International travel during peak pandemic (Jan 2022)
I recently traveled from the SF Bay Area to India during the Christmas break of 2021. Omicron was taking off in the US at the time. Here are a few things that worked for me.
Update Jan 12, 2022
Looks like 7 day home quarantine is now required, followed by RT-PCR test and mandatory uploading of test result to Air Suvidha.
Background
I have lived a fairly isolated and conservative life since the pandemic broke out in 2020. I had to visit my parents over the Christmas break and had to fight my fears to do the trip safely. I leaned on many of my frequent traveler friends for advise. This is a summary of what worked for me. This advise is based on my experience of travel to India, which is probably harder than traveling to say Europe, but this is just one person’s opinion, so take it for it is.
Risk Reward
One of my friends introduced the notion of a risk reward framework. If you can avoid travel during this time, do so. There are cases where you absolutely have to travel. It is personal and you decide if it is required to travel. There is a reward for traveling and there is definite risk in traveling. Only you can be the judge of if the reward is worth the risks involved. If you strongly feel that the reward is worth it, read on.
Get vaccinated and boosted
You can not fly to India and return to the US without a vaccination record. You can, with some significant workarounds, but if you are not vaccinated, this is the wrong page for you. Please ignore rest of this page and move on. It is ideal if you are vaccinated at least two weeks before travel.
Fly as direct to your destination as possible
Airports are the trouble spots for catching Covid. The air is stale, you end up mixing with all kinds of passengers who are traveling to different countries with different requirements. You can not avoid the source and destination airports, but you can avoid transit airports. I flew from San Francisco to Chennai via Dubai. My maximum exposure was at Dubai airport. There were unmasked people. Coughing people. Unmasked coughing people. During my return journey, the airline parked the flight further away from the terminals so they put us in crowded buses and drove us to the terminals. Unnecessary exposure. Avoid transits if you can. If you are flying to a destination country, try to fly at least direct to that country. In India, there are many flights into New Delhi. At least fly direct to Delhi instead of Dubai. You can avoid rules of the intermittent country and the crowds that come into an airport like Dubai.
Fly Business Class if possible
This is not an elitist advise. Fly Business Class if possible. It simply reduces the number of people you have to interact with during the process. You get special lines that are less crowded. You get special lounges that are less crowded. You are surrounded by few people when you are inside the flight. You get out first from the plane and you can exit the airports quickly (some airlines have a priority treatment for business class travelers luggages).
N95 respirators are a must
If there is one thing you need to follow, it is that N95 respirators are the only masks you should be using. You need a N95 respirator at the airports as much as you need them inside the plane. Interestingly, you need a mask that breathes well, since you have to wear them for long periods of time (16 hours for a Dubai flight). I was planning on wearing the Armbrust KN95 masks on the flight and I asked Lloyd Armbrust for advise. Lloyd suggested I look at the Gerson Duckbill Respirators because they breathe the most.
The Gerson Duckbills are magnificent. I wore them for 36 hours straight (changed masks twice) during the onward journey and return journey. They are immensely breathable, NIOSH approved (for doctors) and do their job. I was able to sleep wearing them for hours. They are hard to put on and take off, but once you put them on and adjusted, you can leave them on. My acid test for good masks is to see if my eyeglasses fog. My weak point is under my eyes, that is where there is a gap in my mask. I can adjust the nose bridge on my Gersons tight enough so that there is no leak and my glasses do not fog. Find your acid test and stick to it. I always wore my glasses with the Gerson mask. If my glasses fogged, I had to fix the leak.
There is definitely a thing called “too much masking”. If you wear multiple masks, you may find it hard to breathe. If you find it hard to breathe, you are going to take off the masks to breathe. Every time you are off your mask, your exposure goes up. That is what you want to avoid. I would rather wear one good mask that allows me to breathe and be comfortable even with a tight fit, instead of multiple masks that I take off every hour.
Be intentional about mask breaks
Every time you take off your mask, you are exposed. I would be very wary of eating at the Airport restaurants. At least inside the airplane, there is air being pumped in constantly. Emirates says they change the HEPA filters every few minutes continuously. At the airport, you have no such guarantee. I simply did not eat any airline meals. I find it absurd that we wear multiple masks and shields and yet the entire plane takes them off for a good 30–45 minutes and we all eat at the same time. I had a few coughing people in my section of the plane, so I decided the risk of catching Covid was not worth the reward of airline food, so I skipped them.
I am not saying you should starve. I regularly fast 16 hours, so I just lived with it. I did carry some food cooked at home that I can eat quickly with me. When no one else was eating (an hour after meals were served), I had a quick snack to buy me a few hours. That is just me. You should do what works for you. Be very intentional on when you take off your mask. I took my mask off to drink water. I was careful that it was for very short durations and I put the mask back on quickly. I had one quick snack when no one else was eating.
Be busy in the plane
Unfortunately for me, this international trip was my first air travel experience in two years. It drove me nuts. Larry David and Curb Your Enthusiasm Season 10 saved my onward journey. I binge watched all episodes in one go (7 hours). I meditated with Jon Kabat-Zinn and watched movies on the way back. Find something to keep you occupied.
Plan your tests
I am writing this four days after I returned. These are the tests I had planned and taken. Each one for a reason. This is probably too much for some of you, but this is a guidance.
- 72 hours before departure: I took a RT-PCR test 72 hours before departure to satisfy India’s travel requirements. In the days of Omicron, this is pretty much useless. How many of you go straight to Costco to buy almonds aright after you give the test? How valid is that test anymore?
- 24 hours before departure: I took a RT-PCR test 24 hours before departure. This was intentional. There were rumors on being tested on arrival at Indian airports. I wanted to eliminate the possibility that I test positive on arrival and put on institutional quarantine. This test provided me with the confidence I won’t test positive on arrival. Even if you catch Covid on the flight, you are not going to test positive on arrival.
- 6 hours before departure: I took a at home antigen test 6 hours before departure. At this point, I was looking for reasons to cancel my trip. I decided to travel only after this test.
- Day of arrival at home: After two days of multiple airports, planes and a car travel, I arrived at my parents home. I had carried a few antigen test kits with me, but I also ordered antigen test kits and shipped to my parents home in India. I ordered Covi Find from Flipkart and my parents had them before I reached. I tested both my parents and myself using Covi Find on arrival. This was our baseline.
- Day 4 of arrival: I did a second antigen test on day 4. I had carried 2x emed.com proctored antigen tests. I thought I could use them for return, but did not realize that Emirates does not support them (more on this later), so I used this test to ensure I did not catch anything during arrival.
- Day 10: I was leaving my parents home in Coimbatore on Day 12. I did a RT PCR on Day 10 to make sure I was safe to travel out of Coimbatore. If I caught something, I would rather be at my parents home. This was a defensive test. This also allowed me to sort out how the system worked in India. Everything is done over Whatsapp. I never got my report via Whatsapp, so I had to stay on top and call the lab to get the report via email.
- Day 12: I was flying out the day after, so I had to take a RT-PCR test the day before to fly back to the US. I scheduled two RT-PCR tests on this day, just to eliminate any paperwork related issues. Doing this has a negative effect that you may get conflicting results. That is something you should consider.
- Day 2 after arrival: I had nausea the day after I arrived. I could not determine if it was due to jet lag, to rule out Covid, I used my second proctored eMed.com test and tested again.
- Day 4 after arrival: California Department of Health advises international travelers to test between days 3 and 5 of arrival. I had scheduled a RT-PCR test when I bought tickets. I tested on Day 4. I was in isolation at home till then.
- Day 7 after arrival: I am not there yet. Double vaccinated people with booster can test positive on day 7 after infection. I have scheduled an appointment already.
Too much? Probably. Did it give me peace of mind? Absolutely.
Post arrival
I have kids going to high school in person. I do not want to be the person who gives them Covid, so I isolated myself in a separate room in the home till my day 3 RT-PCR results arrived. I was wearing a mask if the door to the room was open. I was careful to not mix with my family till then.
Travel inside India
I had a choice of flying from Chennai to Coimbatore. Local flights in India are as bad as local flights inside the US. Folks in India have moved on from Covid (this was just before Omicron was taking off). The risk of catching Covid is directly related to the number of people you are exposed to. I decided to instead take a taxi, to reduce exposure. I was wearing my N95 respirator the whole time, had my window rolled down. I insisted on getting a driver who was double vaccinated. I insisted on the driver being masked fully (nose covered). Try to reduce contact with large numbers of people at your destination. Work around it.
Trust the N95 respirator
Irrespective of what others are doing, if you are double vaccinated and boostered, a N95 respirator works to protect you. Trust the mask. Wear it properly. Fit it properly.
Flying back to the US
This warrants a different post, but be aware that CDC requires a negative rapid antigen test to travel back to the US. This is important.
If you catch Covid-19, you can test positive for up to 90 days in a RT PCR test.
Why is this important? Emirates (and most Asian airlines) that transit through a different country follow the rules of that country. That often means a negative RT PCR result. In the days of Omicron, the chances of you catching Covid-19 anywhere in the transit or destination is high. RT PCR introduces an open-ended wait for return. This can be avoided by flying airlines that fly directly to the US and support rapid-antigen tests to fly.
United Airlines, American Airlines, most European airlines support rapid-antigen test results alone to fly back to the US. Air India says they do (but call them).
I highly recommend you ONLY fly on Airlines that support rapid-antigen tests.
