What is ‘economy class syndrome’? How budget air travel could kill you

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Free booze, early boarding and extra pillows might not be the only benefits of flying first class.

Known colloquially as “economy class syndrome,” deep vein thrombosis, or DVT, is a life-threatening medical condition that occurs when a blood clot forms in a vein located near the center of the body — making it more difficult to pinpoint and access.

DVT can develop anytime, but long-haul flights and cramped coach seats can amplify the risk.

The blockage forms due to a lack of vigorous blood circulation, often caused by sitting in the same position for an extended period. As the clot forms, many individuals will feel acute pain and swelling near the site.

An estimated 1 million Americans will develop DVT annually, and up to 100,000 will die from it.

Dr. Pinakin V. Parekh, a cardiologist at Singapore’s Harley Street Heart and Vascular Centre, tells CNBC that where you sit on the plane may have a bearing on your likelihood of developing DVT, “Theoretically people who are in better classes of air travel — business class, first class — have more space to move about, stretch their legs. So it’s all about real estate in the plane.”

While it is dubbed “economy class syndrome” Dr. Parekh notes that DVT doesn’t discriminate and is linked more to mobility than cabin class, “it can be the only flight of your life, if you decide not to move.”

In addition to flying, an increased risk of DVT is associated with similarly long periods of sedentation. One young gamer in England lost his life after hours of playing video games during the COVID-19 lockdown.

DVT affects the deepest veins in your body, usually in the legs or pelvis, though it has been known to occur in the arms, too. Per the Mayo Clinic, symptoms of DVT include swelling, pain, feelings of warmth, and changes in skin color.

However, some people who develop the condition have no symptoms at all.

If left untreated, DVT can result in a pulmonary embolism. The often fatal condition is caused by a blood clot breaking loose and making its way to the lungs, thereby blocking the lung artery and reducing oxygen in the blood.

Dr. Robert Lookstein, professor of radiology and vice chair of interventional services at Mount Sinai Health System, told The Post. “Ten to 30 percent of pulmonary embolisms will not survive. It’s associated with significant mortality.”

There are a number of risk factors associated with DVT, such as obesity, smoking, pregnancy, heart disease, certain medications, and hormone treatments like birth control.

Flying, however, is its own kind of risk factor.

“The stereotype is the person who drinks a double latte, gets onto a coach class seat flying across the country, has a scotch, falls asleep, and wakes up seven hours later,” Dr. Lookstein said. “They haven’t moved, they’re profoundly dehydrated and they have a blood clot.”

According to Dr. Lookstein, the combination of inaction, dehydration, and a confined space puts the air traveler in specific danger.

Dr. Parekh says long-haul flights pose the most significant risk for DVT, but those with shorter commutes are not immune, “People used to define long-haul flights as eight hours,” he said, “but there’s some data to suggest that even four hours now is considered long enough.”

While risk can not be totally eliminated, Dr. Lookstein says it can be mitigated.

“My rule of thumb that I give my patients is that any time you are traveling, you should be up and moving every two hours or so. If you’re driving a car, you should pull over, walk around, get a bottle of water. Anything beyond a few hours is unhealthy, even more concerning if you’re in a cramped space like a compact car or coach class seat.”

Mayo Clinic also suggests circling your ankles while sitting, drinking plenty of water, and wearing support stockings in flight.

For flyers who can’t afford first class, Parekh suggests choosing an aisle seat, which “encourages you to walk up and start walking much more easily because when you’re all the way inside the row, you’re always worried you’re disturbing the guy [next to you].”