Author: Doret de Rooij, National Institute of Public Health and the Environment (RIVM), Netherlands
In the first 1.5 years, many efforts have been made by the consortium of the EU Joint Action Healthy Gateways to support points of entry in the preparedness and response to public health threats . A network and stakeholder overview has been developed, several training-of-trainers sessions have been conducted and many guidelines and documents developed to support countries in the implementation of core capacities at their designated ports, airports and ground-crossings.
With the COVID-19 pandemic, POEs faced significant challenges in operational preparedness and response. Initially in January and February 2020, the news was dominated by the severity and transmissibility of the SARS-CoV-2 virus, its global spread and the measures taken by countries at points of entry . The EU Joint Action Healthy Gateways went into emergency mode and started to provide evidence- and practice-based advice to Europe’s professionals dealing with COVID-29 at points of entry.
In the current literature on COVID-19, the majority of studies covering points of entry report on the effectiveness of public health measures, such as entry- and exit screening , hygiene measures , or combinations . Other studies use develop forecasting models to research the contribution of travel to the spread of COVID-19 [6, 7]. However, no actual data from POEs is available yet, regarding the challenges and needs POE face. In this way, they are not yet researched as an acting entity.
Harvesting the experiences and challenges of the professionals involved with the response to COVID-19 at POE is pivotal to continuously improve COVID-control, as many countries gradually release the (total) lockdown and it is likely that traffic at POE will increase in the coming months. Equally, it is pivotal to draw lessons for future crises from current experiences.
Therefore, we, a team of several partners in the Joint Actions started a study to collect these experiences. We invited national partners and local professionals to participate in interviews. Several countries have reacted and participate in the study, but data collection will continue for some more weeks. The results of this study can be used soon to serve this collaborative workforce better, and, in the long term, to analyze the COVID-19 crisis from a point of entry perspective. We focus on adequate capacity, capability and the organizational effectiveness experienced during the first months of the outbreak. And we collect the recommendations for the operational readiness  that is required for the coming months in which travel and trade will increase.
- European Union Healthy Gateways Joint Action. EU Healthy Gateways Joint action preparedness and action at points of entry (ports, airports, ground crossings). 2018 [cited 6 May 2020]. Available from: https://www.healthygateways.eu/.
- Shoichet CE. 93% of people around the world live in countries with coronavirus travel bans. CNN. 2020 (cited 6 May 2020) Available from: https://edition.cnn.com/travel/article/countries-with-travel-restrictions-coronavirus/index.html.
- Quilty, B.J., et al., Effectiveness of airport screening at detecting travellers infected with novel coronavirus (2019-nCoV). Euro Surveill, 2020. 25(5).
- Hirotsu, Y., et al., Environmental cleaning is effective for the eradication of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in contaminated hospital rooms: A patient from the Diamond Princess cruise ship. Infect Control Hosp Epidemiol, 2020: p. 1-8.
- Mouchtouri, V.A., M. Dirksen-Fischer, and C. Hadjichristodoulou, Health measures to travelers and cruise ships in response to COVID-19. J Travel Med, 2020.
- Zhong, P., S. Guo, and T. Chen, Correlation between travellers departing from Wuhan before the Spring Festival and subsequent spread of COVID-19 to all provinces in China. J Travel Med, 2020.
- Zhuang, Z., et al., Preliminary estimation of the novel coronavirus disease (COVID-19) cases in Iran: A modelling analysis based on overseas cases and air travel data. Int J Infect Dis, 2020.
- World Health Organization. First global face to face meeting of the WHO Operational Readiness Task Force. WHO 2017. Available from: https://www.who.int/hac/events/who-operational-task-force-meeting-2017/en/.
- World Health Organization. International health regulations (2005). World Health Organization. 2008.
- European commission Eurostat. Decision No 1082/2013/EU of the European Parliament and of the Council of 22 October 2013 on serious cross-border threats to health and repealing Decision No 2119/98/EC (Text with EEA relevance). Official journal of the European Union 5.11.2013:L293. [cited 6 May 2020]. Available from: http://data.europa.eu/eli/dec/2013/1082/2013-11-05.
Authors: Evelien Belfroid, Doret de Rooij (National Institute of Public Health and the Environment (RIVM), Netherlands)
Since the COVID-19 pandemic is still a serious problem in the EU and other parts of the world, it is important to keep collecting and analyzing epidemiological data. As the outbreak evolves, also the epidemiological data evolve.
One important measure during outbreaks is the case fatality rate (CFR). The case fatality rate of a disease is the proportion of deaths from a certain disease compared to the total number of people diagnosed with the disease for a certain period of time. In this way, it is a measure of the severity of the disease.
During an outbreak the CFR can be over- or underestimated. As the COVID-19 pandemic is still unfolding, the outcome of a case (recovery from COVID-19 or death due to COVID-19) is not known yet for all the cases. The majority of COVID-19 infections are asymptomatic or mild, and do not require hospitalization. This may lead to an underestimation of the total number of cases. In addition, test strategies (criteria for performing a COVID-19 test and testing capacity) also affect the number of identified cases, and subsequently the CFR. As the pandemic unfolds, test strategies were changed based on new insights or capacity which has an impact on the CFR.
In the same way, the numerator also depends or the test policy. WHO disseminated advice on how to define fatalities due to COVID, but these might be applied differently in different situations. For example, is a positive confirmed PCR test needed, or is fatality with COVID-like symptoms enough? Lastly, the numerator may be affected by the population affected by the disease. If the majority of COVID cases are found in risk groups, one would expect a higher case fatality rate. This number cannot be generalized for a whole area or country.
In short, the case fatality rate is a useful number to monitor outbreaks, but be careful with comparing the numbers over different situations and always have close look how the numerator and denumerator are defined.
EU HEALTHY GATEWAYS publications
Interim advice for restarting cruise ship operations after lifting restrictive measures in response to the COVID-19 pandemic (Version 1 - 30 June 2020)
The purpose of this document is to provide general guidance to EU/EEA MS and to cruise lines about options for measures on travel and tourism that could be applied after lifting the restrictive measures implemented in response to the COVID-19 pandemic.
Interim advice for preparedness and response to cases of COVID-19 on board ferries after lifting restrictive measures in response to the COVID-19 pandemic. (VERSION 1, 24/06/2020)
This guidance is addressed to ferry companies, as well as competent public health authorities at ports. The objective of these guidelines is to provide recommendations on preventive measures that ferries should implement to protect passengers, crew members and onshore personnel, as well as to create an environment of trust in the maritime transport of passengers by ferry.
General guidance for restarting transportation activities to serve tourism after lifting restrictive measures in response to the COVID-19 pandemic (Version 1 - 15/05/2020)
The purpose of this document is to provide general guidance to EU/EEA MS about options for measures that could be considered to be applied to the transport sector for tourism after adapting to the context of both national and local frameworks. These options could become applicable after lifting the current restrictive measures implemented in response to the COVID-19 pandemic and in order to restart tourism.
Communications from the Commission about COVID-19 and transport
· The European Commission presented on 13 May, guidelines and recommendations to help Member States gradually lift travel restrictions, with all the necessary safety and precautionary means in place. All available guidance and communications on safely resuming travel are available here.
· Re-open EU – new web platform to help travellers and tourists. On 15 June, the European Commission launched ‘Re-open EU’, a web platform that contains essential information allowing a safe relaunch of free movement and tourism across Europe.
ECDC ERA COVID-19 Rail Protocol Recommendations for safe resumption of railway services in Europe
- The European Union’s Agency’s for Railways (ERA), the European Commission, and the European Centre for Disease Prevention and Control (ECDC) have developed the guidance available here.
Updated EASA Guidance
- Aircraft Cleaning and Disinfection available here.
- Management of Crew Members available here.
EASA—ECDC COVID-19 Aviation Health Safety Protocol
- The European Union Aviation Safety Agency (EASA) and European Centre for Disease Prevention and Control (ECDC) issued a joint document defining measures to assure the health safety of air travellers and aviation personnel once airlines resume regular flight schedules following the severe disruption caused by COVID-19. The document is available here.
IMO-UNCTAD Joint Statement
- Circular Letter No.4204/Add.21 (8 June 2020) - Joint statement IMO-UNCTAD – Call for collaborative action in support of keeping ships moving, ports open and cross-border trade flowing during the COVID-19 pandemic. The document is available here.
IMO—Crew changes and repatriation of seafarers – a key issue explained
- IMO has included in their website a comprehensive FAQ about crew changes and repatriation of seafarers. The FAQ are available here.
Exploring the Roles of High-Speed Train, Air and Coach Services in the Spread of COVID-19 in China
Yahua Zhang, Anming Zhang, Jiaoe Wang, Transp Policy (Oxf). 2020 Aug;94:34-42. doi: 10.1016/j.tranpol.2020.05.012. Epub 2020 May 26.
Abstract: To understand the roles of different transport modes in the spread of COVID-19 pandemic across Chinese cities, this paper looks at the factors influencing the number of imported cases from Wuhan and the spread speed and pattern of the pandemic. We find that frequencies of air flights and high-speed train (HST) services out of Wuhan are significantly associated with the number of COVID-19 cases in the destination cities. The presence of an airport or HST station at a city is significantly related to the speed of the pandemic spread, but its link with the total number of confirmed cases is weak. The farther the distance from Wuhan, the lower number of cases in a city and the slower the dissemination of the pandemic. The longitude and latitude coordinates do not have a significant relationship with the number of total cases but can increase the speed of the COVID-19 spread. Specifically, cities in the higher longitudinal region tended to record a COVID-19 case earlier than their counterparties in the west. Cities in the north were more likely to report the first case later than those in the south. The pandemic may emerge in large cities earlier than in small cities as GDP is a factor positively associated with the spread speed.
Identification of critical airports for controlling global infectious disease outbreaks: Stress-tests focusing in Europe.
Nikolaou, P. and L. Dimitriou. J Air Transp Manag, 2020. 85: p. 101819.
Abstract: As the global population increases and transportation connectivity improves in quality and prices, the demand for mobility increases, especially in long-haul services. According to the 2017 report of the European Commission in Mobility and Transport, the performance of all modes for passenger transport (roadways and airways) are reaching record highs. Although the benefits of the increased demand for mobility are substantial and welcome, an effort should be paid such as to ameliorate possible threatening side-effects that may also arise. As World Health Organization (WHO) denotes and as has been evident from the global COVID-19 epidemic outbreak, infectious diseases can be spread directly or indirectly from one person to another under common exposure circumstances such as air transportation (especially long-haul airline connections) that may act as the medium for transmitting and spreading infectious diseases. In this paper, analytical and realistic models have been integrated, for providing evidence on the spread dynamics of infectious diseases that may face Europe through the airlines system. In particular, a detailed epidemiological model has been integrated with the airlines' and land transport network, able to simulate the epidemic spread of infectious diseases originated from distant locations. Additionally, a wide set of experiments and simulations have been conducted, providing results from detailed stress-tests covering both mild as well as aggressive cases of epidemic spreading scenarios. The results provide convincing evidence on the effectiveness that the European airports' system offer in controlling the emergence of epidemics, but also on the time and extent that controlling measures should be taken in order to break the chain of infections in realistic cases.
Estimating COVID-19 outbreak risk through air travel.
Daon, Y., R.N. Thompson, and U. Obolski. J Travel Med, 2020.
Abstract: Background: Substantial limitations have been imposed on passenger air travel to reduce transmission of SARS-CoV-2 between regions and countries. However, as case numbers decrease, air travel will gradually resume. We considered a future scenario in which case numbers are low and air travel returns to normal. Under that scenario, there will be a risk of outbreaks in locations worldwide due to imported cases. We estimated the risk of different locations acting as sources of future COVID-19 outbreaks elsewhere. Methods: We use modelled global air travel data and population density estimates from locations worldwide to analyse the risk that 1364 airports are sources of future COVID-19 outbreaks. We use a probabilistic, branching-process based approach that considers the volume of air travelers between airports and the reproduction number at each location, accounting for local population density. Results: Under the scenario we model, we identify airports in East Asia as having the highest risk of acting as sources of future outbreaks. Moreover, we investigate the locations most likely to cause outbreaks due to air travel in regions that are large and potentially vulnerable to outbreaks: India, Brazil and Africa. We find that outbreaks in India and Brazil are most likely to be seeded by individuals travelling from within those regions. We find that this is also true for less vulnerable regions, such as the United States, Europe, and China. However, outbreaks in Africa due to imported cases are instead most likely to be initiated by passengers travelling from outside the continent. Conclusions: Variation in flight volumes and destination population densities create a non-uniform distribution of the risk that different airports pose of acting as the source of an outbreak. Accurate quantification of the spatial distribution of outbreak risk can therefore facilitate optimal allocation of resources for effective targeting of public health interventions.
· NEW COVID-19 ADVICE for the passenger shipping industry here
· New versions of Passenger Locator Forms for aircrafts, cruise ships, ferries and ground crossings available here
· New WHO/Europe catalogue of technical support, trainings and other means of assistance related to the COVID 19 pandemic for Point of Entry (updated 22 May 2020) available here
The web-portal has served as the main means of disseminating information to stakeholders during the COVID-19 crisis.
The web-portal analytics presenting a noticeable increase in users, page views and the number of downloads of the COVID-19 guidance documents demonstrate the importance of the webportal as a communication and dissemination tool.
Quarterly Number of views
January 2020-April 2020
Total Number of views
October 2018-April 2020
Unique page views