Canada: Mandatory Testing to Fly Home will be Largely Ineffective
This article analyzes the new Canadian measure imposing tests, in the country of departure, for all air travel to Canada. It first retraces how this measure was taken, based on a poorly informed article that appeared in the Quebec press. It then shows that we can only expect a very poor effectiveness of this measure, once we take into account the inaccuracies inherent to C19 testing, both in terms of false negatives and false positives. Finally, the article recommends alternative, much more effective measures to really secure air transport and travel in the South and elsewhere during this pandemic. The article is also available in French.
You may remember the comedy “Airplane” where all the crew members were victims of food poisoning, and a makeshift pilot was assigned to land the plane.
In Canada, the latest government action on C19 suggests authorities appear to be the victim, not of food poisoning, but of a systemic inability to formulate coherent measures that can curb infections, hospitalizations and deaths.
The most recent of these measures concerns air travel, in particular for those who have decided to venture for a vacation in countries such as Cuba, the Dominican Republic or Mexico.
It was an article from the Quebecor media group that started the saga. The article is signed by an under cover journalist who was paid for a trip to Mexico, in an all inclusive resort, by her employer.
https://www.tvanouvelles.ca/2020/12/28/des-quebecois-sur-le-party-dans-le-sud
Basically, according to the article, in this hotel in Mexico, all the vacationers are bad citizens, named “touristas” (a term also used for gastro-intestinal issues when travelling) except her, who explains how she is the only one to strictly follow the Quebec measures on COVID-19. (note: the Province of Québec has one of the worst records in the world when it comes to the pandemic)
Before moving to the substance of the testing issue, here are quick comments on the article. The journalist nowhere mentions that the risks of transmission outdoors, in the sun, in a hot climate, are significantly lower than in closed environments (home, office, bus, metro, car, etc.) where people usually are in winter time in Canada. She demonstrates that she does not understand the transmission of the virus, to the point that she thinks that the mask / face cover she is wearing protects her, when at most it only provides a slight protection, from her, to those who are in her vicinity. If she was truly among a group of irresponsible and infected citizens, the journalist took considerable risks of infection!
https://www.mayoclinic.org/diseases-conditions/coronavirus/in-depth/coronavirus-mask/art-20485449
This article, as well as others and various comments in the mainstream and on social media, made waves, both in Quebec and in Canada, and animated some demons at the level of a population that is very poorly informed by the media and that is afraid and tired of this pandemic and the lockdown measures, that are again being made stricter.
All of this led to a sort of witch hunt, embodied by politicians who had dared to travel during the holiday season, when such trips were perfectly permitted. Witch hunting is now a pan-Canadian occupation in the media, from coast to coast.
https://www.huffingtonpost.ca/entry/list-canadian-politicians-travel_ca_5fec992ac5b6ff747985d01e
In Ontario, Finance Minister Rod Phillips suspected his trip would not be well received by the public. His staff posted photos of him on social media, taken in advance at home, while he was in the Carribbean. It became known, and he resigned.
https://www.huffingtonpost.ca/entry/rod-phillips-vacation-twitter-posts_ca_5fecc9fdc5b6ec8ae0b10a54
New measures in force on January 7
Following the outcry, the Trudeau government, through two Quebec ministers in charge of transport and foreign affairs, announced that negative tests would be mandatory to be allowed to board a flight to Canada.
This is on top of a mandatory 14-day quarantine. Flights to and from Canada were not completely disrupted during the first wave of the pandemic. The tour operator Air Transat resumed flights on July 23 after a 4-month hiatus, with the consent of the authorities.
https://www.transat.com/en-CA/corporate/media/news-releases
The new measure decreed by the federal government, relating to compulsory tests, comes into force on January 7.
“Effective midnight on January 7, 2021 (00:00 EST or 05:00 UCT), regardless of citizenship, all travellers five years of age or older must provide proof of a negative laboratory test result for COVID-19 to the airline prior to boarding a flight to Canada.”
“All travellers coming to Canada must present this information at the time of boarding. Failure to do so will mean an automatic denial of boarding by the airline operating the flight to Canada.”
The Canadian government requires a test for which the sample was taken within 72 or 96 hours before departure.
The main destinations in the South are governed by the 96-hour deadline: Cuba, Dominican Republic, Costa Rica, Brazil, Colombia, Mexico, Bahamas, Bermuda, Saint-Martin, Guadeloupe, etc.
A temperature check before boarding is also planned.
So, are the good Canadian people who stayed at home now protected from these dangerous travelers, from these “touristas” from abroad?
As we will see, not really. Excessively little in fact. And many will even be declared positive – plague carriers in short – even if they are not …
Even in the South, in case of an infection, the virus will probably come from Canada …
From Canada, travelling South in the winter is generally very common, but this year traffic is down by around 90%, with devastating consequences for the airlines.
Often these are trips of a week, sometimes of two weeks, typically with all-inclusive packages at large resorts.
Let’s take the common example of a typical one-week trip, for which you will be required to provide proof of negative PCR testing upon check-in. Whether the sample was taken within 3 or 4 days before the flight does not change much in the analysis.
The whole logic behind these tests is that there is a particularly high risk of catching C19 during your week of travel, and that the test will prevent an infected person from boarding the plane.
The risk of catching C19 abroad obviously exists. Everything will depend on the behavior of the person. The thing to understand with all-inclusive travel is that people are generally going to travel together and stay together.
In general, there is very little contact between Canadians and locals, other than hotel staff. If a traveler contracts C19, it will likely be from an infected person who was on the same flight or who is staying in the same hotel.
For a destination like Cuba, the likelihood of contracting the virus from a local person is very low. Cuba had only 148 deaths from C19 for a population of 11 million, compared to Canada with its 16,369 deaths for a population of 38 million.
https://www.worldometers.info/coronavirus/
Per capita infections are 32 times higher in Canada, and about 150 times higher in a city like Montreal, compared to Cuba, which has actually allowed tourists on very specific parts of its territory.
So if there is an actual infection on an all-inclusive trip to a destination like Cuba, its origin will likely be a Canadian traveler, unknowingly carrying the virus.
As such, but we will not analyze it, perhaps tests should rather be required of travelers before embarking for a destination in the South, rather than at their return!
False Negatives and False Positives Vastly Complicate Matters
Now we come to the issue of false negatives and false positives.
Contrary to popular, uninformed, belief, PCR tests are far from 100% reliable. This is one of the reasons why any self-respecting doctor treats the disease early (but not in Canada…) and on the basis of the first symptoms and not of the test results.
Kucirka et al. published a study in August on PCR tests and the time required, after infection, for these tests to become positive.
The study shows that the probability of a false negative is considerable. It is 100% on day 1, and gradually decreases after, but it is still 67% on day 4.
Even on day 5, when a person will typically develop first symptoms, there is still a median of 38% false negatives.
On day 8, that is, three days after the onset of symptoms, there are still 20% false negatives in median value.
https://www.acpjournals.org/doi/10.7326/M20-1495
https://medical.mit.edu/covid-19-updates/2020/07/when-should-i-be-tested
According to this study, for a real infection which would be contracted in the country of destination, during a short stay, one must expect a probability of a false negative result of between 67% and 100%!
Ironically, even the Canadian authorities knew this, yet they developed and mandated in a record time, compulsory testing that will yield numerous false negatives and give a false impression of safety on planes, in addition to creating havoc in the lives of travelers and sometimes substantial spending for an ineffective test.
Even though everyone tested negative before the flight, it is quite possible that there may be several infected, and even contagious, people on board.
From these figures, we can derive that at most one new infection in 5 could be detected by these PCR tests before returning to Canada, while we have been led to believe, by the authorities and the media, that such tests were important for the protection of the public.
How could the authorities decree such a measure on the basis of such unreliable tests? This defies all logic in terms of health policy.
To add insult to injury, beyond the predictable non-detection of the majority of people actually infected, there will also be people who will have positive tests, but who will in fact be false positives.
The false positive results of PCR tests can be explained by various factors: too high sensitivity of the test to non-pathogenic fragments of the virus, mixing or contamination of samples at the laboratory level, etc.
Estimates of the prevalence of false positives vary. They are typically between 0.4 and 4.0%.
https://www.icd10monitor.com/false-positives-in-pcr-tests-for-covid-19
This may sound low, but since we are testing everyone, and not just people who have symptoms or who have been identified as at risk via contact tracing, the implications are substantial.
If we make the conservative assumption of a false positive rate of 1%, per 1000 passengers, this gives 10 passengers declared positive when they are in fact negative.
Of this same group of passengers, how many will actually be positive?
Currently, in the province of Quebec, the virus infection rate (active people / total population) can be estimated at 0.29% (26,064 / 8,485,000) based on official figures.
Let us assume here an infection rate of 0.5% among “touristas,” who will have to be tested at their destination, with a view to their return.
For every 1000 travellers, roughly 5 will be expected to be infected. But, according to the above analysis related to false negatives, only about one in five truly infected passengers will be detected.
So in our example of 1000 passengers, the false positives would be 10, while there would be only one true positive detected through testing and banned from travel.
We can therefore expect that the detection error rate will be of the order of 90%! It could actually be much worse.
Nine out of ten people denied boarding because of a positive test will likely not have COVID-19.
And for every true positive being detected, one can expect that 4 will fly, with their negative test, yet with the virus having not been detected through the test!
In case of a positive test, travellers will have to do 2 weeks of quarantine in the country of destination, and then present a negative test to the airline before being allowed to return to Canada.
And then, on arrival in Canada, they will again have to do, like all other travelers, a new two-week quarantine, even if they just go over C19!
Tip 1: Plan to get tested twice during the eligible 3-4 days. If you test positive the first time, isolate yourself immediately but also have the test repeated, to check if the initial test is not a false positive, because as we have analyzed, there is a good chance that it is.
Tip 2: If you have any symptoms, see a doctor straight away, especially if you are 50 or older. Perhaps you will also have access to an early therapy, banned in Canada, which could cure you of the disease in a few days.
What are the Real Solutions for Air Travel?
In the author’s experience during a recent trip south, there is much more to do by airports, airlines and travellers to better prevent infections, both before boarding and flight.
Before boarding, it is possible to reinforce the detection of possible cases of C19, by compulsory questionnaires, interviews by qualified personnel of passengers who appear to have symptoms, by oximetry tests (measurement of oxygen in blood through a small device where a finger is inserted) in addition to temperature tests.
During flights, especially when they last only a few hours, it would be advisable not to provide meals, and even to offer water only exceptionally, so that people keep their masks as much as long possible and do not go to the toilet.
Regarding masks, it is important to demand effective masks, and not simple face coverings. Ideally, you should opt for N95 type masks.
It would also be possible to create bubbles at the level of the planes, and to improve the boarding procedure, this to reduce to a minimum the contact between passengers and the on-board personnel, who are at high risk of infection.
As Professor Paul Marik pointed out during our recent webinar, an additional measure, but probably the most effective of all, would be to introduce travel prophylaxis, with ivermectin.
Recent studies have shown that it is a very potent and very safe prophylactic agent. In a comparable setting, of healthcare workers wearing personal protective equipment, 100% protection was achieved for treated workers, while without prophylaxis, with PPE only, just about 50% protection was reached.
We will be pleased to have as our speaker, for our next webinar, the lead author of this major prophylaxis study, Professor Hector Carvallo, from Argentina.
As we point out in a recent article, there are many infections on flights, and such measures, including prophylaxis, are expected to significantly reduce infections.
As mentioned on numerous occasions also, acute cases of COVID-19, leading to serious forms of the disease, are very largely preventable, through early treatments, which are however vehemently prohibited by the Canadian authorities, with devastating consequences in terms of mortality and excessive pressure on the hospital systems.
Today, there are both prophylactic and therapeutic solutions to COVID-19.
In this context, going to the South or elsewhere, on vacation, or more generally for travel, should not be a problem and should only pose a minimal risk.
In fact, for many, a few days of rest, in the sun, can only do good to later face the lockdown measures, always more coercive although largely ineffective.
The main problem today with COVID-19 in Canada lies in the inconsistency, or even incompetence, of the authorities, which is well illustrated by these new yet mostly ineffective tests now required to enter the country by plane.
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