CRA Travel News – USA
To be clear: Staying home is still safest.
What’s the safest way to travel during the new coronavirus pandemic—if any? As of this writing, COVID-19 has killed more than 130,000 people in the USA alone, according to the Centers for Disease Control and Prevention (CDC). New hotspots continue to pop up, like those in Arizona, California, Texas, Florida, and Louisiana, among other states. And it’s becoming clearer that some people who contract but don’t die of the virus may face ongoing medical issues like intense fatigue, brain fog, and trouble breathing, according to reporting by The Atlantic.
So, to some extent, it feels wrong to be writing about traveling for the rest of us. This virus is real, and it’s doing real—and in many cases deadly or lasting—damage. To be extremely clear, staying home is still the safest option when it comes to your health along with that of everyone you would come into contact with during and after travel. Various states reopening to differing degrees doesn’t automatically make it completely safe to resume regular life, including traveling.
With that said, many people are already traveling or are planning to, whether for essential or non-essential reasons. My social media feeds are full of folks on road trips. I know of a few friends’ plans to get on a plane. I myself have been camping and biking dozens of miles, willing the fresh air to keep me both safe and sane. The question is, how risky is it to travel during the new coronavirus pandemic? And what can we do to mitigate that risk? Traveling—or partaking in any other potentially unsafe activity—doesn’t have to be all or nothing. If you’re doing anything that raises your risk of getting or transmitting COVID-19, you should use as many safety techniques you can to bring that risk down to its lowest.
Here, SELF spoke with three experts in epidemiology and infectious disease to find the safest way to travel this summer: Celine Gounder, M.D., former NYC assistant commissioner of health and host of the Epidemic podcast, Sara Hurtado Bares, M.D., associate professor in the division of infectious diseases at University of Nebraska Medical Center, and Maria Sundaram, MSPH, Ph.D., an infectious disease epidemiologist and postdoctoral fellow at ICES Ontario.
We asked for the nitty-gritty details that can help you stay as safe as possible while traveling, ranging from discussions of the mode of transportation itself to bathroom breaks, shopping, and eating. Here’s what you need to know about the safety of road trips, train trips (much of the advice here works for busses, too), and flights as the COVID-19 pandemic rages on in the United States.
Road trips are the safest travel option if you do them right.
SELF: People seem to think that road trips are the safest travel option during the COVID-19 pandemic. Is that true? If you were to design the safest possible road trip, what would it involve?
C.G.: The safest travel option is not to travel. If you do travel, a road trip is the safest because you’re not sharing space with someone the way you do on a bus, in a train, in an airport, or on a plane. One option is to rent an RV or go camping. The general guidance is to stay six-plus feet away from anyone not in your household bubble, wear a mask when outside your vehicle, use lots of hand sanitizer, don’t dine indoors, and avoid crowds.
S.B.: It’s a safer option than flying and trains because you can choose who you’re in the car with. Your most immediate risk during travel is the people within six feet of you. We’re actually planning a road trip for Labor Day weekend. We chose a place that is a short distance. We got an Airbnb cabin that’s more isolated. We have little kids, so we’re going to have to stop at a rest area, but we’ll try to plan a route that is in a low coronavirus-prevalence area. You want to have as few stops as possible, theoretically, because any stop you make, you’re going to be potentially exposed to other people.
M.S.: It’s hard to imagine another travel option that would be safer. You can travel by yourself, so you don’t have anyone else in the car with you, and you also can make your own decisions about when and where you might need to stop.
SELF: How risky is it to use public bathrooms along the way, for example, at gas stations and rest stops? What precautions should people take when using restrooms? Should you leave your mask on in the bathroom or does that expose it to potential contaminants, like fecal particles?
S.B.: We don’t know. More and more data suggests that transmission is much higher in indoor spaces. If there’s no line for the public bathroom and the people in the public bathroom are wearing masks, then the risk is going to be lower than if the people in the bathroom are not wearing masks. There’s some data that says that just flushing the toilet can aerosolize the virus and we know that we find the virus in stool specimens. But I think the biggest risk is still person-to-person transmission. As long as it’s not a crowded bathroom with lines, and as long as you wear a mask, I would think the risk would be significantly lower.
M.S.: When we’re thinking about a public bathroom, we’re thinking about the number of people who might be in it if it’s a multi-stall bathroom or if a lot of people have used it recently. I wear my mask anytime that I’m outside of my house, and for me, that also goes for bathrooms. I try to be quick and efficient. I’m not lingering there for a long time, not checking the mirror looking at my hair, I’m just in and out. I’m definitely making sure to wash my hands very carefully and trying to give others the space they may need. If there are other people there, I’m trying to make sure I’m not, for example, using the sink right next to them, or I’m giving them enough space to get into a stall without them having to get too close to me. I don’t think it’s impossible to be exposed through COVID-infected fecal matter being flushed into the air, but I think the main concern is exposure through respiratory droplets.
SELF: There seem to be mixed opinions on the safety of Airbnbs and hotels. What should people look for when it comes to a place to rest?
C.G.: The key is that the lodging is cleaned between people and that enough time lapses between guests. Many places (including hotels) don’t launder all the bed linens between guests. They wash the sheets and pillowcases, but not the bedspread or throw pillows.
S.B.: You want to be sure that you can allow for distancing. For an Airbnb, ideally you’d ask the owner if anyone has been there for a few days before you’re going to go, if windows could be opened before you arrive, and when you arrive, just wiping down the high-touch surfaces. Similarly, opening the windows of your hotel room when you arrive might help minimize the risks of exposure. Alternatively, calling ahead and asking the hotel to open the windows and/or ensure unmasked guests and staff have not been in the room for at least a few hours before you arrive could also minimize the risks. Don’t congregate in the more crowded areas of the hotel. Don’t go down to the hotel bar. As long as you’re staying in the hotel room, it’s going to be lower risk than if you go into the shared spaces.
M.S.: Airbnb and similar companies have an option where you don’t have to meet the host in order to enter the property. That’s really great because it can reduce your exposure to that person. Hopefully a host will have information about how they’re disinfecting the place and the surfaces that people touch the most, like door knobs and handles of microwaves, as well as detailed information about washing the sheets. You can typically message the host to ask more questions. And if there have been a couple of days between the last person and you, that’s really great. The main thing for me with hotels is about using the elevator, which is not usually a thing for Airbnbs. Elevators represent a small enclosed area that you might be sharing with someone else. You may have to individually make an assessment about whether you want to be walking up two flights of stairs or whether it’s fine for you [based on your specific health risks and circumstances] to stay on, say, the 14th floor and carefully wash your hands after using the elevator.
SELF: Is camping any safer than a hotel?
C.G.: Yes, if you stick to the general safety guidance. You’re better able to socially distance. You’re not coming into contact with other guests or staff like bellhops, valets, or housekeeping.
S.B.: Yes. It’s outdoors, you’re bringing all of your own supplies, especially if you’re taking your own tent. That’s definitely safer. Depending on the campsite, you may have shared bathrooms, which would be the main risk, but camping would probably be the safest—from the virus, not necessarily from outdoor creatures.
M.S.: Camping is safe for a lot of reasons. The fact that it’s outside lends more safety to it than some of these other options. There’s a lot of air circulation and opportunity for people to stay as far away from each other as they possibly can. The one thing about camping is there may be challenges with washing your hands carefully or using the bathroom in a safe way.
SELF: Is it safe to travel in the same car with people who aren’t in your household? What if everyone wears masks, or you roll down the windows, or keep the AC on?
C.G.: The safest is to only travel with people in your household bubble. If you’re going to travel with people outside your household bubble, you and they should ideally quarantine at home for 14 days prior. Wearing masks and keeping all car windows wide open will reduce the risk of transmission within a car, but the risk is still not zero. And you can also transmit via skin-to-skin contact or through contaminated surfaces in the car. If you have the AC on [in the mode that is] recirculating the car air, that would likely increase risk of transmission within a car. Even if you aren’t recirculating air with the AC, you won’t achieve the same level of ventilation and air exchange as you would with all the windows open.
S.B.: We don’t know. What’s so hard about this virus is everything involves some sort of mental calculus, and the problem is the data isn’t perfect. If the people that you’re in the car with are people you’ve chosen as part of your pod or your “quaranteam,” and the risks they’re taking are similar to yours and lower-risk overall, then I think it’s relatively safe. And if you wear a mask, that’s certainly safer, and if you open the windows, it’s safer. But there’s going to be a small risk.
M.S.: The more people there are, the more different air you’re sharing. I would take into account where those people have been in the past two weeks and if they may pose a potential exposure risk to you or if you may pose a potential exposure risk to them. Rolling down the windows can help but doesn’t solve all of the problems. AC could also help if it’s circulating external air but likely won’t solve all of the problems of that close environment exposure. And it’s a little different if it’s a minivan and two people versus a sedan with five people. I would say masks are appropriate if someone in the car has had a relevant exposure in the last two weeks and you haven’t been interacting with them up until the time you’re on the road trip.
SELF: Road trips used to involve going out for food or shopping. Is there a way to make those things safe while road tripping now?
C.G.: Don’t go shopping. Pack meals or get to-go meals. Eat outdoors.
S.B.: It’s safest to avoid those activities. But if you’re going to be dining at restaurants, look for outdoor dining or takeout, or eat on the road or picnicking. If you’re looking for souvenirs, outdoor market-type areas are going to be safer than indoors. But if it’s an indoor shop, look to make sure that the staff are wearing masks and that the other customers are wearing masks. That would certainly decrease the risk of exposure in the store. And try not to linger.
M.S.: I think eating outside is likely acceptable. Again, you’ll have to make an assessment about how close people are to each other, and it’s related to your individual risk tolerance. [Note: Your risk tolerance is about how high-risk you and the people you’re in contact with are for severe illness from COVID-19 or even how financially devastating it would be if you got sick for a stretch of time, in addition to how anxious potential exposure makes you—not about how brave you are.] If you need gas, you can pay at the pump, you don’t need to go inside. For other supplies, some stores do curbside pickup. For gift shops if you’re somewhere like a national park, think about how you can minimize your contact with other people. For example, if you want a T-shirt, maybe one person goes in and buys T-shirts for everyone. If it’s an antique shop or something in a smaller town, again, I would say to think about the ways you can minimize your direct contact with people. If there are a ton of people inside the store, maybe don’t go in.
SELF: What should you be looking for when it comes to a road-tripping destination? For example, should you be monitoring COVID-19 cases for that area? Is it okay to travel to smaller towns, which may have fewer hospital beds, or is it better to travel to larger areas even if that means a bigger population?
C.G.: Be aware of your state and other states’ quarantine regulations. It may not be worth it to you to travel someplace and find yourself under quarantine there for 14 days or under quarantine when you’re back home. Also be aware of local coronavirus rates. This dashboard makes it pretty easy to assess levels of risk by county. Don’t travel to or from counties in red. Don’t travel between places with mismatched level of risk (i.e., from yellow to green counties or from green to yellow counties).
S.B.: I would be leery of going to a place with high transmission rates right now because that means the virus is circulating in the community, and anything you do in that destination is going to have a slightly higher risk. But I would also be leery of going to a place with very limited hospital capacity should you get sick while you’re gone. Think about what you’re going to do when you go to that destination. Something with more outdoor activities in a physically distanced way is better.
M.S.: If you were to ask me where I would feel comfortable road tripping at this point, it would really only be to larger, open-air destinations. That includes campgrounds where there aren’t that many people. But I wouldn’t say the risk is reduced if you go to a rural area. You still want to be really careful about taking as many precautions as you can.
SELF: What are the biggest factors that could increase the risk of contracting or spreading COVID-19 on a road trip?
S.B.: The amount of time that you’re in indoor public spaces where you’re not able to physically distance.
M.S.: Sharing a car with someone who has COVID-19 is probably your biggest risk factor. Other considerations are sharing close enclosed spaces with other people whose behaviors you don’t have control over, like riding in an elevator with someone who’s coughing and not wearing a mask, or maybe you’re in a bathroom and someone comes into the stall next to you and is not covering their cough.
Trains may offer more travel flexibility, but there are some safety drawbacks.
SELF: Physical distancing seems to be rule number one for avoiding the coronavirus. Do trains provide enough space between passengers to accomplish that?
C.G.: Not unless seats/rows are left empty to allow for adequate spacing of passengers.
S.B.: If you can ensure that you can be six feet from other groups of people it will be safer, but it is an enclosed space, so even six feet may not be enough if they aren’t masked. Indoors, we know that if somebody coughs, it can linger where air is not circulating well.
M.S.: It depends. If you have a whole series of seats or a whole chunk of the car to yourself, that’s a really nice way to go. If you’re on a rush hour train within a city, the situation could be really different for you. That’s something to consider when you’re deciding how safe a train might be.
SELF: If someone wears a mask for an entire train trip, would that substantially decrease their risk of contracting or spreading the coronavirus?
S.B.: Yeah. But what will increase it even more is if all the passengers on the train are wearing masks. There’s probably more of a protective level from a person who’s sick wearing the mask than the incoming filtering capacity of a mask for a person who’s not sick.
M.S.: Unfortunately, the thing with the mask is that surgical and homemade masks—not medical N-95s—don’t really protect the wearer. They protect other people around the wearer. It’s a gesture of social responsibility that you’re taking everyone else’s wellbeing into account when you’re doing that. It doesn’t really benefit you very much or it may not benefit you at all.
Again, the idea of the mask is that it’s really protecting people around you. And it’s helpful because it shows people that you’re taking their safety seriously. It can be so hard to do something if you’re the only one doing it. I’ve had the experience where I’ve been the only person wearing a mask in a social situation, and it feels quite awkward. But there could be another person who wants to wear a mask or had originally intended to wear a mask but then felt weird about it because no one else was. By wearing a mask, you may be empowering them to do what they originally wanted to do.
[Note: As SELF reported previously, there isn’t much research on how effective cloth masks are at protecting the person wearing a mask, but they do seem to be better than nothing; some experts are also hopeful about the protective possibilities of face shields.]
SELF: What should you do if a passenger near you isn’t wearing a mask, or isn’t effectively wearing a mask? (For example, their nose or mouth is exposed.)
C.G.: Move to a different train car.
S.B.: That’s where really changing our culture is going to help us fundamentally combat this virus—learning ways to politely teach people how to correctly wear the mask. I use “I” statements and say, “I would feel much more comfortable if you were wearing a mask.”
M.S.: This is an individual judgment call. Unfortunately in many cases, you won’t have a ton of control over the situation. It could be that the person is not able to adjust their mask or not willing to wear a mask. I would encourage people to assess the situation. If you feel comfortable, you can gently say, “Hey, please don’t forget the mask should also go over your nose and mouth,” or, “I think you forgot to put your mask back on.” If it doesn’t feel comfortable or like a safe thing to say, then I would encourage you to move away and give them the space that you can. Although, again, there may be little you can do in that environment, especially if the train is more crowded.
SELF: Would a private room on a train (for example, on a long-haul Amtrak) significantly decrease risk?
S.B.: Absolutely. If you can ensure you and your family/household members are the only people in the room, it would certainly be lower risk.
M.S.: That likely would decrease your risk somewhat. I could be wrong, but I do think a lot of people don’t spend all of the time in that private room. I’m sure there’s a dining car and a car where you can sit and watch the country move past you. You might want to think about your exposure risk in those other environments as well.
SELF: If you’re on a long train trip and must eat while riding, is there anything you can do to mitigate the risk while your mask is removed to eat/drink?
C.G.: Put on a face shield. You can eat with a face shield on.
S.B.: Washing and/or sanitizing your hands is always important and should ideally be done after removing a mask, before eating, and then again after replacing the mask. When removing the mask, it is also important to avoid touching the front part, which may be contaminated. In the hospital, we teach providers to remove their masks via the straps and store them face down on a paper towel.
M.S.: I would try to sit as far away as I could from other people, keeping in mind that the mask is protecting the other people, so you’re thinking about how you can best protect them.
SELF: Are bathrooms a concern on a train trip? Why?
S.B.: Potentially. They’re a shared space. The surfaces and the air in the bathroom could be potentially contaminated. Wear a mask and wash your hands.
M.S.: If there’s someone in your car or the next car over that doesn’t seem to be doing well or is coughing, that would give me a pause. Other than that, if you have to go to the bathroom on the train, you really only have that as an option. Try to get as much fresh air as possible. If there’s a window, I would really encourage you to open it. Otherwise wash your hands carefully and I would advise not dilly dallying. Be as efficient as you can.
SELF: How concerned should we be about high-touch areas? Should we be wiping down our seats and other areas with a disinfectant?
C.G.: I’m not sure this is a good idea. You could contaminate yourself in the process.
S.B.: It’s a good idea if you can wipe things down just because you could accidentally touch the surface and then your own face. But I don’t obsess over it. The biggest risk is the person-to-person transmission.
M.S.: What sort of things are you touching and then touching your face? This is a virus that can be transmitted through contact with your eyes, nose, and mouth. If it’s something like your arm rests or the tray table that you’re likely touching over and over again, I think it’s best to wipe those down. Then you can reduce the risk of forgetting and accidentally touching your face.
SELF: If someone absolutely must travel by train, what precautions do you recommend they take?
S.B.: The shorter the trip, the better. If you can, touch base with the train company in advance to ensure they’re taking measures to minimize risk and still allowing for distancing and cleaning high-touch surfaces, opening windows, and making sure the air can circulate.
M.S.: Make sure you’re able to clean your hands carefully either with soap and water, that’s the ideal scenario, or hand sanitizer, which is more feasible in many of these situations. Make sure you have hand sanitizer with you. If you have access to sanitizing wipes, have them with you. I would really recommend wearing a mask for the safety of other people that are sharing the environment with you.
Right now, taking a flight seems to be the riskiest mode of transportation.
SELF: Planes are notoriously cramped, and maintaining six feet of distance from other people during a flight is unlikely. Mask-wearing isn’t enforced or required in the same way across airlines and airports, either. But airplanes also have air filtration systems. How risky does that make planes right now?
S.B.: We don’t know. All the calculus is based on so many unknowns. From studies with other viruses, the window seat is probably slightly safer [because you tend to come into contact with fewer passengers]. Planes where you can distance a little more, where masks are being enforced, and shorter plane trips are going to be safer.
M.S.: Of the three kinds of travel that we’ve discussed—cars, trains, and planes—planes are likely the riskiest. I would not feel good about my parents flying right now. My parents are both over 60. I myself would have serious misgivings about getting on a plane right now. I recently drove from Atlanta to Toronto partly because I didn’t want to take a flight. I would say really try not to fly unless you absolutely have to.
What about removing your mask to eat or drink—is that okay, or should you avoid removing your mask for any reason on a plane?
S.B.: We have to remember that we need to stay hydrated and we need to take care of all of our essential needs. If you need to eat or drink, it’s okay, just remove the mask for the shortest period of time possible.
M.S.: Removing your mask represents a potential exposure to the people around you. If it’s a shorter flight, you might find that you don’t miss the small packet of Cheez-It crackers. If it’s a longer flight, then you might find it extraordinarily challenging not to eat for the entire time. In that case, try to be as efficient as possible and also as careful as possible. If you have to cough, cover your cough with a tissue or your elbow. In all circumstances, try to keep the safety of your fellow passengers in mind.
The virus has been detected in fecal matter. Does that mean we should avoid bathrooms in planes and airports? Should you wear a mask while you’re in the bathroom?
C.G.: You should wear a mask or face shield at all times when on a plane, a train, or a bus—any shared mode of transportation with people outside your household bubble.
S.B.: It’s so complicated, right? The best message is to use the bathroom before you leave your house. The bathroom in the airport is just as risky as the one on the plane. If you have to use a bathroom, try to find one without a line so you’re not standing next to someone. Wear a mask when you’re in the bathroom.
Many airlines have announced more regular cleaning protocols. Should passengers plan to wipe down high-touch surfaces with disinfectant when they reach their seats, too?
S.B.: Somebody once told me the person you can trust most is yourself. I’m sure the airlines will be wiping things down and we can take solace in that, but to be most sure, it would be reasonable to also wipe your area down when you get there.
M.S.: I think it will depend on what the individual airline says that they do. And it also may be an individual risk tolerance thing. My parents did fly once in March, they were coming back from vacation during the time when this began to be a really serious thing in the United States. So I said, “Please make sure you’re wiping everything down when you get to your seats.” They did that and they said that they weren’t the only ones. Depending on the individual situation, you may feel more comfortable doing that.
Are there any changes to typical plane travel behavior you’d recommend? For example, is it safer to check bags or carry them on? When we’re going through security, are there any additional measures we should take, like wiping down the handle of a bag afterward?
C.G.: Get yourself a few pairs of washable, reusable cloth gloves. They protect you from the virus that may be on public surfaces. Cloth gloves also function as a reminder to touch your face less. You should wear them when touching things in public (e.g. doorknobs, subway poles) and then remove them upon arrival at your home (or place of work) [or when doing things like eating or touching your face]. Bring plenty of hand sanitizer.
S.B.: The fewer people handling your bags, the safer it is. I’m much less worried about transmission from objects than I am person-to-person transmission. But as long as you’re washing your hands frequently, I don’t think we need to worry too much about all the different surfaces.
M.S.: I would be less concerned about the handle of your baggage and more concerned about whether your hands are washed and if you’ve been touching your face. Have hand sanitizer you can easily access in your carry-on. As far as a location on the plane, people in first class are less crowded because there are fewer seats and they’re bigger. So it’s possible that the risk posed to you in first class may be different than if you’re sitting in economy, like I would be. However, it’s likely not a huge difference because there are still people within six feet of you, and if you sit at the front of the plane, there may be a lot of people walking by you. One important thing to remember about gloves is that they are not antimicrobial. If you do choose to wear gloves, keep in mind that anything you touch with the gloves can spread germs from one surface to another.
What precautions should people take if they must be on a flight?
S.B.: Make sure you’re not sick and haven’t been exposed to anybody with COVID-19 before you get on the plane. In an ideal world, it would be great for everyone to get tested before traveling, but testing is still limited in many areas. The next best step is to avoid traveling if you have any symptoms of COVID-19. Remember that COVID-19 can cause a broad range of symptoms (see CDC website for updated list). We want to be protecting each other as much as we’re protecting ourselves. Wear a mask, wash your hands frequently, and keep your distance at every step of the way. Don’t just worry about the time on the plane, but in the airport, the security line, in the line for a snack at the airport, and the bathroom.
M.S.: Identify which airlines may have more stringent policies about mask-wearing, which airlines allow the flight attendants to take the proper precautions and wear masks, and which airlines are carefully wiping down seats and tray tables after people exit the airplane. One other thing you might consider is that you could bring extra masks with you and ask other people who are in your space to wear one if they don’t have a mask or aren’t wearing one.
Article Credit To Self.