Covid Is Airborne (on Airplanes)

Covid Is Airborne (on Airplanes) 1

By Lambert Strether of Corrente.

B117[1] is the Covid variant shortly to become “dominant” in the United States. Where did it come from? Outside the United States. That makes border control, especially for air travel, of paramount concern. It’s not. Or else B117 wouldn’t be here! That’s basically the post, which is pure common sense as soon as you see it. But allow me to elaborate. First, I’ll briefly summarize the origins of B117, and first spread to the United States. Then I will describe how other Japan and Vietnam have successful controlled it, though [drumroll] border controls, among other techniques. Finally, I will contrast what other countries are doing to what we are doing, and conclude. (All in all, yet another case study for How the West Lost COVID, if preventing the virus from spreading be the appropriate metric for success.)

The Origins of B117

At Virological.org, we find “Phylogenetic evidence that B.1.1.7 has been circulating in the United States since early- to mid-November,” which gives a brief history of the origin and spread of B117:

When SARS-CoV-2 emerged in China late December 2019 and early January 2020, there was little circulating genetic variation as it was exported across the world. This made estimating the number and timing of introductions difficult. Since then, the virus has accumulated mutations (as all RNA viruses do) in a (largely) clock-like manner, diversifying into a myriad of lineages. One of these lineages, ‘B.1.1.7’, first arose in the UK in September after an episode of heightened mutation, likely within a single host. This lineage has continued to evolve over the last several months while rapidly increasing in frequency across southeast England and elsewhere. …. The rapid increase in the UK has made export increasingly likely, and, as of 1/17/2021, the lineage has been detected in 55 countries, including the United States.

“[A]n episode of heightened mutation, likely within a single host” likely means an immunocompromised individual. From Science, “U.K. variant puts spotlight on immunocompromised patients’ role in the COVID-19 pandemic“:

In June, Ravindra Gupta, a virologist at the University of Cambridge, heard about a cancer patient who had come into a local hospital the month before with COVID-19 and was still shedding virus…. That made it hard for him to shake the infection with SARS-CoV-2.

…When Gupta studied genome sequences from the coronavirus that infected the patient, he discovered that SARS-CoV-2 had acquired several mutations that might have allowed it to elude the antibodies.

Now, his analysis, reported in a preprint on medRxiv earlier this month, has become a crucial puzzle piece for researchers trying to understand the importance of B.1.1.7, the new SARS-CoV-2 variant first found in the United Kingdom. That strain, which appears to spread faster than others, contains one of the mutations that Gupta found, and researchers believe B.1.1.7, too, may have originated in an immunocompromised patient who had a long-running infection. “It’s a perfectly logical and rational hypothesis,” says infectious disease scientist Jeremy Farrar, director of the Wellcome Trust.

In terms of the social determinants of health, it’s intriguing that B117 originated in Kent, the sort of place where immunocompromised are likely to be found. From Patrick Cockburn in the London Review of Books:

But it was becoming clear that, whatever the effectiveness of lockdown in other parts of the UK, it wasn’t working in this corner of Kent. The surge in infections moved inexorably inland towards where I live in Canterbury, fifteen miles from Margate and ten miles from Faversham.

It wasn’t surprising that Swale and Thanet should be badly affected: these are areas notorious for their poverty and likely to provide an ideal breeding ground for the virus. They are prime examples of coastal Britain, depressed places where failed hotels and B&Bs have been chopped up into one-room flats and where few can work from home because their jobs won’t allow it; the homes, in any case, are too small to work in. Years of austerity had already cut back the funding and benefits on which such towns depended. People were vulnerable to the virus here because their health was poor before the pandemic and their access to healthcare limited: in Swale the ratio of GPs to residents is lower than anywhere else in England. Inequality is extreme: a woman living in the most affluent ward in Thanet will live on average 22 years longer than a woman living in the most deprived ward.

One thinks at once of deindustrialized flyover and deaths of despair.

Be that as it may, B117 is not a good lineage to have been detected. From the Journal of the American Medical Association, “SARS-CoV-2 Viral Variants—Tackling a Moving Target“:

Epidemiological studies indicate that the B.1.1.7/20I/501Y.V1 strain is 30% to 80% more effectively transmitted and results in higher nasopharyngeal viral loads than the wild-type strain of SARS-CoV. Also of concern are retrospective observational studies suggesting an approximately 30% increased risk of death associated with this variant.

Unfortunately for us all, B117 travels by air. From bioRvix[2], “Phylogenetic analyses of SARS-CoV-2 B.1.1.7 lineage suggest a single origin followed by multiple exportation events versus convergent evolution

[O]ur analyses point to an origin in and spread of the VOC B.1.1.7 from

the UK. As for the virus’ initial and subsequent spread, global connectedness and high levels of human mobility undoubtedly facilitated VOC B.1.1.7 dissemination. The swift global spread of VOC B.1.1.7 illustrates that current restrictions are insufficient to prevent the spread of new and

emerging variants. Similar to Ebola, HCV and HIV, countermeasures to SARS-CoV-2 spread should be developed with a broader perspective than the national level. Otherwise, without population immunity, successful local reductions in SARS-CoV-2 burden will be counteracted by imported infections that set off new waves of viral spread, possibly exacerbated by novel phenotypic characteristics of the imported strains

Yikes. With that background, let’s find out how B117 came to the United States.

How B117 Spread to the United States

B117 came to the United States by air (and not by, say, ocean liner, by surface transport, or by hopping the border). From medRxiv, “Genomic epidemiology identifies emergence and rapid transmission of SARS-CoV-2 B.1.1.7 in the United States“:

[W]e investigated the prevalence and growth dynamics of this variant in the United States (U.S.), tracking it back to its early emergence and onward local transmission. … Our phylogenetic analyses indicate that there have been multiple introductions of B.1.1.7 into the U.S., with the earliest dating back to the end of November, 2020. These analyses revealed large clades of closely related SARS-CoV-2 lineages clustering within individual states, as well as national spread indicated by several smaller clades defined by mixtures of samples from patients who reside in different U.S. states. These findings are consistent with community transmission following several of these introductions, including spread across U.S. states.

… [O]ur TMRCA [median time to the most recent common ancestor] estimates coincide with increased periods of travel, where the U.S. Transportation Security Administration reported over one million travelers crossing checkpoints for several days during the peak Thanksgiving season (November 20-29, 2020) and for twelve of eighteen days surrounding the Christmas and New Year’s holidays (December 18, 2020 to January 4, 2021) (TSA, 2021), providing a likely explanation for how B.1.1.7 may have been introduced via international travel and spread across the U.S. via domestic travel.

From the New York Times, summarizing the above study in “Virus Variant First Found in Britain Now Spreading Rapidly in U.S.”:

The first case turned up on Dec. 29 in Colorado, and Dr. Andersen found another soon after in San Diego. In short order it was spotted in many other parts of the country. The variant was separately introduced into the country at least eight times, most likely as a result of people traveling to the United States from Britain between Thanksgiving and Christmas.

(We will have an individual case when we look at the United States response, below.) Of course the variant arrived by air. How else? Now let’s look at how two other countries handled the appearance of B117.

How Other Countries Have Handled B117

First, Vietnam. From the Financial Times, we see the advantages to citizens of not living in a failed state like our own:

Vietnam’s ability to contain its first wave of infections, thanks to vigorous contact tracing, strict quarantine requirements and border controls, has allowed most aspects of normal life to resume.

Nevertheless, the variant arrived. By air. From Channel News Asia:

The two [B117] patients reported earlier in the day include a support staff worker at Van Don international airport who was responsible for taking infected passengers arriving from abroad to COVID-19 quarantine facilities.

The other case is a factory worker who came into contact with a Vietnamese national who later travelled to Japan and tested positive there for the new UK variant of the virus, which has been determined to be much more easily transmissible.

Interestingly, Vietnam tested travelers across internal borders, quarantining them if necessary. From VN Express, “Hanoi tests all arrivals from areas with coronavirus infections“:

Hanoi said people who arrived from Hai Duong Province, the country’s Covid-19 epicenter, and areas with active cases in 11 other cities and provinces would be tested for the coronavirus.

Hanoi’s Health Department said Thursday it would perform Covid-19 tests on people coming to Hanoi from areas having reported infections since the new wave hit Vietnam late last month.

People subject to the tests include those coming from Cam Giang District, Hai Duong’s biggest hotspot, since January 15, and other places of Hai Duong since February 2.

HCMC and some northern localities have also mandated a 14-day quarantine or even barred entry for people coming from Hai Duong.

It looks to me like the cases at Van Don international airport were all from Vietnamese nationals, since Vietnam’s restrictions for foreigners are rather draconian. From the United States Embassy in Vietnam, “COVID-19 Information“:

On March 17, the Vietnamese government announced that they will work with relevant ministries and agencies to consider gradual resumption of international flights; however, there has been no official guidance at this time. As of today, the Vietnamese government continues to suspend entry into Vietnam to all foreigners, including people with a Vietnamese visa exemption certificate. This policy has very limited exemptions for diplomatic, official duty, and special cases, including experts, business managers, foreign investors, and high-tech workers of businesses involved in important projects as determined by the Government of Vietnam. Family reunification is not one of the exemptions.

Travelers currently allowed to enter Vietnam, including Vietnamese nationals and diplomatic, official duty, and special cases, including experts, business managers, foreign investors, and high-tech workers of businesses involved in important projects as determined by the Government of Vietnam, and their family members, are subjected to mandatory quarantine upon arrival.

(The quarantines are free.) A discussion of Vietnam’s testing strategy, with a chart of their success:

And now, Japan, whose first case of B117 arrived — and I know this will surprise you — by air. From Euroweekly, “British Traveller Violates Quarantine Rules And Infects Tokyo Residents”[3]:

The Ministry of Health, Labor and Welfare announced on Sunday, January 10, that three men and women in their 20s have been infected in Tokyo with a mutant strain of the new coronavirus that is prevalent in the United Kingdom.

Two of them were having dinner with the British man in his thirties, who is said to have tested positive after arriving from England on December 22.

The Brit was supposed to be observing a quarantine period at the time, however, he went out for dinner with about 10 people, although it seems that there are no other people infected.

Of the three men and women, two became ill on December 30 and January 2, respectively, who were confirmed to be infected with the mutant strain.

ABC gives the Japanese government’s response. “Asia Today: Japan halts all foreign arrivals over UK variant“:

Japan is barring entry of all nonresident foreign nationals as a precaution against a new and potentially more contagious coronavirus variant that has spread across Britain.

Japan is also suspending the exemption of a 14-day quarantine for Japanese nationals and resident foreigners in a short-track program that began in November. The entrants now must carry proof of a negative test 72 hours prior to departure for Japan and self-isolate for two weeks after arrival.

Lest you think that “self-isolate” is lax, here are the rules. From Timeout Tokyo:

As of March 18, inbound travellers must install three apps on their smartphones before departing for Japan: the government’s Cocoa Covid-19 contact tracing app (for iOS and Android), the government’s OSSMA location confirmation app (for iOS and Android), and Skype. If travellers don’t have a personal smartphone, they must rent one at the airport.

The revised quarantine measures have come into effect since Friday February 5. Additionally, foreign residents who break quarantine rules will be penalised and could have their residency status revoked. This report also states that from February 13, authorities will be allowed to impose fines and legal penalties on those who break the quarantine law, which may include a one-year imprisonment or a fine of up to ¥1 million.

The inbound travellers must also have undergone testing. From the Japan Times, “With emergency extension for Tokyo area likely, Japan expands border control measures“:

All people coming from abroad are required to undergo tests for COVID-19 prior to their departure for Japan, submit proof they have tested negative upon arrival and observe a 14-day quarantine. However, with the change, people arriving from Austria, Belgium, Brazil, Denmark, France, Germany, Italy, the Netherlands, Nigeria, Slovakia, Sweden, Switzerland and the United Arab Emirates will be required to self-isolate for the first three days at facilities designated by the government. After that period, they will be required to undergo tests for the novel coronavirus once again, and only those who test negative will be able to self-isolate at home or at a hotel of their choice for the remainder of the quarantine period.

These measures seem to have done the trick. From Nikkei Asian Review:

Covid Is Airborne (on Airplanes) 2

Of course, Japan has the Olympics coming up. Good luck to them, is all I can say.

I began with Vietnam’s strong response, then Japan’s somewhat weaker response, which brings me to the weak response of the United States.

How the United States Has Handled B117

We’ve seen how Vietnam and Japan brought B117 under control through a combination of border controls (both international and domestic) and quarantines (combined with existing systems for contact tracing. Since the United States can’t do contract tracing, we won’t look at that). Let’s see how the United States stacks up, at international and domestic borders.

Here is an example of one B117 international-travel case from the CDC’s Morbidity and Mortality Weekly Report, in “Travel from the United Kingdom to the United States by a Symptomatic Patient Infected with the SARS-CoV-2 B.1.1.7 Variant — Texas, January 2021:”

On December 30, the patient disclosed a runny nose during the pretravel interview but was cleared to fly from London to Dallas [!!], Texas the same day. Upon arrival in the United States on December 31, the patient stayed overnight in a hotel and then drove home (approximately 8 hours). On the way home, the patient stopped five times, including twice for food, twice for gas, and once at a grocery store. Throughout the international and domestic travel period, the patient reported trying to maintain physical distance from others and wearing a cloth face mask, except while eating or drinking. The patient began self-quarantine upon returning home, which was broken twice for a medical and testing appointment.

Notice the complete absence of a mandatory quarantine. I have to quote a lot more so you can see what’s not there:

This case demonstrates how a variant of concern, in this case B.1.1.7, might be translocated between communities through travel. At the time of this person’s travel, CDC had an order in place requiring proof of a negative SARS-CoV-2 test ≤3 days before departure, or documentation of recovery from COVID-19, for all air passengers boarding a flight to the United States from the United Kingdom (3). Subsequently, on January 12, CDC issued an order expanding this requirement to all international air passengers arriving in the United States, effective January 26, 2021 (4). Because of the lower sensitivity of some SARS-CoV-2 antigen tests (5,6), the potential for false-negative results when nucleic acid amplification tests (such as RT-PCR) are administered shortly after infection with SARS-CoV-2 (7), and the subsequent potential for exposing others after a test is administered, predeparture testing should be considered one component of a comprehensive travel risk management strategy. Properly timed testing, both before and after travel, together with self-monitoring for symptoms, a period of self-quarantine after travel, use of a well-fitting mask, hand hygiene, and physical distancing, are critical elements of this strategy (8). Persons should not travel if they are experiencing symptoms compatible with COVID-19 or if they have received a positive SARS-CoV-2 test result and have not met criteria to discontinue isolation,¶ have had close contact with a person with suspected or confirmed COVID-19 and have not subsequently met criteria to end quarantine,** or have a pending SARS-CoV-2 viral test result.

Notice that CDC does not recommend quarantine (leaving the matter, as the notes show, to states and localities).

This case is from a US citizen (as with Vietnam), so let’s look more closely at CDC’s current restrictions for US citizens. When leaving the foreign country for the United States:

Covid Is Airborne (on Airplanes) 3

These are only paperwork requirements, and in the absence of some validation and enforcement process, easily gamed. NC reader AM flew to Scotland and back in October 2020, and described the paperwork as “theatre.” Do any readers have updated information? When returning from the foreign country to the United States:

Covid Is Airborne (on Airplanes) 4

More theatre. And “self-isolation”/”self-quarantine” requirements are entirely voluntary (!), as is testing (!!), very much in contrast to Vietnam and Japan.

Now, to be fair, the United States does “suspend or limit” entry to citizens of several countries.

Covid Is Airborne (on Airplanes) 5

However, the list is weirdly arbitrary; we do not limit Indonesia, which has a bad, albeit improving, Covid problem, or Malaysia, which has a lesser but significant one. By contrast, Vietnam and Japan have blanket bans, which are simpler to administer and harder to game.

As far as domestic travel in the United States goes, here’s a handy map of putative restrictions:

Covid Is Airborne (on Airplanes) 6

(Here is a list of state restrictions with detail in prose.) Hilariously, the restrictions bear no relation to variant spread whatever:

Covid Is Airborne (on Airplanes) 7

I would also like to hear from any readers who actually experienced travel restrictions moving from state to state. I would bet it’s all theatre. (Though you would think somebody would get the bright idea of “Covid Traps,” exactly like Speed Traps!)

Conclusion

So, here we are, with the more contagious and lethal B117 variant spreading. From the International Business Times, “Doctors ‘Pleading’ With Public As Air Travel Spikes For Spring Break“:

Public health officials are alarmed by spiking air travel rates, warning that Spring Break travel is premature at this stage in the vaccination effort. The winter COVID-19 surge was driven by holiday travel, and doctors worry that fair weather and vaccine progress could convince vacationers the pandemic is over just as variants loom, CNBC reports.

Air travel rates have reached their highest levels in a year, with one million TSA screenings per day since Thursday. That’s not as high as it was before the pandemic, but it is enough to concern health officials.

I’m pleading with you, for the sake of our nation’s health,” CDC Director Dr. Rochelle Walensky said Monday. “Cases climbed last spring, they climbed again in the summer, they will climb now if we stop taking precautions when we continue to get more and more people vaccinated.”

Pleading! And we’ve seen the same pattern before: Success, followed by relaxation, followed by renewed failure. From the Guardian., “US experts warn new Covid variants and states reopening may lead to fourth wave“:

“Everybody’s focused on the big declines in the number of cases, pretending the plateau is not really substantive, and oblivious to the impact of B117,” a highly transmissible variant first identified in the UK, said Dr Peter Hotez, a vaccine researchers and dean for the national school of tropical medicine at College of Medicine in Houston, Texas.

The potential plateau, highly transmissible new variants, and decision to reopen when vaccines have reached relatively few people “has all the makings of a fourth wave, and gives me a lot of pause for concern,” said Hotez.

The Administration could, of course, have enforced 14-day quarantines for all international flights without exception:

It’s too late to stop B117, but maybe that will stop the next variant, if it evades vaccines.

The Administration could, of course, still restrict domestic travel:

There are 117 international airports in the United States. That means that there are 117 points to choke off the entry of the virus into the country by air. That’s 117 testing facilities, 117 quarantine facilities. That’s about half the number of facilities run by the country’s smallest hotel chain, Hilton Worldwide. It’s very hard to believe that the United States doesn’t have the operational capacity, or the money, to set up such a system. And yet nowhere in the political class, or in the public health establishment, are border controls and quarantine even on the radar. They go unmentioned. A failure to learn? A failure of imagination? Lack of nerve? Lack of desire? Rule #2 of Neoliberalism? The business of America is business, after all….

NOTES

[1] More correctly, B.1.1.7 (lineage), a Variant of Concern (VoC) but that’s a lot of characters to type. Also, B117, for me, has a penumbra of lethal connotation, from World War II bombers like the B-17. B.1.1.7 has other monikers: 20I/501Y.V1, VOC 202012/01. Here is a handy chart:

[2] The paper was withdrawn by the authors for insufficient acknowledgement of the contributions of others, which I take to mean that the content is OK.

[3] In a more pandemic-riddled world, behavior like this might end up being a casus belli.

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