The FAA’s medical policies during the Covid-19 pandemic remain a moving target. We are all continuing to learn more about the virus on a daily basis, and hence policies and protocols get amended from time to time.

Though the FAA has put out a small number of formal policies in written form, beyond that pilots and aviation medical examiners (AMEs) are asked to use reasonable judgment. FAR 61.53 remains in effect at all times—pilots must self-assess on a day-to-day basis whether they are airworthy or not.

AME decisions are only regulatory on the day of the FAA exam. Special issuance authorizations are guidelines in the certification process for individual pilots, but do not cover day-to-day nuances in that pilot’s health. Therefore, the pilot must exercise good judgment at all times, including during the Covid pandemic.

I participated in detailed Covid-related discussions directly with FAA medical officers about one week ago. Additionally, the FAA recently published some guidance regarding the pending approvals of one, and possibly more, Covid vaccines.

There seems to be some misinformation circulating in pilot circles that simply taking a precautionary Covid test invalidates a medical certificate. It clearly does not. Go ahead and obtain precautionary testing should you desire.

That said, what you do thereafter is to use common sense, based on the spirit of—you guessed it—FAR 61.53.

For example, a pilot who takes a Covid test because they had some symptoms or immediately after a known exposure to the virus should quarantine per local and CDC guidelines while waiting for their results. Given that it can take several days for a Covid test to become positive after an exposure, a negative test taken immediately after that exposure could mislead the pilot into thinking that a quarantine period is unnecessary.

There is no way for the FAA to know exactly what to do in all Covid-related situations, as nobody yet has all of the answers. This will take an extended epidemiology study of the data as it comes in, with the ultimate guidelines to be published eventually by the CDC.

Given that there are no all-inclusive answers at the present, the best action is the conservative one. If there is any question about an exposure, a pilot should quarantine.

Pilots can, of course, obtain testing and consult with their primary care physicians and their AME. But until pilots are pretty certain that they are not contagious (and remember, there are many asymptomatic carriers of Covid), the prudent course of action is to quarantine, thus avoiding spreading risks to other crewmembers.

Regarding vaccine trials, a pilot cannot fly when participating in any such trial. This is no different than the longstanding FAA policy that precluded flying if a pilot was participating in a pharmaceutical drug trial. Given that all of the potential side effects are not yet known (hence, this being an experimental “trial” to determine the efficacy and safety of the vaccine or drug being researched), pilots are excluded from flying when participating in any such trial.

A recent FAA statement notes that it is “closely monitoring the active vaccine trials,” adding, “While the agency has made no final decisions, we are prepared to evaluate the use of each vaccine…as soon as an emergency use authorization is issued.”

On December 12, the FAA announced that holders of FAA-issued airman medical certificates or medical clearances may receive the Pfizer-BioNTech Covid-19 vaccine. However, a 48-hour no-fly/no-safety-related duty interval must be observed after each dose.

It must also be remembered that the distribution of approved vaccines will be on a tiered priority basis, and the availability to flight crews is possibly several months away anyway.

Pilots ask me if I am going to get the vaccine. My answer is that, as soon as a vaccine is approved and available to health care workers in Colorado, I will gladly receive the vaccine when offered to me. I continue to take the annual influenza vaccine.

Not only am I in a high-risk group due to my age, but I also spend most days in very close contact with pilots in a small exam room, as I have continued to do since the pandemic began. The pilots I visit with have been all over the world, and soon after their appointment with me, they will be flying again to points afar.

Certainly, I want to avoid my risk of contracting an illness—but just as important I want to reduce the risk that I could unwittingly transmit an illness to a pilot. I do not want a pilot to get ill on the road as a result of my reluctance to obtain an approved vaccine.

Each person must weigh their own risk/benefit ratio for doing everything in life, including whether or not to take a medication or a vaccine. My personal risk/benefit considerations will not be applicable to each and every pilot. I respect that everyone must make decisions that are best for themselves and their families. 

For pilots with a positive Covid test but who are asymptomatic, they can return to work as soon as they complete an appropriate quarantine period. Retesting is not necessary.

If a pilot needed formal treatment, but was not hospitalized and otherwise recovered well, that pilot also may return to work when risks to infect others have subsided. I recommend that the pilot discuss with their treating physician when it is “safe” to again come in contact with others. The pilot should report that treatment to the AME, and typically the AME can issue the next medical certificate simply by documenting that the pilot recovered well.

If, however, a pilot winds up hospitalized or had a protracted and challenging outpatient course of treatment, the return to work decisions get a bit muddied. There is neither a perfect answer nor an all-inclusive policy that covers all such decisions.

For pilots hospitalized, the FAA will expect that the AME gathers all appropriate records. Given that there can be cardiovascular, pulmonary, neurological, or other organ system complications—which sometimes linger after the hospitalization—the AME would need to review documentation relevant to the pilot’s medical status. If the pilot was hospitalized but also fully recovered with no lingering medical deficits, the AME may be able to issue that pilot’s medical certificate at the time of the exam.

If, however, there are aeromedically significant lingering medical deficits, the AME must “defer” the exam—meaning the medical certificate cannot be issued at the time of the appointment—and send the appropriate data for FAA review. Based on that review, the FAA will determine if a pilot continues to qualify for a medical certificate.

All pilots who were hospitalized for Covid treatment but have since been discharged must consider whether to self-ground per FAR 61.53 pending discussions with the AME and possibly also the FAA. All such decisions remain the proverbial “moving target,” and these are cases that will likely require some additional thought before the pilot returns to the flight deck after having been hospitalized. If an employer has consulting aeromedical specialists, I recommend that pilots initiate discussions with them before returning to work.

A comment made during my recent discussions with the FAA summarizes the gist of what the FAA is hoping for in decisions to return a pilot to active flight status after Covid treatments: “Return to flying should remain a (conservative) clinical opinion based on the likelihood of sudden or subtle incapacitation.”

Medical Extensions Update

On a final note, while I have beaten the wording and workings of the medical certificate “extensions” into the ground in prior blogs, I believe there is an additional new clarification worth discussing.

Pilots being followed on formal special issuance authorizations have a specific limitation on their medical certificates that states that the certificate is “Not valid for any class after [date].” We have been awaiting formal legal guidance as to whether the extensions apply to those medical certificates. It certainly did not seem prudent to launch towards a foreign country with a medical certificate that would appear to have expired due to the “not valid after” date having already passed.

While the FAA legal department has not issued guidance on this specific nuance to the Covid policies, the discussions I have had with the FAA medical officers indicate that a formal “not valid after” date cannot be exceeded. The FAA expects that a pilot on special issuance follow the authorization letter and any specific time limits on the medical certificate.

As I have also mentioned previously, in cases where a pilot was simply unable to obtain required special issuance documentation—for example, due to unavailability of the treating physician—the AME can call the FAA for a one-time authorization to issue in spite of not having all of the required data. This is granted only by specific conversation with the FAA regarding a specific pilot, on a case by case basis, and only if it can be done safely. The logistics of doing so are often challenging, but it is doable if necessary.

Fortunately, I have been able to obtain all of the required special issuance data for all of my pilots, and have been able to issue their medical certificates on schedule as a result. However, if this proves impossible in spite of the genuine efforts by the pilot, the occasional verbal extension of a special issuance medical certificate may be granted by the FAA. This would allow the AME to issue a new certificate, with a new “not valid after” date, so the medical certificate would clearly appear valid to any inspector, either domestic or abroad. As soon as the medical data becomes available, the FAA expectation is that the AME will immediately forward it for review.

The challenges to society as a result of the pandemic continue.  We are all learning day to day how to educate our children, how to support local businesses in spite of the many restrictions, and how to safely ride on an airplane, either as a crewmember or passenger. I am hopeful that through the availability of vaccines and with ongoing dedication to virus mitigation strategies—wearing a mask, washing hands frequently, and social distancing—that in the foreseeable future we will gradually see a return to a more congenial and productive society.

While things are sorting themselves out, let’s do our best as individuals and respect the needs of others.

Dr. Sancetta is a former DC-10 captain with 11,000 flight hours. He has worked as a Senior AME since 1993 and is appointed as AME Consultant to the Federal Air Surgeon.