Is That You, Mr. Capgras?

There is a bizarre psychiatric condition associated with Alzheimer’s, schizophrenia or traumatic brain injury called Capgras syndrome where people are convinced that someone they know has been “replaced” maybe by an alien, by someone, something different. 

That is how I feel about the way many people I thought were sane and rational have been behaving over the past year or so. But not to worry, the doctor is in and he is here to help drive – or fly – to a cure!

Whether you pilot a Cessna 150, G5 or Airbus A380, you are doubtless contemplating a return to more normal aviation environments – crew lounges, briefing rooms, the front office, or venturing back into where those lesser beings, the passengers, dwell. Covid-19 has killed and sickened many, hit the travel industry and many other sectors hard, so you may not be flying much due to reduced demand, diminished disposable income, or inability to travel to favored destinations. Hopefully that is about to improve, but just as changing weather requires planning, so too do altered public health situations. So, what do you need to think about in advance of this new journey?

First, let’s deal with the elephant in the room. There are still people who believe that this was a “plandemic,” that the virus is a hoax or a cunning ploy by the government to track or control us. If you don’t believe me, and other doctors, ask around and you will find people who lost loved ones, by the time this article publishes, likely around 600,000 Americans. And incidentally, governments aren’t that clever and can already track us by our cellphones, credit card transactions…and GPS!

Second, the vaccines have been developed carefully and judiciously, adhering to known scientific and regulatory practices; yes, it happened fast but that was because of international collaboration, not by dodging steps or neglecting to ensure safety. The vaccines do not contain aborted fetal lung tissue, will not cause sterility and the tests do not cause cancer. I know I have talked about this before, but without full vaccination many more people will die. The anti-vaccer community never address the fact that we don’t see polio or tuberculosis rampant in the USA. Why? Because vaccines wiped them out.

As for the uproar over “Covid passports” or digital proof of vaccination to travel, I really don’t see why this is such a big deal – any pilot who has flown internationally will tell you that proof of vaccination against yellow fever, cholera or tetanus has been required in the past, and still is. And by the way, you are not just putting yourself at risk by not taking precautions or getting and encouraging others to be vaccinated, you are threatening the lives of others. We must defend personal liberties, and I hold that dear, but not when it may risk the lives and health of others, especially the old and vulnerable. Obviously, the aviation sector wants to get back to business, Covid passports offer a means of achieving that – think of this as being offered “direct to destination” by ATC. I am fully vaccinated and have signed up for my digital passport and am totally fine with the concept; if you are not, I guess I won’t be seeing you on the beach in Italy any time soon!

We are still quite early in this disease and data are being gathered and shared by doctors around the world. Until we know for sure one way or another, it is wise to assume that one can still be infected, or infect others, even if vaccinated. The more people who are vaccinated, the smaller the pool of humans in whom the virus can mutate and spread and the lower the chance of another, potentially even deadlier, outbreak. At this point we do not know how long each vaccine confers immunity, but the data I have seen demonstrates a dramatic reduction in serious infections, suppressed hospitalizations and a huge impact on mortality rates.

The use of masks by all, physically distancing as much as feasible and diligent cleaning of surfaces in the aircraft interior makes eminent sense. Contact tracing, such as on entering an FBO, allows your presence there to be noted in the event someone at that facility develops the disease, because sometimes Covid-19 comes on hard and fast and early treatment could make the difference between life and death. Checking temperature is a crude instrument; one can be unwell and have no fever because of medications like ibuprofen that suppress it, age or other factors; or an elevated temperature can be due to other causes such as a baby teething, a woman ovulating or countless other reasons. But the act of taking a temperature and signing a contact tracing sheet reminds people that this is important.

Frequent testing for presence of the virus is a sound move and certain areas are using these tests to spot new mutant strains; without such data one is operating as much in the dark as if you tried to shoot an IFR approach in IMC with no instruments or radio; it is not possible.

What if you have had Covid-19? You should certainly report this to your AME at next visit and self-ground until completely recovered. Let me be very clear, this virus causes a host of “long-haul Covid” symptoms, a fitting name for aviators. These include neurological problems like headaches and impaired balance, as well as fatigue and altered mood. Remember the introspective test you should practice before each and every flight: IM SAFE! If you develop Covid, or feel unwell for any reason, do not fly and do not expose others to the infection. As an analogy, you may enjoy going to the range to target shoot, but you would surely consider spraying bullets around a crowded airport to be irresponsible and murderous. A coronavirus-laden sneeze could be equally deadly. I have been criticized for using emotive language, but if it makes one person stop and think, I don’t care.

Even if you’re not infected, your emotional state may have been damaged during this time due to loss of a loved one, redundancy, social isolation, or uncertainty concerning the future. And even if not immediately obvious, travel may trigger feelings of anxiety, depression or panic. It is not a mark of shame – we have seen PTSD symptoms in our bravest, most macho special forces warriors – it is brain chemistry, so go with the flow and seek assistance.

We know that alcohol and illicit drug consumption have soared. We know that domestic abuse has increased. We know that calls to mental illness helplines have gone up and so have suicides. For these reasons, think about this very carefully for you and any pilots you know – depression and airplanes do not make happy bedfellows; if you identify an issue, please seek urgent professional help. And remember, you must report any such counseling to the FAA.

The FAA has actually been very reasonable in the handling of Covid-19. Pilots who had proven infection but did not require hospitalization and critical care are being office-issued if asymptomatic. For the more severe cases, FAA are asking for records and considering each on a case-by-case basis.


For symptoms of PTSD, a psychiatric, and probably neurocognitive, evaluation would be required as for all PTSD cases. Please do not be irritated by the FAA’s stance; this is for the protection of all.

Take this point in time to audit your personal health; diet, exercise program, alcohol consumption and social interactions, because health is so much more than the absence of disease or infirmity. And the data are clear: people who lead a sedentary lifestyle and/or are obese have a much higher risk of serious illness and death from the virus. And, of course, other causes.

Pilots are trained to absorb and interpret data, to take charge, to communicate leadership and confidence. We tell our passengers about all the efforts we make for the safe execution of a flight. Use that philosophy to plan your flight away from Covid and toward blue skies for you and those you love. And given that this will happen again, let’s be best prepared.

I believe it was Yogi Berra who said, “When you come to a fork in the road, take it.” I had the pleasure of meeting the great man and he was right, take the fork that leads to a long and healthy lifespan so that you can best enjoy your wingspan.

You can hear Dr. Sackier’s weekly podcast on health matters at Send any comments or suggestions to Jonathan at: [email protected]

Jonathan Sackier
Dr. Jonathan Sackier is an expert in aviation medical concerns and helps members with their needs through AOPA Pilot Protection Services.
Topics: Pilot Health and Medical Certification, Pilot Health and Medical Certification, Pilot Health and Medical Certification

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