As we all know all too well, COVID-19 is an infectious disease caused by a recently discovered coronavirus, SARS-CoV-2. Symptoms of COVID-19 infection can range from none (asymptomatic) to respiratory failure and result in death. Even after the acute infection has passed, physical and mental long-term consequences can occur. Thus, COVID-19 can affect our medical certification to fly in both the acute and the chronic phases of the illness. Before looking at specific COVID-19 symptoms and their effects on pilots, a review of medical certification is needed.
Obtaining a first-, second- or third-class FAA medical certificate signifies that the FAA and its agents have determined your fitness to fly at the time the certificate was issued.
Qualifying under BasicMed is similar in the timing aspect. Assuming that you have complied with the general BasicMed requirements and completed the BasicMed medical education course, you qualify to fly under BasicMed at the time your state-licensed physician completes your Comprehensive Medical Examination Checklist.
Neither first-, second- or third-class class medical certificates nor BasicMed gives you carte blanche to fly until your next recertification. A medical certificate does not cover any mental or physical health changes that occur after the certificate is issued. As a pilot, you must determine your fitness to fly before every flight. To assess fitness to fly, two checklists can facilitate the self-certification process.
The first of these checklists, the PAVE checklist, incorporates preflight risk assessment of four areas, including the:
P = Pilot-in-command
A = Aircraft
V = enVironment
E = External stresses
For the pilot-in-command step, the pilot must ask, “Am I ready for this trip?” in terms of experience, recency, currency, physical condition and emotional condition. For the physical condition and emotional condition sections, simply asking, “Do I feel okay?” is not sufficient. To better assess factors that could influence the ability to fly, the I’M SAFE checklist provides a very useful tool. These elements include:
I = Illness. Do you have a current or recent illness that could affect your ability to fly?
M = Medication. Are you taking any medications (including over-the-counter medications) that could affect your ability to fly?
S = Stress. Are you experiencing any unusual psychological pressure and/or anxiety?
A = Alcohol. Have you had any alcohol in the last eight hours? Are you hungover?
F = Fatigue. Are you tired and/or not adequately rested?
E = Emotion. Are you emotionally upset about anything?
COVID-19 infection (current or previous) can affect five of the six checkpoints in the I’M SAFE checklist, as it is an Illness, usually requiring Medication, and COVID-19 can cause Stress, Fatigue and Emotional upset. Thus, having acute COVID-19 infection or previously having had COVID-19 demands the same rigorous self-evaluation that we would devote to any condition.
First, consider the setting of acute COVID-19 infection. Symptoms typically occur two to14 days after exposure to the virus and can include fever or chills, cough, shortness of breath or difficulty breathing, fatigue, muscle or body aches, headache, new loss of taste or smell, sore throat, congestion or runny nose, nausea or vomiting, and diarrhea.
While some pilots might perceive the loss of taste or smell as an annoyance, most of the other symptoms listed above disqualify a pilot from flying. Moreover, with COVID-19 or any acute illness, symptoms can worsen or new symptoms can emerge at any time. Some COVID-19 symptoms, such as headache, shortness of breath, difficulty breathing or cough, can worsen dramatically at altitude. Additionally, any pilot with an active COVID-19 infection or even suspected COVID-19 infection needs to self-quarantine, which precludes flights with other people.
A final thought about acute COVID-19 infection is that, according to FAR 61.53, if a pilot has or develops a known medical condition that would prevent that person from obtaining a medical certificate, then that pilot cannot act as pilot-in-command or as a required pilot flight crewmember. A physician would never sign off on a pilot’s certification if that pilot had acute COVID-19 at the time of examination.
The second part to consider is that pilots who have recovered from acute COVID-19 infection may still develop lingering effects of the disease. Although most people with COVID-19 feel better within weeks of becoming ill, some people develop symptoms that fall under the term “long COVID.” Symptoms can include fatigue, difficulty thinking or concentrating (sometimes referred to as “brain fog”), headache, loss of smell or taste, dizziness, heart palpitations, chest pain, shortness of breath or difficulty breathing, cough, joint or muscle pain, depression or anxiety, and fever. Some symptoms worsen after physical or mental activity. Other than the loss of smell or taste, the other symptoms can present major obstacles to flying safely and are thus disqualifying.
Other individuals who have recovered from the acute COVID-19 infection develop a multisystem inflammatory syndrome (MIS). In this autoimmune condition, the immune system mistakenly attacks healthy cells in the body. At this time, it is unknown how long this particular post-COVID condition may last.
Individuals hospitalized for COVID-19 treatment can develop PTSD (post-traumatic stress disorder) and PICS (post-intensive care syndrome). These disorders can affect functioning in everyday situations and can worsen during high-stress periods such as the different phases of flight.
These long-term manifestations of “long COVID,” MIS, PTSD and PICS vary in severity. The duration of these post-COVID syndromes is unknown at this time.
Thus, it is not just getting over the acute COVID-19 illness that concerns pilots. Other elements of the I’M SAFE checklist may change after COVID-19 infection, such as new symptoms (Illness), Medications, Stress, Fatigue and Emotional factors.
Most pilots will fully return to flying after contracting COVID-19. All pilots, however, need to reevaluate themselves and, as always, medically self-assess before every flight. As FAR 91.3 states, the pilot-in-command is directly responsible for the operation of the flight. This places the responsibility of ensuring that his or her health is up to the task of flying squarely on the pilot’s shoulders.