Advice on managing the health risks from COVID-19 on international flights

Advice on managing the health risks from
COVID-19 on international flights
Purpose
This document is intended to provide the aviation industry, including air crew, with
support to establish appropriate COVID-19 safety protocols. These protocols are
designed to reduce the health risks to passengers and employees and minimise the
potential for disease transmission during international air travel. This advice should
sit within each airline’s overarching systems-based risk management approach to
preventing COVID-19 transmission.

International travel during COVID-19: Australia’s
protective measures and requirements
Measures are in place to help prevent the spread of COVID-19. This includes entry
restrictions applying to all foreign travellers, except those travelling under the
quarantine free green travel zone arrangements between Australia and New
Zealand.

Travel zones
Travellers arriving in Australia will arrive via either the red or green travel zone, as
determined by the Australian Government. Passengers arriving from a high or
medium-risk country for COVID-19 will arrive in the red zone. Passengers arriving
from a low-risk area will arrive in the green zone.

Red zone
The Australian Government requires travellers arriving in the red zone to undertake
mandatory quarantine in designated accommodation for 14 days from the day they
entered Australia. They may also be required to undergo health screening within the
airport terminal.

Red zone flight crew
Airline, medevac and air ambulance crew are exempt from the mandatory 14-day
quarantine requirements, provided they adhere to alternative arrangements outlined
below. This includes off-shift crew who are travelling as passengers on an aircraft to
reposition at another location.

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The Australian Government requires Crew flying on international flights to undergo a
COVID-19 test every 7 days. Alternatively, be tested on arrival in Australia, as
directed by jurisdictions.

    •   Airline crew who have been on international flights must quarantine in their
        crew accommodation, designated quarantine facility, or home for 14 days after
        arrival. Or, until their next international flight, whichever is shorter. It is at the
        discretion of the relevant jurisdiction where air crew are required to quarantine.
    •   Crew may undertake essential flight-related duties from a regulatory or safety
        perspective during this time. This may include flight simulation training, safety
        and security training.
    •   Medevac and air ambulance crew may request an exemption from home
        quarantine requirements to return to duties beyond the essential flight-related
        duties already exempt.

Note: These are national recommendations. However, as state and territory
governments manage mandatory quarantine, other requirements may apply
depending on the state or territory you arrive in.

Green zone
The Australian Government may establish routes of travel that have eased COVID-
19 border restrictions. For example, the Quarantine-free safe travel zone (green
zone) with New Zealand that commenced in October 2020.
Travellers currently arriving in a green zone are not required to complete 14-day
mandatory quarantine if:
    •   have been in only Australia or a designated green zone area for at least the 14
        days immediately before the date of departure, and
    •   they travelled on a green zone flight.
When travelling to Australia, travellers should complete the Australia Travel
Declaration, which includes confirming they have been only in a designated green
zone area for the previous 14 days. Travellers must not have any signs or symptoms
of COVID-19, or have been in contact with a confirmed case. They must also provide
contact details while in Australia to help with contact tracing if required.
Travellers in the green zone may have to go through additional health screening –
either before boarding their flight or on arrival in Australia.
Travellers in the green safe travel zone will not be in contact with passengers from
any other countries when transiting through the airport. However, travellers are still
required to wear masks on the aircraft and while in the airport environment.

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Green zone flight crew
The New Zealand and Australian governments do not permit airline crew to operate
green zone flights unless they have only been in Australia or a designated green safe
travel zone for the previous 14 days.

Green zone airline, medevac and air ambulance crew are exempt from all quarantine
requirements (including self-quarantine in crew accommodation or home). This is if,
for at least the 14 days immediately prior to operating a green zone flight to Australia:

    •   they have only been in Australia and/or a designated green safe travel zone
        area.

Airline crew operating green zone flights may be subject to health screening on
arrival in Australia. This is at the discretion of the state or territory health department.

Note: These are national recommendations. However, as state and territory
governments manage mandatory quarantine, additional requirements may apply
depending on the state or territory you arrive in.

Pre-departure testing
Passengers travelling to Australia, including transit passengers, from a red zone
must be tested for COVID-19 72 hours or less prior to departure. Passengers must
display evidence of a negative PCR test result at the time of check-in, before being
allowed to board their flight to Australia. The airline representatives will sight this
evidence prior to boarding. Exemptions from this requirement may be provided in
extenuating circumstances.

Face masks
Passengers and crew on all international flights must wear a face mask during their
flight and while in Australian airports. Masks should be changed regularly. Children
under 12 years of age, and those with other recognised exemptions, do not require
masks.

Specific advice for airlines and air crew: protecting
passengers and crew from COVID-19 health risks
Crew should follow their existing infection prevention work instructions for managing
sick passengers or crew members, which includes using personal protective
equipment (PPE) like masks and gloves when recommended and adhering to
mandatory reporting requirements. In addition, air crew should adopt the key
measures outlined below to minimise the risk of COVID-19 transmission.
Crew operating cargo or other flights without commercial passengers should be
familiar with these measures, and adopt those relevant to protecting against COVID-
19 health risks in-flight and during cargo handling.

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When responding to COVID-19 health risks and implementing the measures outlined
below, it is essential to consider how persons with disability and/or reduced mobility
access air travel. Air crew, in conjunction with their employer, should take all
reasonable steps to facilitate inclusion.

Managing passengers or crew who become sick during a flight
Requirements for reporting sick passengers or crew
The Australian government legally requires all aircraft entering Australian territory to
report sick passengers and crew on the pre-arrival report. A Biosecurity Officer will
then meet the aircraft to screen for COVID-19 and other listed human diseases.
Directions for the management of the ill passenger or crew may be issued. These
must be followed.

Minimising the risk of disease transmission to others on board
If possible, sick passengers (including their close personal contacts and family
members) experiencing cough, fever, sore throat, sweats or chills should:
•    Maintain distance from other travellers. Keep the row empty if possible, or at
     least one spare seat on either side.
•    Wear a suitable face mask or face covering.
•    Use an allocated toilet for sick people.
While interacting with sick passengers and/or their bodily fluids, crew members
should:
•    Wear Personal Protective Equipment (PPE) both while interacting directly with
     the passenger and when handling items from affected passengers. PPE
     includes a suitable face mask, disposable full-length gown, gloves and eye
     protection.
•    Remove any PPE before touching other people or surfaces. To avoid self-
     contamination, do no touch the front of mask, gown or outside of gloves.
•    Wash hands with soap or use alcohol-based hand sanitiser after removing PPE.
•    Dispose of used PPE in biohazard bags and use alcohol-based hand sanitiser
     after tying the bag closed.
•    Wear gloves to clean then disinfect surrounding surfaces with a broad spectrum
     disinfectant. Use alcohol-based hand rub after removing gloves.
If a crew member develops signs or symptoms of COVID-19 during flight, where
possible they should:

•   notify the pilot,
•   stop all work-related duties,
•   maintain physical distance from passengers and other crew members, and
•   report illness in the pre-arrival report.
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If a crew member develops signs or symptoms of COVID-19 while at home or during
layover, they should:

•   stay at home or in their hotel room,
•   notify the airline and relevant public health authorities, and not return to work until
    the public health officials and their employer have cleared them to.

Key measures airlines can adopt for reducing the risk of
COVID-19 transmission during international air travel
Each airline should establish a broader system-wide approach to mitigating COVID-
19 health risks in the international air environment. This includes measures that go
beyond individual crew members’ control to address environmental or engineering
factors associated with disease transmission. To support the broader risk mitigation
approach, there are a number of actions that air crew can adopt to directly reduce the
risk of COVID-19 transmission during and between flights, as outlined below.

Cleaning
Implement the following, where possible, in addition to overarching enhanced
cleaning and disinfecting processes during and between flights:
•     Review guidelines and ensure enhanced infection control measures as part of
      normal in-fight processes. Airlines should consider providing crew with
      additional training or inflight specialist support for infection control.
•     Wear gloves, a disposable full-length gown and a surgical mask to clean toilets
      or surfaces contaminated with body fluids or used by a sick person. Disinfectant
      should be broad spectrum with effectiveness against norovirus. Crew should
      check the manufacturer’s claims before use and seek further advice from the
      airline if required.
•     Collect passenger waste at the end of meal service and place it in waste bags
      and store in waste carts.
•     Remove any PPE without touching the front of mask, gown or outside of gloves
      to avoid self-contamination. Wash hands after removing PPE.
•     Dispose of used PPE in biohazard bags and use alcohol-based hand sanitiser
      after tying the bag closed.
•     All materials from a sick passenger or crew member should be considered
      biohazardous waste, and crew should follow protocol for appropriate disposal.
      This includes partly consumed meals or beverages, tissues and PPE.
•     Include maintenance areas and access panels in enhanced cleaning
      procedures for the aircraft.
•     Increase cleaning frequency for training equipment, flight simulators, training
      devices, and other items used during crew training. Do this using cleaning
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products with recognised effectiveness against norovirus infection as per the
    above.
•   Include the cargo compartment in enhanced cleaning procedures to protect
    ground staff and crew involved in cargo handling.

Hygiene
•   Encourage crew and passengers to practise good hand hygiene and good
    sneeze/cough hygiene by:
            o Washing hands often with soap and water, or using alcohol-based
              hand rub before and after eating, and after going to the toilet.
            o Covering nose and mouth when coughing and sneezing, disposing
              of tissues and immediately washing hands.
•   Avoid touching mouth, eyes and nose with unwashed or gloved hands.
•   Support good hygiene with signs, reminders and appropriate facilities or hand
    hygiene products and waste disposal bins.
•   Encourage passengers and air crew to close the toilet lid before flushing to
    minimise the spread of infectious particles.
•   Avoid sharing crew safety equipment for safety demonstrations. Or, where
    sharing is unavoidable, appropriately disinfected all equipment prior to use.
•   Continue practising the hygiene measures listed above during layover or transit
    between flights.

Cabin setup
•   Pre-load sick bags into seats and snacks into self-help bars.
•   Remove magazines from seat backs.
•   Provide passengers with individual waste bags in each seat pocket as well as
    masks, hand sanitiser and government paperwork.
•   Avoid sharing bedding items supplied in the crew rest areas between crew.
    Make sure to appropriately disinfect any items where sharing is unavoidable.

Movement
•   Minimise movement of passengers and crew. Passengers should remain in
    their allocated seat unless going to the toilet. Where possible, restrict
    passengers to using one particular toilet based on seat assignment.
•   Crew should have a separate rest area for the use of crew only.
•   For service, consider allocating crew members to specific sections of the cabin
    and minimise cross-over where possible.

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•   Minimise physical interactions between crew members where possible. For
    example, replace physical flight crew checks with interphone calls or restrict
    access to the flight deck.

Physical distancing
•   Maintain physical distancing and introduce measures to decrease touch and
    increase spacing during check in, boarding and disembarkation such as:
            o boarding by rows or in other smaller groups of passengers
            o limiting passengers to one small piece of hand luggage and
              encourage storage under the seat in front rather than in overhead
              luggage compartments.
•   Minimise contact between aircrew and passengers. For example, provide pre-
    packaged meals and limit meal and drink services.
•   Space travellers out wherever possible and seat flight crew away from
    passengers for take-off and landing. Measures may include;
            o using a maximum of 80 per cent capacity of a flight.
            o leaving empty seats between passengers.
            o seating groups together and separating non-related groups.

Personal Protective Equipment (PPE)
•   Passengers and crew should wear a suitable face mask throughout the flight
    (unless under 12 years of age, and those with other recognised exemptions).
            o Regularly changing face masks or face coverings.
            o Removing face masks or face coverings to eat and drink.
•   PPE should be fitted and worn properly with training provided to crew on
    appropriate use.
•   Crew should wear gloves when touching passenger items or other potentially
    contaminated items. Crew should remove gloves and wash hands after.
•   Designate an area, such as the galley, as a clean area for one-way traffic.
    Clean PPE enters galley and moves one way looping around in a horseshoe
    direction to remove PPE and dispose.
•   No PPE to be worn in crew area unless freshly applied and clean.
•   If a crew member helps a passenger who is sick, the crew member should wear
    appropriate PPE and dispose of this accordingly, as previously outlined.

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Screening:
    •    It is recommended airlines conduct pre-flight health screening for international
         flights to assess passengers for signs and symptoms of COVID-19.
         Recommended questions and actions are in Appendix 1.
    •    Airlines should continue normal processes for the assessment of health risks
         related to flights.

Supporting mental health and wellbeing:
The COVID-19 pandemic and associated restrictions have had a significant impact
on many people’s mental health and well-being. Part of managing the overall health
risk associated with COVID-19 is access to appropriate mental health support
services if required.
Information on support services have been developed for the aviation sector. These
are available via the Australian Government Department of Infrastructure, Transport,
Regional Development and Communication’s Aviation web page.
The Australian Government Department of Health has also prepared general
resources for supporting mental health and promoting mentally healthy workplaces
during COVID-19, including:
    •    Mental health and wellbeing support for employees during the COVID-19
         pandemic
    •    Digital and telephone support for mental health during COVID-19
    •    Mentally Healthy Workplaces during COVID-19 guides for sole traders, small
         businesses and medium to large businesses
Translated versions of these resources, and others relating to COVID-19, are
available in languages other than English via this link.
Further information on how to support air crew and aviation workers’ mental health
during the COVID-19 pandemic is available in the ICAO Electronic Bulletin:
Promoting, Maintaining and Supporting Mental Well-being in Aviation during the
COVID-19 Pandemic.

Minimising COVID-19 health risks during crew layovers at any
international destination
While in transit, crew should:
•       wear a suitable face mask or face covering and maintain at least 1.5 metres
        from people when transiting through airport terminals and other crowded places.
•       proceed directly to the crew hotel on exiting the terminal.
•       avoid crowded or public places and stay at the crew hotel, including for meals.
•       practise good hand hygiene and good sneeze/cough hygiene
•       avoid touching mouth, eyes and nose with unwashed hands

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•    limit interactions with other crew and hotel staff and avoid unnecessary
     interaction with other people
•    practise physical distancing and avoid physical contact with others.
•    remain within individual hotel room to the extent possible.

Where can I get more information?
The fact sheet has been informed by advice provided by public health experts within
the Australian Government, along with information outlined by relevant international
bodies such as the World Health Organization and the International Civil Aviation
Organization). Further information can be sought from these organisations.

Appendix 1: COVID-19 screening questionnaire
This questionnaire is to support facilities to screen for COVID-19 where an infectious
case detected would be detrimental. It is designed to be adapted for local use
according to risk.
Questions
    1. Do you feel unwell with any cold or flu like symptoms such as runny nose,
       shortness of breath, cough or sore throat?
    2. Do you/have you felt feverish or had a temperature in the last 14 days?
    3. Have you been on a cruise ship or in close contacts with a cruise ship
       passenger in the last 14 days?
    4. Have you been in contact with someone that is a suspected (being tested) or
       confirmed a COVID-19 case in the last 14 days?
Temperature
An airline may consider taking a person’s temperature as part of screening
requirements if the passenger answers YES to any of the above questions.
If anyone answers YES to question 1-4, and/or the temperature recording is
>37.5 oC they may require further assessment.
Identify an appropriate referral pathway.

                                                                                         DT000894

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