Effective Covid-19 testing to restart travel
Despite the increasing pace of COVID-19 vaccinations, it gets clearer by the day that for air travel - especially international - to be restarted, testing will continue to be a requirement at least for the next months, if not more likely years, to come.
An online survey conducted by IATA in August 2020 identified that 84% of the interviewees agreed that “testing should be required of all travellers” and 88% claimed “they are willing to undergo testing as part of the travel process”. This indicates a strong acceptance, amongst those surveyed, for testing as a part of travel.
International travel is, therefore, currently not constrained by the hassles of testing per se, but rather by uncertainties regarding border closures, changing conditions and new mutations. Accelerating any kind of rebound for international travel requires developing reliable, quick, scalable and cheap testing facilities. A year on since the first borders closed, there remains no effective testing rollout, but, there is light on the horizon. The ability of the industry to move to this now is already a reality. The only obstacles remain coordination between parties and removal of special interests. Cost is not a factor. Physical space is not a constraint.
In this regard, having integrated testing facilities is a must for any airport aiming to reclaim its position as an international gateway in the years to come. As of February 2020, testing requirements at a national level remain driven on testing passengers on arrival. This is due to the lack of any kind of global standard for testing. Until comprehensive and reliable testing of all passengers immediately prior to departure can be achieved, comprehensive testing on arrival remains a strict necessity.
Current testing modes are grossly flawed
As of early 2020, the global travel industry continues to primarily rely on days old PCR test results. Not only are the tests outdated and have little relevance at the time of travel, test results and certificates have been easy to fake and there is little in the way of verification of test results in many airports.
PCR tests are usually at least 2 to 5 days old. Considering the incubation cycle of covid-19, this makes PCR tests largely irrelevant, as they are currently used.
Most airlines are airports require PCR test results to be provided on paper at airports. This makes it very easy to provide fake results.
The tests are also very expensive with some labs near airports charging more than 400-500 Euros per person for PCR tests. This represents a significant barrier to restart travel, certainly for families.
Most relevant, a regime where we primarily test on arrival is also grossly flawed because it means passengers are exposed to risks from the moment they arrive to airports, while they are at congested check-ins, congested security lines, congested boarding gates, congested boarding bridges, and then constrained in tight spaces on planes, to the mad rush of pushing and shoving to get off the plane, the crowds at immigration, crowds at security, crowds at baggage carousels. All before then being tested on arrival. Should someone have been exposed, they will test negative because not enough time has passed to become infected. And that person goes on into society giving themselves, their family and colleagues and the rest of society a false sense of security.
The roadmap to reopening air travel with confidence
The roadmap to reopening travel needs to be two step.
Immediate testing solutions to protect a nation from incoming travelers
Medium term solutions to ensuring testing occurs universally prior to departure
Immediate solution: Protecting a nation from inbound travellers
Protection on arrival has two components.
First, without universal testing upon departure, the immediate solution is to ensure testing upon arrival. This ensures anyone who was missed ahead of time, gets identified upon arrival to secure the entry and prevent further contagion. Or does it? No, testing on arrival is a stopgap. Infections occurring during travel will not be identified upon arrival.
For this reason, the second part of protection a nation from arrivals is to ensure arriving passengers are quarantined to ensure they do not spread covid-19 after they become infectious. It should be noted that we do not promote the need for quarantine in the long term. This is a requirement only because the industry has not taken the year it had to implement the effective testing regime yet. Some countries are testing arrivals after 5 days and then allowing those testing negative to leave quarantine after the 7th day. This has already proven to be a disastrous policy in some countries in the EU where the new mutation from South Africa has entered circulation from passengers likely infected during the travel where the infection did not yet take hold within the first five days. Numerous studies indicate the effective quarantine is between 7 and 10 days.
Building a longer term solution to restart travel in large scale
The challenge with the above is that is does not provide the necessary confidence for travellers to feel safe and secure during travel. Travellers are still asked to take risk. For this reason, we need to shift the paradigm of testing from after the travel to before the travel. Passengers need to have confidence that everyone walking around in the terminal has been screened just before entering the communal space.
“Along with the availability of a vaccine or a treatment for COVID-19”, says the IATA report, “the availability of rapid COVID-19 testing is among the top three signals that travellers will look to for reassurance that travel is safe”.
There are enough reasons to believe this is the way forward regarding international air travel.
The critical next step needed is for an industry-wide mandate to have testing performed at the airport shortly before travel. PCR tests performed 2-5 days prior to travel provide little assurance that a traveler on the day of travel is not infectious. Almost all studies indicate the unreliability of testing during the pre-infectious period. The PCR tests tell us that the passenger was not infected/infectious on the day of the test. They do not tell us whether the person is infected/infectious on the day of travel.
The Netherlands has taken the tremendous step of requiring exactly this. All passengers arriving to the Netherlands for entry or transit must present an antigen test performed no later than 4 hours prior to travel. This provides confidence that all travellers on that day are unlikely to be infectious in that day.
Building the right testing approach at the airport
In order to allow travel to restart in a meaningful way, airports need to build onsite testing and laboratory facilities for both Antigen and PCR testing. Such onsite testing facilities at the airport will provide health authorities with comfort that, especially as COVID-19 mutates into more dangerous strains, the travel chain is secure and travellers will be identified as soon as possible to prevent further spread.
Considering this, the advisory team of German advisory firm Aviado Partners Health have created solutions for testing at the airport as a key for travel reopening and rebound.
“Working alongside airports and local health authorities all around the world, we are developing testing solutions, including full in-house antigen and PCR testing facilities, for the terminals to back a strong and safe pickup of inbound and outbound traffic in the months ahead.” says Shakeel Adam, CEO of the company.
Aviado Partners Health offers back-to-back support for airlines and airports to set up world class testing environments and provide the leadership needed to support local regulators to approve a safe border reopening. The industry must take the leadership role in developing the solutions and not waiting for the health regulators who also have their hands full dealing with domestic issues. From employee testing to large-scale passenger testing, from rapid antigen assessments to onsite fast PCR testing, Aviado Partners Health is the ideal partner to help restart travel.