What guidance can you provide regarding how to keep employees safe who have to visit other locations as part of their job responsibilities? (Aside from screening/attestations, testing, quarantine etc).

There are many factors to consider prior to resuming travel, whether business or personal. For clarity, this response is divided into sections. A list of reference links is provided for further information. These were current at the time of writing, but the user should verify they remain up to date at time or use.

Travel Restrictions/Requirements:

Public health rules for travelers may apply at the point of origin, destination, or both.  Understanding these is critical for travel planning.  Many countries, states and even some cities, have specific quarantine or testing requirements for those entering or re-entering from high risk areas.  Some locations will impose fines if requirements are not met. International travel can present unexpected challenges if borders close, rules change, or if the traveler becomes ill while abroad. See references below for current travel-planning information.

Public Health Considerations
For all travel, the same core principles to minimize spread of SARS CoV-2  should be followed; 
  • Physical distancing (proper spacing and avoiding crowds),
  • Hand washing or use of alcohol-based hand sanitizers (especially after touching high touch items) 
  • Wearing a face covering  or appropriate personal protective equipment (PPE) (and using them properly)
  • Symptom monitoring 
  • Avoiding contact with those who are ill
While the individual may adhere to these principles and the employer may enforce them among their own workers, the traveler must be prepared for contact with non-adherent individuals or businesses, especially in those areas where requirements may differ. 

It also has an impact on the contact tracing efforts where one is protecting the communities against contagious disease spread. 

Travel Considerations

Determining whether travel is necessary and sufficiently safe should be considered, especially for those at higher risk, or living with or caring for those at risk for severe complications from SARS-CoV-2.  

The safest mode of transportation practical should always be selected, including at the origin or destination.  Risk may occur in the conveyance, or in waiting areas.  Use of a personal vehicle will pose less risk than flying, as would use of a rental car rather than mass transit, or ride-sharing.  

Doing research prior to travel is essential to minimize risk of infection. To the extent possible, utilize transportation companies, hotels, restaurants, and client locations that are taking appropriate steps to minimize spread of the virus.  Ask to review their COVID-19 plan and ensure it addresses the distancing, cleaning, face-covering, and screening concerns for both employees and guests, as appropriate. How are seating, waiting areas, food service, boarding and exiting conveyance addressed? If applicable, do they have a plan to address an ill employee or guest? 

When considering any venue or operation; hotel, restaurants, other businesses, planes, trains or  mass transit, seek information on how physical distancing is managed.  Are tables or middle seats removed or blocked off?  Is occupancy or access limited in lobbies, pools, meeting rooms or in fitness centers? Is the process for entrance and exit controlled to limit avoid guests or passengers congregating or passing each other?  Are acrylic barriers or other means of separation used where distancing is not possible?  Avoiding crowds by traveling or eating at off-peak hours can also make it easier to maintain physical distancing in unfamiliar places. The more adequate physical distance is maintained, the safer the experience will be.  

Surface cleaning and air quality should be considered.  To the extent possible, is the use of high touch items limited such as through online or contactless reservations, payments and check-in?  What are the cleaning protocols, especially for high touch or common areas? Are well ventilated areas used if possible (open windows, outdoor dining)? 

CDC provides examples of risk levels from lowest to highest for transportation, lodgings, food, and camping.  In all situations, risks were lower when limiting exposure to those outside the immediate household, whether in vehicles obtaining food or lodging. Points out that if not only with those not in your household, risk is lower when maintaining social distance and with everyone wearing a mask.

Regional Variation in Risk

While essentially no location is totally free of COVID-19, the prevalence of infection varies widely. Social mores, regulations and laws concerning COVID-19 mitigation vary tremendously region to region.  Individual behavior significantly affects the spread of the infection, and compliance with local requirements or even the data use to set these requirements will impact risk.  While some areas may have specific requirements on screening (temperature, health questions), occupancy (e.g. 25%, 50% of normal occupancy), spacing (6 feet), crowd size (e.g. 50, 100, 250), or use of face covering (optional, at all times or  only when indoor), not every location relies on the same data to set expectations.  In some cases, there may be no objective basis for them.  Faced with a choice in restaurant, accommodations, or activities, the traveler should take the lowest risk option.  For example, all else being equal, outdoor dining is lower risk than indoor dining.  A long walk may be preferable to exercise in a gym, especially if face covering is not required to be worn.  Just because an activity is permitted, does not guarantee it is a safe or “safer” choice.  Ultimately, the traveler will base his or her decisions about activities on  the prevalence of infection in the locations of origin or destination and the risk of severe disease to themselves, those they may care for, or with whom they live. 

Different steps for worker protection such as pre-travel quarantine and/or testing might be considered for groups that will be traveling to remote locations and able to stay within a specific “bubble.” 

Travel Resources

Provide appropriate resources to employees who travel.  These should include face covering (possibly a face shield to be used in addition to the face covering or an N95 mask if the individual is high risk, or if the ability to physically distance may be difficult, especially if indoors), hand sanitizer, disinfecting wipes which meet EPA criteria, information on how to obtain health care should they become ill (even more important if international), current information on requirements on quarantine, testing, reporting and other local steps to limit spread of COVID-19 as well as general information on precautions they can take.   

Other items to bring:  A thermometer, forms for symptom logging, an adequate supply of usual medications to permit 14 days of quarantine if necessary, contact information for the employer’s occupational health representative, emergency contact and health care provider information in the event this is required by health care providers.  If food or beverage may be limited at the destination, food and water should be packed. 

Returning from travel

Precautions should continue upon return from travel, especially if the individual had been in a high-risk area (or if required by travel location) and even more so, if they are a high-risk individual or lives or cares for someone who is.  The returning employee should be managed in accordance with the employer’s policy for return to work.  Special consideration may be indicated if the employee has visited a region in which spread of the virus is poorly controlled.  This might include a period of quarantine, and/or testing for SARS-CoV-2.  

As we are limited in space for this very complicated question, some of the many resources available with advice on safe travel are below. It is important to check local requirements shortly before leaving as requirements/guidelines are reassessed weekly or more often.
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The Forum does not necessarily represent an official ACOEM position. The Forum is intended for health professionals and is not intended to provide medical or legal advice, including illness prevention, diagnosis or treatment, or regulatory compliance. Such advice should be obtained directly from a physician and/or attorney. Questions are answered with the best available data or recommendations at the time.