Air Travel in the Time of COVID-19

An interesting editorial in The Lancet Infectious Diseases discusses the implications of this.

The COVID-19 pandemic is changing the way we think about travelling.

Most countries in the world have adopted some measures of lockdown or restriction to movement to reduce the transmission of SARS-CoV-2 and hence ease the burden of admissions to struggling health systems.

These measures have raised questions about the safety of travelling for work and leisure, and current recommendations discourage unnecessary travel.

Although the risk of contracting an infectious disease when travelling has always existed, the COVID-19 pandemic has made travellers more aware of this possibility.  However, with the relaxing of lockdown measures in some countries due to reductions in the number of COVID-19 cases and with the holiday season in the northern hemisphere, many people have faced the dilemma of choosing to travel after months of restriction or to remain at home for fear of being confined in an airplane for hours with other people. Considerations include:

  • Where is it safe to go?
  • What is the risk of travelling?
  • What are the new measures in place to reduce the risk of COVID-19 for those who decide to travel?

Many countries have introduced border closures to prevent the arrival of infected travellers from countries where there is continuing community transmission of SARS-CoV-2 in order to protect the progress made in the control of the pandemic.

Global surveillance with the dynamics of the COVID-19 pandemic is a key element to inform governments around border closures, and this is a decision can have heavy implications for the economy.  This is especially true in countries that rely on tourism as a source of income. 

In many cases, instead of full border closure, quarantine is required for any traveller coming from countries where COVID-19 is ripe.  These measures are dynamically applied depending on changes in the epidemiological situation.

An extreme example is quarantine for passengers on a flight from Nice to Oslo because they landed one minute after Norway had declared France a high-risk country. 

Some countries have introduced travel bubbles, or what are known as Coronavirus corridors, which allow the opening of borders for specific countries they deem safe while the maintaining more rigid restrictions for the rest of the world. 

Beyond what countries decide, individuals still need to balance benefits and risks of the decision to travel. 

Most cruise ships are not operating at the moment and the focus is therefore on international travel with flying.

The very idea of being in close proximity to strangers with an unknown infection status for hours is understandably a concern, however, cases of SARS-CoV-2 transmission on airplanes have been very few so far.

With the emergence of COVID-19, airlines and airports introduced new rules and measures to minimise the chance of infection with SARS-CoV-2:

  • Wearing masks in airports and on airplanes.
  • Expanded cleaning of public spaces to reduce the presence of the virus on inanimate surfaces.
  • Physical distancing 2 metres.
  • Hand sanitising. 

Some airlines have reduced the number of passengers allowed on a flight to guarantee more distance between travellers or they have cancelled food and drink sales during flights.

Despite concerns about the spread of SARS-CoV-2 through air ventilation, airplanes benefit from air-conditioning systems with far more sophisticated and effective filters than those generally found on the ground.  The high-efficiency particulate air filters used on airplanes are found to remove almost all particles of the typical size of Coronavirus.

Airlines perform temperature checks and countries require details of home address and locality address, and a health declaration questionnaire to be filled out to ensure that there are no coronavirus symptoms within the passengers about to travel.

Some countries require negative PCR COVID-19 test certificates.

So, what does the future hold for travellers?

The availability of a COVID-19 vaccine will be instrumental in reinstating confidence in travel.  However, it is expected that many airlines will cut services such as meals, drinks and free magazines, not so much for economic reasons, but as a way to limit so called touch points, which are opportunities for SARS-CoV-2 transmission via close physical proximity between flyers and crew. 

Rapid testing for COVID-19 for both crew members and passengers could become a regular feature.  Enhanced cleanliness and sanitisation will become the normal.  Use of masks or other protective equipment will become more common.  Touchless technology will reduce human interaction and facilitate payments and processes linked to travelling.

This pandemic will redefine what is normal for travellers, with a potentially positive outcome of reducing the risk of transmission of many other infectious diseases besides COVID-19.

Here at The London General Practice we regularly perform COVID-19 PCR swabs for travel.  We have a very close contact with our laboratory which ensures rapid results as soon as they are available subject to the laboratory methodology. 

We are exploring all the new tests which are available and will ensure that those with high specificity and sensitivity that is near 100% accuracy, will be used as soon as they are commercially available.

In the meantime, we are happy to use the current methodology of nasopharyngeal swab-taking and hope to get results back within 24 hours, subject to the laboratory, for those who have to travel and require certificates.

To learn more about the services of The London General Practice including our Fitness to Fly Travel Certificate service please visit our web page

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