Holiday travel can quickly spread COVID-19: what to know before you go
All data and statistics are based on publicly available data at the time of publication. Some information may be out of date.
Crowded terminals, packed flights, weary travelers — these are common sights of holidays past.
With the United States hitting record numbers of COVID-19 cases, that scene will likely look different this winter.
Mask wearing, physical distancing, and hand hygiene are definitely on the itinerary.
It’s also important for holiday travelers to be aware of the potential risks along the way.
“I think there’s more and more data that domestic travel or flights of under 3 hours where people wear masks is actually low risk,” said Dr. Keith Armitage, an infectious disease specialist and the medical director of the University Hospitals Roe Green Center for Travel Medicine & Global Health in Ohio.
“It’s not the travel that concerns me. It’s more the social events associated with holidays,” he said. “If the travel brings people together in larger family groups, I think we will see more cases.”
Experts were asked about the risks travelers face, how they can easily transmit the virus back at home or at their destination, and what they can do to protect themselves and others.
The risks on the ground
The act of traveling itself may not be the riskiest part of going somewhere right now. The airplane environment, for instance, is believed to be relatively safe when masks are worn.
Experts say it’s what you do when you arrive at your destination that could potentially put you at greater risk for contracting the new coronavirus.
“It’s really the behaviors that people engage in once they’re there or once they’re back that probably have the biggest impact,” Armitage stated.
He emphasizes the importance of physical distancing, mask wearing, and testing.
A new study out of Europe, which hasn’t yet been peer-reviewed, found that a new variant of the virus may have been brought to other European countries by tourists vacationing in Spain.
Whether this new strain is more easily transmittable than others still remains to be seen.
Contracting the virus at their destination is a risk travelers take. That risk is higher if they don’t follow safety measures.
“Certainly following all the basic rules at all times — the face coverings in public areas, hand hygiene, carrying hand sanitizer, social distancing — is so important,” said Dr. Henry Wu, an associate professor and senior physician at the Emory University School of Medicine and director of the Emory TravelWell Center in Georgia.
“I think it’s really important that travelers really internalize that distance so that they’re always 6 feet away from others, in every situation, not just when standing in lines,” he said.
Wu sees the study as a general warning that there are risks involved with travel.
“Until we have a vaccine that’s universally effective and safe and available, your main tools are to either not travel or to really take to heart our current preventative measures.”
Gathering with people whom you don’t normally see could expose you to the virus. Especially if you’re doing so indoors and unmasked, Armitage says.
“There are so many case studies of family reunions, surprise parties, multigenerational birthday parties, where everyone got infected,” he explained.
“If your cousin, who is 20 years old, has gone to bars and restaurants and he comes to the surprise birthday party for your grandmother, they can infect everybody,” Armitage said. “It’s really indoor social events around the holidays with larger groups of different people that is really concerning for spread.”
Know before you go
States have different requirements that you must or are at least encouraged to adhere to before entering.
These include quarantining and testing.
Several states, such as Arizona or Delaware, don’t have any restrictions, but experts say it’s a good idea to quarantine or get tested out of an abundance of caution.
“The real reason to quarantine is two things: If you traveled from a low incidence area to a high incidence area, then you may want to quarantine when you come back,” Armitage said.
“Or if you engaged in risk behaviors of basically being indoors with strangers, and by strangers we mean people you don’t see day to day — that could include your cousins or your aunts and uncles.
“We’re seeing rising cases, and eventually that’s going to lead to more ill patients who require more critical medical care, and this could be exacerbated if people don’t follow social distancing around the holidays,” Armitage said.
Testing may be a requirement at your destination. Your home state may require a test when you return.
“In general, testing is like all of our other tools. It’s a tool that is potentially effective, but it’s not perfect,” Wu explained. “Unfortunately we don’t have any test yet that’s totally sensitive to catch infection at all stages of the infection, and we may never have a test that good.”
One big caveat is a false negative, which means you may be incubating the infection, but it’s too early for the test to be positive.
“We know there’s an incubation period for the coronavirus that unfortunately can take up to 14 days, which is where that whole 14-day quarantine rule comes from,” explained Dr. Natascha Tuznik, DO, FACP, an assistant clinical professor at the University of California, Davis division of infectious diseases. “The median incubation period for most people is a minimum of 5, at least 7 days, but again, it could be as long as 14.”
If you’re testing the day before you travel or the day when you get back, that doesn’t mean you don’t have an active infection that can transmit to others, she says.
“All that means is that when you took the test in that moment in time, you didn’t have enough detectable virus to be picked up by the test,” Tuznik stated.
If you think you may have contracted an infection on your trip but show no symptoms, Tuznik recommends waiting at least 5 to 7 days before you get tested.
“Because if you do it right away, you’re going to get a false negative,” she said. “And a lot of people don’t know that. They test and they are negative and they’re like, ‘I’m good to go.’”
“If somebody really wanted to be sure they weren’t infected after a trip, you would want to delay the test, so it’s not immediately after your trip,” Wu added. “Wait several days, or even test a couple times over 2 weeks after you return.”
Protecting yourself and others
Tuznik has some simple advice on holiday travel.
“Just because you can doesn’t mean you should,” she said.
As we all have learned throughout this pandemic, there are other ways to connect with family right now.
“I do think Zoom, Google Meet, Skype, WhatsApp, whatever your platform is, I do think that that is certainly better than nothing,” Tuznik said. “I foresee our Thanksgiving table having literally some placeholders for laptops so we can talk with family.”
But if you must travel, she says, always consider your own personal risk and the risk of those around you.
“If you have a high-risk individual at home or are traveling to someone that is high risk, I don’t know if it’s worth either putting yourself in danger or putting that person in danger just for some holiday time, because the worse case outcome is that somebody could die from it,” she explained.
Wu is encouraging folks not to travel if it’s not critically important, “or at least keep your gatherings small and local to the extent possible,” he said. “If you are traveling, you can certainly take precautions to keep both the risks to yourself and as well as whoever you’re visiting — the community you’re visiting — at lower risk.”
That means following all the distancing recommendations, mask-wearing rules, and keeping gatherings small.
“Even if not everyone has been tested or cleared of infection, I think the more that all of you are sticking to the precautions in their everyday life, that would really decrease chances that any of them happen to be sick when you’re getting together,” he said.
Wu also notes the importance of getting a flu shot, because influenza is commonly contracted while traveling.
If you make the journey to see family — or they come to you — the joy of seeing them should also include some important discussions.
“Make sure that every family member is on board with masking and trying to maintain somewhat of a distance. Oftentimes in quite a few households there may be that one individual who just doesn’t think COVID is a real threat or is refusing to wear a mask, and it’s probably good to hash that out before traveling or having people come to visit,” Tuznik said.
“I would not let that person into my house,” she added. “If you’re going somewhere where that person is going to show up, then seriously consider either not going or having that family not invite that person. That’s a big thing.”
Another important thing to consider as you make plans is that COVID-19 cases are rising across the United States.
“It’s particularly concerning because we’ve not even hit the height of winter yet, when we’ll be indoors even more, when we know that respiratory viruses spread even more readily,” Wu said.
“Many things are converging into the holiday season, and that does raise some concern, so really for the good of everyone, I think it’s a good time to set the bar a little higher for in-person get-togethers, and again, if you do get together, keeping it local and small is going to probably be your best bet,” Wu said.
When travel is unavoidable, use the safety methods available to us all.
“There may be reasons why you need to see somebody or travel, and again, the good news is I think the tools that we have when used consistently can be pretty effective,” Wu added.