The urge to be with family for the holidays is strong, even during a deadly—and surging—viral pandemic. The U.S. Centers for Disease Control and Prevention is advising that Americans just stay home. Like many people, my wife and I wanted to travel across the country to see her over-age-65 parents, but we hoped to do it as safely as possible. Could COVID-19 tests or other measures boost our confidence?
As a science editor at National Geographic, I’ve covered the pandemic since January, interviewing dozens of scientists and producing dozens of articles on everything from the start of the outbreak in Wuhan, China to promising (but not perfect) vaccine news.
One fact has emerged: You can’t eliminate the risk of catching the SARS-CoV-2 coronavirus while traveling, but you can certainly minimize it. This mantra—and some advice from epidemiologists and virologists—helped me come up with a less risky plan to travel and spend time indoors with at-risk relatives. Here are the key questions I asked myself.
Pandemic travel precautions
I felt uneasy as we left our home in Washington, D.C. to fly to California earlier this month, my mind buzzing with case rates, death rates, the CDC’s don’t-travel-now advice, and every COVID-19 stat I’ve learned over the past 10 months.
But I’d plotted like a scientist, breaking down each stage of the trip and considering the risks to myself and anyone else I’d meet along the way. First, this meant keeping up basic layers of protection—mask wearing, social distancing, good hygiene, attending only outdoor social events—while traveling.
“Everything we’re doing to try to limit the spread of this virus is imperfect, but hopefully, when layered, can add up to a greater degree of safety than just one measure by itself,” says Jennifer Nuzzo, an epidemiologist who leads the Johns Hopkins Testing Insights Initiative at the Center for Health Security.
Things get trickier and riskier if you want to stay overnight—or feast indoors—with friends and family from outside your household. “We’ve seen family meals listed among some of the more common superspreader events where a lot of people are infected at once,” Nuzzo says. “It’s probably because peoples’ worries about being exposed from family are lower.”
That’s why my wife and I used a combination of testing, isolating, and extra precautions on our trip. It’s also what scientists recommend for anyone else attempting to travel in a safer way now.
The importance of quarantine
Nothing will protect your health and that of your relatives as much as skipping all interactions with people outside your bubble for two weeks before you come together. That means no visiting the grocery store and no sitting at cafes, even outdoors.
If you want to eat turkey with grandma or gather around a Christmas tree with your seventysomething parents, you’ll also need to build in a quarantine period. That’s particularly true if anyone you’ll be seeing indoors for a prolonged period is at a higher risk of serious COVID-19 complications.
My wife and I opted to travel to California two weeks before Thanksgiving so we could quarantine at an Airbnb before decamping to her parents’ house for the holiday. We worked from the rental, got groceries via curbside pickup, and went on solo hikes. Your loved ones must also behave the same way—a bubble only works if no one busts it.
If you’re driving a long distance and can completely avoid other people (say, in an RV or overnighting in short-term rentals with contactless check-in), you could do part of your quarantine en route.
Why testing is vital
“One thing is clear: A negative test does not completely rule out that you have not been exposed to COVID,” says Esther Babady, director of the Clinical Microbiology Laboratory at Memorial Sloan Kettering Cancer Center.
You could have a negative result and still be infected with—and pass along—COVID-19. After exposure, the average person takes about five days to develop measurable levels of the virus, known as the “incubation window.” This window doesn’t always match the symptoms, which can take up to 14 days to appear. In the meantime, people could pass the virus to anyone they come into close contact with. Some 50 percent of COVID-19 transmission comes from those without symptoms.
The safest protocol to protect yourself, your family, and strangers is to get three negative test results over a two-week period. Here’s how that works:
Get a test right before your departure. If it’s positive, then go home and isolate for at least 10 days to keep from delivering the virus to new places and people. If you test negative, go into quarantine and keep up basic precautions—masks, social distancing, and hand washing—recognizing that every close contact with strangers could mean a new exposure.
After hopping into quarantine, Saskia Popescu, an epidemiologist at George Mason University always seeks COVID-19 tests six and 11 days later. The first test is for peace of mind—because it comes after that average incubation window.
Popescu goes back a second time because “studies have shown 97 to 98 percent of people, if they are going to test positive, will do so by day 11.” Plus a comprehensive analysis published in mid-November found that COVID-19 patients don’t tend to be infectious after nine days, mirroring new CDC quarantine options. The centers still prioritize a a 14-day quarantine, but also published seven- and 10-day alternatives depending on factors such as negative test results and the absence of symptoms. (The new rules don’t apply to anyone who tests positive, who must follow a separate set of isolation practices.)
The most reliable option is a PCR (polymerase chain reaction) test, which are nearly 100 percent accurate if you’ve waited long enough after exposure. But it can take hours to days to get results. Rapid tests give quicker—sometimes 15 minutes—results, but can miss up to 16 percent of cases relative to PCR tests. “What we gain in speed, we lose in accuracy,” Popescu says. “It’s not a lot, but I prefer PCR.”
Do you need more than one test?
If you’re symptom-free and following stringent health rules at home, you don’t need to test before leaving. Fly or drive to your destination and just get tested on day 11 of your two-week quarantine, which will only miss about three percent of COVID-19 cases.
Some places, including New York State, recommend that travelers quarantine for three days, get tested, travel, then get another test four days later. This is risky, because about half of all COVID-19 patients test positive between the fifth and the eleventh day after exposure. “Statistically, it’s just that you don’t know if you’re on the tails,” Nuzzo says.
Where to get tested
Under the strictest rules, your quarantine clock doesn’t start until you stop coming in close contact with strangers, so we used drive-thru testing in Los Angeles. To find testing locations both where you are going to and coming from, check the city or county health departments, which may be more precise than state sources, especially about costs. While COVID-19 tests in the United States are supposed to be free, some people have been surprised by exorbitant medical bills. Read the fine print.
If you can’t test and quarantine before a holiday trip, hold joint festivities outdoors, keep six feet apart, and stay masked at all times. “Encourage people to do the highest level of safety possible, recognizing that now is a non-ideal time to travel,” Nuzzo adds.
How to calculate risk
“Think about the number of people that you encounter in the course of your travels compared to who you may encounter in the course of your day,” Nuzzo says.
This mental exercise can help a person decide what their potential exposure might be during a journey—whether it makes more sense to drive (minimize contacts) or fly (mix more often with strangers) or just stay home.
If you’re nervous about catching or spreading the virus, consider two simple numbers rather than fancy risk calculators.
Travelers should look up viral caseloads both where they live and at their destinations. Start by searching for how many people recently caught the virus in both places. “That’ll tell you your likelihood of encountering people who may be infected,” says Nuzzo.
For instance, Washington, D.C., where my wife and I live, had a moderate outbreak when we left with 13 cases per 100,000 residents over the prior week—meaning about 90 people are catching the virus every day. Contrast that with Milwaukee, where about 900 new cases were being recorded daily; a case rate of 97 per 100,000 people. Heading to or traveling from the Wisconsin city increases your odds of catching—or spreading—the virus.
Also consider the test positivity rate. If it’s above five percent in a given location, governments and hospitals may be focusing all their testing resources on the sickest patients, meaning mild cases and potential spreaders are being missed. A rapid rise in test positivity can also signal that the outbreak isn’t under control.
Navigating air travel
Road trips have soared in popularity during the pandemic, and driving to your holiday destination—while avoiding contact with others—does mean less indoor time with strangers than flying. But we opted to fly, since a cross-country road trip would take a week, and many experts say airplanes are safer than you think.
Remember that SARS-CoV-2 most often spreads when people come in close contact, increasing their exposure to hefty respiratory droplets or smaller particles called aerosols that linger in the air over a few feet. Airplane ventilation systems filter out 99 percent of those particles.
“Millions and millions of people are flying, and very few are getting sick [with coronavirus] from their time on an airplane,” says Joe Allen, the director of the Healthy Buildings Program at Harvard T.H. Chan School of Public Health.
The bigger danger is the airport, which Allen and other experts say presents the highest risk of catching the coronavirus during air travel. Surfaces like ID scanners or bins in the security line pose a much lower threat than germy fellow passengers, but the danger quickly compounds when many people are touching the same surfaces.
The labyrinth of human bodies means you’ll want to practice social distancing, mask wearing, and good hygiene (bring hand sanitizer!) in check-in and boarding lines. If you’re hungry, eat far away from other people. “I keep seeing [travelers] getting food to go and then going to the gate. They’re sitting there unmasked way closer than they would be in the restaurant,” says Popescu, who has traveled for work by plane eight times over the past two months.
On the flight, open your overhead vent. The gust coming out is not only filtered, it also creates an invisible buffer between you and others. “It’s helping to limit the air that’s being transported across rows,” says Allen. Snacking or drinking en route should be OK as long as you don’t take your mask off for longer than 15 minutes.
Do a little homework before you book your flight. Check if your airline keeps its ventilation on when the plane is parked at the gate, if it boards back to front, and if it keeps flight capacity under 60 percent to ensure social distancing. All these practices can help ensure your safety.
“It’s not a no-risk environment,” says Leonard Marcus, co-director of Harvard’s Aviation Public Health Initiative. But, “while we’re in the midst of the pandemic, there are ways that risks can be significantly reduced.”
Masks and other matters
Everyone’s safety formula ultimately depends on how much risk they’re willing to take while also considering the burden they may be putting on others if they catch the virus.
For example, I’ve been wearing a standard fabric mask to go to the grocery store or walk around Washington, D.C. But for prolonged travel, I opted for an upgrade: Chinese KN95 masks. They’re close cousins of the N95 masks—which filter out 95 percent of particles—which aren’t recommended for the general public due to the limited supply for health-care workers.
“The only difference between KN95 and N95 is who certifies it,” says William Ristenpart, a chemical engineer at the University of California, Davis, whose lab studies disease transmission. To avoid counterfeits, I checked the list of authentic KN95s on the websites of the CDC and U.S. Food and Drug Administration.
Make sure your mask fits well. Eugenia Kelly, a researcher at the University of Cambridge, worked on a study about mask effectiveness which found that a poor fit could reduce their effectiveness by up to 40 percent. The problems were most common with KN95s. “It was almost hanging off of a lot of participants,” says Kelly. Her crew also worked on hacks to prevent leakage, such as layering a surgical mask under a tight fabric one or sealing off gaps with tape and pantyhose.
The good news? My plan has worked so far. My wife and I tested negative twice and stuck to our regimen, and we’re now podded up for two weeks with my in-laws (who also took precautions). Yes, like any journey now, this put all of our health at risk. It’s irrational. It’s primal. But that’s family.
“It’s so hard. Everyone wants to see their family, and everyone is so tired of being cooped up,” says Nuzzo of Johns Hopkins, who also recently traveled to see at-risk in-laws without incident (Nuzzo quarantined for 14 days first). “It’s all about trying to mitigate risk as much as possible.”