How Can We Resume International Travel During the COVID-19 Pandemic?

This document is part of a series of discussion notes addressing fundamental questions about the COVID-19 crisis and response strategies. These documents are based on the best scientific information available and may be updated as new information comes to light.

This publication is written by Natalia Rodríguez-Valero, Medical Research Fellow at ISGlobal and medical doctor in the International Health and Tropical Medicine Department at Hospital Clínic in Barcelona, and José Muñoz, Associate Research Professor at ISGlobal and head of the International Health and Tropical Medicine Department at Hospital Clínic in Barcelona. The text adresses how to resume international travel during the COVID-19 pandemic, with measures to protect the health of travellers before, during and after their journey. 

The COVID-19 epidemic has had an enormous impact on transport and global connectedness. In order to contain the spread of the virus, many countries have closed their borders and imposed internal travel restrictions. As a result, the number of flights has fallen dramatically worldwide (by over 90% in April).

As soon as the public health situation allows, countries will start to reactivate their economies and international passenger flights will resume. It is therefore important to define and implement a series of measures to protect the health of travellers and transport workers, with special consideration for the populations most vulnerable to the disease.

Regardless of the status of the COVID-19 outbreak at any given time, it is always advisable to provide travellers with specific advice and encourage a series of preventive health measures, including vaccination, especially for people travelling to high-health-risk destinations such as countries with a high risk of malaria, dengue fever or other tropical diseases.

Before You Travel

• Before embarking on an international journey, we recommend scheduling a virtual appointment with a health care facility that offers international health or travel health services. During this appointment, you will receive advice about how to make your trip safer. In-person visits should be limited to travellers who require vaccination and those who have difficulty with virtual appointments.
• Make sure you have travel insurance that covers COVID-19 as well as repatriation costs.
• If you develop any symptoms that could indicate COVID-19, do not travel. Seek medical attention immediately. Likewise, if you develop symptoms during your trip or on your way home, seek medical attention immediately.

First-aid kit for travellers

Besides following basic travel recommendations, remember to pack:

• Masks
• Alcohol-based hand sanitiser
• Thermometer

Can I Travel Now? What Rules Apply in My Destination Country?

Although no international protocol has been adopted, certain countries or airlines may establish special measures for international travel during the COVID-19 pandemic. Various options have been considered, including:

• Quarantine on arrival, even for asymptomatic travellers. This option could make short trips—whether for business or for pleasure—impractical.
• Immunity passports. These documents could be issued to individuals who test positive for specific antibodies against SARS-CoV-2. Such a scheme could potentially be used to identify travellers who have already had the disease and are therefore protected against reinfection. However, given our limited understanding of the virus, we believe that immunity passports are not a viable solution. Among other scientific and ethical concerns, there is currently no evidence that the presence of antibodies confers protective immunity.
• Certificate of a negative PCR test in the last 48-72 hours. This document would show that the traveller underwent a PCR-based diagnostic test two or three days earlier and was negative for active SARS-CoV-2 infection. 

The website of the Spanish Ministry of Foreign Affairs provides up-to-date information on travel requirements for different countries. The International Air Travel Association (IATA) website also provides information on travel regulations. Travel clinics at major hospitals are another good source of information, although travellers themselves are ultimately responsible for complying with the latest requirements. Moreover, given the circumstances, countries may impose certain last-minute requirements.

At the Airport

AENA, the Spanish airport authority, recommends the following:

• Keep a safe distance from other people and always wear a mask while waiting in a queue (security checkpoints, etc.).
• Do not arrive more than 90 minutes early for your flight.
• Avoid crowded areas inside the airport.
• Check your departure time, since flight schedules may be affected.
• Remember that airport access is likely to be restricted, so non-travellers will not be able to accompany you inside.

Some international airports may perform extra checks and impose security measures such as frequent temperature screenings or some form of traveller “disinfection”. Be prepared for longer wait times and other eventualities.

During Your Flight

While aboard the airplane, remember:

• Masks are required on many, if not all, airlines.
• Use hand sanitiser and wash your hands often.
• Drink enough water to keep your mouth and throat hydrated (the air inside airplanes is very dry).
• Cabin air is either 100% fresh or a mixture of fresh and recirculated air (10%-30%). According to the IATA, most modern commercial aircraft are equipped with high-efficiency particulate air filters similar to those used in operating theatres. Therefore, the risk of infection during a flight is not high. However, it is possible to become infected through contact with a seatmate, even if he or she is asymptomatic—hence the importance of wearing a mask and practising good hand hygiene.
• It is also advisable to remain seated whenever possible, use the designated toilets in your section of the cabin, and contact a crew member if you feel unwell. At the moment, it appears that airlines are not planning to leave empty seats between passengers. Recommendations are changing frequently, so it is important to stay abreast of the latest developments.
• Some services, such as in-flight meals, might not be offered for reasons of hygiene.

At Your Destination

Some countries may require travellers arriving from heavily affected areas, such as Spain, to quarantine themselves. Alternatively, travellers may be asked to present health certificates.

During your stay in the destination country:

• To avoid contagion, do not visit health care facilities unless you become ill.
• Stay away from markets and animals, which can be vectors of diseases, including COVID-19.
• Avoid busy or crowded areas where it is impossible to keep a safe distance from other people.
• When visiting remote areas, remember that the nearest health care facility may be very far away.
• Choose accommodation that complies with regulations, especially with regard to common areas.
• Avoid shared transport, especially if you belong to a vulnerable population.
• Follow the guidance of the health authorities in your destination country.
• Consider using specialised telemedicine tools during your trip to stay in contact with medical specialists. 
• If you develop symptoms during your stay or, in particular, when you are about to head home, the airline may prevent you from returning. Always seek medical attention if you develop symptoms of any sort. However, if you travel to a vulnerable country, bear in mind that the health system might be overwhelmed and it could be difficult to access care and treatment.

If you have been in contact with suspected or confirmed cases of COVID-19, notify the health authorities and follow their instructions.

After You Return Home

Do you have to quarantine yourself after you return? In theory, after you visit a country with a larger number of cases than Spain, it would be logical for you to quarantine yourself or use another method of controlling SARS-CoV-2 infection. In any case, comply with local guidelines and follow official recommendations.

1.  If you develop any symptoms, seek medical attention and notify the health authorities if you have been in contact with a suspected or confirmed case of COVID-19.
2. If you have visited a tropical or subtropical region—and, as a rule, after any international trip—it is advisable to consult an international health or tropical medicine specialist, since diseases such as malaria can be very serious if not treated promptly.

Remember that, in addition to the possibility of contracting SARS-CoV-2 or other infections, travellers can also infect other people. Always follow official recommendations and make sure you do not put others at risk.