COVID-19: Travel risk assessment

Factors health professionals should consider when advising those who are planning international travel during the COVID-19 pandemic

Background

COVID-19 is an infectious disease caused by a respiratory coronavirus, SARS-CoV-2. It is mainly transmitted from person to person by breathing in droplets from the nose or mouth of an infected person or by touching the infected droplets on surfaces, then touching the eyes, nose or mouth.

COVID-19 presents with a range of symptoms of varying severity. It is estimated that one in three individuals who are infected with the virus will not experience any symptoms [1]. Fever, a new continuous cough, shortness of breath, fatigue, loss of appetite, loss of, or change to, sense of smell or taste are common symptoms. Non-specific symptoms may include muscle aches, sore throat, headache, stuffy or runny nose, diarrhoea, nausea and vomiting [1].

Early in the pandemic, most people infected with COVID-19 (approximately 80 percent of those who developed symptoms) experienced mild to moderate illness and recovered without requiring special treatment. Approximately 15 percent developed more severe disease and 5 percent had critical disease [1]. The severity of illness with successive COVID-19 strains has differed, with decreasing risk of hospitalisation and death observed compared with the earlier variants [1].

Some individuals experience prolonged symptoms or develop long-term complications following COVID-19 infection [1].

A number of COVID-19 vaccines and treatments are authorised for use in the UK and research on potential new products continue [2-4]. Further information about COVID vaccines and the recommendations for their use in the UK are available in the UK Health Security Agency (UKHSA) publication, Immunisation against infectious disease 'the green book', COVID-19 chapter.

Risk assessment prior to travel

The following information is to help health professionals and travellers to assess the potential risks associated with COVID-19 infection during travel. Other general travel health advice can be found on our Country Information pages.

Although most of the COVID-19 related travel restrictions and entry requirements have been dropped, travellers should continue to check the rules for their destination and any transit countries on the Foreign Commonwealth and Development Office (FCDO) travel advice pages and subscribe to updates. There are currently no COVID-19 entry requirements for travel to England, Northern Ireland, Scotland and Wales.

General considerations

All individuals should follow current UK recommendations to reduce their risk of catching COVID-19 and passing it on to others.

In addition, travellers should:

• Ensure they have adequate travel insurance and check any exclusions that apply, including those related to COVID-19.
• Be prepared to follow the advice of local authorities abroad. This includes complying with local isolation, social distancing, or quarantine requirements, and relying on the local public health systems and advice.
• Ensure they have enough personal medical supplies (including regular medicines) in case they are abroad longer than planned and be prepared for logistical and financial disruption to their travel.
• Ensure that they researched other health risks at their destination and have accessed other vaccines and malaria prophylaxis (where recommended).

Individual factors

People over 60 years of age and those with certain underlying health conditions are more likely to experience severe COVID-19 illness [5]. A list of clinical risk groups can be found in Tables 3 and 4 in immunisation against infectious disease, the 'Green book' chapter 14a [6].

Individuals in these clinical risk groups continue to be invited for COVID-19 vaccinations in the UK. These vaccines provide important protection against severe disease, hospitalisation, and death [6].

General travel advice for special risk travellers, including older people and pregnant women is available from a number of our special risk travel/traveller factsheets.

Those who are at higher risk of severe COVID-19 disease should assess their individual circumstances and consider whether postponing travel would be appropriate. Seeking pre-travel health advice from a health professional is worthwhile.

Destination related factors

There is a global risk of exposure to COVID-19.

Travellers should check the Foreign, Commonwealth & Development Office (FCDO) advice for their destination and ensure they have up to date information on COVID rules and requirements.

Those at higher risk of severe COVID-19 should also consider the medical facilities at their destination if they were to become unwell.

Preventive advice

Travellers can reduce their risk of being infected or spreading COVID-19 by taking some simple precautions, see living safely with respiratory infections.

If symptoms of COVID-19 develop, travellers should follow current public health advice, which may differ in: England, Wales, Scotland and Northern Ireland.

Those developing symptoms abroad should review the local regulations. It may be necessary to self-isolate (stay indoors and avoid contact with other people) and arrange a test locally at your destination if required.

Those testing positive for COVID-19 abroad, must follow local public health advice. It may be necessary to quarantine or self-isolate and stay longer than planned. Travellers should plan ahead for any possible delays to their return home. The FCDO website may have some contact details for testing and local helplines overseas.

Resources

• COVID-19: Resources
• GOV.UK Coronavirus guidance (for the public and health professionals)
• GOV.UK Foreign travel advice