COVID-19: Travel risk assessment

Factors health professionals should consider when advising those who are planning international travel during the COVID-19 pandemic COVID-19: Travel risk assessment

Background

Coronavirus disease (COVID-19) is an infectious disease caused by a novel coronavirus (SARS-CoV-2). According to current evidence, it is primarily transmitted between people through droplets of saliva or discharge from the nose when an infected person coughs or sneezes, and direct or indirect contact with these secretions. Fever, cough, anosmia (loss of, or change to, sense of smell or taste) chest tightness, myalgia (muscle aches), fatigue and shortness of breath are the main symptoms reported (1).

Most people infected will experience mild to moderate illness and recover without requiring special treatment. Older people and those with underlying health problems are more likely to develop severe disease. Current evidence also shows that there is a higher risk of infection and of severe disease in Black, Asian and Minority Ethnic groups in the UK, but reasons for this are currently not clear. At this time, there are no specific vaccines or treatments for COVID-19. However, there are ongoing clinical trials evaluating potential treatments (2).

Risk assessment prior to travel

A comprehensive risk assessment should be undertaken for any person who is travelling. Consider all travel related risks, prevention advice and provisions for the traveller, such as insect bite avoidance, immunisations, and malaria prophylaxis. Information to help with a comprehensive risk assessment can be found on each Country Information page.

The following aims to help health professionals to assess and communicate the potential risks associated with COVID-19 infection, and allow the traveller to make as informed a decision as possible regarding their travel plans.

Additional NaTHNaC COVID-19 specific information is also available: general information, advice for those returning from abroad, and those travelling as humanitarian aid workers.

It is particularly important that travellers always check the latest travel advice from the Foreign, Commonwealth & Development Office prior to booking any travel, as well as prior to departure.

Current UK Government guidance on travel

The Foreign, Commonwealth & Development Office (FCDO) has updated the Exceptional Travel Advisory Notice advising all British people against all non-essential travel worldwide. As of 4 July 2020, some destinations that no longer pose an unacceptably high risk for British travellers are exempt. This will remain under constant review to take into account the latest situation in each country. Further information and details of the exempted countries and territories can be found on the GOV.UK website.

General considerations

Travellers should be aware of travel advice, government, and public health recommendations for the UK, any transit-countries, and all destination countries. Advice may change quickly, and therefore travellers should stay up to date before, and during travel.

General considerations for all travellers include to (3):

  • check the latest general guidance from the Foreign, Commonwealth & Development Office for UK travellers.
  • check the latest FCDO country-specific travel advice regularly.
  • ensure appropriate travel insurance.
  • be prepared to follow the advice of local authorities abroad. Be ready to comply with local isolation, social distancing, or quarantine requirements, and to rely on the local health system.
  • make sure you have enough medication with you in case you are abroad longer than planned.
  • be prepared for logistical and financial disruption to your travel.
  • arrange extra support for family members, dependants or pets who may need care if you are abroad longer than planned.
  • ensure that you can access all recommended travel services including vaccines and malaria prophylaxis (if required).

Individual factors

All individuals, but particularly those who are clinically vulnerable or extremely clinically vulnerable to severe COVID-19 disease, need to consider current UK recommendations to reduce their risk of infection. This may mean considering postponing travel particularly if the individual is considered clinically extremely vulnerable.

All those who do decide to travel, and particularly those who are vulnerable to severe illness from COVID-19, should ensure prior to travel:

  • they have adequate insurance coverage, reading details carefully. A specialist policy may be required.
  • they have a good supply of any regular medications.
  • they have considered the availability and capacity of local health services if they do become unwell.

Travellers at higher risk of developing serious illness include those who are:

  • older (aged 70 or above).
  • living with existing health problems (including immunosuppression).
  • in Black, Asian and Minority Ethnic (BAME) groups.
  • pregnant.

General travel advice for special risk travellers is available from a number of our factsheets listed here.

Older travellers

Regardless of medical conditions, those aged 70 or older are clinically vulnerable to severe illness from COVID-19 (4).

Those falling into this age category should check the latest NHS guidance before considering travel. Remember older travellers should also consider other important risks and prevention measures before booking any travel.

Travellers with existing health problems, including immunosuppression

Some underlying health conditions put individuals at increased risk of severe COVID-19 disease. Currently, UK advice is that this includes anyone instructed to get a flu jab as an adult each year on medical grounds (4).

Those who are clinically vulnerable include those with the following conditions:

  • chronic (long-term) mild to moderate respiratory diseases, such as asthma, chronic obstructive pulmonary disease (COPD), emphysema or bronchitis.
  • chronic heart disease, such as heart failure.
  • chronic kidney disease.
  • chronic liver disease, such as hepatitis.
  • chronic neurological conditions, such as Parkinson’s disease, motor neurone disease, multiple sclerosis (MS), or cerebral palsy.
  • diabetes.
  • a weakened immune system as the result of conditions such as HIV and AIDS, or medicines such as steroid tablets.
  • being seriously overweight (a body mass index (BMI) of 40 or above).
  • pregnant women (see below).

Those who are clinically extremely vulnerable include:

  1. Solid organ transplant recipients.
  2. People with specific cancers:
    • people with cancer who are undergoing active chemotherapy.
    • people with lung cancer who are undergoing radical radiotherapy.
    • people with cancers of the blood or bone marrow such as leukaemia, lymphoma or myeloma who are at any stage of treatment.
    • people having immunotherapy or other continuing antibody treatments for cancer.
    • people having other targeted cancer treatments which can affect the immune system, such as protein kinase inhibitors or PARP inhibitors.
    • people who have had bone marrow or stem cell transplants in the last 6 months, or who are still taking immunosuppression drugs.
  3. People with severe respiratory conditions including all cystic fibrosis, severe asthma and severe chronic obstructive pulmonary (COPD).
  4. People with rare diseases that significantly increase the risk of infections (such as SCID, homozygous sickle cell).
  5. People on immunosuppression therapies sufficient to significantly increase risk of infection.
  6. Women who are pregnant with significant heart disease, congenital or acquired.

Those who are clinically vulnerable to severe disease from COVID-19 should follow current UK advice. If travel is considered essential, follow the general travel advice carefully to minimise risk of COVID-19.

Black, Asian and Minority Ethnic (BAME) groups

The current evidence is that there is a higher risk of infection and of severe disease in BAME groups in the UK. The reasons for this, and how this is affected by other factors such as environment, occupation, medical conditions, or obesity is unclear. However, consideration should be given to how a travellers ethnicity may increase the risk of severe disease when undertaking a risk assessment.

Pregnant travellers

All pregnant women are considered to be clinically vulnerable to severe illness from COVID-19. Pregnant women with a serious heart condition are considered to be clinically extremely vulnerable (alongside anyone that has a condition that would place them in the very high risk category, irrespective of pregnancy) (5). Women who are more than 28 weeks pregnant are advised it is especially important to follow the current coronavirus-related pregnancy NHS advice.

More detailed information on pregnancy and coronavirus is available from the Royal College of Obstetricians and Gynaecologists.

All pregnant women who are considering travelling should check the latest NHS guidance on what measures are currently recommended to reduce the risk of COVID-19. If they do decide to travel they should also consider other important risks and prevention measures necessary when travelling before booking any travel.

Destination related factors

Each country is classified as high, moderate or low risk of exposure to COVID-19 based on currently available information assessed by Public Health England and the National Travel Health Network and Centre.

  • HIGH – All travellers are advised to avoid non-essential travel to these countries/areas. Travellers should discuss their plans with a health professional, this is particularly important for those at increased risk of severe COVID-19. Individuals entering or returning to the UK from these countries/areas will be required to follow additional UK border measures which includes self-isolation for 14 days.

  • MODERATE – Travellers at increased risk of severe COVID-19 should consider avoiding non-essential travel to these countries/areas. Travellers should consider discussing their plans with a health professional, this is particularly important for those at increased risk of severe COVID-19. Travellers returning to the UK may be required to follow additional UK border measures which may include self-isolation for 14 days.

  • LOW – There are no additional health advisories for these countries/areas, but travellers are reminded that on return to the UK they may be required to follow additional UK border measures which may include self-isolation for 14 days.

There are also a number of official sources of information on in-country COVID-19 case numbers and fatalities (often reported in both daily and total figures over weeks/months). Those reporting comprehensive global figures include:

When considering the risk of COVID-19 infection at any planned destination, the following should also be considered:

Affected areas in a country

  1. The risk of COVID-19 may vary within a country. Where specific information exists, this will be provided in our Country Information pages.
  2. In many cases, it will not be possible to identify specific risk areas within a country. In these situations, the degree of risk will be assumed to be uniform in the whole country depending on what information is available.

Transmission levels

It is important to be aware that countries will vary in terms of capacity and methods for surveillance, testing, and reporting of COVID-19 cases and deaths. This can affect the numbers of cases and fatalities being published, and therefore may not be a real-time reflection of ongoing COVID-19 transmission and risk.

As population numbers also vary greatly between countries, so absolute numbers of COVID-19 cases may be hard to interpret in terms of the level of virus transmission. It is also therefore important to consider the rate of change in the number of cases. Epidemic curves may better help visualise this.

The WHO are currently producing a daily situation report summarising the level of COVID-19 transmission for each country that is reported as having any cases, using the following categories:

  • Sporadic cases: one or more cases, imported or locally detected.
  • Clusters of cases: cases, clustered in time, geographic location and/or by common exposures.
  • Community transmission: larger outbreaks of local transmission.

Preventive advice

General advice

Travellers can reduce their chances of being infected or spreading COVID-19 by taking some simple precautions:

  • Maintain a 2 metre (6 feet) distance between themselves and others. If this is not possible, take additional precautions.
  • Avoid going to crowded places.
  • Stay in accommodation and self-isolate even with minor symptoms such as cough, mild fever, or loss of, or change to, sense of smell or taste, until they recover. Have someone bring them essential supplies.
  • If they are concerned, seek medical attention, but call by telephone in advance if possible and follow the directions of the local health authority.
  • Current UK guidelines are that if you can, wear a face covering in enclosed public spaces where social distancing isn’t possible and where you will come into contact with people you do not normally meet – you can read more here.
  • If you do use a face covering (and it may be a requirement at your destination), you should ensure you continue to use all the recommended precautions in order to minimise the risk of transmission.

Handwashing and respiratory hygiene

There are general principles travellers can follow to help prevent the spread of respiratory viruses, including (6):

  • washing your hands more often - with soap and water for at least 20 seconds or use a hand sanitiser when you get back to your accommodation, when you blow your nose, sneeze or cough, eat or handle food.
  • avoid touching your eyes, nose, and mouth with unwashed hands.
  • avoid close contact with people who have symptoms.
  • cover your cough or sneeze with a tissue, then throw the tissue in a bin and wash your hands.
  • clean and disinfect frequently touched objects and surfaces in your accommodation.

First Published :   18 Jun 2020
Last Updated :   11 Aug 2020

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