Coronavirus: How to Reopen Travel Safely

Which Citizens Should Countries Allow In? Under What Conditions?

Our previous articles, Coronavirus: Why You Must Act Now, The Hammer and the Dance, Out of Many, One, and many others have gathered over 60 million views together and have been translated into over 40 languages. Translations at the bottom. New translations welcome. To receive the next installments and articles, sign up here.

Article summary: The current plans to reopen EU countries are too blunt. Citizens from different countries are either blocked or fully allowed to travel. This will result in new outbreaks. Instead, there should be tiers of countries based on best guesses on prevalence and value per visitor. Within that, higher value visitors such as those owning a home should be treated differently. There is no excuse for lack of PCR tests. European countries with special situations, such as Sweden, Portugal or the UK should be treated separately.

The European Union is opening up its borders on July 1st. But not to everybody. The US, Russia and Brazil seem to belong to a long list of countries banned from travel. European officials are working against the clock to propose rules for the international reopening. How are they thinking about it?Is there anything else they should consider? But before that, we should wonder: How important is it to get this right?

How Important Is It to Get Travel Restrictions Right?

A lot.

This chart, from Coronavirus: Learning How to Dance, shows how a few infections coming from abroad—in blue—caused the outsized outbreak they’ve been fighting ever since.

The same thing happened in Argentina.

The blue area was the imported cases that caused the outbreak that has raged out of control ever since. For context, these were around 800 cases over a full month.

A few hundreds of seeds can be enough to cause massive outbreaks. Is the EU plan making sure this doesn’t happen again?

The European Union’s Plan

The EU is already broadly open to citizens from other EU countries.

Now, they want to go one step further. According to sources from within the European Union, the New York Times reports that the EU wants to open up all travel within its borders, allowing movement from any country to any other country, including the UK, Switzerland, Iceland and Norway.

The second question they’re trying to figure out is: Which other countries should also be allowed? Currently, there are a lot of restrictions.

Apparently, the rule of thumb they’re using is the number of positive cases per 100,000 inhabitants: If your country has more than the EU, your citizens are not allowed to enter, and vice-versa. Since the EU has had around 14 cases per 100,000 people over the last two weeks, that is the current threshold.

This sounds reasonable. Until you start looking at the details.

Looking at this chart, it makes obvious sense to restrict travel from countries like Russia, the US, or Brazil. They have 10 times the prevalence of EU countries. They haven’t controlled their epidemics. Why should the EU pay for their mismanagement with more outbreaks and deaths?

Except there’s a problem here.
Sweden.
It has more cases per capita than Russia or the US.

Sweden

Sweden has a prevalence 15 times higher than the rest of the EU (excluding Portugal and, obviously, the UK). If the EU is consistent, Swedes should not be allowed to travel openly to the rest of the EU. They are more dangerous than Americans or Russians.

Freedom of movement is important for the EU, and Sweden is part of the Schengen area that enshrines that. But Sweden is not in this position because of lack of luck. Quite the opposite: Its initial caseload was very low. Unlike all its neighbors, it decided unilaterally to let the virus run through the population, just flattening the curve.

Their independence in epidemic response is important. But it should have consequences too. Should other countries throw away all their hard work containing the virus because Sweden decided to interpret science differently?

Portugal

Portugal is in a different boat. It has fought to crush the coronavirus. But it still has 40 cases per 100,000 inhabitants, five times higher than the EU average (outside of Portugal, Sweden and UK). One of the reasons might well be that, all this time, it has allowed travelers from Brazil and the US (among others).

Countries like Italy, Spain or France have fought the pandemic hard, suffering a massive death and economic toll. If I were a politician from these countries, how could I justify to my voters that citizens from other countries will put these hard-won victories at risk, just because their countries didn’t want to suffer the same costs?

Especially since, once the borders open within the EU, there’s a loophole: US and Brazilian travelers can simply land in Portugal and travel from there to anywhere else in the continent.

United Kingdom

This is a harder case.

With 27 cases per 100,000 inhabitants, the UK has over 3 times more cases than the EU average (again, outside of Portugal, Sweden and the UK). The reason the country is in that position is because it wasted precious time in March, not imposing lockdowns when everybody else around was.

However, the UK is one of the main sources of tourists for many other EU countries. How should these countries think about opening up to the UK?

None other country has as much at play than Spain

What Should Spain Do?

This decision matters a lot in the EU, but in few other countries as much as in Spain.

The Ticking Bomb

It’s one of the EU countries where tourism matters the most. According to the latest figures, it could account for up to 15% of GDP. So it’s crucial to get this right, especially with the UK, since it gets ~18 million visitors from there every year.

Let’s do back-of-the-envelope math. The UK has had ~20,000 official cases between June 10th and June 24th. Let’s assume authorities there catch 20% of cases. That means there are approximately 100,000 active cases as of June 24th, or ~0.15% of the population. That means 27,000 of the 18 million are infected.

Let’s assume 70% of the trips are during summer. That means 19,000 infected people will travel from the UK to Spain during the summer, which is around 1,700 new infections in Spain per week. Even if you halve that to account for diverse factors, you still have hundreds of cases coming to Spain every week.

And that’s just the Brits. Add the Portuguese, the Swedes, those from other countries…

Remember: This is exactly what caused the outbreaks in countries like Singapore or Argentina. Except in Argentina they received around 800 cases over a month, not over a week…

Add to that the fact that tourists are more likely to move around, to party, to meet people, and that tracking their contacts is going to be much harder than locals. It’s a ticking bomb.

How Is the Spanish Government Planning to Fight It?

The government says they have measures to stop this. Which ones? An interrogation and temperature check.

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Temperature checks have lots of false negatives and only work with people who already have symptoms. Source: RTVE

The interrogation, as you can assume, won’t be very useful since there’s a strong incentive to lie. The temperature check as two big issues:

  1. You don’t show symptoms until you reach peak infectiousness. People who just caught the virus won’t be identified by the thermometer, and will then go on to spread the virus. In fact, if you catch the person with fever, their infectiousness is already going down.
  2. Lots of false negatives.

So most cases won’t be caught.

One of the arguments used by the Spanish government to open up to UK citizens is the fact that ~400,000 of them have a second residence in Spain. But that’s a pretty poor excuse. If you have a residence in Spain, you probably want to stay there, and can quarantine for a few days.

The interesting piece is that the UK does not reciprocate with Spain. Yes, that’s right. Spaniards, with a much lower infection rate than the UK, must quarantine there for two weeks—applied only since June 8th.

The Spanish government is so anxious to get the business from Brits that it’s “hoping for reciprocity”, instead of demanding it. Having followed the Brexit negotiations from the last few years, I’m not convinced this is how British leadership negotiates.

What Can Learn from Other Places?

After the dramatic events of March and April, you would imagine that European countries would have learned to look around for best practices. Let’s look at a few.

East Asia

Taiwan and South Korea have proven to be some of the best countries in the world at controlling the epidemic while keeping the country open.

Taiwan bans foreigners, whereas South Korea dramatically limits them. Both countries require a two week quarantine for all incoming travelers. And despite all their care, South Korea still has been growing in cases for weeks.

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Do we really think we can do better than South Korea with less experience controlling the virus and opening up travel more?

The South Korean and Taiwanese example give a sense of how risky it is to open up our countries. Yet it doesn’t need to be open or shut. There are many options in between, and different European countries give us good ideas

Danish Summerhouses

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Denmark makes an exception for people who own a house there. It is logical that these people would suffer a lower oversight than other travelers.

PCR tests

Several countries in the EU already require PCR tests, either in the country of origin or on arrival.

PCR tests catch around 70% of infected people. They tend to fail early in an infection. So to be extra safe, a country could ask for a recent PCR test result, require a quarantine of a couple of days, and ask for a new PCR then. If both turn negative, the person is free to go.

What Should the EU Do?

In Coronavirus: Prevent Seeding and Spreading, we went into the detail of how to prioritize countries.

It’s encouraging to see the European Union use active cases per 100,000 inhabitants as a rule of thumb, but it shouldn’t be the only measure.

First, there are plenty of ways that number can be gamed, as Donald Trump recently suggested. Who believes Russia’s Case Fatality Rate is lower than South Korea’s? Or that North Korea has no cases? The European Safety Aviation Agency has taken into account many more factors to assess the risk of a country of origin. That’s a good idea.

Another problem is that this treats all travelers the same, independently from their value to a country. If a tourist is twice as likely to be infected as one from another country, but spends five times more, shouldn’t she be prioritized? If she owns a second home in your country, shouldn’t she be prioritized?

Citizens from richer countries, or owners of a home in a European country, are much more valuable to the economy. That should be a consideration. If the UK has 3 times more cases per inhabitant than, say, Bulgaria, but also spends 3 times more money, maybe it makes sense to accept that traveler. Especially if she has a second home in the country.

Finally, it believes the decision is binary: You’re either part of the club or you aren’t. This forgets that there’s a big array of options that can be considered. There could be tiers of countries, and different countries could move from one to the other based on their prevalence and value to the destination economy. An example of tiers could be:

  1. Full transit, no restrictions
  2. PCR on arrival
  3. PCR within 96h of arrival and another PCR three days after arrival
  4. The same, but with quarantine in between the tests
  5. Requirement to use a tracking app, or to give the phone number for automatic tracking of movements, to ease contact tracing,
  6. Two-week quarantine
  7. No travelers allowed—only repatriations

Takeaways

Freedom of movement is a cornerstone of the European project. We should strive to get back to it as soon as possible. But we shouldn’t do it while putting at risk our health and economy. Let’s slowly and intelligently open up:

  • Go beyond just cases per 100,000 inhabitants. Use instead several epidemiological factors, to get a sense of the risk associated with the citizens of a country.
  • Don’t consider all EU countries the same. There are very significant differences rooted in their choices during the pandemic.
  • Take into account the value per tourist. If you don’t have precise data, just use spend per tourist, or even cruder, GDP per capita.
  • Don’t just have two lists: allowed countries and forbidden countries. Design several tiers, with more requirements for riskier countries.
  • Since PCRs tests will catch many people around the time when symptoms appear—which takes ~5 days to appear on average, try to use PCR tests as frequently as possible. A good tradeoff is during the trip (in origin or destination), and a few days after (ideally with quarantine in between).
  • Treat tourists, long-term visitors and homeowners differently. The latter should have more rights.

Translations:
Spanish
German

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2 MSc in Engineering. Stanford MBA. Ex-Consultant. Creator of applications with >20M users. Currently leading a billion-dollar business @ Course Hero

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