Breaking Free From 14-Day Quarantine: A Way Forward for Travel

Covid-19

Breaking Free From 14-Day Quarantine: A Way Forward for Travel

Paper
Posted on: 4th August 2020
By Multiple Authors
Ryan Wain
Strategic Advisor
Jeegar Kakkad
Head of Productivity and Innovation
Daniel Sleat
Special Adviser
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    Overview

    Overview

    The FCO advises against all foreign travel other than to areas designated as travel corridors.1https://www.gov.uk/foreign-travel-advice These are the exception, not the rule. If a citizen returns to the UK from somewhere not designated as a travel corridor, they must quarantine for two weeks.2https://www.gov.uk/government/publications/coronavirus-covid-19-how-to-self-isolate-when-you-travel-to-the-uk/coronavirus-covid-19-how-to-self-isolate-when-you-travel-to-the-uk

    Communication has been opaque and haphazard, with travel-corridor status removed at short notice causing chaos and confusion for holidaymakers. The knock-on effects are significant. Quarantine makes a dent on mental wellbeing. It comes at a huge cost to employers in terms of lost productivity and to employees in lost wages. The policy is causing immeasurable damage to the sector itself. Many people are now opting not to travel at all.

    This must change quickly. We recommend testing returning travellers after five days to reduce quarantine periods and allow this time to be baked into planed annual leave. More effective communication of travel-corridor status, centred around a traffic-light system, would reduce confusion and ensure that travellers have enough warning when the designation of a destination was due to change.

    The Criteria for “Travel Corridor” Status

    How travel-corridor status is granted remains unclear. We know the data that are taken into account but do not know what weight is attached to which datasets and whether there are any upper or lower limits. These criteria should be made available to the public; transparency alone could positively shape the actions taken by countries wanting to attract British tourists. For example, we know that testing capacity is taken into account, but it is unclear what an acceptable capacity is.

    Assessment on travel-corridor status is made by the Joint Biosecurity Centre (JBC), in close consultation with Public Health England and the chief medical officer. As yet, the JBC does not have a public-facing profile such as a website, which is challenging given the impact of the decisions it has taken. This should be quickly addressed, and its website should launch with a data dashboard at the fore, showing the criteria for travel-corridor status and how countries across the world are performing against this. This would quickly give people planning to travel visibility of those areas likely to lose travel-corridor status.

    According to the government, categorisation of travel corridors has been informed by an estimate of:

    • The proportion of the population that is currently infectious in each country
    • Virus incidence rates
    • Trends in incidence and deaths
    • Transmission status
    • International epidemic intelligence
    • Information on a country’s testing capacity and an assessment of the quality of the data available

    Data have been used from official sources in each country and modelling by the London School of Hygiene and Tropical Medicine, as well as from Public Health England and the National Travel Health Network and Centre.

    From Quarantine to Testing

    Those who have visited or transited through any non-exempt country or territory within their trip are currently required to quarantine for the remainder of the 14-day period since they last left such a country or territory.

    Testing presents a more appealing alternative which could see the post-travel quarantine period reduced to just five days. Reducing the length of quarantine is an important policy goal which could positively impact transmission rates, as we know that compliance with self-isolation is not guaranteed, particularly when there is a concern about loss of income. For example, one study suggests that when income was assumed, the compliance rate was 94 per cent but, once removed, the compliance rate dropped to less than 57 per cent. Such concerns will be heightened outside of a national lockdown when employers have no obligation to cover salaries of staff in quarantine.3https://www.healthaffairs.org/doi/full/10.1377/hlthaff.2020.00382

    Testing over long periods of quarantine requires a risk calculus. No test is completely accurate, but studies suggest that testing eight days after infection will be 80 per cent accurate, whereas testing three days from infection (i.e. in the pre-symptomatic stage for most people) will see accuracy reduced to 68 per cent.4https://www.sciencedaily.com/releases/2020/06/200610094112.htm To address this – and allowing for an acceptable level of risk – we recommend the quarantine period be reduced to five days on condition of citizens having a negative test at the end of this period. This would account for those who contract the virus towards the end of their holiday and affords holidaymakers foresight, allowing them to time their return to the UK five days before returning to work. The incentive to shorten the quarantine period serves as a behavioural tool, encouraging take-up of testing among returning travellers. As an additional precaution, any traveller who develops symptoms and anyone testing positive should quarantine for the entire 14 days, accounting for the incubation period of the virus.5https://assets.publishing.service.gov.uk/government/uploads/system/uploads/attachment_data/file/882710/15-spi-m-o-consensus-statement-03022020.pdf

    Reciprocal agreements to cover testing on departure could be introduced, funded by countries who have an interest in British tourists visiting their countries and whose testing capability is of a high standard. Data on the quality of international testing are readily available to the government, as this is already being regularly assessed by the JBC.6https://www.gov.uk/government/speeches/travel-corridors This new approach to travel testing and quarantine would go hand in hand with drawing out greater clarity around the process of how countries are identified for the travel corridors.

    We have seen Germany move towards this approach, with all states agreeing that return travellers should be voluntarily tested at ports. Bavaria remains an outlier, calling for these tests to be made mandatory.7https://www.thelocal.de/20200701/free-coronavirus-tests-for-everyone-in-bavaria-what-you-need-to-know

    Communicating to Avoid Confusion, Not Cause It

    Among other failings on this issue, the government’s communications have been particularly poor. The decision to implement a quarantine on travellers from Spain caught many people off guard. Discussions about additional countries that may also end up on the quarantine list – for instance France and Germany – have further spooked the market at a fragile time, in this case without any concrete decision arising.

    The UK government’s decision on Spain caused a sharp drop in airline and tour-operator shares. EasyJet shares dropped 8 per cent, while IAG, the owner of British Airways, saw shares drop 6 per cent. The British Chambers of Commerce commented on Monday that the “abrupt” decision by the UK “will be yet another hammer blow for the fragile travel and tourism industries.”

    While we make recommendations for how these lengthy quarantines can be avoided, the UK government must quickly move to a system of clear, transparent, consistent and predictable communications around the status of countries.

    Figure 1 – The European travel and leisure sector has lost almost 40% of its value in 2020

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    Recommendations

    Recommendations

    The criteria for which countries are granted travel-corridor status are opaque and unclear. We believe this leaves scope for anomalies, with countries unclear why they are de facto on the quarantine list. Where travellers are arriving from countries not designated as travel corridors, there is an avoidable and costly quarantine period which could be significantly reduced through effective testing.

    To address this, we call on the government to:

    1) Bring forward clear and transparent criteria by which countries are assessed.

    This requires clear and consistent data across each country, along with clear benchmarks on:

    • Proportion of the population that is infectious
    • Virus incidence rates
    • Transmission status

    2) Introduce a traffic-light system for countries, underpinned by a publicly available, real-time dashboard on a new Joint Biosecurity Centre website.

    Hosted on a new JBC website, the traffic-light system would make it much easier to plan travel. The following categories would apply to countries outside the UK:

     

    Travel is allowed without quarantining and the situation is unlikely to change anytime soon.

     

    Travel is allowed without quarantining, but the situation could change quickly, and indicators are moving in the wrong direction.

     

    Quarantining and testing are required upon return.

    3) Introduce testing after five days of quarantine. If this test comes back negative, the person should be able to leave quarantine.

    This accounts for the likelihood of tests returning a false negative. Over time, as tests become quicker and more accurate, this quarantine period should be reduced further still. The ultimate objective is for travellers to be tested on arrival, receive their results almost instantly and use this to inform quarantine requirements.

    4) Agree a globally co-ordinated approach to testing and the traffic-light system.

    Given the incentive for countries to receive British tourists and for other country’s citizens to visit the UK, reciprocal agreements should be put in place that sees travellers tested either on departure and/or arrival. These arrangements would allow testing capacity to be pooled between countries.

    5) Provide clear and consistent communications.

    The government must move to a system of clear and consistent messaging on this issue. Aside from new announcements, based on clear evidential changes to the situation in a country, the government should not routinely be communicating on this issue to avoid unnecessarily disrupting the stock market and travel plans.

    6) Move towards rapid, on-the-spot tests at ports of entry.

     As we have set out in our recent paper “Pressing Go On Mass Testing”, there is potential for a rapid, on-the-spot antigen test. The government should focus an ecosystem of innovators on developing this and gradually transition to travellers being tested on arrival, receiving their results within minutes and these results determining quarantine requirements.

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