Traveling without care.

By Paul Goldfinger MD

What should you do regarding someone you  know who has just returned from a trip?

There is a great deal of information about COVID-19, but the conclusions are often more general than practical.   We know that some states have higher rates of transmission then others.  Currently over 30 states are “at risk,” but the virus is everywhere.

So If you come from one of those risky states, like New York, you might be asked to quarantine for 14 days.  That is to protect those who live in the destination state.

But if you are traveling, maybe you shouldn’t go to a high risk state because you might catch the virus.  However you could catch the virus no matter where you go–high or low risk.  And  it’s hard to avoid worrisome contacts like using public bathrooms.  So travel has risks, but the risks depend on the epidemiology of that state and how careful you are.  The best advice has been “Stay home.”

But what if you take a trip, what do you do when you get home?  You have been traveling around and staying in motels and eating in restaurants,  and you have been wearing your masks and washing your hands, but you still could have become infected silently  (without symptoms.) You could get tested when you get back, but that won’t be foolproof because you might be infectious even if you test negative. The virus has an incubation period and may turn positive after 2-7 days.

Naturally if you were exposed during your trip to someone who is infected then you must self quarantine, but what if were not knowingly exposed and you return and you feel fine?  Should you self quarantine anyhow?

What is the risk of passing on the virus, if you feel fine, to those at home such as high risk elderly relatives or people with specific medical problems where their immunity may be impaired?   If you traveled through a high risk state, your concern will be heightened. Or can you take a chance and just bop around with your mask and hand washing?  Or just stay away from everybody for 14 days?

The answers are not clear, and the guidelines are inadequate.

After getting home you could wear masks, distance, and wash hands, but you still could be a problem for someone. Testing can be revealing if you are positive, but if you are negative that is not totally reassuring. (See comment below.)

Here is what the CDC says:     “You may have been exposed to COVID-19 on your travels. You may feel well and not have any symptoms, but you can be contagious without symptoms and spread the virus to others. You and your travel companions (including children) pose a risk to your family, friends, and community for 14 days after you were exposed to the virus.

“Regardless of where you traveled or what you did during your trip, take these actions to protect others from getting sick after you return:

• When around others, stay at least 6 feet  (about 2 arms’ length) from other people who are not from your household. It is important to do this everywhere, both indoors and outdoors.
• Wear a mask to keep your nose and mouth covered when you are outside of your home.
• Wash your hands often or use hand sanitizer (with at least 60% alcohol).
• Watch your health and look for symptoms of COVID-19. Take your temperature if you feel sick.

“Follow state and local recommendations or requirements after travel.”

If I were at increased risk but traveling nowhere, I would avoid any contact, if possible, with someone who has just returned from a trip–for 14 days even if they have not tested positive or developed worrisome symptoms.

If you can’t isolate yourself from such risky people, then follow the CDC guidelines above and do the best you can.  If it is a relative or good friend who just came back from travel, just tell them that you can’t associate with them for 14 days.   And if they say “how about 7 days?” you say, “Better safe than sorry!”  (Unless they agree to be tested after 7 days of arriving home.—see comments)

KAREN ELSON WITH VINCE GIORDANO AND THE NIGHTHAWKS  from HBO’s  Boardwalk Empire:

Karen Elson