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

Updated February 13, 2020


This document provides interim recommendations for the commercial airline industry about the Coronavirus Disease 2019 (COVID-19)  first identified in Wuhan, China. CDC reminds air carriers of the requirement under Title 42 Code of Federal Regulations section 71.21 to report ill travelers to CDC who have certain signs and symptoms during flight, and all deaths onboard, prior to arrival in the United States. This document also contains recommendations for managing ill travelers onboard if novel coronavirus infection is suspected.

Please also see Safety Alert for Operators 20001: 2019 Novel Coronavirus: Interim Health Guidance for Air Carrier and Crews pdf icon[PDF – 4 pages]external icon

Situation summary

An outbreak of respiratory illness caused by COVID-19 first detected in Wuhan, Hubei Province, China is ongoing. Cases also have been identified in travelers from Wuhan to other parts of China and the world, including the United States. Early on, many of the patients in Wuhan reportedly had some link to a large seafood and animal market, suggesting animal-to-person spread. At this time, person-to-person spread is occurring. Some viruses are highly contagious (like measles), while other viruses are less so. It’s not clear yet how easily this new coronavirus spreads from person-to-person

Symptoms include fever, cough, and difficulty breathing. These symptoms also can occur with many other common respiratory infections, such as flu.

Investigations are ongoing and these recommendations will be updated as more information becomes available.

Report to CDC travelers with specific symptoms arriving from China.

  • Report travelers with
    • 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
    • fever 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.

Review CDC’s Infection Control Guidelines for Cabin Crew

  • CDC recommends that companies review and update, as needed, their personal protection policies and communicate and train employees on how to manage sick travelers.

CDC recommends the following measures for cabin crew to protect themselves, manage a sick traveler, clean contaminated areas, and take actions after a flight.

  • Practice routine handwashing.
    • Wash hands often with soap and water for at least 20 seconds after assisting sick travelers or touching potentially contaminated body fluids or surfaces.
    • Use alcohol-based hand sanitizer (containing at least 60% alcohol) if soap and water are not available.
  • Identify sick travelers who meet the above description.
    • Minimize contact between passengers and cabin crew and the sick person. If possible, separate the sick person from others (2 meters or 6 feet is ideal) and designate one crew member to serve the sick person.
    • Offer a facemask, if available and if the sick person can tolerate it. If a facemask is not available or 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 if they are infectious.
    • Wear disposable 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.
    • When tending to a sick traveler from China who has fever, persistent cough, or difficulty breathing, use additional protective equipment in the Universal Precaution Kit pdf icon[PDF – 1 page]external icon: face mask, eye protection, and a gown to cover clothing.
    • Properly dispose of gloves and other disposable items that came in contact with the sick person or body fluids in biohazard bag or a secured plastic bag labeled as “biohazard.”
  • Clean and disinfect contaminated surfaces according to airline protocol.

After arrival, CDC Quarantine Station staff will 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.