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. 2021 Sep;26(39):2001440.
doi: 10.2807/1560-7917.ES.2021.26.39.2001440.

Strategies to reduce the risk of SARS-CoV-2 importation from international travellers: modelling estimations for the United Kingdom, July 2020

Samuel Clifford  1 , Billy J Quilty  1 , Timothy W Russell  1 , Yang Liu  1 , Yung-Wai D Chan  1 , Carl A B Pearson  1 , Rosalind M Eggo  1 , Akira Endo  1 ; CMMID COVID-19 Working Group  2 ; Stefan Flasche  1 , W John Edmunds  1 ; Centre for Mathematical Modelling of Infectious Diseases (CMMID) COVID-19 Working Group
Collaborators, Affiliations

Strategies to reduce the risk of SARS-CoV-2 importation from international travellers: modelling estimations for the United Kingdom, July 2020

Samuel Clifford et al. Euro Surveill. 2021 Sep.

Abstract

BackgroundTo mitigate SARS-CoV-2 transmission risks from international air travellers, many countries implemented a combination of up to 14 days of self-quarantine upon arrival plus PCR testing in the early stages of the COVID-19 pandemic in 2020.AimTo assess the effectiveness of quarantine and testing of international travellers to reduce risk of onward SARS-CoV-2 transmission into a destination country in the pre-COVID-19 vaccination era.MethodsWe used a simulation model of air travellers arriving in the United Kingdom from the European Union or the United States, incorporating timing of infection stages while varying quarantine duration and timing and number of PCR tests.ResultsQuarantine upon arrival with a PCR test on day 7 plus a 1-day delay for results can reduce the number of infectious arriving travellers released into the community by a median 94% (95% uncertainty interval (UI): 89-98) compared with a no quarantine/no test scenario. This reduction is similar to that achieved by a 14-day quarantine period (median > 99%; 95% UI: 98-100). Even shorter quarantine periods can prevent a substantial amount of transmission; all strategies in which travellers spend at least 5 days (mean incubation period) in quarantine and have at least one negative test before release are highly effective (median reduction 89%; 95% UI: 83-95)).ConclusionThe effect of different screening strategies impacts asymptomatic and symptomatic individuals differently. The choice of an optimal quarantine and testing strategy for unvaccinated air travellers may vary based on the number of possible imported infections relative to domestic incidence.

Keywords: COVID-19; PCR testing; SARS-CoV-2; quarantine; travel screening.

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Conflict of interest statement

Conflict of interest: Akira Endo received a research grant from Taisho Pharmaceutical Co. Ltd.

Figures

Figure 1
Figure 1
Possible traveller trajectories for the considered SARS-CoV-2 screening scenarios pre- and post-flight
Figure 2
Figure 2
Expected number of infectious and pre-infectious individuals entering the United Kingdom from the United States (A) and total infectious person-days remaining after release (B) based on estimated travel volumes and quarantine duration with no pre-flight testing, United Kingdom, July 2020
Figure 3
Figure 3
Expected number of infectious and pre-infectious individuals entering the United Kingdom from the United States (A) and total infectious person-days remaining after release (B) based on estimated travel volumes and quarantine duration with no pre-flight testing, stratified by asymptomatic or pre-symptomatic infection, United Kingdom, July 2020
Figure 4
Figure 4
Risk reduction per infected traveller compared to a baseline of syndromic screening and no quarantine and no testing on arrival, United Kingdom, July 2020
Figure 5
Figure 5
Risk reduction per infected traveller compared to a baseline of syndromic screening and no quarantine and no testing on arrival, stratified by asymptomatic or pre-symptomatic infection, United Kingdom, July 2020
See this image and copyright information in PMC

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