International Flights Are Ramping Up. Slowly. And With Plenty Of Caveats

I've been stranded in Kenya since March, trying to get a "repatriation" flight to return home to the United States. I was finally able to book a flight but I'm still not sure I'll be able to board at the scheduled departure time – a week from Saturday. Not only are cancellations part of the new normal for international flights, but passengers in some countries need to present evidence they're likely not infected with the novel coronavirus before being allowed to board.

In Kenya, that means going to a private laboratory chain within 72 hours of my scheduled departure time and undergoing a COVID-19 test, which will cost about 8,000 shillings — about $80. The lab will provide documentation of my test results which I must present to airline staff at check-in.

As governments worldwide ease lockdown restrictions and lift bans on international travel, travelers will have lots of questions about how to proceed. Whether you are an expatriate hoping to return to your home country, a traveler with an urgent personal or business matter that requires an international trip or a tourist willing to consider a holiday in another country, here is what you need to know.

First: Flight schedules remain uncertain with frequent and last-minute cancellations and changes in departure dates and times, mainly because airlines can't fill enough seats on the plane to make it financially worth it. To make life less painful for passengers in these uncertain times, many airlines have dropped fees for changing flights and are even honoring unused but expired tickets.

Second: Some destinations have only opened their borders to travelers from select countries where there is a low or declining number of new COVID-19 cases. Those in countries such as the U.S., Brazil and Russia, where outbreaks are still surging, will not be permitted to enter any European country that has recently opened its borders, for instance. Cyprus will only allow incoming flights from about 35 mostly European countries, and Thailand will only allow in certain groups of foreigners such as students studying at Thai schools, those with valid work permits or spouses of Thai nationals.

Third: Many airlines and destination countries are now requiring passengers to undergo COVID-19 testing prior to boarding a flight and to provide a variety of paperwork proving they do not have the respiratory illness. Kenyan citizens returning home from India, for instance, are required to provide an electronic note from a physician confirming they have tested negative for the virus before they are allowed to fly. Those flying Kenya Airways have to arrange for a COVID-19 PCR test, which determines if a person is contagious within 72 hours of their flight and present negative test results to airline staff at check-in. Emirates airline has been conducting rapid COVID-19 blood tests at the airport, which take 10 minutes to return a result, for passengers flying through Dubai to destination countries that require documentation that you're COVID-19-free. Other airlines similarly require passengers to be tested between 2 to 7 days before their scheduled departure.

Dr. Lin Chen, an associate professor at Harvard Medical School and president of the International Society of Travel Medicine, says that requiring passengers to show proof of their virus-free status is, overall, a good step to help prevent the transmission of the disease both during the flight and once passengers reach their destination.

However, these new measures are not perfect. Prospective travelers may test negative for COVID-19 days before their flight but can still be exposed to the virus between the time they go for testing and the time they board.

Moreover, COVID-19 testing is not foolproof. Testing may not be done properly and even if it is, there can be false negatives which might allow contagious individuals to board a flight. Another consideration: Depending on your country of residence, it may be difficult to get tested if there is a shortage of testing centers, health-care staff or testing equipment. And in some countries, expats may not be eligible to receive care from public health services while private health insurance policies may not cover the cost of testing if the test is not considered medically necessary.

Apart from logistical challenges, the looming question remains: is it safe to travel?

Scientific studies and outbreak investigations have found that COVID-19 transmission in crowded, indoor spaces such as cruise ships, churches and factories can be explosive.

But according to Chen, transmission of COVID-19 between passengers on airplanes is rare.

On one January flight from China to Canada, a passenger with a symptomatic case of COVID-19 did not infect any of the 350 passengers on board, according to a brief report by Canadian researchers. Similarly, on a flight from New York to Taipei, a passenger with COVID-19 also did not infect anyone else on board, according to Chen.

The U.S. Centers for Disease Control and Prevention also asserts that the risk of getting an infectious disease on a flight is low while the United Nation's International Civil Aviation Organization states on its website that restricting international travel is not an effective means of containing outbreaks.

Yet despite these reassurances, there are documented cases of transmission of COVID-19 on an airplane. On a March 2 flight from London to Vietnam, a woman who was infected with the virus went on to infect at least 13 other passengers, according to Vietnam's Ministry of Health.

The IATA, International Civil Aviation Organization, World Health Organization, and the US Federal Aviation Association have all released guidelines for travel during the pandemic, and many airlines have adapted them and introduced protective measures to keep crew and passengers safe. For example, many airlines have stopped giving passengers reusable items such as blankets, magazines and headphones and have increased layover times and time between flights to allow for more thorough cleaning of the cabins. Most, if not all,airlines have also installed high efficiency particulate air, or HEPA, filtration systems which are better at cleaning the air than most systems used in hospital isolation rooms, Chen says. Airlines provide information about their air filtration systems on their websites.

Chen says that passengers can further protect themselves by following all the anti-virus guidelines they would follow outside of the plane including wearing a mask, washing hands and practicing social distancing as much as possible. In addition, Dr. Chen recommends passengers avoid crowded areas of the airport, carry hand wipes, sanitize or avoid "high-touch" areas and bring their own food.

In addition, says Chen, travelers should research the current COVID-19 situation in their prospective destination country and the country's capacity to test and treat people with the viral illness. She also suggests finding out if the destination country has policies requiring people to wear masks in public or encouraging hand-washing and practicing social distancing while on public transit, grocery stores and other public-gathering places. Prospective travelers can find this information on national and international health agency websites including the World Health Organization and CDC and from health ministries, immigration offices and embassies in destination countries.

And then there are questions, if travel is optional, that only you can answer."For tourism or adventure travel, the individual traveler has to consider their own personal risk and whether they tolerate that potential risk of getting infected and whether they might bring it home to their family or community especially if they have older family members who are more susceptible to severe disease," Chen says.

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