The recent spate of vaccinated travel lane (VTL) announcements has brought great excitement for many, particularly as the holiday season draws near. For many, the VTLs are a sign of the long-awaited resumption of travel. This has given rise to a phenomenon known as “revenge travel”, where there is a pent-up demand for travel, making up for lost time and opportunities over the past two years. However, the travel landscape that travellers will encounter abroad will be vastly different, and much more complex compared to pre-pandemic days. As doctors, how can we support and prepare travellers in this new landscape?
Travel advice in the new normal
Doctors would usually have travellers (their patients, friends, colleagues, relatives or family members) approaching them for medical advice prior to travel. In some instances, these are very specific requests, such as certification for fitness to travel, which may even be a requirement from their companies for business trips.
When approached for such requests prior to the COVID-19 pandemic, most doctors would share their knowledge on travel medicine, centring around two categories:
- Stabilising any chronic conditions before travel.
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Providing preventive medicine advice and chemoprophylaxis (if required), including for malaria, and vaccinations for yellow fever, meningococcal diseases, typhoid, etc.
Some doctors would advise travellers to bring a medical kit with some common over-the-counter medications (paracetamol, antihistamines, charcoal tablets, etc). Others may also recommend and prescribe a course of oral antibiotics, subject to exclusion of drug allergies (most prescribed include Augmentin, Ciprobay or Klacid). Travellers with underlying medical conditions would need a review to ensure their medical conditions are controlled before travelling and that sufficient medication is brought for the trip.
With the increase in complexity and risks faced when travelling today, we would recommend that doctors also look into four additional areas.
COVID-19 vaccination
Travellers should be fully vaccinated before they travel (regardless of their destinations). When vaccine boosters are due, it is recommended for travellers to receive their booster before travelling.
COVID-19 risk factors
Chronic illnesses (eg, diabetes mellitus, hypertension, coronary heart disease), immunosuppressive conditions, age, obesity, smoking and pregnancy are factors that may increase the risk of severe disease when infected by COVID-19.
COVID-19 risk at destination
A surge in cases and an upward trend may indicate a higher risk of COVID-19 transmission, even to vaccinated travellers. Besides preventive measures such as vaccinations, we need to look at the daily number of new cases. The higher the number of daily cases, the higher the risk of community transmission. Understanding the destination’s COVID-19 positive test rate is also a good indicator of risks. The World Health Organization recommends a COVID-19 positive test rate of below 5%.
Destination health facilities
As we are aware, COVID-19 vaccination does not provide 100% protection against the virus. While vaccination does reduce the risk of hospitalisation and severe disease, it is important to consider the destination’s health facilities, especially for those with COVID-19 risk factors. Such considerations include low COVID-19 active cases per million (with a preference of three digits and below), low case fatality rates, low intensive care unit occupancy rates and of course, good health facilities.
Helping all have a SAFE TRIP
Travellers should remain abreast of the different COVID-19 testing requirements when travelling, which may vary from antigen rapid tests (ART) and polymerase chain reaction (PCR) tests, to pre-departure and on-arrival testing. As these testing requirements are constantly evolving, we recommend doctors to refer their patients to the International Air Travel Association or the respective countries’ embassy website for the latest inbound measures. Undeniably, these measures and fluctuating guidelines will be a source of stress for some travellers. When travelling during the COVID-19 pandemic, a traveller may feel anxious over various situations, such as facing issues of quarantine upon arrival even if travelling via VTLs or testing positive during an on-arrival COVID-19 test and being subjected to an isolation period of at least ten days. Doctors should take note of those with mental health concerns and provide appropriate medical advice ahead of travel.
I share below an easy to remember SAFE TRIP mnemonic I developed to assist doctors when advising their patients on the topic of travel.
Subject
Subject refers to the traveller who may be the patient, friend, colleague or family member.
Assistance
Assistance refers to the availability of a helpline for the traveller in the event of an incident or illness.
Fitness to travel
Fitness to travel, especially for those with underlying chronic illness or other COVID-19 risk factors.
Environment
Environment refers to the COVID-19 risk and non-COVID-19 health risks that the traveller may be exposed to during the trip, including at the accommodation and methods of transportation.
Tests
Testing requirements: travellers should understand the different country-specific requirements for COVID-19 testing (eg, pre-departure versus on-arrival, ART versus PCR tests).
Resilience
Mental resilience: travellers need to be mentally prepared and ready to face the risk of prolonged isolation should they test positive for COVID-19 (even if asymptomatic). Asymptomatic COVID-19 cases in certain locations such as Hong Kong are managed in hospitals and not in hotels.
Insurance
A comprehensive travel insurance which includes COVID-19 coverage is recommended. In addition, if a senior individual must travel, a high insurance coverage amount is preferred. Senior travellers should check on the coverage during travel and upon return to Singapore (or their home country). The coverage is typically much lower compared to younger travellers.
Preventive measures
Preventive measures including safe distancing, wearing of face masks and maintaining personal hygiene are important even for vaccinated travellers.
In addition to the above, medical professionals should also be aware that other infectious diseases, such as acute gastroenteritis, dengue, malaria and yellow fever also exist in endemic countries. Meanwhile, security and safety concerns such as being exposed to the risk of accidents (through transport, work or residence), crime, civil unrest and natural disasters also remain when travelling.
Overseas evacuations
In the event of a worst-case scenario, where travellers face medical emergencies abroad and a medical evacuation is needed, engaging an experienced provider is highly recommended. This is especially so as the processing time for handing medical evacuations for both COVID-19 and non-COVID-19 cases has taken on a new level of complexity amid the pandemic. In recent years, International SOS has brought many Singaporeans, including COVID-19 patients, safely home. We have transported COVID-19 patients, either single case or multiple casualties, as well as stable or ventilated cases in Patient Medical Isolation Units using our special air ambulances.
In all, while travel is back, restrictions and complexity are here to stay. Advising travellers on the new travel landscape and precautions will help ensure a smooth, safe trip and return. While there is no crystal ball to anticipate the challenges or risks that a trip might bring, travellers who are equipped with information, advice and resources to navigate this new environment will be empowered with confidence and resilience when travelling.
Have a SAFE TRIP!