The International Civil Aviation Organization (ICAO) has published a Manual on Testing and Cross Border Risk Management Measures. The manual provides governments with a risk-based assessment tool for a testing program that could alleviate quarantine requirements.
The Manual is the result of bringing together the expertise of states, public health authorities (the World Health Organization, Centres for Disease Control and Prevention, European Centre for Disease Prevention and Control) and industry experts such as IATA, Airports Council International and International Coordinating Council of Aerospace Industries Associations.
This encouraging progress follows recent comments from the WHO’s International Health Regulations Emergency Committee Chair, Dr Didier Houssin, who foresees a role for testing as a means of reopening international travel without quarantine measures.
“Clearly, the use of the tests is certainly now supposed to have a much larger place compared to quarantine.”
“Momentum is building in support of our call for systematic testing to safely reopen borders without quarantine measures. ICAO, working with health authorities and industry, has produced a high-level framework. Health authorities are beginning to explore how testing could supersede quarantine to stop the cross-border spread of the virus. Encouraging results from testing pilot programs should now give states the confidence to move forward quickly,” said Alexandre de Juniac, IATA’s director-general and CEO.
Pilot programs for COVID-19 testing of travellers are beginning to produce encouraging results proving their efficacy.
- A study on arriving passengers in Toronto tested passengers three times: on arrival, at day seven and at day 14. Just 1% of passengers tested positive over that period, with 70% being detected with the first test. In other words, the study’s results could indicate the potential for about 60 out of every 20,000 travellers to go undetected on arrival, which is significantly lower than the underlying prevalence in Canada.
- A pre-departure testing program for the Milan/Linate-Rome/Fiumicino route detected about 0.8% of passengers with Covid-19. As this level of incidence is considerably higher than the reported prevalence of Covid-19 in Italy at the time, it would appear that not only was testing highly effective in identifying infected travellers but that systematic testing is the best way to detect asymptomatic cases and to break chains of transmission.
- A soon to be published European study is even more optimistic. It models scenarios for a highly effective testing mechanism. In a low prevalence scenario, there is the potential to see the number of undetected positive cases as few as five per 20,000 travellers, increasing to 25 in high prevalence situations. These levels of incidence are still much lower than the underlying prevalence of Covid-19 in Europe.
- IATA modelled the testing results to quantify the risk that would remain if systematic pre-departure testing were implemented. Assuming that testing identifies 75% of travellers correctly who have Covid-19 (the effectiveness of the test) from a source population with a prevalence of 0.8% of the population (e.g., similar to Chile), the risk is that 0.06% of passengers would have the disease and go undetected. That would mean 12 undetected positive cases for every 20,000 arriving passengers.
Testing is supported by travellers. An IATA survey revealed that 83% of people would not travel if it required quarantine. It also showed that some 88% of travellers would be willing to be tested if it enabled travel. The same survey also revealed that 65% believe that quarantine should not be necessary if someone tests negative for COVID-19. “Public opinion supports COVID-19 testing. They see it as a far better option compared to quarantine