Following the emergence of the COVID-19 (SARS-CoV-2) and its rapid spread across the globe, several countries have experienced large epidemics and many others are currently experiencing a high risk of catastrophic outcomes due to their already strained health systems and infrastructure. In response to the global and rapid dispersion of the virus, the absence of curable medications and effective vaccines, governments have opted to adopt non-pharmacological interventions – ultimately opting to either lock down entire countries or implement strict control measures. Although these policies have been beneficial in decreasing the number of cases and deaths worldwide, they have been disruptive to businesses and detrimental to the economy on the short-term. To avoid further economic loss, exit strategies were set in place and implemented.
One of the sectors to suffer the most during, and post-lockdown is air travel. Using international highways and airline transportation allows the spread of the virus to previously uninfected areas and exposes individuals who were otherwise not at risk of the infection. This is largely caused by air travel, which is the major driving force increasing the frequency and reach of epidemics. There is evidence suggesting that travel restrictions have considerably decreased the daily rate of COVID-19 case exportation, delayed the importation of cases into unaffected areas, and allowed countries to prepare their public health response.
As the world is slowly easing its way out of lockdown, it is experiencing a shift in air travel. The automation of airports is critical to decrease contact between individuals and subsequently to decrease the risk of viral transmission. When planning the reopening of airports, authorities must ensure they have the required resources to implement protective strategies in airports and airplanes to prevent the resurgence of the virus.
These measures include the disinfection of surfaces and facilities, whether by constantly making disinfection products available for workers and passengers or by introducing high-tech innovative products. Some technologies have already been developed to sanitize floors, public areas and passenger facilities such as the self-driving robots equipped with ultraviolet lights. Disinfection facilities, such as disinfection booths are also being built where passengers could get disinfected through a forty-minute procedure. Another technique recently used is the application of an invisible coat of antimicrobial agents to all surfaces that passengers frequently come in contact with.
Additional precautionary measures to consider include the redesign of passenger flow. Previously introduced strategies could be effective in preventing queues at boarding, such as boarding by seat number and virtual queuing features on apps which notify passengers on their seat boarding status. Furthermore, signs, floor markings and other schemes should be used to encourage physical distancing between passengers and to avoid overcrowding in airport spaces. Customary behavior during travel should also be altered by implementing new regulations, such as mandatory use of facemasks, installation of plexiglas and other protective barriers at check-in and passport control desks, and the allocation of isolation rooms for COVID-19 suspected cases. A complementary measure may include decreasing seat occupancy on board of airplanes by around 30 to 40% to increase the physical space between passengers.
A growing industry, which is beneficial at these times, is the automation of airports. Authorities should reorganize airports to adapt to the new norm and facilitate containment efforts for any future outbreaks. Procedures should become contactless to further avoid interaction between personnel and passengers, such as self-serve bag drop systems and biometric check-in screens, e-gates, and boarding procedures using facial recognition. Other technologies that have been developed to enable touchless use self-service devices include a user interface using voice recognition control and a method to scan passports without having to place them on a machine. Moreover, automated thermal scanners must be installed on arrival and departure to either allow passengers to proceed with their journey or to be redirected for further screening.
In response to the COVID-19 pandemic, governments have developed an interest in e-Health Passports. The latter is a virtual certificate indicating the health status of passengers. Some authorities have settled for COVID-19 antigen testing, a test that indicates whether the individual is infected with COVID-19 or not. Other governments have adopted the Immunity Passport Plan, which certifies that the passenger is immune to SARS-CoV-2, and therefore not considered a threat to themselves or the population. This system requires a negative test for COVID-19 and a positive blood test for COVID-19 antibodies using Antibody Rapid Test Kits. Although Immunity Passports would ultimately serve as the perfect solution for the resumption of air travel and tourism, several barriers emerge when discussing the validity of the virtual certificate. First, researchers are not clear on the duration of patients’ immunity against the virus and on the risk of cross-reactivity between antibodies for SARS-CoV-2 and other coronaviruses leading to false-positive results. Second, the risk of false-positive and false-negative results depends on the timing of the antibody test. Therefore, the accuracy and reliability of the antibody test requires further validation.
In addition to the technical obstacles, social barriers also arise. In the event of false-positive results, individuals might be erroneously led to thinking they were immune to the virus, further leading them to changing their behavior despite being susceptible to infection. These individuals could potentially pose health risks to themselves and others. Finally, equitable barriers also emerge in this situation. Immunity Passports might be discriminatory against those who are unable to afford getting tested or skipping work; therefore, creating a perverse incentive for those individuals to seek out the infection and become immune to it.
The Global Health Institute at the American University of Beirut addresses an array of health concerns amid COVID-19. More information is available, here: COVID-19
 Research Associate, Conflict Medicine Program, Global Health Institute, American University of Beirut
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DISCLAIMER: The views and opinions expressed in this blog are the author's, and do not reflect the views of the Global Health Institute or the American University of Beirut.
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