A Borderline Strategy
The Local Situation
The JEP noted:
“With new cases of Covid-19 slowing down, the chamber believes the time is right to take the next step in boosting the economy. Earlier this week Chief Minister John Le Fondré said it was still hoped that borders could open early in July. Daphne East, chairwoman of the chamber’s retail and supply committee, said that the visitor economy was worth £280 million per year and was vital to both the retail and supply sectors.”
Senator Lyndon Farnham has said:
‘We have already undertaken a comprehensive trial at Jersey Airport to introduce a testing regime on arrival, supported by track and trace, and this will pave the way for the opening of our ports in a manner that continues to protect our Island, while sustaining our valuable visitor economy.’
So what is the testing regime?
“During the trial, passengers will have the option of being tested for COVID-19 when they arrive at the airport. They would then be tested for COVID-19 tests again on subsequent days while they remain in Jersey. Passengers who choose not to participate in the trial will be required to self-isolate for 14 days, as per the current guidance. Participating passengers will receive an initial swab (polymerase chain reaction or ‘PCR’ test) to determine whether they are currently displaying the virus. They will then need to self-isolate until receiving the first test result (within 48 hours). “
“Passengers whose first PCR test is negative will then receive written permission not to self-isolate. However, that permission will be of limited duration and will be conditional on completing the full testing programme. Passengers who test positive for the PCR test at any stage during the process will be required to self-isolate. The next stage in the testing programme will be a finger-prick dual blood test, clinically called a serology test, to be taken on the fourth day after arriving in Jersey. Passengers may then be required to take up two additional PCR tests on the fourth and seventh days after arriving. The combination of a series of PCR tests, plus a serology test, is a robust approach to border testing, as advised by Scientific and Technical Advisory Cell (STAC).”
Note the “may” for the additional PCR tests, suggesting it might be dropped at some stage. For a test with only 70% accuracy, that is a concern.
Looking the the numbers
Bailiwick Express comments that:
“Condor are in talks with Government with a view to resuming sailings between St. Malo, Poole and Jersey at the beginning of next month, with face masks and a cap of 250 passengers likely to be part of the ‘new normal’.”
So let’s see what it would be like. Assume – in additional to local testing – that 500 people can be tested a day, and that the addition PCR test is dropped – but not the serology test.
So for July at 500 per day, 31 days = 15,500 visitors.
The statistics give somewhere like 70,000 visitors for July 2019 and for August approx. 105,000.
That’s 22% for July, and 15% for August which still leaves a huge shortfall for tourism.
The Dangers of No Testing
The problem is that if you don’t do some kind of border checking, the virus may creep back and expand in the community again, in which case – in the absence of a vaccine – a second wave and another lockdown may be on the cards.
The case of Greece highlights issues involved. The Guardian reported this on 3 June:
“Greece has been forced to confront the risks of restarting international tourism after authorities announced that 12 out of 91 passengers onboard a Qatar Airways flight to Athens had tested positive for coronavirus. The civil protection ministry responded by suspending air links to and from the Arab state until 15 June. All 91 travellers on the flight were immediately placed in quarantine.”
As Forbes reported:
“The decision goes to show that no move to reopen borders to tourists or others is absolute. There is plenty of scope to backtrack or adapt the policy to exclude arrivals from some countries. But it also shows how the risk is there. Not only for European countries welcoming back international tourists, but for passengers taking a plane.”
And there are also decisions to be made about whether all tourists are acceptable. For example, France has restrictions on some travellers:
“France opened its Schengen borders on 15 June, but will not open borders to international visitors before the beginning of July and even then it is not expected to allow tourists from certain countries still struggling with the coronavirus.”
Which countries pose lower risks?
Greek Reporter.Com noted different categories in allowing countries tourists into others:
“Israeli authorities express the concern that Greece might close the tourist corridor between the two countries as there is an increase in cases of COVID-19 in the Middle Eastern country. According to Israeli newspaper Haaretz, Cyprus and Montenegro downgraded Israel from “Category A” to “Category B” in the relevant evaluation list. This means that Israeli visitors should have a negative test to allow them to enter those countries. There is a worry that the same might happen with Greece as well.”
The regime in Greece for many travellers is as follows:
“Every passenger arriving in Greece must be tested for the virus and stay overnight at a designated hotel. Visitors who test negative are required to self-isolate for seven days, while the ones who test positive must spend 14 days under a supervised quarantine.”
But in order to ramp numbers of visitors up, they are loosening that to random tests:
“International flights will be allowed to all airports in Greece and visitors will be subject only to random tests. Restrictions applying to specific countries might be announced at a later date.”
That may be a poor decision, if a second wave or spike hits.
An Alternative to Travel Insurance
Cyprus, as the BBC reports, has considered other encouragements:
Cyprus has pledged to cover the holiday costs of anyone who tests positive for the virus after travelling there. In a letter made public on Wednesday, the government said it would pay for accommodation, medicine and food for patients and their families. Tourists "will only need to bear the cost of their airport transfer and repatriation flight".
Given the very low incidence of cases, it does not seem prudent to lose testing altogether. The case of the flight to Greece shows that – without testing – 12 cases could have been loose in the community, and then pass that on to others. With social distancing down to one metre, the potential for a spike would be increased.
Iceland: A Good Model for Jersey?
Schengenvisainfo news notes that:
"A total of 5,500 travellers have been tested for Coronavirus upon their arrival in Iceland since the country began the screening process at its borders one week ago. From 5,500 tests, 11 of them have tested positive, and only two of those were active cases requiring isolation "
Clearly what is needed is to ramp up testing. Iceland is also charging for testing – although quarantine is free, because otherwise the enterprise is not commercially viable. The alternative is mandatory quarantine. For those who like the mathematics, this is on a 7 day week, an average of 786 tests per day, not massively more than ours.
But it shows what can be done if you ramp up testing enough, and any strategy for Jersey Tourism needs to plan for that.
Shaping up a Policy
So what shape might Jersey’s policy look like?
And above all, a properly thought out and documented strategy.
The Local Situation
The JEP noted:
“With new cases of Covid-19 slowing down, the chamber believes the time is right to take the next step in boosting the economy. Earlier this week Chief Minister John Le Fondré said it was still hoped that borders could open early in July. Daphne East, chairwoman of the chamber’s retail and supply committee, said that the visitor economy was worth £280 million per year and was vital to both the retail and supply sectors.”
Senator Lyndon Farnham has said:
‘We have already undertaken a comprehensive trial at Jersey Airport to introduce a testing regime on arrival, supported by track and trace, and this will pave the way for the opening of our ports in a manner that continues to protect our Island, while sustaining our valuable visitor economy.’
So what is the testing regime?
“During the trial, passengers will have the option of being tested for COVID-19 when they arrive at the airport. They would then be tested for COVID-19 tests again on subsequent days while they remain in Jersey. Passengers who choose not to participate in the trial will be required to self-isolate for 14 days, as per the current guidance. Participating passengers will receive an initial swab (polymerase chain reaction or ‘PCR’ test) to determine whether they are currently displaying the virus. They will then need to self-isolate until receiving the first test result (within 48 hours). “
“Passengers whose first PCR test is negative will then receive written permission not to self-isolate. However, that permission will be of limited duration and will be conditional on completing the full testing programme. Passengers who test positive for the PCR test at any stage during the process will be required to self-isolate. The next stage in the testing programme will be a finger-prick dual blood test, clinically called a serology test, to be taken on the fourth day after arriving in Jersey. Passengers may then be required to take up two additional PCR tests on the fourth and seventh days after arriving. The combination of a series of PCR tests, plus a serology test, is a robust approach to border testing, as advised by Scientific and Technical Advisory Cell (STAC).”
Note the “may” for the additional PCR tests, suggesting it might be dropped at some stage. For a test with only 70% accuracy, that is a concern.
Looking the the numbers
Bailiwick Express comments that:
“Condor are in talks with Government with a view to resuming sailings between St. Malo, Poole and Jersey at the beginning of next month, with face masks and a cap of 250 passengers likely to be part of the ‘new normal’.”
So let’s see what it would be like. Assume – in additional to local testing – that 500 people can be tested a day, and that the addition PCR test is dropped – but not the serology test.
So for July at 500 per day, 31 days = 15,500 visitors.
The statistics give somewhere like 70,000 visitors for July 2019 and for August approx. 105,000.
That’s 22% for July, and 15% for August which still leaves a huge shortfall for tourism.
The Dangers of No Testing
The problem is that if you don’t do some kind of border checking, the virus may creep back and expand in the community again, in which case – in the absence of a vaccine – a second wave and another lockdown may be on the cards.
The case of Greece highlights issues involved. The Guardian reported this on 3 June:
“Greece has been forced to confront the risks of restarting international tourism after authorities announced that 12 out of 91 passengers onboard a Qatar Airways flight to Athens had tested positive for coronavirus. The civil protection ministry responded by suspending air links to and from the Arab state until 15 June. All 91 travellers on the flight were immediately placed in quarantine.”
As Forbes reported:
“The decision goes to show that no move to reopen borders to tourists or others is absolute. There is plenty of scope to backtrack or adapt the policy to exclude arrivals from some countries. But it also shows how the risk is there. Not only for European countries welcoming back international tourists, but for passengers taking a plane.”
And there are also decisions to be made about whether all tourists are acceptable. For example, France has restrictions on some travellers:
“France opened its Schengen borders on 15 June, but will not open borders to international visitors before the beginning of July and even then it is not expected to allow tourists from certain countries still struggling with the coronavirus.”
Which countries pose lower risks?
Greek Reporter.Com noted different categories in allowing countries tourists into others:
“Israeli authorities express the concern that Greece might close the tourist corridor between the two countries as there is an increase in cases of COVID-19 in the Middle Eastern country. According to Israeli newspaper Haaretz, Cyprus and Montenegro downgraded Israel from “Category A” to “Category B” in the relevant evaluation list. This means that Israeli visitors should have a negative test to allow them to enter those countries. There is a worry that the same might happen with Greece as well.”
The regime in Greece for many travellers is as follows:
“Every passenger arriving in Greece must be tested for the virus and stay overnight at a designated hotel. Visitors who test negative are required to self-isolate for seven days, while the ones who test positive must spend 14 days under a supervised quarantine.”
But in order to ramp numbers of visitors up, they are loosening that to random tests:
“International flights will be allowed to all airports in Greece and visitors will be subject only to random tests. Restrictions applying to specific countries might be announced at a later date.”
That may be a poor decision, if a second wave or spike hits.
An Alternative to Travel Insurance
Cyprus, as the BBC reports, has considered other encouragements:
Cyprus has pledged to cover the holiday costs of anyone who tests positive for the virus after travelling there. In a letter made public on Wednesday, the government said it would pay for accommodation, medicine and food for patients and their families. Tourists "will only need to bear the cost of their airport transfer and repatriation flight".
Given the very low incidence of cases, it does not seem prudent to lose testing altogether. The case of the flight to Greece shows that – without testing – 12 cases could have been loose in the community, and then pass that on to others. With social distancing down to one metre, the potential for a spike would be increased.
Iceland: A Good Model for Jersey?
Schengenvisainfo news notes that:
"A total of 5,500 travellers have been tested for Coronavirus upon their arrival in Iceland since the country began the screening process at its borders one week ago. From 5,500 tests, 11 of them have tested positive, and only two of those were active cases requiring isolation "
Clearly what is needed is to ramp up testing. Iceland is also charging for testing – although quarantine is free, because otherwise the enterprise is not commercially viable. The alternative is mandatory quarantine. For those who like the mathematics, this is on a 7 day week, an average of 786 tests per day, not massively more than ours.
But it shows what can be done if you ramp up testing enough, and any strategy for Jersey Tourism needs to plan for that.
Shaping up a Policy
So what shape might Jersey’s policy look like?
- Increase capacity for testing. It is a huge gamble to remove testing. While the numbers may be low at present, a second wave could bring them back in numbers. The late restriction of travel globally showed how easy was is to act too late and restrict flights. If flights are not to be restricted, testing needs to be in place. It is Jersey’s travel insurance. Any removal should be a decision by the States, not just the Government.
- Better contact tracing and documentation. For Iceland, on their arrival, travellers will be required to fill out a pre-registration form adhere to rules regarding infection control and are advised to download the tracing app, Raking C-19. Through the pre-registration process, passengers’ testing will be facilitated and will shorten their wait time.
- Covering the holiday costs of anyone who tests positive for the virus after travelling there. Remember there is no travel insurance cover for Covid-19 at present.
- Categorise countries and only permit travellers from countries with falling rates to come as tourists. Countries like Brazil or the USA should be currently on a high risk category.
- Fines for anyone breaking quarantine or the short term self-isolation.
And above all, a properly thought out and documented strategy.
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2 comments:
Interesting Blog. 2 minor points to consider:
1. A single PCR test will only likely detect around 30% of inbound infectious cases. While the test is about 70% accurate on infectious cases, it misses 100% of cases that are still in the incubation phase. Those cases would then become infectious after a period of time on Island (hence the current multi time point testing). The serology test also does not assist in picking up potential infectious cases in any meaningful way. So either some form of isolation and / or multiple tests are needed even if you want to stop 50% of cases.
2. 15,500 arrivals a month (even if you can achieve that) is going to be quite a lot less than the 22% / 15% of tourism - Because that doesn't include local residents travelling (who would also need testing). In a typical month several thousand Islanders would be returning to the Island from trips - and you would expect Islanders travelling to meet family and potentially take holidays themselves to be prioritised over inbound tourists. So the actual % of normal visitors would actually be much less than those figures. To get even close to that would require a much higher number of passengers to be tested.
Interesting Blog. 2 minor points to consider:
1. A single PCR test will only likely detect around 30% of inbound infectious cases. While the test is about 70% accurate on infectious cases, it misses 100% of cases that are still in the incubation phase. Those cases would then become infectious after a period of time on Island (hence the current multi time point testing). The serology test also does not assist in picking up potential infectious cases in any meaningful way. So either some form of isolation and / or multiple tests are needed even if you want to stop 50% of cases.
2. 15,500 arrivals a month (even if you can achieve that) is going to be quite a lot less than the 22% / 15% of tourism - Because that doesn't include local residents travelling (who would also need testing). In a typical month several thousand Islanders would be returning to the Island from trips - and you would expect Islanders travelling to meet family and potentially take holidays themselves to be prioritised over inbound tourists. So the actual % of normal visitors would actually be much less than those figures. To get even close to that would require a much higher number of passengers to be tested.
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