Flatten the curve: Keeping your distance from others is essential to slow down the spread of COVID-19.
[Editor’s note: This is an updated version of an earlier article that originally ran on January 28 with multiple updates since then.]
Everyone’s talking about the new coronavirus, and it can be hard to differentiate between the facts, misinformation, sensible precautions, and overreaction. All over the world, measures are being taken to control and contain the virus, sometimes based on scientific evidence but sometimes just because it sounds like it’s the right thing to do. However, more and more countries are implementing decisions based on the World Health Organization’s advice.
The middle of March brought advisories from many countries that their citizens reconsider or avoid nonessential travel not only to COVID-19 hot spots but anywhere abroad. Many countries closed their borders to foreign nationals and are urging their citizens to return home from vacations and business trips wherever they are in the world. But many people are unable to comply because of flight cancelations, closed air space, and lockdowns. Except for essential travel and returning home, travel should be on hold for a while. On the ground, physical distancing and staying at home as much as possible is encouraged and, in some places including several U.S. states, is mandatory. While the vast majority of COVID-19 cases are mild, this can mean anything from not realizing you’re sick to what’s been called “the worst case of flu you’ve ever had.” Governments are increasing measures to slow the spread of disease transmission so that health care systems are not overwhelmed by the serious cases they have now and the high numbers they know will come.
We outline what you need to know, but remind you that the World Health Organization (WHO) is the expert source for advice.
The Latest
On March 24, the world‘s COVID-19 cases rose above 400,000. Cases are climbing quickly. On March 20, the count was 254,493, on March 23 it was 360,096, and on March 25 the count is at 445,815. The United States became the third most-affected country in the world on March 23, rising from the sixth most affected as of March 20. As of March 25, the U.S. has 808 deaths and 59,966 confirmed cases. The U.S. epicenter is New York state with more than 25,000 cases and experts predicting a peak in cases in two to three weeks.
On March 23, the United Nations Secretary-General called for an immediate ceasefire in all armed conflicts around the world to focus instead on fighting COVID-19. The International Olympic Committee and Tokyo 2020 Organising Committee announced on March 24 that the Tokyo Olympics are postponed from July 24 start to summer 2021.
Countries continue to encourage, and sometimes enforce, staying at home. The Guardian says approximately 20% of the world is living in lockdown conditions. Most are allowed out of their homes for essential purchases and, perhaps, to exercise. India’s 1.3 billion residents are under a strict 21-day lockdown with the prime minister saying “For every Indian, there will be a total ban on venturing out of your homes.” Other countries beginning lockdowns are Britain and New Zealand while countries like Spain are extending their lockdowns. Countries also continue to close their borders to non-nationals; see Al Jazeera’s updated list. Governments continue to work to repatriate their citizens, but this is growing increasingly difficult as flights are canceled and airlines shutting down operations. More countries are stopping international flights from landing.
However, other countries like Brazil, Mexico, and Nicaragua are downplaying the seriousness of COVID-19, as reported by CNN. While 40% of Americans are living with some kind of restrictions, Donald Trump is focused on the U.S. economy. NBC reports his March 24 statements that he would “love” to end COVID containment measures, have the economy opened back up, and have “packed churches” by Easter, April 12. This is contrary to the advice of U.S. medical experts.
In his March 23 remarks, the head of the WHO, Tedros Adhanom Ghebreyesus, continued to press for more testing, isolating, tracing and quarantining. He remarked on the rising number of COVID-19 infections amongst medical staff and recommended that limited protective equipment be prioritized for use by medical teams. He also encouraged countries to work together in the WHO’s SOLIDARITY clinical trial study, saying it will bring faster and more effective results than many smaller observational studies.
Misinformation and conspiracy theories continue to spread. CNN reports that Donald Trump, for example, retweeted misleading articles about the effectiveness of chloroquine in treating COVID. The price of the drug, an antimalarial treatment, skyrocketed, three people in Nigeria overdosed and an Arizona man died.
Last Week
The WHO reported that it took three months for the world’s COVID-19 cases to reach 100,000, but “only 12 days to reach the next 100,000.” On March 23, the WHO added it took “just four days for the third 100,000.” On March 20, the number of COVID-19 deaths in Italy reached 3,405, exceeding the number in China. On March 19, the U.S. State Department upped its warning to U.S. travelers to “Level 4: Do Not Travel,” the highest level. It advises Americans to “arrange for immediate return to the United States unless they are prepared to remain abroad for an indefinite period.” California began its lockdown period on the night of March 19. All 40 million residents in the state are asked to stay at home unless absolutely necessary to go out. Malaysia is the hardest-hit country in Southeast Asia. The Guardian reports the country has over 1,000 confirmed cases. On March 20, the government announced the army will begin enforcing movement restrictions after the borders were closed and a lockdown put in place.
In his remarks on March 18, the head of the WHO, Tedros Adhanom Ghebreyesus, again pressed countries to enhance COVID-19 measures beyond physical distancing (like canceling events and large group gatherings). Without “isolating, testing, and treating every suspected case” and then tracing contacts of anyone diagnosed, Tedros says transmission chains will continue at low levels and then surge again once physical distancing restrictions are lifted.
Officials in many countries are expressing shock at the number of people, particularly young people, who are ignoring advice to maintain physical distance and not attend events of any kind, including going to bars and restaurants. There is grave concern about how much disease is being spread because of these activities. News outlets report comments from spring breakers in Florida saying they don’t care if they contract COVID-19, seemingly unaware that young people can also have serious symptoms and of the significant role they would then have in spreading the disease and putting health care systems in jeopardy. A French minister said, “There are people who think they are modern-day heroes by breaking the rules while they are in fact idiots.”
China reported three days of no new domestic COVID-19 cases starting on March 19. However, one new domestic case was announced on March 23. If there are 14 straight days without new cases, the lockdown in Wuhan is expected to be lifted. As described by The Washington Post, starting on March 19 China’s new cases were all from people coming from other countries.
Cases in other countries, Italy and Spain in particular, are surging. Italy had the largest daily increase in deaths ever recorded during the COVID crisis. Concern about refugee camps in countries like Turkey and Syria is rising. In the United States, New York state has 5% of the world’s COVID-19 cases (over 15,000 as of March 22). More than 110,000 hospitalizations, one-third needing intensive care, are predicted in New York, which, as The Washington Post reports, “vastly overwhelms…health care capacity”
March 19 brought announcements of more border closures to non-nationals, including New Zealand (as of midnight March 19) and Australia (as of 9 p.m. March 15). United Arab Emirates closed its borders even to ex-pat residents hoping to return to the UAE. The decision to close the U.S.-Canada border to all but essential travel took effect midnight March 20. Two hundred thousand people and $2 billion in goods and services normally cross this border daily. Nationals of each country will be able to return home and commercial goods will still be allowed through. Nonessential travel across the U.S.-Mexico border was barred as of March 20 at midnight. The Guardian reports that construction of the southern border wall will be increased.
Many travelers are finding it increasingly difficult to get to their home countries as airlines cancel flights and borders close. For example. India announced that starting March 22, no international flights will be allowed to land for at least one week. Saudia Arabia is doing the same. About 500 foreigners are in quarantine and unable to leave Panama after attending a music festival near Playa Chiquita.
On March 16, CNN reported several new U.S. guidelines including to “limit discretionary travel,” avoid gatherings of more than 10 people and to avoid sitting in restaurants and bars. The guidelines are called “15 Days to Slow the Spread.”
While curfews and lockdowns, as exist in several countries, have not been imposed, the U.S. president said some restrictions could be in place until July or August. On March 16, the Canadian prime minister announced that, with a few exceptions, foreign nationals will not be allowed into Canada as of March 18.
More and more countries are implementing mandatory self-isolation or quarantine for people entering their borders and often prohibiting non-nationals from entry at all. Vietnam is one example, with the county no longer granting visas. Africa is closing land borders, seaports and airports, especially to visitors from Europe and the United States. In Latin America, many borders are closing. For example, Chile’s borders are closed as of March 18. Countries like Peru and Venezuela issued orders for citizens to stay home in mandatory isolation. Around the world, more and more restrictions are in place to encourage people to stay in their homes.
Late on March 13, the United States declared a state of emergency. The U.K. and Ireland were added to the U.S.’s Europe travel ban. Canada put out an advisory on March 13 recommending that Canadians not travel at all outside of Canada, just as spring break was about to start. On March 14, Canada advised that Canadians who are abroad return home. Anyone entering Canada is asked to self-isolate for 14 days. Public life around the world is shutting down and many destinations are asking residents to stay home except for essential excursions to buy food or seek health care. Italy and Spain are in lockdown and France has followed.
We provide the details below.
What Is This New Virus?
In early January 2020, China and the WHO confirmed the identification of a new virus. It stems from several cases of pneumonia identified in Wuhan, a city in the Chinese province of Hubei, on December 31, 2019. The new illness initially had the temporary name 2019-nCoV. On February 11, 2020, the WHO officially named the illness COVID19, pronounced “co-vid 19.” It’s short for coronavirus disease, with the “19” designating 2019, the year it was first identified. The official name of the virus itself is severe acute respiratory syndrome coronavirus 2, or SARS-CoV-2.
A Coronavirus—What’s That?
The Centers for Disease Control and Prevention (CDC) describes coronaviruses as a type of virus that causes a fever and symptoms of the upper respiratory system, like a sore throat, coughing, and a runny nose. Sometimes coronaviruses can cause more severe symptoms like difficulty breathing, illnesses of the lower respiratory system like bronchitis and pneumonia, and sometimes death. Other coronaviruses include the common cold, as well as SARS (Severe Acute Respiratory Syndrome), and MERS (Middle East Respiratory Disease). Coronaviruses were first identified in the 1960s and have “corona” in their name because, at the molecular level, they have a crown-like shape.
Cold and flu viruses generally mutate frequently, which is why we keep getting sick from them and why the flu vaccine changes every year. We don’t yet know if people who recover from COVID-19 will have lifelong immunity to it, or if the virus will change.
Coronaviruses can infect both humans and animals. Scientists don’t yet know the origin of SARS-CoV-2. When a virus jumps from an animal to a human, or vice versa, the virus can change rapidly and even become a new virus.
Scientists pay close attention to new viruses because they don’t know how they’ll behave and how dangerous they might be. For example, a virus that’s contagious only when the infected person is clearly sick and that causes only minor symptoms isn’t a big concern. But a virus that transmits rapidly, especially before an infected person even realizes they’re sick, is more dangerous, as is one that causes severe symptoms. Viruses that are transmitted by direct contact, like touching mucus membranes or bodily fluids, are easier to control than smaller viruses (like measles and chickenpox) that are transmitted through the air by floating on dust particles.
From a Global Health Emergency to a Pandemic
On January 30, 2020, the World Health Organization declared COVID-19 a global health emergency. On March 11, the head of the WHO, Tedros Adhanom Ghebreyesus, declared the spread of COVID-19 a pandemic. However, Tedros accompanied that declaration with several important statements:
- “…we are deeply concerned both by the alarming levels of spread and severity, and by the alarming levels of inaction.”
- “Pandemic is not a word to use lightly or carelessly. It is a word that, if misused, can cause unreasonable fear, or unjustified acceptance that the fight is over, leading to unnecessary suffering and death.”
- “Describing the situation as a pandemic does not change WHO’s assessment of the threat posed by this virus. It doesn’t change what WHO is doing, and it doesn’t change what countries should do.”
Tedros added that this pandemic has shown it can be controlled. On March 11, he pointed out that 90% of cases are in only four countries (China, South Korea, Italy, and Iran) and said that in the former two, the number of new cases has been significantly declining.
Linked are Tedros’ statements from March 2, when he said, “We are in unchartered [sic] territory. We have never before seen a respiratory pathogen that is capable of community transmission, but which can also be contained with the right measures. If this was an influenza epidemic, we would have expected to see widespread community transmission across the globe by now, and efforts to slow it down or contain it would not be feasible.”
On March 16, Tedros noted that many countries have implemented decisions to enhance social distancing, for example by canceling events and closing schools. However, he said there is not “an urgent enough escalation in testing, isolation and contact tracing” and that these are needed to “extinguish this pandemic.” He added “We have a simple message for all countries: test, test, test. Test every suspected case.”
He also reminded that “all countries must strike a fine balance between protecting health, minimizing economic and social disruption, and respecting human rights” and called for all sectors of society to work together to mitigate the pandemic’s social and economic consequences.
How Many People Are Sick?
As of March 25, 2020, there are 445,815 cases of COVID-19 and at least 19,772 people have died. More than 112,000 people have recovered. As of March 25, 96% of active cases are classified as mild (the rate was 93% on March 17, and the rate has been climbing steadily since early March when it was at 82%). On March 18, the WHO reported that 80% of the world’s cases are in Europe and the Western Pacific.
The WHO reports that, overall, 3.4% of people who have tested positive for COVID-19 have died, up from the two percent estimated earlier. The death rate in Italy is higher. However, experts say it is too early to know the actual rate, as explained in this Economist article. For example, it’s assumed the total number of cases is much higher than what’s being reported because many people experience mild symptoms and believe they just have a cold and because some countries are not doing much testing. Dr. William Spangler, Global Medical Director with AIG Travel, says, “There could be large segments of the population who contract it and never know it.”
Many experts suspect that cases of COVID-19 have been circulating within many countries for weeks and that the high numbers of cases in countries like Italy and South Korea are known mainly because they are doing extensive testing. Korea’s strategy of extensive testing, even of people who had no symptoms, is seen as one of the reasons they were successful at combating COVID-19. On March 18, the head of the WHO described the initiatives South Korea implemented which have resulted in a declining number of new cases. On March 18, South Korea reported only 90 new cases while the peak number was 800 cases per day. On March 25, South Korea reported 100 new cases.
The country with the highest concentration of cases remains China (more than 81,000), but the rate of new infections there has slowed significantly. COVID-19 has spread to 196 countries and the total number of cases outside China is higher than China’s. As of March 25, there are 16,485 deaths due to COVID-19 outside of China, far surpassing China’s death toll of 3,281. Both Italy and Spain have more COVID-19 deaths than China.
The number of COVID-19 cases and deaths will continue to rise and we still need to learn a lot about the disease. A vaccine is not expected for at least a year. Several clinical trials around the world are underway, including in Seattle as of March 16. The BBC reports that Australian scientists have mapped out the body’s immune response to COVID-19, a significant benefit for vaccine development. On March 18, The Guardian reports that the Japanese flu drug favipiravir has helped COVID-19 patients show improvements faster than control groups. On March 18, the head of the WHO described a new study to collect data on the effectiveness of the variety of treatments around the world, naming it the SOLIDARITY trial (a reminder to world leaders that the only way to combat COVID-19 is to work together). There’s a new antibody test which may help count the number of undetected cases. Global News reports that Canadian Emergent Biosolutions is developing treatments for patients already diagnosed with COVID-19 and is working with two U.S. Novavax and Vaxart to develop two vaccines.
Perhaps a New Normal?
COVID-19 may become a new normal. In the short-term at least, the new normal means, at a minimum, social distancing, enhanced cleanliness, and vigilance in monitoring ourselves for symptoms, even the most mild. It certainly means no travel, except for returning to your home country or for the most essential of reasons. For many, self-isolation is necessary and perhaps quarantine (usually at home). People around the world are asked to stay in their homes as much as possible. Staying home will save lives.
The aim is to prevent the most at-risk populations from contracting the disease and not overwhelm health care systems. Known as “flattening the curve,” this NPR article explains what it means and why staying home and social distancing can save lives. Individual action is critical in ensuring success and we all must take on responsibility in helping prevent those more vulnerable from getting sick.
In the long term, the new normal might mean COVID-19 becomes a new disease we always have to watch out for. The Atlantic reports that “‘cold and flu season’ could become ‘cold and flu and COVID-19 season’” and describes the situation according to Marc Lipsitch, an epidemiology professor from Harvard. He predicts that “some 40 to 70 percent of people around the world will be infected” with COVID-19 over the next year, but “many will have mild disease or may be asymptomatic.” Canada’s health minister made a similar statement on March 11, as did German Chancellor Angela Merkel. The Guardian reports on a U.K. public health briefing where it was predicted that the COVID crisis could last until spring 2121.
COVID-19, like the flu, is a significant health risk to the elderly, people with pre-existing illnesses, and to countries with underfunded health care systems and where many citizens live with low incomes. COVID-19 cases will pressure the health care systems of all countries, especially during flu season. While health care workers are trained to take extra precautions, they are also at greater risk of getting sick from the virus as well as from burnout.
Also serious is the economic risk of COVID-19. Not being able to go to work is having significant financial effects on individuals without paid sick leave and on businesses without workers. Economies around the world are being affected as commerce and production slow. Spending in all but a few sectors, such as on groceries, has slowed significantly. Small businesses are at particular risk. Governments are implementing monetary and fiscal stimuli to protect citizens and businesses and ward off the worst of the recession that is expected.
How Does COVID-19 Compare to Other Respiratory Diseases?
Spangler says that it’s important to put COVID-19 in the context of other diseases. SARS had a mortality rate of 9.6% and MERS’ rate is 34% (the disease is still active, the most recent case was reported February 18, 2020, in Qatar). 2013’s H7N9 “Bird Flu” had a 39.3% mortality rate and 1997’s H5N1 “Bird Flu” was 57%.
The 2009 H1N1 “Swine Flu” was designated as a pandemic and hit 214 countries. The CDC provides these estimates for the April 2009 to April 2010 period:
United States:
- 8 million cases (range 43.3-89.3 million)
- 274,304 hospitalizations (range: 195,086-402,719)
- 12,469 deaths (range: 8,868-18,306) (fatality rate 0.02%)
Worldwide:
- 151,700 to 575,500 deaths, 80% of which were in people younger than age 65.
Consider annual flu statistics too. The CDC says that during the current 2019-2020 flu season (October 1, 2009 to present, as of March 14, 2020):
United States:
- 38 million to 54 million cases
- 23,000 to 59,000 deaths (fatality rate 0.06-0.11%)
In each one week period, the number of seasonal flu cases in the U.S. is climbing by two million and the number of deaths by about two thousand. Many Americans aren’t getting a flu shot despite the number of deaths from flu. Last year, 62.6% of U.S. kids got a flu shot while only 45.3% of adults did. And many people who have the flu—14%—don’t have symptoms, but can spread the flu virus.
COVID-19 is new and there’s still a lot we don’t know about it. There are millions more cases of H1N1 and annual flu. COVID-19’s fatality rate is higher than H1N1 and annual flu, but much lower than SARS and MERS and some other flus. SARS got a lot of worldwide attention and COVID-19 has been top of the daily news. Everyone needs to take precautions to stop the spread of the disease, particularly to prevent health care systems from being overwhelmed. But is there a reason to panic more over COVID-19 than we did over H1N1 or seasonal flu or even SARS? Take the advice of governments seriously, but panic behaviors are making the situation worse. Consider this article by infectious disease specialist Dr. Paul Sax who explains What Does (and Doesn’t) Scare Me About the Coronavirus from the U.S. perspective.
Spread of COVID-19 Outside Asia
Reports of a rapid spread of COVID-19 outside of Asia began late in the week of February 17, 2020. As of March 25, countries with high incidences include Italy (6,820 deaths, 69,176 cases), Spain (3,434 deaths, 47,610 cases), Germany (181 deaths, 35,714 cases), Iran (2,077 deaths, 27,017 cases), France (1,100 deaths, 22,304 cases), Switzerland (149 deaths, 10,537 cases), South Korea (126 deaths, 9,137 cases), and the U.K. (433 deaths, 8,227 cases). The United States is the third most-affected country in the world with 808 deaths and 59,966 confirmed cases.
Europe is the current epicenter of the disease. Italy, Spain, France, Belgium and now Britain are essentially locked down. Everything except essential services is closed. Everyone is encouraged to practice physical distancing and stay in their homes as much as possible. In Germany, for example, gatherings of more than two people are banned.
For more on what’s happening in Europe, check out Coronavirus Outbreak: Should You Cancel Your Trip to Europe?
The good news is that, in some of the earliest affected countries, things are starting to return to normal. On March 20, the Japanese prime minister announced that some schools can reopen in April. As of March 9, the head of South Korea’s public health agency said they believe the peak has passed. On March 10, China reported and the country no longer has need for 11 of its 14 new temporary COVID-19 hospitals. However, the BBC reports on March 18 that many parts of Asia are now experiencing a second wave of COVID-19 cases as travel to countries like China, Singapore, and South Korea starts again. Tokyo implemented a new lockdown on March 25.
The disease is rapidly spreading to the rest of the world. Many eyes are on the United States, with questions about the extent of COVID-19 testing taking place and concern about whether coronavirus-related information must be approved by the White House before it is released to the public. Read more about U.S. travel including about new bans below, and in our Coronavirus Outbreak: Should You Change or Cancel U.S. Travel Plans?
The WHO’s Advice About Travel
On March 13, the head of the WHO expressed relief that more and more countries are now acting on their advice but said there is much more to be done. Tedros Adhanom Ghebreyesus reiterated this on March 16 and March 18 and expressed concern as the virus is spreading to low-income countries, particularly those with high levels of malnourished children and high rates of HIV infection.
As of March 25, 2020, the WHO’s advice to the general public remains taking the usual precautions: wash your hands frequently, avoid touching your face, practice respiratory hygiene, practice social distancing and maintain at least a three-foot distance from people, and seek medical care if you have a cough, fever, and difficulty breathing. (We explain the details of this below.)
The WHO recommends that people who have recently been in an area where COVID-19 is spreading and who have symptoms (even if mild like a headache and runny nose) should stay home until they recover. This is especially the case if the person has been at a destination with an outbreak of COVID-19, which is now most countries.
People with more serious symptoms like fever, cough and difficulty breathing should call medical providers to seek advice before visiting a doctor’s office or hospital.
With respect to travel bans, the WHO reiterates that “evidence shows that restricting the movement of people and goods during public health emergencies is ineffective in most situations and may divert resources from other interventions.” The organization says some short-term restrictions, carefully weighed against risk, may be justified at the beginning of an outbreak to allow countries to implement preparedness measures and identifies circumstances where the temporary restriction of movement may be useful “such as in settings with few international connections and limited response capacities.”
The WHO also provides advice on international mass gatherings, defined as events where the number of participants could drain the destination’s health system. The WHO has ruled out blanket cancellations but has provided advice on how assessments should be made including that multiple stakeholders, particularly public health authorities, be involved.
In a statement on March 16, the WHO gave advice on how to care for a COVID patient who is quarantined at home to minimize the chance the virus is spread to other family members (a key way COVID-19 spread in China). New guidance is also available for how to care for older people, pregnant people, and children.
Travel Bans and Restrictions
Travel restrictions began in Wuhan in January and grew. With COVID-19 now on every continent except Antarctica, further restrictions arise daily. Some infectious disease specialists are saying that not all of the bans are medically necessary but are being put in place for political reasons. To non-experts, some of the decisions may sound like they make sense, but experts say to rely on evidence-based scientific advice. Steve Hoffman, a professor of global health at York University, described how a travel ban “actually undermines the public-health response because it makes it harder to track cases in an outbreak.” Bans encourage people to lie about their symptoms and about whether they may have been exposed to illness. Many people are so desperate to get home, they board flights knowing they have symptoms.
Some decisions may even be driven by fear and xenophobia. Certainly, statements calling the virus “Chinese” or “foreign” are xenophobic and can make controlling COVID-19 and the consequences of it more difficult. Public health experts reiterate that bans against travel and trade are ineffective, not scientifically or economically warranted, and can cause more harm than good. However, encouraging individuals to make decisions to avoid travel or self-isolate can help slow the spread of disease, flatten the curve, and reduce pressures on health care systems.
The CDC has issued level 3 “warnings” to avoid nonessential travel to a list of countries that changes frequently. On March 11, a global outbreak was noted with a level 2 alert. As of March 19, the State Department’s warning is at “Level 4: Do Not Travel,” the highest level. It advises Americans to “arrange for immediate return to the United States unless they are prepared to remain abroad for an indefinite period.” This follows the March 11 Level 3: Reconsider All Travel advisory
The U.S. began implementing new border rules on February 2, prohibiting foreign nationals who had visited China in the previous 14 days from entry and subjecting U.S. citizens traveling from there to health screenings and, potentially, restrictions on their movements for 14 days. A ban on travelers from Iran was added on February 29. Advice for travelers from other high-incidence countries, including all countries with a level-3 warning, includes that they should self-isolate for 14 days. On March 11, Trump announced that all travel from Europe is suspended for 30 days as of midnight March 13. Originally the U.K. and Ireland were exempt from this ban, but on March 14, the ban was revised to include them. Later clarifications confirmed that the new rule does not apply to U.S. citizens, most of their immediate family members, or U.S. permanent residents. Rather, the Europe ban is similar to the previous ones for China and Iran, i.e. foreign nationals who have been in China, Iran, the 26 Schengen countries of Europe, Ireland, and the U.K. during the previous 14 days are not allowed entry into the U.S.
All countries are screening arrivals at their borders. Some are encouraging—and others insisting on—14-day self-isolation for travelers under some conditions and sometimes for all travelers. More and more countries are restricting entry to people who have recently been in hot spots and some are banning all foreigners from entry. Many countries are advising their citizens not to travel; Israel was the first, on February 26.
Canada has been following the WHO’s advice but on March 16, the prime minister announced new restrictions on who can enter the country. The aim is to further increase social distancing and the middle of March is seen as a critical period to avoid an escalation of Canadian cases. Starting March 18, only Canadian citizens and permanent residents (with some exceptions) will be allowed into Canada and the U.S.-Canada land border is closed to all but essential travel as of March 21. Anyone coming into Canada, regardless of where from and regardless of whether they have symptoms, must self-isolate for 14 days. These measures are on top of the March 13 announcement advising Canadians to avoid all but essential travel abroad and the recommendations that all Canadians who are traveling come home.
Air Travel Restrictions
Airlines are adjusting their flights both in response to government bans and because of reduced customer demand. Many airlines are announcing that they are discontinuing international flights and some are shutting down operations. Some carriers are working with their governments to help repatriate citizens abroad. Some governments, such as India’s and Saudi Arabia’s, are barring all international flights for at least a week. Travel, even if one wanted to, is increasingly difficult. Passengers around the world report showing up for flights at airports only to find they’ve been canceled and the pattern repeats with subsequent flights. The air travel situation is extremely fluid and travelers should check with their airline or travel agent for the latest news. The three major U.S. airlines are issuing travel waivers to customers who booked tickets under specific circumstances. This means increased flexibility to postpone travel with change fees waived. Find more information at:
Cruise Ship Restrictions
Cruise ship travel has been significantly disrupted. Following the rerouting of itineraries, limitations on who can board, and enhanced health checks, many cruise lines have suspended operations for at least a few weeks.
Many countries, including Canada and the United States, recommend citizens avoid cruise ship travel during the pandemic. Some countries are closing their ports to cruise ships completely. It began in Asia, followed by the South Pacific, the Middle East and continues. On March 13, Canada announced that it is deferring the start of cruise ship season from April 2 to July 1, applying to all ships with more than 500 aboard. All cruise ships, regardless of size, are prohibited from Canada’s fragile northern regions for the 2020 season.
Cruise Critic is monitoring the situation and includes links to all cruise lines’ latest COVID-19 updates and well as to port closures.
If Bans and Restrictions Don’t Affect Me, Should I Still Travel?
No. Not right now.
Many countries are advising their citizens to reconsider or avoid nonessential travel and to return home if they are abroad. Wherever you are, you should also be minimizing contact with other people as much as possible to slow the spread of COVID-19.
While the risk of getting sick is low to moderate, the chance of spreading COVID-19 is high. We all need to practice the WHO’s advice of social distancing, washing hands, and avoiding touching faces (see below). Many countries are advising that people stay in their homes as much as possible. Consider this advice from an anonymous doctor in western Europe, reported in Newsweek.
If you must travel, check the website of the public health authority of the destination you plan to visit to see their latest advice, including how strained their health care system is.
Travelers should assume that new restrictions and bans could arise at any time, that flights are canceled with little to no warning and that their travel history will be scrutinized. More and more countries are advising that people self-isolate for 14 days after traveling and some are implementing mandatory quarantine periods for travelers from some destinations or if they have been abroad at all.
It’s not new to the COVID-19 situation, but keep in mind that airlines have the right to refuse passengers who appear to have a communicable disease. The captain has the final say and many airlines employ medical consultants. As fears over COVID-19 rise, expect increased vigilance and potentially restrictions on people who simply have a cold or allergy symptoms.
You should consider whether it’s wise to book new travel, even for months from now. It’s true that there are deals to be had and many airlines, cruise lines, and tour groups are offering unprecedented flexibility to make changes. However, most travel insurance will not reimburse you for coronavirus-related cancellations so check policies very carefully. Further travel bans, restrictions, and advisories are likely in the weeks to come. And you need to consider how you may be contributing to the spread of disease, particularly to vulnerable populations. We need to flatten the curve.
Easy and Common Sense Protections
Following the advice of health experts like the WHO will minimize your chance of getting sick from this new coronavirus. The advice to protect yourself from getting sick—and to minimize the spread to others—is pretty easy to follow, and it’s what we should all be doing anyway to prevent colds and flus.
- Wash Your Hands: A 20-second scrub using warm running water and soap is best (the Mayo Clinic says to sing “Happy Birthday” twice); one of Canada’s provincial health officers says “wash your hands like you’ve been chopping jalapenos and you need to change your contact [lenses]”). Then, rinse with clean water and dry your hands. It’s important to dry them, though the jury is out about the best way (some studies say hot air blowers spread germs and that paper towels or clean fabric towels are best; other studies disagree). Soap and water are more effective, but if you don’t have access to a sink, using a hand sanitizer that contains at least 60% alcohol is fine (scrub well). Regardless, wash your hands often: certainly after coughing, sneezing or blowing your nose; before you prepare food; before and after eating, and after using the restroom. And throw those used tissues away immediately (and then wash your hands).
- Avoid Touching Your Face: Most viruses and bacteria enter the body through mucous membranes like the mouth, nose, and eyes. It’s easy to re-contaminate your hands after washing them, so keeping your hands away from your face is the best way to prevent germs of any type from getting in you.
- Cough and Sneeze Into Your Elbow: Yes, covering your cough or sneeze with your hand is preferable to spraying all those tiny virusy droplets directly into the air. But then you’ve contaminated your hand and you’ll inevitably touch something or someone. So, make a new habit of coughing/sneezing into the inside of your elbow (although a tissue should be your first choice). And while you’re at it, break that other habit of crossing your arms and putting your hands right onto your sneeze spots.
- Social Distancing: It’s always wise to keep your distance from sick people. During the COVID-19 outbreak, try to keep a three- to six-foot distance from others. No hugs, kisses, or handshakes, please. And really, during cold and flu season why not keep close contact just for loved ones?
- Don’t Touch Animals You Don’t Know: Regardless of whether there’s a new virus circulating, staying away from animals when you travel (even that cute stray cat or dog) is a sensible precaution. They likely carry bugs that your body isn’t used to. The WHO is also reminding people of its general advice to be extra careful in markets that have live animals or non-refrigerated meats and fish.
And of course, to prevent others from getting sick, isolate yourself if you have COVID-19 symptoms.
People who have higher risks—the immunosuppressed, those with other health conditions, and older adults—should follow the advice of their doctor.
Extra Protections
Still feeling a little paranoid? It’s good practice to regularly disinfect surfaces that get handled frequently (your phone is filthy). On the plane, you can also use a wipe to clean off your tray table, armrests, and seatbelt, though the evidence is unclear whether this is effective in killing germs or just cleaning up that bit of sticky spilled Coke. Don’t assume you’re safer in a taxi or Uber: it’s easier not to touch surfaces on the subway or bus, and those vehicles have a regular cleaning schedule while cars do not.
At restaurants, do an extra hand wash after you’ve given back the menu and before you start to eat. Use hand sanitizer before and after you touch serving utensils at a buffet. Be sure to only put food on a clean plate; don’t bring your used plate back to the smorgasbord. And while we’re at it, let’s call a halt to waiters at fancy restaurants picking up your used napkin and refolding it when you step away from the table. Let’s all just keep our germs to ourselves, yes?
Should I Wear a Mask?
Speaking of keeping your germs to yourself: if you’re sick, wearing a mask is a courtesy to the people around you (here’s how). You’ll be less likely to spread your illness when you cough, sneeze, laugh or talk. However, masks aren’t perfect and most of us don’t use them correctly. We fidget with them, put them on and off without washing our hands, and re-use masks that are meant to be single-use. It’s different for medical staff—they receive special training on mask use and wear masks specifically fitted to their faces.
There is no recommendation to wear a mask to prevent getting sick yourself unless you are in close contact with a sick person. The CDC is recommending that caregivers wear a disposable mask when touching a person sick with COVID-19 or when they have contact with the person’s body fluids, like disposing of their used tissues or doing their laundry.
People using masks when they don’t need them diminishes the supply for those that do. In fact, there are mask shortages in many countries because people are buying and wearing them when they don’t need them, which encourages others to follow suit. Before you buy a mask you don’t need, consider that your health is more at risk if there aren’t any masks available for the sick people around you.
What If I’m Sick?
Stay home and self-isolate if you feel sick. To help stop the spread of COVID-19, the WHO and other experts are asking people to stay home from work, school and travel if they have symptoms of a cold, even if they’re mild.
Given the increased monitoring since the discovery of the new coronavirus, travelers who do show signs of illness could be prevented from boarding a plane, cruise, train, or bus. Many airports and seaports have installed thermal imaging cameras to scan people as they walk by. Anyone showing a fever is pulled aside for additional questioning and maybe quarantine.
If you exhibit symptoms of the coronavirus—fever, cough, and difficulty breathing—follow the instructions of your health care provider as soon as possible. Usually, this means calling ahead to your doctor or hospital so that they can take precautions to isolate you from other patients while they carry out testing. Be sure to advise doctors if you’ve been traveling.
Where to Get Updated Information
A new virus like this coronavirus means a rapidly changing situation. Scientists at the WHO have the up-to-date intel on the virus. Rely on their information, advice, and travel restrictions on the WHO’s website. Other reliable government advice includes Canada’s and the U.K.’s.
Note that fake coronavirus news (see these busted COVID-19 myths) is spreading fast with the WHO calling it an “infodemic.” Well-meaning people are also spreading misinformation or opinions presented as facts, which is increasing fear and confusion. Trust in governments, public health institutions and scientists is being affected, which could have more serious consequences than COVID-19 itself.
Scams related to COVID-19 are also starting to emerge. For example, the WHO reports that criminals are using the WHO’s name to steal personal information and money.
Written by: Fodor