With the COVID-19 pandemic continuing its march across the United States, airlines are responding as they battle to keep flying and keep infection rates at bay. For some time, US airlines have mandated the wearing masks inflight. Now, Delta Air Lines is taking it one step further. From July 20, Delta passengers will need medical clearance if they want to fly without wearing a mask.

Previously masks required, but mixed enforcement

Since May 4, Delta Air Lines has required its employees and passengers to wear a mask. The rule not only extended to flights, but the check-in process, Sky Clubs, boarding gates, and jetbridges. Young children, unaccompanied minors, and people unable to keep a covering in place were exempt.

Stay informed: Sign up for our daily aviation news digest.

The mask requirement was part of a suite of measures Delta put in place to help prevent the transmission of COVID-19. Other airlines across the United States employed similar practices.

While most passengers were happy to play by the rules, there were regular reports of some people refusing to wear masks. Some passengers also removed masks once inflight, declining requests from crew to put them back on.

Further, the cabin crew was limited in their response if a passenger refused to comply with a direction to wear a mask once onboard.

“Airlines have said follow the guidelines, but don’t enforce them, don’t tackle people to the ground and don’t turn flights around if they don’t listen," Sara Nelson, president of the Association of Flight Attendants union told the New York Times.

Delta Air Lines gets tough on masks

Now, Delta Air Lines is toughening its stance. If for some reason, you cannot wear a mask, the airline asks you to reconsider your need to travel. Alternatively, you can undergo a "clearance to fly" procedure at the airport.

The clearance to fly procedure involves a virtual or telephone consultation. That will be with a Delta facilitated medical professional at the airport before departure. The consultation will be conducted in private. If given the tick off approval, the passenger will be allowed to board the flight. Barring a bona fide condition, there will be no automatic tick of approval.

“If you require this exemption, please arrive early to complete the process during check-in and avoid missing your flight – this process can take over one hour. Please arrive early to allow additional time. Mask exemptions apply only to travel on flights operated by Delta,” said Delta in a statement.

“Customers with health conditions or disabilities that explicitly prevent the wearing of a face covering or mask are strongly encouraged to reconsider travel."

A change in messaging from Delta

To date, Delta has been taking a relatively softly-softly approach when it came to wearing masks in flight. Sure, masks were required, but the messaging from the airline was about health and safety. Now it's moving to wrongdoing and punitive action.

Now Delta says if passengers make a false claim to avoid wearing a mask or remove their mask inflight (except for eating and drinking), they'll put the passenger on their no-fly list.

Young children, unaccompanied minors, and adults with conditions who have received clearance to fly remain exempt from the mask rule.