In a recent study posted to the medRxiv* preprint server, researchers evaluate the travel restrictions placed by nations worldwide following the emergence of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) Omicron variant.
Study: Fifteen Days in December: Capture and Analysis of Omicron-Related Travel Restrictions. Image Credit: Bakhtiar Zein / Shutterstock.com
Background
After the emergence of the SARS-CoV-2 Omicron variant in South Africa in November 2021, despite the risk-based approach advised by the World Health Organization (WHO), several nations around the world imposed stringent travel restriction policies to minimize the importation of Omicron into their country. These policies primarily targeted South African countries, even after Omicron community transmission was reported in other parts of the world.
About the study
In the present study, the authors analyzed national-level travel restrictions imposed globally during the first three weeks following the emergence of the SARS-CoV-2 Omicron variant.
The researchers differentiated between the travel restriction policies by those targeting travelers from particular nations and broad screening techniques. The researchers also evaluated differences in regional-level approaches for mitigating Omicron transmission.
Study findings
The data capturing process of Omicron-related travel restriction policies revealed that a total of 221 Omicron-associated travel policies were implemented across the world between November 24, 2021, and December 15, 2021, following the emergence of the Omicron variant.
During the first three weeks following the identification of the Omicron variant, the entry bans or flight restrictions that were implemented by several nations primarily targeted seven countries from Southern Africa. These countries included Eswatini, Botswana, South Africa, Mozambique, Namibia, Lesotho, and Zimbabwe, followed by additional bans on travelers from Malawi, Zambia, Angola, Egypt, and Nigeria.
Although the entry bans led to the repatriation of residents and citizens to their own countries, airport transit restrictions for travelers from the targeted countries barred their return.
The entry bans on travelers from Egypt and Nigeria were based on the detection of Omicron-positive cases among those who traveled from these countries. Hence, in most cases, the travel restrictions were not based on Omicron’s epidemiological data in these countries and were instead tied to Omicron positivity among those who traveled recently from these countries.
The travel restrictions enacted during the later periods of the Omicron wave included enhanced screening at the borders through universal entry requirements. These screening approaches required travelers to provide recent SARS-CoV-2 polymerase chain reaction (PCR) test results and mandatory quarantine for travelers.
Most countries that placed flight suspensions or entry bans during the initial weeks of Omicron emergence continued those measures and incorporated layers of testing and quarantining during the later periods. By contrast, four countries including the United Kingdom, Israel, Cambodia, and Sri Lanka replaced travel bans with nuanced SARS-CoV-2 screening protocols.
Map illustrating the number of Omicron-related travel restrictions that imposed specific measures against each country, 24 November – 15 December 2021. Countries in which confirmed Omicron cases had been reported as of 15 December are outlined in yellow.
Most travel restriction policy documentation did not mention the anticipated duration or criteria for the relaxation of these restrictions. In fact, only 15% of the travel included an expected end date.
Only African countries had more than 50% of the Omicron response policies based on universal entry requirements. For entry policies, these nations relied on vaccination requirements, despite their own lower coronavirus disease 2019 (COVID-19) vaccination rates.
On November 26, 2021, European countries placed a temporary travel ban on travelers from seven Southern African countries into the European Union (EU). Further, the Eastern Mediterranean and European countries implemented flight suspensions mainly from the Gulf nations.
Following an initial burst of policies targeted to specific countries over time, measures became slightly more focused on enhancing screening measures such as testing for all travelers – though initial entry bans were rarely rescinded.
Due to the shortage of direct travel routes, the American and South-East Asian countries avoided airline suspensions, instead of relying on screening measures and entry restrictions implemented by the intermediaries. The Western Pacific region, including Australia, did not permit the repatriation of Australian citizens from Southern Africa until December 15, 2021.
Despite the implementation of similar COVID-19 screening methods across several countries, variations were seen in quarantining requirements. These ranged from unsupervised quarantining at any place to stringent monitoring at specified hotels, quarantining costs borne by travelers including prior purchasing of quarantine packages, COVID-19 testing on specified days of quarantine, and criteria to end quarantine.
Variations in COVID-19 testing requirements were also observed among different countries. Out of the 81 Omicron response policies that mentioned testing, PCR tests were required in 51, whereas nine allowed rapid antigen or PCR tests.
The frequently mandated pre-travel COVID-19 test period was 72 hours in most countries and varied from 24-120 hours across countries. Several African countries enforced the requirement of COVID-negative PCR test before leaving the country, regardless of the destination, to pre-empt African countries-associated travel restrictions in other nations.
Omicron-associated travel restrictions posed many logistical and practical difficulties in nations worldwide. These included delays in the repatriation of citizens to their own countries and in the shipment of reagents to researchers in South Africa, thereby affecting the early understanding of the Omicron in the high seroprevalence setting.
Additional difficulties were encountered in obtaining PCR results 24-48 hours before boarding the flights. Additional challenges included financial implications of quarantining and testing, as well as differences in the criteria of fully vaccinated status across different nations.
Moreover, identifying and tracing Omicron response travel policies was difficult due to differences in the documentation of these guidelines among various countries and language barriers. Nations with national airline websites, air carriers, and social media handle provided up-to-date Omicron-related travel restriction policies rather than official government portals.
Conclusions
The current study highlights the importance of aligned response approaches worldwide and understanding transmission epidemiology for mitigating the future emergence of novel SARS-CoV-2 variants or other viruses.
*Important notice
medRxiv publishes preliminary scientific reports that are not peer-reviewed and, therefore, should not be regarded as conclusive, guide clinical practice/health-related behavior, or treated as established information.
