Prior to the Covid-19 pandemic, conventional wisdom in public health was that travel bans didn’t make sense. There’s now a reconsideration of that view, though that doesn’t mean travel bans make sense in all contexts either.
I’ve argued that the U.S. ban on travel from China was poorly executed, the ban on travel from Europe came too late, and the list of countries chosen for bans was incomplete. Once the virus was spreading, the U.S. didn’t ban travel within the country. Travel bans can work – see New Zealand, Australia, Fiji, etc. – but they have to be absolute and they can’t be lifted until the threat has passed.
.@kakape asks the $64 trillion dollar question: How does @WHO feel about travel restrictions now? Question comes in the context of the emergence of new variants in the UK & South Africa.
David Heymann, chair of a WHO advisory group: That's a country decision.— Helen Branswell (@HelenBranswell) December 28, 2020
The U.S. has proven itself incapable of effectively implementing a travel ban whether it was early in the pandemic when the CDC told local health departments not to bother with contact tracing of international arrivals for a few days while it updated its systems, or banning arrivals from China directly but allowing people to fly to Vancouver and cross into the U.S. by land. The testing requirement on U.K. arrivals works a bit better because the government relies on the airlines to enforce it.
There are basically two reasons to impose a travel ban during a pandemic:
- The virus is not currently spreading in the community, and a travel ban may avoiding importing the virus. That’s why restrictions in low-transmission countries like New Zealand, Australia, Vietnam, Thailand, Cambodia and Laos (among others) can make good sense.
- The hospital system is in danger of becoming overloaded. Even if the virus is already spreading, bringing more into a community could tip over a hospital system to the point that care might have to be rationed.
If a virus is already spreading but not overwhelming hospitals then travel bans don’t really serve a significant public health purpose. Where virus is widespread, adding incremental cases doesn’t change the trajectory of the pandemic.
And most discussion of travel bans assume that announcing a policy and implementing it are the same thing. The U.S. has proven that’s not the case.
It’s hard to know ex ante whether a travel ban is the right policy to follow in a pandemic, even if it can be implemented well, because you don’t know the course of the pandemic. If it’s long-lasting, then the ban must be also – otherwise, when it’s lifted, all of a country’s citizens are freshly vulnerable to the virus.
Travel bans have worked out well for many island nations that could pull it off, both because of the effectiveness of implementation but also because vaccines are coming. Right now it makes good sense to hold the virus at bay as much as possible, because help is just around the corner.
U.S. attempts did not work out well, and of course there were no outright bans on domestic travel – only roadblocks on internal travel implemented in a haphazard way.
Of course if the CDC hadn’t failed at testing for six weeks at the start of the pandemic, and if the FDA hadn’t blocked use of other tests, we might have known where the virus was – and where it wasn’t – and have had some idea at what better policy might have looked like before it was too late.
Hind sight is always 20/20
This logic underpins the existing justifications for the lockdowns and travel bans, but doesn’t ask the right question. Instead of asking how to stop the spread and limit hospitalizations, we should be asking how to protect those individuals who are most susceptible to the worst effects of COVID-19. Travel bans and lockdowns are both severely gross overreactions.
Travel bans haven’t worked out well for island nations unless your single criteria is covid virus.
Take into account the completely destoyed livelihoods/careers of island residents reliant on tourism, and families separated for almost a year now due to closed borders, mental trauma of being stuck on a tiny island with no escape, with no guarantee that they’ll be able to keep the virus at bay if and when they open to vaccinated people (even vaccine is 70-90% effective,so every plane load might bring in 1 covid person), and you’ll see that they have handled this situation the worst.
Unfortunately travel bans are now dogma. Any attempt to discuss what is or is not an effective means of containing a highly contagious virus is unacceptable to many.
Travel bans are most effective if they are pre-emptive. So expect a large percentage of people (who have no desire to travel) to insist they remain in place indefinitely as a means to contain future outbreaks.
I love it how people who read this blog are more concerned about the livelihoods of those who work in the tourism industry than they are about saving lives in the population at large.
If people are so concerned about savings lives, start banning tobacco (600,000 cancer deaths per year), start banning soda (85,000 deaths per year) start banning driving cars (38,000 traffic deaths per year), etc. In fact perhaps start banning actual “living” and not just “surviving”. Better to lock everyone up perpetually so we can all be “safe forever”.
Of course, it is the egoist Baby Boomers who cry “safety first” and demand we kill off people’s livelihoods and saddle future generation with another trillions of dollars so they can continue to live their luxury lives another month instead of dying of old age next week.
And for people who still don’t get it: there were more death by suicide (in Japan) than the entire year of COVID deaths (google CNN about it)! Way to go, humanity!
Nine months into the pandemic, some people still don’t understand that the US at a federal level may provide guidance to states and can block international traffic but nearly all execution of health-policy is at the state and local level. Was that way before covid and will be afterwards.
The US is a federal republic and functions that way more than just about every other western country.
I would appreciate Gary leaving social commentary to others and concentrate on reporting actual
changes and events and leave the readers to decide for themselves the effects. Reporting there is a travel ban is sufficient, trying to explain the por or con of the ban and favoring one over the other is not why I read Under the Wing.
Gary: This was a great article. I like this kind of content. You have some unique perspectives (some of which I agree with, and some of which I don’t), and this is why I read View from the Wing. Don’t let anyone here talk you out of giving your opinions.
Testing and quarantine (with good tests and an enforced quarantine including air crews) would be sufficient and are better than an outright travel ban. For a large country though, a total travel ban is easier to enforce in general.
The NBA bubble this summer, which was essentially an enforced testing and quarantine arrangement, proved that process can be 100% effective on a small scale.
So far, the biggest failure in the US is the lack of adequate testing.
The administration deserves credit for assisting in the speedy development of effective vaccines. But vaccines are worthless unless people get vaccinated. It is now becoming apparent that there was little thought about how to get the vaccines into arms. We were promised 20,000,000 would be vaccinated by year end. The total to date is more like 2.1 million.
States are largely responsible for distributing vaccines but the federal government can be a big help in many ways including with guidance, coordination, and expertise. After healthcare workers and nursing home residents who are relatively few in number and easy to locate, other than broad categories of priority, there has been basically no info on when, where, and how more than 300 million of the rest of us will get vaccinated. There are a zillion big and small issues that process raises and none have been publicly addressed.
@Ben, 70-90% effective does not mean that 10-30% of the population are actively contagious. It means of what would maybe be 1% of the population that was contagious, now only .1-.2 % would be contagious. The vaccine should get the retransmission rate down near zero this year even if only had the population takes it and it’s 80% effective. Fingers crossed.
An over simplification. Travel bans should be used on countries like the UK right now to prevent a rapid spread of the new variant which will certainly overwhelm the hospital systems across the country. In addition even when there is not a travel ban this non-essential travel needs to stop. That is why the virus is everywhere in the US, because people keep getting on planes and bringing it with them to new places. That festival down in Mexico was a super spreader event and the cases coming out of that were completely avoidable.
> “If a virus is already spreading but not overwhelming hospitals then travel bans don’t really serve a significant public health purpose”
Killing more Americans in a year than ever is not a “significant public health purpose”? What planet do you live in???
Also, you gave two reasons but you forgot the most important one why travel bans work:
The country (or area) in question has an active program to reduce and potentially eliminate the virus and a travel ban enables it to avoid the introduction of new infections while the elimination takes place.
This is how the virus was reduced in Italy back in March (when people could barely leave their commune) and completely eliminated in China (when every single mode of transport, including trains, was stopped).
Conversely, without a travel ban you get superspreader events like Sturgiss, who has been traced as one of the key reasons for all the deaths in the fall in the Midwest.
Anything that discourages unnecessary proliferation of the virus while hospitals are already inundated with patients makes sense.
@john
The US has done 250 MILLION covid tests. Only India has done more than 100 million. Just a quick look but the EU doesn’t appear to be anywhere near as close – and the per capita death rates in many European countries are growing faster than in the US. Multiple countries of E. Asia that did well during the spring and summer are seeing alarming increases in deaths.
The US could benefit from a full-scale “post mortem” of the covid crisis – but a lot of people simply don’t understand how devastating this has been worldwide and repeat that the US is handling this all poorly when much of the world is suffering to pretty similar degrees.
@ Tim Dunn, 250 million tests sounds like a lot but we’re also talking about more than nine months and a country with a population of around 330 million. The real issue is how many tests should be done. That depends on factors like the goal of testing and the positivity rate on tests performed.
If the US tested at the rate of the ROK and Taiwan, which have done decent jobs with controlling the pandemic, the US would be performing 3 million test per day/ 21 million per week. The Harvard Equilibrium model, which is designed to protect hospital capacity, says the number is 4 million per day/28 million per week. It is easy to see we are far short of those numbers. A good testing program would avoid lockdowns and social distancing requirements.
See, https://www.kff.org/policy-watch/what-testing-capacity-do-we-need/
The Association of American Medical Colleges asserts that opening schools, businesses, and public gathering spaces with safety and confidence requires 8 to 9 million tests per day.
See, https://www.aamc.org/covidroadmap/testing
I agree a post mortem (appropriate term) is a great idea. One for sure conclusion is the US doesn’t spend enough on public health.
@john
The US has tested a higher percentage of its population than any other country.
There are aspirational recommendations and there are realistic recommendations.
The US has tested a higher percentage of its population than any other country. No other country has come close.
The way to have limited the number of deaths would have been to protect seniors and those most vulnerable. Some states aggressively protected those in long term care facilities after the Washington state outbreak that put covid on the map in the US. The US government issued orders to protect residential care facilities for seniors very early in the crisis.
Testing doesn’t stop anything. It simply confirms if someone has a disease once they think they do.
protecting the most vulnerable is what government should do – but people make their own decisions including allowing socially active people to mix with the most vulnerable.
Travel bans aren’t necessary if the most senior are protected. Some seniors shouldn’t travel while others can safely travel during a pandemic.
@Tim Dunn
Actually the US is currently 20th in per capita testing with 753,650 tests per million population (https://www.worldometers.info/coronavirus/), behind countries including the UK, Denmark, Singapore, Israel, the UAE, Malta and Iceland. The UAE for instance has an average conducted two tests per person in the country.
@Tim Dunn, You are right to be concerned about the way out of the mess we are in.
Testing is the first and arguably most important step in stopping the virus. Without adequate testing to identify who actually has the virus, the assumption becomes everyone has it. That assumption is the reason for lockdowns, wearing masks, and social distancing restrictions that keep us apart, close businesses, and limit the size of public and social gatherings.
It is feasible to conduct an adequate number of tests to stop the virus (quarantine and contact trace the positives) and avoid the assumption everyone has it. ROK and Taiwan and perhaps others proved that. But it takes effort and acknowledgement that the virus is not a hoax or will magically go away.
You protect everyone (not just those we think are most vulnerable) by identifying people who have the infection and now by getting vaccines to as many people as possible as quickly as possible. It is easy to make statements that X million will be vaccinated in X days. But without well thought out plans, procedures, policies, infrastructure, communication, and commitments etc. from all involved, such statements are just BS and we wind up with SNAFU.
Fact. The only way stopping a spreading virus will help is if EVERYONE STAYS PUT INSIDE AN INSULATION TANK BUBBLE HOUSE FLAT HUT WHATEVER IT IS with the exact correct equipment and hydration and air flow temperatures and procedures in place. And that AINT gonna happen. Not right now on this planet. Thereis NO point putting a travel ban in place IF the countries and places people are travelling to and from Still have folks entering a shop or are in and out of hospitals and people are being active full-time as otherwise it is a total contradiction. If it is airborne then come on folks stopping folks travelling or flying Wont help unless you stop all weathering systems and transportation and all else from creating air pressures and currents that would move virally impacted particles. If One thing stops and a virus really IS killing the whole ban species rapidly then a full blown lockdown of whatever sort was resolvable would need to happen. It is concentric and absolutely not at the same time