Coronavirus: Travel Risk

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With the Coronavirus, Travel Risk questions are being asked of us a great deal. While we're certainly not epidemiologists or our clients' physicians, here are some of the considerations we'd suggest thinking about when deciding to travel.

Travel Destinations

A number of countries now have at least one coronavirus case, although in many countries there's been limited testing, so there could be quite a bit of undetected community transmission. Most travelers will for now be avoiding mainland China and Iran, which both have many cases and many deaths. For reference, see the Johns Hopkins Coronavirus Map.

Let's look at some of the other countries that have CDC warnings:

Italy

Italy has a CDC Level 3 warning, “Avoid nonessential travel: widespread community transmission.” That said, the majority of cases and the vast majority of deaths have been in Lombardy (98 deaths); Emilia-Romagna (30 deaths); and Veneto (10 deaths). As of time of writing, there have been no deaths in Tuscany (which includes Florence) or in Lazio (which includes Rome) or in Campania (which includes the Amalfi Coast).

Also keep in mind that most of the deaths in Italy have been of elderly patients, many of whom had underlying respiratory ailments, other pre-existing conditions, or were already unwell.

While it's very likely that Italy has far more coronavirus cases than the >4000 that have been confirmed by testing, it's also likely that these cases are more concentrated in the northern Italian regions the most deaths have occurred in, and which travelers may want to avoid. A bigger issue for travelers is likely to be needing to self-quarantine upon returning to their home country.

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South Korea

South Korea also has a CDC Level 3 warning, avoid non-essential travel. Interestingly, however, the country, which is currently reporting over 6500 cases, at time of writing has about a fifth of the deaths of Italy–most likely an indication of the additional testing that still needs to be done in Italy, combined with the older and more sickly population that was infected in Italy.

Again, a bigger issue even for travelers who look at the relatively few deaths in South Korea and deem themselves unlikely to acquire the coronavirus in South Korea, is the need to self quarantine upon their return to their home country.

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Japan

Japan has a CDC Level 2 warning, “Practice enhanced precautions.” There have been just 6 deaths in Japan (this excludes the Diamond Princess cruise ship) and 3 of those were in Hokkaido, which is less visited by foreigners, apart from ski trips. So that's 3 deaths for non-Hokkaido Japan, compared to 14 deaths in the U.S. (although to date these have been concentrated in the Seattle area). So in terms of the pure risk of contracting the virus in Japan, excluding Hokkaido, it's hard to say that it's more likely in Tokyo, say, than in Seattle or even some other parts of the U.S.

That said, it's important to consider the pros and cons of Japan travel during the coronavirus. There are many fewer tourists, making popular temples, shrines and parks less crowded, but there are also many museums closed, and many hotels have closed their swimming pools and switched from breakfast buffets to a la carte breakfast.

Whether you'll have to self quarantine when returning from Japan depends on your country of origin; many U.S. schools and businesses will ask you to self quarantine for 14 days if returning from Japan. On the other hand, countries such as Russia, perceiving the much lower risk of coronavirus from Japan and Hong Kong, don't ask for self-isolation for returning travelers from those countries, but do decree quarantining for 14 days if returning from China, South Korea, Iran, France, Germany, Italy and Spain.

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Hong Kong

Hong Kong only has a CDC Level 1 advisory: “Practice Usual Precautions,” unlike China, which has a CDC Level 3 warning. Hong Kong has had only 2 deaths, and residents have mostly hunkered down, with schools and major attractions such as Disneyland closed, and all those who can work from home doing so. Many residents still have vivid memories of SARS, and have taken precautions to minimize the chance of becoming infected or of inadvertently infecting others. As with Japan, be sure to bring your own masks if visiting, as everyone is expected to wear masks when out and about.

Although Hong Kong is arguably a safer place to visit than Seattle right now, visitors returning to the U.S. should be prepared to be asked to self quarantine, depending on your school's, office's or gym's rules.

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Coronavirus: Traveler Risk

As has been covered extensively in the media, those most at risk of serious symptoms and possibly death from the novel coronavirus are the elderly, especially those over 70 or so that have pre-existing respiratory ailments or other health conditions. A recent study by Hong Kong researchers found an average mortality rate of 1.4%, but that this rate could be lower if it took into account those who were infected but asymptomatic. That said, it's always key to de-average numbers: in this case, the mortality rate for those 70 and older was about triple the 1.4% number, or ~4%.

There are of course common sense precautions everyone can and should take regardless of age to help avoid getting sick, whether from coronavirus or the seasonal flu: avoiding crowded public transit, using social distancing, washing hands thoroughly (20 seconds) with soap and water, avoiding touching one's face, and disinfecting commonly touched surfaces, such as one's phone and keyboard.

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Coronavirus Worry

In addition to one's risk, due to health, age, hygiene conscientiousness etc. of contracting coronavirus whether in one's home country or while traveling, destination risk, and the potential hassle of having to self quarantine, there's at least one other consideration: how much you tend to worry and obsess about getting coronavirus. People vary enormously in how much they worry, and since worry can affect sleep, mood, and general travel enjoyment, it's something to take into account quite apart from the other factors.

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