Air travel in the middle of the pandemic: some tips from a personal journey
Bhramar Mukherjee, Ann Arbor, Michigan
In December 2019, a villager in Wuhan got infected by a novel coronavirus most likely originating from a bat. From that singleton 1 to 47 million reported cases in ten months [Microsft Bing COVID tracker, November 2, 2020], uncountably many silent/unreported infections, with a death toll of nearly 1.2 million worldwide, and still no end in sight, the past eight months have been a failure of our collective social imagination. The fragility of our advanced civilization has stunned all of us. In these last eight months, we have come to appreciate the simple things in life, in particular, for me, personally, an intensified devotion to science, nature and family.
Being an immigrant scientist from India, I have always celebrated my hyphenated identity, shuttling back and forth between the two continents each year. This is the first time in 24 years that I have lived in acute agony that I cannot visit my parents if something were to happen to them. This anxiety led me to start the COV-IND-19 Study Group back in March so that we can repurpose our shared anxiety into something meaningful, and serve India as public health data scientists of Indian origin. We have been very nimble with building an App, writing multiple papers on COVID in India at the University of Michigan [covind19.org].
However, as the winter days loomed large in Michigan, compounded with the uncertainty of the US Presidential Election, it became clear to me that I had to return to my motherland. After being in the fortitude and sanctity of my sterilized apartment, my world had shrunk. Being around people, crowded streets and airports appeared daunting and scary to me. As a busy academic and department chair, my stay-at-home days became rectangular, mapped on a zoom photo gallery grid, and people became the (i,j)-th entry on that participant matrix. I had to find the courage and a feasible way to get back to real people, to India and be with my loved ones. This implied that I had to manage my risk of a long airplane flight. I would definitely not recommend travel if you do not have to but for me it became absolutely essential. I could not wait for the vaccine as my parents’ health and spirit were declining. Everyone has to take their decisions very cautiously and I had to take mine.
I spoke with my Epidemiologist colleagues, read papers and news articles and finally designed my personal risk management and mitigation strategy. I am hoping many of you who are contemplating long airplane travel will benefit from my experience. For the sake of complete transparency, I am writing this article on my second day of quarantining in New Delhi so that you know that there is no assurance that I was able to escape the virus, but still I tried to protect myself as best as I could. Some part of this article is specific to India, some are very general (in particular Step E).
Step A. Finding out the immigration and quarantine rules of the country you are traveling to.
These rules keep changing depending on the COVID situation but usually the local embassies and consulates are very helpful. I had emailed the Indian consulate in Chicago where they had shared some very helpful links with me:
1. For taking any flight to India, all passengers are required to register individually on web link: https://repat.videshapps.gov.in/regis . Once registration is done, your registration No. would be displayed on the screen and you must note down your registration No. and then you may proceed for online purchase of air ticket for India.
2. Guidelines for international arrivals in India may please be seen on https://www.mohfw.gov.in/pdf/RevisedguidelinesforInternationalArrivals02082020.pdf and https://www.newdelhiairport.in/covid19.
3. Traveling to India requires filling in online Air Suvidha forms
(i) Self-Reporting Form on web link https://www.newdelhiairport.in/airsuvidha/apho-registration and
(ii) Exemption from Institutional Quarantine (if desired) on web link: https://www.newdelhiairport.in/airsuvidha/covid-19-exemption-international-passenger
4. COVID 19 test is not mandatory for taking repatriation flight to India. However, only asymptomatic passengers are allowed to travel. Temperature checks were done prior to boarding.
5. You DO need a RT-PCR negative test and can upload the results to the previously linked website to receive prior approval for exemption from institutional quarantine. I decided to have the a RT-PCR test done prior to 96 hours of my flight departure time so that I can avoid Institutional quarantine. When I landed in New Delhi, I noticed that you can get tested at the airport and the results are fairly quick so that you can move on to your next destination from the institutional quarantine arrangement in a day or two and self-isolate at a designated address. So do not be super-stressed if you cannot get the test done prior to leaving.
Step B: Purchasing your airline ticket
This is the step that was complex for me. Should I go through Europe where case counts are rising? How about routing through the middle east? At one point of time I had three tickets: one on Qatar Airlines flying to Abu Dhabi, then to Kolkata,the second on Lufthansa, flying through Frankfurt. However, based on my reading of the literature that airports are much more conducive to transmission of the virus, significantly more than airplanes, I decided to minimize my risk of traveling through multiple airports and availed the ticket on Air India direct flight from Chicago to New Delhi. I begged a friend to drive me to Chicago from Ann Arbor so that I minimize my chance of availing public transportation and they smilingly nodded. I take this opportunity to applaud and thank my friends in Ann Arbor who have supported me in this journey every step of the way.
Please note that India is not allowing all commercial airlines to fly at this time and there are restricted air bubble flights. From USA, United Airlines and Air India are the two most reliable choices where flights have been operating on a regular basis. I examined the data for the past month in terms of reliability of the flights and decided to avail the Vande Bharat flights as I have an OCI card.
About Air Transport Bubbles| Ministry of Civil Aviation
The Minister of Civil Aviation is the nodal ministry that is responsible for the formulation and implementation of…
Full flight schedules under Vande Bharat Mission may please be seen on web link http://www.airindia.in/images/pdf/VBM-Phase-6-Sheet-B-Air-Bubble-flights.pdf. This gets updated with each Phase.
I registered for travel. Then I called Air India to buy the tickets as their websites were flaky. When I tried initially on the Air India website, my transaction was processed with no ticket number issued and I had to file for a refund. Calling and waiting till you get a seat number was important.
It may not be possible for everyone, and it sounds elitist but if you can afford it I will strongly recommend the first class. I bought a business class ticket and then negotiated a first class ticket with Air India for additional payment. This was to make sure I am not directly in the vicinity of many people and particularly, not too many people were passing by me through the vessel corridor. I will always recommend a non-Aisle seat just to avoid coming near more people.
Step C. Getting tested prior to traveling
India requires an RT-PCR test to be exempt from institutional quarantine so I booked an appointment at the University of Michigan Drive-through testing site on North Campus Research Complex exactly 72 hours prior to travel via MLabs (1–800–862–7284). There are many other facilities through Michigan Medicine and other healthcare providers, pharmacies in Ann Arbor. I told them I was traveling and the insurance covered my test regardless. If I did not have insurance, the test will be available at no cost for most patients. The results appeared in my patient portal within 48 hours and I uploaded this test results as a pdf in my Exemption request form under link Step A.3.ii
I will recommend Drive-Through testing if possible. The technician was amazing. They were changing PPEs in between each test and were taking every precaution, it was also in the open air. I had to slide my car window and lower my mask for less than a minute. The bendy wires in the nasopharyngeal swabs have improved substantially and I had no issues or discomfort with the test.
Though India is still not accepting the point of care Abbott ID NOW test, if I was getting tested for my own need, I will recommend booking an appointment at a pharmacy/Lab that is offering the Abbott test. It has higher sensitivity than RT-PCR and the results come to you in an hour. That is what we need for a test, cheap, fast and accurate. I hope the Indian government accepts this test soon and this point-of-care test becomes readily available.
Step D: Preparing for travel
I wanted to prepare myself to stay healthy so that I have the best chances of fighting the virus. This is what I did for the month of October
- Exercised regularly. Took Vitamin C and Zinc to boost my immunity.
- Downloaded many apps to my smart watch to monitor my temperature, heart rate, stress level so that I can track minute departures and detect early signs of infection.
- Practiced wearing masks for a long time.
- Got all standard health parameter tests done including a complete blood work, and a thorough blood pressure check in collaboration and consultation with my physician.
- I spoke with my colleagues, my students, my Dean and the University leadership why I needed to do this so that I am not stressed about my work. I did not want to feel guilty about being away for two months. I made sure I have the internet bandwidth in India to still continue working remotely in an efficient manner. This is important to make you feel secure about your decision to travel and to work from abroad. My University was amazingly supportive and I executed an international telecommuting agreement with restricted working hours that I could still aspire to manage from India.
Step E. Protecting yourself during Travel:I knew I had to take the strongest precautions through the airport and get my own personal protective equipment (PPE). This is what I did:
- My epidemiologist colleagues told me to be most careful through security lines and passport control where people gather and line up. Those are the the high risk points of my travel. Before getting into Chicago O’Hare airport I wore my hazmat suit, my N95 mask, goggles, face shield and disposable gloves. I looked like an astronaut, but I was totally ok with looking completely foolish. I would rather overprotect than under. Vanity has no place when maximizing my chance of defense is concerned.
2. I had disinfecting wipes, hand sanitizers, disposable gloves handy and in abundance in my pockets. All sanitizers hand more than 70% Alcohol. I wiped everything off and touched them only with gloves on. I tossed away the gloves as I moved on. I constantly kept washing my hands.
3. I had to take the hazmat suit off during security and had to put my masks down for photo identification. These nerve-wracking moments scared me but the exposure time was short, so do not let those moments panic you. I think I was closest to other passengers during the security line and it was the most difficult part of my journey.
4. I learned quickly to tell other travelers to back off and maintain social distancing or put their masks on whenever I needed to. Do not be shy, you are protecting yourself and others. This is neither invasion, nor rudeness.
5. After the security line, I made one mistake that I regret. I went into the first class lounge for ten minutes. This was NOT wise. It was a confined space with people eating and talking on the phone. I left within ten minutes and found an empty place to sit in the airport, far from the other travelers. We know that confined spaces with people not wearing masks are conducive to aerosol transmission. The airline lounge was not worth the wifi and the free snacks with increased risk of exposure.
6. I changed my hazmat suit, my N95 mask and goggles to a simpler KN95 mask, topped by another layered mask and face shield before boarding the flight. I needed to be comfortable for the next 17 hours. I was also the first one to board the flight.
7. KEEP YOUR VENTS ON. Airplanes have a better air circulation system with outside air coming in, compared to other indoor confined spaces with people. You want to keep the air going. So keep those vents above your seat open even if it is a little cold sometime.
8. Bathrooms: This was my biggest fear. I had not used any other bathroom except for my own home for the last eight months. I avoided going to the bathroom in the airport. In the airplane I carried my own wipes, toiletries in my pocket and used the auto sensors of the taps so that I did not touch anything. I still wore fresh pair of gloves and tossed them away each time and sanitized my hands afterwards.
9. Eating and Drinking in Flight: When I boarded, I wiped my seat with disinfectant wipes and also carried my own blanket. I had protein energy bars in my purse. I kept drinking hot water with Emergen-C, lemon and those bars with my mask down, underneath my face shield when needed. It was important to stay hydrated. Each eating/drinking episode took about 10 minutes. I personally did not eat any food offered by the airline but I do think the airline was very careful with packaged foods and supplying a hot meal on an as needed basis.
10. It is important to stay hydrated. I used natural tears, saline nose spray, hand creams and lip balms. Each time I disinfected my hands with sanitizers before applied these or touched my face.
11. I wanted to stay inspired and in high spirits to deal with my travel anxiety. I had saved this issue of the TIME magazine on RBG and I read about her fight to achieve the impossible, always. This was a tremendous boost.
Step F. Landing, Customs and Immigration
- I uploaded a copy of my RT-PCR test result on to the link in Step A.3. (ii) and quickly received an approval form. I carried my filled out immigration form, health report form (the airline gives you these two forms during the flight), a hard copy of this quarantine exempt form and RT-PCR test report in my handy purse. Make sure you carry your own pen.
- Since I had all of this paperwork handy it took me two minutes to get the exemption stamp. I did freak out with someone touching my hand for stamping, but I had no choice. At this point my smartwatch was indicating I was stressed so I paused to deep breathe.
3. Downloading the Aarogya Setu app is a requirement for contact tracing. I had downloaded it before leaving Ann Arbor. However, I could not get it to work with an international phone number so I just had the app downloaded and explained my situation at immigration and provided an alternate number and address.
4. I breezed through the customs and immigration. I hired a porter who was wearing a mask and a face shield so that I do not have to crowd around the belts and touch my luggage.
Finally, I was on my way, in a sanitized car on the streets of New Delhi. As I breathed the air of Delhi, I realized that I have waited for this moment for so long. How can I model the pandemic in India and give sermons on television and newspapers from my sterilized kitchen counter in Ann Arbor without immersing myself in the reality of India. I am hoping my modeling work and my life will be more real from this moment.
The journey is not over yet. Many pharmacies in India are doing at home collection for nasal samples for COVID tests. You can book an appointment online. I am self isolating in a room with attached bath in a friend’s house for the next five days. Practicing regular exercise, healthy eating and getting re-tested in five days at home. I am rooting for a negative test result while I wait. I will then go to Kolkata, my hometown and get tested again before I see my octogenarian parents who are anxiously waiting to see the me. I had been looking at their photos on my desk for too long. This trip is a tribute to them and to public health prevention strategies. The countdown has begun till I see them and I sincerely hope it is a happy ending for me and my family.