Earlier in the week I offered a detailed explanation of why it’s fine for some people to start planning some trips to certain destinations.
Nuanced takes don’t always do so well on the internet, but I’m happy with the analysis that I laid out why it can make sense to do limited domestic travel this summer if you aren’t living in a coronavirus hotspot, aren’t heading towards one, and are not in a high risk group (and do not live or work with people that are). I’m not telling anyone that they should travel for leisure but I don’t think the argument holds that no one should.
I laid out my thoughts in response to Southwest Airlines CEO Gary Kelly declaring that air travel is safe. That same claim prompted Brian Kelly to weigh in and argue that you shouldn’t travel.
I don’t find his argument persuasive, and I think it’s a good exercise to hash this out in public to help folks make up their own mind.
Here’s what Brian suggests:
- There isn’t enough available testing.
- Travelers could unknowingly spread the disease.
- Information about COVID-19 is incomplete and confusing.
- The virus could mutate over time, making it harder to treat and prevent.
- It’s important to protect frontline workers.
- Better cleaning on airplanes is necessary.
Argument 1: There’s Not Enough Testing To Travel Now
Brian is worried that without testing someone on a plane might have the virus and spread it. That’s a concern we face even with adequate testing, and even in the grocery store, so I would have liked to know what level of testing would make Brian comfortable and why?
There’s no controversy over limited testing capacity. However relying on testing as a panacea isn’t realistic. Paul Romer’s re-opening plan involves 25 million tests per day, testing every American every other week. The math works beautifully, but that testing capacity won’t ever exist – and the logic works at a societal level but not to ensure that any particular person won’t have the virus because of the rate of both false positives and false negatives from tests (a function of the tests themselves but also errors in sample collection).
Indeed even a test that shows someone doesn’t have coronavirus doesn’t necessarily mean that they do not have the virus, so implying that ‘if we had enough testing then travel would be completely safe’ is wrong. There aren’t going to be enough tests to test everyone getting on a plane any time this year, and even if there were the tests aren’t reliable enough to tell us what we’d want to know.
That’s why I would have liked to see Brian develop his idea further. What level of testing would make him feel safe to travel, and why?
Later in the video Brian suggests things would be better with temperature checks, and while those would be helpful in identifying people with one common symptom of the virus, since he elsewhere talks about the risk of asymptomatic spread I’m not sure why this would give him the comfort he seems to think that it would.
In any case Brian here is really just talking about travel by air where you’re stuck in a metal tube. This isn’t an argument at all against taking a road trip – drive to a city a few hours away, rent a house, maybe it has a pool, just something different to do?
More broadly he seems to be making an argument against being anywhere. Planes with seats as barriers between passengers and HEPA air filters, with everyone wearing masks, are probably safer than many other ‘opening up’ activities you might undertake. It may be safer than going to a restaurant and sitting indoors, or going for a haircut or going to the gym. It’s fair to say don’t do those things, stay home, but in many states people are now doing them – is travel a riskier activity than what people are already doing?
Argument 2: Masks Won’t Keep Us From Unknowingly Spreading The Virus
Brian says ‘makeshift’ masks ‘won’t control the spread of the virus’ because they’re not N95 masks, but that conflates what different masks do. Masks that most people are wearing will catch large droplets the wearer might emit, while wearing an N95 mask is going to filter out virus particles from being inhaled. That’s necessary in a health care environment where the virus might become aerosolized from intubation of patients and in virus-intense environments such as COVID wards in hospitals with many infected patients. While not a complete solution Brian is too quick to dismiss the benefit of mask wearing.
Separately he expresses the concern that “masks are not a part of our culture the way they have been in Asia for years” and this needs to change. Are masks of no help, or are masks a crucial tool to fight spread? I’m left confused on this point listening to Brian.
Argument 3: We’re Getting Confusing Information About The Virus
This is absolutely true – CDC and WHO were advising against use of masks, until they weren’t. This was largely a noble lie, to buy time where people weren’t buying N95 masks, so that governments could secure masks and health care institutions could secure personal protective equipment ahead of everyone else. The TSA is hoarding 1.5 million masks.
Early on it was thought that the virus spread almost exclusively by symptomatic patients, then new work began to find asymptomatic spread. The French government advised against taking ibuprofen, favoring acetaminophen instead, butt his wasn’t based on solid science at the time.
There are fairly robust results suggesting that smokers may be somewhat protected from the virus, perhaps because damage to the lungs from smoking giving the virus less healthy tissue to latch onto. This contradicts earlier beliefs about people with lung damage from smoking being more vulnerable.
We’ve learned a tremendous amount in a short period of time. Science that takes years is taking mere months. This is the first global pandemic in the true social media era, and much of scientific peer review is taking place on twitter.
That’s confusing to the general public, as Brian notes, for sure. We’re learning so much so quickly. That’s a good thing and as time passes it should make us more and more confident traveling not less confident. It means protocols are getting better.
Argument 4: Virus Mutations Means Things May Be Getting More Dangerous
Virus mutations usually become less dangerous. Viruses that are too lethal to their hosts don’t persist. There’s no scientific consensus that mutations so far have made the virus harder to treat. Rather than predicting that things will become more difficult, the truth is that treatments will become easier because of how much we’re learning about the virus quickly.
For instance tactics as simple as putting a patient on their stomach improves outcomes for those having difficulty breathing. Many patients are now started on breathing assistance much less extreme than use of a ventilator (ventilators were damaging lungs and often not helping). And treatments are being developed, and in the case of remdesivir, approved.
We’ll have more and better knowledge, and likely better treatments, in the coming months.
Argument 5: You’re Putting Employees At Risk If You Travel
Brian says ‘we need to protect front line employees’ and here I think what he’s saying is that someone who travels might have the virus and might expose someone working for an airline. That’s true as far as it goes. It’s why social distancing, masks, and cleaning are so important.
It’s also true that someone who goes to the grocery store might have the virus and infect a grocery employee. Or someone who goes to a restaurant might infect a worker there.
There’s an argument to be made that total lockdowns should continue, or at least continue to the greatest extent possible. That’s not a politically feasible argument, as we’re seeing not just in the United States but around the world as well.
The goal of lockdowns of course wasn’t to wrap all of society in a bubble. Lockdowns in the U.S. haven’t gotten the reproduction rate of the virus low enough to eradicate it. Lockdowns are merely slowing down the rate at which people get sick, and perhaps not reducing the total number of people who eventually contract the virus. That’s ok – we wanted to slow the spread so that the health care system didn’t get overwhelmed the way it did in Italy and in New York. Where there are excess ICU beds that’s one metric telling us we’re handling the virus well.
Lockdowns did get the reproduction rate down below one, by most estimates, so the current slow burn we’re experiencing is hopefully sustainable. If it turns out not to be we return to lockdowns.
In the meantime, there are livelihoods on the line and businesses that may not return, and dreams being crushed and those have consequences – including public health consequences too. This is an insidious virus and public policy responses involve tradeoffs, but Sara Nelson’s proposed ban on leisure travel is certainly a minority view and not one that’ll even be good for airline and airport workers (even as Delta self-servingly deploys this argument).
Ultimately this is just a subset of ‘if you go out of your house you might spread the virus’ and isn’t a different argument than not enough tests, or that masks aren’t protective enough. And here’s one flight attendant who says their biggest risk is making sure other flight attendants social distance from them rather than coming into contact with passengers.
Argument 6: Planes Aren’t Being Cleaned Well Enough
Brian worries that enhanced cleaning might not be “happening on every single flight” and “what about during the flight?” and inflight in the bathroom, since the virus can spread via fecal matter.
If he’s looking for a guarantee that a person can’t shed the virus on a plane and infect someone else, he’s right, there is no such guarantee. But the steps being taken by airlines to clean aircraft are unprecedented, including electrostatic spraying between domestic flights.
While not every airline is doing this on every flight yet, Delta committed it would happen on all its flights by May and American committed to June. Indeed Delta says it is happening on every flight now. It won’t be sustainable over time, but while I fault airlines for a lot of things the cleaning they’ve been doing over the last month is not one of those things.
As I wrote earlier evaluating the risks to travel I would avoid use of the aircraft’s lavatory inflight now, and that means sticking to shorter flights, but the risk that Brian is outlining isn’t different than what exists in most other activities. Grocery stores clean regularly throughout the day but not constantly. And in any case the primary transmission mechanism of the virus seems to be person-to-person via respiratory droplets, rather than from surfaces.
These Are All Good Concerns
Our government failed us. This was a massive failure perhaps on a greater scale than any government that’s come before. When it became clear that there was rapid person-to-person transmission of the virus, little was done. Travel bans were useless because they came too late to contain the spread. There was no ramp up in testing in fact the opposite is the case – the FDA and CDC together combined to limit testing to a government-supplied test that did not work. No European government was prepared for this either, so I don’t think this is about political party.
As a result we’re dealing with a nasty virus that seems to cause the human body to attack itself, and it’s leading to more than just respiratory failure but also to organ failure and strokes.
We’re learning more about the virus rapidly, improving treatments, and most important so far have adapted our behaviors to distance and reduce contact and that has prevented the health care system from becoming overwhelmed.
Where we are today should factor into your evaluation of risk in all of the activities you undertake, whether it’s going to the drugstore or considering whether to go to a restaurant or barber shop as they re-open in many communities – as well as travel.
If you go to work you have some risk. If you go to the gas station you have some risk. If you go out of your house you have some risk. Not everyone with the virus spreads it equally. There are a small percentage of super-spreaders.
Not all travel entails the same risks either. South Dakota, Montana, Idaho, Arkansas and West Virginia just aren’t as challenging as Chicago, Miami, New Orleans or the New York area even though New York seems to be improving. The most salient characteristic of the novel coronavirus is its heterogeneity. It is different in different places and for different people. And our response needs to be calibrated as well.
At the end of the day it seems that trip shaming is waning, and that’s a good thing. Some people should consider traveling to some places based on their circumstances, and there are perfectly valid reasons for others not to do so.