The document provides governments with a risk-based assessment tool for using testing programs that could alleviate quarantine requirements.
It has been produced by the ICAO Collaborative Arrangement for the Prevention and Management of Public Health Events in Civil Aviation (CAPSCA). CAPSCA brings together the expertise of states, public health authorities (World Health Organization/WHO, Centers for Disease Control and Prevention, European Centre for Disease Prevention and Control) and industry experts (IATA, Airports Council International, International Coordinating Council of Aerospace Industries Associations).
“Momentum is building in support of our call for systematic testing to safely re-open borders without quarantine measures,” said Alexandre de Juniac, IATA’s Director General and CEO. “ICAO, working with health authorities and the 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.”
Testing—Efficacy and Performance
Pilot programs for the COVID-19 testing of travelers are beginning to produce encouraging results.
- A study on arriving passengers in Toronto tested passengers three times: on arrival, on day 5 and on day 14. One percent of passengers tested positive over that period, with 70% being detected with the first test. In other words about 60 out of every 20,000 travelers could 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 was 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 travelers 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, undetected positive cases could be as low as 5 per 20,000 travelers, increasing to 25 in high prevalence situations. These levels of incidence are much lower than the underlying prevalence of COVID-19 in Europe.
- IATA modeled the testing results to quantify the risk that would remain if systematic pre-departure testing were implemented. Assuming that testing identifies 75% of travelers who have COVID-19 correctly from a source population with a prevalence of 0.8% of the population, 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.
These studies all point in the direction of testing being an efficient means to limit the spread of COVID-19 through air travel. “Data show that systematic testing can reduce the risk of importing COVID-19 through travel to very low levels—not zero, but very low,” said de Juniac. “Certainly, in most cases it would reduce risk to levels that mean that arriving passengers are less likely to be infected than the local population and therefore do not add meaningfully to the prevalence of COVID-19 in most places. Efficiency will increase. Advances in technology are happening every day that will improve testing performance.”
Significant advances in testing technology will help governments implement testing for travelers without compromising the availability of tests directly related to the healthcare sector, particularly polymerase chain reaction (PCR) testing. For testing to be incorporated into the travel process it must be fast, accurate, scalable, easy to use and affordable. While IATA does not recommend a specific test type, laboratory reported accuracy for the rapid antigen test (RAT) does meet the aforementioned criteria. The Oxford/Public Health England study indicates 99.6% specificity along with very high sensitivity for RAT.
Testing is also supported by travelers. An IATA survey revealed that 83% of people would not travel if it required quarantine. It also showed that some 88% of travelers 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.
Global standards are needed to transform the many testing pilots and “bubbles” into a global re-start of international flying. To support this IATA is developing:
- A practical implementation guide for the Manual on Testing and Cross Border Risk Management Measures
- The IATA Travel Pass to manage COVID-19 test certifications, one of several solutions in development to help manage testing certifications. IATA welcomes the evolution of a competitive market for these solutions that should be cost-effective, global, accurate and interoperable.
IATA urges governments to work quickly with the industry to implement a globally harmonized and systematic approach to COVID-19 testing in the travel process.
Travel essentially remains in lockdown. Each day that this situation is prolonged puts more jobs at risk and makes the road to recovery that much more difficult.
Implementation of a globally harmonized systematic testing regime for international travel would complement measures already well established to keep travelers safe. In June, ICAO published Take-off: Guidance for Air Travel through the COVID-19 Public Health Crisis, which calls on governments to implement a multi-layered approach to sanitary measures throughout the travel process. Mask-wearing is especially key to the Take-off requirements with a strong consensus among recently published studies of air travel and COVID-19 pointing toward the very low risk of inflight transmission.