SARS-CoV-2: how safe is it to fly and what can be done to enhance protection?

With lockdown restrictions over COVID-19 being relaxed, airlines are returning to the skies. Published evidence of SARS-CoV-2 transmission on aircraft is limited, but in-flight transmission of respiratory infections such as tuberculosis, influenza and SARS has been well described. Risk factors include proximity to index patients and sitting in aisle seats. Personal protection on aircraft could be enhanced by always wearing a well-fitting face mask and face shield or sunglasses, wiping surfaces and hands with alcohol-based sanitizers, not touching the face, not queuing for washrooms, changing seats if nearby passengers are coughing and choosing a window rather than an aisle seat.