The SARS-CoV-2 virus is the cause of COVID-19 (coronavirus disease 2019), a contagious respiratory disease that was first identified in December 2019, in Wuhan, Hubei, China. The disease is a type of coronavirus, the same family that includes SARS, MERS, and some varieties of the common cold. It was declared a pandemic by the World Health Organization (WHO) on 11 March 2020. While much about COVID-19 is still unknown, preliminary data suggests that it is more virulent and contagious than the seasonal flu, and less virulent but more contagious than SARS and MERS. Older people and those with underlying conditions are the most at risk of serious complications including death.
Due to the spread of the disease, you are advised not to travel unless necessary, to avoid being infected, quarantined, or stranded by changing restrictions and cancelled flights. Avoid crowded places whenever possible. This is not just to protect you, but also those you come in contact with. As it happens, you probably aren't missing much by staying home, as many attractions around the world are closing their doors to avoid spreading the disease.
If you do need to travel, take precautions as you would for other infections: wash your hands frequently, avoid touching your face, cough and sneeze into your elbow or a tissue, and avoid contact with sick people. Before traveling, read up on the extensive and fast-changing array of travel restrictions that have been imposed around the world. After travel, monitor your health and consider self-isolation for two weeks to avoid transmitting the disease to others.
Transportation from long-distance passenger flights to local buses has been curtailed or completely shut down in many countries due to low demand or government orders. Many international and regional borders are closed. If you are away from home, and especially if you are in another country, consider returning home as soon as possible; this may get even more difficult as restrictions continue to change. In some cases it may simply not be possible, even if you're healthy and meet the legal requirements for entry. If you can't find a way back to your country, contact your nearest embassy or consulate for assistance. They may be able to organize an evacuation, identify non-regularly scheduled flights, or give you an emergency loan to pay for transport. In case they can't, make preparations in case you need to stay where you are for an extended period. If you do find a way back home, be prepared that it may be expensive, inconvenient, and have unusual restrictions (such as no checked baggage).
As of early April 2020, the number of confirmed cases of COVID-19 is approaching one million. Though the disease started in mainland China, it has spread around the world and China has fewer confirmed cases than the United States, Italy, Spain, and Germany. Europe is the new epicenter of the pandemic, with cases growing quickly in Southern and Western Europe, while the death toll in Spain and Italy is now higher than in China. All but a handful of countries have reported at least one case, with the highest numbers of reported cases in the United States, Italy, Spain, Germany, mainland China, France, Iran, and the United Kingdom. Local transmission is established in many countries in all major inhabited regions of the world except parts of Africa and some Pacific island nations. (See updates from the WHO.)
The full extent of the spread is uncertain, due in part to limited testing. Many countries are experiencing a severe shortage of test kits, and the authorities have not been able to test everybody who is at high risk, so the real number of cases is probably much higher than the official one. Countries also differ in their testing and reporting practices, so comparisons of the number of reported cases do not tell the full story of how the epidemic has progressed in different areas.
The virus is transmitted through respiratory droplets and through objects. The coronavirus is a relatively large virus, meaning it is not truly airborne: it will settle down in respiratory droplets. Staying two metres (six feet) away from other people is usually enough to prevent transmission through this route.
Transmission from objects can happen, for example, if someone sneezes, touches a doorknob, and then other people touch the doorknob and then touch their faces. The SARS-CoV-2 virus may last on cardboard for up to 24 hours and on plastic for up to 3 days. Transmission via the fecal–oral route may also be possible.
Evidence suggests that COVID-19 is contagious even without symptoms, though to what extent is still being investigated.
Symptoms and prognosis
Common symptoms include a fever, dry cough, and fatigue. Other less common symptoms include shortness of breath, a sore throat, headache, muscle pain, or sputum production. Some patients have very mild symptoms, similar to a cold. Serious complications include pneumonia, acute respiratory distress syndrome, and multi-organ failure leading to disability or death. About 80% of infections result in mild symptoms, while the remaining may result in hospitalization. Case fatality rate is estimated at 1-3% of infected individuals, most of whom are elderly with underlying health conditions. The fatality rate is much higher for those over 70 but significantly lower for those under 40.
Those most at risk of COVID-19 infection and serious complications are the elderly and those with weakened immune systems or underlying health conditions like cardiovascular disease, diabetes, hypertension, chronic respiratory disease, and cancer. Not many cases are reported in children and most of these are mild or moderate, though a significant fraction do get pneumonia. Some infected people don't get symptoms at all. Occupationally, health care workers have higher risk compared to others with clusters of disease among workers and in health care settings.
The time between being exposed to the virus and the emergence of symptoms (incubation period) is typically between 2 and 14 days, though there has been one reported case in China where symptoms appeared 27 days after exposure. As of February 2020, the period of infectiousness is unknown, but is likely most significant when people are symptomatic. There is evidence of transmission from people who don't have symptoms, although to what extent is still being investigated. It is unclear whether it is possible to be reinfected with the virus after recovering from it the first time around.
Long-term effects for people who have recovered remain unclear, but there is evidence of reduced lung capacity in some recovered patients.
Testing for the virus usually consists of a swab inserted through the nose or a throat swab which is analysed in a laboratory for the virus. The current "gold standard" test involves extracting the genetic material from the sample and analysing it for known genetic markers of the virus. There is no established test assessing for the virus or antibodies in the blood, although tests are being developed. There is no test to establish immunity to the virus.
Many governments around the world have advised their citizens not to travel unnecessarily amid the pandemic. Lots of airlines and package holidays are making it easy for you by waiving cancellation and change fees. Particularly avoid cruise ship travel. Older travelers and those with underlying health conditions are most at risk and should avoid travel that puts them at risk, such as long plane flights, visits to crowded places, and especially cruises, even outside of severely affected areas.
In affected areas, most experts recommend a practice known as social distancing. This means minimising contact with others by keeping a distance of six feet or two meters from them and avoiding gathering together in groups. Some areas permit small groups; others prohibit all group gatherings. Measures you are encouraged to take include working from home whenever possible, avoiding crowds and avoiding leaving your home unless absolutely necessary. If you must go out, try to stay at least 2 meters (6 feet) away from other people. In many places these measures are required.
Follow hygiene practices like for flu prevention. These include:
- Frequently wash your hands with soap and warm water, and then dry your hands on a clean towel. As coronaviruses are enveloped viruses, washing your hands with soap kills the virus by disrupting the mostly fat-based viral envelope. Effective hand washing requires rubbing your hands for at least 20 seconds. Drying your washed hands physically removes some germs from your skin (so don't skip that step, and don't share towels).
- If soap and water are not available, then use a >60% alcohol-based hand sanitizer. Alcohol is a quick germ-killer, but it's not quite instant, so this still requires the same 20 seconds of rubbing your hands together, making sure that every single scrap of skin gets wet, and then you have to wait about another minute, for the alcohol to completely dry.
- Avoid touching your eyes, nose and mouth with your hands. Most people touch their faces every few minutes, all day long. Try to do this less, and try to wash your hands before touching your face. Also, try to avoid touching surfaces you don't have to touch in the first place, at least with your bare hands.
- Cough and sneeze into your elbow or a tissue, and then immediately throw away the tissue and wash your hands.
- Don't stand or sit near people who might be sick. Stay at least one meter – and ideally two meters (six feet) – away. As a quick way to eyeball this distance, imagine that you and the other person both reached your hands towards each other. Could you touch the other person's hand without taking a step towards that person? If the answer is yes, then you're too close.
Other actions include:
- Clean objects and surfaces that a lot of people touch, such as doorknobs, phones, and television remotes with regular household cleaner. Disinfect the surfaces with a suitable disinfectant, such as diluted household bleach.
- Stay home when you are sick, and avoid contact with other people until your symptoms are gone.
- Do not share personal items that come into contact with saliva, such as toothbrushes, eating utensils, drinks, water bottles, and towels. The practice of serving yourself from a common plate with your own chopsticks, common in China, should be avoided.
- Greet people without touching them. Avoid hugs, kisses, handshakes, fist bumps, and any other contact. If it's impossible to avoid contact, then wash your hands both before and after.
- Get a flu vaccine. It won't protect you from the coronavirus, but it will partially protect you from the flu, which remains a greater risk than COVID-19 in many areas. This also saves you from unnecessary worry if you get the flu and think it might be the coronavirus.
- If you are elderly or otherwise in a high-risk group and can be vaccinated for pneumonia, get that vaccination. It won't protect you from viral pneumonia from COVID-19, but some COVID-19 patients have died of bacterial pneumonia that attacked their weakened lungs, so a pneumonia vaccination could save your life.
Wearing medical masks (not thin dust masks) is recommended for those who are suspected of carrying of disease and those who are in close contact with those infected. For those who are asymptomatic, the WHO does not recommend masks, though some national governments do. Wearing a mask of some kind is required in some countries and cities in an effort to reduce community transmission. There are worldwide shortages of surgical masks.
If you do wear a mask, make sure to use it correctly. The mask should cover your nose and mouth and fit without gaps. Wash your hands before putting on the mask and avoid touching the mask while wearing it. If you do touch it, wash your hands immediately afterwards. When the mask becomes damp, discard and replace it. Remove it from the back, throw it away, and then wash your hands. Don't reuse disposable masks. Remember that masks are not a substitute for good hygiene: continue to wash your hands frequently.
Don't stock up on masks if you don't need them. Mask shortages mean that healthcare workers are having trouble getting a hold of masks, which puts everyone at risk. That includes N95 respirators, which are not recommended for the general public – these are specialist equipment which must be fitted to be optimally effective. Leave them for healthcare workers.
Lots of museums, attractions, and even national parks are offering virtual tours, so that would-be visitors cooped up at home can experience them over the internet. Some institutions were already offering virtual tours to begin with; others have worked hard during the crisis to get online visits up and running. Closed performance venues are streaming recordings of past performances. At other attractions, live webcams let you see for yourself what's going on at zoos, parks, and famous tourist sites.
Avoid crowded areas, especially enclosed areas without much air circulation, such as conferences, performances, shopping malls, public transportation, and religious services. Events which involve a large scale gathering of people, from religious pilgrimages to music concerts, are being canceled worldwide, in an effort to contain the spread of the virus. Tourist attractions, businesses, and transportation may be closed, especially in affected countries. Some canceled events, especially performances, sporting events, and classes, are being moved online, which means you can experience them without traveling.
The U.S. and Canadian governments recommend avoiding travel by cruise ship. Infections spread easily on board, and medical care is limited. Amid a cruise ship outbreak, quarantines and docking are challenging partly due to the large number of people aboard. Even cruise ships without confirmed cases have been denied permission to dock due to virus fears, and in the high-profile case of the Diamond Princess in Japan, hundreds of people were infected on the ship.
If you believe you may be infected, call a hospital or local emergency medical services instead of going in person to avoid infecting others. Mention your symptoms and travel history. Wear a medical mask and follow the instructions of authorities and doctors.
- See also: Flight and health
On a plane, follow the same hygiene practices as anywhere else: wash hands frequently, or use alcohol-based hand sanitizer if it's not convenient to leave your seat, and avoid touching your face.
Researchers have found that passengers in window seats have less risk of contact with sick people. Try to book a window seat, and avoid moving around the cabin during the flight.
After washing your hands and before sitting down, use disinfectant wipes to wipe down the area around your seat. Wipe hard surfaces, and if your seat is leather you can wipe that too. Don't wipe a cloth seat, as the moisture can make transmission easier. When using disinfectant wipes, follow the instructions on the packaging. And remember, viruses enter through your mouth, nose, and eyes – wiping down the area doesn't hurt, but it's not a substitute for proper hygiene. Wash your hands and avoid touching your face. And use a tissue to touch the touch screen or other controls.
When using the lavatory, use paper towels to turn off the faucet and open the door, then throw them away.
Airlines in affected areas are taking steps to reduce transmission and keep passengers safe. For instance, these may include cleaning facilities more frequently, allowing flight attendants to wear masks, and serving prepackaged instead of freshly heated meals. If a group of passengers is connecting from an area with a severe outbreak, the flight attendants may be able to seat them away from the rest of the passengers (and if you were recently in a high-risk area, consider telling the flight attendants for this reason).
You may be prohibited from changing seats on the flight. This is so that, if someone on the flight turns out to be infected, the authorities can track down the people who were sitting near them for testing or quarantine.
COVID-19 is treated by relieving symptoms and preventing complications. There is no vaccine or specific treatment for the novel coronavirus. Research into a vaccine or specific antiviral drug is underway. There are a variety of trials using HIV medications and other novel antiviral medications for treatment of COVID-19. Mild symptoms may be relieved by taking paracetamol (acetaminophen).
If you are infected with COVID-19, countries will isolate you until several consecutive tests for COVID-19 are negative. If you have been in close contact with someone infected with COVID-19, many countries will quarantine you for 14 days since the last exposure and monitor you for signs and symptoms. Some countries will also test you even if you don't have symptoms.
In many countries, the healthcare system has been stretched to the point of not being able to handle the sheer number of patients, and there is a chance you may be refused treatment due to the lack of available medical staff, supplies or equipment.
Screening, quarantine, and self-quarantine
When leaving or returning home from an affected area, expect to be screened and questioned about your travel history and possible symptoms. For reference, the U.S. CDC has published an explanation of their screening and quarantine procedures. These will be different in other countries, of course, and are changing as the situation develops.
Many countries have shut down or severely limited flights, ships, and border crossings, especially to and from affected areas. Even more countries have imposed restrictions on arriving travelers, either barring entry (maybe with an exception for local citizens and permanent residents) or requiring you to be quarantined, typically for 14 days. Even if a mandatory quarantine is not imposed, you may be asked to "self-quarantine" by staying at home and not interacting with other people. The most severe restrictions are on travellers who have recently been to affected areas, but increasingly many countries are applying them to incoming travellers overall. Some countries have even prohibited all or almost all foreigners from entry or limited the ability of local citizens and residents to leave.
What are the affected areas? Well, this is a fast-changing situation, and each country/region/organization has its own list of what areas are subject to restrictions. The city of Wuhan is on every list and the rest of mainland China is on most. Other areas that are often included: France, Germany, Hong Kong, Iran, Italy, Japan, Macau, Singapore, South Korea, Spain, Taiwan, the United Kingdom, the United States, the Schengen Area as a whole, and sometimes various others. Some countries have imposed restrictions based on citizenship or residency from severely affected areas. A detailed list of entry restrictions is maintained by the IATA. It doesn't cover all the restrictions, but it's still useful. Keep up to date—the outbreak and the travel restrictions are changing rapidly.
For travel in the near future, consider making refundable reservations in case the changing situation forces you to change your plans. Avoid buying tickets with a connection in an affected area – even changing planes can make you subject to restrictions.
Flights may get canceled with little notice, either due to the disease's spread and ever-changing entry restrictions, or simply because fewer people are flying and airlines are having trouble filling seats. You might also be delayed for hours upon arrival waiting for temperature checks and related procedures and paperwork, or even get quarantined for two weeks. Be prepared for the possibility of disruption to your travel plans, especially if traveling internationally.
Even if you're nowhere near affected areas there's a risk that you'll have to stay at the destination longer than planned if you've shared a building or vessel with an infected person. For example, in late February an Italian doctor on vacation in Costa Adeje (Canary Islands) was diagnosed with COVID-19, and as a result all the guests in the hotel he stayed at were quarantined.
Lockdowns and other internal restrictions
Some countries and regions, especially severely affected ones, are implementing emergency lockdowns and restrictions on people's movements and activities, even for those who haven't recently been abroad. These include the temporary reintroduction of some border controls, restrictions on travel within the country, closing or limiting service at restaurants and other establishments, banning large public events, and in the most severe cases prohibiting people from leaving the house except for essential reasons. Beyond government restrictions, individual establishments are shutting their doors and cancelling events to try to reduce the spread of the virus.
In China, there are extensive restrictions on transportation and activity, which vary widely by province, city, and even by district or village. Many governments recommend against traveling to China at this time. If you have no choice, do your research and get up-to-date information about the local situation wherever you are going. People who have traveled to Hubei face particularly severe restrictions. Examples of restrictions that you may encounter in some parts of China (this is not an exhaustive list):
- 14-day quarantine, self-quarantine, or COVID-19 test upon arrival from other parts of China or from other countries, at your expense
- questions about your travel and medical history (lying can get you years in prison)
- mandatory registration using an online or paper form
- requirement to wear a face mask in public
- frequent temperature checks
- people who have been outside of China within 14 days not allowed into public places like malls
- shops only accept mobile payments, not cash
- restaurants, transportation and other establishments refusing service to non-Chinese citizens
- many forms of transportation reduced or shut down
- mandatory real-name registration for public transit cards
- access in and out of a town, village, or city completely blocked
- non-resident visitors prohibited from entering apartment complexes
- only allowed to go outside once every two days to get supplies
- businesses, activities, and attractions closed
- businesses need local government permission to re-open
- restaurants (if they are even open) require a minimum distance between customers
- selling substandard face masks has a maximum sentence of life imprisonment
As of mid-March 2020, Europe is the epicenter of the epidemic, and many European countries have closed their borders to international travel - only border commuters and freight are allowed to cross. Also businesses other than food stores and pharmacies are closed, and public transport has been reduced or stopped. In the worst affected countries including Italy, Spain and France, lockdowns like in China in January, have been implemented. As well the EU has closed its outer borders.
COVID-19 is prevalent also in North America. The borders between Canada, the U.S., and Mexico are closed to non-essential travel, and in many areas bans on big gatherings are in effect (this means places like restaurants are closed, and events are canceled). Numerous state, county, and municipal jurisdictions have issued stay-at-home orders that require all nonessential businesses to close.
With lots of flights canceled, warnings issued, and restrictions imposed, flying in the time of coronavirus can be a challenge. Some routes are not possible. Others will require more inconvenient connections than usual—multiple stops and long waits between flights. In some cases that means more expensive tickets.
On the other hand, the good news is that many flights are cheaper than usual due to decreased demand, and there's a decent chance you'll get an empty seat next to you.
Build in extra time for your connections, especially if transferring from an international flight to a domestic flight and especially if your itinerary involves a country that's seriously affected. Screenings, temperature checks, extra paperwork, and the associated waiting around can add minutes or hours before you're allowed to continue on your journey.
You may find it harder than usual to buy a ticket to or from a destination subject to warnings and restrictions. This is a real concern if you're trying to get out of an affected area. For instance, most aggregators are not selling tickets from China to the United States (presumably to avoid falling afoul of restrictions and being on the hook for a passenger's flight out). To buy a ticket for an itinerary like this, you may have to contact the airline or use a lesser-known aggregator. Another possibility is to buy two separate tickets (for instance, a ticket from China to Cambodia and a second ticket from Cambodia to the U.S.), but be careful you won't get quarantined or lose your luggage in between.
Connecting flights can be a problem. The risk of getting stuck in the connection city is higher than usual right now, due to delays for screening and testing as well as extensive cancellations. Connecting in an affected area may lead to entry restrictions later on, and if you've been in an affected area recently some countries won't even let you change planes. On certain itineraries there is a risk of getting quarantined somewhere along the way. So book a direct flight if you can, and if not, think carefully about where to connect. Avoid short layovers.
In uncertain times, plans can change. Consider buying refundable tickets.
Many embassies and consulates have evacuated nonessential staff, and some have shut down operations completely. Emergency assistance should still be available, though it's possible you may have to contact a further-away consulate if your local one has shut down. If you have been stranded due to the pandemic, your nearest consulate may be able to help you find a flight home, arrange an emergency loan so you can buy a ticket, or provide an emergency passport. At the very least they can keep you informed about the local situation and notify you about recently introduced travel requirements and restrictions.
Ordinary consular services such as visa and passport processing may be suspended or restricted to urgent need, depending on the location and the consulate.
Although some people call the disease "Wuhan pneumonia" (武汉(漢)肺炎/武肺), "Wuhan disease", or "Chinese virus", the use of these terms is considered racist in China and by many people of Chinese origin. It is still common to refer the disease as "Wuhan pneumonia" or "Chinese virus" in places like Hong Kong and Taiwan. To be safe, use location-neutral terms when referring to the disease, such as "COVID-19", "novel coronavirus", or just "the virus" or "the pandemic".
Particularly in developing countries where law enforcement are poorly trained, enforcement of curfew, lockdown or stay-at-home orders are often brutal, often using forces not proportionate against crowds. Comply with these orders, and avoid crowds in public.
As a result of the coronavirus pandemic, xenophobia has risen in many countries, primarily but not exclusively targeting people perceived to be Chinese. There has been a worldwide spike in racist incidents targeting people of East Asian origin, including in major cities such as New York, London and San Francisco.
In Hong Kong, Sinophobia, which was already high to begin with, has intensified as a result of the pandemic, with the result that many shops and restaurants are now denying service to mainland Chinese customers and banning Mandarin speakers from their premises (with the exception of Taiwanese).
Levels of xenophobia have also risen in East Asia, with some restaurants and other businesses in Japan and China refusing service to foreign customers.
Government travel advisories
Sources for further information on the coronavirus outbreak include:
- World Health Organization
- The US government Centers for Disease Control and Prevention
- European Centre for Disease Prevention and Control (daily updates)
- United Kingdom government, - Foreign and Commonwealth Office advice for Travellers
- An online map and dashboard from the John Hopkins University Center for Systems Science and Engineering with live updates
- Partial lists of entry restrictions from IATA and The New York Times
A variety of misinformation and conspiracy theories about the virus are being promoted online and even by some government officials, so be careful which sources you check for information. Ensure that all information and advice you receive has been backed by reputable doctors and scientists.
In a crisis, it's natural to want to keep following the latest updates, but it may be better for your mental health to moderate the amount of news that you look at, and stick to reliable news sources. If you normally watch the news twice per day then stick to this schedule and do something else, rather than having the 24-hour news on continuously.