COVID-19: Pre-Travel Testing is Not Enough

COVID-19: Pre-Travel Testing Not Enough

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COVID-19 Pre-Travel Testing is a Common Requirement for Most Destinations that Americans can still visit, including Hawaii, French Polynesia, and Caribbean countries. Meanwhile, Canada now requires both a negative COVID-19 test just to board a plane, and will continue to require a 14-day quarantine of everyone arriving. We think neither approach strikes the right balance between safety and convenience for travelers.

Why COVID-19 Pre-Travel Testing Also Should Be Accompanied by Testing on Arrival

COVID-19 pre-travel testing is only part of the equation. As most people now realize, a significant portion–up to 60%–of COVID-19 transmission occurs via asymptomatic or pre-symptomatic carriers: people who don't realize they're infected. COVID-19 PCR tests can return a negative result soon after a person is infected (before there's sufficient viral material to generate a positive result) which means that a traveler could have the requisite negative COVID-19 result from a pre-travel test, but subsequently be in his/her most symptomatic period during the flight or at the destination. And while commercial flights are one of the safest modes of mass transit, thanks to highly effective HEPA filters, there have been some cases of COVID-19 transmission on long plane flights. That's why a test on arrival is needed.

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Testing on Arrival Could Mean a Longer Time Period for Pre-Travel COVID-19 Testing

If all passengers were tested on arrival and went into hotel quarantine until the results came back that night or the next day, then it would make sense to allow more time for travelers to get their pre-travel test, for example 5 days prior to flight departure, instead of the current 72 hours that is common. This has two benefits:

  1. Spreading out the two tests so that most passengers will be tested 3-5 days apart increases the likelihood of identifying those infected with COVID-19.
  2. It's challenging for travelers in many parts of the U.S. to both take a COVID-19 PCR test and receive a negative result in the 72 hours prior to flight departure (which is required to avoid Hawaii's 10 day quarantine).

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For Added Protection, Consider a Bubble Resort Concept

This won't be popular with some travelers, but destinations with vulnerable populations and limited medical resources, such as Kauai, are right to implement bubble resort concepts, where visitors must stay within the confines of the resort until taking a COVID-19 PCR test on Day 3, which must come back negative for them to go off the resort and explore the rest of the island. This isn't required for inter-island travelers who have taken a COVID-19 test on another Hawaiian island in the 72 hours before flying to Kauai, and obtained a negative result (see Kauai: COVID-19 Test to Avoid Interisland Quarantine).

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Bermuda is a Model

It's hard to get the balance right between safety and convenience, for destinations that seek to attract visitors while protecting their local residents. In our view, Bermuda has done an admirable job since most travelers (apart from the UK, due to concerns about the UK variant) only spend one night in quarantine, while keeping local COVID-19 cases quite low.

  • Pre-travel COVID-19 testing is required, no more than 5 days prior to arrival
  • On-arrival testing at the airport; results typically are provided within 24 hours, and we received our results that night. Until the results are returned, visitors quarantine in the hotel room.
  • Subsequent COVID-19 tests are mandatory on Day 4, Day 8 and Day 14

Due to the more contagious UK variant, passengers arriving from the UK now have to quarantine in their accommodation for four days and cannot be released until they test on Day 4 and receive a negative result.

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Vaccines will certainly help, but as we wrote COVID-19 Vaccines: Why Travelers Will Still Need to Test, testing will continue to be important for quite awhile, not only because it will take so long to vaccinate all the people who want a vaccination, but also because the way the Pfizer and Moderna vaccines were tested focused on symptomatic COVID-19–that's what the 95% efficacy reflects. Neither Phase III trial collected data on asymptomatic cases, which could well be significant. We also don't yet have good data on how well the vaccines protect others from getting the virus, not just the vaccinated person from developing symptomatic COVID-19. And of course, with the UK variant (which is already circulating in the U.S. and other countries), we'll need to increase the percentage of the population that is vaccinated and doesn't transmit the virus to have the same effect on the reproduction value, R, that we'd have had with non-mutated virus.

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