Airports Drop COVID-19 Screening For International Passengers: How to Stay Safe

As of this week, international travelers flying to the U.S. are no longer subject to enhanced COVID-19 screenings upon arrival. Additionally, international flights are no longer being rerouted to a select 15 American airports. While the U.S. Centers for Disease Control and Prevention (CDC) says these relaxed measures are safe based on our current understanding of COVID-19 transmission, the moves raise questions about what air travel will look like and how people can stay protected.

On September 14, the CDC began shifting its strategy away from uniform COVID-19 screening of all passengers on flights from China, Iran, the United Kingdom, Ireland, Brazil, and the Schengen region of Europe. Screenings included a questionnaire about symptoms and exposure risk, as well as a temperature check.

Now, the organization will focus on mitigating risk at an individual passenger level, using methods such as:

• Pre-departure, in-flight, and post-arrival health education for passengers
•  Illness response at airports
• Electronic and voluntary collection of contact information
• Country-specific risk assessments
• Enhanced training to help transportation sector employees recognize COVID-19
• Post-arrival passenger recommendations for self-monitoring
• Potential COVID-19 testing

Airlines are not required to conduct their own COVID-19 screenings. Emirates, however, requires a negative coronavirus test to fly and conducts rapid tests on-site.

Do Airline Screenings Work?

Christopher P. Morley, PhD, chair of the Department of Public Health & Preventive Medicine at SUNY Upstate Medical University, tells Verywell that ceasing screenings for travelers may have its drawbacks.

Morley says continuing to screen for COVID-19 symptoms could help with new outbreaks, which have been seen in other parts of the world such as Europe.

"Across Europe, a number of E.U. member states have begun re-closing borders as a fall spike begins to show itself," Morley says. "It is too soon to lower our guard. If we can occasionally identify a case by screening for symptoms, that is one more case that we can act upon."

Lawrence O. Gostin, JD, faculty director of O'Neill Institute for National and Global Health Law at Georgetown University and director of the WHO Collaborating Center on National & Global Health Law, thinks airlines should conduct their own screenings.

"Airlines are key partners and have a duty to keep passengers safe," he says. "This is especially true while boarding and disembarking a plane and during the journey. Airlines need to be sure there is good air circulation, seating is spaced out, and surfaces are regularly disinfected."

Gostin thinks it’s premature to stop enhanced questioning about COVID-19 symptoms, emphasizing the need to make international travelers aware of the importance of not traveling while symptomatic.

Still, physicians say there are reasons why symptom screening may not be so useful for international travelers.

Timothy F. Brewer, MD, a professor of medicine and epidemiology at the University of California, Los Angeles, points out there’s little to no evidence to show that screening travelers for fever or other symptoms can prevent the spread of COVID-19.

When the CDC and California Department of Public Health conducted a screening program in February and March, they found only 3 cases of COVID-19 in 11,500 airport travelers.

"The program did not prevent SARS-CoV-2 [the virus that causes COVID-19] from coming into California," Brewer says. "Because individuals infected with SARS-CoV-2 may be asymptomatic at the time they travel, screening programs may miss potentially infectious persons."

He says computer simulations suggest that 50% or more of travelers infected with COVID-19 may be missed by screening programs.

"Stopping screening programs will allow public health agencies to focus on more effective programs," Brewer says.

Gostin agrees that temperature screenings, in particular, are ineffective.

"We know from SARS and H1N1 that temperature screening is a highly inefficient screening method," he says. "It picks up very few real cases and it has a very high false-positive rate. In fact, scientists do not see value in temperature screening even outside airport setting."

Is Flying a Must?

Screenings aside, public health experts urge people not to fly unless absolutely necessary.

“I would stress that the safest thing travelers can do, regarding air travel, is to avoid it unless it is absolutely necessary,” Morley says. "My concern at this point is not about keeping cases out of the U.S.—we have a worse prevalence than many countries from which travelers might arrive. I am concerned about air travel more generally. Loading people into an enclosed space, densely packed, for hours on end, creates an opportunity to incubate new cases and create super-spreader events."

According to William Schaffner, MD, a professor at Vanderbilt University Medical Center, flying requires too much human interaction in close, indoor spaces over a span of time.

"The question is, ‘Is this trip really necessary?’” Schaffner says.

Reducing Risk During Air Travel

If you do choose to travel via airline, take as many precautions as possible to lower your risk for COVID-19. There is no such thing as traveling “safely” right now, because it automatically puts yourself and others at some sort of risk, Schaffner says.

Ways to lower your risk for infection while traveling include:

• Wearing a mask properly at all times
• Staying physically distant from others
• Eating and drinking before getting on the plane, so you can keep your mask on during flight
• Practicing good hand hygiene
• Wiping down surfaces on the plane
• Expediting hotel check-in

Passengers can also look into which airlines are blocking off seats, allowing people to sit further away from each other.

Southwest Airlines announced it will cap the number of people allowed on flights through November. Delta Air Lines announced it will block center seats through January 6. JetBlue Airways and Alaska Airlines are limiting the number of people on planes into October.

Still, your level of risk for COVID-19 on a plane may be largely out of your hands.

"A lot comes down to the air circulation patterns, and whether someone is seated in the direct breath plume of an infected individual,” Marney White, PhD, an associate professor of public health at Yale School of Medicine, tells Verywell. “Unfortunately the biggest risk on a plane, even with thorough temperature screening procedures, will likely be due to pre-symptomatic transmission in a confined space. I think, unfortunately, masking and distance will be the best people can do,”

Pre-symptomatic is not the same as asymptomatic, White clarifies.

Most people may not know the difference from being pre-symptomatic and asymptomatic, White adds. If you’re asymptomatic, you have the virus but no symptoms, and you won’t get them later. But pre-symptomatic people have the infection—just no symptoms yet.

"Some studies have found that the virus is being transmitted two to three days before the onset of any symptoms,” White says, explaining why the pre-symptomatic period can be dangerous. "So it is absolutely critical that everyone on the plane remain masked."

Flying Post-Pandemic

In addition to travel insurance fee hikes, flying will look a lot different as this pandemic continues—and after it’s a thing of the past.

Some airlines are currently conducting extra cleaning on airplanes. But Schaffner doesn’t think that will continue post-pandemic.

"I think there will be a regression to what was done before," he says.

As a result of the pandemic, he expects a lot of business and professional travel to be reduced. People will realize that they can do a lot of business virtually.

"That crystal ball of a post-pandemic time is still pretty far in the distance," Lauren Bryan, RN, MPH, an infection control nurse at UCHealth Yampa Valley Medical Center in Colorado. "I wish I could forecast that people will pay better attention to respiratory hygiene and hand hygiene. But honestly, in my opinion, I doubt that in five years from now there will be a discernible difference in [airline] operations than from pre-pandemic. Enhanced cleaning consumes resources that requires ongoing investment."