29 Dec Why COVID-19 travel restrictions may be less effective in the US
WASHINGTON (Sinclair Broadcast Group) — Travel restrictions are reemerging internationally and domestically in the United States as a popular mitigation tool to try to manage the spread of COVID-19 and new strains of the virus. But with worldwide coronavirus cases surpassing 81 million and the U.S. expecting a post-holiday surge, there are questions about how effective those measures are.
Internationally, reports of a new, potentially more transmissible strain of coronavirus in the United Kingdom prompted widespread travel bans. At least 60 countries halted or sharply restricted travel from Great Britain. Last week, the United States required all passengers coming from the U.K. to present a negative COVID-19 test before their flight.
The response has left the U.K. increasingly isolated and raised doubts about whether stopping travel can stop the virus. A majority of European countries blocked travel from Britain after the new variant was discovered and France temporarily closed the border to British passengers and goods. Yet, according to the World Health Organization’s regional office in Europe, at least 11 E.U. countries have detected the new strain.
Outside of Europe, the variant has been found in Canada, South Africa and Japan, which implemented a monthlong travel ban on all nonresident foreign nationals starting Monday. Even with flights down 90% between Great Britain and the United States, top U.S. health officials have said it’s only a matter of time before the new variant is found here.
According to a recent article in The Lancet, travel restrictions have been shown to help slow the spread of the virus but only in countries that have very little community spread. Travel bans, border closures and targeted restrictions on countries with the highest prevalence of disease helped several countries reduce the number of imported cases, including China, New Zealand and Australia. For months, those countries have kept new cases within the tens or close to zero.
However, in countries that had higher local infection rates, travel bans and restrictions had less value. Researchers noted, “These measures carry a high economic and social cost, and might have little effect on COVID-19 epidemics if there are many more cases resulting from local transmission compared with imported cases.”
There is also evidence that the type of travel restrictions mattered in slowing the introduction of the virus. Ruud Koopmans, director at the WZB Berlin Social Science Center, wrote that among various types of travel restrictions, targeted bans on high-risk countries were more effective than global ones and mandatory quarantines were more effective than entry bans. Quarantines were found to be more effective because most entry bans allowed residents to return. Requiring them to quarantine cut down the risk of transmission.
Inside the United States, travel restrictions are even more complicated. Beyond the difficulty of enforcing them across a large, interconnected country, there’s also so much virus in so many communities.
The United States continues to lead the world in new coronavirus infections, reporting more than 1 million new cases last week and a steady increase in hospitalizations. As of Sunday, 27 states had test positivity rates above 10%, suggesting high community transmission.
“It’s not that travel restrictions do nothing,” said Dr. Justin Lessler, a professor of epidemiology at the Johns Hopkins Bloomberg School of Public Health. Once states or regions have the virus under control, travel restrictions could play a bigger role in preventing the reintroduction of the virus.
“But in the current environment, when states have the large outbreaks they currently have and there’s a vigorous epidemic, it’s hard to see how they can have much of an impact,” Lessler said.
Since the start of the pandemic states and regions have been experimenting with travel restrictions. In the spring, states took targeted, often aggressive measures against travelers from New York and Florida. By the summer, more states, including popular tourist destinations, announced new measures to limit the flow of people from coronavirus hot zones.
Now, governors and local officials in nearly half of all states have implemented some kind of travel restrictions, either by county or statewide, in an attempt to get the virus under control.
In Ohio, Maryland, Connecticut, Massachusetts and New Mexico, people traveling from states with high rates of COVID-19 infections are required to complete a ten to 14-day quarantine or show proof of a negative test result. In New Jersey, visitors can show proof of a negative test but will still be asked to quarantine.
At least nine states ask travelers from out of state or returning residents to quarantine for two weeks before going out into the community. Another nine states require travelers to present proof of a negative coronavirus test. In Alaska, which has some of the strictest measures, passengers can be tested on arrival for $250.
In Hawaii, New York, Pennsylvania, Rhode Island, Washington, D.C. and Chicago, visitors have the option to choose to quarantine or show proof of a negative COVID-19 test.
According to a recently published study, quarantining for the full 14 days appears to be the most effective way to lower the risk of COVID-19 transmission among travelers. Members of the CDC’s COVID-19 Response found that people who quarantined the full 14 days reduced their risk of spreading the virus by 90-100%.
Simply testing was less effective. A negative test three days prior to travel resulted in a 5-9% reduction in transmission risk. Testing the day of travel reduced the risk of transmission to 37-61%.
A combination of a seven-day quarantine and a test three days after arrival was found to be between 95-99% effective in preventing the spread of the virus.
It’s not clear how many Americans are complying with state travel requirements or CDC recommendations. In the week leading up to Christmas, the Transportation Security Administration screened more than 7 million passengers. AAA estimated some 84.5 million Americans would travel from Dec. 23 through Jan. 3.
Public health officials have pleaded with Americans to stay home, avoid travel and refrain from gathering with family or friends outside their immediate households. Top U.S. infectious disease expert Dr. Anthony Fauci warned of “a surge upon a surge” in the wake of Christmas and New Years’ travel.
“As much as we advise against it, nonetheless, it happens,” Fauci told CNN Sunday. “That’s one of the reasons why we’re concerned about that being a real risk situation for the spread of infection.”
New guidance that combines testing and quarantining could make it easier for Americans to travel safely, according to Dr. Lin Chen, director of the Travel Medicine Center at Mount Auburn Hospital and president of the International Society of Travel Medicine.
“People are dying to travel. They’re dying to see their families,” Dr. Chen said. “It will be very helpful when people follow such guidance because I think most people will prefer to self-quarantine for seven days and do a little test between the third and fifth day rather than having to self-quarantine for two whole weeks, not being able to move about.”
In many cases, the public health response has struggled to get people to buy in and willingly participate in mitigation measures, like mask-wearing, avoiding travel and avoiding large gatherings.
Making it easier for people to follow travel restrictions could increase compliance and allow for safer travel, Dr. Lesser explained. “It may be better to have less draconian restrictions that have high compliance than a targeted restriction that is so intense that people feel like they have to lie or try to avoid it.”