Chapter 20:  Aircraft as Illness Incubators

The jubilation over my Alaskan achievement was short-lived—a letter dated July 6th from Davis, NorAm’s human resources manager, jolted me back to reality. My employment would be terminated, he threatened, if I did not qualify for the IMMS- generated leave of absence, which must be applied for by July 31st—or if the leave was granted and I had not secured alternate employment within the company at the conclusion of my leave. Fuming with indignity, I began the familiar circus of trying to get in touch with my union brothers and airline management on Monday, July 18th. “Sister Fiona never arrives before 10 A.M.” I was told by a pert union staff member. At 10:30 she rang.

No, she claimed, she did not have a clue about the newest development. I gave her a synopsis and demanded that the July 31st deadline be extended. “I’ll take NorAm to court if need be. They’re not getting away with this,” I warned.

“Hang on—I’ll talk to Harry about it,” she said, and minutes later she told me that the deadline extension should not present a problem. She would attempt to obtain the accident report, she said, and would set up a meeting with Harry to discuss Davis’ letter. They’d keep me posted.

While in the swing of things, I got in touch with the wage indemnity brokers, who said that in order to assess my claim, my psychiatrist and my general practitioner would be asked to provide statements of my history and a current medical diagnosis. Later on that afternoon, my lawyer, McCormick, called to say that WCB insisted that I expose myself to additional psychological treatment. “It’s, of course, unlawful of the Board to presume you might become better from it, however, what do you think if I forwarded documents of my choice to Dr. Kruk to get his evaluation without seeing you?” Kruk was one of the two psychologists that WCB deemed appropriate for my treatment. I consented.

My patience in trying to contact Harry ran out on the 24th when, miraculously, I reached Tobias. He said, ‘“I’m trying to arrange a meeting for the 26th—and don’t worry about the extension. Harry’s coming back from Glasgow today, and I’m going to remind him.”

”My arse,” I thought hanging up. After ringing Tobias again on the 25th, I discovered that he hadn’t spoken with Harry. I was not to be concerned about the deadline, he said, because even though I had been predisposed to develop PTSD, the company could not terminate me.

Flying into a rage I yelled, “What are you talking about? I was not predisposed! I know it, and my WCB file and company file proves it!”

“Well, don’t get upset now,” said Tobias, retreating. “I’m off until Wednesday next week and there’s plenty of time to talk things over.” He disconnected. At 10:30 A.M. the following day Tobias rang, his tone changed, and he demanded to see me at the union office within the hour.

“Sorry, can’t. Annemarie’s at the dentist, and I’m not going without her.”

“Well, I don’t know when we can meet before the end of the deadline, then, ’cause I might have to fly tomorrow, you know.”

“So be it,” I responded, thinking, “Screw it. Its just another one of their plots to catch me alone so they can fabricate all sorts of things afterwards.” Three hours later he rang again to propose a meeting on the 28th—with Harry also in attendance.

“That’s fine, Tobias,” I agreed, knowing Annemarie would be in town, “but I want Fiona there as well.”

“Oh. I’ll see what I can do. Call you later today.” He didn’t.

Taking the initiative of phoning him at 8:45 that evening, I learned that a meeting had now been planned for August 2nd or 3rd. “What about the deadline?” I questioned.

“Oh, don’t worry about that. It’ll be arranged.” On August 3rd. Tobias informed me that we now would get together on August 8th. Harry and Fiona would be present, he assured me. But on the day of our meeting, only Tobias greeted Annemarie and me at the union office. The others were “busy,” he said.

“Harry settled the IMMS deadline?” I inquired. “No, I’m still working on that.”
“For how many months is it, anyhow,” I asked.

“Oh, I don’t know. Haven’t checked it out yet,” he responded, candidly unashamed of his poor performance.

“Would be lovely if you did, Tobias, because I’m not signing anything until I know that. And I’m not considering retirement either, until my pension appeal has been settled, because McCormick advises against it. Why should I, anyhow? NorAm’s not even paying my group insurance, and the only thing I’d get out of it would to be without a job when I’m ready to go back flying.”

“But you can’t!”

“Who says I can’t? Don’t be ridiculous,” I answered. “And what’s this about firing me? Davis threatens me with it three times in his letter if the IMMS isn’t granted? Why threaten me, period? We only threaten when we feel threatened. And how can they? I’m sick with an injury sustained on-board aircraft? Don’t they want to take any responsibility for what happened? And why doesn’t the airline release the accident report? I’ll tell you why!” I went on. “The engine was damaged before start-up!”

“You’ve proof of that?” he asked, his piggy eyes wide in astonishment.

“Of course I have,” I said, and pushed the Safety Board’s report over to him while relating Dr. Walton’s comments.

“Mind me taking a copy?”

“I sure do mind,” I quipped, snatching the file out of his porky hands before continuing my agitated spiel. “And what happened to the flight attendants we know of who had near misses, Tobias? If their experiences and mine aren’t truly on-the-job accidents—I don’t know what are! And I’m not taking responsibility for it. I wasn’t predisposed and you know it. And I assure you, I’ll be compensated for my suffering, my loss of enjoyment of life, and the loss of my career if it comes to that.

“Davis’ letter just adds insult to injury!” I continued. “As far as I know right now, there’s no research on PTSD in flight attendants. But, by golly, sooner or later I’ll find out. And then watch out. McCormick says that NorAm is very aware of the volatility of the situation because they didn’t attempt to accuse me of sloppy work performance, knowing that it wouldn’t fly. Consequently, they chose another convenient avenue to get rid of me by allowing WCB to clobber me to death.”

“Well, cool it now. Can’t be all that bad,” he said condescendingly before promising to present my concerns to NorAm—“at the earliest convenience.” We parted company.

“Wonder when that’ll be?” I said to Annemarie over lunch. “Don’t you think we have here a typical example of male oppression and supremacy? They’re trying to bully me onto the well-established path of female submission, aren’t they? Nothing but power games and egocentrism accentuated by prolonged periods of silence to scare the prey and make her flee. ‘Till donkeys fly! If they don’t watch out, they’ve got a thing or two coming to them!”

By August 20th, brother Tobias’ expertise in evasiveness merited an award of excellence. Instead of wasting more time tracking him, I hunted down Fiona and let her know the extent of my disenchantment “I want a written apology from the airline for what happened to me,” I instructed her. “I also want it in writing, that they refuse to release the accident report. And I also it want in writing, that they failed to monitor me after my return to work. Furthermore, I want it in writing, that they provided inaccurate income figures to the Board—and I want it in writing that the figures which they provided are against the collective agreement. I also want a letter of employment. And,” I concluded my list, “I want you to get this for me. Otherwise I’ll sue them!”

“We better have a meeting,” she responded breathlessly.

“Annemarie and I’ve already had one with Tobias, and it proved to be a waste—good for nothing. Haven’t heard from him since, even though he promised to get answers from the company in a hurry.”

“When was that?”

“August 8th. I requested your presence but was told that you were busy. Perhaps you want to get the minutes from him and call me back later?”

“Shall do,” she said, and we disconnected. I hurried off to meet Erika at the Airport Inn.

“You won’t believe this,” Erika cried as she opened the door to her room, “Look what I just found in my mail folder!” She handed me a letter from NorAm’s medical office dated July 28th, 1994, which stated that a passenger on her mid-May London, England flight had been ill with active infectious tuberculosis (TB). The letter kindly suggested that she be tested privately at her own expense to find out if she was infected.

“Can you believe this? Couldn’t they have mailed it to me? They knew I’ve been on vacation from the end of June until today!” she exclaimed exasperated.

“Jessus! And if you’re infected you’ve probably given it to Josy,” (her little daughter), “And possibly a trillion others.” At the time, both of us were unaware that four Vancouver flight attendants had been infected with TB that year, nor did we know that the topic of airborne diseases had been discussed on the ABC program 20/20 on May 13th, the same week that Erika had been exposed to TB. The broadcast’s headline was “The Air Up There.”1

During that televised program, a man named Bob Kahn was interviewed. He had been traveling with his wife on a MD-80, along with a passenger who was later diagnosed with infectious tuberculosis. Shortly after the flight, Mr. Kahn tested positive for the disease—his wife showed no symptoms. Mr. Kahn maintained that other passengers contracted the disease as well. San Francisco’s Department of Health was reportedly investigating if Mr. Kahn and other passengers contracted TB on that flight. On another flight carrying a passenger with contagious TB, ten out of twenty-five passengers later tested positive for the disease.2

The fact that cabin crew is just as vulnerable to catch TB was documented by Consumer Reports investigators. They found that a flight attendant from an unnamed airline worked for several months with respiratory symptoms before being diagnosed with contagious tuberculosis. Epidemiologists believe she infected thirteen out of forty-three of her co- workers.3 Their research could not determine whether or not she infected any passengers. Until August 1994, the U.S. Center for Disease Control in Atlanta had only investigated four cases in which a crew member or an airline passenger had been flying while suffering from active infectious tuberculosis.4

Aircraft as Illness Incubators

While we know that North American airlines are exceedingly fond of stating that airplane air is equal to, if not better than, air found in office buildings, it is noteworthy that some epidemiologists have documented the spread of measles and tuberculosis through buildings’ ventilation ducts, and that this kind of disease transmission increases with the amount of recycled air.5 Others, including Dr. Harriet Burge, a Harvard professor of environmental health, have maintained that no amount of ventilation will prevent TB transmission.6

Consumer Reports investigators also documented how airline passengers with respiratory problems can infect those sharing their air—meaning all people, in all cabins— unless enough outside air is supplied to dilute the contagious airborne particles distributed by coughs and sneezes.7 Other researchers concluded that people traveling in First or Business class, receiving between 30 and 50 cfm of air, are less vulnerable to getting infected than those traveling in coach.8 But, as Mr. Witkowski of the American Flight Attendant Union explained in the 20/20 interview,

When we had planes—most planes—with 100% fresh air, the air used to come in totally...almost totally clean and then be exhausted every three minutes. Today, with the 50% fresh air and 50% recycled air, the plane isn’t changed—completely changed until approximately seven minutes or even longer in some cases. So you have air that’s less...has less quality to begin with. It’s got more contaminants and it stays in the plane longer.

However, Michael Rioux, Vice President of Engineering and representative of the Air Transport Association, the air carriers’ organization, happily announced during the broadcast,

We certainly don’t want to believe that we’re trying to squeeze another nickel out of everybody’s wallet just because we found out a way to make the airplane use less air, so what they’ve done is they’ve developed a system still maintaining,—in fact improving—the ventilation flow to each passenger that’ s sitting in the airplane.9

He doesn’t have to believe his spiel about the nickel. He knows that it’s fact, not fiction. But the ABC News medical editor, Dr. Timothy Johnson rushed to Rioux’s support by hurriedly pointing out that sophisticated filters installed to trap air contaminants are changed by the airlines according to manufacturers guidelines. Some critics, however, contend that these air filters are replaced far too infrequently to be effective.10

Most filters currently in use on-board aircraft are capable of removing 90 to 95% of bacteria and viruses. And new filtration systems, apparently installed on Boeing 777 and 747-400s, claim to remove up to 99.99% of airborne contaminants of 0.5 microns and larger. But that still allows potentially harmful bacteria, and especially viruses from the cabin environment, to slip through because the most common pathogenic viruses—those responsible for colds, flu, croup, and pneumonia—are all considerably smaller than 0.5 microns. The practical difficulties and prohibitive costs of measuring viruses on-board aircraft, however, inhibit research and development in this area, although the techniques are available.11 But, the carrier corporations may well reason, why hasten such a costly undertaking when, after all, passengers and cabin crew fly by choice, not by invitation?

Just how magnificent an aircraft is as a testing site for germ breeding and spreading (with or without ventilation and filtration), however, was illustrated when a jet with an inoperative ventilation system was grounded for more than four hours in Homer, Alaska, in the 70s with fifty-three people aboard. Within one week, 72% of passengers came down with influenza. All cases were traceable to one individual who developed flu symptoms during the delay.12 On a U.S. military DC9 with its 100% ventilation and filtration system running in perfect working order and at full capacity, eighteen out of thirty-four Navy squadron members aboard caught the flu.13

Therefore, it can be deduced that over 50% of passengers on any given aircraft with any kind of ventilation and filtration system will be infected if only one person in the cabin carries an airborne disease. On a fully loaded Boeing 747-200, that means approximately 250 passengers could walk off the aircraft ill. Flight attendants are, of course, thought to be immune. The only official scientific cabin air quality study that has been conducted by the U.S. Department of Transportation was done around 1989. It has been reviewed with skepticism by many experts, who claim that such contaminants as air pollutants and germ transmission health threats were not adequately researched.14 Therefore, the American Broadcasting Company commissioned a Harvard research team to collect air quality samples on twenty-two flights on ten different types of aircraft on every major American airline on domestic routes, and to test for eleven categories of contaminants, including carbon dioxide, noise levels, organic compounds and dust.15

The researchers brought a sinister picture to light. The high carbon dioxide levels they found was no surprise. Though no specific data were presented in the broadcast, the research provided a clear analysis of the cabin environment. The high levels of mites found in dust samples collected from seats and carpets indicated that they had permanently settled in. Extensive evidence of cat allergens, presumably brought on-board by passengers, was also noted. Other substances irritating to sensitive travelers were found, such as aromas from perfumes, aftershaves, cooking, fuel, de-icing chemicals, cleaning fluids, pesticides, carpeting adhesives, insecticide, cleaning agents, ethanol and benzene, and upholstery finishes, all of which cannot be soaked up or eliminated by the ventilation system. Every one of those particles and odors can cause allergic reaction and asthma attacks in passengers.16 Again, cabin crew was excluded from the research.

Dust samples collected by the team revealed relatively high levels of endotoxins, which are substances found in the cell walls of certain bacteria. The researchers purport that those may be causing the dry eye and scratchy throat symptoms suffered by passengers and cabin crew alike. But Mr. Rioux, the industry representative, protested wildly.17

Infectious disease transmission

In 1992, Dr. Harriet Burge, Associate Professor of Environmental Health at the Harvard School of Public Health and one of the air quality researchers, said that,

There are many episodes of infectious diseases that could, if you took the trouble, be directly traced to travel on aircraft. It is also possible that if someone on the flight has an active case of an infectious disease like influenza, then other people on-board will also have that disease by the end of the flight.”18

Let’s use the Ebola virus for an example. Ebola is an infectious virus spread by just breathing in air. An Ebola infection starts with a bad headache, then the stomach revolts, high fever sets in, the blood first clots, then loses that ability, and the body turns into an oozing, melting mass of virus within days.19 When a recent outbreak in the Congo region caused hundreds of deaths, flights to that region were canceled to prevent spreading the disease to other parts of the World.

In 1990, when monkeys, imported from the Philippines to the Hazelton Research Primate Quarantine Unit in Reston, Virginia died of Ebola, panic silently arose because many people had been exposed to the creatures during their transport by aircraft and trucks. The virus was airborne—proven by the fact that non-infected monkeys, isolated in a different tract of the building, caught the disease as well. All 500 monkeys were killed by lethal injections and the building decontaminated with formaldehyde by the U.S. Army. No human being has set foot inside since, even though the military purports to have killed every single Ebola virus.20

Hantavirus is another virus transmitted directly through the air from people coming into contact with infected droppings from deer mice and rats. The virus can be contacted in our own back yards, if the urban development explosion continues displacing rats and mice from their habitual quarters. It can be brought on-board aircraft with great ease. Strains of the virus have caused outbreaks in Europe and Asia. During the Korean War, 3,000 United Nation soldiers were struck down with it.21 It has now been reported all over the United States and Canada.

Plagues are another force to reckon with. There are two main forms of the disease: bubonic and pneumonic. Diseases of rats rather than humans, plagues are caused by bacteria—microorganisms not much larger than 1/1000 of a millimeter—transmitted from one rodent to another by fleas. If fleas from an infected rodent bite a person, swelling occurs at the bite mark, in the groin, or under the arm. These swellings, or buboes, give the Bubonic Plague its name. Pneumonic Plague is contacted by breathing in the bacteria when, for example, handling an infected rodent. The disease is then transmitted from person to person by air.

Fleas do not need a passport to make their way on-board aircraft. In 1995 many airlines proved divinely indifferent to the dangers of the bubonic plague by flying in and out of India as usual, even though a plague raged in parts of the subcontinent. During an epidemic, up to 90% of a population may be infected. If treatment with antibiotics is not administered within twelve to twenty-four hours, more than 50% of those with bubonic, and nearly 100% of those with pneumonic plague will die.22

Lassa fever, an acute and often fatal viral disease, must not be forgotten either. In the late 70s, when a passenger on an international flight was rushed into a Toronto hospital with a suspected case of highly contagious Lassa fever, health officials quarantined the hospital after about 700 people had been exposed to the disease. The case turned out to be a false alarm.23 What happened to the aircraft, its crew and passengers has never been revealed.

Then there are also the diseases caused by the Marburg, Machupo, and Junin viruses—equally incurable and infectious as most of the others I’ve mentioned, and equally as eager to travel by airborne routes. Mr. Carl Johnson, a virologist, said on the CBS program 48 Hours, “We’re going to be so unprepared the day one of them [virus] lands on our shores and takes off that I cannot imagine the kind of panic it’s going to produce in this society.” Miss Jenkins, a medical anthropologist, says later on, “Oh, diseases move very quickly. Hop on a plane with a person—it’s not hard for a disease to move. Diseases move with great ease.”24 I guess someone kicked her under the table, for she did not elaborate, nor was she invited to discuss the issue further.

“What about disinfecting aircraft ?” you might well ask. Well, there is only a 1972 report from the International Sanitary Regulation (ISR) of the World Health Organization (WHO), in conjunction with the International Aviation Transportation Association (IATA), which examined new methods to accomplish that task. It appears as if, twenty- five years later, they are still examining. However, if public health officials suspect that an aircraft has transported a plague-cholera-smallpox-typhus-relapsing fever-chicken pox-gonorrhea-syphilis-tuberculosis-salmonellosis and/or streptococcal infectious passenger, they may request an aircraft disinfection.25 But when that action is taken, after having run through a multitude of channels for consideration, the plane has most likely circumnavigated the globe a 100 times.

Concurring with the very limited documentation on the topic of aircraft as illness incubators, the Harvard research team believes they demonstrated beyond a shadow of a doubt that contaminants can be picked up throughout the aircraft.26 When contaminants can be picked up, so can bacteria and microorganisms. The day the ABC 20/20 episode aired, the Air Transport Association, who a few weeks earlier had released their own study in which they noisily tooted that the cabin air was perfectly fresh and health- promoting, released a statement saying that they looked forward to reviewing the team’s findings.27 In airline industry lingo that means that they’ll still be looking forward to reviewing Harvard’s study when pigs fly unless they’re forced into action.

Until then, one has the benevolent advice of Dr. Timothy Johnson, ABC’s News Medical Editor, as a guideline. He proposed, when asked how passengers can increase their chances to deplane as disease-free as when boarding, that they should try to avoid being exposed to someone who is coughing and sneezing. It appears that the doctor has yet to travel on an aircraft that is packed solid, where seats are dished out before one is able to examine one’s neighbors for any obvious or invisible health deficiencies, and where there is no possibility of escape to a more conducive location, should the person be undesirable, if only by apparent health indicators.

As a remedy for special allergies Dr. Johnson recommends you travel with appropriate medication.28 But that, alas, might be a trifle difficult when not knowing what sort of critters, viruses and odors stream through the ventilation system or harbor in the upholstery or carpets on a particular plane or flight, since that mostly depends upon the route the aircraft has recently flown—information that, in turn, is often unknown to both passengers and flight attendants.

It is vital to pass on one piece of advice for air travelers, which escaped Dr. Johnson’s attention. Take along your own blanket and pillow—even on short trips. At least you know where they’ve been. Blankets handed out on-board, unless wrapped in plastic and sealed, have embraced a multitude of people who have coughed, farted, jerked off, burped, sneezed, urinated and snotted into them—you do not wish to know how many times—before they end up around your body. They are cleaned only once in a blue moon. This gives bacteria and viruses more than adequate time to prosper and multiply. Your own pillow is a must for the same reasons.

But while you contemptuously wave your own blanket and pillow in front of a flight attendants’ eyes when she or he is offering you one, be gracious. The attendant is only trying to make sure that you’re comfortable with what has been provided. And as long as people want to travel around the world for $99, passengers will be offered dark-colored blankets and light-colored pillows that create the illusion of cleanliness and may hide a sullied past. With those bargain basement flying prices (paid by your cabin crew to begin with), you should accept both graciously and gratefully if arriving on-board unprepared. Of course, it goes without saying that you must live with the potential consequences.

How does cabin crew fare in this airborne infection-loaded environment, disregarding the issuing of questionable pillows and blankets, and the subsequent collecting and folding task demanded by airline management? Well, as far as regulations for cabin crews’ protection from infectious airborne diseases are concerned, the situation is similar for all other physical or psychological illnesses potentially contracted or acquired on-board an aircraft. There are none. And as early as 1972, in the days when 100% fresh air circulated in passenger cabins, researchers report that airline medical officers were regularly faced with unusual illnesses in aircrew members due to the constant contact with foreign populations, as well as to the viruses and bacteria carried in foreign foods and water.29

Because pilots’ contact with the on-board populace is practically nil, for once, flight attendants are the focus of that study. The probability of contracting an airborne disease is vividly demonstrated by the boys’ reluctance to admit passengers to the flight deck. Though it was a practice once regarded as an easily-granted flight attendant request, it is now often denied because of their fear of flight deck contamination. The boys know how to protect themselves. To consider that cabin crew—most of whom regularly visit the cockpit if for nothing else but a breath of fresh air—also could be contaminated with a multitude of viruses, seems yet not to have dawned on them.

At an International Labour Organisation conference in Geneva in 1977, hosted under the auspicious title Occupational Health And Safety In Civil Aviation, conferees heard that

Very little has been done in the area of flight crews occupational health and safety [whose] problems can clearly be divided into those arising in the air, where there can be no real comparison with other industries, and those arising on the ground.30

Those present discussed all the ailments that cabin crew suffer, and pilots, because of their oxygen-drenched and sheltered kennel, do not. In the proceedings from the conference we find this succinct observation:

It is possible, in conventional aircraft, to fly right round the world—well within the incubation period of most infectious diseases. As a result, airport workers may be at some risk to these as visitors from infected areas [who] arrive at the airport often without showing any signs of illness. Besides the potential risk of infection involved in the transport of human beings and animals, the rodent and insect vectors of certain diseases may infest an aircraft on an international journey, and measures may have to be taken against them for the protection of the airline staff. 31

The conference participants also determined that air transport has been responsible for outbreaks of influenza when it appears simultaneously in many parts of the world, and for influencing the mutant strains of the influenza virus which occur from time to time. They also asserted that many communicable diseases for which there are no vaccines—including Marburg and Lassa fever, which came into prominence around 1977—could be spread wonderfully well by aircraft.32 Additionally, the researchers asserted that the carriage of animals may produce hazards such as zoonoses, which are any of the various diseases naturally transmitted to humans. Furthermore, they warned that poisonous chemicals may leak and affect crew.33

Despite these documented findings, the airlines still maintain, twenty years later, that there is no conclusive correlation between the cabin air which constitutes an aircraft’s natural environment, and the health of flight attendants and passengers. U.S. Aviation authorities sing the same tune when they reassert that a link between air circulation and health is difficult to prove, because no data base can be established for passengers health before they board a plane.34 This might be a viable argument where the public is concerned—after all, the day has yet to dawn when airline passengers will be required to present medical certificates before being granted permission to buy tickets to Disney World. Such a modus operandi would not be greatly conducive to corporate finances. Therefore, the only people aware of the dismal health conditions in the sky are flight attendants, who have no proof or research on which to base their assertions, and pilots who, because of the remunerative incentives they receive, are gagged.

When earning up to $247,000 as a Boeing 747 captain, it is easy to understand a pilot’s complacency unless he or she is moved by exceptional ethical values. Thus, flight attendants are the ones who put their health on the line. Why, you must be asking yourself, don’t they object? If they protest against the abysmal work conditions under which they labor, they will be harassed and prosecuted with such expertise—expertise aided by their own flight attendant unions—that they soon disappear between the cracks. Because the vast majority of flight attendants are unemployable in earthly pursuits, a fact which they are intuitively aware of, they would rather live to die with cancer or whatever they contract in their time in the skies, than to protest against the conditions imposed on them by carriers, pilots and their unions.

Therefore carriers such as Deutsche Airbus can get away with the eloquent statement that “Stale air, at least, has offered no cause for passenger complaint for a long time.”35 No. Of course not! Who in their sane mind would inquire about an airline’s ventilation and filtration system cleaning policies before climbing aboard? Who, unless they are mentally challenged, would think that the stale air could be an indicator of what I have termed the aircraft illness incubator? Who would, without deeming oneself to be obsessively paranoid, believe that the conditions were caused by the lack of oxygen and cleanliness? The very concept is rejected by the average person—with the exception of flight attendants. They receive neither media coverage nor researchers’ attention. Furthermore, as has been documented time and time again, their union officers are not interested in working on the membership’s behalf.

We can be certain that the world’s commercial airlines are aware of the health risks associated with cabin air quality and quantity because they conducted a symposium on aircraft air in California in the spring of 1995. Dr. C. Thibeault, Air Canada’s Chief Medical Officer, delivered a symposium paper, “Cabin Air Quality: Myth vs. Reality,” in which he states,

As people became concerned about indoor air quality when energy efficient buildings came about, they also became concerned about cabin air quality with the newer generation aircraft. However, it soon became obvious, as incident reports came in, that crews and passengers were confused about the different elements of air quality. Even though there hasn’t been much research on the subject so far, the basic knowledge about pressurization, ventilation, filtration, and air conditioning have been around for a long time, but deserve to be reviewed again to set the stage for a reasonable discussion based on facts as opposed to emotions. We believe that the perceived problem related to Cabin Air Quality is multifactorial and that the review of the different factors involved will go a long way towards orienting future work and discussions.36

The question we must ask of Dr. Thibeault is who perceived the “perceived problem related to Cabin Air Quality?” Who should be addressed in the discussion to be based on “Facts as opposed to emotions?” On which facts and on whose emotions? There are no empirical cabin crew studies available on psychological makeup or on their perceptions of air quality-quantity. What does exist are only a handful of studies conducted on air crew’s menstrual cycles, pregnancies, relative metabolic rate and heart rate variations, and work expenditure compared with the earthbound population.

If cabin crews’ and passengers’ problems with the air are truly a figment of their imaginations, why does Dr. Thibeault suggest, in an article jointly written with Drs. Kikuchi and Pinto-Ferreiar for the Aerospace Medical Association, that the specifications for the Very Large Airplane (VLA), presently on manufacturers’ drawing boards, with a capacity of 600–1000 passengers, should provide 19 cfm airflow and 10 cfm fresh air supply per passenger? Why do they recommend levels of less than 1000 ppm carbon- dioxide, and ozone levels of less than 0.1 ppm? Why, suddenly, is a relative humidity of as close to 30% a desirable goal? Why do Dr. Thibeault and his colleagues suggest that high efficiency particulate air filters (HEPA) be installed and properly maintained on the VLA? And why do they recommend that VLAs maintain a cabin altitude as close to sea level as possible? Why suggest all these changes when, according to Thibeault, the quality and quantity of air presently found on aircraft is not harmful to passengers and cabin crew? Why indeed.37

Passengers have remained largely ignored by researchers except for studies describing physical ailments exacerbated by air travel. One study describes “Economy Class Syndrome,” a venous problem caused by the cramped seating arrangements particularly evident in economy class.38 Another explores contraindications for aircraft travel which include contagious or communicable disease, coronary occlusion, anemia, pneumothorax, cardiac decompensation, wired jaws or trismus, perforating eye lesions, mental disturbance and bladder or bowel incontinence because these conditions can be complicated by the reduced air pressure in passenger cabins.39 None, however, have been conducted on passengers’ psychological ailments.

So then, whose emotions are Dr. Thibeault referring to in his address to the air quality/quantity symposium? Pilots are not supposed to be emotional whatsoever, so of course, he must be referring to cabin crew. They are the only ones who do know that there’s something awfully wrong with the air up there. The vast majority of passengers don’t have a clue what’s happening to them when they take wing. Flight attendants also have unions whose officers, mainly males who have occupied their union positions for an eternity, notoriously act as employer advocates rather than membership advocates.

What better way is there to attack the mainly female cabin crew’s psychological integrity than by blaming their complaints about the air up there on their innate emotional fragility, as insinuated by Air Canada’s Chief Medical Officer. One could not wish for a more enlightening statement to reflect the level of esteem and confidence North American airlines maintain toward their inflight service personnel. And is it not reassuring that the air quality problem will be discussed in the future? In air carriers’ terms that means discussions could drag on for the next twenty years. Those discussions—given the length of their duration—will not prevent the long-term repercussions from oxygen starvation, intense carbon dioxide, radiation, and ozone exposure, hypoxia, and the effects of airborne microbiological diseases on flight attendants’ health. No one has even begun to discuss the issues of the shorter term effects and the misery of paying passengers.

Cabin crews’ book off rates should serve as an indication of how much is really amiss with the working environment and working conditions. Approximately 50% of Canadian flight attendants book off at least once a year for more than 14 days, and approximately 20% are on long-term disability. This excludes WCB claimants. 40 Compared to the lower percentages of book offs for pilots, who are considered to be highly motivated, those high percentages appear to be unjustifiable, unless we consider cabin crew as an inherently unhealthy species. But how could that be, when every single one of them passed a pre- employment examination conducted by their airline’s medical officer, who certified that they were in superb physical and mental health? Doubtlessly, Canadian flight attendants’ illness rates are similar to those experienced in the U.S. Comparable figures with earthly workforces are unavailable because with whom should one compare them? Coal miners? Steel workers? Office staff? British blue collar workers in the auto industry?

Flight attendants’ health risks, well-known to the carriers since 1972, become an even more insidious problem when we realize that most, if not all, North American airlines closed their medical clinics to cabin crews a long time ago.41 Why? It is so much more conducive to allow the public health care system to take care of their disease-stricken cabin personnel. Not only is it cost-efficient, it also conveniently eliminates all documentation of the causes for flight attendant illness, thus allowing North American carriers to continue to do what they have perfected to a fine art—willfully and knowingly endangering the health and well-being of cabin crews and passengers on a perpetual basis. Without this supporting documentation, the corporations have only to plead innocence or ignorance unless proven guilty of neglect. But by whom?

At the Geneva International Labour Organization Conference in 1977, the essential work of flight attendants was described:

“they have a considerable role to play over and above the obvious one of attending to the physical needs of the passengers. They have the responsibility for maintaining the morale of passengers and keeping order in case of an emergency, operating safety equipment in the passenger cabin and controlling emergency evacuations on the ground if necessary. With the introduction of wide-bodied aircraft carrying hundreds of passengers, their safety role has become [even] more prominent.”42

As the failure to improve their working conditions continues, flight attendants, regardless of age, seniority, color, race or religion, can only pray that their oxygen-deficient, germ- loaded, radiation, ozone, carbon monoxide and dioxide-infested working environment will not doom them an untimely, lingering, and gruesome death. On an uplifting note however, shareholders of any self-respecting stock exchanged airline corporation will see an increase in profit if they can, at the greatest speed possible, get rid of cabin attendants before they reach the top pay scale.

Remember Erika? Well, she decided to go ahead with her London flight the following day knowing that, if contagious tuberculosis had been in her system since May 13, 1994, infecting a few others in the process had not made a difference to NorAm. So why should it to her? Especially since it would cost her twenty hours flying-time pay plus tax-free expenses.

That settled, we spent a lovely evening gabbing about life in the fast lane before I returned to my home and continued to await sister Fiona’s summons to a meeting.

* * *

Chapter Twenty Notes

1 “TheAirUpThere.”Reporton20/20,AmericanBroadcastingCompany.Transcript#1419, May 13, 1994.

2 Ibid.

3 “What’s Happened to Airplane Air?” In: Consumer Reports, A publication of Consumers Union. Yonkers, N.Y. August 1994.

4 Ibid.

5 Ibid.

6 “The Air Up There.” Report on 20/20, American Broadcasting Company. Transcript #1419, May 13, 1994.

7 “What’s Happened to Airplane Air?” In: Consumer Reports, A publication of Consumers Union. Yonkers, N.Y. August 1994.

8 “Smokescreen Over Cabin Air Quality.” In: Interavia, A Jane’s Information Group Publication, Volume 47, June 1992.

9 “The Air Up There.” Report on 20/20, American Broadcasting Company. Transcript #1419, May 13, 1994.

10 Ibid.

11 “Smokescreen Over Cabin Air Quality.” In: Interavia, A Jane’s Information Group Publication, Volume 47, June 1992.

12 “What’s Happened to Airplane Air?” In: Consumer Reports, A publication of Consumers Union. Yonkers, N.Y. August 1994.


14 “The Air Up There.” Report on 20/20, American Broadcasting Company. Transcript #1419, May 13, 1994.

15 Ibid.

16 Ibid. and “What’s Happened to Airplane Air?” In: Consumer Reports, A publication of Consumers Union. Yonkers, N.Y. August 1994.

17 “What’s Happened to Airplane Air?” In: Consumer Reports, A publication of Consumers Union. Yonkers, N.Y. August 1994.

18 “Smokescreen Over Cabin Air Quality.” In: Interavia, A Jane’s Information Group Publication, Volume 47, June 1992.

19 “In The Danger Zone.” Report on 48 Hours, CBS News, May 4, 1994.

20 Ibid.


22 Strange Stories, Amazing Facts. The Reader’s Digest: Pleasantville, New York, Montréal, 1976.

23 “Killer Viruses” Report on CBC Prime Time News, CBC, December 14, 1994.

24 “In The Danger Zone.” Report on 48 Hours, CBS News, May 4, 1994.

25 Programme of Industrial Activities, Tripartite Technical Meeting for Civil Aviation. Occupational Health And Safety In Civil Aviation. International Labor Organisation, Geneva 1977.

26 “The Air Up There.” Report on 20/20, American Broadcasting Company. Transcript #1419, May 13, 1994; and “What’s Happened to Airplane Air?” In: Consumer Reports, A publication of Consumers Union. Yonkers, N.Y. August 1994.

27 “What’s Happened to Airplane Air?” In: Consumer Reports, A publication of Consumers Union. Yonkers, N.Y. August 1994; and “The Air Up There.” Report on 20/20, American Broadcasting Company. Transcript #1419, May 13, 1994.

28 “The Air Up There.” Report on 20/20, American Broadcasting Company. Transcript #1419, May 13, 1994.

29 K. Vaandrager. “Task of a Medical Department in Civil Aviation.” In: Aerospace Medicine. April 1972.

30 Programme of Industrial Activities, Tripartite Technical Meeting for Civil Aviation. Occupational Health And Safety In Civil Aviation. International Labor Organisation, Geneva 1977.

31 Ibid.

32 Ibid.

33 Ibid.

34 The New York Times, N.Y., Sunday June 6, 1993.

35 “Smokescreen Over Cabin Air Quality.” In: Interavia, A Jane’s Information Group Publication, Volume 47, June 1992.

36 C. Thibeault. “Cabin Air Quality: Myth vs. Reality.” Air Canada Occupational Health Services , Montréal, Québec. Canada. Issued by the Ministry of Transport, July 1995.

37 Air Transport Medicine Committee, Aerospace Medical Association. “The Very Large Airplane: Safety, Health, and Comfort Considerations.” In: Aviation, Space, and Environmental Medicine. October 1997.

38 F. Sahiar. “Economy Class Syndrome.” In: Aviation, Space, and Environmental Medicine. October 1994.

39 R.E. Yanowitch and J.A. Sirkis. “Air Travel and the Handicapped.” In: Aerospace Medicine. August 1974.

40 Airline Division of CUPE, Summer, 1996.

41 K. Vaandrager. “Task of a Medical Department in Civil Aviation.” In: Aerospace Medicine. April 1972; and J.D. Alter and S.R. Mohler. “Preventive Medicine Aspects and Health Promotion Programs for Flight Attendants.” In: Aviation, Space, and Environmental Medicine. February 1980.

42 Programme of Industrial Activities, Tripartite Technical Meeting for Civil Aviation. Occupational Health And Safety In Civil Aviation. International Labor Organisation, Geneva 1977, p.67.

Broken Wings: A Flight Attendant’s Journey

Copyright ©1997 Nattanya H. Andersen

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