How air passenger ignorance and behaviour aided SARS-CoV-2's entry into the UK

Many studies have indicated that air travel was integral to the long-distance spread of severe acute respiratory syndrome coronavirus 2 (SARS‑CoV‑2). It was observed that UK citizens who returned from mainland Europe such as France, Spain, and Italy, rather than China, were responsible for introducing SARS-CoV-2 into the UK. Sequencing studies have highlighted approximately 1,300 independently-introduced virus lineages in the UK during early 2020, which led to the first COVID-19 wave. It was estimated that 0.02% of infected passengers arrived during this period out of 8 million passengers. However, this was lower compared to the 1.3% of passengers who left Wuhan during the pandemic's beginning, which caused the rapid spread of the disease throughout the world.

During the start of the second COVID-19 wave, transmission from passengers on a flight from Greece to Ireland was also reported since the attack rate was 10 to 17%. Moreover, this transmission was found to occur irrespective of the use of face masks and enforcement of social distancing. Many epidemiological and modeling case studies have confirmed that infection can spread to multiple passengers on a flight from one infected person. Additionally, the transmission of other respiratory pathogens has also been observed within crowded airport terminals, suggesting that one infected person can infect several people traveling to multiple destinations.

Although international flights were stopped to prevent the spread of the virus, it led to significant job and economic losses in most countries. Consequently, there is an urgent push from the travel industry to reopen international air routes. However, in order to ensure public health protection, this must be done responsibly, practically, and economically. To achieve this, effective disease surveillance and control are necessary, as well as the development of cost-effective and practical surveillance technologies. The public's support is also crucial for programs involving isolation and quarantine.

An increase in screening measures at the airport entry is observed to be ineffective and highly resource-demanding. While several national disease surveillance strategies are available, effective ways to estimate disease entry from overseas travelers are limited. However, the continuous import of SARS-CoV-2 variants in the UK suggested that the current surveillance strategies are not entirely effective both at the point of entry and departure. Several countries have implemented quarantining of passengers for 10 to 14 days on arrival to resolve this problem.

However, self-quarantining is effective only if people obey the quarantining policies. Obedience is a socially learned behavior where people comply with fundamental social norms or formalized laws, while disobedience is when people refuse to obey such laws. Individuals who refuse to follow quarantining policies due to disobedience are also more likely not to follow other health advice to prevent the spread of COVID-19. The risk of infection increases for them and others as a result.

A new study under review at the Scientific Reports journal and currently posted to the Research Square* preprint server aimed to analyze the increased risk of COVID-19 spreading due to human behavior associated with travel among UK air travelers that have flown during the pandemic.

Study: Poor air passenger knowledge of COVID-19 symptoms and behaviour undermines strategies aimed at preventing the import of SARS-CoV-2 into the UK. Image Credit: Lightspring / ShutterstockStudy: Poor air passenger knowledge of COVID-19 symptoms and behaviour undermines strategies aimed at preventing the import of SARS-CoV-2 into the UK. Image Credit: Lightspring / Shutterstock

This news article was a review of a preliminary scientific report that had not undergone peer-review at the time of publication. Since its initial publication, the scientific report has now been peer reviewed and accepted for publication in a Scientific Journal. Links to the preliminary and peer-reviewed reports are available in the Sources section at the bottom of this article. View Sources

About the study

The study occurred when the UK was under strict COVID-19 restrictions and involved participants aged 18 years and above who had undertaken foreign travel and were living in the UK. The participants were recruited from YouGov's online research panel, an ESOMAR-accredited market research company. The survey was conducted online through the YouGov data portal, and the invitation to participate in the survey was sent through email.

The survey comprised 18 closed-ended questions, which consisted of questions associated with air traveling and sociodemographic topics. The questionnaire was designed by public health specialists, environmental microbiologists, and social scientists. Data on gender, age, employment status, social grade, marital status, and educational or professional qualification were also collected. In addition, Postcode was collected from the participants to determine their social grade and indices of multiple deprivations (IMD). Moreover, information on whether there was a child in the household, the social media platform they used in the previous month of the study, their travel history, and their COVID-19 infection status were also collected.

Study findings

The results indicated that most of the participants had a good knowledge of the common COVID-19 symptoms, while the less common symptoms were not recognized by most of them. In addition, females and older participants were found to be better at recognizing symptoms. Adults with children also showed better recognition of symptoms than those without.

Out of the total percentage of participants who took part in the study, 27% showed strong concern about catching COVID-19, 56% showed some concern, and 17% showed no concern about catching the disease. Females and those with children were observed to show greater concern. Additionally, 1.3% of the participants were previously reported to test positive for COVID-19, while 10.3% believed they had been infected but did not undergo formal testing.

Furthermore, 23% of the participants reported boarding a flight while being ill, with most of them belonging to the younger age group and without children. Moreover, 21% of participants indicated that they would return to the UK on their scheduled flight despite experiencing potential COVID-19 symptoms, 27% indicated they were unsure, and 52% indicated that they would not. Individuals of the young age group were more likely to return to the UK irrespective of COVID-19 symptoms. Similar responses were obtained when people were asked if they would travel back with another person who was experiencing symptoms while they were not.

10.2% reported they would not undergo the 10-day quarantine, while 83% said they would. The younger generation was more likely to disobey the self-isolate guidance than the older generation. Additionally, 15.2% were observed to have flown since the beginning of the pandemic, with the younger generation and those belonging to the affluent social grades taking the highest number of flights. Among them, 47% reported feeling safe while taking the flight, while 13% reported that they did not. Moreover, 32% said face coverings were effective on the flight, 32% said they were ineffective, and 36% said they were partially effective. While 93% of individuals revealed they would wear face masks on the plane, 31% would do so only if it was mandatory. Among them, those in the 55 age group were found to wear face masks whether it was compulsory or not.

Conclusion

Therefore, the current study indicated that the lack of compliance among a particular section of air travelers and insufficient government policies and guidelines led to the entry and rapid spread of SARS-CoV-2 in the UK. Therefore, for future pandemics, emphasis must be given so that all individuals follow public health guidelines, hygiene, and quarantine measures to prevent the spread of infection. Furthermore, the disease symptoms should be explained, so everyone understands them, especially the young.

Limitations

One significant limitation of the study is that it included only UK citizens. However, non-UK citizens with diverse cultural and socioeconomic barriers might also play a role in the risk of entry of SARS-CoV-2 in the UK.

This news article was a review of a preliminary scientific report that had not undergone peer-review at the time of publication. Since its initial publication, the scientific report has now been peer reviewed and accepted for publication in a Scientific Journal. Links to the preliminary and peer-reviewed reports are available in the Sources section at the bottom of this article. View Sources

Journal references:

Article Revisions

  • May 15 2023 - The preprint preliminary research paper that this article was based upon was accepted for publication in a peer-reviewed Scientific Journal. This article was edited accordingly to include a link to the final peer-reviewed paper, now shown in the sources section.
Suchandrima Bhowmik

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Suchandrima Bhowmik

Suchandrima has a Bachelor of Science (B.Sc.) degree in Microbiology and a Master of Science (M.Sc.) degree in Microbiology from the University of Calcutta, India. The study of health and diseases was always very important to her. In addition to Microbiology, she also gained extensive knowledge in Biochemistry, Immunology, Medical Microbiology, Metabolism, and Biotechnology as part of her master's degree.

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Comments

  1. Holly Agate Holly Agate United States says:

    Yeah…. Nobody is going to willingly go into quarantine, or go into quarantine while willingly stay behind in another country if they are sick. On the second one, why should they? They should stay behind hundred if not thousands of miles away from their home and family and friends, and everything they know and love, possibly wind up DYING while in another country, where who knows what will happen to your body IF your family and friends are allowed to travel to collect it to bring it back home for burial. When instead we can go home as quickly as possible and tough it out there in the comfort of your home with your loved ones around you with everything that is familiar. Plus going home would be CHEAPER than the hundreds if not thousands of dollars you will be wasting by trying to find new living accommodations for you to stay in where you are during the duration of your forced quarantined, plus the extra costs of any hospital stays while there, and possible return to a rebooted quarantine.

    Plus another reason to go home as quickly as possible even while sick, is look at the thousands if not millions of people who are STRANDED outside of their home country, probably haven’t been back home since the pandemic first started back in 2020, being forced to live outside of their home countries away from their loved ones and everything, because FIRST travel anywhere has been put on lockdown so if you were on vacation when news of the lockdowns first started, you had a choice of either cutting your vacations short and TRY and catch the first flight back home immediately before you are locked out of your home country for the foreseeable future, or try and get on the ‘first flight’ back home immediately only to have your flight canceled because all seats were already taken, and you wind up missing the time limit you needed to get back home to your home country. So your vacation trip gets extended. Okay. Maybe you can last a few WEEKS or MONTHS there with what litttle money you have, while trying to find a job to keep you going, because obviously your job back home won’t be paying you while your gone if they don’t outright fire you if you are gone too long, as you wait for lockdown to finally be declared over so that you can finally go back home where you belong, but various things happen over time that keeps your temporary stay in your vacation place become longer and longer, until those weeks and months turns into years as there are no sign of you going home any time soon happening.

The opinions expressed here are the views of the writer and do not necessarily reflect the views and opinions of News Medical.
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