The Centers for Disease Control and Prevention recommends that all travelers avoid nonessential travel to China, Iran, South Korea and Italy and that older adults or those who have chronic medical conditions consider postponing trips to Japan. But should other people cancel, postpone or abstain from travel?
Not necessarily, said Larry Burchett, an ER doctor and board-certified family physician based in Sonoma, Bakersfield and Los Angeles. “This may be an opportunity for young, healthy people to take advantage of cheap vacations,” Burchett said.
According to CDC guidelines, areas in Watch Level 1 (essentially every spot that shouldn’t specifically be avoided) can be visited as long as getting there doesn’t require a layover in an infected area. In fact, the CDC doesn’t recommend canceling or postponing travel to those areas, because the risk of becoming infected with covid-19 there is believed to be low.
Contrary to popular perception, the risk of getting covid-19 on an airplane also is low, as long as one is not seated within six feet of an infected passenger, according to the CDC. “Because of how air circulates and is filtered on airplanes, most viruses and other germs do not spread easily on airplanes,” it says on its website. Cruises, on the other hand, “put large numbers of people, often from countries around the world, in frequent and close contact with each other,” which can spread respiratory viruses.
As potential travelers weigh the pros and cons of going ahead with travel plans, here are specific suggestions based on different health statuses.
According to the American College of Obstetricians and Gynecologists, pregnant women are not at higher risk than the general population of falling victim to coronavirus. But it should be noted that very little is known about the coronavirus as it relates to pregnant women, the developing fetus or infants, said Kecia Gaither, director of perinatal services at NYC Health + Hospitals/Lincoln in New York City.
What is currently known — and this information is continually evolving — is based on knowledge about previous coronavirus outbreaks (MERS-CoV and SARS-CoV) and the small number of covid-19 cases involving pregnant women.
Since this is so new and unstudied, Gaither said that it’s still not completely known whether pregnant women may be more susceptible to the risk of disease acquisition (despite what the ACOG said) and associated death. It’s also unclear whether transmission to the fetus occurs, either via the placenta or through breast milk, Gaither said.
“From the few case reports out of China, the virus may have adverse effects on the newborns, causing issues such as preterm labor, fetal distress, respiratory distress, low platelets, abnormal liver function tests and thrombocytopenia,” she said.
Daniel Roshan, director of Rosh Maternal & Fetal Medicine in New York City, personally advises pregnant women not to fly.
“However, if one must fly, I recommend precautions,” Roshan said, suggesting hand washing frequently, hydrating, taking prenatal vitamins and vitamin C, and wearing a mask during the flight.
In general, older adults are more susceptible to viral illnesses, including the flu and coronavirus, because their ability to fight off infection is diminished, said Steven Reisman, a cardiologist with New York Cardiac Diagnostic Center. In addition, he said, older adults may also have other underlying health issues such as lung or heart disease, which will result in a more severe outcome with a viral illness.
Before traveling, anyone 65 or older should receive a pneumonia vaccination. While coronavirus is only a viral lower respiratory infection, one complication is pneumonia or bacterial infection in the lungs, Burchett said.
In case of quarantine, older adults should travel with an extra two weeks’ worth of essential medicine.
It’s also essential that older adults (and anyone with a medical condition) travel with their health records, said Reuben Elovitz, internal medicine physician with Private Health Dallas. These will be needed in case you get sick or require medical care. Providing the local medical team with your health information is essential for obtaining optimal treatment and avoiding adverse effects and complications, Elovitz said.
“Your records are even more crucial if you are not able to communicate with your health care providers due to the severity of your illness,” he said.
The CDC is advising those at higher risk of complications from COVID-19 — older people and those with underlying health conditions -- to avoid crowds and, if they are in an area with an outbreak, to stay at home as much as possible. Vice President Mike Pence has recommended that older people with underlying health conditions not take cruises, and Health and Human Services Secretary Alez Azar advised both older people and those with serious health problems to avoid crowds “especially in poorly ventilated spaces.” On March 8, the State Department advised U.S. citizens, particularly those with health issues, not to travel by cruise ship.
As a rule, young kids touch everything around them with hands that frequently make their way to their mouths, as well as to the faces of their adult companions. This alone makes it easier for them to get infected and to pass along any illnesses — and it also makes it less safe for them to travel, said Chad Sanborn, pediatric infectious disease specialist at Palm Beach Children’s Hospital. If you do plan on traveling with young children, make sure their vaccines are up to date, and take at least an extra two weeks’ worth of any essential medications with them should they need to be quarantined.
Children who are immune-compromised should not get on a plane or go to an airport unless it’s truly necessary, Sanborn said. “Young children who may be immune-suppressed or with chronic illness, in particular, may not be good travel candidates because they don’t wash their hands as well, they touch their face more often, they do not cover their cough and sneezes as well, and they pick their noses and wipe their nasal secretions more often,” he said.
If kids need to travel to a high-risk area (as designated by the CDC), Sanborn recommends that they avoid contact with immune-suppressed friends for two weeks post-travel, especially if they were in direct contact with someone subsequently found to be infected.
“If a child traveling internationally becomes sick upon return, it may not be coronavirus, but I would still recommend 14 days of school avoidance if they are coming from an area with covid-19 activity,” he said.
Those who have compromised immune systems, perhaps because they are undergoing chemotherapy or are on immunosuppressant medication for a disorder such as Crohn’s disease, are at higher risk of having complications from viral diseases such as coronavirus, Burchett said. The same applies to those with significant poor health, especially chronic lung disease or severe heart failure. “Saying ‘no travel across the board’ is extreme in my opinion, but I would certainly recommend avoiding places with high incidences of corona,” Burchett said.
It’s not uncommon to become sick after traveling. In fact, up to 79 percent of those traveling to low- and middle-income countries experience a travel-related health problem, according to the CDC. Fortunately, most illnesses aren’t serious. But depending on where you were traveling, your risk of infection from the coronavirus could limit your movement back home.
The CDC is not allowing foreign nationals who have visited China or Iran within the past two weeks to enter the United States (those returning from other highly affected countries including Iran, South Korea and Italy will be heavily screened and may face quarantine measures). American citizens, permanent residents and their families will be allowed to enter, but will have to undergo a health screening that includes being checked for fever, coughing and trouble breathing. They will also have restrictions on their movement for up to 14 days. Travelers returning from Italy and South Korea are undergoing exit screenings in those countries.
If you are returning from any area with an outbreak, avoid close contact with anyone in a nursing home or anyone sick just in case: Even if you don’t have symptoms, you could still potentially be contagious if you were exposed to the virus, Elovitz said.
Braff is a writer based in Chicago. Find her on Twitter: @daniellebraff.