Dutch Discussion on Public transport

By Arnold Bosman, on a personal title.

Issue

On 12 June, the Dutch Government decided that airline travel could commence operations as usual, based on scientific advice from the Dutch Ministry of Health. The advice had 3 main references:

1. COVID-19 Aviation Health Safety Protocol. Guidance for the management of airline passengers in relation to the COVID-19 pandemic. Issue no: 1.1 Issue date: 21/05/2020.
2. European Centre for Disease Prevention and Control. Considerations for travel-related measures to reduce spread of COVID-19 in the EU/EEA. ECDC: Stockholm; 2020.
3. RAGIDA MERS-CoV.

ECDC Technical Report

Reference 2 clearly states the travel-related risks for COVID19: “ Travel and tourism could lead to an increased risk of SARS-CoV-2 transmission amplification in at least two ways. The first is related to mobility of people and the risk of transmission following arrival at the point of destination, and the second to the gathering of people at various venues such as airports, resorts and similar settings. Public health measures applied specifically to or within the travel sector are intended to minimise the likelihood of COVID- 19 transmission on board various conveyances, at sites of embarkation/disembarkation and at destinations.” This means that

• ECDC recognizes the increased COVID19 risk due to:
  • gathering people at airports
  • transmission on board
  • transmission at sites of embarkation and disembarkation
  • transmission risk at destinations

The document continues: “Travel-related introduction and tourism-related spread within the EU/EEA and the UK contributed substantially to the transmission across and within countries during the early phase of the COVID-19 pandemic” Since the Netherlands is returning to the containment phase, with an aim to reduce endemic transmission as much as possible (though this has never been defined as the strategic goal by the Dutch governing coalition), travel related introduction and tourism related spread are again to be expected becoming substantial contributors to COVID19 transmission.

Indeed, this is specifically acknowledged by ECDC, as the report continues: “In a situation where some Member States have decreased transmission to very low levels, while in others the virus is still circulating, the role of tourism and travel-related transmission may become significant due to the possibility of the virus being re-introduced at multiple sites, causing further spread. Furthermore, a high level of tourism- related activities may increase the risk of over-crowding in certain areas or during tourist events, which in turn may increase spread.”

What are the risks?

• “SARS-CoV-2 is believed to be transmitted mainly via respiratory droplets and by direct contact. However, indirect contact with contaminated fomites is also believed to play a role in transmission. Moreover, transmission through aerosols cannot be excluded.”

In order to reduce these risks, ECDC repeats the relevant interventions: “ Standard non-pharmaceutical countermeasures are the most important approach for controlling the spread of COVID-19 in all settings, including during travel. Such measures include physical distancing, hand hygiene and respiratory etiquette, as well as other infection prevention and control (IPC) measures (e.g. cleaning and disinfection of frequently touched surfaces and toilets, use of face masks, etc).” This list of interventions is not a ‘choose what you prefer’ list. It does not mean that each single intervention item can replace the others. Masks alone are not a good replacement for the lack of physical distancing. To make this explicit, ECDC states clearly in this technical report: “It must be noted that the use of a face mask complements but does not replace other personal protective and IPC measures.” And: “ travel service providers should still optimise physical distancing to the extent possible (e.g. by leaving an empty seat between passengers.”

The issue in many discussions will be: what is ‘to the extent possible’? Airlines might argue: this is not possible, or else we must double (or triple) the prices of tickets.

So what do you do as government? Well, that is a political choice. But please, do not cherry-pick scientific advice and then use science as an excuse for your choice. Be transparent. The public (your voters) deserve this, since you represent them.

ECDC is unambiguous at this point: “Passengers travelling on conveyances where the recommended physical distancing of 1.5−2.0 metres cannot be guaranteed should therefore be aware of the transmission risk even if face masks are used. Overall, the purpose of these measures is to mitigate the risk, however it cannot be fully eliminated.”

So: the bottom line is that no matter what measures you take in air-travel, there is always an increased risk of COVID19, even when all measures mentioned in this technical report are taken. And when less measures are taken (such as in case of the Netherlands’ decision to allow fully packed flights), the risks will be even higher.

Contact Tracing

The ECDC Technical Report is also quite explicit in terms of relevant contact tracing when COVID19 occurs while travelling: “Contact tracing is a core public health measure, which aims to rapidly identify persons who have been in contact with a case, in order to reduce further onward transmission. ECDC‘s technical report Contact tracing: public health management of persons, including healthcare workers, having had contact with COVID-19 cases in the European Union - second update outlines the key steps of contact tracing. These steps are:

• i) to identify persons who may have been in contact with an infected person;
• ii) to trace and communicate with the identified contacts, and to provide information about suitable infection control measures, symptom monitoring and other precautionary measures, such as the need for quarantine;
• iii) to monitor the contacts regularly for symptoms. Contact tracing data are sensitive health data and appropriate data protection needs to be guaranteed at all stages of contact tracing, as well as during follow-up.

When a traveller develops symptoms upon arrival at the destination or during his/her stay, testing, diagnosis, isolation and contact tracing will take place in accordance with the local practice. Public health authorities will communicate with public health authorities in the country of origin if necessary for the purposes of contact tracing and this can be done via the Early Warning and Response System (EWRS). The follow-up of contacts in the country of origin are the responsibility of the public health authorities in that country. Fellow travellers exposed to a probable or confirmed case during travel should be followed-up by the public health authorities in the country where the traveller is staying. “