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Travel During a Viral Outbreak

Disclaimer: This article is for informational purposes only. Sources are referenced but it is not a replacement for official guidance and advice from your local public health unit. Please refer to Resources for more.

Travelling abroad is not advised during global outbreaks of infectious diseases by many public health agencies. For those returning home or embarking on emergency air travel, this is a resource of suggestions to keep your travels safe and healthy.

Summary

The strategies employed can be summarized into 3 key guiding principles:

  1. Prevent surface transmission and prolonged exposure in close quarters to crowds
  2. Prevent contact with infection routes: eyes, nose, mouth
  3. Air travel is more than just sitting in the plane. This part is generally considered safe because of the air circulation and filtration systems on-board the plane. However, from departure to arrival, passengers encounter many checkpoints, surfaces, and individuals that may be carriers of infectious disease. It is important to be familiar with each of the steps of air travel, what’s required, and to anticipate delays at each step.

Contents

Before Travel

Before even thinking about traveling, ensure that you are up to date with current information from credible sources.

Information Gathering

  • Check National and Regional (Provincial, State) Public Health bulletins and news for the latest protocols in the origin and destination locations
  • Check National and Regional (Provincial, State) Travel bureaus for travel restrictions
  • Check insurance providers, emergency medical insurance providers, and travel insurance providers for their policies and updated policies in the case of the COVID-19 outbreak
  • Check airlines for updated policies and service changes
  • Monitor news and current events at both origin and destination locations

Before Traveling

  • Pack lighter: There are advantages to not having checked baggage in this situation. Changing flights becomes easier. You avoid your baggage being out of your hands, and you skip baggage claim. Consider leaving some nonessential things behind if possible. Keep hygiene essentials as well as medications in accessible pockets.
  • Plan A, B, C: Plan different modes of travel, different routes, and be prepared to switch if travel service changes suddenly. Know where to purchase tickets and to ask questions, know about flights departing before and after your intended flight. Keep checking the status of your flight(s).
  • Ensure travel essentials: Outbreak or not, you can always assume that you will not have access to hand-hygiene as often as necessary during air travel. Have travel sized hand sanitizers: alcohol-based hand rubs and non-aerosolized sanitizer sprays in a travel-appropriate container. Wipes, gloves, and masks are not essential but can be helpful.
  • Optional: TSA Precheck or NEXUS memberships (in North America) are helpful to expedite security and customs clearance lines. If you don’t have these, rest assured the crowds may thin as travel restrictions become tighter.

Etiquette and Mental Preparation

Travelling through an outbreak is very stressful as policies and service can change minute by minute. It is important to keep the following in mind to stay calm.

  • Be courteous. Everyone you encounter in the service and hospitality sector is experiencing the same conditions of the outbreak and will invariably help you get to your final destination safely.
  • Be mindful. It’s easy to panic and be worried about all sources of contamination, if you’re going to get there, what’s going to happen, etc. Be mindful of the present moment, take pauses to think things through. Documenting your actions can help slow you down and can help you improve every time you travel during cold/flu seasons – not just during an outbreak. Print out your plan if necessary for reference.
  • Help others where possible. Everyone is going through the same thing. If you can hold a door, give space when you can, share a wipe or a spritz – helping your neighbour keep healthy and safe (without jeopardizing your own health and safety) isn’t a bad thing.

6-24 hrs Before Travel

What to Wear

  • Check the weather of origin and destination before choosing your travel outfit
  • Choose at least 2 climate-appropriate layers to ensure an outer layer that can be removed quickly and comfortably
  • Layers with pockets can keep important documents and valuables close to you and on-hand as you travel
  • Hoodies, hats, and caps can serve as a layer to protect hair and scalp from contact with airline headrests
  • If you have long hair, consider tying it up or clipping it out of the way to ensure less irritation with any masks, hoods, hats, etc. We want to reduce any reason why you may touch your eyes, nose, or mouth
  • If you intend to wear a mask, consider skipping makeup and only applying minimal skincare/sun protection to avoid touching face, readjustments, need for touch-ups, and transfer/staining
  • Note what your “outer layers” are going to be: Keep clothing that will be exposed to seats and surfaces at a minimum
  • Designate specific pockets for ONE item only. One pocket for gloves, one pocket for phone, one pocket for passport, etc. This reduces cross-contamination and the need for sanitizing more than 1 item at a time. Keep frequently taken out items in outer pockets (passport, phone, sanitizer).

Planning for the Airport

  • Drive: make arrangements with your local taxi or ride-sharing service or a friend/family member to drive you directly to the airport with no other passengers. Public transit to airports can mean longer exposures in close quarters with others.
  • Time Departure: Time your departure for the airport for at least 3 hours prior to boarding time. Customs, security may be delayed with lines. Check your airport’s websites for updated security wait times and gate information.
  • Supplements, Medication, and Oropharyngeal Health: Take any supplements or medication before leaving your home if possible. Brush your teeth, floss, etc. before leaving the house. Optional sinus rinse or salt-water gargle. Ensure you take with you any necessary medications as well as extra in case of emergencies.
  • Hydrate and Time Meals: There are two goals with this: (1) Reduce trips to the bathroom and (2) to eat and drink as little as possible both in the airport and on the plane. This will reduce the chances for nose/mouth contact and contaminated surface contact. In short, eat before you go and pee before you go.
    • For short haul (<3 hrs) flights, this may be possible. For long haul (3-6 hrs) flights, consider low-contact snacks and beverage containers. Granola bars that can be held with the wrapper and bottles with a button-activated flip top are examples of this.
    • Drink plenty of water during the hours leading up to departing from home.
    • Plan a hearty balanced meal high in protein. Use the bathroom as much as needed before going to the airport.
    • Wear or pack incontinence pads or underwear in case of long wait times without access to a restroom.
    • This plan may differ for those with medical conditions. Plan accordingly.

Planning for Arrival

  • Arrange Transport: Arrange for a driver or taxi to receive you on arrival to your final destination. Instruct them not to wait in the terminal but instead to keep updated with your flight information, and be prepared to wait for customs and baggage processing times up to 2 hrs post-touchdown. Ensure they have your accurate contact information to coordinate pickup from a cellphone lot or nearby location.
  • Coordinate: With a contact at your destination to prepare pick-up and housing arrangements on your arrival
  • Pick-up Transport: Have 1 clean unused garbage bag for each piece of baggage and 1 more for outer layers of clothing
  • Final Destination Social Distancing: Have protocols for limiting contact between the traveler and other members of the household/roommates. Using 1 room, 1 bathroom, avoiding utensil crossover, having hand sanitizers readily available, etc.
  • Final Destination Decontamination: Ask to have a room (preferrably the laundry room) of your final destination to be emptied for decontamination of your baggage and clothing upon your arrival. Detergent, soap, a dryer sheet, and hangers can remain. Ask for disinfecting wipes if available.

Personal Protective Gear

  • Gloves: Disposable gloves can be a way to reduce the number of times you need to sanitize your hands. Bring multiple clean, unused pairs and change them whenever you contact a surface or have to take them off for security. Wear gloves that are suitable for your skin and are proper size for your hands.
  • Masks: Masks are not currently recommended by any health authority for healthy individuals. The WHO recommends masks for caretakers of those who have COVID-19. Masks are not effective at preventing coronavirus transmission unless combined with proper hand washing and/or hand sanitation techniques. If you have access to masks, this may be helpful as a respiratory barrier. You may need more than one as passport verification checkpoints will require you to remove them (make contact with the masks) for security. Proper handling and disposal techniques are necessary in order to use masks properly.
  • Use personal protective gear at the time of leaving home until you reach your destination to decontaminate

At the Airport

  • Gloves: Have a pair of disposable gloves on. Have a pair of gloves ready in a designated “clean gloves” pocket. Have other pairs of gloves in a sealed bag. Sanitize your hands before putting on gloves and after taking off gloves.
  • Boarding Pass: Have your boarding pass printed by a kiosk or an agent. This reduces the amount of contact you need with your mobile phone.
  • Ensure Space: As best as possible, give space of at least 1-2 metres / 6 feet from others. Be prepared to wait in lines.
  • Biometric Verification: Take off gloves, sanitize hands before and after verifying biometrics at fingerprint scanning kiosks. Don new gloves if available.
  • Security Checkpoints: Passport verification may require your full face to be shown. Take off your gloves and remove or lift the mask. Re-glove or sanitize your hands.
  • Service Desk: If available, ask your airline service desk if it is possible to be moved to an earlier flight or a more spaced-out seat arrangement.
  • Water: Try to find a smart filter to fill your water bottle. Else, purchase a small bottle of water and wipe it down.
  • At the Gates: Wipe down any seats that you want to take. Stand or keep distance from others. Avoid crowding especially at the boarding line.

Boarding and In-Flight

  • Seat: Upon boarding, stow away your baggage. Wipe down the seat, seat belt buckles, armrests, and headrest before sitting down. If you’re in a window seat, wipe down the window side wall and screen.
  • Food and Water: During drink or meal service, try to eat your own snacks and water. Else, ask for bottled water. Avoid eating and drinking on the flight if you can.
  • Contact Awareness: Be aware of the things that you may touch while in your seat: Outlets, touchscreens, pamphlets, headphones, light switches, vents, etc. Reduce the amount of contact that you make, and sanitize often. Avoid using the seat tray if possible. Avoid walking around the cabin.
  • Air circulation: Sanitizing before and after, open the air vent to create a flow of HEPA-filtered air.

Arrival and Pick-Up

Arrival

  • Sanitize baggage handles and surfaces as needed when you retrieve them to deplane.
  • Prepare for customs lines. Keep your space and follow advice as directed by border agents.
  • If waiting for checked baggage, ensure space of 1-2 m or 6′.

Pick-Up

  • Keep space between others waiting in the pickup area (1-2 m or 6′)
  • When your driver arrives, place baggage in clean garbage bags. Take off outer layer of clothing along with hat/hood and place in a clean garbage bag. Seal with a knot or tape and sanitize the surface. Change gloves or sanitize hands after sealing.
  • Spray or wipe down the car trunk handle, door handle, armrest, seat, and seat belt buckles before entering the vehicle.
  • Sit in the back seat as far from the driver’s seat to protect yourself and the driver. Avoid contact with other surfaces of the vehicle.
  • Keep your mask on if available.
  • Sanitize hands.

At Destination

Decontamination

  1. Establish or find the decontamination room: Remove all other clothes or shared items from a room. Have wipes or sprays ready to clean any surfaces your baggage touches.
  2. Bring bagged items to the decontamination room. Remove baggage and clothing from bags, change gloves, sanitize/wipe down the outside surfaces
  3. Empty pockets and sanitize/wipe down everything including your passport. Discard anything you don’t need anymore (boarding passes, luggage tags).
  4. Wipe down that which can’t be laundered immediately (down coats, current clothing, shoes, etc)
  5. Dispose of the bags that carried your baggage and outer layers.
  6. Dispose of wipes, remove gloves, wash hands for 20+ seconds with soap and water
  7. Launder everything including all your travel clothes
  8. Take a shower, washing hair and scrubbing thoroughly (enjoy it!)
  9. Optional oropharyngeal hygiene: facial steam inhalation, saline sinus rinse, brush teeth, or salt-water gargle
  10. Hydrate and eat a nourishing meal. You made it!

General Self-Isolation Hygiene

It’s generally recommended to self-isolate for at least 14 days after arrival for the sake of yourself and your housemates. Social distancing is now the best strategy for limiting spread of an outbreak. Be sure to monitor the news for your airline’s or travel bureau’s updates on any infected individuals on your flight.

Living Arrangements

As described above, ensure living arrangements are separate enough to keep space and avoid possible spread of infections during the 14 day self-isolation. Consider separate:

  • sleeping arrangements
  • working arrangements
  • cups, plates, utensils
  • mealtimes
  • showers, bathroom, and toiletries

Hygiene Upkeep

  • Avoid close contact with housemates: 1-2 m, 6′ space
  • Wear masks in public spaces: kitchen, hallways, living room, etc
  • Frequent hand washing with soap and water, 20+ seconds
  • Frequent hand sanitizing
  • Continue avoiding touching your eyes, nose, and mouth
  • Cover nose and mouth with a tissue while sneezing or coughing and dispose of the tissue
  • Sneeze or cough into the fold of your elbow
  • Regular laundering of clothes and linens (separate from the collective laundry)
  • Discarding used masks or gloves
  • Document and share travel history with healthcare provider
  • Eat only well-cooked food

⚠ During your time at your final destination, AVOID contacting elderly, immunocompromised, and vulnerable populations while in self-isolation.

Conclusion

To reiterate, this article is for informational purposes only. The steps recommended here are by no means fool-proof or guaranteed for a perfectly sterile travel environment. Sources are referenced but it is not a replacement for official guidance and advice from your local public health unit.

If you have symptoms emerging your self-isolation period, report to your local public health authority for next steps and testing. If you become symptomatic, wear masks whenever you are in the presence of others including at healthcare facilities. Call your doctor or hospital before your arrival. Treatment and care should be initiated on the instruction of your licensed healthcare provider. Telehealth options may be available.

Travelling abroad is not advised at this time by many public health agencies. There is no guarantee that any one action can prevent transmission of an illness. All infectious diseases have a spectrum of parameters that determine their viability, infection rate, transmission rate, etc. Novel coronavirus (COVID-19) is still being studied in all facets of its immunology including treatment and prevention. Please refer to this sampling of resources for updated and vetted information:

Resources

World Health Organization (WHO)

Health Canada

Center for Disease Control (CDC)

British Medical Journal (BMJ)

National Health Service (NHS – UK)

UK Government Self-Isolation at Home Guide

Good luck and be well. ♥ Dr. V

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