At six on a Friday morning, some two weeks ago I got on a plane at Lahore airport and at six in the evening on the same day I landed at the New York’s Kennedy airport. I have made this trip many, many times before and yes it is a tedious, twenty four hour trip. But this was the first time I travelled during the Covid-19 pandemic raging through the world.

Almost every day new information is coming out about how Covid-19 spreads. A very recent study suggests that the chance of getting infected during air travel is really very small. But I am sure that this low incident is, of course, due to precautions taken by the airlines and by the passengers themselves.

Even though my airline did not require a Covid-19 test before departure, I did get one done a few days before I left and it came back negative. Would I have travelled if my test had come back positive but I did not really feel sick? Probably not.

Of the precautions during the travels, first of course I wore a mask from the time I left home in Lahore to the time I arrived at my home in New Jersey. It was an N-95 mask which I only took off when I needed to show my face to the immigration authorities on both sides of the trip. And, of course, when having a meal on the plane or in the lounge during the transit stop.

Why an N-95 mask and not a regular surgical or cloth mask? I have written in these pages that a regular mask covering the mouth and the nose is quite effective in preventing a Corona virus infection except in healthcare environments where the virus becomes ‘aerosolised’ or becomes thinned by losing its moisture coating and can only be stopped by a high filter mask. Whether this can happen in busy enclosed and air-conditioned spaces as well as in airplanes is not really known.

Frankly, I was behaving like a doctor and indulging in an excess of caution, perhaps quite unnecessarily. And to my readers I will suggest that a regular mask worn properly is quite adequate, especially if everybody is wearing one. Here I cannot emphasise that the mask to be effective must cover the mouth and the nose.

Almost all passengers checking in were wearing masks. So were all airline and airport workers. And once on the plane, every passenger and every cabin crew member was also wearing a mask. I even saw a few people with plastic face coverings. Some airlines evidently distribute these shields along with hand sanitisers to all the passengers though the airline I was travelling on did not.

And yes, every passenger was having their temperature checked before boarding. However, I did not see any passenger being pulled aside for having a fever. I suppose a couple of Panadols or Brufens taken a couple of hours before boarding would bring a mild fever reading down to normal.

Most modern airplanes have very efficient air circulation systems. The entire cabin air is recirculated quite rapidly after being filtered to remove most if not all particles including viruses. However if you are sitting next to an infected person who is not wearing a mask and keeps coughing in your direction, and you are not wearing a mask either, even the best air circulation system cannot prevent you from getting infected.

Exposure to the Corona virus does not necessarily lead to the disease called Covid-19. Many factors are involved in leading to the infection becoming established.

Essentially three important precautions were being taken by most airlines. Checking for fever before getting on the plane, use of masks, shields and hand sanitisers and the basic air filtration system in the airplanes. Pre-flight tests for Covid-19 also help though a test done three days before travelling does not completely exclude the possibility that a traveller is infected at the time of departure.

Here an important medical point needs to be made. Exposure to the Corona virus does not necessarily lead to the disease called Covid-19. Many factors are involved that lead to the infection becoming established. These include things like the extent of the exposure or what might be called the viral load and then there is the ability of the body to fight off the infection.

Also, even after exposure to the virus it takes a few days for the person to have the infection established and then only can the infected person pass it on to somebody else. It is for this reason that a negative Covid-19 test a few days before travelling makes it unlikely that such a person even if exposed to the virus during that time is infected enough to pass it on during travel.

Now to one of the more famous precautions that is most often not followed. That is ‘social distancing’. The idea here is that the virus is most commonly spread by droplets released by an infected person while coughing, sneezing or talking loudly and these droplets can only travel a few feet before falling to the ground. Therefore any distance beyond five or six feet is safe.

In Lahore we often see a family of six travelling on the same motorcycle at ten in the morning. That is a time when shops are closed and schools are closed so the question is where are they going? Wherever they might be going, the problem is that people used to such togetherness cannot really comprehend the concept of social distancing.

And all those that have taken an international flight out of Lahore airport during the night when three or four international flights are leaving at about the same time also knows how crowded the one-door entrance to the customs area becomes.

Social distances at that entry point would lead to a line of passengers stretching all the way up to the Royal Artillery (RA) Bazaar. Frankly, our airports are not designed for the possibility of social distancing. Fortunately, on the day I left the flights were not too full and by the time I arrived the crowd had thinned considerably.

As far as social distancing inside the plane is considered, since I was in the front cabin, we did have one or two seat distance between passengers. But once airline traffic picks up, social distancing inside the planes will be virtually impossible. Hopefully, by that time the pandemic will have subsided. It is important to point out that a properly worn mask will help prevent transmission of the virus even in a crowded environment.

On arrival at New York’s Kennedy Airport (JFK), I got through immigration and customs pretty quickly. My luggage also arrived early so I was able to get out of the airport in a lot less than an hour. At JFK there were no Covid-19 questions or a fever check. But that might have been because I was travelling on a blue passport.

Things changed a bit when I got home. I have since gone through a two week self-quarantine. And I can report that I am so far evidently free of SARS-CoV-2 infection. And every one that comes to see us for any reason wears a mask as do we.

The writer has served as Professor and Chairman at the Department of Cardiac Surgery, King Edward Medical  University