How Airport Covid‑19 Testing Will Change Travel

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Everything you need to know.

The federal government advises that Canadians avoid all non‑essential travel, both at home and abroad. Stay informed on the latest travel rules and restrictions by visiting the Government of Canada’s site on travel health notices.

If your reason for travel is considered essential by a province or territory under the Quarantine Act’s emergency orders (and you are given an exemption by the government of Canada) here are some helpful resources to help you plan your trip.

Should you need to travel, Air Canada is flying to destinations across Canada, the U.S., Europe and Asia.

In exchange for open borders and peace of mind while travelling, would you be willing to spend a little extra time at the airport to get a Covid‑19 test? In Canada, airport Covid‑19 testing pilot projects are underway to see whether these travel points of entry and exit make ideal gatekeepers for containing the pandemic: Can departure tests prevent infected travellers from boarding a flight and spreading the virus? Can arrival tests shorten mandatory quarantine periods?

We interviewed Canadian medical health experts to find out. Dr. Don Sin is a respirologist and professor of medicine at the University of British Columbia (UBC) who is a co‑principal investigator for a testing study out of Vancouver International Airport. Dr. Vivek Goel is a professor at the University of Toronto’s Dalla Lana School of Public Health and a co‑principal investigator of a study that was conducted at Toronto Pearson International Airport.

Which Canadian airports have Covid‑19 testing?

As of December, limited testing is available on a voluntary basis for interested travellers at Calgary International Airport and Vancouver International Airport. These tests will add some time to your schedule, but the tradeoff is potentially less quarantine time in Alberta, or more peace of mind before your flight out of Vancouver.

Calgary is part of the Alberta International Border Testing Pilot Program that operates in partnership with the province and the Canadian government. It is focused on qualifying travellers coming from outside Canada and arriving directly in Alberta – meaning those coming from other Canadian airports are ineligible. Other provinces are also eyeing Alberta’s program as a possible model for their own airports.

At the same time, Calgary departure testing is being offered by a private company for a fee of $150 to $175. This option is unrelated to the border testing pilot project.

Vancouver’s WestJet‑YVR Covid‑19 Testing Study is conducted by UBC and Providence Health Care, and differs from testing in Calgary in that it is open to departing domestic travellers on WestJet who are residents of British Columbia and have not tested positive for Covid‑19 in the last 90 days. It differs from the Calgary program because it is considered a pre‑travel screening test to identify infectious travellers – not a diagnostic test, Dr. Sin explains. Vancouver has other private testing options, available by appointment both inside and near the airport as well.

Toronto’s Pearson International Airport carried out its own airport Covid‑19 testing project that wrapped up in November. The voluntary program was similar to the one in Calgary and focused on arriving international travellers. It was part of an academic study conducted by McMaster HealthLabs (MHL) in collaboration with Air Canada, with support from the Canadian government. Data collection from the tests has completed and researchers are analyzing the results.

How do these airport Covid‑19 testing programs work?

Participants in the Calgary airport Covid‑19 testing program must quarantine immediately after arrival until they are notified of their results via text or email, which are typically available within 48 hours. Unlike regular international arrivals who are required by law to quarantine for a full 14 days, participants in the program are allowed to leave quarantine if their tests come back negative, provided they follow public health guidelines and make daily check‑ins. They must also take a second test after a week at a participating pharmacy such as Shoppers Drug Mart and not leave the province for 14 days after arriving in the country.

Unlike participants in Alberta’s program, Toronto Pearson volunteers were still required to quarantine for the full 14 days regardless of the results since the tests were for research purposes only. Two more tests were taken at the seven‑ and 14‑day mark. In all, more than 16,000 volunteered for more than 40,000 tests.

The Vancouver project is the first of its kind in Canada and uses antigen rapid Covid‑19 testing, with results available in about 15 to 20 minutes. Because of its focus on departures, passengers who test positive can’t fly, but can cancel or rebook their flights at no charge. The study’s two key objectives are first, to examine the feasibility of implementing rapid testing at departure sites for airports and second, to test the efficacy of oral rinses as an alternative method of rapid testing, Dr. Sin says. The mouth rinse test involves swishing, gargling a solution and spitting out the sample.

Participants interested in these pilot projects should add at least 15 to 30 minutes to their schedule and must register online for Calgary or Vancouver testing before arriving at customs.

Will more airports start offering Covid‑19 rapid testing?

While it is likely that Covid‑19 tests will increasingly be available at airports, it is too soon to say what type would be used. Right now, only the Vancouver study offers a true “rapid test” because it uses the Abbott Panbio antigen rapid test approved by Health Canada in early October.

“Airports could be a very good site for these kinds of tests because the turnaround time between the swab and the test result is 15 minutes,” says Dr. Sin. “While somebody is getting a cup of coffee, you can have the test results ready at hand so that they can board.”

Meanwhile, Calgary uses the polymerase chain reaction (PCR) test, the same kind of swab test as those used by hospitals and clinics.

The Toronto program was not a “rapid” test either, Dr. Goel says. “We provide the gold standard PCR test with results back in 48 hours. Because our turnaround time is fast, it has been referred to as a rapid test.”

Private options like the ones in Vancouver and Calgary also use the PCR test, which usually takes about 48 hours to turn around.

How are airport Covid‑19 tests administered?

The Alberta program uses throat swabs for their PCR tests administered by a health professional, according to a spokesperson for the program.

Vancouver participants provide a nasal swab sample as well as an oral rinse sample, so that researchers can compare the sample results and determine the effectiveness of the mouth rinse.

The Toronto test, which was self‑administered by the participants and overseen by researchers, used a single nasal and cheek swab instead of the more common (and more uncomfortable) long nasopharyngeal swabs that require healthcare professionals in PPE, Dr. Goel says. Volunteers took a sample from inside the cheeks first, before swabbing the lower portion of each nostril.

How effective are airport Covid‑19 tests?

The PCR test used in the Toronto and Calgary airports detects the RNA of the virus, while the rapid antigen test detects specific proteins.

“The PCR test is the gold standard test for Covid‑19 because it is nearly 100 percent accurate and can detect Covid‑19 in symptomatic or asymptomatic people,” says Dr. Goel, adding that the sensitivity and specificity of detection using the oral (nasal) swab method is comparable to the nasopharyngeal swab.

The rapid antigen tests are only approved in Canada for use in symptomatic individuals. For the purposes of the Vancouver study, researchers are using the kits “off label” since they are testing asymptomatic or pre‑symptomatic travellers.

While rapid antigen tests are not as accurate as PCR tests, they are considered “very accurate” in identifying those who are actively infectious, says Dr. Sin. “A positive test almost always means that they are carrying the virus.”

While a negative test indicates a person is probably not infectious, one limitation of the antigen test is that it is not as sensitive as the PCR and will not identify someone who contracted Covid‑19 half a year ago, for example, and is still shedding “bits and pieces of the virus”, Dr. Sin explained.

What are the concerns about airport Covid‑19 tests?

One of the biggest questions about the Alberta program, which allows people to shorten their quarantine, is whether two days is sufficient for those who test negative the first time, given it can take several days between contracting the virus and for it to appear on a test. The Toronto study aims to have a better understanding of the most effective quarantine period.

An interim report based on more than 20,000 tests and 8,600 participants arriving in Toronto found that 70 percent of infected passengers would be detected on arrival, and the bulk of the remaining positive cases would be found in the second test. These results support the approach taken in Alberta, researchers say.

A key concern around the rapid antigen tests is accuracy, but Dr. Sin says some of that may stem from lack of experience with this new method. He hopes that wider adoption in more jurisdictions will help to alleviate those worries.

How might widespread airport Covid‑19 testing impact Canadians’ travel plans?

More widespread testing at airports could potentially help make travel less restrictive eventually and bring more peace of mind to travellers if pilot programs and studies help prove the measure works.

International Air Transport Association (IATA), the trade group for the world’s airlines, has argued for governments to implement rapid Covid‑19 testing for all international travelers prior to departure, and for a global testing standard so that tests and results are accepted by other jurisdictions along with a more “systematic and harmonized approach” to contact tracing.

A number of airports in the United States and around the world already offer some kind of airport Covid‑19 test. In some cases, testing is mandatory, in others, a test option may be available for a fee.

“In terms of aviation, you need both the departure and the arrival data to implement the best policies,” says Dr. Sin.

“The screening procedures at airports for potentially infectious Covid‑19 patients isn’t very stringent, so I think we need some sort of testing before passengers board... I think this will give tremendous confidence for the passengers if we deploy this kind of technology widely.”

December 18, 2020