China COVID flight testing makes no sense

The Biden administration announced that all air travelers originating from China must provide proof that they are not infected and contagious with COVID-19. This means a negative test within two days of their departure, or if they were recently infected, proof of recovery. The policy will go into effect on Thursday.

What may have helped precipitate this policy is a report of two flights from China to Milan, Italy having nearly one-half of the passengers deplaning infected. This highlights how easily COVID-19 spreads and can be transmitted across continents.

On the surface, the purpose of such testing it to stop new infections from entering the country. The problem with such protocols is that it is too porous and unreliable to be effective. It will also not yield meaningful population risk reduction benefits domestically.

The problem with the proposed point-of-departure testing from China is the reliability of the results. Such testing can be effective if the testing is done immediately prior to boarding, by personnel who can be trusted to administer, read and report the results.

China has not proven themselves to be transparent with their COVID-19 challenges, as demonstrated by how they are communicating and dealing with the recent outbreak. Asking to trust test results conducted in China is naïve at best, and more realistically, simply foolish.

In contrast, point-of-arrival testing would be more reliable. The question is, how should those who test positive be dealt with? The best one can hope for is providing all incoming travelers their infection status and educating them on how they can limit further spread of infections.

The reality of the situation is that hundreds of thousands of infected people are already freely circulating in communities around the United States. Given that just a few thousand visitors from China enter the United States on average every day, adding a few hundred infected people each day into the population from China barely increases population risk.

For practical purposes, point-of-arrival testing immediately upon arrival by authorized and trained personnel would provide useful epidemiological information about variants circulating in China.

Once China dropped their zero-COVID policy, they have been ill-equipped to manage the surge of new infections. Chinese-manufactured vaccines like CoronaVac and Sinopharm have not been uniformly well received, with vaccine hesitancy ubiquitous. China has been slow to introduce mRNA vaccines, which have proven to be most effective to suppress the worst outcomes from COVID-19. As such, many in China remain vulnerable to severe disease.

Note that college students returning from China for their spring semester could bring an onslaught of new infections to campuses around the country. These infections could spawn pockets of outbreaks in university towns that have been somewhat quiet over the past few weeks. 

Attempting to control the surge in COVID-19 infections from China is futile. The best strategy is to minimize the spread of the virus domestically and its impact on communities. This means ensuring that booster vaccines are available, using face coverings judiciously when in crowded indoor venues and maintaining good indoor ventilation. 

The situation in China demonstrates how small the world is, and that infection outbreaks somewhere are fertile grounds for new infections anywhere. Borders between countries are meaningless and provide no barriers against spreading infectious diseases. 

As COVID-19 continues to percolate and spread across China, every country around the globe remains vulnerable. Attempts at isolation or testing mandates are futile to stop the spread of the virus. This is a reality that must be accepted. 

Point-of-departure and point-of-arrival testing can both be useful to slow the spread of the virus and gain epidemiological data. They will not however stop it. Until China becomes more transparent and open in communicating the severity of their situation, accepts assistance from other countries better equipped to advise them, and adopts mRNA vaccine for their entire population, infection leakage out of China will persist.

Sheldon H. Jacobson, Ph.D., is a professor of computer science at the Carle Illinois College of Medicine at the University of Illinois Urbana Champaign. With a background in risk-based analytics and data science, he applies his expertise in data-driven risk-based decision-making to evaluate and inform public policy.