In recent months, the World Health Organization has been using the Greek alphabet to denote potentially significant mutations of the original coronavirus strain. If you remember your high school math, the Greek letter Delta (Δ) means “change”, and all eyes are now focused on the COVID-19 Delta Variant as it spreads rapidly across the globe. This seems like an appropriate time to ask the question: Is the COVID-19 Delta variant a game changer for the return to international travel?
In my role as an international travel risk manager, my job has been to not only assess current realities, but to analyze future potential scenarios as well. In the case of the pandemic, there are multiple factors that I assess when planning trips. First, I look at the current and potential future spread of COVID-19 in the United States. Second, I examine vaccination progress abroad. Third, I analyze how aggressive or passive different countries have been in changing rules surrounding travel. Fourth, I explore the quality of health care systems in a given country to see how prepared they are to handle a surge in COVID-19 cases. All four factors point to the same conclusion: The Delta variant very well could be a game changer for some international travel in the months ahead. But I believe these risks for healthy vaccinated travelers are more logistical in nature than they are health and safety, and there are certain destinations that are more logical choices for you to consider. So let’s take a look at each of the four factors.
The spread of COVID-19 – in three paragraphs
Back early May, we thought we had seen the last wave of the pandemic in the United States. Vaccination rates were still climbing. The United States was among the Top 5 highly populated countries in terms of vaccination percentages with national vaccine rates surpassing 40%. A look at neighboring Canada showed less than 5 percent of its population fully vaccinated at the time. Most European countries also had single digit vaccination rates. It looked like the United States was ahead of the curve and on the right track. But there were some concerning warning signs. Stories out of India showed a massive surge in daily cases, which peaked at more than 400,000 per day, as hospitalizations/deaths overwhelmed their systems. At the same time, the U.S. hit a wall in terms of vaccine hesitancy. Within two weeks, we flipped from struggling to find vaccine appointments to there being a ready inventory of doses at almost every Walgreens and CVS location. Even today, the U.S. still has not quite reached 50% of the population vaccinated (49.92%) while countries like Canada (58.21%) and the United Kingdom (56.53%) have surged past us.
At the same time, we started seeing the phrase “Delta Variant” appear in the media. While the Delta Variant does not seem to cause severe illness, hospitalization or death for the majority of vaccinated individuals, it is significantly more transmissible. Studies indicate that amount of virus in a person’s respiratory tract is 1,000 times greater than with the original strain of COVID-19 and that each infected person may be passing along the infection to an average of 5 others – compared to 2 others with the original strain in the early days of the pandemic. Average incubation times have been reduced from 6 days to 4 days, meaning people become contagious sooner. And the spike protein on the Delta variant is structured in a way that makes it easier to enter human cells. All of this means that it is more possible for fully vaccinated individuals to spread the Delta Variant to other individuals. As a result, 92% of new COVID-19 cases in the United States last week were of the Delta Variant.
While those in the anti-vaxx or vaccine-hesitant camp like to say that getting a COVID-19 shot is a personal choice and those who have gotten their shots no longer need to worry, there are three significant concerns that they overlook. First, there are still more than 160 million Americans who have not gotten vaccinated – including all children younger than age 12 who aren’t eligible yet. A variant that can be spread unwittingly by immunized individuals to those who are not immunized or immunized/immunocompromised could result in a massive increase in cases here at home. Second, breakthrough cases among those fully vaccinated and among those who have already had COVID-19 are becoming more common. In July, baseball all-stars Aaron Judge and Christian Yelich, both fully vaccinated at different times with the one-shot J&J vaccine, tested positive and had to be isolated. And Baltimore Ravens quarterback Lamar Jackson has now tested positive for the second time in eight months. Third, the more that COVID-19 spreads, the more time there is for new mutations or variants to form. At some point, there could be a variant that current vaccines are not effective at fighting, and that significant illness among vaccinated individuals becomes a reality. Bottomline: It is important to take steps necessary to protect the vaccinated and unvaccinated at the same time as we dramatically reduce the number of unvaccinated. Enough of the soapbox. Moving on.
Vaccination progress abroad
Health officials have warned for more than a year about the need to develop a global distribution plan for any COVID-19 vaccine. Though a global cooperative network (COVAX) has been developed, there are clearly massive inequities in vaccination percentages around the globe. Look at the following examples of developing countries from the six populated continents: Guatemala (1.83% vaccinated), Paraguay (4.07%), Kenya (1.19%), Armenia (1.48%), Vietnam (0.40%), Papua New Guinea (0.03%). All of these countries (and dozens more) lack both the vaccine and the distribution infrastructure to vaccinate their populations. Developing countries are proving to be incubators for ongoing transmission and new mutations/variants as COVID-19 continues to progress. It isn’t a surprise that the biggest surges in COVID-19 cases in the past month are in developing countries with low vaccination rates that had previously been doing very well with cases (meaning they don’t have many people with antibodies from prior infections). Cuba, Indonesia and Malaysia are all seeing daily cases representing more than 1% of their total since the pandemic began. In Thailand, each day’s new infections represent more than 3% of their total cases.
Changing rules for entry/exit
On one hand, it is great to see countries adapt to changing realities on the ground – loosening and tightening rules as necessary. On the other hand, it is hard to plan travel to a country if its rules are constantly changing. Over the past two weeks, I have been working with a client on summer travel to Thailand. After being shut down for a year, Thailand gradually reopened to international travelers by creating “the Phuket sandbox”, a requirement for all travelers to isolate for 14 days at the famous beach destination before continuing travels in the country. But due to the recent spike in COVID-19 cases fueled by the Delta Variant, the country shut down all flights between Bangkok and Phuket making it virtually impossible to leave the island. Unpredictability greatly impacts the ability to sell and support travel to a destination.
Countries across continental Europe reopened to vaccinated travelers from countries like the U.S. earlier this summer, and have held the line even as cases have begun to spike in Spain and France to per capita rates greater than the U.S. If you are American and you are holding plane tickets and hotel reservations, you can continue with your plans to the EU. The United Kingdom and Canada have both announced that they will be allowing vaccinated Americans to travel in the weeks ahead. These rules are unlikely to change.
It is interesting to note that the United States has not reciprocated with its European and Canadian allies, and the government has recently reaffirmed that the current restrictions will remain in place. Non-U.S. citizens from these countries, therefore, are not yet permitted to visit the United States as tourists. Ironically, no such restriction has been placed on tourists from those countries in Southeast Asia and some countries in South America where COVID-19 is spiking due to the Delta variant.
Quality of medical care
A couple of years ago, my late father had a heart attack and stroke while on holiday in Aruba. He was ultimately evacuated by air to Florida, and I remember early conversations with his U.S. doctors that led to significant questions about the care he received abroad. I never got the sense that he received poor care overseas, but it was clear that it wasn’t at the same level he would have gotten had his heart attack and stroke occurred in Florida. I also remember a comparatively minor client medical situation 7 or 8 years ago in an Eastern European country. I was assisting with the insurance claim and all of the information from the hospital – both medical and financial – was handwritten on paper as they had no central computer system for doctors, nurses, and administrators to communicate with each other.
With the spike in COVID-19 cases, it is easy to imagine hospitals in some developing countries unable to provide the level of care needed to support travelers – whether a traveler contracts a breakthrough case of COVID, is injured in a traffic accident, or has a heart attack or stroke. Because of this, it is also essential for travelers and travel professionals to assess the medical capabilities of desired countries of travel before finalizing plans. Now more than ever, travel insurance that provides medical coverage as well as medical evacuation coverage should be an essential part of your travel budget.
Summary and recommendations
Travelers have been waiting a long time to resume their journeys overseas. It is frustrating to think that the Delta variant and the level of global vaccinations could throw another wrench in international travel plans. With careful destination selection, itinerary flexibility, and an understanding that nothing is 100% risk free, healthy vaccinated travelers can take to the skies in the weeks and months ahead. Countries like Canada, Germany, and Chile all with low current incidence of infection, 50%+ vaccination rates, and highly-rated medical systems are just three examples of places you can confidently visit at the moment. The biggest risks remain logistical – in that a country could change the rules for entry or exit based on COVID-19 cases in their country or here in the United States.