Could travel be revived with coronavirus testing at airports and immunity passports?
In the current travel maze created by the coronavirus, passengers are faced with constantly changing rules. Airports, countries and even airlines impose their own restrictions – such as tests, measures and protocols – on who can cross international borders.
Several places have adopted the tests as key to allow travel in the coronavirus era. This has led to more calls from the travel industry to use the tests to facilitate a return to a more normal flow of passenger traffic.
Travelers also prefer testing for coronavirus. According to a recent survey by SmartBrief for the Business Traveller, more than 65% believe a coronavirus test should be required for travel, CNN review.
But are tests, and the introduction of so-called covid-19 immunity passports -which show when someone has recovered from infection- really the key to get the world moving again?
The answer, of course, is not simple.
Coronavirus PCR tests: the gold standard
There are two categories of tests for covid-19, which determine whether you have a current or past infection.
Virus tests, using a swab, confirm if you do in fact have the virus. And the gold standard is the polymerase chain reaction (PCR) test. That’s the type of test we’ll focus on in this travel article.
The antibody test determines if you have had covid-19 in the past. We don’t know if this means that a person is immune or how long the immunity might last.
The problem with PCR tests is that it is only a snapshot in time. When Iceland introduced coronavirus testing at airports as a way of allowing travel, it quickly became apparent that the virus was still arriving despite the negative tests. This led the country to reintroduce a limited quarantine.
“I don’t think people have a clear concept of the tests,” Rex Gerald, a senior researcher at the Missouri University of Science and Technology, told CNN Travel. “By the time you get tested, you’re negative, but when you get home you could have interacted with people and gotten the disease.
Testing in practice
Emirates became the first airline to require passengers to undergo coronavirus testing for travel. The company went further and promised passengers that it would pay for covid-19 treatment, including repatriation and, if the worst happened, funerals.
Hong Kong International Airport was the first airport to implement arrival testing and its approach illustrates the cumbersome logistical problems involved.
Passengers were taken to a facility to undergo coronavirus testing and wait for the results, which usually arrived on the same day of their travels. Since then, complex rules have been imposed on who will be denied entry, who can transit through the airport to another destination, and who must present proof from an accredited laboratory.
Similarly, the test that costs 120 euros (US$ 140) at Vienna airport puts arriving passengers in a waiting area while they wait for the results. The fact that coronavirus testing is mandatory or not dependent on the country of origin means more confusion for travelers and the likelihood of more customs and immigration-style delays.
Today, many airports, including London Heathrow and New York JFK, are working on coronavirus testing. But those who have a health certificate showing a negative covid-19 result within 72 hours of arrival may skip entry testing.
Coronavirus testing, replacing travel bans
The travel industry wants governments to develop a global and harmonized approach with rapid and accurate testing to replace travel bans that crush the passion for travel and 14-day quarantines.
A global standard could alleviate traveler confusion. Today, with so many requirements, questions remain: Should you get tested for coronavirus, if so, when and how often should you get tested during travel?
What does the airline, country, or hotel require? Do recovered covid-19 cases retain immunity, and if so, for how long?
For many questions, there are no answers. Even the development of a coronavirus vaccine will not necessarily end travel questions, as the duration of effectiveness is unknown.
A constantly changing list of countries, airports, airlines, cruise lines, spas and hotels are implementing restrictions that require a negative outcome for travel.
In many countries, travelers can access pre-travel coronavirus testing through their healthcare provider within days of travel, depending on availability, country, or airline requirements. Armed with negative test results, they are not supposed to be able to spread the disease, although, of course, they could still contract the virus immediately after leaving the test center.
As for who pays for the tests, it depends. The International Air Transport Association (IATA) reported that incoming coronavirus tests cost travelers up to US$200 for some European destinations. Multiply that by a family of four and a trip becomes questionable, in addition to the question of whether or not such costs are covered by insurance.
Coronavirus “immunity” passports for travel
Chile, Germany, Italy, the United Kingdom and the United States are playing with the idea of “immunity” passports. It would be a physical or digital document that certifies immunity to covid-19 and identifies those who have antibodies that make them immune. But the duration of immunity for recovered patients is unknown. Scientists in Hong Kong recently confirmed that a man was reinfected, just four months after recovery.
Public health officials, including the World Health Organization (WHO), are resisting so-called “covid-19-free” or immunity passports. WHO cites how little is known about the virus. It is concerned that relaxing testing requirements could lead to further spread of the disease. Also, that authorized persons should not wear masks, wash their hands, or distance themselves from society.
One “passport” innovation is the covid-19 international travel card from the Israeli company Pangea. It is a secure digital card designed to enable rapid cross-border identification, according to CEO Rafi Kaminer. Other concepts would inform whether a recovered person is immune or not.
“Our card allows authorities to know the current status of covid-19 of all incoming and outgoing travelers, whether they were tested, who did the test, the results and whether they were tested for the current trip,” he told CNN Travel.
“Travelers must submit a request to the government medical authorities implementing the online system that is integrated into the Passport Control Authorities, which can quickly approve or deny entry based on the data on the card. It is automatically updated with the test or when a vaccination is administered”.
Meanwhile, U.S. researchers and technology companies are scrambling to develop rapid tests that they say are blocked by government approvals.
Few of these rapid tests meet the strict requirements set by the WHO for “point-of-care” testing in August, reported Chemical and Engineering News, a journal of the American Chemical Society. These requirements include: results within 40 minutes; administration outside a clinical setting with 70% accuracy for true positivity and 97% accuracy for true negativity. Costs should not exceed $20.
As scientists strive to develop rapid tests, a new debate is emerging about tests that are faster than the standard PCR test, if not as accurate. They question the need for accuracy at that level.
Michael Mina, assistant professor and epidemiologist at the Harvard TH Chan School of Public Health, argues that CRP tests are too slow, too expensive, and do little to stop the spread of the disease because they do not identify when a person has covid.
He advocates do-it-yourself tests that do exactly that. Like home pregnancy tests, but using saliva, these tests, now being developed by a handful of companies, indicate when someone is most contagious. It could be as good as a vaccine, says Mina, who spoke at a recent press conference urging faster approvals for the technology.
Easing the Delays
“Diagnosing people doesn’t do much to stop the outbreak,” says Mina. “PCR used as a diagnostic tool not only offers little to break transmission chains, but is actually putting us on the wrong track.
“I want evidence that tells someone they are transmitting at the time they are transmitting so they can act on it. I want them to take it every day or every other day. If everyone who tests positive stays home, we would break the transmission.
Gerald says that by delaying the deployment of alternative tests that could alleviate testing delays, public health officials could be doing more harm than good. The problem is that current government approval requires a comparison to the PCR test and the alternative tests are not as accurate. The tests must also be approved by international health authorities.
“The idea is to keep the flow of traffic moving,” Gerald told CNN, describing the machine he and his colleagues are developing for the airport inspection, which gives results in three seconds. “It sorts passengers into passing or failing and allows most to continue on their way. If someone is flagged, they are given a five- to 15-minute PCR test.
For now, testing is considered the way to free up travelers to roam the planet. However, it is clear that travelers should proceed with caution. The fact is that solutions designed to open up travel remain complicated. But the rapid progress being made means that it is only a matter of time.
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