5 experts weigh in on pandemic travel risks
How do you measure the risks of pandemic travel, and when will the time be right to go again?
We asked five infectious disease experts. The first thing we must do, they agreed, is stay close to home for at least several more months, get vaccinated and watch virus transmission and ICU numbers closely. Putting down the pandemic, they said, will depend on how faithfully we use masks, keep our distance and wash our hands — habits that will remain vital as authorities strive to vaccinate 300 million or more Americans by summer.
“I will never get on an airplane again without a mask,” said Dr. Kimberly Shriner, an infectious disease specialist at Huntington Hospital in Pasadena, California.
“Now is not the time to be traveling. For leisure or business,” said Dr. Luis Ostrosky, a professor of infectious diseases at McGovern Medical School at UTHealth in Houston.
If you fly now, said
Dr. Krutika Kuppalli in Charleston, South Carolina, “you can almost guarantee that there are going to be people on the airplane with you who have COVID.”
These experts all are wary of new variants of the virus. None is flying now. But their perspectives vary.
Ostrosky, born in Mexico City, has a lot of family there. So when his grandmother died recently, he thought about making the trip south. Mexico is one of the few countries Americans can visit without a mandated quarantine.
But after much talk, he stayed put in the U.S. because of the pandemic. Before he resumes travel, he said, he’ll ask several questions.
What’s the positivity rate? “I would avoid trav
eling to any place that has a positivity rate over 5%,” he said. Above that, “you dramatically increase your chances of exposure.”
How full and how capable are the hospitals? Scores of U.S. hospitals are at surge capacity, with shortages of ICU beds. Because most county governments report COVID-19 information daily, Ostrosky said, “it’s actually pretty easy” to find data. As for capability, any hospital with a Level 1 trauma center (the most comprehensive trauma care) would satisfy him, Ostrosky said. The American College of Surgeons maintains a database.
Does this destination require testing to enter or leave? Many travelers might hope for that, but “I just don’t want to get stuck somewhere,” Ostrosky said. “People can test positive for a long period of time without being infectious.”
This is now a factor in any flight to the U.S., including returning roundtrip flights. As of Jan. 26,
the U.S. Centers for Disease Control and Prevention requires all air travelers to show a recent negative COVID-19 test result before they can board any flight heading to the U.S.
Shriner, who also is a tropical disease specialist, has been vacationing in Europe for years and has spent more than 20 years making regular visits to a medical project in Tanzania.
But at Huntington Hospital, ever since the holidays, “we’re just absolutely getting hammered with cases of people who traveled,” she said.
Outside the hospital, Shriner has done some driving around California but hasn’t flown since March. Like her colleagues, she believes that driving (especially if you bring food and avoid public toilets) is safer than flying and much safer than cruise ships (most of which are idle now).
Like Ostrosky, she wants to see a positivity rate of 5% or less at her departure
point and at her destination. For data, she recommends the Johns Hopkins University Coronavirus Resource Center.
Shriner likes the idea of airlines and destinations requiring negative test results or vaccination. Whether or not those are required, Shriner said, people should get vaccinated, wait at least four weeks (to allow resistance to strengthen) and consider their age and immunity history before making travel plans.
In darker moments, she said, she worries that “this could just go on for another year or two if people don’t widely accept the vaccine.” She also shared a recent nightmare: She was on the Pirates of the Caribbean ride at Disneyland (which remains closed) surrounded by unmasked strangers.
On the brighter side, she’s hopeful that travel might be safe as soon as late summer or early fall. “But it is all dependent on human
behavior,” Shriner said, “and we know how unreliable that is.”
Kuppalli moved in August from the San Francisco Bay Area to Charleston, where she is an assistant professor in the division of infectious diseases at the Medical University of South Carolina. She grew up in the Bay Area and had planned to visit her parents there this month.
Then the numbers surged. “I decided not to travel,” she said in mid-January. “I haven’t left my house in the last four days.”
To assess risk, “you can’t look at one particular piece of information,” she said. “You have to look at the entire thing. I totally get that this is hard for everybody. But this is not the time to travel. We all need to be thinking not just about ourselves, but everybody.”
Before Dr. Nancy Binkin became a professor at the Wertheim School of Public Health and Human Longevity Science at
University of California, San Diego, she lived for 12 years in Italy, doing epidemiology training for the Italian National Institute of Health.
So when that country’s fatalities soared in the early weeks of the pandemic, followed by escalating U.S. numbers, “it put fear into me,” Binkin said. “I have not been out of San Diego County since March.”
One pandemic number she watches closely is the adjusted case rate.
That count measures the seven-day average of daily new cases per 100,000 people ( jails and prisons excluded). Any number above seven per 100,000 puts a county in the state’s most dangerous category, the purple tier.
When it comes to flying, she worries about jet cabins and tiny bathrooms, but perhaps even more, she worries about the lines of people and gathering points at airports, she said.
“Would I feel comfortable going down to
Mexico? No,” she said. “I wouldn’t.”
Dr. W. David Hardy, former director of Cedars-Sinai Medical Center’s infectious diseases division and adjunct clinical professor at USC’s Keck School of Medicine, has mixed feelings.
He’s angry about “rampant disregard for science” and inconsistent messaging under the Trump administration. But Hardy sees great hope in the vaccines.
When he was treating HIV patients during the grimmest years of the 1980s, Hardy recalled, there was no such cause for encouragement.
“To have a vaccine that prevents 90-95% of people from getting sick is amazing,” Hardy said. He suggests that the vaccines are “going to be the final answer,” especially if the vaccines thwart transmission of the virus.