas. So it’s a really interesting perspective, I think, from practice and then how that comes in as a this is what we’re seeing in practice. What does the science tell us that would help? I think it was a very interesting insight from the airports themselves.

LEONARD MARCUS: And if you want to just understand the dynamics of those of us who are on this call, we discussed this and the difficulty of how could you create a policy? Do you get five minutes per hour for a drink from a bottle? You get ten minutes? And we couldn’t come up with a policy. It’s very difficult to do. The other thing is that all of us in this project get many calls from family, friends, colleagues. I’m about to take a flight, what do you suggest? For family and friends, we say eat and eat as little as possible. Keep your mask on. Go underneath your mask. Our recommendations on a personal level, this isn’t policy, is to keep it to an absolute minimum, make sure that look around if going to take a drink or eat something under your mask, make sure that nobody around you have got the mask off. And that’s what we’ve been recommending to all of our family and friends. And to the public.

Q: Makes sense. So looking through some of the some of the findings and the recommendations, do you anticipate continued sort of limited travel in looking at this or are you looking at a full pre- pandemic return to normal in terms of that kind of a crowd at smaller and larger airports?

LEONARD MARCUS: It’s difficult right now to predict what the pandemic will look like in the future when it’s going to look different. However, one of our recommendations is that the aviation industry, as well as all of society, always consider the possibility that we could see another pandemic like this and that we ought to be prepared for that possibility and then follow the science. As Ed said, we’re right now in the midst of the vaccination program. We’re in a race against the variants. It’s hard to predict. However, some of these practices that we’ve seen here are wise to continue so that we don’t find ourselves in another pandemic and that what we don’t end these recommendations and these restrictions until this pandemic is truly behind us. I don’t know if you want to jump in on that.

ED NARDELL: No, I think that’s right, and I think structurally, for example, we ought to be thinking about wherever eating is going on. Well, of course, that we have adequate ventilation. We’ve never really thought about that as a society. In the past it’s been not been a factor, but I think it needs to be in the future. There are, as Jack mentioned, germicidal UV. I think it has a lot to offer for spaces where it’s difficult to generate large amounts of ventilation, but you can do it equivalent to ventilation with germicidal UV. And I think these interventions will be with us for a while. I hope we don’t have to wear masks for the indefinite future because it really you know, it interferes with our communication, among other things, expression, facial expressions, certainly dealing with children. So hopefully that will pass as vaccination reaches the levels that it needs to be. But I think some of the other things we need to think more about, you know, how can we avoid crowding in general? You know, this isn’t the first infection we’ve complained about on track with travel. We’ve always complained about going on trips and coming back with colds. If you’ll notice and I can speak for myself and I’ve asked a lot of people, not very many people are getting colds at the moment, there’s been very little flu and not very many people are getting colds. Maybe if you have little kids, you you’re still getting colds. But basically, the same things that we’re doing prevent a lot of respiratory infection.

LEONARD MARCUS: And the other things will probably not be having birthday parties with somebody blowing out candles before people eat it. They’re going to be a lot of things that we can anticipate will change on the other side of this crisis.

Q: Fair enough, thanks so much.


WENDY PURCELL: I was going to say one of the things that’s accelerated by the crisis has been this adoption of digital technologies. We’ve seen, you know, Jack mentioned the kind of apps for the cueing or ordering food, but we’ve seen a real impetus. They were already doing some of it before. But there’s been a real push around digital innovation in the airports, and we saw a lot of that.

ED NARDELL: And there may be less flying as we have adapted to online meetings, and not everybody has to be in person at a convention. And likewise, you know, it may take a long while for people to get comfortable with getting back to a full vacation, traveling even.

MODERATOR: Next question.

Q: Hi all, thank you for doing this, I’m curious, you mentioned the federal mask mandate. Do you see a role for additional federal action in regard to sort of airports, air travel?

LEONARD MARCUS: And that’s a good question. I mean, we right now, we’re focused on what’s in the report and we were true believers in the mask mandate. One of the big questions right now is requirements regarding tests, that question we’ve already addressed. I don’t know if any of my colleagues have ideas.

JACK SPENGLER: Interesting question. Let me look at the opposite side of this thing is because we’ve already we recognized it ourselves and put it in our report. And sure enough, we’ve seen CDC guidance on this. Airports have been besieged by vendors selling equipment to install in air ducts, dry hydrogen peroxide, bipolar ionization. Some of these machines put out ozone. And ozone is a very effective disinfectant. But we really don’t want this in our indoor spaces, one for the irritation effect on us and the chemistry that it can drive. And we recognized it is by looking at the literature supported by CDC. Maybe they should be stronger and saying, listen, until you have the efficacy, until we really know whether there’s transmission through mechanical systems, not person to person in a big room or close to each other, but through the returned air ducts, that evidence does not exist. True for measles. Right? And Ed, true for TB, but not so far for SARS. So there may be some good some thou shall not recommendations that come out of the federal government that would help give guidance to these airport operators that they don’t need to install these things. My gosh, they’re doing a lot with disinfection now. And so the question is, what more do they get from these additional methods?

LEONARD MARCUS: Another answer to the question is we recommended in our first report the gate to gate report, that ventilation systems be on when the plane is at the gate, when the plane is on the ground, when the plane is deicing. That recommendation was taken on by the airline operators here in the United States. And they’re now, we’re told, all running their ventilation systems while the planes are on the ground. So they’ve adopted that on a voluntary basis.

Q: I had one other follow up, which is, you know, we’ve talked a lot about what the government can do, what airlines can do, and I think you touched on this in both reports. But it seems like a lot of this is also on the individual right. You can take all the steps. Airports can do all the mitigation, but it’s the guy next to you or the woman next to you is refusing to comply, I guess that’s a hard one, because how do you make everyone behave?

LEONARD MARCUS: Well, the airlines did in the summer implement a face mask policy, and this was very difficult. We interviewed flight attendants. It was very difficult for them because there were people who were refusing to wear face masks and there is some bad behavior on planes. And so the airlines adopted a policy that you would get one warning, a second warning, and that that third warning would be given either a yellow slip or you would be put on a no fly list for the duration of the COVID crisis. So the airlines have taken this very seriously. A, they want to protect their workforce. They want to protect other passengers. They want to make sure that people, when they look around, have confidence in the state, in the public health, safety of being on board an aircraft. So they’ve taken the face mask policy very seriously. The industry was in support of that face mask policy because they believed that it would encourage further compliance with those policies. We can’t emphasize enough if you want to fly, there are many things that you can do to keep yourself safe, to reduce your own risks, including if you see a lot of people gathered around a gate, just stand back a little bit, keep yourself distance, be vigilant that you don’t find yourself in a crowd. And right now, because the volume is not extensive, there are ways in which you can keep your physical distance from other people, and that’s a big piece of this as well. I don’t know, Wendy you heard more about this.

WENDY PURCELL: Now, I just think just to tie up those two things, there definitely was a call across the industry for consistency, for harmonization, just to make it easier for the airports to know where to best invest at the risk reduction that is available, but also from the passenger’s side just to make it and to know from going from one airport to the next airport that, you know, what’s expected of you just makes it easier to comply. And one of the things that I think the airport associations and industry groups, so there was a lot of sharing going on there about what they were doing, what was working, investing in educating their staff, educating each other. So I think there’s definitely a sort of an appetite, if you like, for greater harmonization and consistency. It’s all to the good for the traveling passenger makes it easier. But also, I think it makes it easier for the industry to know where to best invest in terms of the different opportunities that they have to reduce risk. So I think there’s definitely an appetite that.

Q: Thank you.

MODERATOR: It looks like that’s our last question, and it is also 4:30. Would you like to wrap up the call or a couple of words?

LEONARD MARCUS: I just want to thank you again. And if there are any ways that we can answer at any of your other questions, you can find us at the Harvard School of Public Health and happy to answer any questions you might have. Jack, anything else you’d like to say?

JACK SPENGLER: No, I think these are very good, insightful, challenging questions in many cases. And I think that’s good. I think that these are challenging times, and we need to be guided properly and have the press provide a conduit for the science to the public is really helpful.

LEONARD MARCUS: Thank you. Wendy?

WENDY PURCELL: No, I think it’s been great and as Jack said, just that public engagement, translation of the signs out into the public is very grateful.


ED NARDELL: I would just say that, you know, we’ve come a long way, there’s a light at the end of the tunnel, but we still have to keep the mask on for a while.

LEONARD MARCUS: Thank you. Well said. Nicole, thank you. And thanks to all of you.

This concludes the February 11th press conference.

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