Travel Guard Health Advisory: Coronavirus (COVID-19) outbreak

12/08/2021

Date issued: 8 December 2021, Travel Health Advisory #18

As of 8 December 2021, there have been at least 267,344,049 total cases worldwide with 5,275,476 reported deaths. Countries with the highest numbers of reported COVID-19 cases are the United States, Germany, United Kingdom, Russia and France. The World Health Organization (WHO) advised that if any traveler has symptoms suggestive of acute respiratory illness during their travel period or after returning, they should seek medical attention and highlight their recent travel to medical personnel. 

Due to viruses constantly changing and mutating, new variants will continue to occur. Some variants may be more transmissible or cause more severe illness and death. The CDC issued the following guidance regarding the emergence of variants:

• Obtain a COVID-19 vaccine.
• COVID-19 booster shots are recommended for those who are 18 or older at least two months after their initial J&J/Janssen vaccine or six months after their initial Pfizer-BioNTech or Moderna vaccine series.
• If you are not fully vaccinated continue to wear a mask in public areas indoors to prevent spreading COVID-19 to others regardless of the level of transmission in your area.

On 26 November 2021, the WHO named a new variant, Omicron, detected in South Africa and the CDC continues to monitor this new Omicron variant and is still working to understand how contagious it is and the severity of illness it causes. However, the highly contagious Delta variant continues to be the predominant variant in the U.S. On 11 May 2021, the WHO named the Delta variant, detected in India and data showed that the Delta variant was more transmissible, even in vaccinated people and caused more severe illness in unvaccinated people. The CDC continues to monitor the Delta variant and issued more information about its infections and transmissibility. Some data showed that fully vaccinated individuals with breakthrough Delta variant infections spread the virus for a shorter amount of time when compared to unvaccinated individuals.

On 3 December 2021, the U.S. Department of State issued COVID-19 testing required to advise U.S. citizens and permanent residents two years of age and over that a negative COVID-19 test taken within one day of departure will need to be presented prior to boarding when entering the United States.

The CDC issued information for traveling during COVID-19 containing resources on travel risks, domestic and international travel, travel health notices, air travel and cruise ship travel. These include taking the following steps to reduce exposure and slow community spread:

• Obtain a COVID-19 vaccine.
• Stay home and postpone travel if you are sick or test positive for COVID-19 or have been exposed to someone with COVID-19.
• Wear a mask and continue to social distance when possible.
• Avoid touching your mouth, nose, or eyes before washing your hands.
• Wash hands with soap and water for at least 20 seconds especially after going to the bathroom; before eating; and after sneezing or coughing. If soap and water are not readily available, use an alcohol-based hand sanitizer that contains at least 60% alcohol.
• Supplies of hand sanitizer, tissues, and other hygiene products may be limited, so consider bringing them with you.
• Older adults and people of any age with serious chronic medical conditions are at increased risk for severe disease.

The CDC issued guidance to help explain quarantine and isolation recommendations:

• Review and understand entry and exit testing regulations and quarantine requirements for destinations you are traveling to.
• If you test positive for COVID-19 during travel you will need to quarantine according to the local health and/or government’s mandatory quarantine period and postpone your return until it is safe to do so.
• After returning home from travel individuals who are fully vaccinated should self-monitor for any COVID-19 symptoms and isolate and get tested if you experience symptoms.
• If you are not fully vaccinated, get tested three to five days upon your return and self-quarantine for seven days. If you do not get tested, self-quarantine for ten days.

The CDC and the WHO published health resources with advice for gatherings and holidays. These include recommendations to celebrate safely and help protect yourself, reduce exposure and limit community spread:

• Help protect young children and people with underlying medical conditions or weakened immune systems by getting the COVID-19 vaccine. Other eligible individuals who may be around them should also get the COVID-19 vaccine.
• If you are not fully vaccinated wear a mask if you are indoors. Do not host or attend a gathering if you are feeling sick or have symptoms.
• Children younger than two should not wear a mask.
• Avoid touching your mouth, nose, or eyes before washing your hands.
• Wash hands with soap and water especially after going to the bathroom; before eating; and after sneezing or coughing. If soap and water are not readily available, use an alcohol-based hand sanitizer that contains at least 60% alcohol.
• If you develop symptoms of COVID-19 after attending a gathering you should get tested.

A new outbreak of pneumonia was first seen in early December 2019 in Wuhan, Hubei Province, China. On 7 January 2020, this outbreak was identified as being caused by novel Coronavirus (2019-nCoV). On 11 February 2020, the World Health Organization (WHO) announced an official name for the disease that is causing the coronavirus disease, COVID-19.

Coronavirus refers to a family of respiratory viruses that can range from the common cold to a more severe disease, such as Middle East Respiratory Syndrome (MERS-CoV) and Severe Acute Respiratory Syndrome (SARS-CoV).

The first Coronavirus was isolated in birds in 1937 and the first Human Coronavirus (HCoV) was identified in the nasal swab of patients with the common cold in the mid-1960s. Until now, seven strains of Coronavirus infecting humans have been identified. The newest strain, known as novel Coronavirus (2019-nCoV), was identified in China on 7 January 2020.

The virus is mainly zoonotic, which means that the disease normally exists amongst animals, but some of the viruses have the ability to spread to humans in what is known as a spillover event.

There is limited research on the exact mode of transmission of COVID-19, but the most likely route for a human-to-human transmission is via contact with an infected person’s secretions.

Depending on the virulence of the Human Coronaviruses, the most common transmission from an infected person to others would be through the air (coughing and sneezing), close personal contact (touching or shaking hands), touching an object or surface that an infected person has touched and then touching your mouth, nose, or eyes before washing your hands and, in some rare cases, via fecal contamination.

The novel Coronavirus was initially linked to the Wuhan food market, as many of the initial patients were customers of the market where a positive sample was isolated.

The common Human Coronaviruses mainly present as mild to moderate upper respiratory tract illnesses similar to the common cold. COVID-19 symptoms may include runny nose, cough, fever, sore throat, headache, loss of taste or smell, shortness of breath, skin rash or discoloration of fingers or toes, red or irritated eyes, diarrhea and may progress to pneumonia or bronchitis with shortness of breath and easy fatigability.

Those at high risk of developing complications include those with underlying chronic conditions, such as respiratory and cardiac diseases, immunocompromised individuals, diabetics, as well as those in extreme age groups (e.g. infants or the elderly). In addition, pregnant women are also at higher risk if infected by COVID-19.

There are several types of tests for this virus available. This would include serum PCR assay, nasal swab, broncho-alveolar lavage, sputum and sometimes stool samples.

The WHO published advice to help reduce the chances of being infected and prevent the spread of infection. These include:

• Obtain a COVID-19 vaccine.
• COVID-19 booster shots are recommended for those who are 18 or older.
• Wear a mask and continue to social distance in public areas indoors.
• Avoid crowded places especially within a closed and confined space and try instead to meet people outdoors. Avoid shaking hands and greet people with a wave instead.
• Wash hands with soap and water for at least 20 seconds.
• Use an alcohol-based sanitizer if soap and water are unavailable.
• Cover mouth and nose when sneezing and coughing and follow with hand hygiene.
• Avoid contact with people suffering from acute respiratory illnesses.
• Stay home when you are having symptoms of upper respiratory tract infection or have minor symptoms.
• Drink plenty of water and keep well hydrated.
• Regularly clean and disinfect objects and surfaces touched by an infected person.

The above measures are effective against all infectious agents, including Influenza A and B (“the flu”), which sickens millions of individual worldwide and kills thousands each year.

If you develop a fever (100.4F/38C), cough or have difficulty breathing call your health department for advice before seeking care. If you can’t reach your health department, call ahead before going to a doctor’s office or emergency room.

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AT-12280-20 (12/2021 R18)