Stopping Coronavirus 2

Credit: Bogdan Khmelnytskyi

Scientists named it SARS-CoV-2, short for Severe Acute Respiratory Syndrome caused by a second-generation coronavirus. It’s the seventh strain of betacoronavirus that has infected humans and it spreads up to 10 times as fast as the original 2002 SARS-CoV bug. Other coronaviruses include Middle East Respiratory Syndrome (MERS) and four milder viruses that cause common colds.

First discovered in the 1960s, these germs get their names from the crown-like spikes on their surfaces. SARS-CoV-2 began as a mutant form of betacoronavirus that originated in bats, perhaps ones that were slaughtered in so-called “wet markets” in Wuhan or Guangdong. Transferring and mutating between species of different wild animals in very close proximity inside the markets, this novel virus finally morphed into a zoonotic form that infected people.

Because this is a novel virus, humans have no natural immunity to it. Even so, 80+% of the people who come down with COVID-19 (coronavirus disease discovered in 2019), the illness caused by SARS-CoV-2, experience mild to moderate symptoms, including fever, dry cough and shortness of breath.

The other 20% can become seriously or fatally ill. Pneumonia is a major cause. Doctors at China’s Centers for Disease Control determined that people over the age of 65 are particularly at risk from COVID-19, especially if they have pre-existing medical conditions, such as diabetes, lung disease or hypertension. The U.S. Centers for Disease Control and Prevention also warns that people undergoing cancer treatment and with compromised immune systems, or those with heart conditions, long-term corticosteroid use or severe obesity, especially if accompanied by liver or kidney disease, are more at risk. Chinese scientists also hypothesize that their statistics are skewed because the vast majority of people who contract COVID-19 quickly recover and never report their symptoms to medical authorities. At this point, the testing is inadequate to determine the true rate of infection.

SARS-CoV-2 is spreading far faster than previous coronaviruses, such as the 2002 SARS-CoV-1, especially as the world population has grown more than 20% since 2002 and there is much more affordable access to international air travel. The rate at which the infection spreads from one person to others, known as R0 (R naught) or R-factor, is between two to three, perhaps higher because of the unique characteristics of this form of coronavirus compared to other strains. One person infects three, three infect nine, nine infect 27, 27 infect 81. In contrast, common flu bugs have R0 factors of about 1.0 to 1.3.

Moreover, “silent transmission” of the virus can occur during the period after a person becomes infected but before experiencing COVID-19 symptoms. This phenomena became apparent on the cruise ship Diamond Princess in February when more than 600 people aboard tested positive but fewer than half showed symptoms. All those infected potentially were contagious.

SARS-CoV-2 spread from China to other regions in early 2020, recently including the U.S. The first case in the U.S. was confirmed in January. It slowly ramped up to eight in early February, then 42 in early March. But then in mid-March, COVID-19 began to spike exponentially in the U.S. By late March, more than 112,000 cases had been confirmed, almost half of which were in New York City. The Big Apple is becoming America’s Wuhan Virus Central, with New Orleans emerging as another center.

As with COVID-19 outbreaks in China, Iran and Italy, the rapid spread of COVID-19 in the U.S. threatens to overwhelm health care facilities. The University of Washington’s Institute for Health Metrics and Evaluation (IHME) projected the U.S. epidemic to peak in mid-April 2020 with more than 460,000 cases. Between now and early August, the IHME estimates that more than 81,000 people will die of the disease, with 79,000+ by June 1.

At present, there is no vaccine, no cure, no medicines proven to fight the virus. Limited clinical trials using protease inhibitors, such as lopinavir and ritonavir, and/or chloroquine or hydroxychloroquine approved to fight malaria, have yielded mixed results, anecdotally positive in some cases. Health officials say we’re months away from getting a SARS-CoV-2 antiviral vaccine approved.

So, it’s critical to flatten the exponential expansion of the disease, drag it down into a months-long, gradual rise and fall of those infected in order to buy time to beat the bug and avoid overwhelming hospitals and healthcare providers. It’s back to basics, just as it was with the bubonic plague in the 14th century: Social distancing, self-quarantining, strict personal hygiene, shelter in place. Do it long enough and wait out the disease. But the months-long pause could result in devastating economic consequences the likes of which no one has experienced.

Here’s what some aviation organizations are doing to combat SARS-CoV-2 while maintaining essential services.

NBAA’s Resource Center

The NBAA provides a broad range of resources and references to help members protect against the spread of coronavirus. Information from the NBAA is available on U.S. ports of entry for international flights, restrictions on arrivals from specific countries, updates on ATC facilities closures due to virus contamination and individual state shelter-in-place orders. There are links to the FAA’s SAFO 20003 (Safety Alert for Operators) on COVID-19 as well as the CDC website.

Elevated body temperature often is the first sign of COVID-19. SAFO 20003 emphasizes self-quarantining for anyone who has a fever of 100.4F (38C) or higher, staying away from crowds, avoiding public transportation and maintaining a distance of 6+ ft. between people. It recommends only using ground transportation arranged by one’s employer, staying inside hotel rooms as much as possible and using room service or food delivery services rather than eating in restaurants. Other precautions include frequent 20-sec. soap-and-water hand washing, use of 60% minimum alcohol hand sanitizers and avoiding touching one’s face. The FAA also recommends choosing lodging facilities close to airports and checking ahead to determine how well they’re cleaned and sanitized.

The advisory also suggests finding contact information for local health departments, taking one’s temperature twice daily, and checking for cough and shortness of breath — all early warning signs of the onset of COVID-19. And, of course, steer clear of sick people, being mindful of the fact that in the early stages of COVID-19, the symptoms can mimic the common cold or seasonal flu.

The SARS-CoV-2 virus can remain active on hard surfaces for 72 hr. or more, cardboard for 24 hr. and aerosols (cough and sneeze droplets) for 3 hr. or more, according to a study in the New England Journal of Medicine. The NBAA provides an “Aircraft Disinfection and Cleaning Procedures” guide that recommends cleaners don personal protective equipment (PPE) for enhanced cleaning of aircraft on which people with COVID-19-like symptoms have traveled. It details sanitizing procedures and products that are effective. The association also provides links to aircraft manufacturers’ documents, including Bombardier, Dassault, Embraer, Gulfstream and Textron, that suggest recommended sanitizing products least likely to damage interior furnishings.

It’s critical to assume that PPE, including gloves, is contaminated after cleaning and sanitizing processes are complete and thus after use must be put into bio-safe containers for disposal or transport to cleaning facilities. Cleaning staff are advised to take warm, soapy showers and dress in clean clothes before coming into contact with other people, offices or homes. Clothes hampers need to be cleaned and disinfected after contaminated PPE has been removed for cleaning.

The CDC provides comprehensive instructions for how to clean surfaces to remove grime, germs and impurities and then how to disinfect with chemicals to kill germs. It lists 350+ EPA-approved disinfectants, along with well-proven diluted solutions of household chlorine bleach or 70% alcohol. The University of Virginia also recommends certain glutaraldehyde, phenolic and iodine compounds.

As coronavirus remains active on surfaces, the CDC recommends cleaning and sanitizing anything that people might touch in homes and offices, including landline and mobile phones, door and cabinet knobs, light switches, bathroom fixtures, soap dispensers and faucets, tables, desks and work surfaces, and staircase handrails. Computer screens, keyboards and cursor control devices must not be overlooked as germ sources.

Oddly, neither the NBAA nor the CDC discuss using face masks. We’ve witnessed new ab initio pilots arriving from mainland China on international airline flights, destined to undergo pilot training in the U.S. These days, they all wear masks and observe strict personal hygiene protocols. They’ll wave, but they don’t shake hands or make personal contact. Six months ago, we saw them smile and shake hands. When asked about these disciplines, they say it’s not just about avoiding catching the disease, but also about preventing its spread from themselves to others, should they be infected but have yet to show symptoms.

Risk Management Protocols

Matt Hagans, CEO of Eagle Creek Aviation, the Indianapolis-based family of aircraft charter, management, sales, maintenance and FBO companies, takes heed of NBAA, World Health Organization and CDC guidelines and directives, as well as best practices recommended by aviation industry specialists. In addition to daily cleaning of facilities, he also has all surfaces that people might touch cleaned and disinfected at least three times throughout the work day.

Pilots and staff are adhering to social distancing, handwashing and covering their coughs. At the first sign of cold, flu or COVID-19 symptoms, employees are sent home for quarantine, assured their jobs are secure when they’ve recovered and are able to return to work.

Charter and managed aircraft are cleaned and disinfected after each flight, using products recommended by aircraft manufacturers and/or “hospital grade,” EPA-approved chemicals. Hagans considers these protocols to be a personal responsibility, as some of his clients are elderly, have pre-existing medical conditions or are undergoing cancer treatment that compromises their immune systems.

Aircraft inducted for maintenance are cleaned and disinfected using the same procedures as charter and managed aircraft to assure they’re germ-free when delivered to customers.

Another large, midwestern operator that wishes to remain anonymous explains that it’s considered to be an “essential business” in accordance with its state health department’s stay-at-home order intended to curb the spread of the virus.

“Essential also means we have to be extra vigilant, super proactive. An epidemic could shut us down,” says a company official. Nonessential staff members have been sent home. The company is using videoconferencing in place of face-to-face meetings whenever possible.

He added, “We’ve halted all domestic travel, except for emergencies. International travel must be pre-approved. We’ve recalled most of our international people. Those returning from China or Italy are self-quarantined for 14 days.”

But the MRO business unit still has to provide essential AOG maintenance issues, so it’s keeping its technicians at work and taking steps to prevent the spread of COVID-19 among the staff. It’s splitting shifts to reduce the number of employees on site at any one time. It’s staggering work breaks and using multiple break rooms to reduce the number of people who congregate.

Furthermore, it’s locking down most entry doors and restricting access through only a select few points. Employees entering the premises are screened for body temperature. Fever frequently is the first symptom of a COVID-19 infection. “This is everybody, every day,” says the official.

Anybody who exhibits mild cold or flu symptoms immediately is sent home for at least three days. If the employee is asymptomatic after 72 hr., he or she can return to work. However, if symptoms persist or worsen after three days, the firm requires employees to self-quarantine for a total of 14 days.

The company has designated monitors who enforce its rules. It also strongly encourages staff members to observe social distancing and shelter-in-place protocols when off work.

Still, some people are minimizing the risks of spreading the disease, sloughing off the guidelines, meeting their friends and partying after work, says the official. Many openly talk about their social gatherings and post pictures of events on social media.

“They can do as they please after work. But they may find we won’t let them return to work here,” he added. “This is all about risk management.”

Interiors of aircraft inducted for maintenance are considered contaminated. Mechanics first work on the outside of the aircraft. If access to the flight deck or cabin is required for maintenance, staff members in PPE carefully disinfect those areas to be occupied by mechanics. Access to the inside of aircraft is limited to only those areas where maintenance functions will be performed.

Cleveland-based Constant Aviation announced that it is treating the entire 160+ Flexjet fleet with MicroShield 360, an antimicrobial coating that is electrostatically applied after first cleaning and disinfecting aircraft interiors.

The firm “has been evaluating a number of products over the past year and MicroShield’s solution and electrostatic application process offers an incomparable aviation solution,” said Constant CEO David Davies. “Since becoming the only MRO certified to apply MicroShield to aircraft, we have applied the product to more than 40 aircraft via our MRO facilities and we are nearly finished applying MicroShield to the entire Flexjet fleet.”

It costs about $3,000 to apply MicroShield 360 to large-cabin aircraft, but according to Constant it is effective in killing 99.99% of bacteria, along with reducing “viruses, mold, algae, yeast, mildew, fungi and odors.” The EPA-approved product is clear, colorless and odorless, proven safe and hypo-allergenic for humans and pets, say company officials. 

Post-COVID-19 Protocols

The SARS-CoV-2 pandemic serves as a wake-up call for the aviation community, a warning that even more virulent and contagious zoonotic diseases may emerge from bats and other animals. The world population is projected to grow to 8.5 billion by 2030, 9.7 billion by 2050 and 10.9 billion by the end of the century, according to the United Nations. Ready access to international airline travel, coupled to forecast population growth, potentially will increase the spread of disease exponentially.

Thus, the business aircraft community cannot relax from strict cleaning and disinfecting procedures, along with comprehensive personal hygiene protocols, after the COVID-19 pandemic has passed. People must assume their hands are contaminated after opening doors, holding handrails, handling packages, touching tools, manipulating cockpit controls, hoisting luggage, using a handkerchief or even shaking hands. Handwashing and hand sanitizing will be even more critical before touching food or face.

Aircraft should be cleaned and disinfected often. Flight decks are known to be germ-laden, so they too should get special attention. One airline pilot tells BCA that he assumes everything up front is contaminated. He won’t touch a crew meal without using hand sanitizer.

New technologies are emerging to disinfect facilities and aircraft. One firm, for instance, is developing a mobile ultraviolet germicidal irradiation (UVGI) system that uses short-wave (UV C) light to neutralize or kill germs by destroying RNA and DNA. Such systems already are in use by more than 300 hospitals. Using a similar system adapted for aviation use, technicians could sweep through an entire large-cabin business aircraft interior in 10 min.

Regardless of promising new technologies, personal and corporate responsibility remains key to preventing the spread of disease. Those with cold or flu symptoms, such as coughing and sneezing, will quite likely feel peer pressure to wear face masks if coming into contact with others. People will feel increasing pressure to self-quarantine at the first sign of illness. No longer will it be acceptable, much less encouraged, to come to work with a cold or the flu. Employers will feel compelled to authorize sick leave to ensure employees don’t return to work until they’re healthy. Working at home and videoconferencing will likely become more commonplace to promote social distancing.

As noted, disease prevention is all about risk management. As always, business aircraft operators need to identify, rate and mitigate risks, including this new one, while continuing to provide travel services. COVID-19 was a surprise attack that is causing severe health and economic consequences.

Prompt, decisive, prophylactic action can help flatten future pandemic mountains into molehills. But only if we heed the hard lessons we’re learning from the 2020 global health crisis.

Fred George

Fred formerly was senior editor and chief pilot with Business & Commercial Aviation and Aviation Week's chief aircraft evaluation pilot. He has flown left seat in virtually every turbine-powered business jet produced in the past three decades.