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Travel in 2021 Myths with Dr Chris Sanford

05/26/21 Christopher Sanford, MD, MPH, DTM&H, University of Washington;

Season 3 | Episode 2


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>>Joe McIntyre: Where's the first place, you're going go, when all this is over?


>>Dr.Sanford:  I'm going to go to a lot of places. One place I'm going to go to is I teach every year in Uganda, I teach in a tropical medicine course, and I'm going to start teaching there again. But I love Mexico. I love Latin America, Africa and Asia. And I've got a lot of listeners, a lot of places I haven't seen I've been to maybe 60/65 countries. But where I really haven't been that much is Europe, I haven't seen Eastern Europe, I haven't seen Southern Europe. So I'm going to I'm going to travel a heck of a lot. As soon as the CDC says it's a reasonable thing to do.




>>Joe McIntyre: Welcome to another episode of the Merck Manuals Medical Myths podcast. Thanks for joining us. Once again I'm your host, Joe McIntyre, and today I'm lucky to be joined for the second time on our show by Dr Chris Sanford. Dr. Sanford is an associate professor in the department's of Family Medicine and Global Health at the University of Washington. Dr. Sanford thanks for coming back.


>>Dr.Sanford:   Hey, thanks for having me.


>>Joe McIntyre:   So the last time we had Dr Sanford on the podcast, his guide for travelers, Staying Healthy Abroad: A Global Travelers Guide had just been published. The world has changed quite a bit since then and we're here to talk specifically about traveling the world of COVID-19. So Dr. Sanford let's start with the blunt question when it comes to travel today. Is it safe to travel in the world of COVID?


>>Dr.Sanford:   You know, Not as much as it was this kills me to say being a travel advocate as I am. But, now and for the next several months, it really is a sub optimal time to travel, so I can't say absolutely don't travel, for any reason, but in general in the near future, less travel is better.


>>Joe McIntyre:   Now we've heard that driving is probably could be maybe safer than flying when it comes to the risks of exposure to COVID-19. Is that true because of the science of COVID-19 or are the risks associated with being a plane with strangers, simply the reason for that increased risk?


>>Dr.Sanford:    Well one caveat I would interject just before we talk about one or the other being absolutely safer, What's the duration of the trip? If it's a one day trip I suppose it would be the equivalent of a six hour drive or a single Jet ride. It'd be probably a car is safer because it's all about exposure to people. But if you're talking about Los Angeles to New York drive versus a single jet flight, Then there's low risk either way, and with all of the hotels and restaurants and such, I'm not sure that it's true that the driving would be safer.


>>Joe McIntyre: Interesting.   So we know that COVID has exploded, obviously as the weather has gotten colder. So it stands to reason that it may be better to travel in warmer destinations than colder destinations. Is that right?


>>Dr. Sanford:    I would not base the decision to travel on weather, I would base it on recommendations from the CDC and other organizations. Now there's some truth to what you say indeed COVID seems to be more easily spread in cold weather, and it does seem to partially go away in the summertime, however that trend is not such that I would rely on weather alone to make a decision.



>>Joe McIntyre:   Now, is it in general, right now today we're recording on February 3 That COVID-19 is the biggest risk for travelers right now? Many seem to think so.


>>Dr. Sanford:    A couple of myths that I deal with routinely my travel clinic is one that it's dangerous to travel and two that to the extent there is risk that it's infectious disease. Pre COVID, It was generally safe to travel, and most of the risk was not infectious disease such as automobile accidents. Now there is heightened risk from COVID, but all of the old risks haven't gone away so if you do travel I think COVID represents a significant risk, but all of your usual things do too, so if one does travel COVID is not your only worry you still need to think about, seatbelts helmets and all the routine immunizations for all the other illnesses including influenza and hepatitis A and so on. So I'm actually not sure if COVID is a bigger risk than car crashes, I would say currently they're both significant.


>>Joe McIntyre:   Now, if people need to travel or have a desire to travel, it's often recommended that they do a COVID-19 test before they get on an airplane or go anywhere certainly out of state, but we've also heard that people need to quarantine, even after getting a negative test when they arrive at their destination. Can you explain why that is?


>>Dr. Sanford:    One reason is that you may have to whether you want to or not depending on where you go to. So some states and a lot of countries require quarantine. Another reason is that the tests are not fully accurate, and they're most accurate after you have symptoms but you probably don't have symptoms or you wouldn't be traveling, and before you have symptoms, the tests are better than nothing but there's a fair false negative rate. And so quarantining really is the safest way to make sure that you don't represent a risk to other people.


>>Joe McIntyre:   Now, in a similar vein to having a negative test let's say I already had unfortunately, COVID-19 but have since recovered. Does that mean I'm free to travel, any way shape or form that I want now?


>>Dr. Sanford:    I wish. Indeed, it's thought that you're only transmissible on average for about 10 days after the onset of symptoms, but that's not known with all people, and it's not really knowing how long you might spread the virus for. And from a public health standpoint we really can't start making different sets of rules for people who've had it people who haven't. So as a general rule, all of the rules about social distancing and wearing a mask still apply even if you've had a positive diagnosis.


>>Joe McIntyre:   Now I believe the first time we had you on this podcast we talked a little bit about certain immunizations that you may need to travel in certain parts of the country. Obviously, the COVID-19 is a very important vaccine that's becoming available to more and more people across the country. When an individual receives the vaccine, and has received the second dose of the vaccine if necessary. Are they free to travel wherever they like is the vaccine like a ticket to freedom?


>>Dr. Sanford:    You know, similarly, sadly, no. Right now and again I would base this on CDC recommendations that does not give you a Get Out of Jail ticket immediately. Indeed, you're less likely to get it, but the vaccines are not 100%, protective, and importantly, whereas it's known to vaccines have a high level of protection for you not getting the disease. It doesn't know if you can transmit it while you're asymptomatic to someone else. So for public health reasons, no. The even after you've had the vaccine, you have to do the social distancing and the mask and the hand washing and all those are the things that we're all getting very tired of.


>>Joe McIntyre:   I know I am. So when we talked, the first time, you mentioned some medication that individuals may need to bring when they travel certainly internationally. But now, whenever we travel whenever we leave the house we need to bring masks along with us. What else do you recommend people bring if they have to travel or want to travel during COVID-19, along with them on their trip?


>>Dr. Sanford:    One would be a way to wash your hands frequently so something like alcohol wipes or alcohol-based hand sanitizer. Another would be a thermometer, because if you get a what it might be a head cold or might be COVID Of course you're not going to know from the symptoms alone, and you start talking to a medical person on the phone, the first thing you're going to want to know is do you have a fever so I would take a thermometer with you. Those would be the main things that is specifically relating to COVID that I would take.


>>Joe McIntyre:   As far as medication goes, is there anything specifically that people should bring, just in case they get sick on their trip with COVID-19 other any specific medications either over the counter or otherwise that individuals who bring with them?


>>Dr. Sanford:    You know some people feel better if they take an over the counter analgesic and that can either be an anti-inflammatory like ibuprofen or a non anti-inflammatory such as acetaminophen those give some people relief. You could also do the standard over the counter cold stuff like saltwater gargles for a sore throat or decongestion for a runny nose, but the over the counter outpatient treatment is pretty low tech and symptom based, so I basically would treat it like a bad head cold and use the same medications you would do for that.


<music break>


>>Joe McIntyre:   The Merck manuals website offers a variety of video, audio, and interactive content. With so many choices, it's easy to access information is the best first place to go for free, understandable medical content.


>>Joe McIntyre:   Are there any specific destinations or activities that you would recommend people stay away from, to avoid extra risk for COVID-19 exposure?


>>Dr. Sanford:    Broadly, travel, which is probably a larger answer than you're looking for. Within that, it's all about being around people. So the worst thing would be to go to a large I don't know, you know 50,000 people in one enclosed rooms and start kissing a lot of strangers, the fewer people you're around the better. And so I would not go to any kind of mass gathering, You know if you're traveling with your significant other, maybe just be a twosome for your whole trip to the extent you can, I would just avoid being around people and do the usual things that that you do in terms of masks and such. In terms of activities being outdoors is probably okay. Exercise is good for your body it's good for your mood, and as long as you're socially distancing, I think it's good to get outdoors. So, the thing I would avoid would be a lot of people and B being indoors with closed windows.


>>Joe McIntyre:   Yeah, my next question was, we have been a little negative so far in this podcast, where some of the safe places that people can travel, obviously, places where you're going to be outdoors, most of the time so places such as hiking, and visiting national parks perhaps where you're camping out. Would that be a safe place to travel?


>>Dr. Sanford:   Well I wouldn't say absolutely safe any travel at all involves some risk I would call that lower risk, yes. Outdoors not around people sure it is better than crowds.


>>Joe McIntyre:   Now what types of questions have you been receiving about COVID-19 and treble from your patients, are there any questions that you be getting really often are people getting anxious to travel again I'm sure we all are, but do you see more of your patients and more people getting out on the road or getting on airplanes again.


>>Dr. Sanford:   People are curious, if they can travel and if so, where the lowest risk places are and of course as you would expect people want to know when they can be vaccinated. There's a lot of you know curiosity something like this has not happened during my career people want to know what happened, why this is happening now, they would they want to point out to me that this is grossly unfair, and that they did nothing to deserve this limitation, but a lot of it is about where can I go, that is safe. And that's a complicated answer because, let alone every country but even now different states have different rules, Airbnb has different rules for different counties. And so one thing that I encourage people to do before they travel if they're going to is really go online, and, for example, if they're going to a particular foreign country, go to at least half a dozen websites and this may be something you're going to ask me about but I would check out the CDC, Centers for Disease Control and Prevention, which is I would check out the US State Department I would go to the embassy site for that country. You know, I would go to the airlines site if you're going to go through a particular company like Airbnb, I will go to their site and look at their regulations, because every foreign country and now many states have a different set of rules and they're changing quickly. Also, I would consider seeing a pre travel doc just about routine immunizations and such before you go.


>>Joe McIntyre:   Now, I won't ask you to speculate on when COVID will quote unquote end because it's obviously very difficult to know right now, I'm sure, almost all of us want this to be behind us. But when the world has COVID under some sort of control, how do you think this virus will impact travel over the long term?


>>Dr. Sanford:   That's really good question and I'll speculate but of course I don't know with certainty. I don't think this thing, I don't think this is going to go back in the bottle so I think we now have Coronavirus is a virus that's you know like influenza is with us for the foreseeable future. I think it's going to mutate, as it already has it's going to continue to mutate, and there's some speculation that just as people need annual flu shot, you may need a different COVID shot in the future. That is pure speculation but we're not at all sure that this year's COVID shot will be good, year after year. Another way things very likely may change, although this is not certain is that people will need what's being called a COVID passport, so you may need to show that you've been vaccinated or have had the illness, have some electronic or other representation of that before you fly in the future. So currently there's not very many requirements vaccine wise for international travel. There's yellow fever for some countries and then meningococcal meningitis for a limited number of circumstances, but it may very well be in the near future. You're going to need proof of COVID vaccination for entry to a lot of foreign countries.


>>Joe McIntyre:   So Dr. Sanford, you mentioned a handful of resources people should check out before they travel the CDC and otherwise, what else. Where should I go for resources to find out how to travel safely, and how to make sure I'm following all the proper rules and regulations?


>>Dr. Sanford:   One I would go to is every country has an embassy where they have a discussion of requirements and rules and regulations for people who are entering their country, and I would look at that, and it's not up to negotiation. So if you get there and you disagree with their rules. Well, that's tough. You're gonna get back on the jet or otherwise have problems. There's a lot of countries you just flatly can't go to currently regardless of vaccine or otherwise. And I would you have to be a little passive with this, you're not in full control of the situation. And if you're going to do international travel, I would look at the places that are options and then follow the rules that they say. So to answer your question the embassy site.


And then I just go to places like the New York Times in The Washington Post and other publications that I trust, for example both New York Times and Washington Post have updated lists of countries you can go to and a summary of the rules. So I just sort of broadly go to Google and see what's new and don't do it three months before you travel and assume it's going to be unchanged, I would do it regularly, because these things really are changing on a day to day basis. Another excellent resource is the online Merck Manual site. They've got chapters on every medical topic in the universe. And there's two editions there's one for medical professionals but there's a nicely accessible version two for laypeople, that talks both about general travel things but also things pertaining to COVID. And also, then, as you may know there's an editorial I did on COVID and travel recently that's at the Merck Manual website.


>>Joe McIntyre: So Dr. Sanford we covered a ton of different topics related to travel and COVID-19, but I do have a few additional questions, more broadly about travel if you'd be able to stay on a little longer for an additional podcast.


>>Dr. Sanford:    Yeah, I'd be happy to.


>>Joe McIntyre:    Great, okay. Well Dr. Sanford thanks for joining us for this episode, and we'll welcome you back for an additional one later on. But always, as we say at the Merck manuals,


>>Dr. Sanford: Medical knowledge is power,pass it on.


>>Joe McIntyre: Thanks so much.

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