The hantavirus outbreak on a cruise ship earlier this month, which saw a transiting passenger collapse at OR Tambo International Airport, served as a reminder of how public health can intersect with global air travel.
For travel professionals and travellers, it highlighted a question that goes beyond managing a localised virus. When is a client simply too sick to fly?
To provide actionable clarity, the South African Civil Aviation Authority (SACAA), on behalf of global aviation bodies and South African airlines, maintains strict health protocols and medical clearance frameworks.
When should passengers report their illness?
While ordinary passengers are not generally required by SACAA to disclose all pre-existing medical conditions before boarding a flight, airlines may require passengers to provide medical information or medical clearance where a condition could affect the safety of the passenger, other passengers, or the operation of the flight.
“Passengers are encouraged to consult a medical practitioner before travelling if they are unsure whether they are fit to fly. The aircraft environment, including reduced oxygen levels, prolonged sitting and cabin pressure changes, may aggravate certain underlying medical conditions,” a SACAA spokesperson explained.
However, when it comes to communicable diseases, passengers may not always show symptoms during travel due to incubation periods or the masking of symptoms through medication.
“For this reason, aviation public health measures rely on a layered approach involving passengers, airlines, airports, health authorities and aviation regulators,” said SACAA.
Who can deem a passenger ‘unfit to fly’?
Airlines may refuse boarding where a passenger appears visibly unwell or where there are concerns that the passenger may pose a health or safety risk to themselves or others on board the aircraft, confirmed SACAA.
Airlines’ cabin crew along with airport personnel are trained to identify certain symptoms and signs that may require further assessment before travel, including persistent coughing, breathing difficulties, vomiting, diarrhoea, fever, an unexplained skin rash, bruising or bleeding, or irrational behaviour.
Where concerns arise, the matter may be escalated to a supervisor, medical personnel or the relevant public health authority before a decision is taken on whether the passenger may travel.
Airlines also apply their own conditions of carriage and operational procedures when determining whether a passenger is fit to fly.
Airline policies
Certain airlines offer passengers leniency with rebooking their flights should the passenger be deemed unfit to fly by a medical professional or by the airline and airport personnel, supported by medical opinion thereafter.
Airlink
Airlink’s ‘Fitness to Fly’ policy contains special clauses for passengers deemed unfit at the time of their flight.
“If a passenger appears to be physically ill in the terminal area or while boarding the aircraft, or presents other symptoms which create a reasonable concern that they may not be able to complete the flight safely, the passenger may be denied boarding and not be permitted to travel until medical clearance is obtained,” says the airline’s Fitness to Fly policy, clause 6.1.3.
The airline requires confirmation to fly from a medical professional at least 72 hours before the flight departure time for a condition that is believed to be actively contagious or communicable and life threatening to other passengers or crew; which may cause or induce unusual behaviour, or a physical condition that could have an adverse effect on the safety, welfare and comfort of other passengers or crew members; or which is considered to be a potential hazard to the safety of the flight.
An Airlink spokesperson explained that should a passenger cancel their booking at least one hour before their departure time in these specific situations, they will be able to place their tickets on hold.
“When the passenger is ready to rebook, depending on the scenario, they will need to provide a doctor's letter advising that they placed their tickets on hold due to their being unwell,” explained the spokesperson.
“Airlink will then authorise a waiver of the rebooking fee as per the fare rule of their ticket. However, the passenger will be liable for any fare differences if tickets in the same booking class are not available for their new flight.”
FlySafair
In FlySafair’s policy, the airline allows for ‘medical passengers’ to change their flight prior to its departure or receive a refund.
The policy identifies medical passengers as “passengers who have been physically or mentally compromised due to temporary or permanent disability or incapacity, have undergone surgery, hospitalisation, experienced illness”.
These passengers must submit a medical clearance and the FlySafair special-needs form directly to FlySafair no later than 48 hours before departure.
“Passengers who are deemed unfit to fly with a doctor’s note, will receive 50% of their fare back if they missed the flight and didn’t opt for a refund, voucher or change before the flight,” explained Kirby Gordon, Chief Marketing Officer of FlySafair.
Personal responsibility
While airlines have these policies in place to protect their staff and passengers’ interests, it is also the responsibility of passengers not to travel when seriously ill or when advised by a medical practitioner or public health authority.
“Ultimately, preventing disease transmission in aviation is a shared responsibility between passengers, airlines, airports, health authorities and regulators,” said SACAA.
