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Covid's in the rear-view mirror so what's bugging travellers now?

Vijay Verghese, Editor, Smart Travel AsiaNo virus-free utopia as humans increasingly collide with nature and animals. And forget guilty carbon offsets. Those are red herrings. Think safeguards like masks, boosters, and common sense.

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by Vijay Verghese/ Editor

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Tourists throng Hong Kong's TST shoreline for a sunset shoot

Tourists throng Hong Kong's TST shoreline for a sunset shoot. Aloft, airlines are boosting cleanliness protocols to prevent viral transmission in-flight. Covid has receded, not gone/ photo: Vijay Verghese.

COVID SCHMOVID, it would appear. Travellers insouciantly scamper from board meetings to trade shows to weddings to party the nights away. It is good to see cities stirring and travel bustle returning. Covid19 rates have dropped to insignificant levels — largely due to vaccinations and non-reporting as nerves ease — but the viral mayhem is not in the rear-view mirror as yet. It may never be.

It is easy to forget that the pre-pandemic years were not some bug-free utopia. The world continues to battle various strains of flu and Asia remains alert to the dangers of wily saboteurs like malaria, chikungunya, dengue fever, hepatitis, tuberculosis, typhoid, cholera, bird flu and Japanese encephalitis. Some of these culprits have been around for decades, even centuries, but with greater media scrutiny and mounting interest on the horrors they cause, it might seem like we've stepped into some Devilish cauldron of mutating zoonotic (animal origin) viruses.

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Though inured to aches and pains, frequent flyers are most at risk from random infections. In December 2016 I developed a mild dry cough that I ignored for weeks as I travelled from Bangalore to Singapore to Hong Kong and on to Bangkok. I grew increasingly tired and my chest began to feel like it was being squeezed by a python. Well accustomed to travails on the road, I made a note to see a doctor and started myself off on Zithromax and Brufen.

I started flitting in and out of reality. Alerted by nonsensical WhatsApp ramblings, my son asked a doctor friend to intervene. And so he kindly did. I was unconscious and in the ICU within a half hour of reaching the hospital. It was swiftly diagnosed as Legionnaires' disease. One lung had collapsed and the other had just 15% capacity left. Looking back, I believe I contracted the bug from the aircon in a dank and mouldy Bangalore taxi (whose driver was distinctly unwell). Later as sense and clarity returned I started following notifiable illnesses like Legionnaires' in the region and was taken aback by random listed incidences including at the newly launched The Parisian Macau. It seemed just this one bug was everywhere. And it is not alone.

{"The most serious outbreak on Planet Earth is that of the species Homo Sapiens." Now link this with a simple statistic: 38.9 million flights in 2019

According to David Quammen, science writer, dogged zoonotic virus hunter, and author of the book, Spillover, “The most serious outbreak on Planet Earth is that of the species Homo Sapiens.” Now link this disturbing thought with a simple statistic: there were 38.9 million flights in 2019. This represented a resounding victory for travel (before Covid knocked it back to 16.9m in 2020).

Travellers have a profound effect on the ecosystem, carbon offsets notwithstanding. Alarmingly, research into rainforest carbon offset certification (by The Guardian, Die Zeit and SourceMaterial) found that 90% of listings were "phantom credits". From sniffles and sneezes to genetic quirks and random travel plans, frequent travellers offer viruses a unique mobile laboratory for rapid mutation and experimentation.

This is nowhere more evident than with the unstable single-strand RNA virus genomes that have produced a slew of variants. RNA viruses are the fastest to make switches and, while most of these mutations are imperfect, the sheer rate of adaption is what makes them so dangerous. They have been closely studied for decades and this is what enabled a fast-track game-changing mRNA vaccine.

The speed of worldwide outbreaks was amply demonstrated during the 2003 SARS episode where, from the index patient in Hong Kong (who infected 16 persons at his hotel of whom six took intercontinental flights), the pathogen rapidly spread within days to Canada, Singapore, the Philippines, Australia, and Vietnam.

The US Centres for Disease Control (CDC) has its Yellow Book for returning travellers and a destination breakdown of possible ailments to watch for. This is a useful compilation.

The most common ailments for travellers it notes, are leptospirosis (fever, headaches, jaundice, from bacteria carried by animal urine), influenza, legionellosis (Legionnaires' lung infection through inhalation of aerosolised droplets carrying the bacteria), malaria, and the less serious chikungunya (mosquito-borne illness with no cure that presents with joint and muscle pains, spiking fever, headaches and rash).

Europe is meanwhile carefully watching a novel tick-borne infection called CCHF (Crimean-Congo haemorrhagic fever) that in 2016 claimed its first victim, a hiker in Spain, within nine days of the bite. Hotter drier summers are offering fertile pastures for ticks who are moving steadily northwards into Europe. Those keen to scrutinise unusual world health events afflicting humans, animals and plants, can visit a site run by ProMed (Program for Monitoring Emerging Diseases).

Clearly, while common sense remains a traveller's best friend, the health map has changed and there are dangerous accelerants afoot. The humble mask is often poohpoohed and stigmatised as a mark of shame for neurotic weaklings but it has played a fundamental role in curbing transmissions of various kinds. Masks are still advised in crowded spaces like buses, commuter trains, airplanes and indoor wet markets. This is particularly sound advice for elders and those with compromised immune systems.

Airports are rich viral breeding grounds. On airplanes, researchers are zeroing in on airline waste water to check for virus mutations and seasonal flu strains. Once abhorred window seats are becoming prized for their relative isolation. The news is not all bad though. A 2018 Emory University study concluded most passengers have just a 3% chance of catching the flu from a fellow passenger but the probability climbs to 80% if seated within three feet of that person. Masks offer some degree of protection and they should certainly be worn by travellers who feel unwell. While the heavy duty N95 mask may not suit everyone, normal medical masks are useful companions.

Seasonal influenza shots (based on projected variants for the coming year) are a sensible option — as are Covid booster shots (now available as combination bivalents) if the traveller's last booster (or Covid episode) was over six months ago.

By July 2023 the World Health Organisation had plotted 768m confirmed cases of Covid worldwide with just under 7m deaths against a total of 13bn vaccine doses. It is immediately evident that the massive defence mounted with vaccinations and masking provided strong deterrence for the SARS-Cov-2 virus.

The despoilation of nature by humans and exploitative intrusion need careful re-examination. As Quammen states in his more recent book, Breathless, “The more numerous we become, the more crowded, the more interconnected, the more demanding of resources, the more invasive of wild places, the more disruptive of richly diverse ecosystems — the closer we stand to the epidemic threshold for any new virus that probes us as a possible route to greater evolutionary success.”

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