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Title: Strategies at points of entry to reduce importation risk of COVID-19 cases and reopen travel
Authors: Dickens, Borame L 
Koo, Joel R 
Lim, Jue Tao 
Sun, Haoyang 
Clapham, Hannah E 
Wilder-Smith, Annelies 
Cook, Alex R 
Keywords: Lockdown
travel restrictions
border measures
air passengers
Issue Date: 1-Dec-2020
Citation: Dickens, Borame L, Koo, Joel R, Lim, Jue Tao, Sun, Haoyang, Clapham, Hannah E, Wilder-Smith, Annelies, Cook, Alex R (2020-12-01). Strategies at points of entry to reduce importation risk of COVID-19 cases and reopen travel. JOURNAL OF TRAVEL MEDICINE 27 (8). ScholarBank@NUS Repository.
Abstract: Background: With more countries exiting lockdown, public health safety requires screening measures at international travel entry points that can prevent the reintroduction or importation of the severe acute respiratory syndrome-related coronavirus-2. Here, we estimate the number of cases captured, quarantining days averted and secondary cases expected to occur with screening interventions. Methods: To estimate active case exportation risk from 153 countries with recorded coronavirus disease-2019 cases and deaths, we created a simple data-driven framework to calculate the number of infectious and upcoming infectious individuals out of 100 000 000 potential travellers from each country, and assessed six importation risk reduction strategies; Strategy 1 (S1) has no screening on entry, S2 tests all travellers and isolates test-positives where those who test negative at 7 days are permitted entry, S3 the equivalent but for a 14 day period, S4 quarantines all travellers for 7 days where all are subsequently permitted entry, S5 the equivalent for 14 days and S6 the testing of all travellers and prevention of entry for those who test positive. Results: The average reduction in case importation across countries relative to S1 is 90.2% for S2, 91.7% for S3, 55.4% for S4, 91.2% for S5 and 77.2% for S6. An average of 79.6% of infected travellers are infectious upon arrival. For the top 100 exporting countries, an 88.2% average reduction in secondary cases is expected through S2 with the 7-day isolation of test-positives, increasing to 92.1% for S3 for 14-day isolation. A substantially smaller reduction of 30.0% is expected for 7-day all traveller quarantining, increasing to 84.3% for 14-day all traveller quarantining. Conclusions: The testing and isolation of test-positives should be implemented provided good testing practices are in place. If testing is not feasible, quarantining for a minimum of 14 days is recommended with strict adherence measures in place.
ISSN: 11951982
DOI: 10.1093/jtm/taaa141
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