[Editor’s note: This is an updated version of an earlier article that originally ran on January 28 with multiple updates since then.]
More destinations are rolling back their previously lifted coronavirus travel restrictions as new COVID outbreaks are reported. And it continues to be a challenge to differentiate between the facts, misinformation, sensible precautions, and overreaction. Until the pandemic is over (and it’s far from over), keep asking: Yes, you CAN travel, but SHOULD you travel?
Concern remains about whether we’re opening too much and too soon—most destinations that are lifting restrictions see corresponding new COVID outbreaks, many directly related to travel—and if destinations and businesses that depend on tourism can recover. In some countries, mayors and regional governments want to slow down the re-openings pushed by national governments, and in other countries, it’s the opposite. Around the world, some people are impatient for life to get back to normal, while others fear it will mean all the sacrifices made so far will be for naught.
Several dozen countries have reopened to international tourism, including, as of July 1, Europe. About three dozen countries are open to U.S. travelers, largely Caribbean countries (we outline some of them in Americans Can’t Go to Europe, So Which Countries Can You Travel to?). However, some countries are reinstating restrictions they’d previously lifted and some are delaying reopening their borders. Due to the high case numbers in the U.S., Americans continue to face more restrictions than residents of most other countries. Many countries continue to recommend their citizens not travel at all, internationally, or even outside of their state or province. For those who must travel during the pandemic, we’ve created a free guidebook: Fodor’s Guide to Safe and Healthy Travel.
Physical distancing and mask-wearing are strongly encouraged when in public and, increasingly, are mandatory. Many nations are still fighting first waves of infection and others are trying to prevent second waves. Everyone is worried about revitalizing economies that are in deep recession and many countries are reopening their economies before their peak of cases has passed. Protests in the U.S. and around the world have slowed down, though the need for justice, equal rights, and an end to police brutality and systemic racism continue to outweigh COVID risks.
We outline what you need to know, but remind you that the World Health Organization (WHO) is the expert source for health advice.
The Latest Statistics
It now takes just a few days for another million cases to be recorded. According to Worldometers, the world crossed the 20 million case mark on August 10, after reaching 19million cases on August 6, 18 million on August 2, 17 million on July 29, 16 million on July 26, 15 million on July 21,14 million on July 17, 13 million on July 13, 12 million on July 8, 11 million on July 3, 10 million on June 28, nine million on June 22, eight million June 15, seven million on June 7, six million on May 29, five million on May 20, four million on May 8, three million on April 27, two million on April 15, and one million on April 2. June 18 marked 100 days since the WHO declared a pandemic.
As of August 12, 2020, there are 20,593,737 cases of COVID-19 and at least 747,245 people have died. At least 13,504,442 people have recovered.
COVID-19 is in 213 countries and territories, using the United Nations Geoscheme definitions. While North Korea reported its first suspected COVID case on July 26, those results were deemed inconclusive on August 5, The Guardian reported. Prior to this, Lesotho was the most recent country to report its first COVID case, on May 13.
As of August 12, the top ten nations with high incidences are the U.S. (5,310,415 cases, 167,804 deaths), Brazil (3,112,393 cases, 103,099 deaths), India (2,360,358 cases, 46,536 deaths), Russia (902,701 cases, 15,260 deaths), South Africa (566,109 cases, 10,751 deaths), Mexico (492,522 cases, 53,929 deaths), Peru (489,680 cases, 21,501 deaths), Colombia (410,453 cases, 13,475 deaths), Chile (376,616 cases, 10,178 deaths), and Spain 373,692 (cases, 28,581 deaths). China, the first country to report the disease, has reported 84,737 cases and 4,634 deaths. The CDC published a study saying that actual U.S. COVID cases are six to 24 times higher in several states than what’s been reported and there’s new concern that COVID data is no longer being sent to the CDC.
Confusion remains about who can travel where, which destinations are considered “safe” and by whom, and the requirements of each jurisdiction. Many question whether it is even ethical to travel at all, particularly for tourism. Tourists planning vacations can wait, but foreign-passport holders caught outside their normal country of residence and spouses with different nationalities are facing ongoing difficulty.
A group of engineers from MIT created a new website, Covid.Control.com, to help reduce confusion over restrictions and rules within each country. An interactive map provides, by country, details on the epidemiological situation, current restrictions, and the infrastructure of interest to travelers that’s open and closed.
The U.S Department of State lifted the Global Level 4—Do Not Travel Health Advisory on August 6. It had been in place since March 19. This is a return to the State Department’s pre-pandemic practice of designating individual countries with a specific travel advisory on a one to four scale. Many countries remain at Level 4, but most of the world is classified at Level Three—Reconsider Travel. There are a few exceptions, such as Thailand, New Zealand, French Polynesia, and Fiji which are at Level Two—Exercise Increased Caution. Taiwan and Macau are at Level One—Exercise Normal Precautions. Most countries have not yet removed border restrictions allowing Americans to enter, particularly for tourism purposes.
The New York Times reports that the U.S. government is considering banning U.S. citizens from entering the county if an official “reasonably believes that the individual either may have been exposed to or is infected” with COVID. The draft regulation obtained by the Times does not specify how long citizens would not be allowed re-entry. Legal experts have said blocking citizens from entry into their own country is not constitutional, even if temporary, reports the Times.
New York City implemented traveler checkpoints at airports and train stations, reports NBC. The checkpoints are meant as an awareness campaign to remind anyone arriving from three dozen high-risk states about the mandatory 14-day quarantine. New arrivals must complete a health form, usually onboard their train or flight.
Several countries are delaying their reopening plans. Belize, for example, had planned to reopen August 15 but the prime minister announced August 5 that those plans are on hold. A projected date has not yet been announced; updated information is posted at TravelBelize.org. The Cayman Islands, originally planning a September 1 reopening, has delayed reopening until at least October.
The deputy governor of the Tourism Authority of Thailand said he expects Thailand likely won’t reopen until after the 2021 lunar new year (mid-February). The country is first testing to see how limited reopening, for example for film crews and medical tourism, work. Thailand is discussing a proposal to allow visitors from cities with zero infections for the last 30 days, with travel restricted to specific areas and hotels. Proof of a negative COVID test, insurance, and a test on arrival will also be likely requirements.
Destinations that had seemingly conquered the disease are facing new infections. After having no locally-transmitted COVID cases for 102 days, New Zealand reports four new cases and there aren’t yet answers as to how. Auckland is under a three-day lockdown while the situation is assessed, and restrictions are raised for the rest of the country, reports Global News. This follows Vietnam, which had no COVID deaths and no new cases since April. July brought four cases in Da Nang, which spiked into more than 800 cases and 16 deaths as of August 11.
Germany reports the highest rates of new infections since early May, with over 1,000 new daily infections. The Guardian reported that Germany’s health minister said the infections were due to travelers, family gatherings, and parties. The average age of people with COVID-19 in Germany is now 34, down from the pandemic’s early months when it was 50.
Several countries are heightening measures to protect their citizens and health systems as transmission rates continue to climb. The Netherlands is instituting mandatory quarantine for anyone exposed to COVID-19, reports The Guardian. Face masks are mandatory in Amsterdam and Rotterdam’s busy areas, even outdoors. Face masks are mandatory in all public places in Brussels. As of August 10, masks are mandatory in crowded outdoor spaces in Paris and police are ramping up spot checks. Paris announced August 12 that the Paris marathon is canceled (it had been postponed from April 5 to November 15). Travelers from Spain are facing additional restrictions, imposed by several countries including Germany, Italy, and France. Norway is advising against all international travel and is reinstituting quarantine for those that arrive from abroad. Jordan, which had planned to reopen to international flights on August 12, has delayed those plans and has increased restrictions at land borders.
England made more changes to its “green list” of countries exempt from quarantine. As of August 11, there are 76 countries on the list. The most recent changes are August 11’s addition of Brunei and Malaysia and the August 7 removal of Andorra, The Bahamas, and Belgium. See our latest Europe update for details on how the list developed and what applies to Northern Ireland, Scotland, and Wales.
The E.U.’s green list, originally of 14 countries when first released June 30, was again updated. The green list has ten countries, with Morocco most recently removed (previously removed were Algeria, Serbia, and Montenegro). China remains on the list if China removes restrictions on E.U. travelers.
Governments continue to release and adjust green lists of countries that are allowed entry into their borders, but there are few similarities between the lists. Some lists are based on the country you’re traveling from, and others based on the passport you carry or your country of residence. Other countries are publishing red, orange, and yellow lists of countries that face additional travel restrictions. Countries with green, yellow/orange, and/or red lists include Tunisia, Norway, Ukraine, Hungary, Malta, and Ireland. Italy has a red list of 13 countries banned from crossing its borders (though likely only enforceable for air travel). Aruba and Jamaica have red lists of high-risk U.S. states.
Transportation-wise, Delta Air Lines placed 100 people on their no-fly list because the passengers refused to wear a mask, which has been required since May. Both Delta and United are closing loopholes that passengers had been taking advantage of, but are providing mechanisms for passengers with documented medical exemptions to fly. American and Southwest announced the only allowable exemptions to wearing masks onboard are children under two years old. A Delta flight from Detroit to Atlanta returned to the gate on July 23 because two passengers refused to wear their masks onboard.
The Guardian reported that it will likely be 2024 until air travel recovers to pre-pandemic levels, according to an airline trade association. To help boost travel, Emirates is providing passengers with free COVID insurance. Emirates passengers will have any COVID-related expenses covered up to 150,000 euros if they’re diagnosed with the virus during travel. It affects passengers flying up to October 31 and is valid for 31 days after the beginning of their trip.
Spain’s Canary Islands are also offering to cover COVID medical expenses, reports Travelweek. Some hotel groups are now implementing similar initiatives. Palladium Hotel Group is offering free COVID health insurance for guests at its hotels in the Americas and Spain. Any incidents that are directly related to COVID-19 during guests’ stays will be covered. Palladium’s properties include Grand Palladium resorts and TRS hotels in Mexico, Jamaica, Dominican Republic, and Spain.
Club Med expanded its Emergency Assistance Program to include COVID-19 coverage for all trips to any of its resorts until April 30, 2021, TravelPulse reported. Club Med Sandpiper Bay opened June 12, Turkoise will open September 5, and other Caribbean resorts reopen October 17 and in December.
We’ve integrated previous news into the sections below.
Earlier News and Changing Travel Restrictions
Additional countries are reopening and others announcing reopening plans, however, the CDC and State Department continue to advise against all international travel. Countries are implementing different reopening rules and protocols based on different evidence, and confusion remains about which rules apply where and to whom. The International Air Transport Association launched a world map detailing travel requirements to help.
As The Washington Post reports, some countries are reimposing lockdowns as their COVID cases resurge. Restarting travel is on the radar of most governments, given the importance of tourism to their economies. With travel’s role in spreading COVID-19 in the first place, many are proceeding with caution. Recent restrictions and lockdowns include Mexico’s La Paz, which reclosed beaches, and parts of Quintana Roo, which reimposed hotel occupancy limits. Earlier, The Guardian reported, for example, that 133 million people in India are now in lockdown, as are the cities of Caracas, Venezuela; Melbourne, Australia; and Tangiers, Morocco. In Spain, a 15-day lockdown for 160,000 residents in several towns in the Catalonia region began July 15. In the Philippines, a lockdown was announced July 13 for a district of the capital with a population of 250,000. On July 15, The Guardian reported over a dozen lockdowns, including in Lisbon’s suburbs in place since July 1, and in Azerbaijan from June 22 to August 1.
Though tourism is reopening, the economic and health situation is still grim. On June 10, the OECD reported that all its 37 member countries are in a recession, global GDP is in the sharpest decline since the creation of the OECD in 1961, and the world is on track for the most severe peacetime recession in a century. On June 24, the International Monetary Fund projected the world’s economy will shrink by 4.9% in 2020, worse than its April prediction. Some countries will fare worse; South Africa predicts its economy will shrink by 7.2%. Poverty and starvation will follow in many countries. In mid-June the UN raised concerns about food security in Latin America, saying 40 million people are at risk of hunger. The World Wildlife Fund published a report on June 17 making the case that the COVID pandemic—as well as likely future pandemics—is due to humans’ “destruction of nature” through agriculture, deforestation, and the trade-in wildlife. The WWF issued a comprehensive call to action for governments, industry, civil organizations, and members of the public to “mend our broken relationship with nature.”
June 30 was the six-month anniversary of when the World Health Organization first received reports from China of unexplained cases of pneumonia. In his June 29 remarks, the head of the WHO reminded that “national unity and global solidarity are essential” for saving lives and reducing the economic and social costs of COVID-19. He also warned that “the worst is yet to come.” The Guardian reported on a July 1 United Nations statement that the world is expected to lose 3.3 trillion in tourism revenue and that the United States will be the hardest hit country. Other countries listed which are likely to incur high losses are China, France, Thailand, and Jamaica.
The United Nations World Tourism Organization announced on June 4 that “the time has come to restart tourism” (this followed their May 31 announcement 31 that 100% of the world’s destinations had travel restrictions in place, 75% had borders closed completely to international tourists, and 3% of destinations had started easing restrictions in some way).
Several airlines announced they’ll no longer block middle seats on flights, given the International Air Transport Association’s advice that HEPA filters and mask-wearing are sufficient. Delta Air Lines is an exception, Delta will continue to block middle seats until September 30.
Reuters reported that science has not yet confirmed whether the presence of COVID-19 antibodies will provide protection against reinfection and there is less talk of “immunity passports” to allow those who have had COVID-19 to return to normal life. Chile began issuing immunity cards as of April 20, the first country to do so. The WHO says tests that can differentiate between the immune response to various types of coronaviruses, including that of the common cold, are needed, as is a better understanding of the level of protection prior disease exposure brings.
Al Jazeera details current restrictions by country. For planning travel, we outline considerations to keep in mind: Will It Be Safe to Travel Again When This Is All Over? Will We Even Know?
Outbreaks started climbing again in Europe in mid-July. In early August, The Guardian reported that several western European countries are facing significant rises in infection and that French authorities said the country “could lose control of COVID-19 at any time.” Germany, Greece, Turkey, and the Netherlands, amongst others, all report rapid increases in case numbers. Greece’s prime minister said it was due to “complacency” and that only 10% of cases were imported from outside Greece, reported The Guardian. Face coverings are mandatory in many places across Europe, both indoors and outdoors.
Prime Minister Boris Johnson announced he may re-implement the lockdown in England. In Ireland, the planned reopening of pubs has been canceled and face coverings mandatory in shops as of August 10. Scotland reimposed some restrictions, including asking visitors to stay away from the city of Aberdeen and for residents to stay at home as much as possible. There’s fear that German protests by anti-vaxxers and conspiracy theorists on August 1 will lead to a spike in new COVID cases, as few protestors wore masks. Plans to restart cruises in Germany and Norway are on hold as many crew members test positive for COVID-10.
Additional countries have implemented mandatory quarantine for travelers from Spain. They include the U.K., Ireland, Norway, and Switzerland, while several other countries have renewed warnings for travel to Spain. Face coverings are mandatory in some parts of Spain, including in Madrid.
Reuters reported in late July that testing in France expanded so that anyone can get a COVID PCR test without the need for referral and at no cost. However, in early August this has resulted in long lines at testing centers and some have criticized the decision saying that targeted testing is more effective.
After reopening for travel by Europeans (and foreign nationals with E.U. residency) on June 15, as we detail in our Europe update, Europe opened its borders further as of July 1. Residents of fourteen non-EU countries were initially allowed into Europe. Several changes to the list have the current green-lit countries at 10The current list does not include the United States, nor did the draft list of 54 leaked on June 25. China is listed as an additional country allowed into the E.U., provided it changes its rules to again allow Europeans into China. Countries continue to lobby the E.U. to be allowed access.
The E.U. updates their list of countries every two weeks, largely basing it on countries with epidemiological situations better or similar to Europe’s. Both epidemiology and reciprocity were supposedly factors in determining which nations will have access to Europe. The E.U.’s benchmark was 16-20 new cases per 100,000 people in the most recent two weeks. When the list was created, the U.S. currently had 107 new cases per 100,000, according to the New York Times. Until the White House’s Europe travel ban is lifted, it’s likely the E.U. will maintain reciprocal rules.
On July 3, the U.K. released a list of 59 countries and territories allowed into England countries) without the mandatory 14-day quarantine in place for the U.K. since June 8. Each of the four U.K. countries chose to manage their green lists independently. On July 8 England’s list was updated to 76 countries (mostly to specifically list all countries that had been exempt from the quarantine for other reasons), and on July 11 Serbia was removed. As of July 15, England’s list includes 75 countries. The list took effect July 10 and is for “passengers arriving from” these 75 destinations, “unless they have visited or stopped in any other country or territory in the preceding 14 days.” On July 9, Wales and Scotland adopted somewhat similar lists (Wales’ list was updated July 16 to remove Serbia) and on July 10, Northern Ireland announced it will use the same list as applies to England.
England’s list of 75 is very different from the E.U.’s list of 12.
- There are four countries on both lists: Australia, Japan, New Zealand, and South Korea.
- There are eight countries on the E.U.’s list that are not on England’s: Algeria, Canada, Georgia, Morocco, Rwanda, Thailand, Tunisia, and Uruguay (Serbia, initially on the U.K.’s list, and Montenegro were both removed from England’s list on July 14).
- England’s list includes all but eight of the E.U.’s 28 members (missing are Bulgaria, Estonia, Latvia, Portugal, Romania, Slovakia, Slovenia, and Sweden).
- nationals are allowed entry into Europe because the U.K. is, for now, still a member of the E.U.
- The Guardian reported July 7 that Portugal and the U.K. are in discussions about the U.K.’s decision not to include Portugal on their list of quarantine-exempt travel. It’s expected further changes to the various U.K. lists will be forthcoming.
Some E.U. countries have different measures in place. In response to a rise in new cases, many associated with travelers, the CBC reported that Greece now requires a negative COVID test for entry at the Bulgarian border, though Bulgaria is a member of the E.U. The test must be taken within 72 hours and must be translated into English.
As of July 1, Angela Merkel is the E.U. president for the next six months. In her July 8 statement to the E.U. parliament, the Associated Press reports her concern over “fact-denying populism,” and how “democracy, facts, and transparency are needed to fight the health, social and economic effects of the pandemic.
After first suspending flights from Bangladesh (over concern that 36 passengers on a July 6 Dhaka-Rome flight tested positive for COVID-19), Italy issued a list of 13 countries barred from entry into Italy because of high coronavirus cases.
The Guardian reported that police clashed with protestors in Belgrade, Serbia due to the return of some lockdown measures. The government says the measures are to combat a rise in COVID cases but some, including members of the opposition, say it’s due to rising authoritarianism. The U.K. removed Servia from their list of countries allowed into England without quarantine.
European countries that have reopened include Belarus, Georgia, Malta, Poland, Serbia, and Turkey. Ukraine issued a “red list” and “green list” of countries, which will be updated every three days. People who have been in green list countries for the previous 14 days, i.e. countries with fewer than 40 active cases per 100,000 population, are allowed to enter Ukraine without quarantine.
Cases in some European countries are on the rise again. For example, after a June increase in cases in the Balkans, Croatia reinstituted, as of June 25, its mandatory 14-day isolation for arrivals from Bosnia, Kosovo, North Macedonia, and Serbia, reported The Guardian. Bulgaria extended its state of emergency until July 15 and made mask-wearing mandatory indoors in public, given rising case numbers after restrictions began lifting earlier in June. Following isolated outbreaks, Portugal reinstituted a few restrictions in Lisbon, as did Spain in parts of the northeast.
Mandatory quarantine for arrivals into England began June 8, though this rule was lifted for arrivals from 75 countries as of July 10 as reported above. Criticism accompanied the initial announcement, for example from the U.K.’s former chief scientific advisor, that it’s too early given the lack of a contact tracing system.
Earlier announcements included that Disneyland Paris’ phased reopening will begin July 15, following processes similar to what’s in place at the Orlando parks. Spain lifted its mandatory two-week quarantine for anyone entering the country as of July 1. Bilbao’s Guggenheim and Madrid’s Prado are open. Amsterdam’s Rijksmuseum opened June 1 as did the Vatican Museums. In France, the Eiffel Tower opened June 25. The Louvre and Versailles are both open, though advance booking of specific entry times is required.
See our Coronavirus Outbreak: Should You Cancel a Trip to Europe? for details.
Vietnam provides an example of how quickly a small number of cases can grow. On July 26, three COVID cases were reported in the popular tourist area of Da Nang, open only to domestic travelers for now. As of August 5, the country had 713 cases and eight deaths; as of August 11, it had 863 cases and 16 deaths. Vietnam earned a reputation for handling COVID-19 better than almost every other country—it had previously reported no COVID deaths—and hadn’t had any new cases since April. Domestic travel and other restrictions gradually lifted. At the end of July, Reuters reported that 80,000 domestic travelers needed evacuation from Da Nang. Flights, trains, and buses to and from Da Nang were suspended July 28 for at least 15 days and the city of 1.1 million is under lockdown, said CBC. On July 29, Vietnam closed bars and pubs in Hanoi and the 21,000 travelers returning from Da Nang to Hanoi received rapid COVID tests.
Singapore and Malaysia are working to reopen their borders for business travelers and daily commuters, reports the Strait Times, as well as for compassionate reasons such as family separation. Prior to the pandemic, about 300,000 people traveled between the two countries daily. Singapore began phase two of reopening on June 19 and recently launched the SG Clean campaign and has already issued more than 800 cleanliness certifications to tourism-related businesses. Singapore’s TraceTogether app facilitates contact tracing.
The Maldives, which opened its uninhabited private islands July 15, reopened hotels and guesthouses on its 200 inhabited islands to international tourists, including U.S. travelers, as of August 1. The full list of reopened resorts and information on COVID protocols for the Maldives’ 1,192 islands is available for travelers. Airlines flying to the Maldives as of July 2020 are Emirates, Etihad, Qatar, and Turkish Airlines.
Cambodia has some of the most extreme border control measures in the world. As described on the Cambodia Airports’ website, travelers need to pay a deposit of 3,000 USD to cover the costs of a COVID test, accommodations while awaiting the test results, and other costs should the test be positive. Adequate health insurance is also required for entering the country famous for the Angkor archeological site.
Thailand is delaying its reopening to international tourists possibly until the fourth quarter of 2020. The country is implementing a new COVID safety certification system by the Amazing Thailand Safety & Health Administration.
Japan still has entry restrictions on 111 countries, though Vietnam, Australia, and New Zealand will likely be the first countries to have those restrictions lifted. Japanese tourists will have domestic travel subsidized. Hotels like Hoshino Resorts are helping guests avoid Japan’s Three Cs (close contact, confined spaces, and crowded places) through private kaiseki dining and a proposed app to check if property onsens are crowded.
In response to record highs of new cases in Tokyo—over 200 per day for several days—the capital is at the highest level of its four-level COVID alert system as of July 15. Advice to avoid unnecessary travel, including to other towns and cities, accompanied the new alert.
Hong Kong imposed new measures as of July 14 in response to 48 new cases, including making masks on public transit mandatory. Newly reopened Hong Kong Disneyland has closed again.
Announcements of upcoming reopenings include Sri Lanka, which will open as of August 1. However, Sri Lanka will have some of the world’s strictest measures to prevent virus transmission, including new arrivals taking multiple COVID tests and not being allowed on public transportation.
The Middle East
The Islamic Eid al Adha holiday took place from July 30 to August 2 this year. It’s traditionally a time for prayer and gatherings of friends and family. Mosques around the world had already implemented social distancing and other precautionary measures and the head of the WHO shared Safe Eid practices for the COVID context. The Hajj pilgrimage to Mecca was reduced to only 10,000 people this year, all from Saudi Arabia, rather than the two million from around the world who normally attend.
There’s another indicator for destinations that have implemented COVID-protection standards. Joining the already-popular World Travel and Tourism Council (WTTC)’s Safe Travels Stamp is Bureau Veritas’ SafeGuard Assurance Program, which also includes audits. The first city to receive both certifications is Ras Al Khaimah, in the United Arab Emirates. Ras Al Khaimah, known as RAK, is the most northern of the seven Emirates and features 64 kilometers of beaches and mangroves as well as the UAE’s highest mountain.
Dubai reopened on July 7 and requires travelers to complete a health declaration card and register on an app. Testing on arrival or proof of a negative COVID test is also needed. Unusually, both masks and gloves are required in Dubai’s airport. In the city, masks are required indoors and outdoors when near other people.
Egypt reopened to international tourists as of July 1, though tourists are restricted to one of three resort areas on the Red Sea and the Mediterranean for now. A health declaration and proof of health insurance are required. Depending on the country they’re traveling from, visitors may be required to show proof of a negative COVID test.
Saudi Arabia announced June 22 that the hajj pilgrimage to Mecca, due to begin in late July 2020, will be restricted to people already living in Saudi Arabia.
Israel, the first country to recommend its citizens not travel abroad and one of the first to close its borders and ground flights, reopened domestic travel as of May 3, reports Travel Week.
Tunisia is another country to release a list of approved countries. After first announcing it would open its border fully as of June 27, Tunisia revised its reopening rules. Tunisia now has both a “green list” and an “orange list” of countries. Passengers arriving from green list countries (such as many EU and Caribbean countries, including the U.S. Virgin Islands) are only required to fill in an online health declaration. Passengers from orange list countries (which includes several countries on the E.U.’s list of 14 approved countries, like Canada and Uruguay) need to provide a negative PCR test taken within 72 hours of departure. Countries that are on neither list are not permitted tourist entry to Tunisia, and that includes the United States.
Newly reopened, but only to charter flights, is Rwanda; the country is also offering discounts on gorilla trekking permits. Tanzania is open to international travel.
South Africa is another country approaching reopening carefully, with plans to reopen domestic tourism later in 2020 and international tourism only by February 2021.
Oceania and the South Pacific
Australia is limiting the number of Australian citizens and permanent residents that can return home from abroad—an unusual move given most democracies allow an unconditional right of return to their citizens. Only 4,000 Australians will be allowed back into the country per week. Al Jazeera also reports that returning Australians will now need to fund their mandatory two-week quarantine period.
In reaction to rising cases numbers, Melbourne, Australia, began a new six-week lockdown July 9. After declaring itself COVID-free, New Zealand had a small number of new cases deemed to be from travelers.
Another popular beach location, the Islands of Tahiti, are open again to tourism as of July 15. To enter French Polynesia, travelers need to complete an online health commitment form, provide a negative COVID test no more than three days old and self-administer a COVID test four days after arrival (the kit is provided free of charge upon arrival).
Bloomberg reported that the Caribbean is facing a once-in-a-century tourism shock with a best-case scenario of losing 50% of its 2020 tourism revenue. Several islands opened in June with more in July and August, including to U.S. passport holders. However, in mid-July, several islands are reinstituting restrictions in response to new cases amongst travelers.
The Bahamas temporarily halted commercial flights from the U.S., but then reinstated them at the same time as announcing a mandatory 14-day quarantine for anyone visiting The Bahamas. All foreigners arriving in the country must provide a negative COVID test, complete a health visa application, quarantine for 14 days in a designated facility at passenger expense, and test negative before release from quarantine. This is in response to a significant rise in COVID cases since the country reopened to tourism July 1—rising from about 50 on July 1 to cases 715 as of August 4. A 7:00 p.m to 5:00 a.m. curfew is in place, inter-island travel stopped as of July 28, beaches and parks are closed, gatherings prohibited, and face masks required in many circumstances.
Bermuda updated its entry protocols and now requires a negative COVID test within 48 hours of departure as well as three in-country tests after arrival, on day four, eight, and 14 of stay. A mandatory $75 US arrival fee covers the cost of testing. A Bermuda Travel Authorization must be completed within 48 hours of departure to Bermuda. As well, Bermuda is joining Barbados and Chile in offering year-long visas to some visitors. Bermuda’s One Year Residential Certificate Policy allows work, research, or study on a 12-month temporary basis, ideal for nationals from other countries who can work from home and want to substitute their digital Zoom background for the real thing. The application will be on the government’s website.
Grenada, which delayed its originally-announced reopening date of July 1, announced it now plans to reopen August 1. A negative PCR test within seven days of departure is required and a swab/PCR test will be administered upon arrival. Passengers will be required to stay in quarantine (at own expense) for two to four days until a negative result is confirmed. A Health Declaration Form and contact tracing app are also required, as is insurance that covers COVID-19. Details are on Grenada’s Ministry of Health website at covid19.gov.gd/.
Turks and Caicos, which reopens July 22, will require travelers to complete a pre-screening questionnaire and provide confirmation of a negative COVID test taken within the last five days, a change from the previous three-day requirement. Health insurance, including with medevac provisions, is also required. Details are at TCI Assured and the tourist board’s website.
The Nature Island, Dominica, is reopening to international travel on August 7 and will require an advance online health questionnaire and a negative PCR test 24 to 48 hours prior to arrival as well as screening upon arrival.
Strengthened COVID protection measures include in Jamaica, which now specifically requires a negative COVID test for travelers from high-risk locations. As of July 10, those locations are listed as Arizona, Florida, New York, and Texas. All travelers to Jamaica will now be screened upon arrival to determine if further testing or quarantine will be required. Further details are online, including the portal to apply for the required travel authorization. The Jamaican government plans to update the entry rules every two weeks or as required.
Aruba opened to U.S. travelers on July 10 but now says that travelers from 24 high-risk U.S. states listed on its website must provide certification of a negative COVID test taken within 72 hours of departure. Other travelers can take a test on arrival (at passenger expense). TravelWeek reports that Sint Maarten changed the date it reopens to travelers from the U.S. to August 1 from July 15 (the earlier date was maintained for other travelers, such as those from Canada).
To enter Antigua and Barbuda, travelers now need a negative COVID test no more than 48 hours old. This follows reports of several Americans threatening to sue the government of Antigua and Barbuda because they (erroneously) believed a COVID test on arrival was a violation of their rights and because of some Americans who refused to obey quarantine orders after testing positive for COVID-19, as reported by TravelPulse.
Early July saw more Caribbean countries reopening, as well as updates to protocols for countries already open. For example, Antigua and Barbuda updated its rules on July 2. The country requires, as of July 9, a negative COVID test within 7 days of arrival, a health declaration form, and visitors may be monitored and tested for 14 days after arrival. Saint Lucia, reopened as of June 4, also updated its entry rules. A negative COVID PCR test within seven days of travel is required as of July 9 (arrivals from “travel bubble” countries in the Caribbean are excluded from this new requirement). Details are at StLucia.org.
Also reopening, but slowly, is Barbados. Barbados will first welcome flights from Canada, as of July 12. Requirements include advance online approval via a new Embarkation/Disembarkation card, wearing face masks onboard flights, and temperature checks on arrival. Rules for advanced COVID testing depend on the epidemiological situation in the country of departure; testing on arrival is available with required quarantine until negative results are confirmed. Information is on Barbados’s website.
The Turks and Caicos plans to reopen its borders on July 22. To avoid a 14-day quarantine, international travelers must be certified by TCI Assured. This means applying for the certification through the tourist board’s website by providing proof of medical insurance, completing a health screening questionnaire, and confirming an accredited negative PCR test (originally 72 hours prior to arrival, it’s now five days). Face coverings in public are mandatory (and recommended on the islands’ beaches, including the “World’s Best Beach,” Grace Bay Beach).
The first Caribbean countries to reopen included Antigua and Barbuda (June 4), Saint Lucia (June 4), the U.S. Virgin Islands (June 4), Jamaica (June 15, advance application for the Jamaican COVID travel authorization is needed), and Saint Barth (June 22). Newly reopened as of July 1 are Bermuda; Cuba; the Dominican Republic; and the French-Dutch “Friendly Island” of Saint Martin and Sint Maarten. The Bahamas reopened July 7 with an apply-in-advance travel health card. As of July 1, Aruba will welcome visitors from many Caribbean neighbors and Europe and Canada. Visitors from the U.S. were welcomed as of July 10. The “Spice Islands” of Grenada, Carriacou, and Petite Martinique delayed their reopening, deciding that only charter, rather than commercial, flights will be allowed until further notice.
Earlier, Club Med announced reopening plans for several resorts with new health and safety protocols. Club Med Sandpiper Bay was the earliest to reopen, on June 12, with most resorts reopening later this year. Club Med Cancún and Club Med Turkoise (in Turks and Caicos) will open October 17 and September 5, respectively. Most Sandals Resorts, with their new Platinum Protocols of Cleanliness, opened June 4 where border restrictions allowed.
The U.S.-Mexico land border remains closed to nonessential travel, but that has not prevented some American tourists from driving across the border. For example, as The Guardian reports, residents of Sonoyta blocked access to the beach town of Puerto Peñasco, popular with weekend visitors from Arizona, and are requesting increased measures by the Mexican government. Additional Mexican destinations received the World Travel & Tourism Council’s Safe Travels stamp. The state of Guanajuato and popular tourist city San Miguel de Allende is new on the list, for example. Hotels there such as Live Aqua Urban Resort San Miguel de Allende can accept bookings as of July 15. All the destinations on the WTTC’s Safe Travels Stamp list are on their website, as are details about required protocols.
The Prime Minister of Canada announced another extension of the Canada-U.S. border closure, until at least August 31. This is despite, as CBC reports, lobbying by U.S. members of Congress for a phased reopening out of concern that the border closure is “creating tension and uncertainty. Several U.S. travelers in Canada have been fined for not obeying Canada’s mandatory two-week quarantine period and for stopping to sightsee en route to Alaska (driving to a residence in Alaska is, currently, allowable). Spot checks have been increased. CTV News reports that more than 10,000 U.S. citizens and 1,500 other nationals were turned away from the Canadian border between March 22, after the border was closed, to July 12.
Only essential travel between Canada and the U.S. is allowed and, as of June 10, foreign nationals who are immediate family members of Canadians are now allowed to enter Canada (like almost all arrivals to Canada, they’re subject to a 14-day self-quarantine). The rule requiring mandatory 14-day quarantine was extended to August 31. These are the current rules on who can enter Canada.
On May 29, Canada extended its ban on cruise ships from July 1 to October 31. Previously the ban affected ships of over 500 passengers and crew, but it now affects ships over 100. Cruise ships that are members of Cruise Lines International Association canceled cruises in the U.S. until at least September 15, the Miami Herald reported.
Within the U.S., travelers to Connecticut, New Jersey and New York coming from some parts of the U.S. must quarantine for 14 days upon arrival. This applies to 34 U.S. states, the District of Columbia and Puerto Rico, and to anyone coming from areas with more than 10 COVID cases per 100,000 residents over the most recent seven days.
The TSA announced a few new measures, including that passengers will now scan their own boarding pass on the electronic reader. However, there’s not yet news about whether that also applies to identity documents or news about factors like sanitizing security bins, opening passengers’ bags for inspection, or pat-downs. While a few airlines and some businesses are screening for fever, new evidence shows that this may not be effective for preventing COVID exposure, as reported by Healthline. Masks are strongly encouraged aboard planes and passengers must wear them while boarding. At the end of June, many airlines announced they will no longer block middle seats on flights, following the advice of the International Air Transport Association (IATA) which cites HEPA filters and mask-wearing as combatting the lack of physical distancing. Delta Air Lines is one of the exceptions. Delta announced it would continue to block middle seats and restrict the number of passengers until September 30.
Rising cases in the U.S., both new numbers and the percentage of the population infected, caused some cities and states to slow or reverse reopening measures in mid-July. Lockdowns are being reinstated in several parts of the country, including in California. Reuters showed the differences between Canadian and U.S. boats at Niagara Falls, providing citizens on both sides of the border an apt depiction of why U.S. cases are rising so rapidly.
In Nevada, masks are now required in indoor public places. Hawaii has delayed reopening trans-Pacific travel, which had been aimed to restart as of August 1. Citing the high case numbers in the continental U.S., the Governor of Hawaii said that until September 1, travelers to Hawaii will continue to be required to quarantine on arrival. After that, it’s expected proof of a negative COVID test will be sufficient. Restrictions are increasing in some states. For example, a nightly curfew was imposed in Miami as of July 3. Connecticut, New Jersey, and New York have implemented mandatory two-week quarantine for anyone arriving from hot spots within the U.S.
Aimed first at domestic travelers, many U.S. tourist sites, such as theme parks, continue reopening. We detail whether visiting theme parks will ever be the same. Orlando continues to open, with businesses required to follow safety guidelines and encouraged to, as Orlando’s mayor described, “lead by example, hold ourselves accountable and positively reinforce those who are doing it right” via Orlando’s “Safer, Stronger, Together” program and “DoYourPartORL.” Universal CityWalk began reopening May 14 and Disney Springs began May 20. Universal Orlando Resort’s three theme parks opened to the public June 5. Disney’s Orlando parks are open, by reservation only, as follows: Animal Kingdom and Magic Kingdom as of July 11, and EPCOT and Hollywood Studios as of July 15. Legoland opened June 1 and the three SeaWorld Parks opened June 11. Making new safety requirements fun is an Orlando goal, with Star Wars stormtroopers at Disney Springs encouraging mask-wearing and reminding visitors to “stay in your sector.” Guests at all Orlando theme parks have their temperature checked for fever upon arrival and are required to wear masks. Parks have reduced capacity, frequent cleaning of high-touch surfaces, hand sanitizer available, and mechanisms to enhance physical distancing in attraction lineups. See the latest on Visit Orlando’s Healthy Traveler Information page. Disney is delaying the reopening of its two California parks, originally planned to reopen July 17.
Here’s what’s open and closed in all 50 states. For example, Las Vegas, casinos opened June 4, but many restaurants and shops in the city are still closed. Alaska, as of June 6, is the first U.S. state to require travelers to take a (free) COVID test upon arrival and self-quarantine (at their own expense) until negative test results are back. Or, passengers can show a negative COVID-test taken within 72 hours of arrival. Rhode Island is in phase two of its reopening with state parks open and indoor dining allowed. To help physical distancing, hotels like The Wayfinder Hotel have curbside check-in and keyless entry. In Lexington, Kentucky and the rest of the state, park resorts and cabins reopened June 1, and many outdoor attractions, museums, and aquariums reopened June 8. Some U.S. destinations are offering deals to attract tourists. Maine, which has a mandatory 14-day quarantine for anyone arriving from out of state, has some hotels offering pay-what-you-can rates, for example.
The U.S. also continues reopening of top tourist sites. Orlando’s theme parks are open and now Disney’s California locations are following suit. Downtown Disney will reopen July 9 and Disneyland and Disney California Adventure plan to open July 17, which is also Disneyland’s official birthday. Fort Worth, Texas has a responsible reopening plan called Y’all Get Ready so tourism businesses and visitors alike know how to stay safe. Other destinations announcing reopening include Door County, Wisconsin (known as “Cherryland USA” for its abundance of summer cherries) with special packages to encourage visitors to explore the peninsula, which has implemented a new Commitment to Cleanliness and Safety Initiative.
Mexico has a five-phase reopening plan by region. The U.S.-Mexico land border remains closed until at least August 21, though air travel is available to cities like Cancun and Puerto Vallarta. Several tourist areas are now open, including the Mexican Caribbean (as of June 8), Jalisco and the Riviera Nayarit, as well as Baja California Sur which includes Los Cabos, La Paz, and Loreto on the Sea of Cortez (all as of June 15). Several Mexican destinations have received the World Travel and Tourism Council’s Safe Travels Global Safety & Hygiene Stamp—Quintana Roo was the first destination in the Americas to receive it.
In Central America, flights to Costa Rica are restarting August 1. The first ones will be from Europe and, in September, from Canada. A negative COVID PCR test no more than 48 hours old is required to enter Costa Rica, as is an online epidemiological form and proof of insurance that covers quarantine accommodations and medical expenses. The country known for its quality health care, pura vida life, and Blue Zone centenarians received the World Travel and Tourism Council’s Safe Travels Stamp.
Belize reopens August 15. To enhance the country’s health and safety standards, Belize implemented the Belize Health App and a nine-point Tourism Gold Standard program To enter Belize, COVID protocols include registration on the health app and a negative PCR test within 72 hours of travel; testing on arrival is available and a positive test will mean 14 days quarantine at passenger expense. The health app requires a daily check-in and reporting of symptoms. International travelers may only stay at approved hotels and take approved transportation.
As cases in Brazil climb, the mayor of Rio de Janeiro announced in mid-July that the city’s beaches will remain closed to swimmers and sunbathers until a vaccine is available. Walking on the beach, with a mask, is still allowed.
The White House’s new travel ban for Brazil began at midnight on May 27. People are no longer able to enter the U.S. if they have been in Brazil during the preceding 14 days. The restriction does not apply to U.S. citizens or green card holders, though it will be more difficult for them to get home as flights are usually curtailed in response to these types of bans. The Washington Post describes how flights between the two countries were already limited because of travel restrictions Brazil imposed in March against all foreigners. At the time, the United States had about four times as many COVID cases as Brazil and almost three times as many cases per capita. CTV News points out that the U.S. has not issued a travel ban against Russia, the country with the third-highest reported cases.
We’ve integrated other key events from earlier this spring into the information below.
The Evolving Spread of COVID-19
Reports of a rapid spread of COVID-19 outside of Asia began late in the week of February 17. When March began, cases were climbing in China, Italy, Iran, and South Korea. By mid-March, Western Europe and the U.S. had high numbers, and COVID was in 125 countries. Europe became the epicenter of the disease, but by the end of March it had shifted to the U.S.
For more on what’s happening in Europe, check out
Coronavirus Outbreak: Should You Cancel Your Trip to Europe?
Read more about U.S. travel below and in our
Coronavirus Outbreak: Should You Change or Cancel U.S. Travel Plans?
Many experts say that cases of COVID-19 have been circulating within many countries long before confirmed cases started to be counted. A new study indicates that a man in France may have had COVID-19 in late December 2019, Dr. William Spangler, Global Medical Director with AIG Travel, says, “There could be large segments of the population who contract it and never know it.” It’s assumed that the total number of cases is much higher than what’s being reported because many people experience mild or no symptoms and because most countries are not able to test everyone with symptoms. This means that the mortality rate is also unknown, as explained in this Economist article. Case numbers rose dramatically throughout March and even more so in April. Dr. Faheem Younus, Chief of Infectious Diseases at the University of Maryland, says it took 66 days for the case count to go from 100,000 to 200,000; 12 days to go to 300,000; four days to go to 400,000; two days to go to 500,000; and less than two days to go to 600,000. It then took one day to go to 700,000 cases. In April the number of cases rose from one million to three and by May 20 were at five million.
In March, most countries started to pay a lot more attention to COVID-19, while in China the disease was easing. On March 10, China reported that the country no longer needs 11 of its 14 new temporary COVID-19 hospitals as new domestic cases dropped. However, occasional domestic cases continued to be confirmed and a second wave of cases, brought in by travelers to China, then began. Second waves hit several of the earliest affected countries, including South Korea, Singapore, and Japan, as the BBC reported on March 18.
The United States became the third most-affected country in the world on March 23, rising from the sixth most affected as of March 20. March 26 saw the U.S. case count not only surpass that of Italy but also of China. A White House official said on March 30, “If we do things together well, almost perfectly, we could get in the range of 100,000 to 200,000 fatalities.” New York, as CNN explains, is the U.S. epicenter. On April 11, the state of New York alone surpassed the COVID-19 case count of Spain. The U.S. crossed the 10,000 COVID-19 deaths threshold on April 6 and on April 11 became the country with the highest number of COVID-19 deaths. At the beginning of March, the U.S. had about 100 confirmed cases. Two separate studies tracing the virus genome show that COVID cases in the United States originated not from travelers from China but Europe. The first U.S. case was reported on January 13, well before the White House’s January 31 China travel ban and the March 11 Europe travel ban.
Countries and territories with their first COVID cases in April included Yemen, Sao Tome, and Principe, South Sudan, the disputed territory of Western Sahara, the Falkland Islands, and the French archipelago Saint Pierre and Miquelon, which is off the coast of Newfoundland.
May brought the easing of COVID cases in Europe, although a German study said actual COVID cases there are likely 10 times higher than confirmed cases, and May 10 brought reports that Germany’s case numbers are rising again. Cases in other parts of the world continue climbing, especially in Russia, India, and Brazil. Many countries are beginning to lift their restrictions. Some citizens are protesting that they want additional freedoms while others fear their governments are putting the economy ahead of their health, often in the same jurisdiction.
What Is This New Virus?
In early January 2020, China and the WHO confirmed the identification of a new virus. It stems from several cases of pneumonia identified in Wuhan, a city in the Chinese province of Hubei, on December 31, 2019. The new illness initially had the temporary name 2019-nCoV. On February 11, 2020, the WHO officially named the illness COVID19, pronounced “co-vid 19.” It’s short for coronavirus disease, with the “19” designating 2019, the year it was first identified. The official name of the virus itself is severe acute respiratory syndrome coronavirus 2, or SARS-CoV-2.
A Coronavirus—What’s That?
The Centers for Disease Control and Prevention (CDC) describes coronaviruses as a type of virus that causes a fever and symptoms of the upper respiratory system, like a sore throat, coughing, and a runny nose. Sometimes coronaviruses can cause more severe symptoms like difficulty breathing, illnesses of the lower respiratory system like bronchitis and pneumonia, and sometimes death. Other coronaviruses include the common cold, as well as SARS (Severe Acute Respiratory Syndrome), and MERS (Middle East Respiratory Disease). Coronaviruses were first identified in the 1960s and have “corona” in their name because, at the molecular level, they have a crown-like shape.
Cold and flu viruses generally mutate frequently, which is why we keep getting sick from them and why the flu vaccine changes every year. We don’t yet know if people who recover from COVID-19 will have lifelong immunity to it, or if the virus will change.
There was initial hope that the virus would not survive in warm weather and therefore cases would ease off as the northern hemisphere entered summer, but outbreaks in warm countries like Singapore proved that wrong. As Spangler says, “unfortunately, it does not appear this particular virus is susceptible to heat and humidity.” For more detail see Is It Safe to Go to the Beach Right Now?
Coronaviruses can infect both humans and animals. Scientists don’t yet know the origin of SARS-CoV-2. When a virus jumps from an animal to a human, or vice versa, the virus can change rapidly and even become a new virus.
Scientists pay close attention to new viruses because they don’t know how they’ll behave and how dangerous they might be. For example, a virus that’s contagious only when the infected person is clearly sick and that causes only minor symptoms isn’t a big concern. But a virus that transmits rapidly, especially before an infected person even realizes they’re sick, is more dangerous, as is one that causes severe symptoms. Viruses that are transmitted by direct contact, like touching mucus membranes or bodily fluids, are easier to control than smaller viruses (like measles and chickenpox) that are transmitted through the air by floating on dust particles.
From a Global Health Emergency to a Pandemic
On January 30, 2020, the World Health Organization declared COVID-19 a global health emergency. On March 11, the head of the WHO, Tedros Adhanom Ghebreyesus, declared the spread of COVID-19 a pandemic. However, Tedros accompanied that declaration with several important statements:
- “…we are deeply concerned both by the alarming levels of spread and severity, and by the alarming levels of inaction.”
- “Pandemic is not a word to use lightly or carelessly. It is a word that, if misused, can cause unreasonable fear, or unjustified acceptance that the fight is over, leading to unnecessary suffering and death.”
- “Describing the situation as a pandemic does not change WHO’s assessment of the threat posed by this virus. It doesn’t change what WHO is doing, and it doesn’t change what countries should do.”
Linked are Tedros’ statements from March 2, when he said, “We are in unchartered [sic] territory. We have never before seen a respiratory pathogen that is capable of community transmission, but which can also be contained with the right measures. If this was an influenza epidemic, we would have expected to see widespread community transmission across the globe by now, and efforts to slow it down or contain it would not be feasible.”
On March 16, Tedros noted that many countries have implemented decisions to enhance social distancing, for example by canceling events and closing schools. However, he said there is not “an urgent enough escalation in testing, isolation and contact tracing” and that these are needed to “extinguish this pandemic.” He added “We have a simple message for all countries: test, test, test. Test every suspected case.”
He also reminded that “all countries must strike a fine balance between protecting health, minimizing economic and social disruption, and respecting human rights” and called for all sectors of society to work together to mitigate the pandemic’s social and economic consequences.
World Leaders’ Reactions and the WHO’s Advice
Leaders around the world first tried to protect their own countries by closing borders and restricting movement. As the disease spread, many countries realized they could better tackle the pandemic, and the economic consequences of it, by cooperating rather than competing against each other.
The WHO said July 28 that the world is still in the first wave of the pandemic, and warned against thinking of COVID as a virus that behaves in seasonal waves, like the flu does. “It’s going to be one big wave. It’s going to go up and down a bit. The best thing is to flatten it and turn it into just something lapping at your feet,” said the WHO’s Dr. Margaret Harris. The pandemic has many side effects as well, for example, the United Nations said 10,000 children are dying every month because of COVID-related hunger, with 550,000 children affected by “wasting” malnutrition, the CBC reported. In early August, the United Nations reported that more than a billion students in 160 countries around the world have missed school due to COVID-19. It’s estimated that over 23 million students are at risk of not having access to school or of dropping out this year, which could lead to “a generational catastrophe.”
International meetings addressing health and the economy continue. For example, on May 4 a global alliance of world leaders pledged to raise $8 billion to research vaccines and therapeutics and distribute them equitably once developed. The U.S. did not attend the virtual meeting.
The head of the United Nations drew attention to the rise in anti-foreigner hate and xenophobia around the world. On May 8, the UN Security Council’s vote for a worldwide cessation of conflict zone hostilities was prevented by the U.S., reportedly because the resolution mentioned the World Health Organization, reports Al Jazeera. CNN reports that international health experts warn that diseases like HIV/AIDS, measles, tuberculosis, and malaria could surge because of a shift in health resources toward COVID-19.
In his April 1 remarks, the head of the WHO, Tedros Adhanom Ghebreyesus, urged governments to put social welfare measures in place to protect vulnerable people. He commended India for providing free food rations for 800 million citizens and free cooking gas for 80 million households. Tedros drew attention to the needs of developing countries and echoed the call from the World Bank and International Monetary Fund to provide debt relief. The WHO, with UNICEF and the International Federation of the Red Cross, is releasing new guidance for handwashing aimed at countries where access to clean water is limited.
Authoritarian governments and police forces are exerting their influence. The Guardian reports that a 13-year-old boy in Nairobi, Kenya was shot dead on his balcony by police enforcing curfew. Global News describes how the word “coronavirus” is banned by the Turkmenistan government and that people who say it or wear face masks are being arrested. The BBC reports that the Hungarian parliament passed a bill that gives the government the ability to rule by decree without any time limits. The law also allows significant jail sentences for people deemed to be spreading rumors or breaking quarantine. Journalists are alarmed by the government-sponsored “hate campaign” against independent news.
The EU and Germany both called attention to the new Hungarian situation and of the importance of the rule of law, human rights, democracy, and an independent and free media. The Guardian also reports on concern about how the coronavirus is affecting European solidarity. A former Italian prime minister, Enrico Letta, said, “If everyone took the strategy of ‘Italy first,’ ‘Belgium first’ or ‘Germany first,’ we will all sink together.” See more on the situation in Europe in Coronavirus Outbreak: Should You Cancel a Trip to Europe?
On March 31, Donald Trump warned that “We’re going to go through a very tough two weeks” with modeling showing that between 100,000 and 240,000 Americans could die of COVID-19. However, Politico reports that the White House has decided against allowing new Obamacare enrollments for uninsured Americans. On April 22, Donald Trump issued a 60-day suspension on green cards and guest worker programs, as detailed by Deutsche Welle.
Also on April 22, the UN secretary general warned that COVID-19 “is a public health emergency that is fast becoming a human rights crisis.” He warned about the rise in authoritarian governments, hate speech, domestic abuse, and the disproportionate effect of the virus on refugees and migrants. World leaders continue to provide mechanisms to try to ease the economic, social, and health effects of COVID-19. The World Food Program warned that 300,000 people daily could starve to death over the next three months and that there could be famine in more than 30 countries.
In the U.S., the CDC lifted its March 28 travel advisories that recommended no nonessential travel to the states of New York, New Jersey, and or Connecticut for 14 days. The advisory has been replaced by the CDC’s general advice about traveling within the U.S. On April 18, Canada and the U.S. agreed to extend their border closure for another 30 days.
On April 16, the White House issued guidelines for reopening the economy. This resulted in, for example, the opening of Florida beaches with reports that they were immediately crowded. USA Today describes some of the new measures. On April 13, Donald Trump claimed that he has “total” authority to order states to reopen. As NPR reported, it is individual state governors, not the U.S. president, that have these powers. Throughout the week, arguments with governors and constitutional experts followed, with Trump tweeting that “a good old-fashioned mutiny every now and then is…exciting and invigorating.” As reported by NBC, some saw tweets to “liberate” Virginia, Michigan, and Minnesota, and describing the 2nd amendment as “under siege,” as a call to arms.
Several international meetings took place in April, including G7 leaders, G20 health ministers, and of the 24 member countries of the Alliance for Multilateralism. Relying on science, supporting the WHO, and the importance of international cooperation were prominent agenda items. However, the planned April 19 statement by G20 health ministers about cooperating to prevent future pandemics and strengthening the WHO’s mandate was not released because the U.S. would not agree to it, as reported by The Guardian. On April 17, the Ministerial Coordination Group on COVID-19 put out a statement endorsing global cooperation to mitigate disruptions to the economy, trade, and travel. Amongst many other things, signing countries agreed to work to extend visas for non-nationals unable to exit countries because of COVID-19 travel restrictions and to offer them essential health care. Thirteen countries signed the statement: Brazil, Canada, France Germany, Indonesia, Italy, Mexico, Morocco, Peru, South Korea, Singapore, Turkey, and the U.K.
Leaders of the G7 met April 16 and, as described by the Globe & Mail, “confronted Donald Trump” about cutting funding to the WHO. The other leaders expressed support for the WHO and the importance of fighting the pandemic through shared information and coordinated science. Supporting funding of the WHO was also discussed at the April 16 meeting of the Alliance for Multilateralism. The goal of the informal network of foreign affairs ministers, founded by France and Germany, is “to renew the global commitment to stabilize the rules-based international order, uphold its principles and adapt it, where necessary.” The Alliance’s April 16 joint statement begins with “The COVID-19 pandemic is a wake-up call for multilateralism” and calls for global cooperation and solidarity. It has 24 signatories from Europe, Africa, Asia, the Caribbean, the Middle East, North, Central, and South America. The United States has not yet participated.
In his April 8 remarks, Tedros Adhanom Ghebreyesus, the head of the WHO, gave an overview of the first 100 days of the COVID-19 crisis. This included that the WHO notified world leaders of the outbreak on January 5 and issued guidance on how to detect, test, and manage cases on January 10. In his April 10 remarks, Tedros outlined six factors for countries to consider in deciding when to start lifting physical distancing and other lockdown conditions. He raised concerns about countries where more than ten percent of health care workers are infected and the need for them to have access to personal protective equipment. He described the UN’s new Supply Chain Task Force to help with procurement and distribution where it’s most needed.
Tedros also drew attention to Africa where the virus is now spreading in rural areas which already lack health capacity. He reported that, after 52 days without any new Ebola cases, an Ebola diagnosis was confirmed in the Democratic Republic of the Congo, which also has 235 COVID-19 cases. As of April 24, Africa has more than 27,600 coronavirus cases in 52 countries. Only two African countries—Comoros and Lesotho—have not yet confirmed any COVID-19 cases.
EU finance ministers reached an agreement on April 9 for a financial rescue package worth 500 billion euros. G20 leaders met on March 26 to discuss working together to address the effects of COVID-19 but no specific actions were shared with the media. This followed a March 25 G7 foreign ministers discussion where they were unable to issue a planned joint statement because the U.S. insisted on calling COVID-19 the “Wuhan virus” and the other G7 ministers refused, as reported by the CBC.
On April 5, the head of the United Nations called for governments to enact measures to protect abused women and children who must self-isolate at home with their abusers.
Tedros Adhanom Ghebreyesus, the head of the WHO, reminded G20 leaders that to address COVID-19, “No country can fight alone; we can only fight together.” In his March 27 public remarks, he said “The chronic global shortage of personal protective equipment is now one of the most urgent threats to our collective ability to save lives,” adding that “when health workers are at risk, we’re all at risk.” He announced next steps in the WHO’s SOLIDARITY clinical trial and requested that countries “refrain from using therapeutics that have not been demonstrated to be effective” against COVID-19, saying “We must follow the evidence. There are no short cuts.”
Tedros said the world “squandered the first window of opportunity” to deal with COVID-19 and must “do everything to suppress and control this virus” and not squander the second opportunity. In his March 25 remarks, he said encouraging people to stay in their homes is slowing the spread of COVID-19, but that it will not extinguish it. He called on countries that have implemented lockdowns to use the time to enhance measures so that the virus does not simply resurge when lockdowns are lifted. He outlined six key actions, including refocusing “the whole of government on suppressing and controlling COVID-19.”
Tedros echoed the March 23 call of the United Nations’ Secretary-General for a ceasefire of all armed conflicts, stating “We are all facing a common threat, and the only way to defeat it is by coming together as one humanity because we are one human race.” Tedros continued to press for more testing, isolating, tracing and quarantining. He discussed the rising number of COVID-19 infections amongst medical staff and recommended that limited protective equipment be prioritized for use by medical teams. He also encouraged countries to work together in the WHO’s SOLIDARITY clinical trial study, saying it will bring faster and more effective results than many smaller observational studies. For individuals, Tedros reminded us that physical distancing does not mean social distancing. He encouraged everyone to reach out to others by phone or electronic means, especially to older people and those who live alone.
In his remarks on March 18, Tedros again pressed countries to enhance COVID-19 measures beyond physical distancing (like canceling events and large group gatherings). Without “isolating, testing, and treating every suspected case” and then tracing contacts of anyone diagnosed, he said transmission chains will continue at low levels and then surge again once physical distancing restrictions are lifted. On March 13, the head of the WHO expressed relief that more and more countries are now acting on the WHO’s advice but repeated that there is much more to be done.
The WHO’s advice to the general public, last updated on March 18, remains taking the usual precautions: wash your hands frequently, avoid touching your face, practice respiratory hygiene, practice physical distancing, and maintain at least a three-foot distance from people. People who show even mild symptoms, like a headache or runny nose, should stay home. Those with more serious symptoms (like a cough, fever, and difficulty breathing) should seek medical care but call for instructions before visiting a medical provider in person. We explain the details of this below.
In a statement on March 16, the WHO gave advice on how to care for a COVID patient who is quarantined at home to minimize the chance the virus is spread to other family members (a key way COVID-19 spread in China). New guidance is also available for how to care for older people, pregnant women, and children.
The WHO also provides advice on international mass gatherings, defined as events where the number of participants could drain the destination’s health system. The WHO has ruled out blanket cancellations but has provided advice on how assessments should be made including that multiple stakeholders, particularly public health authorities, be involved.
With respect to travel bans, the WHO reiterates that “evidence shows that restricting the movement of people and goods during public health emergencies is ineffective in most situations and may divert resources from other interventions.” The organization says some short-term restrictions, carefully weighed against risk, may be justified at the beginning of an outbreak to allow countries to implement preparedness measures and identifies circumstances where the temporary restriction of movement may be useful “such as in settings with few international connections and limited response capacities.”
In April, bidding wars by countries and institutions for increasingly hard-to-find personal protective equipment was jacking up prices and putting health care workers at risk. Dubbed “mask wars,” blame was focused on the U.S. For example, the U.S. attempted to limit exports of N95 masks made by 3M to Canada and Latin America. Canadian officials made statements about how the pulp used to make N95 masks comes from British Columbia and about the number of Canadian medical staff who work in Detroit hospitals. The U.S. was accused of interfering with European mask purchase agreements, including allegedly redirecting to the U.S. a shipment of 200,000 masks from Bangkok bound for Germany. German officials dubbed it an “act of modern piracy” and called the “behavior of the U.S. president…inhumane and unacceptable” and insisted that “the U.S. comply with international rules.” Barbados accused the U.S. of blocking the shipment of 20 donated ventilators. Experts say this kind of individualism will likely increase virus transmission and put everyone at greater risk.
On April 3, the CDC advised Americans to wear face coverings in public to help prevent people without symptoms from inadvertently spreading COVID-19. The CDC provided instructions for making them. Medical experts warned about a false sense of security with a mask, saying that staying home and, when out, keeping physical distance from others is still the most effective way to prevent COVID transmission. People can also easily infect themselves by not using masks properly (we provide more details toward the end of this article). Officials also reminded of the shortage of masks for medical professionals and that everyone is less safe if health care workers become sick.
Cancelations, Domestic Restrictions, and Lockdowns
In most countries, the initial response to COVID-19 was to cancel major events like international conferences and to have sports matches played without audiences in stadiums. Restrictions grew in most countries, first in Asia and then in Europe and elsewhere. Most events around the world are now canceled or postponed. The decision to postpone the Tokyo 2020 Olympics was made on March 24. The Olympics are now scheduled for July 23 to August 8, 2021, and the Paralympics for August 24 to September 5, 2021, though in late May 2020 officials speculated that the Games may not be able to go ahead without a vaccine, and may be canceled altogether.
More and more countries advised their citizens to avoid gathering in restaurants and bars, then closed nonessential businesses, and then told people to stay in their homes as much as possible under guidelines to self-isolate and shelter in place. Several countries enacted official lockdowns, some issuing severe penalties for violations. Public life around the world shut down, relatively easy for people with their own apartments or houses, but sometimes impossible for people with low incomes and homeless people.
The aim is to prevent the most at-risk populations from contracting the disease and not overwhelming health care systems. Known as “flattening the curve,” this NPR article explains what it means and why staying home and physical distancing can save lives. Individual action is critical in ensuring success and we all must take on responsibility in helping prevent those more vulnerable from getting sick.
New guidelines for the United States, called “15 Days to Slow the Spread,” were implemented March 16 and later changed to “30 Days to Slow the Spread.” As USA Today describes, they include advice to “limit discretionary travel, shopping trips, and social visits,” avoid gatherings of more than 10 people and to avoid sitting in restaurants and bars.
The Guardian said March 25 that approximately 20% of the world is living in lockdown conditions. On April 5, the BBC reported it at 25% and other outlets said that half the world’s population faces movement restrictions. Generally, people are allowed out of their homes for essential purchases and, in most countries, to exercise. Several countries have begun warning citizens that COVID-19 restrictions could last for six months or longer.
In mid-March, officials in many countries expressed shock at the number of people, particularly young people, who were ignoring advice to maintain physical distance and not attend events of any kind, including going to bars and restaurants. There was grave concern about how much disease was spread because of these activities. News outlets report comments from spring breakers in Florida saying they didn’t care if they contracted COVID-19, seemingly unaware that young people can also have serious symptoms and of the significant role they would then have in spreading the disease and putting health care systems in jeopardy. A French minister said, “There are people who think they are modern-day heroes by breaking the rules while they are in fact idiots.”
In other parts of the world, South Korea monitors those in quarantine with electronic wristbands. After reports of recovered South Korean patients testing positive again for COVID-19, the WHO began a study on April 11 to find out why. CNN reported that Ecuador’s largest city, Guayaquil, was on the verge of collapse with bodies left in the street. In Peru, anyone who spreads fake coronavirus news could be arrested. In Panama, residents were only allowed to leave their houses for two hours at a time, and men and women not allowed out on the same day. In the United States, at least 90% of the population was under some kind of lockdown; Al Jazeera describes the restrictions in each U.S. state in mid-April.
Travel Bans and Restrictions
Travel restrictions began in Wuhan in January and grew to almost every other country in March. Echoing the WHO, some infectious disease specialists say that not all of the travel bans are medically necessary but were put in place for political reasons. To non-experts, some of the decisions may sound like they make sense, but evidence-based scientific advice suggests otherwise. For example, Steve Hoffman, a professor of global health at York University, describes how a travel ban “actually undermines the public-health response because it makes it harder to track cases in an outbreak.” Bans encourage people to lie about their symptoms and about whether they may have been exposed to illness. Many people are so desperate to get to their destination that they board flights knowing they have symptoms. Axios describes how about 40,000 people flew to the U.S. on direct flights from China after the China-U.S. travel ban was in place, perhaps giving a false sense of security and delaying other actions that may have saved more lives.
Some decisions may even be driven by fear and xenophobia. Certainly, statements calling the virus “Chinese” or “foreign” are xenophobic and can make controlling COVID-19 and the consequences of it more difficult. Asians around the world report increased harassment and discrimination because of the virus. Public health experts reiterate that bans against travel and trade are ineffective, not scientifically or economically warranted, and can cause more harm than good. However, encouraging individuals to make decisions to avoid travel or self-isolate can help slow the spread of disease, flatten the curve, and reduce pressures on health care systems.
In the United States, travel restrictions strengthened during February and March. The CDC and the State Department use different warning scales and issued differing advice. As of March 19, the State Department’s warning is at “Level 4: Do Not Travel,” the highest level. It advises Americans to “arrange for immediate return to the United States unless they are prepared to remain abroad for an indefinite period.” This follows the State Department’s March 11 Level 3: Reconsider All Travel advisory. The CDC issued level 3 “warnings” to avoid nonessential travel to a list of countries that changed frequently. On March 11, a global outbreak was noted with a level 2 alert, but later changed to level 3, the highest, meaning “avoid all nonessential travel.”
The U.S. began implementing new border rules on February 2, prohibiting foreign nationals who had visited China in the previous 14 days from entry and subjecting U.S. citizens traveling from there to health screenings and, potentially, restrictions on their movements for 14 days. A ban on travelers from Iran was added on February 29. Advice for travelers from other high-incidence countries, including all countries with a level-3 warning, includes that they should self-isolate for 14 days. On March 11, Donald Trump announced that all travel from Europe is suspended for 30 days as of midnight March 13. Originally the U.K. and Ireland were exempt from this ban, but on March 14, the ban was revised to include them and clarifications issued about who the ban did and did not apply to.
On March 13, the United States declared a state of emergency. On March 28, the CDC issued travel advisories within the United States, recommending no nonessential travel to New York, New Jersey, or Connecticut for 14 days. That restriction has been lifted, but the CDC provides advice about travel within the U.S. Nonessential travel across the U.S.-Mexico border was barred as of March 21. The Guardian reported that construction of the southern border wall would be increased.
The U.S.-Canada border closed to all but essential travel as of March 21 and the closure was extended until at least June 21. Nationals of each country can return home and commercial goods are still allowed through. Canada was following the WHO’s advice but on March 16, the prime minister announced new restrictions on who can enter the country. Canada’s advisory recommending that Canadians not travel abroad at all was released March 13 and on March 14, Canada advised Canadians who are abroad to return home. Anyone coming into Canada, regardless of where from and regardless of whether they have symptoms, must self-isolate for 14 days and provide border officials with a quarantine plan.
On March 26, the Canadian prime minister confirmed rumors that the White House discussed putting troops near the U.S.-Canada border. Canadian officials were not supportive, with Justin Trudeau saying “Canada and the United States have the longest un-militarized border in the world and it is very much in both of our interests for it to remain that way.” At the time, Canada had about 4,000 cases while the U.S. had about 81,000. On March 31, the CBC reported that a U.S. Department of Defense official said, “As of last night, that is no longer under consideration.” The Nation reported on a leaked Customs and Border Protection memo requesting $145 million in funding to monitor the activities of Canadians.
Most countries screen arrivals at their borders, and some require testing on arrival. Self-isolation or quarantine for 14 days is encouraged and often mandatory. Al Jazeera has a list of border restrictions.
Air Travel Restrictions
Airlines began canceling flights and adjusting schedules in January in response to government bans and because of reduced customer demand. Many airlines discontinued international flights, reduced domestic flights, and some are temporarily shutting down operations. Some countries grounded all international flights. Passengers around the world reported showing up for flights at airports only to find they’ve been canceled, with the pattern repeating with subsequent flights.
Air travel is starting up again, though many airlines are laying off staff and are worried about their ability to stay in business. Airlines have enhanced cleaning protocols, for example with electrostatic spraying of disinfectant nightly and sometimes between flights. Many require that both crew and passengers wear masks and are attempting to seat passengers to allow for more physical distancing.
In May, however, some air passengers posted photos of packed planes on social media, complaining that airlines misled them about their new policies. For example, United Airlines posted “we’re automatically blocking middle seats to give you enough space on board,” which customers took to mean that it would not be physically possible to sit in middle seats. The airline’s website, however, detailed that while United blocked the ability to book middle seats, those seats could still be assigned to passengers if needed, for example when flights are consolidated. Since airlines have cut or reduced flights to secondary airports (such as Oakland, in favor of San Francisco), flights that were half-empty a week ago are now full.
Some countries’ skies remain closed. On April 27, Argentina announced that tickets for commercial flights to, from, or within the country cannot be sold until September 1. Other countries are still flying and there are signs of what air travel in the COVID world could look like. On April 15, with a Dubai-Tunis flight, Emirates began testing passengers for COVID-19 prior to boarding via a 10-minute blood test. Emirates plans to expand testing, particularly for countries that require COVID testing certificates. Passengers on flights departing from or arriving at Canadian airports must demonstrate they have a non-medical face covering and wear it when physical distancing is not possible. Anyone entering Canada must provide a written quarantine plan when they arrive at the border. In the U.K., the training of dogs to sniff out COVID at airports is underway, as some dogs can already detect malaria and cancer. Arrivals in Hong Kong must undergo a COVID test and await the results, provide a quarantine plan, and get set up with a monitoring bracelet and app to record their temperature, a process that takes about eight hours. As travel restarts again, The Guardian describes how airfares might rise by 50% if physical distancing rules remain in force.
The International Air Transport Association (IATA) released a Roadmap for Restarting Aviation providing advice for both airports and airlines. For now, there is no consistency of rules or policies across countries or even within them. The air travel situation remains fluid and travelers should check with their airline or travel agent for the latest news. Flexibility to postpone travel with change fees waived is still possible as airlines try to reignite business. Find more information at:
- American Airlines Travel Alerts
- Delta Air Lines Current Advisories
- United Airlines Important Notices
Cruise Ship Restrictions
Cruise ship travel has been significantly disrupted. Rerouting of itineraries began in January, as did enhanced health checks and limitations on who can board, sometimes based on travel history and sometimes just based on passport regardless of the person’s country of residence. In March, many cruise lines suspended operations for at least a few weeks though several lines are still working to get passengers and crew home from ships that are stranded at sea and not allowed to dock. Cruise Critic is monitoring the situation and includes links to all cruise lines’ latest COVID-19 updates and well as information on port closures.
Many countries, including Canada and the United States, recommend citizens avoid cruise ship travel during the pandemic. Many countries closed their ports to cruise ships completely. The CDC extended its No Sail Order, likely until mid-July 24. On March 13, Canada deferred the start of cruise ship season from April 2 to July 1, applying to all ships with more than 500 aboard. All cruise ships, regardless of size, are prohibited from Canada’s fragile northern regions for the 2020 season. On May 12, the province of British Columbia announced that cruise ships may stop for supplies and fuel, but passengers will not be allowed to disembark during summer 2020. This means the itineraries of many Alaskan cruises are changing, and some cruise lines forgoing the Alaska season entirely for 2020.
In April, dozens of cruise ships were stranded at sea and are trying to dock to allow their passengers and crew, some of whom were sick, to return home. For example, at least eight ships, with crew but no passengers, were ordered to leave Australian waters in early April, reports The Guardian. Two Holland America ships, finally allowed through the Panama Canal on March 29, then faced delays off Florida. The Zaandam’s original March 7 to 21 itinerary was Argentina to Chile, but no one was allowed off after March 14. Sister ship the Rotterdam joined the Zaandam on March 26 near Panama to separate sick and healthy passengers. Florida Governor Ron DeSantis initially did not allow the ships to dock, first saying he did not want passengers “dumped” in Florida and then said only Floridians could disembark. This prompted a barrage of complaints on social media, particularly from Canadians, including reminders of the grounding of flights on 9/11 and how the town of Gander, Newfoundland took in double its population when 38 planes bound for the U.S. needed a place to land urgently. Most passengers disembarked April 3 and flew to U.S. destinations and to Europe, New Zealand, and Canada via charter flights arranged by Carnival Corporation.
Cruise ship crews are having a more difficult time. On May 3, CBC reported information from the U.S. Coast Guard that 122 cruise ships with 80,000 crew members are stuck in U.S. waters, their crews not allowed to disembark until strict CDC requirements are met, including charter flights home. The Guardian says that at least 100,000 crew are living in close quarters on cruise ships around the world, either on ships that aren’t allowed to dock in port, in countries which they can’t fly out of, or they’re from countries that have closed their borders even to citizens. Some are ill or quarantined and at least 17 have died. There are reports that some are no longer being paid and that there are limited means to send and receive information. However, some cruise lines, like MSC Cruises, are allowing crew to use larger passenger cabins, providing free internet, and securing and paying for flights home.
Norwegian is the first cruise line to announce how they’ll operate going forward. They’ll have a public health officer onboard to oversee health practices, including fogging with electrostatic disinfectant and passenger temperature checks prior to all public activities, including meals. Buffets and self-serve drinks are no longer allowed. Itineraries will vary depending on ports’ rules and protocols.
As for the future of the cruise industry, Travelweek interviewed Vanessa Lee, President of Cruise Strategies, in April. She said that “certain areas of the world will not lend themselves to cruising for some time and others will be more logical recipients for cruise guests.” She explained that itineraries will be changed to accommodate and predicts “shorter, closer to home cruises” and river cruises as likely preferences, as will be “visits to private islands where the cruise companies can manage their own guest experience onshore as well as at sea.” We outline What Needs to Change Before You Go on a Cruise Again.
Treatments, Vaccines, and Hope for the Future
The number of COVID-19 cases and deaths will continue to rise and we still need to learn a lot about the disease. A vaccine is not expected for at least a year. Research and clinical trials around the world are underway. False reports circulate daily about new “miracle cures” for COVID-19, often about specific drugs that are effective for other diseases, but which can harm or kill people who don’t have those illnesses. Drug shortages are affecting the lives of people with those other illnesses. Reports of new tests and treatments come almost daily, but often before they’ve been studied thoroughly enough. What seems like good news one week turns out to be problematic the next. On March 18, the head of the WHO described a new study to collect data on the effectiveness of the variety of treatments around the world, naming it the SOLIDARITY trial (a reminder to world leaders that the only way to combat COVID-19 is to work together).
Perhaps a New Normal?
COVID-19 may become a new normal. In the short-term at least, the new normal means, at a minimum, physical distancing, enhanced cleanliness, and vigilance in monitoring ourselves for symptoms, even the most mild. While travel is starting up again and people want to return to normal life, staying six feet from others and minimizing social interactions will save lives.
In the long term, the new normal might mean COVID-19 becomes a new disease we always have to watch out for. The Atlantic reports that “‘cold and flu season’ could become ‘cold and flu and COVID-19 season’” and describes the situation according to Marc Lipsitch, an epidemiology professor from Harvard. He predicts that “some 40 to 70 percent of people around the world will be infected” with COVID-19 over the next year, but “many will have mild disease or may be asymptomatic.”
COVID-19, like the flu, is a significant health risk to the elderly, people with pre-existing illnesses, and to countries with underfunded health care systems and where many citizens live with low incomes. COVID-19 cases are pressuring the health care systems of all countries, and more so during flu season. While health care workers are trained to take extra precautions, they are also at greater risk of getting sick from the virus as well as from burnout.
Also serious is the economic risk of COVID-19. Not being able to go to work is having significant financial effects on individuals without paid sick leave and on businesses without workers. Economies around the world were affected as commerce and production slowed almost to a standstill. Small businesses are at particular risk. Governments are implementing monetary and fiscal stimuli to protect citizens and businesses and ward off the worst of the recession (and perhaps depression) that is expected.
How Does COVID-19 Compare to Other Respiratory Diseases?
Spangler says that it’s important to put COVID-19 in the context of other diseases. SARS had a mortality rate of 9.6% and MERS’ rate is 34% (the disease is still active, the most recent case was reported February 18, 2020, in Qatar). 2013’s H7N9 “Bird Flu” had a 39.3% mortality rate and 1997’s H5N1 “Bird Flu” was 57%.
The 2009 H1N1 “Swine Flu” was designated as a pandemic and hit 214 countries. The CDC provides these estimates for April 2009 to April 2010 period:
- 8 million H1N1 cases (range 43.3-89.3 million)
- 274,304 hospitalizations (range: 195,086-402,719)
- 12,469 deaths (range: 8,868-18,306) (fatality rate 0.02%); note that as of April 7, 2020, the U.S. had more COVID-19-related deaths than H1N1-related deaths.
- 151,700 to 575,500 H1N1 deaths, 80% of which were in people younger than age 65.
Consider annual flu statistics too. The CDC says that during the current 2019-2020 flu season (October 1, 2009 to present, as of April 4, 2020):
- 39 million to 56 million annual flu cases
- 24,000 to 62,000 deaths (fatality rate 0.06-0.11%)
During flu season, every week or so, the number of annual flu cases in the U.S. climbed by a million or two and the number of deaths by one or two thousand. Many Americans aren’t getting a flu shot despite the number of deaths from flu. Last year, 62.6% of U.S. kids got a flu shot while only 45.3% of adults did. And many people who have the flu—14%—don’t have symptoms, but can spread the flu virus.
In comparing how contagious the new coronavirus is, Spangler says the average person with COVID-19 “can transmit it to 2.00 or 2.5, even, [other] people,” while the annual flu spreads to about 1.0 or 1.2 people.
COVID-19 is new and there’s still a lot we don’t know about it. There are millions more cases of H1N1 and annual flu. COVID-19’s fatality rate is higher than H1N1 and annual flu, but much lower than SARS and MERS and some other flus. SARS got a lot of worldwide attention and COVID-19 has been top of the daily news. Everyone needs to take precautions to stop the spread of the disease, particularly to prevent health care systems from being overwhelmed. But is there a reason to panic more over COVID-19 than we did over H1N1 or seasonal flu or even SARS? Take the advice of governments seriously, but panic behaviors are making the situation worse. Consider this article by infectious disease specialist Dr. Paul Sax who explains What Does (and Doesn’t) Scare Me About the Coronavirus from the U.S. perspective. Visual Capitalist put COVID-19 in the context of other infectious diseases throughout history: Visualizing the History of Pandemics shows that HIV/AIDS, which has killed 25 to 25 million people, is by far the modern world’s worst pandemic.
If Bans and Restrictions Don’t Affect Me, Should I Still Travel?
Most countries are advising their citizens to reconsider or avoid nonessential international travel. Minimizing contact with other people as much as possible is still essential to slow the spread of COVID-19. We all need to practice the WHO’s advice of physical distancing, washing hands, and avoiding touching faces (see below).
During the pandemic, check the website of the public health authority of the destination you plan to visit to see their latest advice, including for entry requirements and how strained their health care system is. Travelers should still assume that new restrictions and bans could arise at any time, that flights will be canceled with little to no warning, and that their travel history will be scrutinized. Travelers may be asked to self-isolate for 14 days upon arrival, including to their home country. Some are implementing mandatory quarantine periods for travelers from some destinations or if they have been abroad at all.
It’s not new to the COVID-19 situation, but keep in mind that airlines have the right to refuse passengers who appear to have a communicable disease. The captain has the final say and many airlines employ medical consultants. As fears over COVID-19 rise, expect increased vigilance and potentially restrictions on people who simply have a cold or allergy symptoms.
You should consider whether it’s wise to book new travel, even for months from now. It’s true that there are deals to be had and many airlines, cruise lines, and tour groups are offering unprecedented flexibility to make changes. However, most travel insurance will not reimburse you for coronavirus-related cancellations so check policies very carefully. Further travel bans, restrictions, and advisories are possible. And you need to consider how you may be contributing to the spread of disease, particularly to vulnerable populations.
Easy and Common Sense Protections
Following the advice of health experts like the WHO will minimize your chance of getting sick from this new coronavirus. The advice to protect yourself from getting sick—and to minimize the spread to others—is pretty easy to follow, and it’s what we should all be doing anyway to prevent colds and flus.
- Wash Your Hands: A 20-second scrub using warm running water and soap is best (the Mayo Clinic says to sing “Happy Birthday” twice); one of Canada’s provincial health officers says “wash your hands like you’ve been chopping jalapenos and you need to change your contact [lenses]”). Then, rinse with clean water and dry your hands. It’s important to dry them, though the jury is out about the best way (some studies say hot air blowers spread germs and that paper towels or clean fabric towels are best; other studies disagree). Soap and water are more effective, but if you don’t have access to a sink, using a hand sanitizer that contains at least 60% alcohol is fine (scrub well). Regardless, wash your hands often: certainly after coughing, sneezing, or blowing your nose; before you prepare food; before and after eating, and after using the restroom. And throw those used tissues away immediately (and then wash your hands).
- Avoid Touching Your Face: Most viruses and bacteria enter the body through mucous membranes like the mouth, nose, and eyes. It’s easy to re-contaminate your hands after washing them, so keeping your hands away from your face is the best way to prevent germs of any type from getting in you.
- Cough and Sneeze Into Your Elbow: Yes, covering your cough or sneeze with your hand is preferable to spraying all those tiny virusy droplets directly into the air. But then you’ve contaminated your hand and you’ll inevitably touch something or someone. So, make a new habit of coughing/sneezing into the inside of your elbow (although a tissue should be your first choice). And while you’re at it, break that other habit of crossing your arms and putting your hands right onto your sneeze spots.
- Physical Distancing: It’s always wise to keep your distance from sick people. During the COVID-19 outbreak, try to keep a three- to six-foot distance from others. No hugs, kisses, or handshakes, please. And really, during cold and flu season why not keep close contact just for loved ones?
- Don’t Touch Animals You Don’t Know: Regardless of whether there’s a new virus circulating, staying away from animals when you travel (even that cute stray cat or dog) is a sensible precaution. They likely carry bugs that your body isn’t used to. The WHO is also reminding people of its general advice to be extra careful in markets that have live animals or non-refrigerated meats and fish.
And of course, to prevent others from getting sick, isolate yourself if you have COVID-19 symptoms.
People who have higher risks—the immunosuppressed, those with other health conditions, and older adults—should follow the advice of their doctor.
Still feeling a little paranoid? It’s good practice to regularly disinfect surfaces that get handled frequently (your phone is filthy). You can use a wipe to clean off your tray table, armrests, and seatbelt, though the evidence is unclear whether this is effective in killing germs or just cleaning up that bit of sticky spilled Coke. Don’t assume you’re safer in a taxi or Uber: it’s easier not to touch surfaces on the subway or bus, and those vehicles have a regular cleaning schedule while cars do not.
At restaurants, do an extra hand wash after you’ve given back the menu and before you start to eat. Assuming buffets ever return, use hand sanitizer before and after you touch serving utensils and be sure to only put food on a clean plate; don’t bring your used plate back to the smorgasbord. And while we’re at it, let’s call a halt to waiters at fancy restaurants picking up your used napkin and refolding it when you step away from the table. Let’s all just keep our germs to ourselves, yes? Here’s what restaurants may look like in the age of COVID.
Yes, You Should Wear a Mask
Speaking of keeping your germs to yourself: if you’re sick or may have been exposed to a respiratory disease, wearing a mask is recommended and is, increasingly, mandatory. Many airports require you to wear masks, and many countries require it on public, transportation in indoor public places and anywhere it is difficult to maintain a six-foot distance from people
On July 20, two more big hotel brands, Marriott and Hilton, announced that guests will be required to wear masks in public areas, following the lead of Hyatt which already required it of guests at their Canadian and U.S. properties (employees were already required). The rules went into effect July 27 for Marriott and a date is forthcoming for Hilton.
Medical professionals continue to advocate for mask use, although some non-medical professionals are campaigning against it. h The CDC recommended April 3 that Americans wear one in public and the WHO updated its mask advice on June 6. Masks have been shown to reduce the chance of you spreading your illness to other people when you cough, sneeze, laugh, or talk. There is considerable evidence that masks help prevent the spread of COVID-19 by people who don’t realize they have the virus, as they have no symptoms. However, studies show that masks are not more effective than physical distancing measures, and keeping six feet apart from others is still the most effective way of preventing COVID-19 spread.
Initially, there was minimal evidence that a mask can prevent the wearer from getting sick, unless you wear specific types of medical masks that are fitted to your face and unless you know how to use them properly. These types of masks are in short supply around the world and should be reserved for the people who need them most: medical staff and other essential workers. However, there’s new evidence in mid-July that wearing a mask can reduce the severity of symptoms if you do get sick, in addition to protecting other people around you.
Remember that masks aren’t perfect, most of us don’t use them correctly, and they can give a false sense of security. It is easy to contaminate yourself just by taking off a mask. We fidget with them, put them on and off without washing our hands, don’t wash them properly, and re-use masks that are meant to be single-use. Masks do not cover your eyes, a key way for the virus to enter your body. Staying at home, keeping six feet from others when you must go out, not touching your face, and washing your hands well are the most effective measures to prevent COVID-19. The CDC provides instructions on how to make a mask at home. Remember that when the supply of masks for essential workers is jeopardized, your health is more at risk.
The CDC also recommends that caregivers wear a disposable mask when touching a person sick with COVID-19 or when they have contact with the person’s body fluids, like disposing of their used tissues or doing their laundry.
What If I’m Sick?
Stay home and self-isolate if you feel sick. To help stop the spread of COVID-19, the WHO and other experts are asking people to stay home from work, school and travel if they have symptoms of a cold, even if they’re mild.
Given the increased monitoring since the discovery of the new coronavirus, anyone who shows signs of illness could be prevented from entering a store let alone boarding a plane, cruise, train, or bus. Many airports, seaports, hotels, and tourist attractions have installed thermal imaging cameras to scan people as they walk by. Anyone showing a fever is pulled aside for additional questioning and maybe quarantine.
If you exhibit symptoms of the coronavirus—fever, cough, and difficulty breathing—follow the instructions of your health care provider as soon as possible. Usually, this means calling ahead to your doctor or hospital so that they can take precautions to isolate you from other patients while they carry out testing. Be sure to advise doctors if you’ve been traveling.
Where to Get Updated Information
A new virus like this coronavirus means a rapidly changing situation. Scientists at the WHO have the up-to-date intel on the virus. Rely on their information, advice, and travel restrictions on the WHO’s website. Other reliable government advice includes Canada’s.
Note that fake coronavirus news (see these busted COVID-19 myths) is spreading fast with the WHO calling it an “infodemic.” Well-meaning people are also spreading misinformation or opinions presented as facts, which is increasing fear and confusion. Trust in governments, public health institutions and scientists is being affected, which could have more serious consequences than COVID-19 itself.
Scams related to COVID-19 exist. False claims about cures and treatments are frequent. People have died by following them. The WHO provides myth-busting information and reports that criminals are using the WHO’s name to steal personal information and money. Text messages and emails are impersonating governments and tempting clicks by offering income supports. Always go directly to a government website before giving your personal information. Do not click through links in suspicious messages.