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. 2021 Oct;83(4):413-423.
doi: 10.1016/j.jinf.2021.07.017. Epub 2021 Jul 24.

Public health effects of travel-related policies on the COVID-19 pandemic: A mixed-methods systematic review

Lama Bou-Karroum  1 , Joanne Khabsa  2 , Mathilda Jabbour  3 , Nadeen Hilal  3 , Zeinab Haidar  2 , Pamela Abi Khalil  2 , Rima Abdul Khalek  4 , Jana Assaf  5 , Gladys Honein-AbouHaidar  6 , Clara Abou Samra  5 , Layal Hneiny  7 , Sameh Al-Awlaqi  8 , Johanna Hanefeld  9 , Fadi El-Jardali  1 , Elie A Akl  10 , Charbel El Bcheraoui  11
Affiliations

Public health effects of travel-related policies on the COVID-19 pandemic: A mixed-methods systematic review

Lama Bou-Karroum et al. J Infect. 2021 Oct.

Abstract

Objectives: To map travel policies implemented due to COVID-19 during 2020, and conduct a mixed-methods systematic review of health effects of such policies, and related contextual factors.

Design: Policy mapping and systematic review. DATA SOURCES AND ELIGIBILITY CRITERIA: for the policy mapping, we searched websites of relevant government bodies and used data from the Oxford COVID-19 Government Response Tracker for a convenient sample of 31 countries across different regions. For the systematic review, we searched Medline (Ovid), PubMed, EMBASE, the Cochrane Central Register of Controlled Trials and COVID-19 specific databases. We included randomized controlled trial, non-randomized studies, modeling studies, and qualitative studies. Two independent reviewers selected studies, abstracted data and assessed risk of bias.

Results: Most countries adopted a total border closure at the start of the pandemic. For the remainder of the year, partial border closure banning arrivals from some countries or regions was the most widely adopted measure, followed by mandatory quarantine and screening of travelers. The systematic search identified 69 eligible studies, including 50 modeling studies. Both observational and modeling evidence suggest that border closure may reduce the number of COVID-19 cases, disease spread across countries and between regions, and slow the progression of the outbreak. These effects are likely to be enhanced when implemented early, and when combined with measures reducing transmission rates in the community. Quarantine of travelers may decrease the number of COVID-19 cases but its effectiveness depends on compliance and enforcement and is more effective if followed by testing, especially when less than 14 day-quarantine is considered. Screening at departure and/or arrival is unlikely to detect a large proportion of cases or to delay an outbreak. Effectiveness of screening may be improved with increased sensitivity of screening tests, awareness of travelers, asymptomatic screening, and exit screening at country source. While four studies on contextual evidence found that the majority of the public is supportive of travel restrictions, they uncovered concerns about the unintended harms of those policies.

Conclusion: Most countries adopted full or partial border closure in response to COVID-19 in 2020. Evidence suggests positive effects on controlling the COVID-19 pandemic for border closure (particularly when implemented early), as well as quarantine of travelers (particularly with higher levels of compliance). While these positive effects are enhanced when implemented in combination with other public health measures, they are associated with concerns by the public regarding some unintended effects.

Keywords: COVID-19; Outbreak; Quarantine; Screening; Travel restrictions.

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Conflict of interest statement

Declaration of Competing Interest All authors have completed the ICMJE uniform disclosure form at www.icmje.org/coi_disclosure.pdf. EAA and FEJ declare receiving financial support to conduct this review. All authors declare no financial relationships with any organisations that might have an interest in the submitted work in the previous three years; no other relationships or activities that could appear to have influenced the submitted work.

Figures

Fig. 1
Fig. 1
Travel policies adopted by 31 countries over the period (January 2020 – December 2020) We observed some differences in travel policies across regions (Fig. 2). For example, while Australia was stricter in imposing total border closure across the one-year period, Europe was less strict.
Fig. 2
Fig. 2
Travel policies adopted by 31 countries across 6 regions over the period (January 2020 – December 2020).
Fig. 3
Fig. 3
PRISMA flowchart.
See this image and copyright information in PMC

Comment in

References

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