Infectious disease specialist Dr. Susy Hota joined us March 5, 2020 to answer your most pressing questions about the coronavirus with a special focus on travel safety.

Hota is the medical director of infection prevention and control at University Health Network in Toronto and involved in the Ontario Provincial Infectious Diseases Advisory Committee. She is an expert in infection control, emergency preparedness, March break travel, awareness over anxiety and the growing number of COVID-19 cases in Canada.

As the coronavirus continues to spread in Canada and many other countries around the world, concerns and confusion about what constitutes safe travel is increasing.

Due to an overwhelming number of questions from readers, Dr. Hota ran out of available time and wasn’t able to answer all of the questions. We are working on getting those answered.

Reader questions were condensed and combined for clarity and to avoid duplication.

Answers provided by Dr. Susy Hota:

From Chris: Is Ontario ready for the situation if it does escalate like it has in other places? Do we have the resources and supplies? Also friendly reminder to people, please stop buying masks. They are for the people trying to save you in the hospitals.

A: Hi Chris. There is A LOT of preparedness work being done right now on all levels (national, provincial/territorial, local and hospital/healthcare sector). We are planning for the worst but hoping for the best. We have strong public health and hospitals with existing pandemic plans that we are adapting to fit COVID. Plans include surging on testing, space, people, supplies and equipment to care for an increase in patients. For sure, the entire world will be challenged with supplies, resources and simply responding during a stressful time, if this continues to expand. So not saying it will be smooth sailing but we are doing the best we can to be prepared to respond. Thank you for the mask reminder!! Extremely important!!

From Natasha: We are planning to travel to Dominican Republic tomorrow and have the flexibility to cancel. We are having trouble deciding on whether or not to go. We have 2 main concerns: 1) We have 1 adult (52) with diabetes and 1 adult (48) with asthma. Are they considered to be high risk? and 2) Even if we don’t get sick, do you believe a resort setting can be conducive to higher spread or possible quarantine? Our main concern is around being quarantined there. Would appreciate your input. Thank you!

A: Good questions. We are still learning about what puts people at risk for more severe infection with COVID-19. From the studies we have seen to date, diabetes and asthma (although maybe not mild asthma) would be considered risk factors. Age is an important consideration, as those above 60 years appear to do worse (and especially those over 80 years). Resorts are good if you spend a lot of time in the open air. However there are a lot of communal items, including buffets (you could simply avoid these). You are right that it is difficult to predict what measures a country may decide to impose if things change while you are away. Right now DR is not a “hot spot” for COVID-19, so all up to you.

From Michael: Hi Susy, thanks for doing this. What is the best practice while flying to protect from infection. Would it be any safer for a family to drive instead of flying to the U.S.?

A: Driving is more within your control and would expose you to fewer people so definitely safer (for COVID and non-COVID infection exposure risk)!

From Ivy: Hi Dr. Hota, it seems like there are very few cases of children with coronavirus. Is there any lessened concern about children contracting the virus?

A: It seems that kids can get infected but they show fewer (and milder) symptoms. We don’t know why. Interestingly, we have seen similar trends with other viruses such as SARS.

Editor’s note: Stay tuned for a Coronavirus Q & A with a pediatrician next week.

From Kelly: Our Princess cruise is booked in April. We would be stopping in countries that have no reported viruses to under ten reported cases and disembarcking in Los Angeles. I am just under the age of 60 and have diabetes type 2. The idea of cruises makes me nervous. Is this an over reaction? Given the above should I be considering cancelling my cruise. Thanks

A: Hi Kelly. You are not over reacting. You need to feel comfortable and enjoy your travels (that is the point of a cruise, no?). The global situation with COVID-19 is changing so rapidly that it is difficult to predict what it will be like in April. Cruise ships are environments where respiratory infections can spread rapidly. Currently there is no advisory against traveling on cruise ships so it is your choice whether or not to go. If you do choose to go, I recommend that you make sure you have all of your medications on hand, wash your hands frequently and avoid large buffets. Spend lots of time in the open air and less in the cabins. Good luck with your decision!

From B: Hi Dr. Hota, I’m scheduled to fly to the Netherlands in early April. I will be going with my mother who is in her mid 60s. The insurance I purchased for my flight tickets (priced at $5,000), will not refund any of it unless there is a travel ban. Should I seriously re-think going — given the increase in cases across Europe? Or, given that we are both in good health and will take all basic precautions during our trip — should we be ok to go? Thank you for your time.

A: It is true that there have been rapid rises in COVID-19 cases in parts of Europe recently, including Germany, France, Spain and especially Northern Italy. Given the movement of people within Europe, we may see similar changes in the Netherlands by April. I would be carefully watching what happens over the next 1-2 weeks and you may have a better sense of whether it is advisable to go.

From Andy: Hi there. Thanks for doing this. Our family (two near-50 adults, an 11-year-old and a 13-year old) has a California trip booked for March break. We live in a large building, and a number of our neighbours are seniors. If we go, how much would our trip increase the risk of introducing or increasing the virus in our building?

A: The risk of transmitting a respiratory virus to your neighbors only exists if someone in your family becomes ill. If you are well during and following your travels, you have nothing to worry about. To protect your neighbors if you become ill, make sure to wash your hands frequently (especially before touching those elevator buttons) and cough/sneeze into your sleeve or a tissue. Avoid socializing until you are well. These tips work to prevent infection transmission during usual flu and cold season too!

From Blair: We’re flying to Orlando, FL this weekend for a week-long vacation. Besides using hand sanitizer on the plane, is there more we should be doing? Or things we should avoid?

A: Try to avoid touching too many surfaces while on the plane. But the most important thing is to clean your hands frequently, especially after touching the in-flight entertainment system and before you eat any snacks. Do the best you can!

From Karen: We are booked on a trip to Portugal in 10 days. Are there cases of coronavirus there? Should we be concerned?

A: There are cases in Portugal, though not many have been reported. One of the challenges is that we don’t always know how well COVID-19 infections can be detected in any given country. Some countries have limited testing abilities, for example. So it is difficult to draw conclusions on risk simply from looking at the number of cases reported to the WHO. I suggest that anyone traveling to any location right now should practice good hand hygiene, avoid touching your face, try not to spend much time in very crowded locations and keep informed on developments in your location while traveling.

From Ana: Hi Dr. Hota, Is it safe to travel to a country that may be under reporting cases? I’m also concerned about the ability of their medical infrastructure to respond to the possibility of infection.

A: This is more worrisome — when you know that there are challenges with finding COVID-19 cases or managing them due to the healthcare infrastructure in the place you are planning to visit. I would be cautious travelling to countries where this may be the case. You may have difficulty accessing medical care if you develop an illness there or may end up unable to travel home due to an unstable situation.

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From Priscila: Can you get the virus through the air circulating in the plane?

A: The virus that causes COVID-19 is believed to travel through respiratory droplets that are released when you cough or sneeze and are infected. These droplets don’t travel far — up to 2 metres in general. They will not travel on air currents like some airborne infectious agents like measles virus can. On an airplane , those who are within the 2 metre radius of an infected person that are at risk for contracting the infection.

From Sandra: I live in a border city with the U.S. It’s frightening to see their measures being slow and insufficient ... would you consider restricting entrance into Canada?

A: I hear your concerns. Unfortunately, border closures and travel bans are tough to enforce completely. People seem to find ways around them, and by going through alternative routes of travel, we lose the ability to keep track of these travels and do any kind of screening for symptoms upon entry to Canada. It’s a difficult situation to manage, so instead we are focusing on trying very hard to find possible cases in Canada, as quickly as possible (and isolating these folks quickly to protect the public).

From Sandra: I watch the official websites for Canada and Ontario daily to monitor the progress ... it can be anxiety raising ... being more proactive by having wider testing could help us reduce panic and anxiety, no?

A: Yes, making sure we are testing using the right strategy — according to what we are seeing worldwide, adapting quickly as things change — and importantly, making sure testing is available to healthcare providers is key to reducing the impact of COVID-19 on Canadians! Those of us responding to this issue feel this is critical and are doing this to the best of our capabilities. Regardless, the numbers and reports you read everyday can be anxiety-provoking. Try to keep informed but when you start to feel stressed by what you are reading, take a break and shift to something that makes you feel better. Take care of yourself.

From Pat: Hello Dr. Hota, my neighbours have booked a trip to Japan and are scheduled to leave in 3 weeks. They are in their late 60’s, their daughter is currently in Tokyo teaching ESL, and they would love to see her, but don’t know what the COVID-19 risk might be at this time. Could you advise whether they should consider cancelling their trip?

A: Their decision should take into account a few things — what the situation with COVID-19 is like in Japan, their health status, what they will be doing in Tokyo (staying in a home primarily or spending time in crowded places?) and what their overall risk tolerance is. Japan is a somewhat concerning location at the moment, since there has been some community spread of COVID-19. They should check the Public Health Agency of Canada COVID-19 website for the latest travel notices prior to going, if they choose to continue forward.

From Coty: The U.S. reported deaths so far don’t match up with the 3% death rate for COVID-19 estimated by the World Health Organization. Does this imply that there are infected people wandering around in the U.S. shedding viruses? Presumably mostly in Washington state?

A: We truly don’t know how many cases are present in the U.S. right now and it is difficult to estimate based upon the number of reported deaths at this time. Washington state certainly is concerning, with community spread apparent, an outbreak in a long term care facility and a number of deaths. Increased testing will help us to understand what is happening there, hopefully soon.

From Laura: Hi Dr. Hota, I’m booked for a trip to Egypt in mid-April. Would you advise I travel there or cancel my trip? I’m not sure how safe it is to travel in general, and in particular to Egypt. I’m in my early forties and in good health. I’d appreciate it if you could please advise. Thank you.

A: The decision is up to you in the end, Laura. You have to feel comfortable with the risk of possibly being exposed to COVID-19, given that we have seen cases reported in Egypt (and exported to other countries, including Canada). Also, please be aware that you may not be able to travel back to Canada if you develop an illness or if the situation in Egypt changes dramatically while you are there. Good luck making your decision.

From Marnie: We are booked on a Danube River cruise in June. What is the likelihood that the spread of this infection will quell as the weather warms? We are over 60 years and my husband is diabetic so we are considering cancelling.

A: We have seen COVID-19 cases arise in places with warm and humid climates, which makes the theory that infections will decrease with warmer temperatures in cooler climates difficult to believe. This said, new infections of COVID-19 may be decreasing in Europe by June — it is really hard to say at this time. I suggest you follow the situation closely and decide closer to your travel date.

From Joanne: My immediate question is related to travel safety — e.g., hanging out in airports awaiting flights, We are heading to Colombia during March Break and pretty determined to go but we want to be smart about our time there. Probably more important is the long range planning we all should be thinking about for the safety of our entire society, not just each of us as individuals.

A: Hi Joanne — make sure you wash or sanitize your hands very frequently, and especially before you eat anything. Avoid touching your face in case your hands become contaminated from touching surfaces in the airport. Avoid getting too close to anyone who looks sick and try to find more sparsely populated spots to sit. These are the kinds of things you can do for infection prevention in an airport. Safe travels!

From Stephanie: Is fear “reasonable” when considering travelling to Europe within the next 2-3 months — not-UK/Italy?

A: Many parts of Europe have seen a fairly rapid uptick in cases of the past week. I don’t think that is reason to be fearful, but it does cause pause and should make you watch what happens over the next few weeks.