Professor Michael Bagshaw, Dr Sarah MacKenzie Ross, Professor Helen Muir and Dr William Toff

10 JULY 2007

  Q160  Baroness Platt of Writtle: In the event of an outbreak of a major disease like pandemic flu, air travel would or could be the first crucial vector in the spread of the disease. Can anything be done to mitigate that effect?

  Professor Bagshaw: The World Health Organisation, the International Civil Aviation Organisation and the International Air Transport Association have in place a series of protocols and procedures which have been tested and have been audited in the Far East. Frankly, we will only know if it works when the epidemic or the pandemic happens but procedures are in place and it is a well-recognised risk. We can never take risk out completely, and this is a high risk area, but the industry and the international organisations are cognizant of that risk.

  Q161  Baroness Platt of Writtle: Has any research been carried out on how air travel is a vector in the spread of disease generally?

  Professor Bagshaw: Yes. The World Health Organisation in association with ICAO and IATA have looked at this. I am afraid I have not come prepared with the data, but there has been work.

  Q162  Baroness Platt of Writtle: It would be a good idea perhaps to let us know, if you do know the data, because that would help us.

  Professor Bagshaw: Yes.[12]

  Q163Baroness Platt of Writtle: In your opinion, are screening procedures at the airports robust enough?

  Professor Bagshaw: No, frankly. Putting a thermometer in somebody's ear is not very helpful. You rely very much on the appearance, the personal screening and it is back to personal declaration, somebody saying "I feel unwell; I don't feel fit to fly". If you have good reason to fly, you are not going to admit to having a problem. Frankly, I do not see an easy answer.

  Q164  Baroness Platt of Writtle: Do you not have a recommendation?

  Professor Bagshaw: No, I have no recommendation.

  Q165  Lord Sutherland of Houndwood: At the time of the SARS outbreak in Hong Kong, when you went through Hong Kong Airport there were screening devices as you walked in, I understand taking your temperature.

  Professor Bagshaw: That is correct.

  Chairman: They were still there last Tuesday when I flew into Hong Kong.

  Q166  Lord Sutherland of Houndwood: Are they helpful, minimally or maximally?

  Professor Bagshaw: I believe they are of minimal benefit because there are many causes for a raised temperature and in the early parts of the prodrome your temperature may not be raised anyway. It is a little bit of being seen to do something.

  Q167  Chairman: Surely, it could not do any harm to pull in people with a high temperature and just check what the reason was.

  Professor Bagshaw: No, it would do no harm but there is no guarantee that they indeed have any infectious process going on. Picking up on your point, to see what is causing the temperature is very difficult in an airport situation.

  Q168  Lord Howie of Troon: I was in an aeroplane on Sunday coming back from Budapest and a lady, who was quite clearly afraid of flying, was conducted aboard by a stewardess. Is there much of that particular problem?

  Professor Muir: To get hard evidence is very difficult, but there are undoubtedly people who fly when they are extremely anxious about it. There are courses which they can attend. I also understand—I am nervous with all the doctors here—that if you go to your GP, you can be given medication to reduce anxiety before you fly, but the cabin crew are also trained to help passengers when they experience these difficulties.

  Q169  Lord Howie of Troon: I think they were keeping an eye on this particular lady.

  Professor Muir: They would do; certainly.

  Q170  Chairman: Just before finishing, may I return to you Professor Bagshaw? With the pilots who experienced a fume event and then followed instructions and breathed 100% pure oxygen, what were the types of symptoms that continued then and what are the major first symptoms, other than an unpleasant smell?

  Professor Bagshaw: The symptoms reported are tingling in the extremities, dimming of vision, slight headache, inability to think clearly and a sense of anxiety. The cognitive processes, the tingling of the fingers, the dimming of vision, are all well reported and they occur in a number of medical conditions.

  Dr MacKenzie Ross: Some of the symptoms are what we call non-specific and occur in many medical conditions like headache and feeling tired. Some of the symptoms, things like eye, nose and throat irritation, are actually more indicative of an environmental irritant being present, so there is a mixture of symptoms. The pilots that I saw reported that, if there was a major fume event, they might have these symptoms and it would also include cognitive impairment. Some pilots were cognitively impaired and unwell and lacked insight and had to have their difficulties pointed out by the co-pilot. So people are not always aware that they are under-functioning and this is something that really is of great concern. Also, some pilots say that although they are aware of a smell on board an aircraft, they habituate to the smell and after a while they are no longer able to tell whether it is present or not and they may be unaware of any impairment that has fallen upon them. For that reason alone relying on pilots to be able to tell whether or not a fume event has occurred and whether or not they are impaired is less than ideal.

  Q171  Baroness Platt of Writtle: It is dangerous.

  Dr MacKenzie Ross: Yes; exactly. There should be some sort of objective monitoring which would indicate whether there is a problem or not. I had one pilot who was in a very famous fume event where the plane literally nearly crashed and he said the problem was that he was so incapacitated he could not even raise his arm to pull the oxygen mask down and he was actually slumped over the controls staring at the ground thinking "I'm going to die". He now has post-traumatic stress disorder as a result of the strength of belief he had that he would not be able to recover or help himself by putting on oxygen. Luckily someone else did manage to assist him; his co-pilot was not incapacitated to the same degree at the same time and they were able to put on oxygen and they recovered and they managed to get control of the aircraft again. The kind of stories that have been reported are really quite alarming and a lot more research needs to be done to look at this issue further.

  Q172  Lord Colwyn: How long does a fume event normally go on for? You do not want to be breathing oxygen too long either.

  Dr MacKenzie Ross: No. The oxygen does not last that long, so you have an issue there as to how long it will last. Depending on the aircraft type, my understanding is the BAe146 pilots report that it can smell almost continuously throughout flight, but that when they fire the engine up, they often perform a procedure called a pack burn where they try to burn off the smell by increasing the heat, but that in itself can produce fumes. With the 757, the fumes apparently vary according to the stage of flight; they are worse on take-off and landing and seem to dissipate during flight. We do not really understand enough about what comes in, how long it hangs around, what level it is coming in and how it affects people and that is what we need to investigate further.

  Q173  Baroness Finlay of Llandaff: May I just ask you about the 100% oxygen? What are the cardiovascular effects of breathing 100% oxygen for a length of time? When you say it does not last long, over what timeframe is the oxygen store there for the pilots?

  Professor Bagshaw: They are breathing 100% oxygen for 15 to 20 minutes. It is of interest that the United States Navy pilots breathe 100% oxygen all the time. That is their normal gaseous breathing supply and there is no evidence of harm to the US Navy pilots.

  Chairman: We have run out of time. Thank you very much for your evidence. We appreciate the fact that you have come to speak to us and the time you have given us. Please, if you think of anything else that we need to know, do let us know. Thank you very much indeed.