AINsight: Aviation Medicine in the Pandemic

 - May 8, 2020, 12:02 PM

This story is part of AIN's continuing coverage of the impact of the coronavirus on aviation.

Everything was going along just fine. Almost too smoothly, you worried, with a growing sense of foreboding. All flights had a tailwind, airline and corporate flight departments were healthy, and then, suddenly and without warning, the dreaded ATC communication was received, “Covid-19 heavy, holding instructions, advise when ready to copy.”

Go ahead,” you mumble, without much enthusiasm and with increasing trepidation. “Covid-19 heavy, you are cleared direct to PNDMC intersection, hold as depicted, descend to and maintain your least fuel-efficient altitude, expect further clearance in about a year or so.”

Seemingly out of the blue, we find ourselves in a worldwide crisis. Every aspect of aviation, the economy, and the healthcare system are in turmoil. I will not philosophize as to how we (the whole world) found ourselves so unprepared for a global pandemic, nor will I speculate on what the best mitigation measures might exist to contain the virus and return our society to whatever the “new normal” might be.

I am neither an epidemiologist nor an infectious disease specialist. Therefore, I refer pilots to the Centers for Disease Control and Prevention (CDC) and World Health Organization (WHO) websites for medical information and science-based guidance.

I wish there was more known about “the virus,” especially in regard to how and when we can expect to restore society to some semblance of function. The culprit—a novel coronavirus, Covid-19—has wreaked havoc around the world. I ask everyone to have patience and comply with CDC recommendations, as well as those issued by local, state, and federal governmental authorities. That’s what I’m doing, as frustrating as some of the protocols and policies might be.

My goal in this discussion is to provide some guidance as to how to navigate the FAA medical process during these difficult times. While my introduction was a bit tongue-in-cheek, please understand that it is not my intent to minimize the seriousness of the challenges presented by Covid-19.

I also recognize that families, health care workers, first-responders, and the support staff in all “essential businesses” have been working tirelessly and often at great personal risk in their efforts to aid their relatives and our fellow citizens. I applaud everyone who has contributed in any way to the betterment of society during this difficult circumstance.

Once rearing its ugly head a few short months ago, it quickly became clear that the virus was going to cause serious disruptions to daily life, including social distancing and many other behavioral modifications. Flying either as a pilot or passenger is not the most amenable of activities consistent with social distancing. Face-to-face medical examinations, by definition, require close contact between physician and patient.

It is my hope that, in time, the economy and aviation itself will again flourish. Since airplanes still need pilots to fly them—as an aside, I hope that pilots will never be excluded entirely from an automated cockpit—and since all commercial pilots still need to possess FAA medical certificates to operate as a required crewmember, we have to figure out how to make the process to obtain a medical certificate as Covid-friendly as is possible.

When the impacts of the pandemic were becoming apparent, pilots, aviation organizations, and AMEs asked the FAA to consider temporary relief from the requirement for pilots to obtain regular ongoing FAA medical certificates. Part of the rationale for this request concerns the obvious potential virus transmission risks during a close face-to-face encounter in a small exam room. However, in regard to AME risks, there are other factors to consider.

At a recent AME refresher conference that I attended, the average age of the AMEs in attendance was approximately 64. That age, by definition, is considered high risk for Covid-related complications. At my current age of 65, even though I am generally healthy (and continue to hike 20 to 30 miles weekly in the mountains of Colorado), I too am at high risk.

What some of us hoped for was a ruling somewhat to this effect: “All medical certificates and special issuance authorizations that are currently valid will remain valid for an additional three months.”

Everyone cheered when the FAA issued legal order FAA-2020-0312 on March 26 that, at first glance, seemed to do just that. But it didn’t. Not quite, anyway. 

What the order stated was that pilots “flying in noncompliance with medical duration standards” will be immune from FAA prosecution for doing so. In other words, the FAA won’t take action against a pilot who is knowingly violating the FARs and flying with an expired medical certificate.

This “exemption” applies to medical certificates that expire between March 31, 2020, and June 30, 2020. The exemption further only applies to operations within the U.S. The presumption also exists that, by the end of June, everyone needs to have a current medical certificate.

Nowhere in the order does it state that a pilot’s medical certificate remains “valid” during the exemption period. Having that one word included in the order would have made it much tidier in my opinion. As an 11,000-hour former airline pilot myself, I wouldn’t be very comfortable flying around with an expired medical certificate.

From the standpoint of an AME who is continuing to put themself at risk by conducting pilot medical exams, another issue with the three-month grace period is how a busy AME will be able to take care of all of their April, May, and June pilots all at the same time (at the very end of June or perhaps the beginning of July), while still making time for all of the July pilots. I know I certainly don’t have time to see a typical four-month grouping of pilots in one month.

After reviewing the implications of the FAA legal order, the Office of Aerospace Medicine published the following recommendation: “If you are able, we continue to encourage airmen to accomplish their regularly required airman medical certificate exam with an FAA AME.” Apparently, the FAA’s own aerospace medicine advisors didn’t think that the ruling sufficiently simplified the logistics of medical certification considerations during the pandemic.

The airlines raised questions about the risk of pilots flying outside of the U.S. with expired medical certificates. Given that there are numerous people stuck in various countries worldwide still awaiting repatriation flights, I know I certainly wouldn’t even consider leaving the country, operating as a required flight crewmember, with an expired medical certificate.

On March 30, the FAA, through the Office of Aviation Safety amended the exemption to permit pilots to operate outside of the U.S. using theoretically expired medical certificates. This ruling has slightly different wording, “granting an exemption that extends until June 30, 2020, the duration of medical certificates for pilots…who conduct part 121 operations outside the United States…if those medical certificates expire between March 31, 2020, and May 31, 2020.” This, therefore, appears to actually state that the medical certificates in question (this is now only a two-month window, however) are indeed “valid,” even though the word valid was not used. This ruling refers specifically to operations outside of the U.S.

Does this clarify that the original ruling actually meant that the aforementioned expired medical certificates are also “valid” for operations within the U.S.? Not entirely.

The ruling further reminds us that the March 26 order, regarding operations within the U.S., remains in effect as written. In other words, for the certificates expiring between March 31 and June 30, that wording continues to state that the FAA won’t take legal action against the pilot operating with the expired medical certificate.

Confused yet? Wait, there’s more.

On April 29, the FAA issued a Special FAR that provides relief from regulatory requirements, including recency of flight experience (instrument operations) and pilot-in-command proficiency checks (permitting additional grace months), among other operational considerations.

The salient point to make in regard to medical considerations in the SFAR is that it first refers back to the original ruling that enforcement action will not be taken against a pilot flying in noncompliance with expected medical duration standards. However, the ruling then discusses that “The FAA has determined that pilots may operate beyond the validity period of their medical certificate for a limited time without creating a risk to aviation safety…For the reasons cited, for medical certificates that expire from March 31, 2020, through May 31, 2020, the FAA is extending the validity period of these medical certificates through June 30, 2020.”

Finally, the coveted statement of “validity.” It is confusing that while referring to the original March 26 ruling, the SFAR only discusses the “noncompliance” aspects of flight operations, but finally it provides the presumptive interpretation that a pilot doing so indeed possesses a valid medical certificate.

It took a month to do so, but perhaps the FAA has clarified the situation better than it had at first—I’ll leave it to the aviation attorneys to provide an interpretation to that hypothesis. The confusion persists, however, in that even in this slightly more enlightened wording, only the two-month window is referenced. 

Reviewing the FAA website once again, it continues to contain only the reference to the original March 26 order and further continues to recommend that pilots update their FAA medical certificates on schedule.

Does all this even matter? I bring this up as, for the most part, pilots have indeed been able to update their medical certificates on time. I’ve been operating normally—well, as “normal” as operations are when without an assistant in the office, who we have removed for the safety of her and her family at times when pilots are present, and performing a door-to-door disinfecting protocol between each and every pilot—and seeing all pilots in their regularly due months. 

The FAA has not permitted relief from any of the special issuance medical documentation requirements, which has, at times, complicated renewing a certificate for those pilots. But again, for the most part I’ve been pleasantly surprised that most of our medical consultants have indeed been able to provide data required for special issuance renewals on a timely basis.

When might the exemptions be worthwhile? There are some AME offices that have indeed closed down during the pandemic.

As I previously mentioned, we AMEs are an aging lot. Some of the AMEs in particularly high-risk categories have, quite understandably, closed their offices. I have been told that there are some who have informed the FAA that they do not intend to resume AME work at all in the future. (I have not yet independently verified this with any specific AMEs, but I have been told that this is the case from various contacts within the aviation medicine community.)

There are, therefore, some pilots who simply might not be able to renew their medical certificates, even if they intended to remain on their normal schedule. Their usual AME is unavailable, and many other AMEs are already maintaining a practice that is too full to accept new pilot clients. For these pilots, the exemptions are quite worthwhile—it permits them to fly, even though the medical certificate appears to have expired.

Is the medical certificate valid or not during this time? There are confusing messages from the FAA, but it is clear that there is no intent to take legal action against any pilot operating with an expired medical certificate within the windows stated in the regulatory orders.

In this case, whether the certificate is valid or not might be a moot point. I remind all pilots to discuss their medical certificate status with their flight operations supervisor before acting as a required crewmember. I would also think it prudent to determine beforehand if it’s wise to leave the country with an expired medical certificate. I know that international jurisdictions are “supposed” to accept the rulings of whatever governmental organization is certifying the medical status of its pilots, but my many years of international flying, often to developing countries, leaves me cynical about potentially not having all of the proverbial ducks in a row.

I have been able to take care of all of my pilots in their regular due months, and I am pleased to hear that many other AMEs also have been able to do so. The exemptions, while wordy and unwieldy, do at least provide relief for pilots simply unable to update their medical certificate in a timely manner. The bottom line is that, if you can, update your medical certificate on schedule if at all possible. The exemptions are there to assist you if you can’t. Will we need additional exemption orders in the coming months? There’s no way to know that in advance.

The entire world is learning about Covid-19 and its ramifications on literally a day-to-day basis. The FAA will make a determination in the coming months as to whether additional exemption time periods are necessary. 

Over these upcoming months, there will certainly be aspects of aviation medicine regarding Covid-19 that will be worthy of updates in these pages. In the meantime, while it seems like overkill, and is far from enjoyable to do so, please continue to adhere to health and safety recommendations.

By the time of my next blog, hopefully there will be more information and updates available on an epidemiologic basis to report. I know we’d all like to know what the “new normal” will be, and when we can expect to evolve in that direction.

Over the next year or so, there will be job losses and both health and economic impacts facing all of us. Through individual and group consciousness, along with respect for ethics and for the health and welfare of others, we can, as a society and aviation community, meet the significant challenges ahead of us as a result of Covid-19.