COVID-19 & Flying: What About Prophylaxis?

To varying extents, most of us are afraid of flying. Most governments advise against ‘unnecessary’ travel. And we all heard about infections or even small outbreaks having occurred in planes. There have even been a few deaths attributed to COVID that occured on planes. Of course, authorities and airlines are implementing measures to make air travel safer. Yet, it appears that one can do much more to avoid getting COVID than what is required by the authorities. This is what this article is about. Quoted in the article is one of the world’s top COVID experts, Professor Paul Marik, who absolutely does not want to catch COVID and who explains how he does so both for air travel and in the ICU.

You may have heard the CEO of Qantas Airlines stating that it will be required, once vaccines are widely available, to be vaccinated to fly on the Australian airline. Other airlines, train and other transportation companies are expected to endorse similar policies.

Some countries publish data about infections on board. For example, in just the 14 days preceding December 21, there have been 116 international flights to/from Canada with cases or outbreaks, and 97 domestic flights.


Yet flying appears to be relatively safe. “The risk of contracting coronavirus disease 2019 (COVID-19) during air travel is lower than from an office building, classroom, supermarket, or commuter train,” wrote Pombal & al in an October 1 2020 JAMA article., highlighting that modern airplanes maintain clean air by circulating a mix of fresh air and air recycled through HEPA filters.

The authors mention the following steps passengers can take: 

“Wear a mask, don’t travel if you feel unwell, and limit carry-on baggage. Keep distance from others wherever possible; report to staff if someone is clearly unwell. If there is an overhead air nozzle, adjust it to point straight at your head and keep it on full. Stay seated if possible, and follow crew instructions. Wash or sanitize hands frequently and avoid touching your face.”

While relatively safe, there have been cases of infections on planes, and there will be more even with screening before boarding and compulsory masks.  In a plane, while air filtering and circulation reduce the risk of contamination, the close proximity of passengers is a particularly unfavourable factor, as no social / physical distancing is feasible.

In a plane, if you are really unlucky, you may be seated next to or at the proximity of a contagious asymptomatic person, or even a super-spreader. It’s very unlikely, but it’s not impossible. This is the kind of worst case scenario you need to deal with, if you want to minimize as much of possible the risk of getting C19 on a plane.

And even with vaccinations, which will take years to become widespread, there will be infections, as no vaccination will be 100% effective. 

A first measure you can take, on top of what is usually recommended, is to wear a N95 mask, which is much more effective than other masks at reducing virus intakes in case you are exposed. 

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When it comes to C19, inoculum, i.e. the quality of virus you inhale, matters. A May 2020 Spanish study concludes for example: “our data support that a greater viral inoculum at the time of SARS-CoV-2 exposure might determine a higher risk of severe COVID-19.”

Now can you go beyond these measures to minimize your risk of catching C19 when you need to fly?

Prophylaxis as a Complementary Protection Measure

In our recent webinar with one of the world’s top COVID-19 experts, Professor Paul E. Marik, the question of prophylaxis and transportation arose. Professor Marik not only recommended prophylaxis for high risk activities such as driving a taxi, but also recounted what he did prior to recently taking a flight.

“I don’t want to get COVID. I am completely petrified of getting COVID. It is a terrible disease. I have seen too many people suffocate and die. So what did I do when I recently went to visit my colleague in Houston? On the airplane and in the airport, I wore a N95 mask. What I did (also) is that, before I left, I took 12 milligrams of Ivermectin.” 

Professor Marik also commented on what he takes as prophylaxis when in the intensive care unit.

“When I am in the ICU, I do not want to get COVID. so when I am on clinical duties, I take 12 milligrams (I should probably take 15 milligrams cause I am a little overweight), because I have 12 milligrams tablets from Canada. That’s what I personally do.” 

Regarding his family members, he said:

“The rest of my family are at exceedingly low risk. My wife does not take Ivermectin. Yet I do what I can, so she does not get infected.”

It’s still recent information, and protocols may still evolve, but the recommendation now for pre-exposure prophylaxis for high risk individuals is a weekly dose of Ivermectin, in the right dosage, as explained in the webinar, in addition to a supplements cocktails including Vitamin D, Vitamin C, Zinc, Quercetin and Melatonin.

High risk individuals are not only those who are old or have risk factors such as obesity or diabetes. It’s also people whose work activities are known to likely expose them to an infection. This includes health care workers, workers in the meatpacking industry, and many more industries, one of them being the taxi industry.

Professor Marik specifically commented about taxi drivers: “I would consider a taxi driver high risk. He is in close contact, which is less than 6 feet for more than 15 minutes. So by definition, according to the CDC, it’s a close contact. He has no idea about the COVID status of his passengers. So, I would say that every single taxi driver should be taking prophylaxis.”

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He also commented about the movie industry, especially the set of Mission Impossible 7, where actor and producer Tom Cruise made the global headlines with a rant addressed to staff members who were allegedly not respecting distancing guidelines.

“That would not be an impossible mission. The mission would be quite simple. You would want to prophylaxis everyone on the set. Let me say that again. You would want to prophylaxis everyone on the set with Ivermectin once weekly.” 

“That would be the most effective way of limiting transmission of the disease in people who are  somewhat close together. It’s cheap, it’s effective and it would profoundly influence transmission of the disease.”

Pre-Exposure Prophylaxis and Flying in Practice

Prophylaxis with supplements – Vitamin D, Vitamin C, Zinc, Quercetin and Melatonin – is typically recommended even in the absence of a likely higher risk situation, such as taking a plane.

But when it comes to taking Ivermectin, various situations arise. There are countries where the medication is available with a prescription, either through a script from your doctor, or through a telemedicine service, which exist for example in the US and in Europe (including the UK, but that may change in 2021).

But there are also countries, such as Canada and Australia, where most medical doctors will not prescribe Ivermectin for C19 prophylaxis, and where the medication is not available without a script.

So there is no universal guideline here. Depending on your situation, you may have easy access to Ivermectin as preventative, or you may have no access at all.

What you need to do is to plan ahead to identify a medical doctor who will prescribe, if prescription is needed, and a pharmacy that will dispense the drug.

How long in advance of your trip do you need to take Ivermectin, and in what dosage? Current pharmacokinetic information suggests it does not require to be taken long in advance, even if that may be more the case for people who are overweight.

Gonzales Canga et al reviewed available information on pharmacokinetics and times required to achieve maximum plasma concentration. Those vary between 3.4 and 10.3 hours.

Several doctors contacted informally by the author suggested one or two intakes of Ivermectin, at appropriate dosage, taken on the day of the travel, or the day before. In case of two intakes, the second would need to take place 2 days after.

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Personally (this is not a medical opinion), if I travel, I will probably want to take my prophylaxis the day before travelling, to figure out if I get any side effect (unlikely, but not impossible) outside the stress of the departure.

What about Post-Exposure Prophylaxis and Flying?

While prophylaxis is better taken prior to a possible infection, it’s also possible to consider taking it “post-exposure.” This is particularly important when you cannot access Ivermectin in your country of departure, but can access it at your destination.

You would need to investigate if you can get access to Ivermectin in your country of destination, and if it requires prescription or not. There are quite a few countries, including in Africa, Asia, South America and the Caribbean, where Ivermectin is widely available, sometimes over the counter. Note that the drug is generic and sold under a variety of brand names. 

In case you can’t take it pre-exposure, post-exposure prophylaxis with Ivermectin, combined with pre-exposure with the above supplements (Vitamin D, Zinc, etc.), would be a second-best option to consider.

To Conclude

Especially if you are a high risk person, i.e. above 60 and with health issues such as diabetes, Ivermectin-based prophylaxis, in addition to wearing a N95 mask and complying to all the mandated measures for flying, may help reduce your risk of developing the COVID-19 disease.

Other prophylaxis protocols exist for COVID-19, and are widely used in some countries for high risk groups, such as health care workers. While information still evolves, recent data suggest that Ivermectin-based protocols provide the best protection for COVID-19.

If one thinks one step beyond, what may be suitable is for all passengers, or at least those identified as at significant risk, to take prophylaxis before flying. This is something that airlines could pretty easily implement as a means to make the flights they operate safer.

One group that would benefit a lot from such measures would be the airline personnel, for whom prophylaxis actually also makes lots of sense, given the high risk of repeated exposures they are facing at work.

If you are not yet familiar with the prevention of COVID-19, please watch the full webinar with Professor Paul Marik. 

The most compelling evidence of Ivermectin to be effective as prophylaxis probably is the peer reviewed article published in the Journal of Biomedical Research and Clinical Investigation and titled “Study of the Efficacy and Safety of Topical Ivermectin + IotaCarrageenan in the Prophylaxis against COVID-19 in Health Personnel” by Carvallo  et al.

“The overall infection rate in health care workers recruited for this study was 20% with 237 testing positive for CoVid 19 during the 3 month study recruitment. Of those infected, all patients were from the comparator group of using PPE alone. This represented an overall infection rate of 58.2% (237 of 407) in the PPE group. No patients of the 788 treated with IVERCAR tested positive for CoVid 19 during the study.

For a list of articles where prophylaxis was covered: