By Alex Macheras
If a passenger has been diagnosed with a communicable disease or is suspected of having any, it may be thought necessary for public health reasons to locate the people who have been in close contact with this passenger, to advise them of the exposure and to carry out tests to see if they have contracted the disease. This is what is referred to as ‘contact tracing’ and is a public health responsibility.
Just two years ago, contact tracing was considered a headache by many stakeholders of the industry, but now reliable contact tracing is recognised as essential in stopping the further spread of Covid-19. It is also the strongest back-up should a passenger be detected as infected after arrival. Rapid identification and isolation of contacts contains the risk without large-scale economic or social disruption. While the industry is advocating the use of contactless travel options to reduce the number of physical touchpoints, some states have mandated paper-based forms to collect travellers’ contact information. Airlines have been required to distribute and collect the forms. Furthermore, acting on written information on paper forms may be challenging and resource-intensive, especially when it comes to efficiently tracing individuals who might pose a risk or be at risk.
“The collection of self-declared passenger health data is a transaction that must occur solely between passengers and authorities, even more so during health outbreaks. Airlines should not be responsible for collecting this data. We urge governments to develop web portals dedicated to collect passenger health data. This is the safest, most robust and efficient solution for passengers to provide necessary data to authorities during the Covid-19 crisis and in the future,” said Albakri, of IATA’s Middle East office.
In Greece, any passenger arriving from a foreign country must fill out a passenger locator form 24 hours before they travel, as part of the country’s contact tracing efforts. The move is being reinforced with fines of €500 or Greek authorities not allowing travellers entry to the country.
Last month, US Vice President Mike Pence told major airlines to move forward with an industry-led solution for the contact tracing of passengers during pandemic.
Pence gave a “compromise solution” for contact tracing during a meeting with airline executives. Airlines had initially disliked the government’s demand that they collect detailed contact information on all passengers and distribute it to public health officials if requested. The airlines said it would be impossible to quickly overhaul the massive legacy computer systems that handle the industry’s vast booking networks. But Pence now supports the airlines’ proposal for a third-party app and website that would require passengers to input five points of data.
The industry group, Airlines for America, said in a statement after the meeting that it looked forward to implementing some initiatives to help relaunch the industry. “We appreciate the collaboration and interest of the Administration since the onset of the pandemic,” the statement read. “We had a constructive conversation today with the Vice President and remain grateful for his leadership through this health crisis. We look forward to working with the Administration to identify and implement initiatives that help relaunch the US airline industry, get people moving again and rebuild the American economy.”
However, there are concerns that contact tracing for passengers is still not working as it should be – despite airlines realising the importance of it during the Sars outbreak in 2003. A 2008 report showed that 5 years after the Sars (severe acute respiratory syndrome) epidemic spread around the globe via air travel, significant barriers were still in the way of tracking down and notifying airline passengers who may have been exposed to an infectious disease.
The process for contacting those passengers is complex, involving a mix of international, national, state, and local government agencies as well as private businesses. Public health officials also confirmed that, as recently as last year, there are jurisdictional and data-access challenges to tracing and alerting passengers.
Lancet modelling studies have shown how mobile apps can increase effectiveness of contact tracing compared with conventional approaches, but effectiveness depends on what proportion of the population will use the app consistently for a sufficiently long period of time. Modelling studies have predicted that contact tracing alone cannot control an outbreak if tracing coverage is too low. Lancet also investigated the impact of timeliness and completeness of case reporting on the effectiveness of surveillance and interventions, and we quantified the timeliness of contact tracing of infected passengers during an airline flight for the 2009 influenza pandemic. In all of these studies, the timing of various steps in the monitoring and intervention chain emerged as a key factor for effectiveness of a public health response. Usually, there are identifiable delays in the response chain that might be crucial to the overall effectiveness of a strategy.
There’s one important takeaway: passenger contact tracing and testing must go hand in hand in order for both to be effective health protection measures. Passenger contact requires an infrastructure for testing that allows people with symptoms to be quickly tested and alerted to their results, preferably within one day of symptom onset.
Airline leaders continue to view Covid-19 testing as one of the few strategic options that has the ability reduce further damage to the already suffering global air travel sector. Ideally, testing would be completed in a rapid, reliable way prior to departure. The goal is for an airline to be able to declare a flight as ‘sterile’ or ‘Covid-free’.
* The author is an aviation analyst. Twitter handle: @AlexInAir
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