How to Travel Safely During Covid: What Doctors Recommend After Getting a Vaccine
An airline worker checks-in a traveler from behind a protective plastic screen inside the departures terminal at Cape Town International Airport. (Photographer: Dwayne Senior/Bloomberg)

How to Travel Safely During Covid: What Doctors Recommend After Getting a Vaccine

In the U.S., upwards of 3 million people a day are leaving vaccine sites with new immunity and new questions about what to do with it.

The U.S. Centers for Disease Control and Prevention says that if you’re fully vaccinated, have waited through two weeks of immunity buildup, and are otherwise healthy, you’re all clear to travel. But that may feel easier said than done.

Travel planning today comes with novel anxieties, some of them easier to answer than others. Is it safe to fly? Experts say yes, even though middle seats are no longer being blocked. Is it better to stay in an Airbnb or a hotel? Depends on what type of experience you want. Can I bring my unvaccinated kids? Only if you’re comfortable with their potential viral exposure. (But go ahead, bring the pandemic puppy.)

How to Travel Safely During Covid: What Doctors Recommend After Getting a Vaccine

The considerations worth taking differ from household to household. Being thorough about how you plan can effectively mitigate risk and exposure—and soothe anxiety and eliminate stress before and during a trip. What good is a vacation, after all, if it doesn’t offer mental respite?

As I considered my own much-anticipated return to travel, my list of precautions grew until it was almost prohibitive: Direct flights, a small resort environment where everyone is tested upon arrival, the possibility of a private pool, and a variety of outdoor dining options in-house. I debated whether it was worth it to upgrade to business class. And what about day care? 

How to Travel Safely During Covid: What Doctors Recommend After Getting a Vaccine

I know I’m not alone, so I made the world’s most comprehensive list of travel safety questions and fielded it to a group of experts. Dr. Daniel Caplivski is a professor of infectious diseases and director of the travel medicine program at the Icahn School of Medicine at Mount Sinai; Dr. Scott Weisenberg is director of the travel medicine program at NYU Langone Health; and Johns Hopkins immunologist Dr. Kawsar Talaat is one of the institution’s leading experts on infectious diseases and international health.

Whether you’re neurotically thinking through your first trip back or trying to get your bearings around the new normal for travel, here’s everything the doctors had to say about safe vacation planning in 2021.

Where can I travel? 

How to Travel Safely During Covid: What Doctors Recommend After Getting a Vaccine

The question of where you can travel seems to change day by day, as countries consider and reconsider their border policies. (The travel agency Scott Dunn Ltd. has an updated list of which countries are open to American travelers.)

Sometimes picking your destination is not much of a choice, says Caplivski. His first encounters with pandemic travel safety occurred when his wife had to make an unexpected trip to visit her parents in Brazil.

But if you’re traveling purely for leisure, here are three questions to ask:

  • What are the local Covid-19 caseloads?
  • How burdened is the local health-care system?
  • How much risk do I need to incur to entertain myself once there?

If a country has many cases and poor access to vaccines, its hospitals are likely overwhelmed, Caplivski says. “The idea that vaccines are 95% effective means we likely won’t need to go to the hospital for Covid, but we may slip and fall—simple things that could happen to tourists anywhere,” he says.

How to Travel Safely During Covid: What Doctors Recommend After Getting a Vaccine

Ultimately, the three questions above speak to an overarching one: “Are you more likely to get infected traveling than you would at home?” The answer will be specific to where you’re going—as well as where you’re coming from—says Weisenberg. In other words: The public-health picture in a destination matters only as it relates to the one in your local area.

And if you’re not sure about the reliability of local data, there are other ways to infer the risks that exist on the ground. Talaat advises that “if a lot of people are vaccinated, or people are being vaccinated quickly, then the transmission rate will be slower.” The same is true, she says, if a destination is “strictly enforcing other measures [such as frequent testing, wearing masks, and social distancing] as a means of keeping numbers down.”

Everyone agreed: Domestic travel is not inherently safer than international travel. Talaat says she recently visited family in South Carolina, a state that’s done away with mask mandates. “Everywhere we went there were unmasked people, and almost none of the restaurants there had outdoor seating,” she says. “The reality of that situation just didn’t hit home until we were there.”

Can I vacation in a Covid bubble?

How to Travel Safely During Covid: What Doctors Recommend After Getting a Vaccine

In my own planning, I focused on contained—and in many cases all-inclusive—resorts, finding comfort in the idea that I’d never need to leave. By staying on-site among PCR-negative guests, I figured, I’d eliminate the need for in-the-moment risk assessments in a destination that I don’t know well.

The medical experts I spoke with say this is a valid strategy, but there are other viable ones, too. Exploring a destination, they say, is considered safe so long as you continue to abide by common-sense measures like social distancing, wearing a mask, and limiting indoor activities. “The more people you come in contact with, the more likely you are to encounter the virus,” Talaat says. “But if you’re outside, your risk is much lower across the board.”

How to Travel Safely During Covid: What Doctors Recommend After Getting a Vaccine

Even remote, primarily outdoor trips can carry risks. Among them, says Weisenberg, is not knowing where fellow travelers may be coming from. On a safari, for instance, he says “the primary risk is going to be the other people in your Land Rover, or at dinner, or around the fire. They may come from other parts of the world, so that introduces unknowns,” particularly in terms of virus variants, some of which have shown to “break through” Pfizer Inc.’s shot. The risks of those constant individual exposures may be comparable, in the end, to spending a day on Manhattan’s bustling Upper East Side, where 50% of locals have already received at least one shot and Covid risk tolerance is low. 

Two questions may be especially important when evaluating a hotel—and both likely require an email or a phone call to the front desk. “Asking whether staff are vaccinated will limit where you go, because few countries have the ability to vaccinate so quickly. But if that’s OK with you, it decreases your risk tremendously,” Talaat says. “It means you’re really in a bubble.”

The next best thing, says Caplivski, is ensuring that staff don’t feel compelled to work if they’re feeling sick. The right question to ask is whether the employees have access to paid sick leave. “That’s a very smart approach,” he says, validating one of my stealthy strategies.

Is flying safe?

How to Travel Safely During Covid: What Doctors Recommend After Getting a Vaccine

Picking a “safe” airline used to be easy: As long as Delta was blocking middle seats (which go back on sale starting May 1), it was the obvious choice. Now the standouts include Etihad, whose crew is fully vaccinated, and Emirates and Singapore, which follow closely behind. Qantas has made strides by requiring international passengers to show proof of vaccination. But these airlines primarily serve long-haul routes, many to countries whose borders remain closed. U.S. carriers, meanwhile, offer comparable pros and cons, with none of them showing any immediate intention to require vaccine cards for boarding. 

That leaves most American travelers relying on the small preventive measures within their control, with the hope that those safety benefits can add up when taken together.

How to Travel Safely During Covid: What Doctors Recommend After Getting a Vaccine

Upgrading to business class minimizes risk only “incrementally,” Weisenberg says, adding that “there’s some theoretical value to having fewer people in your immediate vicinity.” Caplivski also ascribed little value to an upgrade: “It might not be enough to warrant the price.”

Their skepticism has to do with data—or the lack of good data, for that matter—on how frequently Covid has been transmitted on flights. What we do know is that in mid-April the CDC announced new evidence that keeping middle seats open decreased exposure risk by half. That figure is based on an analysis of pre-pandemic viral transmission on planes and doesn’t account for the use of masks.

Ultimately, if you’re going to be in a crowded space with strangers—and you don’t have the assurances of testing or vaccine requirements—airplanes and trains are a relatively safe bet. The air in planes produced by Boeing Co. and Airbus SE is exchanged every two to three minutes; Amtrak says its trains cycle air 44 times every hour. On a bus, you may be able to open windows.

But no system is perfect when you’re within 6 feet of others for an extended period of time, and reducing the duration of these exposures is key if everything else remains constant. Bottom line: If private travel is not an option, just get there as quickly as possible.

What precautions should I take when flying?

How to Travel Safely During Covid: What Doctors Recommend After Getting a Vaccine

I also asked about double-masking, wiping down seats, and wearing a face shield—things I know many travelers had already been doing in their pre-vaccinated days. “Transmission from surfaces is much slower than we thought,” Talaat says, citing recent updates from the CDC and adding, “I don’t think you need to wipe down seats.” 

All three experts see value in wearing a face shield—the plastic visors meant to prevent respiratory droplets from reaching your eyes. “The opinions on this wax and wane,” Weisenberg says. “There has been some data that they do decrease risk. It’s incremental. It’s not unreasonable.”

More ample data show the benefits of wearing a single N95 mask throughout as much of the flight as possible. Double-masking, the experts agree, is useful only if you don’t have an N95 or another high-quality mask; the practice of placing a cloth mask over a surgical one creates a better seal around the sides of your face.

How to Travel Safely During Covid: What Doctors Recommend After Getting a Vaccine

Where risks crop up is when the mask needs to come off—say, for meals. “If it’s a short flight, suck it up and don’t eat,” advises Talaat. “Otherwise, do your best to avoid eating at the same time people around you are eating.” You can also get ahead of in-flight meals by filling up at the airport, so long as you find an uncrowded area to do so and avoid the busy food court.

Speaking of airports: It’s impossible to know how crowded they’ll be, or how long you’ll wait at customs and border patrol if you’re traveling internationally. These may be high-stress touch points and are unavoidable.

“A lot of travel medicine websites and the CDC have emphasized trying to complete as much of the bureaucracy of travel online before getting to the airport—checking in online, whatever you can accomplish,” says Caplivski.

One easy thing: Keep a pen in your carry-on. You don’t want to crowd around airport tables looking for ways to fill out traveler information forms.

Which activities are safe once I’m there?

How to Travel Safely During Covid: What Doctors Recommend After Getting a Vaccine

My most burning question to the experts was a hedonistic one: Is it safe to get a massage? Yes, they all said, particularly if it’s outdoors and everyone wears a mask. (The knots in my shoulders loosened at the mere thought of it.)

Likewise, that other vacation imperative: the pool. “Swimming is relatively safe because of the chlorine,” Talaat says. “Think about it: Chlorine is closely related to bleach. It’s there to kill germs and prevent infection.” (Even saltwater pools have chlorine in their filtration systems.)

That said, social distancing should still be practiced, both in the water and on the deck. That could prove tricky in a resort where, say, 1,000-plus guests are sharing a single swimming hole.

Caplivski adds one more reassurance: “Air currents are in your favor.” But because people are unlikely to wear masks in the water, he also believes that “distance is key.”

How to Travel Safely During Covid: What Doctors Recommend After Getting a Vaccine

The CDC’s recent update that surface transmission is low-risk brings new relevance to another pandemic travel debate: whether to allow for housekeeping. Whereas many hotels curbed these services or made them available by request only throughout much of the pandemic, the risk of having another person enter your room while you’re away, or of a housekeeper encountering the virus while on the job, both present a “very remote risk,” Weisenberg says, particularly if the hotel is discouraging employees from coming into work if they feel sick.

Dining out remains a concern while on the road, in all the same ways it does at home. “Eating outdoors, when you’re not in close proximity to others, in an area with natural ventilation, is far safer than indoor dining. Period,” says Weisenberg. Be particularly wary of indoor tables if a resort allows outsiders—meaning people who aren’t overnight guests—to come in for dinner, Talaat says, and avoid these situations entirely in cities or destinations that aren’t taking extensive precautions. (Toes-in-the-sand meals are always the right option, with or without a pandemic.)

Do I still need to get a Covid test when I get back?

How to Travel Safely During Covid: What Doctors Recommend After Getting a Vaccine

If you travel internationally and are returning to the U.S., you’ll need a negative PCR test taken in the three days preceding your homebound flight, regardless of vaccine status. That covers you before you step on the plane, but it doesn’t mean you’re necessarily free to do as you please once you get back home.

Each state has its own rules on how returning travelers should behave in the days immediately following their trip. While the CDC says vaccinated travelers needn’t get tested after returning from an international trip, New York state recommends (but doesn’t require) a follow-up PCR test three to five days post-vacation. Schools and workplaces may also have individual rules; Talaat says that out of an abundance of caution, she refrained from sending her toddler to school for 10 days following her domestic travels, and she’d recommend others do the same if traveling with unvaccinated minors. But she considers it safe to go to the office. “Even if vaccinated people have had known exposure to Covid, they don’t need to isolate if they are asymptomatic,” she says.

As for my own travels, I found my oasis in Jumby Bay, a private island retreat with just 28 suites and villas off the coast of Antigua. It checked all my boxes and then some; the concierge team assured me that many of the staff are already vaccinated, and the hotel even offers private customs and border patrol service to minimize the wait at the airport.

I wouldn’t call my planning process fun. But with travel back on my horizon, I’m relieved and looking forward to a completely new experience for the first time in many long months. That alone has been a boon to my mental health.

©2021 Bloomberg L.P.

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