lwn 2-4-21

FEBRUARY 4, 2021
WEEKLYNEWS.NET - 978-532-5880 9
When will you feel safe to travel?
Five epidemiologists share hopes, fears, data, guess
BY CHRISTOPHER REYNOLDS
LOS ANGELES TIMES
LOS ANGELES — How do
you measure the risks of pandemic
travel, and when will the
time be right to go again?
We asked five infectious
disease experts, including one
who hadn’t left home in four
days, one who has taken two
Mexican vacations since March
and one who recently awakened
from a COVID-19/Disneyland
nightmare.
The first thing we must
do, they agreed, is stay close
to home for at least several
more months, get vaccinated,
and watch virus transmission
and ICU numbers closely.
Putting down the pandemic in
California and elsewhere, they
said, will depend on how faithfully
we use masks, keep our
distance and wash our hands
— habits that will remain vital
as authorities strive to vaccinate
300 million or more Americans
by summer.
“I will never get on an airplane
again without a mask,”
said Dr. Kimberly Shriner, an
infectious disease specialist
at Huntington Hospital in
Pasadena.
“Now is not the time to be
traveling. For leisure or business,”
said Dr. Luis Ostrosky, a
professor of infectious diseases
at McGovern Medical School at
UTHealth in Houston.
If you fly now, said Dr.
Krutika Kuppalli in Charleston,
South Carolina, “you can almost
guarantee that there are going to
be people on the airplane with
you who have COVID.”
These experts all are wary
of new variants of the virus.
None is flying now. Three have
spent recent months within 120
miles of their home, as authorities
urge all Californians to do.
(That advisory remains in place,
despite Gov. Gavin Newsom’s
loosening of many restrictions
on Jan. 25.) But their perspectives
vary:
The numbers he watches
Ostrosky, born in Mexico
City, has a lot of family there.
So when his grandmother died
recently, he thought about
making the trip south. Mexico
is one of the few countries
Americans can visit without a
mandated quarantine.
But after much talk, he stayed
put in the U.S. because of the
pandemic. Before he resumes
travel, he said, he’ll ask several
questions.
What’s the positivity rate? “I
would avoid traveling to any
place that has a positivity rate
over 5 percent,” he said. Above
that, “you dramatically increase
your chances of exposure.”
California’s seven-day average
positivity rate — the number of
COVID-19 tests that yield positive
results — was 12.4 percent
on Jan. 27.
How full and how capable are
the hospitals? Scores of U.S.
hospitals are at surge capacity,
with shortages of ICU beds.
Because most county governments
report COVID-19 information
daily, Ostrosky said,
“it’s actually pretty easy” to
find data. As for capability, any
hospital with a Level 1 trauma
center (the most comprehensive
trauma care) would satisfy him,
Ostrosky said. The American
College of Surgeons maintains
a database.
Does this destination require
testing to enter or leave? Many
travelers might hope for that,
but “I just don’t want to get
stuck somewhere,” Ostrosky
said. “People can test positive
for a long period of time
without being infectious.”
This is now a factor in any
flight to the U.S., including returning
round-trip flights. As
of Jan. 26, the U.S. Centers for
Disease Control and Prevention
requires all air travelers to show
a recent negative COVID-19
test result before they can board
any flight heading to the U.S.
What haunts a doctor’s
dreams?
Shriner, who also is a tropical
disease specialist and director of
the Pasadena Travel Medicine
clinic, has been vacationing in
Europe for years and has spent
more than 20 years making regular
visits to a medical project
in Tanzania.
But at Huntington Hospital,
ever since the holidays, “we’re
just absolutely getting hammered
with cases of people who
traveled,” she said.
Outside the hospital, Shriner
has done some driving around
California but hasn’t flown
since March. Like her colleagues,
she believes that
driving (especially if you bring
food and avoid public toilets)
is safer than flying and much
safer than cruise ships (most of
which are idle now).
Like Ostrosky, she wants to
see a positivity rate of 5% or
less at her departure point and
at her destination. For data, she
recommends the Johns Hopkins
University Coronavirus
Resource Center.
Shriner likes the idea of airlines
and destinations requiring
negative test results or vaccination.
Whether or not those are
required, Shriner said, people
should get vaccinated, wait at
least four weeks (to allow resistance
to strengthen), and consider
their age and immunity
history before making travel
plans.
In darker moments, she said,
she worries that “this could just
go on for another year or two
PHOTO | LOS ANGELES TIMES
How do you measure the risks of pandemic travel, and when
will the time be right to go again? Five experts weigh in.
if people don’t widely accept
the vaccine.” She also shared
a recent nightmare: She was
on the Pirates of the Caribbean
ride at Disneyland (which remains
closed) surrounded by
unmasked strangers.
On the brighter side, she’s
hopeful that travel might be safe
as soon as late summer or early
fall. “But it is all dependent on
human behavior,” Shriner said,
“and we know how unreliable
that is!”
What keeps Dr. Kuppalli
home
Kuppalli moved in August
from the San Francisco Bay
Area to Charleston, where she
is an assistant professor in the
division of infectious diseases
at the Medical University of
South Carolina. She grew up in
the Bay Area and had planned
to visit her parents there this
month.
Then the numbers surged. “I
decided not to travel,” she said
in mid-January. “I haven’t left
my house in the last four days.”
To assess risk, “you can’t
look at one particular piece of
information,” she said. “You
have to look at the entire thing.
... I totally get that this is hard
for everybody. But this is not
the time to travel. We all need
to be thinking not just about
ourselves, but everybody.”
Escaping the purple tier
Before Dr. Nancy Binkin
became a professor at the
Wertheim School of Public
Health and Human Longevity
Science at UC San Diego, she
lived for 12 years in Italy, doing
epidemiology training for the
Italian National Institute of
Health.
So when that country’s fatalities
soared in the early weeks
of the pandemic, followed by
escalating U.S. numbers, “it put
fear into me,” Binkin said. “I
have not been out of San Diego
County since March.”
One pandemic number she
watches closely is the adjusted
case rate. That count measures
the seven-day average of daily
new cases per 100,000 people
(jails and prisons excluded).
Any number above seven per
100,000 puts a county in the
state’s most dangerous category,
the purple tier. On Jan. 27,
California’s statewide rate was
71.6 per 100,000. Before she
travels, Binkin wants to see that
number below seven.
When it comes to flying, she
worries about jet cabins and tiny
bathrooms, but perhaps even
more, she worries about the
lines of people and gathering
points at airports, she said.
“Would I feel comfortable
going down to Mexico? No,”
she said. “I wouldn’t.”
About that second trip to
Mexico...
Dr. W. David Hardy, former
director of Cedars-Sinai
Medical Center’s infectious diseases
division and adjunct clinical
professor at USC’s Keck
School of Medicine, has mixed
feelings.
He’s angry about “rampant
disregard for science” and inconsistent
messaging under
the Trump administration. But
Hardy sees great hope in the
vaccines.
When he was treating HIV
patients during the grimmest
years of the 1980s, Hardy recalled,
there was no such cause
for encouragement.
“To have a vaccine [that prevents]
90-95 percent of people
from getting sick is amazing,”
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Hardy said. He suggests that the
vaccines are “going to be the
final answer,” especially if the
vaccines thwart transmission
of the virus as well as block
symptoms.
Yet “the metrics for measuring
transmission are ever changeable,
and it may be difficult
planning travel based on those,”
he said. “They are going to be
fluctuating for a while. I would
say from six months to a year.”
Since March, Hardy said, he
has scrubbed trips to Europe,
North Africa and Hawaii. But
in September, after California’s
first surge had passed, Hardy
and his partner flew to Los
Cabos, in Baja California,
Mexico, for a vacation. It went
well. So in December Hardy
and his partner flew again, this
time to Cancún and Playa del
Carmen on Mexico’s east coast,
where they found “the local
people there were using masks
religiously.”
The other visitors? Not so
much.
“I would say 50-60 percent of
the tourists were completely ignoring
the mask requirements.”
Most of them were
Americans, Hardy said, and he
began asking people to put on
their masks — or if they had no
mask, “to step away from where
I was standing.”
“The whole experience was
“confusing and disconcerting,”
he said. “When I got home from
my second trip to Mexico, I
turned to my partner and said,
‘This is not a good time to
travel.’ … People are not adhering
to what they should be
adhering to.”
In some respects, Hardy said,
that behavior reminds him of
the 1980s when HIV was new.
Then as now, he said, “until one
of your friends, family or work
associates dies of this disease,
you still look at it as a sort of
distant thing that doesn’t affect
you.”
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