Covid-19 and Returning from Travel

When I flew from Germany via Turkey to Rwanda on February 1 this year, the airports seemed normal, people did not really seem to take special precautions against Covid-19. Upon arrival in Kigali, just before passing immigration, medical screening took place in the form of a brief interview about where I came from, which countries I had visited in the past two weeks, and if I showed any symptoms of a disease. My answers were typed into a tablet computer by the interviewer, and if I got a green light by the app, I was allowed to pass to the immigration desk and enter the country. That was February 1, 2020. My return flight on the following weekend was unspectacular, without any interviews or screening anywhere, not in Kigali, not in Istanbul, not in Stuttgart.

On March 7, I took the same trip once again, and while the German airport did not seem to have any specific measures in place for departures, there were at least questionnaires on board of the Turkish Airlines flight, and Istanbul did a subtle thermal scan of arriving passengers.

Upon arrival in Kigali, the familiar interviewers in protective gear asked the same questions as before, and after being allowed to proceed, there was the first difference from a month ago: at the immigration desk, there was a dispenser of hand disinfectant, and I was kindly asked to use it. In fact, the same happened at the entrance of the hotel, and over the next days, every supermarket, hotel, restaurant, shop and public building asked its visitors to disinfect or wash their hands before entering, sometimes even before leaving. Shopping malls with larger number of visitors put up mobile hand washing stations where you could pump water and use soap to clean your hands. Even at bus stations, those mobile hand washing stations were placed. Honestly, I do wash my hands quite regularily and frequently wherever I am, and that is what my kids have been taught to do as well, but this was even a lot by my standards. However, given the gravity of the situation and a lurking pandemic endangering the lives of especially certain risk groups, that is what I would expect to effectively limit one vector of virus transmission.

The other vector is droplet infections due to the close proximity of people. Public gatherings were banned in Kigali from March 8 on until further notice. Initially, this did not include restaurants, but closed down bars and clubs, as well as concerts, trade shows, exhibitions, and similar events. Restaurants nevertheless felt the absence of customers and with increasingly strict enforcement, the timeline for a resolution of the Covid-19 pandemic has become a question of survival for them. Rwanda is also a country relying on tourism - something we may not see revived until later this year or maybe even only next year. Covid-19 will dampen Rwanda's strongly expanding economy in many sectors. However, despite Rwanda being Africa's most populated country, it has been agriculturally self-sufficient since 2009, i.e., the output is sufficient not only to feed the country's population, but also allows for exports. This does provide a certain independence and level of comfort many other African countries do not have. In essence, my impression of the Covid-19 handling in Rwanda was that of a well-organized, rational and calm enforcement of measures - having started much earlier than in European countries or especially in the USA.

Meanwhile, as the day of my return flight approached, Turkey prohibited travellers not having spent 14 days in safe countries from entering or transiting through the country, so I had to re-book through AMS with KLM. This time, the white-coated medical screeners had already been placed at the entrance to Kigali airport, asking the usual questions, plus, they were equipped with a thermometer to check passengers for fever. Passengers in line for the screening were asked to keep distance to each other. With Covid-19 progressing as a pandemic, such measures should be expected to be the least standard to limit the spread of this disease, especially at airports where travellers would easily take whatever they carry in them to locations world-wide, and considering the increased risk for flight crews facing an unknown health status of their passengers - people they will have to spend many hours with in the confined space of an aircraft.

My real surprise on this trip, however, was the arrival in the Netherlands. Amsterdam Schiphol airport, Monday, March 16. No questionnaires. No thermal scan. Nothing specific. When I asked the immigration officer about the lack of such measures, he replied "we don't do that here"... but also pointed out that there was now a mandatory closure of restaurants and other public institutions since Sunday. As a consequence, lounges were all closed except one, the number of visitors was counted to make sure they would not exceed the maximum allowed, and there were no food items or beverages in the lounge. A lonely coffee shop seemed to be the only place to acquire something to nibble on or drink. Well, time for a nap to wait for the connecting flight to Germany.

Not expecting any further measures on the Dutch side, the handling at the gate and on board was more or less as usual - nothing special - except if you count the masks the ground staff quickly put on before accepting passengers for boarding, and the latex gloves worn and hand disinfection practiced by the flight attendants on board. After a short flight, I arrived at Stuttgart airport - looking just as usual - no questionnaires, no screening, no thermal cameras, nothing. At the same time, Germany has restaurants and public institutions like museums closed, school children have to stay home and receive their tasks by e-mail or other digital means, and many companies already went into a home office mode of operation.

I am happy to have returned home safely and in good health on March 16, but at the same time I was shocked about how supposedly highly-developed countries exhibited a serious lack of very quick, basic measures, while enforcing rather drastic steps at the same time. Returning from Rwanda, I felt a serious, unexpected culture shock with respect to how Covid-19 is handled in the Netherlands and Germany - and reading the news, this seems to apply to other European countries as well. "Flattening the curve" quickly became a new commodity expression for every newscaster on the topic of Covid-19 - yet, the basics of how to achieve exactly that had not really arrived in reality by mid March.

European countries seem to have been hesitant for a long time, then focussed more on isolation, quarantine, and social distancing - with increased hygiene just being a recommendation without enforcement in places where the public convenes, e.g., supermarkets, post offices, and banks. There are still major differences in seriousness between countries in Europe, and even between regions, counties and cities prescribing different measures to different degrees - enforcement being yet another topic of differences. Even as of today (March 30), Sweden does not follow other European countries with their lock-downs. Italy is in panic and public life seems to have stopped. Germany is somewhere in between, on the partial lock-down side, with schools closed until at least April 19. Some countries like the U.K. were very late with their measures.

Europeans probably felt like outside spectators for quite a while, enjoying the sensational media hype we have seen and still see, but were quite hesitant to introduce strict measures to inhibit the spread of the virus. It was "the others" who got sick - until Covid-19 arrived in the very vicinity of every European. There were many recommendations - few definitive actions - at least until mid March, when closures of schools and non-essential businesses happened on a large scale in many countries.

Scanning through news reports, however, you will find many instances where common sense seems to have been ignored:

• Having incoming passengers wait for hours for medical screening at airports is an excellent way to spread any virus. Stories of this sort cover European, Indian, but also and especially US airports.
• Public transport with crowded buses and trains may benefit from frequent vehicle disinfections, but we should not forget that passengers are the infectious sources of droplets travelling from person to person.
• In Germany, non-essential businesses were closed by government order, but that initally excluded hairdresser shops and farmer's markets in the streets. By March 22, hairdressers were fortunately taken off the list. Why were hairdressers so special in the first place?
• While Germany indeed offers very extensive protection for sick workers, this is not the case in some other countries, including the U.K. and the USA. Sick workers may put customers at risk because they cannot afford to stay home. Although there are also steps into the right direction, they are temporary and most likely not sufficient.
• Those supermarkets, banks and other shops that are still open, may put their staff at risk of infections because of inadequate or non-existing protective measures. Many supermarkets in Germany and France started putting up barriers for cashiers. Is it surprising that this typically happens in countries with strong worker representations in unions?
• Still too many journalists seem to take primary interest in sensational reports about celebrities, politicians and other prominent figures having tested positive for Covid-19. Politicians are lost in the information mess caused by pseudo-pundits declaring ideologically-fitting nonsense and the real experts being blind because of a lack of extensive testing. People take pills because their president talked about them - with horrific consequences. There is too much lucky guessing around. Who is there to trust?

It appears, measures and regulations are decided by governments and authorities, while the execution is left to others - often lacking a full perspective on the real consequences and requirements of such implementation. The voice of scientists is not heard, or if so, much too late. Paradox situations countering the original intent will result - like indiscriminate quarantines on cruise ships, long lines of passengers waiting for medical screening, or sick workers having to fear losing their jobs if they stay home. A stronger coordination between all authorities, organisations and businesses involved would be greatly beneficial, but the CDCs of the world may not possess the political support for conveying bad news. The lack of such coordination is the ground on which fake news and misinformation thrive. Everybody is trying to piece together their own picture of the pandemic.

This whole exercise seems to be a global stress test for the true quality of health care and social systems, as well as for the ability of politicians to deal with emergencies proportionately, effectively and rationally. The lessons from recent SARS, MERS, H1N1, H5N1, and others were not learned. While many of the measures (like frequent hand washing, keeping distance from each other, not sneezing and coughing at others) truly are essential to keep any infections at a minimum - whether of SARS, Covid-19, the flu or the common cold - we keep asking ourselves if the lock-downs now enforced in most countries world-wide are the best approach to limit the pandemic?

That is something I should ponder about in a different posting. This one is only about my shock that while drastic restrictions on public life and businesses are in place now, some of the most basic measures still do not seem to be implemented pervasively, and the tools for a thorough understanding of the Covid-19 pandemic are not yet available. I get the impression that for many people, an invisible enemy like a virus is either too abstract to respect or - at the other end of the spectrum - reason for absolute doomsday panic.

How can scientists resolve this dilemma with pragmatic realism and effective solutions to minimize the effects of this pandemic? How can they convey this into politics to focus on what really helps, not what is consistent with the respective ideology of deciders? This is a stress test continuing to cost innocent lives.