Australians are taking to travel again, with vigour. Do we still need to take precautions and if so, what’s the best advice for concerned travellers?
Suzanne Harrison reports
Regular business traveller Christian has done away with COVID-related caution since his first foray into overseas travel earlier this year.
“On my initial trip to US in February, I took all possible precautions, from masks, sanitisers and vaccine boosters,” says the Perth finance professional, freshly returned from another overseas visit.
“Nowadays, I am far less cautious and, dare I say, am back to a pre-pandemic mindset and routines.”
Lucky for Christian, he is not in a high-risk category. Still, he is one of hundreds of thousands of Australians flocking to the skies, vaccinations and testing requirements checked off. And mostly not for business or family reasons.
In August this year, the Australian Bureau of Statistics reported that holidays were Australians most popular reason for overseas travel in June, with 169,000 returning from short trips overseas.
Jenny Dobak, ABS director of migration statistics, said this was the first time such figures had been seen since the beginning of the COVID-19 pandemic, overtaking visiting friends or relatives.
For those without pre-existing issues and the young and fully vaccinated, it’s understandable that concern has dissipated – it was more than an 18-month ban on overseas travel without exemptions.
Yet for many others, such as the elderly, or those with chronic conditions, there is the lingering question of whether travel is safe when it comes to COVID, or how to deal with the problem should COVID arise. And family doctors now have the extra challenge of being at the frontline of that advice, one that can change rapidly with an evolving situation.
So, what is the best advice to offer now, and what challenge does that represent to doctors, especially as people have become responsible for themselves and are not under any obligation – in many countries – to abide by COVID-related regulations?
Be prepared
It seems the consensus is by all means, go travelling, but preparation is key and precautions need to be tailored to suit, depending on an individual’s state of health and where they are travelling to, a situation that is hardly new, just slightly more complicated, and/or time consuming.
When it comes to the patient, “people should be mindful that they are personally responsible,” says Jaya Dantas, Professor of International Health at Curtin School of Population Health. “Have the third COVID vaccination dose if you can, always carry a mask, take a small hand sanitiser and try to avoid huge crowds.”
Professor Dantas herself always wears a mask on long-haul flights when sleeping, downloads her international vaccination certificate with the QR code and takes a printout, too, as some countries may not put as much weight into a digital format.
She ensures other vaccinations are also up to date (flu, yellow fever, tetanus, for example); that she is carrying RATs, over-the-counter pain relief, antihistamines and anti-inflammatories, and a few days before flying checks relevant travel websites for any possible requirements or restrictions to the place of travel.
Mask-wearing is still a hot topic. While many favour it, others are glad it is no longer mandatory on flights.
The “great unmasking” as it was called in the press, was launched on September 9 on all domestic Australian flights and international flights to Australia.
In mid-June this year, major airports declared masks optional, with many keen travellers welcoming the news. Flying now, Professor Dantas says she hardly sees any Australians wearing masks domestically, but on a recent flight to India, everyone was wearing one. As Professor Dantas says, “wear a mask if you want to.”
However, for regular Perth-based business traveller and now, overseas holiday maker Andrew, mask-wearing in the airport – not the plane – has become his go-to when it comes to avoiding COVID.
“I don’t wear a mask on the plane, as most are well ventilated with HEPA filters,” he says. “But at the gate, or in a heavy queue, it’s usually a crowded, locked-in environment, so I am actually more careful in the airport itself.”
As for the need to visit a GP prior to departure, Professor Nick Zwar, chair of the RACGP Travel Medicine Specific Interest Group and based in Queensland, advises that if you are otherwise healthy and travelling to a location such as New Zealand, Central Europe, the US or Canada, then it’s not necessary.
But for those with long-term medication requirements who are older or have a chronic condition, then it’s a good idea.
Ensure insurance
“Your medical summary should be printed out. That can be very helpful, as is travel insurance.” Professor Zwar adds.
A classic example of how COVID can upend travel even in our post-COVID-peak world is the outbreak reported in October this year on the ship, Coral Princess, on which a number of people were infected. Luckily, with vaccination and rigorous testing in today’s travel environment, this kind of drama unfolds with much less fanfare, particularly as the ship was in Australian waters.
More importantly, how would the traveller be best prepared if they do become infected on such a ship?
One thing to note is that the Australian Department of Health and Aged Care says the Government’s ability to provide consular services or support on board an international cruise ship is likely to be limited.
“Cruise ships are a significant risk for COVID, the flu, diarrhoea, there are a lot of people in a small space and even if they are taking steps to contain it, we’re still seeing outbreaks,” Professor Zwar says.
“So, people need to think how they’d respond. And if they are going on a ship, buy disinfectant, wash hands regularly and wear a mask.
“If you want to reduce your chances of catching COVID – or anything in a confined space – and therefore have your travel uninterrupted, wear a mask, even interstate travel.”
Professor Zwar says only about 40% of Australians visit their GP before going overseas, and there is a tendency for people to think about pre-travel advice at the last minute.
“But in our enthusiasm, we have not thought through how things are different now.”
Professor Zwar suggests people simply think potential situations through and be prepared.
As for a reliable website suggestion, he advises checking the US Centre for Diseases and Control and Prevention and in Australia, Smartraveller (www.smartraveller.gov.au/) because they are well-managed and up-to-date, particularly when it comes to areas that should be avoided.
Get info
The Smartraveller website provides travel advisories for 178 destinations, with an advice level for updates to its travel advice, general advice before you go, and while you’re away – especially when things go wrong overseas – and information about Australia’s consular services.
Of course, there is still the issue of variants, which the world will continue to see.
“One hopes that these become less virulent,” Professor Zwar concludes. “But there is no guarantee.”
Amid that lack of guarantee, the RACGP has outlined in the travel medicine document for the 2022 curriculum and syllabus for Australian general practice, that “lots of people won’t make a specific appointment for a travel consultation.”
The document suggests encouraging patients to book a long appointment, where possible, and use systems to help them indicate they’re attending for a travel health consultation.
“However, you might only learn about their travel incidentally,” the report states, “at a consultation for another reason, and they may be leaving too soon to book in again. Be prepared to rapidly prioritise travel health strategies in the available consultation time and give patients resources.”
Always talk about travel insurance and what it does and doesn’t cover, the document continues.
“Pregnancy and pre-existing conditions are essential to declare. Travel-related risks exist even in domestic travel, as it’s still important to discuss (risks) to destinations in Australia, particularly for trips of longer duration, those to more remote destinations, or for individuals with pre-existing medical conditions.”
This checklist from Smartraveller also makes it easier for travellers:
- Read the general travel advice before you go to help plan to stay safe and healthy. Find out what you need to do if you’re travelling with children
- Get a health check and organise your travel vaccinations. Some vaccinations need to be done well before your trip, particularly those that need several doses
- Plan contingencies if you end up overseas longer than expected
- Check with your travel provider. They can help you understand rules and requirements specific to your planned trip.
Dangers
For the unvaccinated, Smartraveller strongly discourages international travel due to the health risks posed by COVID-19.
“Understand that the risks might be different for you. Airlines and cruise lines may have a vaccination policy that prevents you from travelling with them. You may face more difficulty finding flights.”
For the vaccinated, it may be that – like Christian – it comes as no surprise several US data companies reported the second most Googled search of 2021 was, ‘where’s my refund?’
“High airfare costs and significant flight delays have been the biggest pain points,” Christian says of recent travel. “Initially, it was pre-departure and pre-arrival vaccination paperwork but that seems to have all but disappeared on the countries I’ve been visiting.”
ED: Professor Jaya Dantas is also Deputy Chair, Academic Board, Dean International, Faculty of Health Sciences at Curtin University. Professor Nicholas Zwar is also the Executive Dean, Faculty of Health Sciences and Medicine, Bond University, Queensland.