Background Pilots are working in a unique and exacting environment with hypobaric hypoxia and acceleration forces. In military flying, missions are often challenging with possible combat scenarios and in remote areas with impaired infrastructure.

Methods We analysed all German military pilots and pilot candidates with confirmed SARS-CoV-2 infection, who have all been evaluated prior to their return to flying duties between April 2020 and January 2022 by the German Air Force Centre of Aerospace Medicine. Symptoms, comorbidities, scope of investigations, examination results, vaccination status and aeromedical disposition are described.

Results 90 pilots (82 active pilots and 8 pilot candidates) with a median age of 35 years (IQR 15 years) were included. 78 pilots (87%) reported symptoms, with median duration of 6 days. Symptoms included influenza-like symptoms (70.0%), headache (45.6%), impaired physical fitness (37.8%), anosmia/ageusia (36.7%), fever (27.8%), exertional dyspnoea (8.9%), memory and concentration disorders (4.4%), diarrhoea (3.3%) and dyspnoea at rest (2.2%). Only one pilot (1.1%) was hospitalised, two (2.2%) required outpatient treatment. All pilots were allowed to return to unrestricted flying duties after the assessment, with eight (8.9%) reporting ongoing mild symptoms.

Conclusion Due to their demanding working environment, pilots, and other high-hazard employees, should undergo medical evaluation prior to return to their duties to exclude ongoing symptoms and the development of post-acute COVID-19 or post-COVID-19 syndrome. The scope of examinations may depend on the severity of the disease, comorbidities, the vaccination status, the predominant SARS-CoV-2 variant and the type of aircraft flown.