Time to relax global travel restrictions

By PETER BOONE & SIMON JOHNSON

Anyone who risks a visit to Canada these days needs to take care. Canadians are threatening six months in jail, and up to $750,000 in fines, for disobeying testing and quarantine rules upon arrival. In the UK, travelers arriving from outside the country have been warned they could face 10 years in prison for inaccurately recording their previous whereabouts on entry forms. The Biden administration recently extended the outright ban preventing most non-Americans in Europe from traveling to the US, with threats of fines and deportation for noncompliance.
These complex and ever-shifting restrictions make foreign travel a daunting proposition. Relatives continue to pass away without visits from loved ones, parents are isolated from children, and there are fewer jobs in travel-related industries. It is time to relax these rules in a responsible manner.
The risks from the coronavirus disease (COVID-19) have been dramatically changed by vaccination. All vaccines authorized by the US Food and Drug Administration have proved well over 95 percent effective at preventing deaths, and over 90 percent effective at preventing serious disease, including against the more infectious delta variant. Vaccination lowers the overall infection fatality ratio (IFR), which measures deaths among infected people, from 0.41 percent to about 0.02 percent (because IFR varies significantly by age, we calculate these ratios from official data by age group, weighted by the age composition of the US population).
Of course, vaccinating people with any kind of vulnerability, including those who are elderly or who live in congregate care settings, must remain a top global priority.
The COVID-19 vaccines do not fully prevent infections, but they do a good job of preventing severe illness. The US Centers for Disease Control and Prevention estimates that the 2019-20 influenza season caused 38 million infections, leading to 18 million medical visits, 400,000 hospitalizations, and 22,000 deaths. That implies a 0.06 percent IFR for the flu, more than double the IFR for COVID-19 once the vulnerable are vaccinated. There are still important open questions, including what percentage of people may suffer debilitating long-term COVID-19 symptoms, but the risks are now similar to those from diseases with which we already cope.
Epidemiologists have shown persuasively that wearing masks, social distancing and generally avoiding close in-person contact reduces disease transmission. International arrivals do not disturb that outcome at all; if we have stopped spreading the disease, then new arrivals that follow our rules don’t change much.
Listening to public health advice is important, but our policymakers also need to focus on what really matters.
In 2019, 241 million passengers arrived and departed the US by air, implying that an average of roughly 330,000 passengers entered the country per day. If all those 330,000 arrivals came from countries near the height of an infection cycle, and all symptomatic passengers still boarded the flight, then approximately 1 percent of those passengers (3,300 people) would be infected. The US has recorded nearly 35 million infections in the roughly 500 days since the start of the pandemic, implying an average of about 70,000 new infections per day. The true number is probably double that, owing to undetected asymptomatic infections. If about 140,000 new infections of domestic origin per day is a reasonable estimate, the addition of up to 3,300 new cases is a minor blip.
Even though passengers on airplanes carry few infections (relative to the population size for large countries), some might argue that air travel is a breeding ground for infections, so we should ban it for that reason. There is no doubt that traveling in confined quarters is a risk, but so are many other activities: Eating in restaurants, swimming at a pool, inviting friends to your house, visiting an art gallery, etc. There is little reason for international air travel to be the only activity restricted severely. It seems far more sensible to take measures that make air travel safer.
The desire to keep out potential new variants of the disease is understandable but unrealistic. There are only a few countries that have managed a near-zero COVID-19 outcome — notably island states like New Zealand and Australia. Most borders are far more porous. –AN