As the country continues efforts to “flatten the curve” on the coronavirus pandemic, it faces a dichotomy: Keep sheltering in place to protect ourselves and save lives — or get out there and rebuild a healthy economy to protect jobs and save businesses.
The goal is to strike the right balance, guided by evidence to ensure public safety.
Many people around the world are itching to get on a plane for that summer vacation, to make up for the missed graduations and family get-togethers. Business travelers are desperate to resume their global networking, industry conferences and market-moving deals.
But people don’t want to get onto airplanes, particularly those long international flights, until they feel safe. Many find themselves under 14-day quarantines and tough travel restrictions.
As a result, the airline industry has been one of the hardest hit by the global shutdown. The International Air Transport Association estimates 300 airlines could lose a staggering $113 billion by the end of 2020 due to the lack of international travel caused by the COVID-19 pandemic.
Stanford Health Policy’s Jason Wang, MD, PhD, is looking for a solution. He and his colleagues are launching an international travel study with the Taiwanese government to see whether quarantine periods might safely be shortened — and travelers less wary of taking to the skies once again.
“I’m hoping to prove that instead of the 14-day quarantine that we currently have, you could reduce it by a week or more if you do pre-testing before you get on the flight — and people will feel safer because they know everybody on the flight has tested negative for coronavirus,” said Wang, an associate professor of pediatrics at Stanford Medicine and director of the Center for Policy, Outcomes, and Prevention. “If we can prove that you only need to be quarantined for three days — that’s a beautiful thing, not only for business, but for summer tourism.”
Wang is working with Stanford Medicine infectious disease epidemiologist Bonnie Maldonado, MD, to design the study protocols, along with the government of Taiwan for the pilot study that will recruit volunteers for three flights between San Francisco and Taipei in June.
A native of Taiwan and former project manager for its National Health Insurance Reform Task Force, Wang was the first to highlight the effectiveness of Taiwan’s response to the virus, hoping that other countries would follow its example. The island-state has fared far better than most countries, with fewer than 450 cases and only seven deaths despite its close proximity to China, where the virus first took hold. No new case of the virus has been brought into Taiwan for over 10 days; there have been no domestic cases for more than 30 days.
Wang hopes the pilot project could serve as a model to help open up air travel in other countries.
“We are hoping to learn from this experiment the necessary protocols to protect people’s health when one travels in the global village,” he said.
A Randomized-Controlled Trial
Wang said volunteer participants will fly on six flights from San Francisco to the Taiwanese capital. Five hundred volunteers will be randomized into an experimental group that gets testing; another 500 will be in a control group that gets no testing before they fly.
Those in the experimental group will first take the Stanford Medicine coronavirus test and remain quarantined at an airport hotel for a day, until they get their results; 500 volunteers will be placed in the experimental group on three separate flights and only those who tested negative will be allowed to board. Those 500 passengers in the control group who are not tested will also take three separate flights.
The Taiwanese government will pay for hotels and meals while those who make the 14-hour flight remain quarantined for 14 days in Taipei. Those who test positive for the virus will not be allowed on the flights and will be referred to local health departments for care and continued monitoring.
Once the passengers arrive in Taiwan, they will be tested at the airport, then again on days three, five, seven, 10 and 14. The second control group will be tested just once upon arrival and then follow the standard protocol of 14 days of quarantine.
“The idea is to try to figure out if you tested negative prior to the flight, what’s the latest we could pick up a positive test upon arrival,” Wang said. “The goal of the experiment is to figure out the earliest time we can release people if they get tested.”
Taiwan’s collaborators in the study are Vice Premier Chen Chi-Mai, himself a preventive medicine physician, and Dr. Shan-Chwen Chang, an infectious medicine expert and chair advisor of Taiwan’s National Health Command Center. Chen said the country is being cautious about travelers from China because they have no data on how many people have been tested on the mainland. But the Stanford study, Chen told the Financial Times, could lay the groundwork for something more scalable with countries that are more transparent.
“We hope to develop a safe travel protocol which we could use to gradually restart some travel links with likeminded countries,” he told the Financial Times.
The Taiwanese government and an alum of the Stanford Graduate School of Business are helping to fund Wang’s study.
The travel experiment has been put on hold while logistics get resolved.