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.