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What Public Health Factors to consider when resuming International Travel in Coronavirus Times?

 

Consideration of Public Health Factors when resuming International Tours and Travel in Coronavirus Era

COVID-19 Travel Advisory

1. Introduction

Since the outbreak of the COVID-19 pandemic, many countries have stopped some or all international travel, but now plan to reopen for travel. This document outlines the main factors that national health authorities need to consider when considering or starting to gradually resume international travel services.

 

The decision-making process should be multi-sectoral and should ensure that the measures taken by the national and international transportation authorities and other relevant departments are coordinated and consistent with the overall national strategy aimed at adjusting public health and social measures.

 

The phasing out of travel measures (or temporary restrictions) should be based on a comprehensive risk assessment, taking into account specific country conditions, local epidemiology and transmission patterns, national health and social measures adopted to control the epidemic, and countries of departure and destination (including the capacity of the health system at the port of entry). 

Any follow-up measures must be commensurate with the degree of public health risk. At the same time, as the COVID-19 situation develops, regular and systematic adjustments should be made based on the risk assessment and regularly communicated to the public.

 

2. Purpose

The purpose of this document is to clarify the factors that need to be considered when adjusting international travel measures to governments, health authorities of WHO member states, and relevant stakeholders to adapt to the changing epidemiology of the COVID-19 pandemic.

 The situation, the existing national public health and health service capacity of each country, and the continuous development of the virus. This document should be read in conjunction with other relevant WHO guidance documents.

 Especially the WHO COVID-19 strategy update on April 14, 2020, precautions when adjusting public health and social measures, 2020 A scientific briefing on the spread of SARS-CoV-2 on July 9, 2012 and the WHO strategic preparedness and response plan.

 

3. Factors to consider when resuming international travel

Each country should conduct a risk-benefit analysis and determine its priorities.

 

WHO recommends that priority should be given to urgent and necessary travel, humanitarian operations (including emergency medical flights and medical evacuation), and necessary personnel (including emergency personnel and public health technical support personnel, crew members and other key personnel in the transportation sector, and diplomatic officials) travel and evacuation operations.

 Freight should also give priority to basic medical supplies, food and energy supplies. Sick travelers and those at risk, including elderly travelers and those with chronic or underlying diseases, should postpone or avoid international travel to and from areas with community transmission.

 

In view of the possibility of import or export of potential cases during international travel, there is no "zero risk" situation.

Therefore, comprehensive and continuous risk assessment and management will help to identify, reduce, and mitigate these risks, while balancing the socio-economic consequences of travel measures (or temporary restrictions) with potential adverse public health consequences.

 

The decision-making process should include an analysis of the situation, taking into account the local conditions of the country of departure and destination. 

Specifically, the following factors should be considered: local epidemiology and transmission patterns. National public health and social measures adopted by the country of departure and destination to control the epidemic.

 National and sub-national levels, including ports of entry (ports, airports, land ports) to reduce and manage the import or export risk of the disease, manage the public health and health service capabilities of suspected and confirmed cases among travelers.

The evolving understanding of the spread of COVID-19 and its clinical characteristics.

 

3.1 Epidemiology and transmission patterns in source and destination countries

As the epidemiology of COVID-19 varies from country to country, international travel will carry different levels of SARS-CoV-2 virus export/import risks according to the country of departure and arrival of passengers. 

WHO’s situation report follows its March 20, 2020 global surveillance interim guidance document on COVID-19 caused by human infection with the COVID-19 virus, which provides the COVID-19 epidemic in each country, learning situation. There are four types of defined transmission conditions:

 

No cases

 No reported cases in the country/territory/region

Sporadic cases

 the country/territory/region has one or more imported or locally detected cases

Clusters of cases

 countries/territories/regions found clusters of cases in terms of time, location and/or common exposure


Community transmission

 a country/region/territory has a large-scale local transmission epidemic, which needs to be determined by evaluating a series of factors, including but not limited to:

A large number of cases cannot be linked to the transmission chain

Sentinel laboratory has detected a large number of cases

There are multiple unrelated clusters of cases in several places in the country/territory/region

The risk of imported cases in the country of arrival depends on a series of factors, including the epidemiology of the country of departure and the country of arrival:

 

If the spread of the SARS-CoV-2 virus in the country of departure and the country of destination is similar, there is no major risk that may affect the current epidemiological situation.

If the SARS-CoV-2 virus is spread more severely in the country of departure than in the country of destination, the risk of adversely affecting the epidemiology of the country of destination is higher.

If the transmission intensity in the country of departure is low, the risk of adversely affecting the epidemiological situation in the country of destination is also low.

The aforementioned risk assessment should also consider emerging knowledge. In addition, both countries can consider differences at the sub-national level.

 

Countries should continue to plan and evaluate their rapid reinforcement capabilities in detecting, tracking, isolating and managing imported cases and isolating contacts.

 

3.2 Public health and intersectoral capacity

Assessing the risks that imported cases may pose to the national pandemic response depends on the capacity of public health and health services and the capacity of other relevant departments.

 

The WHO interim guidance document on "Precautions when adjusting public health and social measures in the context of COVID-19" emphasizes the six areas required to minimize the increased risk of COVID-19 transmission: 

  • Control transmission, including tracing and isolating contacts 
  • Having sufficient public health manpower and health system capacity
  • Minimizing risks in highly vulnerable environments
  • Establishing preventive measures in the workplace
  • Managing the import or export of cases with high risk of transmission in the community
  • Risks and full community participation


WHO has developed detailed technical and operational annexes for most of these areas, and has provided a set of standards to assess the need to adjust public health and social measures at the national level.

 

1) Has the COVID epidemic been controlled?

 

2) Is the public health surveillance system able to detect cases and their contacts and determine any rebound in the number of cases, especially among travelers?

 

3) Can the health system respond to the rebound of COVID-19?


WHO’s updated COVID-19 strategy outlines relations with sectors other than health (such as foreign affairs, finance, education, transportation, travel and tourism, public works, water supply and sanitation, environment, social protection, and agriculture) related goals. Its purpose is to use resources and efforts to ensure that every sector of the government and society is mastered and involved in taking response measures. 

At the same time, it helps through general measures for specific sectors, including promotion of hand hygiene, breathing etiquette, and personal distance. Prevent spread.

 

What Factors other than public health regarding COVID?

When deciding to resume international travel, countries should consider other economic, political and social factors in addition to the public health risks caused by the COVID-19 pandemic. 

These factors should be evaluated together with relevant stakeholders and appropriate experts and authorities. 

  • United Nations Development Programme (UNDP)
  •  World Tourism Organization (WTO)
  •  International Labour Organization (ILO)
  •  International Maritime Organization (IMO)
  • World Bank
  • Other institutions can provide relevant guidance

 

Some United Nations agencies that play a key role in supporting countries in resuming international travel have initiated specific COVID-19-related initiatives with the active participation of countries and other international organizations, in accordance with the mandates of their specific agencies. 

For example, the International Civil Aviation Organization (ICAO), in cooperation with other United Nations agencies and related industry partners, has developed a guidance document ("take off" document) for the resumption of international air travel.

 

4. Reduce the necessary capacity for imported cases

It should be recognized that destination countries and territories will ultimately need to work hard to contain COVID-19 to reduce its impact. 

Countries should have appropriate public health and health system capabilities, especially at ports of entry (ports, airports, land ports) to detect, isolate and treat cases, isolate their contacts, and exchange information and data internationally as appropriate.

 

4.1 Coordination and planning

Working across departments is essential for the proper implementation of public health measures. 

The transportation sector is the core of the travel business, but the participation of other sectors such as trade, agriculture, tourism, and security is also crucial, covering all business aspects related to the gradual resumption of international travel.

 

General capacity assessment tools for health emergencies prevention, although not specifically designed for the COVID-19 pandemic, can help. The WHO has produced a tool that outlines key preparedness, preparedness and response actions.

 

4.2 Surveillance and case management capabilities

In order to effectively manage the COVID-19 pandemic, epidemiological surveillance must be actively carried out to help detect cases, cases must also be isolated and contacts must be identified and followed up.

 Suspected and confirmed cases should be quickly isolated, and contacts of confirmed cases should also be isolated. Suspected or confirmed cases of COVID-19 and contacts of confirmed cases should not be allowed to travel.

 

Public health factors to consider when resuming international travel in Coronavirus Times, infographics
International Traveling Rules for COVID-19

Utilize existing monitoring systems and laboratory capabilities

The national COVID-19 surveillance system will benefit from the information shared through existing respiratory disease surveillance systems, such as those used for influenza, influenza-like illness or severe acute respiratory disease. 

The key elements of effective surveillance include case detection and contact tracing by a sufficient number of well-trained public health or community health workers, and the combination of risk communication and community participation through social media to ensure population acceptance.

Countries should have sufficient laboratory testing capabilities and clear testing strategies to reliably confirm cases and trace contacts, including confirmation and tracing among inbound travelers.

 The WHO guidance on surveillance and contact tracing should be followed.

 

What are the Digital Tools to trace coronavirus?

Some countries are already using or are considering using digital tools to support contact tracing. These tools include mobile phones and apps for location tracking or close-range tracking, and/or apps for reporting symptoms within 14 days of arrival. 

This technology cannot replace the public health measures of contact tracing, but it can be regarded as an auxiliary method under certain conditions recommended by the WHO.

 Only when the majority of the masses use mobile phones and apps, can this program effectively identify and notify travelers who may have been in contact with a COVID-19 confirmed patient or a COVID-19 positive tester. 

As far as travelers are concerned, if it is necessary to trace contacts on an international scale, compatibility and data sharing issues between countries need to be considered.

Before adopting such digital tools, countries may have to consider legal and ethical issues related to personal privacy and personal data protection.

 

What is international contact tracking for coronavirus?

If agglomerated transmission or transmission chain involves several countries, you can quickly share information through the international network of national focal points of the International Health Regulations, and track contacts internationally in a coordinated and cooperative manner. 

The national focal point is readily accessible and can obtain direct support from the WHO International Health Regulations regional contact point. 

The contact details of all the national focal points of the International Health Regulations and the contact points of the WHO International Health Regulations in each region are contained in the WHO Event Information System that allows national health authorities to visit.

 

4.3 Risk communication and community participation

Traditional media, social media and other channels must be actively used to publicize the reasons for the gradual resumption of international travel, the potential risks of travel. 

The measures needed to ensure safe travel for everyone, including regular updates on changes in international travel, or assistance through COVID The hotline disseminates information and provides suggestions suitable for the situation at all levels below the country. 

This is essential for building trust in travel advice, improving compliance with health advice, and preventing the spread of rumors and false information.

 The public, travelers, operators of transportation departments, health authorities and other relevant departments should be targeted to communicate changes in international travel in a timely and accurate manner.

 

4.4 Capacity at the port of entry

Countries should maintain or strengthen their ability to respond to COVID-19 at ports of entry when necessary. These include entry and exit inspection capabilities. 

Early detection through active case finding, isolation and testing of sick passengers (including the provision of personal protective equipment at ports of entry).

Cleaning and disinfection; case management, including sending to any medical institution if necessary.

Identifying contacts It can be used to track people; publicly share local policy information on appropriate personal hygiene and environmental hygiene measures.

Maintain physical distance and wear masks. Share emergency phone numbers; and communicate travel-related risks and educate on responsible travel behavior.

 Applicable procedures for handling baggage, cargo, containers, means of transport, articles and postal parcels should be provided and clearly communicated. 

Countries also need to ensure that they have the ability to conduct ship inspections and issue ship sanitation certificates within the framework of the International Health Regulations. 

The WHO guidance document on managing sick travelers at ports of entry and other relevant guidance, such as business factors to be considered by airlines and other transport operators, should be followed.

 

WHO recommends an integrated approach to support and manage travelers before departure and upon arrival, including a set of measures that should be considered before departure and upon arrival.

General advice for travelers includes taking personal and hand hygiene measures, observing breathing etiquette, maintaining a physical distance of at least one metre from others and using masks as appropriate. 

Travellers who are ill and at risk, including elderly travelers and those with severe chronic diseases or underlying medical conditions, should postpone international travel to and from areas with community transmission.

 

Entry and exit inspection measures include checking signs and symptoms (fever above 38°C, cough) and asking passengers if they have symptoms of respiratory tract infection and whether they have been in contact with any high-risk contacts, etc.

 This helps to actively detect cases among sick travelers. Symptomatic travelers and confirmed contacts should be directed to seek or receive further medical examinations, and then be tested for COVID-19. 


Confirmed COVID cases should be isolated and treated as needed

Temperature screening at entry and exit may only be partially effective in identifying infected individuals, because infected individuals may be in the incubation period. 

It is also possible that in the early stages of the disease without showing obvious symptoms, or may even use antipyretics to cover up the fever.

 In the case of limited resources, immigration inspection is desirable, and priority should be given to passengers arriving on direct flights from areas with community transmission.

 

In addition, passengers can fill in a form to inform the health authorities of possible contact with the case in the past two weeks (contact of health care workers with patients, visits to hospitals, staying with COVID-19 patients, etc.).

The form should include the relevant contact information of the passenger, as they may need to be contacted if they are identified as possible case contacts after the trip. 

It is recommended to fill in this form during the flight to avoid congestion on arrival. 

National authorities may also require arriving passengers to download and use their national COVID control applications.

 

Crowd control measures should be implemented to prevent transmission in areas where travelers gather, such as interview areas.

 

Molecular tests for SARS-CoV-2 immediately before departure

Laboratory polymerase chain reaction tests (molecular tests for SARS-CoV-2) performed immediately before departure or upon arrival can provide information on the traveler's condition.

 However, laboratory results should be interpreted with caution, as there may be a small number of false negative and false positive results. 

If tested, it should be accompanied by comprehensive follow-up measures for COVID-19. For example, it is recommended that departing travelers who have been tested report any symptoms to the local public health authority. 

If testing is done on arrival, an emergency phone number should be provided to all travelers in case of symptoms. If the test is positive, the relevant case management procedures should be followed.

 

Is there any proof of immunity during international travel in coronavirus era?

There is currently no scientific evidence to support the use of “proof of immunity” during international travel during the COVID-19 epidemic, so WHO does not recommend its use.

 To understand the effectiveness of rapid detection of SARS-CoV-2 antibodies, more evidence is needed. 


Immunization Passport

For more information, please refer to the WHO Scientific Bulletin: "Immunization Passport" in the Context of COVID-19, which will be updated when new evidence is available. 

In addition to scientific factors, it is also necessary to consider moral, legal and human rights aspects related to personal data privacy, medical confidentiality, potential risks of forging or participating in dangerous behavior, stigma and discrimination.

 

Travelers should self-monitor for possible symptoms within 14 days of arrival, report symptoms and travel history to the local health agency, and follow national regulations. 

According to WHO's guidance document on contact tracing of COVID-19, as part of the national response strategy, contacts of confirmed cases should be isolated or required to self-isolate.

 

Can countries implement quarantine measures for travelers?

If the country chooses to implement quarantine measures for all arriving travelers, it should be based on risk assessment and consideration of specific local conditions, and should also follow the WHO guidance document on quarantining contacts in the context of COVID-19.

 

Is it mandatory for the countries to follow the International Health Regulations (2005)?

Countries must follow the special considerations for travelers under the International Health Regulations (2005), including treating travelers with respect for their dignity, human rights and fundamental freedoms, and minimizing any discomfort or suffering caused by any applicable health measures.

 

Countries must not charge travelers for necessary health protection measures, including:

 (a) Inspections to determine their health

 (b) Vaccination or preventive measures on arrival (not announced 10 days before)

 (c)  Proper quarantine or quarantine

 (d) Certificate issued to describe the measures taken, or

(e) Measures taken for their carry-on baggage.

 

5. Monitoring and evaluation

While countries are gradually resuming international travel, they should regularly repeat the risk assessment procedures and review the capabilities of their public health and other relevant departments. In this process, countries should also consider new knowledge about the virus and its epidemiology by consulting the latest WHO Scientific Bulletin.




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