Flying economy class risks ECS

Flying economy class risks ECS

By Maria Endah Hulupi and I. Christianto

JAKARTA (JP): Frequent fliers now have something more to worry
about than the usual irritations of turbulence, missed
connections and bad airline food.

A spate of reports point out that flying economy class on
long-haul flights may bring something more serious than pains in
the neck, legs and backside from sitting for hours in cramped
seats.

The big news in the travel industry in recent months is
economy class syndrome (ECS).

Several well-publicized deaths blamed on the syndrome have
grabbed headlines around the world -- and prompted a class-action
suit in Australia from passengers saying they suffered effects of
long-haul flights.

Faced with a potential public relations disaster, airlines
argue the term itself is inappropriate to describe a condition
which increases the risk of deep vein thrombosis (DVT), or the
formation of a blood clot within the blood vessels in the legs.

Although the limited leg room in economy class hampers one's
ability to move the legs and increases the risk of forming a
blood clot, the airlines say anyone traveling long distances on
trains and buses as well as drivers may develop the syndrome
under particular conditions.

Pilots and flight attendants would also be prone to developing
a blood clot in their legs, but fortunately they have the
opportunity to walk to ease their fatigue and freshen up, which
help improve their blood circulation.

While it has garnered headlines in recent months, the syndrome
has affected hundreds of people since the 1940s, but it first
started to make news in the 1980s. Although the syndrome appears
to affect Caucasians in higher numbers than Asians and people of
other races, it has been reported at Tokyo's Narita Airport and
in Hong Kong.

But many travelers, due to lack of awareness, may have never
known that they experienced the symptoms of blood clots in their
legs.

Airlines

The wave of negative publicity spurred by the recent death of
a woman in Britain and incidents in other parts of the world has
irked the airline industry.

They say the association of ECS with airline travel is unfair.

"Economy class syndrome is an inaccurate term as there is no
firm link between air travel in any class and the development of
DVT," said Ida Sylviana, assistant manager marketing and
passenger Sales of Cathay Pacific in Jakarta.

"The appropriate term is 'travelers thrombosis'."

She said it was immobility, not the environment of a cabin,
which caused the condition.

General manager of KLM Royal Dutch Airlines for Singapore,
Indonesia, Malaysia and Brunei, Marcel de Nooijer, said that
thrombosis and long-haul air travel was the subject of several
scientific studies in the past.

He said none of the studies revealed any link.

Mita Sampaguita Lamiran of Indopacific, the public relations
agent for Qantas, also said that DVT was not linked to seating
space or leg room, but to long periods of inactivity. She
asserted it was not specific to airline travel.

From the neutral corner is Y. Kisyanto, chairman of the
Indonesian Travel Health Society and cardiologist with the
Department of Internal Medicine of the University of Indonesia.

He said prolonged immobilization would encourage DVT but
people having blood coagulability problems or blood vein
irregularity because of certain diseases would be at greater
risk.

"How it happens is simple. When a passenger sits for more than
two hours in an area with limited legroom, he will feel numbness
in his legs, which is the early symptom of poor blood
circulation," he said.

If the condition continues, the blood will coagulate and form
a clot in the vein. In some cases, the clot could travel along
the vein, which is called embolus, and end up in the lungs and
cause sudden death.

The symptoms vary, and may include numbness in the legs,
cramping and even swelling. Coughing, coughing up blood and
breathing difficulties may occur when the clot has traveled to
the lungs.

Kisyanto identified smokers, diabetics, pregnant women, women
taking birth control pills or hormone replacement therapy, the
elderly, the obese and people with high blood pressure and a
history of leg clots as having a greater susceptibility to the
syndrome.

Other physicians have advised passengers to avoid crossing
their legs, not to wear tight-fitting underwear and to wear
support socks or hose.

Class matters

Away from the airlines' counter arguments about ECS, there is
a reason why the syndrome has been linked to the economy class of
a plane.

Airlines boast they provide various amenities for their
passengers' comfort. During a long flight, passengers can enjoy a
wide selection of news, movie or music programs. Some airlines
boast of their economy class seats with individual screens for
each passenger.

Nonetheless, economy class passengers usually have less
comfort mainly due to the seats with less leg room.

Passengers in first class or business class are usually
pampered with much better facilities, such as more space, while
the seats are more comfortable. In fact, almost all air carriers
provide more space for economy class on their planes' seating
configuration, which automatically creates cheaper fares.

The configuration of an Airbus A340-300 of a popular air
carrier in Asia, for instance, totals 249 seats, including 12 in
first class, 40 in business and the bulk of 197 in economy class.
Meanwhile, one of its Boeing 747-400s has 389 seats, consisting
of 12 first, 55 business and 322 economy class.

The issue of ECS has prompted major airlines to take
precautionary measures, although they insist that the syndrome is
not exclusive to air travel.

Qantas recommends passengers undertake light exercise on board
to increase blood circulation. It advises people move their legs
and feet for three or four minutes per hour while seated and move
about the cabin occasionally.

Cathay Pacific said it has taken a number of precautions to
ensure the safety of its passengers, such as through cabin crew
training.

KLM said it offered extensive in-flight information on its
in-flight magazine as well as a video on health and fitness on
board.