IAMAT |International Association of Medical Assistance to Travellers| IAMAT |International Association of Medical Assistance to Travellers|

Travel Health Journal

COVID-19 virus (SARS-CoV-2)

The disease on every traveller’s mind: COVID-19

The end of 2019 ushered in something new: an epidemic.

For the last two months, the coronavirus (COVID-19) outbreak has captivated the world’s attention. COVID-19 has spread to 6 continents – only Antarctica is free of infections – and as cases increase, many of us have questions about the virus and how or if we should be travelling. In this blog, we answer your questions about COVID-19 and provide information on what to do if you’re travelling soon.

What is the novel coronavirus?

Coronaviruses are a large family of respiratory viruses that can cause illness in people and animals. Infections from coronaviruses can vary in severity from the common cold, which causes mild illness, to more severe forms such as Middle East Respiratory Syndrome (MERS-CoV).

The novel (new) coronavirus was first detected in December 2019 in Wuhan, Hubei Province, China when a cluster of cases of viral pneumonia with unknown origin were reported. Scientists identified the new virus as genetically related to Severe Acute Respiratory Syndrome coronavirus (SARS-CoV) and officially named it SARS-CoV-2 (the virus that causes the disease COVID-19). SARS-CoV-2 is more infectious, but less deadly than SARS-CoV.

There is still a lot we don’t know about SARS-CoV-2 and we are still at the early stages of understanding the full scope of the COVID-19 epidemic.

How does COVID-19 spread?

The virus that causes COVID-19 (SARS-CoV-2) can be transmitted from person-to-person in two ways:

  1. Through coughing or sneezing – when an infected person coughs or sneezes nearby (within 3 feet / 1 metre), droplets can land in another person’s mouth or nose and inhaled into the lungs.
  2. A person can also catch the virus by touching droplets containing the virus on a surface or object and then touching their own mouth, nose, or eyes.

Current studies show that COVID-19 is not an airborne infection like Measles or Varicella – the virus does not seem able to survive for long periods of time in microscopic droplets that are released in the air.

What are the symptoms of COVID-19?

Symptoms of COVID-19 include fever, cough, and shortness of breath. They typically appear between 2 to 14 days after exposure. The majority of cases, around 80%, appear to have mild symptoms, though a small proportion of people develop breathing difficulties, including pneumonia. Current data shows that elderly persons, those with a pre-existing condition, and those with weakened immune systems appear to be more susceptible to severe forms of the disease.

How does COVID-19 compare to the flu?

Both COVID-19 and the flu (influenza) are viral infections that can spread from person-to-person through droplets, typically from coughing or sneezing. Both viruses can also cause similar symptoms such as fever, cough, and in severe cases, pneumonia. They are also treated through supportive care of symptoms (note: antibiotics only work on bacterial infections, not viral infections).

However, COVID-19 and the flu are caused by different viruses. The flu is caused by different strains of the influenza virus, whereas COVID-19 is caused by a new type of coronavirus.

Preliminary data indicates that COVID-19 does not appear to spread as efficiently as the flu. People with the flu can transmit the virus before they show symptoms of illness. This does not seem to be the case with COVID-19; current data suggests the virus can be transmitted when a person has mild symptoms.

COVID-19 can cause more severe disease than the flu. Unlike influenza viruses, which circulate seasonally, COVID-19 is a new disease that the population has not been exposed to before, leaving many people vulnerable to infection. It’s still too early to determine accurate mortality rates for COVID-19. Preliminary estimates from the World Health Organization suggest it is 3.4% for vulnerable populations (note: this estimate is based on current confirmed case counts and does not account for missing mild or symptom-less cases). According to the Centre for Disease Control, the death rate for the flu is 0.1%.

There is no vaccine for COVID-19 and it will likely take 1-2 years for it to be commercially available. The flu vaccine, which is widely available, prevents 4.4 million flu illnesses and 3,500 deaths in the US each year. Even so, at least 32 million flu cases and 18,000 flu-related deaths have been reported in the US as of February 22nd. As of March 5 in the US, there have been 162 COVID-19 cases and 11 deaths.

Where have cases been reported?

Cases have been reported in many countries around the world (for real-time updates on cases, see: Coronavirus COVID-19 Global Cases).

At this point, most COVID-19 cases and deaths are from China, where sustained local transmission is ongoing. As of March 5, local transmission (person-to-person spread in communities) has also been reported in 34 other countries, including Italy, Iran, South Korea, Singapore, and Germany. Imported COVID-19 cases (from travellers who were infected abroad) with no local transmission have been reported in 46 countries.

In many countries, including the United States, testing for COVID-19 is just getting underway. As such, we may see increases in COVID-19 numbers as existing cases are identified and new cases are recorded.

Should I cancel my travel plans?

Before you decide whether or not to travel, consider the following:

  • Personal health: It’s important to consider your current health status and your capacity to cope with the illness if you do get sick. COVID-19 generally causes mild illness, especially among young adults and children. However, persons who are older, have a pre-existing condition, and those with a weakened immune system appear to be at increased risk of severe forms of COVID-19 infection. Make an appointment with your healthcare practitioner to discuss your travel plans and health status.
  • Destination: It remains to be seen how specific countries fare with potential outbreaks as COVID-19 continues to spread. Currently, the disease has been reported in over 80 countries, but not all are experiencing local transmission. Practice enhanced caution if travelling to a destination with local transmission and hundreds to thousands of cases. Areas at increased risk for transmission are where large crowds congregate (e.g. airports, bus terminals, train stations, cruise ships, planes, and public transportation). Practice enhanced caution if you are going to a country with poor surveillance and a resource-limited healthcare system, as access to treatment may not be adequate.
  • Travel health insurance and cancellation coverage: Most travel cancellation policies will only provide reimbursement for trip expenses if your government issues a travel advisory against all nonessential travel to your destination. Otherwise, you may only be able to get reimbursed if you have ‘cancel for any reason’ coverage, which typically costs 30-40% more than regular cancellation policies. It’s also important to consider how your medical expense coverage will be affected if you travel to an area with COVID-19 cases – call your travel health insurance provider to ask.
  • Tolerance for risk: Any trip comes with some degree of risk, but it’s up to you how much risk you are willing to tolerate. Consider postponing or cancelling if the idea of travelling is causing you undue stress and is going to negatively impact your entire trip.

How can I stay protected while travelling?

Now more than ever, we need to travel responsibly and take precautions that protect everyone’s health. The COVID-19 epidemic has demonstrated the importance of basic hygiene measures, such as washing your hands, avoiding touching your face, and coughing/sneezing etiquette. It also highlights the importance of avoiding travel if you feel sick. As travellers, we play a role in the health of the communities we visit and our community back home – we need to act cautiously and responsibly wherever we go.

See the following tips to protect yourself and others during travel:

Before you leave:

  • Check with your government to see if any travel advisories have been issued for your destination.
  • Check for ongoing COVID-19 outbreaks at your destination (see real-time updates here).
  • Speak with your healthcare provider about your travel plans. Make sure you are fit to travel and that you are up-to-date with your routine immunizations, including a recent flu shot.
  • Check with your insurance company to ensure you have appropriate coverage for your trip. Make sure you have cancellation insurance (opt for ‘cancel for any reason’ coverage to ensure you can get the full cost of your trip reimbursed).

During your trip:

  • Wash your hands frequently and thoroughly. Use soap and water and wash your hands for at least 20 seconds. If soap and water are not immediately available, use a hand sanitizer containing at least 60% alcohol.
  • Avoid touching your face.
  • Sneeze and cough into the crook of your arm or a tissue. Dispose of the tissue immediately after use.
  • Avoid close contact with people who are coughing, sneezing, or appear unwell.
  • Pay attention to how you feel. Call a doctor or local health authority if you experience a fever, cough, and shortness of breath and tell them about your travel history. Postpone any further travel until you are well again.

After you return:

  • Continue to pay attention to how you feel. Call your doctor or local health authority if you experience a fever, cough, and shortness of breath and tell them about your recent travel. Stay at home and minimize your contact with others.

Should I wear a mask?

If you are healthy, it is not recommended that you wear a mask. There is currently insufficient evidence to prove that masks are effective protection against COVID-19.

Masks are only recommended for persons who are in close contact with someone who is sick (for example: healthcare professionals and those living in the same house as someone diagnosed with COVID-19). Masks are also recommended for persons who are sick to reduce the likelihood of spreading the virus.

There is currently a worldwide shortage of masks. To ensure healthcare providers and those directly affected by COVID-19 have appropriate protection, please do not waste masks.

The most effective way to protect yourself and others from COVID-19 is to frequently and thoroughly wash your hands, use correct cough/sneeze etiquette, stay at least 3 feet (1 metre) away from people who appear sick, and to stay home if you feel sick.

COVID-19 resources:

Photo by NIAID-RML

Article by Claire Westmacott