International Air Travel is Down. Can Rapid COVID-19 Tests Resurrect It in the Caribbean?

Facing one of the biggest downturns in international air travel and tourism amid a still surging coronavirus pandemic, Caribbean nations and airlines are hoping rapid COVID-19 testing will help them lure travelers back.

American Airlines, the region’s primary air carrier, has announced that it will soon be piloting a preflight coronavirus testing program with Jamaica, followed by the Bahamas. The U.S.-based carrier, along with United Airlines, also announced it’s launching a similar program for passengers traveling to Costa Rica and Hawaii.

But exactly what that means is unclear.

For flights to Costa Rica and Hawaii, American is offering rapid tests at the airport prior to boarding. Laura Masvidal, a spokesperson with American Airlines, said the carrier is still working to finalize details with the government of Jamaica on how the testing will work.

“The testing that we will offer will be optional for the convenience of our customers. Jamaican residents that volunteer for our pilot program [and get a negative test result] will not have to quarantine upon arrival,” she said.

Jamaica’s health minister, Christopher Tufton, declined to comment, saying that the matter is still being discussed.

Like most Caribbean countries, Jamaica currently requires an RT-PCR COVID-19 laboratory test for all incoming visitors and returning residents. (The letters stand for reverse transcription polymerase chain reaction, considered the most reliable of the tests widely available.)

But even with that requirement, Jamaica is seeing an explosion in COVID-19 infections, which now stand at more than 7,100 confirmed cases and 123 deaths.

Tufton has attributed the community spread to returning residents who have flouted the country’s 14-day home quarantine requirement.

American isn’t saying why it decided to offer preflight testing in Jamaica and potentially elsewhere after delaying its planned June return to St. Lucia because it didn’t want to be responsible for enforcing the country’s testing requirement.

Reduced passenger loads likely play a role. In September, American Airlines flights from Miami to Kingston and Montego Bay averaged less than half full, said Greg Chin, a spokesperson for Miami International Airport.

Across the region, airlines are struggling to bounce back. After canceling service to Cap-Haïtien from Fort Lauderdale in 2019 last year, low-cost carrier Spirit Airlines recently announced that it will be returning on Dec. 3, four months after American Airlines left the northern Haitian city without regular commercial air service. American, which also reduced flights to Port-au-Prince, confirmed that starting Thursday, it will begin operating two daily flights from Miami to Port-au-Prince with no service on Tuesdays and Wednesdays. On Nov. 4, it will increase to three daily flights except for Tuesdays and Wednesdays.

Additionally, on Thursday American will resume service from Miami to Eleuthera, Freeport and George Town, Bahamas; Barbados; Bermuda; and Grenada. Saturday, it plans to reinstate service to Marsh Harbour, Bahamas; and on Oct. 15, to Havana, Cuba.

Overall, international travel is down 92% globally compared to 2019, according to the International Air Transport Association. In a release last month endorsing preflight testing, the airline trade organization said that countries’ varied and changeable requirements for testing and quarantine have made travel impractical and planning impossible.

The problem: Rules regarding testing and quarantine vary from one island nation to the next.

In its release, IATA called for the deployment of rapid, accurate, affordable, easy-to-operate COVID-19 testing for all passengers before departure. Previously IATA had backed airlines’ resistance to testing.

“This will give governments the confidence to open their borders without complicated risk models that see constant changes in the rules imposed on travel,” IATA’s Director General and CEO Alexandre de Juniac said. “Testing all passengers will give people back their freedom to travel with confidence. And that will put millions of people back to work.”

Caribbean countries are still considering how to handle incoming cruise passengers as cruise companies prepare to restart sailings from Florida as soon as Nov. 1. Cruise lines have promised to test every passenger before he or she is allowed to board, but have not specified the type of test they will use.

But some health officials aren’t convinced that pre-travel tests offer sufficient protection as the Americas region remains home to over half of all COVID-19 cases and deaths, according to the the latest figures cited Wednesday by the Pan American Health Organization. The World Health Organization continues to warn that traveling carries risks. Recent scientific studies, including by the U.S. Centers for Disease Control and Prevention, have documented likely cases of COVID-19 transmission on flights.

Dr. Carissa Etienne, the director of the Pan American Health Organization, recently said rather than relying on testing, countries should work collectively to limit travel for those who have symptoms or have been exposed. This includes strengthening their abilities to test, isolate positive cases, identify and quarantine their contacts.

She and other public health experts have warned that antigen tests, which are typically cheaper and provide results in minutes rather than days, are still far less accurate than the gold-standard RT-PCR laboratory tests, which most countries in the region continue to demand for entry.

Regardless of the type of test, testing for travel “is not recommended at this stage of the pandemic,” said Ashley Baldwin, a PAHO spokesperson.

COVID-19 travel requirements fallen short

Since borders began reopening in June, Caribbean countries, like travelers, have been grappling with travel and restrictions. Many governments have found that their testing requirements have fallen short and that government-mandated quarantines are either too expensive, or impossible, to police.

“While Brazil and the U.S. remain significant drivers of new cases in our region, we are concerned by spikes in cases, including in places that had effectively managed outbreaks like Cuba and Jamaica,” Etienne said Wednesday in an update with regional journalists. “In fact, over the past 60 days, 11 countries and territories in the Caribbean have moved from moderate to intense transmission, which is a concerning development as countries reopen airspace.”

Barbados, for example, found that even after some incoming passengers arrived with proof of a negative RT-PCR laboratory test, some individuals still tested positive for COVID-19 after health officials administered testing upon arrival. The first tests were taken within 72 hours of arrival.

“If you come from a high risk country like the USA, you are tested a second time between two to five days after,” Barbados Minister of Health and Wellness Jeffrey Bostic said. “We do a second test because a person could be exposed to the virus after they took the test overseas but the virus would not incubate by the time you arrive.”

Bostic said he isn’t in favor of rapid tests because they “are not safe enough for border screening.”

So far, Barbados has managed to keep its number of confirmed coronavirus cases low at 203 with seven deaths.

Vincent Vanderpool-Wallace, a former Bahamas tourism minister who has been advising the Caribbean region on reviving tourism amid the global pandemic, said while he and others are still awaiting clarification on the American Airlines preflight testing offer, he doesn’t believe it’s going to “preclude what the destinations have agreed to do.”

He believes countries will continue to demand the RT-PCR COVID-19 test from incoming passengers anywhere between three and 10 days of arrival, depending on the destination.

“What’s going on is a convergence to common sense across the region,” said Vanderpool-Wallace, who is also active with the Caribbean Hotel and Tourism Association. The American Airlines program of testing before boarding, which the carrier hopes to roll out across the Caribbean, will help reduce the burden of putting people in isolation and contact tracing, he added.

“The logic of having these two tests, one before our departure from the United States ... into the country and then having another test at the [Caribbean] airport before departure, prevents what is the biggest problem for our region: We have a number of people who are coming into our countries who are testing positive upon arrival and that creates a whole series of problems that we wish to avoid,” Vanderpool-Wallace said.

With visitor numbers down in the world’s most tourism-dependent region, tourism ministers and travel industry professionals have argued that it’s in everyone’s interests to find a way to provide confidence to prospective visitors, as well as governments, several of whom are seeing large spikes in COVID-19 infections since reopening their borders in June and July.

The Bahamas testing model

The Bahamas, for instance, has seen a drop in visitors from 140,000 to 7,000 per month, said Vanderpool-Wallace. “That’s not atypical of what’s happening in the region. This is the biggest loss of employment, the biggest loss of tax revenue, the biggest loss of foreign exchange for our region.”

The Bahamas has acknowledged its enrollment in the American preboarding test program. Still, incoming passengers to the island chain will need to obtain an RT-PCR laboratory COVID-19 swab test. The test will need to be taken no more than seven days prior to travel to the Bahamas and takes effect Nov. 1 when the country’s current “Vacation in Place” 14-day quarantine requirement will be replaced with the new COVID-19 travel requirement.

Those who participate in the American Airlines program will not need to take a rapid antigen test once they land in the Bahamas, but anyone who doesn’t will be given a rapid antigen test upon landing. Another rapid test will be conducted four days later if the visitor is still in the Bahamas.

The Bahamas, which has taken drastic lockdown steps to stop a deadly spread of the virus, said it’s aiming to reopen the country to tourism next week on Oct. 15. The country currently has 4,452 confirmed cases registered and 96 deaths. Both the number of cases and deaths rose drastically after borders fully reopened on July 1.

St. Lucia is one of the few nations in the eastern Caribbean that has managed to control the spread of COVID-19, thanks largely to its $1 million monthly quarantine bill the government is paying to house returning nationals during their 14 day isolation.

Prime Minister Allen Chastanet welcomes the American Airlines initiative. Chastanet has championed the use of rapid tests from the pandemic’s onset and broached the idea early on, only to find airlines uninterested.

“The American Airlines pilot program shows that the industry is listening,” he said. “I am pleased to see this type of pre-testing initiative begin to gain traction, as this represents a clear path to bringing back the travel industry.

“Restarting tourism to the Caribbean is a partnership that requires both the destinations and the airlines to push for pretesting,” added Chastanet, a former tourism minister in his nation. “This is a significant step forward not only to build confidence among vacationers, but also to jump-start Caribbean economies.”

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