Updated Guidance for Airlines and Airline Crew: Coronavirus Disease 2019 (COVID-19)

Updated May 25, 2021

Summary of Recent Changes

This document was updated May 25, 2021, as follows:

Key Points

  • This document provides interim recommendations for the airline industry about Coronavirus Disease 2019 (COVID-19).
  • CDC reminds air carriers of the requirement under Title 42 Code of Federal Regulations (CFR) section 71.21 to report to CDC ill travelers who have certain signs and symptoms during flight, and all deaths onboard, before arrival in the United States.
  • This document also contains recommendations for managing ill travelers onboard if COVID-19 infection is suspected.
  • All passengers and crew are required to wear masks at all times while on public conveyances entering, traveling within, or departing the United States, and in U.S. transportation hubs, as per CDC Order effective February 2, 2021.
  • Pre-departure SARS-CoV-2 testing or documentation of recovery from COVID-19 is required for air passengers traveling into the United States from a foreign country regardless of vaccination status, consistent with CDC guidelines for International Travel During COVID-19, as per CDC Order effective January 26, 2021. 

Situation summary

Travel increases a person’s risk of getting and spreading COVID-19 by bringing people in close contact with others, often for prolonged periods, and exposing them to frequently touched surfaces. Air travel often requires spending time in security lines and busy airport terminals where staying 6 feet away from others may be challenging. Staying 6 feet away from others may also be difficult on airplanes. People may not be able to distance themselves by the recommended 6 feet from other people seated nearby or from those standing in or passing through the aisles.

Information about CDC’s Order on wearing of masks on U.S. transportation and in transportation hubs

CDC issued an Order, effective February 2, 2021 requiring the wearing of masks by travelers (both passengers and crew) on public conveyances to prevent the spread of COVID-19. Conveyance operators must require all persons onboard to wear masks when boarding, disembarking, and for the duration of travel. Operators of transportation hubs must require all people to wear a mask when entering or on the premises of a transportation hub.

This Order must be followed by all passengers on public conveyances, including airplanes, traveling into, within, or out of the United States, as well as crew and other workers involved in the operation of aircraft, and all people entering or located in transportation hubs, including airports. This Order includes certain limited exemptions.

Summary of CDC Order requiring pre-departure testing of international air passengers to the United States

CDC issued an Order, effective January 26, 2021, requiring all passengers flying from a foreign country into the United States to provide either (1) proof of a negative SARS-CoV-2 test, with specimen collected no more than 3 days prior to the flight’s departure, or (2) documentation of recovery from COVID-19 in the form of a positive viral test result during the past 90 days prior to the flight and a letter from a licensed health care provider or public health official stating the passenger has been cleared for travel. The Order includes limited exemptions, including for crew members of airlines or other aircraft operators. CDC has developed a checklist to help airlines and aircraft operators verify passengers’ COVID-19 status before they board flights to the United States.  

Ill Travelers Identified during Flight

In accordance with CDC’s interstate and foreign quarantine regulations [42 CFR 70.11 and 71.21], airlines must report travelers with the following symptoms to CDC:

  • Fever (person feels warm to the touch, gives a history of feeling feverish, or has an actual measured temperature of 100.4°F [38° C] or higher) that has persisted for more than 48 hours
    OR
  • Fever of any duration AND one of the following:
    • persistent cough
    • difficulty breathing
    • appears obviously unwell

Report as soon as possible before arrival by one of the methods described in the Guidance for Air Travel Industry Reporting of Onboard Death or Illnesses to CDC.

Information for Airlines and Crew members

  1. CDC recommends the following measures for cabin crew to protect themselves and others, and manage a sick traveler:
    • Get a COVID-19 vaccine.
      • Crew members are encouraged to share their vaccination status with their employer’s occupations health program.
      • Airlines should keep records of crew members’ vaccination status.
    • Wear a mask that complies with requirements of the CDC Mask Order at all times except for brief periods when eating, drinking, or taking medications, or if experiencing difficulty breathing, or vomiting.
    • Practice routine handwashing.
      • Wash hands, particularly after assisting sick travelers or touching potentially contaminated body fluids or any surfaces; after coughing, sneezing, or blowing your nose; after using the restroom; and before preparing or serving food or beverages.
      • Wash hands with soap and water for at least 20 seconds. Use an alcohol-based hand rub that contains 60% alcohol if soap and water are not available.
      • Airlines should provide alcohol-based hand sanitizer to cabin and flight crews for their personal use.
    • Identify sick travelers with the reportable symptoms listed above and take the following precautions:
      • Minimize contact between passengers and cabin crew and the sick person. If possible, separate the sick person from others (by a distance of 6 feet or 2 meters) and designate one, preferably vaccinated, crew member to serve the sick person.
      • The sick person should continue to wear a mask unless they cannot tolerate it because of difficulty breathing or vomiting, or if wearing a mask interferes with necessary medical care such as supplemental oxygen administered via an oxygen mask. If a facemask cannot be tolerated, ask the sick person to cover their mouth and nose with tissues when coughing or sneezing.
      • Treat all body fluids (such as respiratory secretions, diarrhea, vomit, or blood) as infectious.
      • Wear disposable medical gloves when tending to a sick traveler or touching body fluids or potentially contaminated surfaces. Remove gloves carefully pdf icon[PDF – 1 page] to avoid contaminating yourself, then wash hands with soap and water for at least 20 seconds. If soap and water are not available, use alcohol-based hand sanitizer that contains at least 60% alcohol.
      • Use additional personal protective equipment in the Universal Precaution Kit pdf icon[PDF – 1 page]external icon: disposable surgical or medical mask, eye protection, and a gown to cover clothing, when tending to a sick traveler who has fever, persistent cough, or difficulty breathing.
      • Properly dispose of gloves and other disposable items that came in contact with the sick person or body fluids. Place contaminated items in biohazard bag or a secured plastic bag labeled as “biohazard.”
      • Clean and disinfect contaminated surfaces according to airline protocol, using products on the U.S. Environmental Protection Agency’s (EPA’s) List N: Disinfections for Coronavirus (COVID-19)external icon that are compatible for use inside aircraft.
      • After the flight’s arrival, CDC Quarantine Station staff may conduct a health assessment of the sick traveler’s symptoms and possible exposures. If necessary, CDC staff will coordinate transport to a health care facility for medical evaluation and testing. CDC will update the airline about the results of the testing and any need for follow-up of exposed crew members or passengers.
  2. CDC’s Infection Control Guidelines for Cabin Crew
  3. FAA-CDC Safety Alert for Operators (SAFO) 20009: Updated Interim Occupational Health and Safety Guidance for Air Carriers and Crews pdf icon[PDF – 10 page]external icon
    • This guidance document, jointly issued by CDC and the Federal Aviation Administration (FAA), provides COVID-19 occupational health and safety recommendations for air carriers and crewmembers.
    • The guidance includes recommended actions to reduce exposure to and transmission of SARS-CoV-2 infection among crew members, including recommendations for those who are fully vaccinated.1
  4. Runway to Recovery: The United States Framework for Airlines and Airports to Mitigate the Public Health Risks of Coronavirus
    • This guidance document contains US Government recommendations to airlines for implementing measures to mitigate the public health risks posed by SARS-CoV-2 infection.
    • The full recommendations can be found here pdf icon[PDF – 57 pages]external icon.
    • Of special note, all areas with potential for human contact and transmission should be disinfected and cleaned per defined schedules as recommended by CDC and Occupational Safety and Health Administration (OSHA). High-touch surfaces should be cleaned frequently. Enhanced cleaning should also be performed in the vicinity of any identified ill travelers. Cleaners and disinfectants used should be compatible for use inside aircraft and included in the EPA’s List N: Disinfections for Coronavirus (COVID-19)external icon

Unaccompanied Minors

If airlines offer unaccompanied minor services, they should be aware of the challenges and responsibilities this service may represent. Airlines must ensure that all requirements for the arrival destination are met prior to departure, including for intermediate destinations in the event there is a connecting flight and especially if minors are traveling internationally. Unaccompanied minors are not exempt from the requirements of CDC’s testing and mask orders. For minors traveling domestically or departing from the US to a destination that requires testing, airlines a should encourage parents and guardians to follow CDC guidance to avoid travel while waiting for test results. In the event that minors are unable to continue travel mid-itinerary due to a positive test for or exposure to SARS-CoV-2, the airline will need to assume responsibility for their care until they can complete travel or until they can be reunited safely with parents, guardians, or sponsors. If minors are found to be infected with SARS-CoV-2, or are identified as close contacts, and travel is absolutely essential, CDC guidance for transport of infected or exposed persons must be followed.

Footnotes

1People are considered fully vaccinated for COVID-19 2 weeks after they have received the second dose in a 2-dose series, or 2 weeks after they have received a single-dose vaccine. CDC’s guidance applies to COVID-19 vaccines currently authorized for emergency use by the FDA: Pfizer-BioNTech, Moderna, and Johnson and Johnson (J&J)/Janssen COVID-19 vaccines. CDC’s guidance can also be applied to COVID-19 vaccines that have been authorized for emergency use by WHO.