Flying with an infectious disease in 2025: Do's and don'ts

On a recent flight from Charleston, South Carolina, to Newark, Sukrut Dwivedi noticed a passenger a few rows ahead of him coughing violently and uncontrollably.

"The man appeared feverish and kept reaching for tissues," said Dwivedi, a physician who works for ID Care, an infectious disease care provider. "I could see the passengers around him were very uncomfortable."

With flu season taking off, you might find yourself in a similar situation soon. Maybe someone seated near you looks sick. And maybe you're wondering what to do about it – or if you can do anything at all.

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I'm not going to mince words, folks: If you fly when you have an infectious disease, you win the award for the biggest jerk on the plane.

You're worse than the negligent parent with the toddler running free on the plane, worse than the honeymooners trying to join the Mile High club – worse, even than the whiny elite-level frequent flier in business class who calls the flight attendant "honey."

Your negligent actions could literally kill someone.

"Staying home could save the life of a baby, young child, or older person who is immunocompromised, is undergoing chemotherapy, or is not up to date on important vaccinations," said Robert Glatter, an emergency medicine physician who is also an editor at large at Medscape Emergency Medicine.

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Here's what Dwivedi did when he saw the sick passenger on his flight: He offered the coughing man a face mask, which he "gratefully accepted."

"The passenger confessed that he had been diagnosed with the flu the day before," he recalled. "But he felt compelled to travel for work."

With memories of COVID-19 fading, people like Dwivedi are concerned that too many passengers are flying with an infectious disease – perhaps more people than at any time since the pandemic.

Under current disability rules, airlines can only remove a customer if they present a "direct threat" to the safety of the passengers and crew. New government regulations, set to go into effect in April, will require airlines and ticket agents to issue non-expiring travel credits if passengers are restricted or prohibited from traveling because of a serious communicable disease. But that wouldn't stop someone like the Influenza Man from boarding his flight.

It's not always that simple

Reality check: Things can get complicated when you're traveling. For example, deciding to postpone a trip if you get sick before your flight may be a no-brainer. But what if you get sick when you're at your destination? And what if you don't have the resources to extend your hotel stay?

All the experts I spoke to seem to agree on this: If you think you might be contagious – even on your return journey – seek the advice of a medical professional. Sometimes, it might be fine to fly with a face mask, but ask a doctor and don't assume you're OK to fly.

There are two things you can do to avoid flying while sick. First, ensure that you have a travel insurance policy that covers you if you fall ill. "Insurance to cover hospital bills is essential," said John Gobbels, chief operating officer of air medical transport and travel security program Medjet. But insurance can also cover a hotel if you become ill or have your travel interrupted. (For more serious problems, you may need a more robust medical evacuation membership like Medjet.)

And you should also travel with a basic medical kit. It should include hand sanitizer, tissues, over-the-counter medications for common ailments, and a few disposable masks, according to Eugene Delaune, an ER physician and senior medical advisor to Allianz Partners. "Treating your symptoms not only helps you feel better but also reduces the risk of spreading the illness to others.”

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What should you do if you feel sick before your flight?

If you don't feel 100% before your flight, see a doctor, for goodness' sake.

“If you have any signs or symptoms of a possible contagious ailment, you should be tested prior to traveling," said Jeff Weinstein, the medical operations manager for Global Rescue. "It is impossible to tell the cause of your symptoms without the appropriate testing."

And if you are sick, ask your doctor to recommend your next steps.

"But if your doctor advises against travel, heed the advice," said Bob Bacheler, managing director of Flying Angels, a medical transportation service. (This is also important if you need to file a travel insurance claim.)

Bacheler said the best way to avoid the question of: "Am I OK to fly?" is to take all necessary precautions. He's taken the flu vaccine every year for the last 30 years, and he gets a COVID booster whenever it's available. He also takes sensible precautions when he flies, like avoiding crowds and not touching surfaces that might be contaminated (he travels with disinfectant wipes).

What should you do if you're seated next to a sick person on a flight?

If your seatmate looks unwell, I think you have a right to know if you're going to end up in the ER after the flight. So striking up a friendly conversation and maybe an "Are you feeling OK?" is a good idea.

Raymond Yorke, a spokesman for Redpoint Travel Protection, said Dwivedi had the right idea. During the peak of flu season, you should wear a mask on the plane – and bring extra ones. Hand sanitizer is a must, too. And share.

"Wearing a mask and practicing proper hand hygiene can help minimize the risk to others," he said. "This has become an expected practice post-pandemic."

But what if the passenger next to you won't talk to you and tells you to mind your own business? I've seen that as well. In that case, asking a flight attendant to move you might be the best solution. If the passenger is sneezing and wheezing uncontrollably, you may want to privately ask a crew member if they would consider removing the ill passenger. Remember, this person is a selfish moron for flying sick.

What's the solution to people flying while infected?

The solution to people getting infected on a plane isn't as simple as sick people refusing to fly. There will always be selfish knuckle-draggers who fly even when they could infect the entire plane.

The government took a necessary step by requiring airlines to issue flight vouchers to infected passengers starting this spring. But it's not enough. The only way more travelers would cancel their plans is if it didn't affect them financially. That's right – airlines would have to refund the entire ticket if passengers get a doctor's note.

Some forward-looking, compassionate airlines already quietly do this for passengers on a case-by-case basis. But it needs to become a formal policy so passengers can safely cancel their flights when they fall ill.

There's no telling how many lives this policy would help. But even if it saved just one person, wouldn't it be worth it?

Christopher Elliott is an author, consumer advocate, and journalist. He founded Elliott Advocacy, a nonprofit organization that helps solve consumer problems. He publishes Elliott Confidential, a travel newsletter, and the Elliott Report, a news site about customer service. If you need help with a consumer problem, you can reach him here or email him at chris@elliott.org.

This article originally appeared on USA TODAY: Airlines should offer refunds if you're sick before a flight