Have passport, but should you travel?

Access to reliable health care not guaranteed overseas

Have passport, but should you travel?

By now most of the country has learned that because of COVID-19’s recent surge, Gov. Gavin Newsom made the correct yet depressing decision to close many California businesses that only just reopened following the first lockdown.

While many countries are slowly opening up to tourism, American residents are absent from many lists of permitted entrants. We have become the Pariah States of America, welcome on 12 Caribbean islands, four Balkan states, Albania, Ukraine, Lebanon, Mexico and nine other countries, all of which have varying COVID-19 test and/or quarantine requirements and fines. Thinking of skipping out? Don’t. The United Arab Emirates, for example — requiring both a COVID-19 test and mandatory 14-day quarantine even with negative test results — imposes fines of nearly $30,000.

I don’t blame the countries that exclude us or make us jump through hoops to travel there. Too many Americans have behaved badly or chosen to ignore science, instead engaging in magical thinking or worse, calling COVID-19 a hoax.

For those who are considering traveling to any of these countries — or to Hawaii after Sept. 1 – keep in mind that it is often very difficult to get COVID-19 test results in seven days, much less three, despite what laboratories tell your physician. On June 26 I took a test at my internist’s office that was sent to a nearby lab promising three-day results. Seven days later I received negative results.

If you do decide to go, armed with up-to-date entry requirements and negative test results, is it safe getting there? Here’s my conversation with Dr. Dipesh Patel, a Los Angeles-based emergency medicine specialist with certification in Tropical Medicine and Hygiene, who also serves as a search and rescue physician as part of a team deploying internationally on the U.S. government’s behalf.

Julie: We do not yet have federal guidelines mandating maximum flight loads and masks, and airlines haven’t been uniform in reducing loads or enforcing mask-wearing for boarding or in-flight. Given that COVID-19 is so easily transmittable, if one is otherwise healthy and not immuno-compromised, is it safe to fly?

Dr. Patel: I don’t think so for several reasons. First, there are many who consider themselves healthy because they haven’t been formally diagnosed with a medical condition, but may actually harbor poor health — for example, obesity, one of the most significant risk factors necessitating admission to an intensive care unit or death from COVID-19. Second, being healthy doesn’t preclude COVID-19 complications requiring quality medical care. This is difficult to gauge when traveling overseas or out-of-state.

These last few weeks, almost daily, I’ve seen healthy 40-year-old COVID-19 patients so nauseated and weak, they were unable to tolerate food or liquids and suffered fainting spells. If you’re in L.A. or S.F., it’s not hard, for now, to find an ER and get admitted until one can finally self-hydrate. However, if overseas or out-of-state where hospitals have reached capacity and unwilling to admit patients given the absence of available beds, patients would need to go home, wait and hope for good luck.

Most healthy people think travel is safe because they believe they are unlikely to develop complications. Three key things to note: Healthy people are getting pretty sick from COVID-19, minor ailments become major complications when you’re away from home and without reliable access to good care, and finally, most areas that haven’t experienced large COVID-19 outbreaks are unfamiliar with the nuanced care required for infected patients.

Julie: During flight, aircrafts obtain air from outside through a series of complex vents and have hospital grade high-efficiency particulate air filters that clean the air every few minutes, making it about as safe as other indoor settings. Is that safe enough, given the proximity of other, potentially asymptomatic, infected passengers in the cabin?

Dr. Patel: Most viruses, and other germs, do not easily spread on flights due to how air is circulated and filtered. However, social distancing is difficult on crowded flights. Sitting within six feet of others for hours increases exposure risk to the virus causing COVID-19.

The Centers for Disease Control and Prevention found that only one-half of COVID-19 infected individuals could identify those who had been sick around them. That tells me most aren’t aware of how they contracted the virus or from whom. Asymptomatic spread obviously contributes to this. Also, air travel requires time in terminals, close contact security lines and frequently touched surfaces. So I don’t know if it’s safe unless mandated minimum distancing between passengers is established and enforced.

Julie: Do you think airplanes are super spreaders?

Dr. Patel: There’s no evidence pointing to this yet. However, in a number of past infectious disease outbreaks, including tuberculosis and most recently Ebola, only a very small percentage of people are usually responsible for super-spreader events. Since there hasn’t been a lot of air travel up until now, there hasn’t been an opportunity to study whether air travel contributes significantly to spread of COVID-19. We’ll learn more as more people start traveling.

Julie: Sadly, that seems like a double-edged sword.

Dr. Patel: My best advice is that if one must travel, go alone, stay in the U.S. and be somewhere with reliable access to health care should things turn south.

Julie: During the last three decades, I’ve lived abroad twice while working and traveled to over 100 countries. My most fervent desire is an effective vaccine. I know travel has been an enormous part of your life. Do you have any air travel planned in the immediate future?

Dr. Patel: I’ve lived on three continents and have a love for travel that goes beyond mere passion. But I have nothing planned for the next year. I’ve seen enough to know that families are torn apart and forever altered by this pandemic. And though I know I’m healthy, I’d rather not travel and put my family, friends and others at risk. Instead, I’ve chosen to stay put, see those I care about more regularly while socially distancing and redirecting my travel passion to more meaningful local adventures and experiences.

Julie: Stay safe out there, and happy travels even if your travel is limited to your backyard, patio or local park.

Julie L. Kessler is a journalist, attorney and legal columnist and the author of the award-winning travel memoir “Fifty-Fifty: The Clarity of Hindsight.” She can be reached at www.vagabondlawyer.com.

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