International travel during the COVID-19 pandemic

The WHO in its COVID-19 Travel Advice document suggests that the lifting of restrictions, especially with regards to international travel, must be taken after a thorough assessment of the risk factors involved in opening up international borders, as well as the status of the disease in the respective countries.

India, for instance, has the third-highest cases of COVID-19 in the world, and cases are still rising. Whenever India decides to lift travel restrictions, it must:

• Take into account all the measures that the other country is taking to stop further spread of the disease.
• Get a deep understanding of local epidemiological and transmission patterns of the outbreak.
• Assess the readiness of the country's public health system to be able to tackle any spike in the number cases.

The WHO's set of recommendations includes which members of society should be given priority, to be able to travel internationally despite the pandemic:

• Essential travel for emergencies: Anyone who needs to travel internationally due to an emergency or a situation that cannot be avoided must be given priority to travel internationally.
• Humanitarian work: Persons who are involved in humanitarian missions and work around the world, which includes the operation of emergency medical flights or evacuation due to medical reasons, should be given priority.
• Travel of essential personnel: Essential personnel include emergency responders and public health technical support, diplomatic officials, etc.
• Transport of cargo: Unavoidable international cargo flights, especially those taking essential medical, food and energy supplies, must be allowed to operate between countries.

While the above-mentioned should get priority for international travel according to the WHO, the health body has also shared recommendations for who must avoid travelling internationally for their own health and well-being:

• People who are sick or at risk of requiring urgent medical attention.
• The elderly
• Those with chronic or pre-existing health conditions
• People from countries which have proven community transmission must avoid travelling internationally, at least for some more time.

COVID-19 initially spread across the world through international travel. Resuming international travel in a haste could also prove to be tricky to manage.

The decision to allow people to travel internationally will require a thorough analysis of the situation on the ground, not only in the country of departure but also the country of arrival.

As there isn't a definitive treatment for COVID-19 yet, and vaccine candidates are in different stages of development, it is quite important to try and avoid the infection. The situation vis-a-vis COVID-19 would have to be assessed in both the country of departure and arrival for international flights. One of the ways to do this is to check which stage of transmission the two countries are in. There are four stages of COVID-19:

• No cases reported
• Sporadic cases
• Clusters of cases
• Community transmission

Read more: Epidemic vs Pandemic

Travelling to countries with clusters of cases or community transmission involves a higher risk of someone becoming infected and importing the disease upon return to a country where cases have dropped. Thus the WHO recommends travel to only those countries where the situation is similar to the country of origin for international travel, so that the risk of increasing transmission is reduced.

The WHO has also set up a list of recommendations for what to check in terms of the public health and social measures of a country, before opening up travel to that country:

• Contact tracing, isolation and quarantine
• Sufficient public health workforce and health systems in place
• Reducing the risk of transmission in areas of high vulnerability
• COVID-19 preventive measures at offices and other places of work
• Managing the risk of importing or exporting cases from communities with high risk of transmission
• Full engagement of communities towards reducing the risk of transmission

Read more: How does COVID-19 spread

Besides the strategies mentioned above, the following points should be considered:

• Has the country been able to control the spread of the disease at the local level?
• Is the public health surveillance system good enough to detect a surge in cases and address it via contact tracing and isolating positive cases, especially if there are travellers involved?
• Is the public health system of the country in question ready to deal with a resurgence of the disease?

These are important factors to consider before opening up travel to any country.

The opening up of international borders carries with it the risk of a traveller bringing the disease with them. The readiness of the port authorities—at airports, seaports, ground crossings—to be able to test people and isolate them is critical when talking about throwing international borders open.

Besides assessing the public health systems and surveillance systems of respective countries, as well as their testing and treatment facilities, there are several other factors that need to be kept in mind before allowing international travel.

How robust is the public health system of a particular country? Can they identify, test, isolate, trace contacts, and provide treatment to travellers?

People who may be symptomatic or at risk of contracting the infection should be isolated and their contacts traced to be quarantined. If they are about to travel, they should not be allowed to board if they are suspected of or confirmed as carrying the new coronavirus infection.

Other important points to consider for all countries consider before opening up international travel include:

• Setting up a proper channel for international contact tracing
• Increasing the daily laboratory capacity to test samples
• Involving local communities to break the chain of transmission
• Boosting the capacity of workers at ports of entry to a country
• Screening of passengers upon entry and departure

Along with institutional measures to control and test travellers, those who are still travelling must ensure they practice all the rules of hygiene and safety, physical distancing, and wear masks, face covers and face shields while travelling. Travellers should also monitor their own symptoms during travel right from the point of departure to the point of arriving in another country, and must inform local authorities about their travel history and follow all the protocols in place.

Read more: Severe and mild symptoms of COVID-19

By the same token, countries must also treat travellers with dignity and respect their rights and avoid any kind of stigmatisation over their health and physical condition. Countries are also recommended not to charge travellers for the facilities or preventive measures in place such as physical exams, vaccinations or medications upon arrival, isolation or issuing any documents to certify any of the conditions mentioned before.

Read more: COVID-19 and stigma

Even though international travel may open up, the movement of people will be limited based on priority and based on the situation on the ground. Therefore, all international travel should only be done when absolutely unavoidable, to minimize the chances of becoming infected ourselves, but also reduce the chances of transmitting the virus to fellow travellers.