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No need to quarantine international travellers, says PAHO

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The Pan American Health Organisation (PAHO) has recommended that international travellers should not be quarantined nor be subjected to sampling and isolation in destination countries, given the need to restore consumer confidence to reactivate economies shattered by the novel coronavirus pandemic.

Additionally, PAHO said, “Interventions that might generate a false sense of security” such as body temperature screening, travellers completing forms/declarations focused on symptoms, and COVID-19-related testing, are not warranted.

The recommendations are contained in a document developed by the Pan American Sanitary Bureau, in collaboration with the World Health Organization Secretariat, in compliance with Resolution ‘COVID-19 Pandemic in the Region of the Americas’. It was adopted by the 58th PAHO Directing Council in September.

The document, released last Monday, summarises considerations for the decision-making process for resuming non-essential international travel in the context of the pandemic. Pointing out that the document includes key actions for accepting and mitigating the risk of international spread of the SARS-CoV-2 virus, which cannot be eliminated, PAHO said it “expands on the potential use of COVID-19-related testing, highlighting both primary challenges (biological, technical, and epidemiological), and secondary constraints (legal, operational, and resources-related)”.

According to PAHO, the purpose of the document is to inform the decision-making process of national authorities in relation to resuming non-essential international traffic. It is based on the available evidence at the time of writing and will be updated as new evidence emerges.

“It is tailored to countries and territories in the region of the Americas, taking into consideration their overall capacities at present, as well as the rational and sustainable use of resources in their respective contexts,” PAHO stated.

The international public health agency said that in response to COVID-19, authorities in some countries, as well as stakeholders in the transport sector are considering or are already implementing COVID-19-related testing of international travellers prior to travel, at points of entry, and after travel.

“However, such testing has limitations that must be critically assessed as part of the decision-making process, in the context of the overall national and sub-national COVID-19 response strategies,” PAHO said. “At present, the risk of SARS-CoV-2 virus spread is inherent to international travel. And while this risk cannot be eliminated, it can be accepted and mitigated.”

The risk, PAHO said, is managed according to controlled procedures applied to a relatively limited number of individuals under the oversight of national authorities in one or more countries.

“However, it is understood that the need to reactivate economies may result in national authorities deciding to resume non-essential international travel (eg tourism or business). This requires restoring consumer confidence, as well as the fluid mobility of large numbers of people, while mitigating the risk of international spread (exportation and importation of cases) of SARS-CoV-2 virus infection,” PAHO said.

It recommended that the risk mitigation approach for resuming non-essential international travel should revolve around:

• Countries’ capacity to prevent individuals under isolation, quarantine, and community-wide restrictions on movement (lockdown) from undertaking international travel. This includes the capacity to exchange information between health and migration authorities.

• Mechanisms in place to monitor the health status of incoming international travellers for 14 days after arrival, or until they depart the country. Such mechanisms should ideally be based on the collection of information prior to departure, possibly online, and should make it possible to locate incoming international travellers for the duration of their stay.

• Capacity of the public health and health services systems to manage imported cases and any subsequent chains of local transmission.

• Countries’ capacity to selectively and dynamically determine which countries/cities should be authorised for direct incoming traffic, based on the epidemiological situation at origin.

• Availability of protocols to manage potential COVID-19-related events occurring on conveyances or at points of entry. These include visual screening of travellers for symptoms compatible with COVID-19.

• Capacity to maintain a fluid flow of travellers and workers on points of entry premises. These include, and are not limited to: self-health monitoring and reporting of symptoms compatible with SARS-CoV-2 virus infection to health authorities; self-health monitoring, with daily measurement of body temperature, and daily reporting on health status to health authorities; daily proactive contact by hospitality operators and further reporting to health authorities; daily visits by hospitality operators and further reporting to health authorities; daily proactive contact by health authorities with travellers; daily visits by health authorities to travellers. Phone apps and other digital applications should be considered in order to make the health monitoring process more agile.

• Countries’ capacity to communicate to different audiences, locally and internationally, including the general public, incoming and outgoing travellers, operators in the transport and hospitality sectors, the diplomatic network, and the network of health authorities. Discouraging individuals who are unwell, regardless of the cause of illness, from undertaking any international travel and promoting health care-seeking behaviour are critical components of risk communication.

• Individual travellers’ adherence to personal protective and hygiene measures and respect of physical distance.

PAHO said that notwithstanding the limited number of documented instances of in-flight SARS-CoV-2 virus transmission, the use of medical surgical masks by crew members and passengers is recommended for the full duration of the flight, as well as at the points of entry.

However, the agency emphasised that “at this juncture in the pandemic, conducting or requiring COVID-19-related testing of prospective or incoming international travellers is not recommended as a tool to mitigate the risk of international spread”.

At the same time, though, PAHO recommended that “individuals under isolation, quarantine, and community-wide restrictions on movement (lockdown) should not be allowed to travel internationally”.

Additionally, PAHO recommended that the countries or cities authorised for direct incoming international traffic “can be dynamically selected in order to mitigate the risk of importing SARS-CoV-2 virus”.

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