Airlines, Caribbean scramble under virus testing orders
Travel industry leaders and governments across the tourism-dependent Caribbean are scrambling to figure out how a new testing requirement for passengers flying into the U.S. will affect them.
The Centers for Disease Control and Prevention announced this week that as of Jan. 26, all international passengers arriving into the U.S. will need to show proof of a negative COVID-19 test, or recovery from the virus. The test will need to be taken no more than three days prior to departure.
The measures are designed to help slow the spread of the virus. But they also risk having U.S. travelers stranded in countries where testing isn't easily accessible, and could further decimate international air travel in a region already struggling to recover from the pandemic's economic fallout.
Even more worrisome is the potential burden the new measures might pose on already strained health systems. Ten months into the pandemic, most countries in the Caribbean and Latin America are struggling to keep up with testing demands as two new variants emerge in the hemisphere and the number of COVID-19 infections sharply increases in one of the world's worst hit regions.
"These growing changes within testing requirements within the travel industry will undoubtedly cause a setback in the economic recovery of small vulnerable destinations globally," Jamaica's Tourism Minister Edmund Bartlett said, as he announced the country's plans to ramp up testing to meet the CDC's new requirement.
"These adjustments will place added pressure on the resources needed to treat our citizens, especially in countries that have made considerable efforts to successfully bolster their health and safety standards to insulate tourists and citizens alike."
The CDC requirement expands on an earlier one for passengers arriving from the United Kingdom and applies to visitors as well as U.S. citizens and permanent residents. The test can either be a viral reverse transcription polymerase chain reaction, RT-PCR, COVID-19 test or a rapid antigen test.
Latin America and the Caribbean are Miami's largest feeder market, with more than half of international overnight visitors to Miami-Dade County coming from the region in 2019, according to research from the county's tourism marketing agency.
Though countries began opening their doors last year after months of lockdown, and many required negative COVID-19 tests for visiting foreigners, they benefited from the fact the U.S. had no such testing requirement —until now.
New CDC requirement comes amid COVID-19 uptick in the Americas
In many countries in the region, laboratory testing kits for COVID-19 are in short supply, and some countries do not not endorse the use of rapid antigen testing kits, which the CDC has said is acceptable. Also, confirming if someone has the coronavirus or not, in many places, is the responsibility of government-run laboratories.
In the case of some Caribbean nations in particular, specimens are flown out to the Caribbean Public Health Agency, or CARPHA, in Trinidad and Tobago, a process that can take days.
The CDC order allows airlines to apply for a 14-day waiver of the testing requirements for a specific country if the agency determines the country "lacks available SARS-CoV-2 testing capacity."
But the pandemic is raging and data suggests infections are on the rise almost everywhere in the Americas.
In the last week alone, 2.5 million people were infected with COVD-19 in the region— the highest weekly caseload since the virus first reached the hemisphere, the Pan American Health Organization said.
That number includes record-breaking figures from more than a dozen states in the U .S., which is seeing more hospitalizations— over 132,000 — than when the pandemic peaked in the spring and summer combined, PAHO said.
Since the start of the pandemic, more than 39 million people across the region have become infected by COVID-19 and more than 925,000 have succumbed to the virus.
On Wednesday, PAHO officials reiterated the regional health body's concerns over pre-departure testing, saying that it should not be used "as a tool to mitigate the impact of the spread of COVID-19."
"The result of the test is [only] accurate at the moment the sample has been taken and it may change until the traveler initiates his journey," Dr. Ciro Ugarte, PAHO's director of health emergencies said.
PAHO, like the World Health Organization, is concerned that pre-departure testing not only presents a false sense of security, Ugarte said, but that such a requirement has the potential to undermine response efforts on the countries of origin as resources needed to detect COVID-19 infections get diverted, yielding a greater public health impact.
In December, after several countries began using testing as a basis for non-essential international travel, WHO published a set of documents stressing that "the antigen rapid detection tests are not to be used in the traveling population."
Concerns were also raised about using the time-consuming and expensive RT-PCR tests, which are still considered the gold standard for detecting COVID-19. While PCR tests may have some public health impact if performed upon arrival, Ciro said the emergence of the new variant first detected in the U.K. and now present in eight countries in the Americas, and a second strain that was detected in South Africa and now present in Brazil and Canada, "might also make use of this test even less cost effective."
So far, there is no evidence that the variants make patients more ill. However, early data suggests that the virus can now spread more easily, accelerating the threat to the region's health systems.
As PAHO reiterated its concerns Wednesday, U.S.-based carriers were still digesting the order.
Jose Freig, managing director of Caribbean and Latin America for American Airlines, Miami International Airport's largest carrier, said travel to smaller countries may become more challenging.
"The bigger locations— Cancun, Montego Bay— we believe the infrastructure will be there in short order given the importance of tourism," he said. "The smaller markets come into concern here because the testing is being sent to the big city for lab results —the Eleutheras of the world."
The company has already started to communicate with affected passengers about the new requirements.
Some countries are ready, others not
So far, reaction to the CDC order by Caribbean governments has been mixed. Many have instituted testing requirements of their own, and the U.S. is in fact among the last in the region to require a negative test for travelers.
"Oddly enough, many of the countries are ready with the rapid antigen tests because they are requiring them for their own purposes and the number of visitors now arriving makes the matter manageable," said Vincent Vanderpool-Wallace, a former Bahamas tourism minister who has been advising the region.
"The real problem," he said, "comes from how this added test will be received by the traveler, especially for persons thinking of a quick getaway. We know that is not helpful. We don't know to what degree it discourages travel. Time will tell."
In a statement, the Bahamas, one of the few countries seeing a decline in cases after a deadly second wave in July, said it is well positioned to integrate the CDC's testing requirements. Currently, visitors who stay longer than four nights and five days are required to take a rapid antigen test on their fifth day.
""This means travelers and residents alike readily have access to the viral tests, now required to enter the U.S.," the Bahamas tourism ministry said.
Charles Sealy, the chief executive officer of Doctors Hospital in Nassau, echoed the ministry's confidence. Sealy told the Miami Herald that the private hospital has been conducting testing throughout the archipelago to assist with return to work, as well as testing for visitors. "Given the amount of healthcare providers certified to prove the test, we are confident that we will be able to meet the demand," he said.
Tiffani Cailor Torrence, a spokeswoman with the Bermuda Tourism Authority, said the British dependent territory's government also feels that it can "quickly adapt" to the new testing protocol.
"Even before the Bermuda government finalizes a public health solution in the next few days, travelers can book a private test with an approved medical practitioner to receive their negative Covid-19 result within the required 72-hours turn-around time," Torrence said.
Jamaica seeks costly expansion
In Jamaica, the number of healthcare providers engaged in testing are not that many. There is one laboratory that does PCR testing and eight private facilities administering antigen tests.
After reopening its international borders in June following a 12-week lockdown, the tourism ministry rolled out an ambitious reopening plan that allowed tourists to get tested upon arrival. But after being overwhelmed, the government was forced to change course and began requiring mandatory negative COVID-19 tests for travelers prior to arrival.
Bartlett, the tourist minister, said urgent steps are being taken to ramp up testing as a result of the new measures, which not only affect travelers to the U.S. but those going to Canada and the United Kingdom as well. He said Jamaica is currently in the process of computing what the costs will be to provide testing for up to an additional 2 million to 3 million people.
"Like all other nations, we understand the need to protect citizens and to put measures in place to help reduce the speed of this deadly virus," Bartlett said.
After initially managing COVID-19, Jamaica has struggled to contain infections. It posted 123 new cases on Tuesday and 92 on Wednesday. Overall, the country has registered 13,700 infections and 317 deaths.
In December as the pandemic continued to spread, the government urged Jamaicans in the diaspora to not come home. It is one of the eight countries in the region where the U.K. variant has been detected.
In an interview with the Herald, Bartlett said countries like the U.S. could help smaller countries like Jamaica absorb the added costs of the new measures by sharing resources. The PCR tests cost between $150 and $171, he said.
He worries that the fallout from the new testing requirements will mean less tourism, and high unemployment in a region where at least 1 million are employed in the sector. "This is an unwitting way of causing economic hardship on small countries and creating joblessness for a host of people," Bartlett said. "Instability is an obvious off shoot of this. I think the Caribbean region is at risk of going into a depression if the tourism economy is destroyed; the pressures on us is now unbearable."
Tests in short supply in Haiti
Dr. Jean William "Bill" Pape, a leading infectious disease specialist in Haiti who runs GHESKIO, a large treatment center in Port-au-Prince, said he wishes the CDC had consulted with countries in the region before taking its decision.
GHESKO has been assisting Haiti's National Laboratory with running COVID-19 tests, and Pape said he is concerned about Haiti's ability to meet the growing testing demand.
The country has a large diaspora living in Florida and New York, and travel between the country and the United States is frequent. It also has weekly charter flights to Canada, which began demanding a negative COVID-19 laboratory test taken within 72 hours for entry into the country as of Jan. 7.
Early on in the pandemic, Pape, as co-chair of the president's commission on Haiti's COVID-19 response, publicly expressed concerns about Haiti requiring a negative COVID-19 test to enter; it currently does not. If it were to take that route others would seek reciprocity, he feared. Haiti, with its limited testing supplies, Pape said at the time, would not be able to accommodate such requests.
As an increasing number of countries in the region began ordering negative COVID-19 tests for travel, GHESKIO, a few months ago, began offering PCR tests for $50 to travelers. Pape said while GHESKIO and the government-run labs have since expanded their testing capacity, there is a shortage of not just staff to process tests, but the reagents, which are the critical ingredient in the chemical analysis used in PCR testing to detect COVID-19 in specimens.
"This has not been easy to obtain," Pape said about the chemical, which faced a worldwide shortage in April. "We are still not receiving enough reagents."
Pape said the few reagents that Haiti has received were donated by PAHO to the National Laboratory, which shared them with GHESKIO. Abott Labs also provided some for another testing platform.
"Even if we were to have all three labs fully operational, and if we were only doing travelers, which mean we would not be able to do patients who are symptomatic...it may still not be sufficient," he said.
New laboratories would need to be opened, he said, and in turn require both equipment and trained staff.
"It's a sophisticated test; you cannot take any technician who is doing their job quite well for other tests to do this test," Pape added. "We still have [Tuberculosis] that's also a cause of concern so we cannot move technicians who can do the test for TB, to do it for COVID. We have a human resources limitation. It's going to be very stressful."
Haiti does not endorse the use of antigen rapid tests.
"In a best case scenario, we would still suffer a lot to provide testing for every traveler," Pape said. "It would also limit our own capacity to diagnose our own patients."
Haiti has registered 10,415 COVID-19 infections and 238 deaths. Though the cases haven't been as severe as many predicted, the country has been seen a spike following the Christmas holiday. Pape said they receive about 2,000 patients daily in need of testing.
"We see it mostly in young people traveling from the U.S., traveling from Europe but we have not seen, thus far, a marked increase in the general population," he said. "At least that part is some consolation we have, but I don't know at the end of this month if this will spread in the general population."