The child in the window seat was sneezing and coughing. Passengers nearby grew increasingly nervous that perhaps the kid had Covid-19 and was spreading the virus. The mother claimed allergies; flight attendants said there was nothing they could do.

Sick passengers on airplanes have become a deeper concern for travelers during the pandemic, as this scene was for a friend of mine. The controversy around how airlines treat the sick has grown, since they give passengers a big financial incentive to fly while ill.

Most carriers in the U.S., and many others around the world, charge fliers the difference in fare between their discounted advance-purchase ticket and a new ticket to travel after illness recovery. That often means a one-way unrestricted walk-up fare, usually hundreds and even thousands of dollars more, which some fliers can’t afford and none are happy to pay.

“The pandemic has really underscored the need for a sick-passenger rule,” says Charles Leocha, president of Travelers United, a Washington, D.C., advocacy group. “Something needs to be done to give people an affordable alternative.”

He faced the issue when he got sick in Spain four years ago. Delaying his trip home would cost $2,000 in airfare, even though he had a note from the doctor who had just treated him at a hospital for an infectious lung ailment, as well as X-rays. Rather than wait until his fever and cough subsided, he got on the flight—and soon after began advocating for a rule addressing very sick passengers.

Airlines argue that removing all financial penalties for sick passengers would mean anyone could extend a trip just by feigning illness. That would upend the entire fare structure. Need another day to close a deal? Meet a new friend and want to stay longer? Just tell the airline you’re not feeling well and fly whenever you want, as long as there’s an open seat.

Requiring a doctor’s note has proved a feeble deterrent in the past—just look at the wave of emotional support animals enabled by doctor’s orders purchased online.

Airlines for America, the industry’s trade group, says passengers who worry about the cost of getting sick could purchase full-price refundable fares. The group also notes that many airlines have done away with most change fees, which had been added on top of fare differences before, and some have been more lenient with allowing ticket changes during the pandemic.

“The adjustment of travel policies to offer vouchers and credit is an effort by carriers to be responsive to customer needs and allow passengers to avoid traveling when they are sick,” an Airlines for America spokeswoman says in an email. “We encourage travelers to communicate with their carrier regarding individual circumstances.”

A Senate committee recently passed an airline-industry health-safety bill with bipartisan support that calls for establishing a joint task force on air travel during and after the pandemic. The task force would be expected to issue recommendations on health, safety, security and logistical challenges for air travel.

Facemasks on passengers have likely reduced the spread of all kinds of contagious illness, medical officials say. But when masks are no longer required on flights, sick passengers likely will be a big concern for travelers.

Photo: Steve Pfost/Newsday/Getty Images

In an interview, Sen. Richard Blumenthal, the Connecticut Democrat who co-sponsored the health-safety legislation, calls airline handling of sick passengers “really insidious malevolence,” because it encourages dangerous travel.

“What they are doing now is creating incentives for sick or contagious people to fly. That really can’t be good for their own employees,” he says, adding that now is a good time for airlines to reconsider travel policy and penalties because carriers got gigantic government bailout support in the pandemic.

Airlines have been pushing improved health standards and practices during the pandemic, trying to reassure customers that getting scrunched next to other passengers is safe because of robust ventilation and enhanced cleaning procedures. Studies have shown that diseases can spread in cabins, with higher occurrence for people within two rows of an infected passenger.

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United got the Cleveland Clinic to endorse its health standards; Delta is working with the Mayo Clinic on health issues. Both medical organizations say they can’t comment on airline policies regarding sick passengers.

“Our work with Delta is intended to help make travel safer, or as safe as possible, but of course there are limitations to that,” a spokeswoman for the Mayo Clinic said in an email.

Some carriers do make accommodations for sick passengers. Singapore Airlines lets sick passengers delay a flight and travel on their original ticket within the same season. A Singapore spokesman says the carrier hasn’t had a problem with passengers abusing the flexibility offered to sick passengers.

Air Canada says it introduced a refundable fare called Comfort in 2018 that gives passengers more ability to make changes to plans. On a Houston-Toronto round trip for September, Comfort fares this week were almost double the lowest economy fare, $754 compared with $388. A spokesman also suggests that customers concerned about having to pay more if they get ill should purchase travel insurance.

Like higher refundable fares, purchasing travel insurance means an added cost whether you get sick or not. And if the illness is related to a pre-existing condition, many travel insurance policies won’t cover added travel costs.

Mr. Leocha, the consumer advocate, says he doesn’t have an answer for how airlines should handle sick passengers because he expects people would take advantage of that leniency, as they did with their pets.

“It’s a tough call. However, it’s a call that the airlines have to figure out,” he says. “Right now, airlines have no way to say someone can’t fly.”

Write to Scott McCartney at [email protected]

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