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Is test-on-arrival our escape from quarantine?

While most of the world has been locked down under strict entry requirements and quarantines for most of the year, economic realities mean countries are under pressure to start easing restrictions, says Carolynne Dear.

More accurate and faster testing in airports could ease quarantine requirements (photo courtesy Unsplash/Hanson Lu).

The Asia Pacific region has been slow to make progress in restoring international links. Governments across the region have raised hopes with talk of travel bubbles or corridors, only to dash them again when no progress is made. A second wave of infections across the region this summer hasn’t helped progress.

But while quarantine reigns, it's unlikely that anybody will be travelling for leisure anytime soon. Countries are now grappling with the workability of airport testing as a replacement for onerous self-isolation requirements.

Singapore has recently surged ahead of its Asian neighbours, albeit with a business travel solution. On September 1, a Reciprocal Green Lane (RGL) was put in place, meaning some travellers into Singapore from Brunei and New Zealand are no longer required to serve a stay-at-home (quarantine) notice. Instead, they can opt to take a Covid-19 test on arrival.

The RGL aims to facilitate short-term business trips and travellers must submit a negative coronavirus certificate to immigration officials and undertake a test on arrival.

Hong Kong also upped the ante this week when commerce chief Edward Yau announced that no less than seven countries had expressed an interest in negotiating a 'travel bubble' with the city. The government has been in talks with Japan and Thailand since the summer and has sent letters to 11 countries inviting dialogue. Seven, including Japan and Thailand as well as Australia, New Zealand, Vietnam, Singapore and Malaysia, have expressed a positive interest. The four remaining countries are South Korea, Germany, France and Switzerland. If bubbles were formed, Yau said that travellers would be tested before departure and twice more at their destination.

“Travellers would take coronavirus tests that are mutually recognised, and the test results would be sent to the destination country via the flight companies for confirmation, before they were allowed to board,” he said. “Once landed, the local health department could demand further testing.”

The one country in the Asia Pacific region to fully reopen so far is the heavily tourist-reliant Maldives. In July, it gave the green light to international travellers with restriction-free entry. However, after rising numbers of infections in August, it will from this week be asking passengers to arrive with negative PCR testing certification on arrival in the country.

London’s Heathrow Airport is currently assessing three new rapid tests with a view to reducing quarantine for ‘red’, or high risk, countries from 14 days to around a week. The airport believes that if passengers can present two negative tests, one on arrival and one three to five days later, they should be released early from quarantine requirements.

Critics of the UK’s quarantine policy claim the government is destroying the economy with arbitrary travel bans. This week, seven Greek islands including Crete, Mykonos, Lesbos, Tinos, Serifos, Santorini and Zante were added to the ‘red’ list, resulting in surging airline prices as British tourists scrambled to return home before the restrictions came into force on September 9.

“The government is using arbitrary statistics to effectively ban 160 countries and in the process destroying the economy,” said Willie Walsh, chief executive of British Airways’ parent company, IAG. “It needs to introduce a testing regime to restore confidence.”

As with other airlines around the world, British Airways has been badly hit by the pandemic and is currently looking to slash a further 12,000 jobs.

So what is the thinking behind the almost universal decision to earmark 14 days as the quarantine ‘gold standard’? Well, it’s all down to the incubation period of the virus, the time between being exposed and when symptoms start. The virus that causes covid-19 most commonly has an incubation period of five days. According to data from the World Health Organisation, around 97% of those who contract coronavirus will show symptoms within 11 days and 99% within 14 days. However, most infected people will show symptoms within a week, which bolsters the argument for double-testing around seven days apart.

According to medical experts, double testing of travellers significantly reduces the risk of false negatives. They say those who test positive after the first test should of course be required to isolate for 14 days, but those found to be negative should self-isolate for five days and undertake another test. If that test returns negative, then they should be given the all clear.

Germany became one of the first countries in the world to introduce airport testing back in June. German airline Lufthansa partnered with healthcare company Centogene to provide PCR testing at Frankfurt Airport. A walk-in testing centre was set up at Munich Airport in July. In late July, the German government launched free, voluntary tests for all returning passengers, with mandatory testing for arrivals from ‘high risk’ countries and a second, negative test is required within a week.

At around the same time, Iceland also introduced a test-on-arrival system. Arrivals can choose between taking a test or quarantining for two weeks. Children born in or after 2005 are not required to take a test or go through quarantine.

In the USA, Alaska is the only US state to offer testing on arrival. Like Iceland, in June it began offering arrivals the choice to test, or undergo 14 days of quarantine. From August, all non-Alaskans arriving into the state have also been required to produce a negative test certificate before travelling.

Back in Europe, the Channel Island of Jersey is operating the same scheme that has been proposed for Heathrow. Tests carried out on arrival are couriered from the airport to a nearby laboratory and results are available in 24 to 72 hours. Anyone testing positive must self-isolate for 14 days, but those with a negative result can move around the island freely. There is no need for a second test.

According to UK health minister Matt Hancock, coronavirus testing for arrivals will be introduced “as soon as it is practical”. However, he added that one test would not be enough as too many asymptomatic cases would be missed. The UK government is currently working on a plan to screen arrivals for a second time after eight days.

Of course ultimately the decision to remove quarantine and replace it with a double testing method over a shorter period of time is down to individual governments and how they balance the ‘health versus wealth’ conundrum.

“If we are going to learn to live with covid, there have to be alternatives to quarantine,” said Paul Charles of travel public relations firm The PC Agency. “Quarantine measures are extremely destructive to the economy, because you quarantine the vast majority of people who are perfectly healthy, affecting productivity and scarring the economy. The alternative has to be testing.”

Let’s hope a way forward can be found soon.


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