Pandemic Fatigue: Travel Plans?

So is this what it has come to?

11 months in, and the pandemic fatigue is so real that I was forced to write an essay for my family, to explain to disappointed teenagers why spring break travel with their friends during COVID19 is not permitted. 

As of today, 12% of the nation has had its first vaccination shot – at current pace, we’ll have 50% with some disease protection by early July. Soon, we will have all had the opportunity to take the vaccine, and we can take to the roads, once again to go exploring.

Travel now? At the present time, my answer is a firm “No” – leisure travel must take a back seat to more essential needs – such as providing healthcare and keeping schools open. Trust me – I know the benefits of time away, I’m the one who penned: Want to Live Longer? Take a Vacation!

As someone with privilege (i.e. continually employed, white male; able to work from a home with sufficient space & bandwidth to support all of us on simultaneous Zoom calls), surrounded by a bubble of those similarly well off, I notice many friends & neighbors questioning the need to stay home. There are overwhelming logical, rational concerns when considering leisure travel.

I, along with my children, am also eager to break free of these walls, explore warmer climates, and get back to a ‘semi-normal’ life. But I will not travel today; let’s break these concerns down, into Community, Regulatory, and Ethical:

 Community Concerns

Are our children at risk? Not so much - they are young, free of chronic disease, and healthy. A significant number have been infected once already. Most of the rest would likely experience flu-like symptoms and recover.

Not zero risk, mind you – one 19-year-old in our circle had the virus in November, and still has not recovered his sense or taste or smell. Hospitalization rates are currently 153 per 100,000 people, for those aged 18-29.

Are our families at risk when those traveling return? There is increased risk here, that varies by underlying conditions. The returning family members will find it difficult to quarantine from other members of the household – most will re-enter immediately, raising the risk of transmission to everyone ‘in the bubble’. Hospitalization rates are currently 596 per 100,000 people (ages 50-64), rising to over 1300 for those over 65. Elders are particular impacted, as are those with additional risk factors – bringing more risk into their bubbles, perpetuating the crisis around them for additional weeks & months is a bigger concern than many are aware of.

What about the communities around us? Absolutely. There is an increased chance of a disease being acquired while on holiday, and transmitted to others during the travel, and back to home community upon return. And this burden falls heaviest on those who can least afford it – see ‘Ethical Concerns’ below.

 Regulatory & Recommended Guidelines

Let us start with federal regulations – the CDC (Centers for Disease Control) rates the United States as ‘Level 4’ – Very High Risk – “avoid all travel to this destination”. Additional language provides unequivocal clarity: “Travel increases your chance of getting and spreading COVID-19. CDC recommends that you do not travel at this time. Delay travel and stay home to protect yourself and others from COVID-19.”

For the target destination - each state has a slightly different take. For example, if you would like to visit California: “Travel increases your risk of getting COVID-19 and infecting others. For this reason, the California Department of Public Health asks that you limit your travel during the pandemic.”

Further insights: “Californians should remain local (not traveling more than 120 miles from their home or other place of residence) and avoid non-essential travel. Travelers from other states or countries entering into California for tourism and recreation are strongly discouraged.”

If you do choose to travel – isolate yourself, indoors, away from all human contact: “All persons arriving in or returning to California from other states or countries, should self-quarantine for 10 days after arrival…”

What about the return to your home state?

For Minnesota – the Minnesota Department of Health has similar guidelines: “Stay home as much as possible… any unnecessary travel is highly discouraged… Out-of-state travel is highly discouraged.”

Should you find yourself traveling away and ultimately returning to the state, quarantine is needed: “Minnesotans returning after traveling out of state, are asked to stay away from others (quarantine) for 14 days after they arrive in Minnesota.”

Who among us is realistically going to take the time to isolate & quarantine for 20-30 days in total, including the front & back end of a holiday?

Both Federal and State guidelines make exceptions for “essential travel”. What falls into this category? Some travel is considered essential and necessary – this includes maintaining our critical infrastructure (like water supply or power generation), food distribution, health care, safety, and sometimes work & study. Notice that pleasure trips are not on that list.

The final source I use when evaluating travel is the “risk in your area” charts from the New York Times. This includes several key components. A risk level by county shows that both destination & origin (San Diego County, CA & Hennepin County, MN) are both considered ‘Very High Risk’. In that category – indoor activities are dangerous, all non-essential travel is to be avoided, as well as ‘events’ that gather people into one location.

Hospital & ICU bed available capacity is a second factor. San Diego has >90% of ICU beds occupied, Hennepin is at 84%. Should things take a turn for the worse – having a free hospital bed is important. Similarly, if you are in another state, and consume one of their hospital beds, you are making the pandemic worse for the locals who rely on that resource.

Ethical Concerns

Stop and think for minute – why are you able to travel at all? If you are considering a trip, my guess is that you are healthy (no underlying chronic disease burden), younger (less likely to personally be impacted by an infection), wealthier (not financial impacted by the massive layoffs of the pandemic-induced recession), and most likely white.

• the BIPOC community is dying at a rate 300% higher than the white community
• lower income people are dying more often than wealthier people – a 1% rise in inequality translates to a 3% rise in related deaths

Why is this true?

Those poorer & discriminated against find it more difficult to isolate themselves and are more likely to be required to work in public settings – there are no work from home options. The barriers faced, the social determinants of health, that prevent many people from leading long, healthy lives cause the same increase in chronic disease burden that make people more susceptible to COVID19 complications – hospitalization and death.

So, what examples do our action set, within the family and externally to others? I go back to five fundamental ethical principles – tests that our action would have to meet:

• Respect autonomy – allow individuals to choose a path for themselves, so long as that choice does not negatively impact the lives of others. Autonomy – allowing each individual a choice – is correct, but at what cost (see below)?
• Non-maleficence – do no harm to others. A pleasure trip does not meet this test – raising the risk for others, by a small, significant, and measurable amount is not ethical
• Beneficence – take actions that benefit others – actively promote the health & well-being of others, especially important to look out for those with fewer advantages than yourself. A pleasure trip does not meet this test – why should you require others to be in public to serve you at every step of the journey (transit, food, shelter, entertainment) – outside any reasonable bubble, away from the safety of home?
• Justice – Fairness, in three parts: impartiality, equality, and reciprocity. The equality test is concerning – while much of the country is struggling to stamp out the virus and protect people from further harm, why should some go on a pleasure trip and increase that risk?
• Fidelity – Faithfulness, in four parts: loyalty, truthfulness, promise-keeping, and respect. No concerns here.

 To reiterate – each of us must evaluate these concerns and make our own conclusion. For my family, the needs of our community, the conscientious desire to support public health guidelines, and overall ethical review outweighs the personal benefits – we will stay home. For now.

Yes, the disease rates are coming down – not because of the vaccine (yet) – but rather due to our collective vigilance in adhering to guidelines, after the holiday season.

And we should endeavor to keep it that way, to give the vaccine distribution a chance to work.

 I believe that the end is finally in sight. Let’s not jeopardize the hard work of the past 11 months.

And, in time, I hope to see you out there.