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Is It Safe to Go to Fly on a Plane High-Risk COVID-19
Credit: Tatiana Ayazo

The U.S. Centers for Disease Control and Prevention recently released new guidance that state fully vaccinated Americans can travel. It’s less clear, however, as to what that means if you’re fully vaccinated but immunocompromised due to an autoimmune or inflammatory condition or taking immunosuppressant medication.

You are considered fully vaccinated if it’s been two or more weeks since you received the second dose of a two-dose vaccine (Pfizer or Moderna), or it’s been two or more weeks since you received a single-dose vaccine (Johnson & Johnson).

Generally, experts have recommended that patients who are immunocompromised continue to follow standard mitigation efforts until more data is available on how the COVID-19 vaccine works in immunosuppressed individuals.

“Vaccine response and vaccine durability [how long protection lasts] is not fully understood in immunocompromised patients,” says Jiha Lee, MD, a Clinical Assistant Professor specializing in rheumatology at Michigan Medicine. “Immunocompromised patients who are fully vaccinated should exercise caution when considering travel.”

The steps you take, however, may depend on your personal situation, such as your medications, underlying health issues, and degree of being immunocompromised. Here’s what to know if you need to travel and you’re fully vaccinated but immunocompromised.

What the CDC Guidance Says About Travel

The new CDC guidance does not include recommendations specific to immunosuppressed individuals, beyond noting that people should discuss with their doctor if they have any questions about their individual situation, such as immunocompromising conditions.

For the general population, the CDC says:

  • Fully vaccinated people can travel domestically and do not need to get tested before or after travel — or self-quarantine after travel.
  • Fully vaccinated people do not need to get tested before leaving the United States unless it’s required by the destination, and they do not need to self-quarantine after returning to the United States.

That said, other standard COVID-19 prevention measures still apply to travelers, even if they are fully vaccinated.

  • All travelers must wear a face mask on planes, buses, trains, and other forms of public transportation.
  • People traveling internationally should closely monitor the situation at their destination before traveling, due to the spread of new variants and the shifting burden of COVID-19 cases globally.

“COVID-19 disease activity varies a lot in different parts of the word, and the United States public health system can really only govern within the United States,” says David Aronoff, MD, Director of the Division of Infectious Diseases at Vanderbilt University School of Medicine in Nashville, Tennessee. “There are restrictions and requirements of other travel locations internationally that may also be very different. Countries may be banning people from going there, or you may have to quarantine or get tested.”

Fully vaccinated air travelers coming to the United States from abroad still need to have a negative SARS-CoV-2 viral test result or documentation of recovery from COVID-19 before boarding a flight.

What the Travel Guidance Means for Immunocompromised Patients

 As the CDC guidance states, you should check with your doctor to gauge your personal situation and risk factors — and what that means for your vaccination status. Your doctor will consider factors such as the medications you take and the underlying conditions you have.

Taking certain immunosuppressant medications may mean you don’t generate as strong an immune response to the COVID-19 vaccine. The vaccine likely still provides protection, but it may be reduced compared to that of healthy adults.

“If your health care team thinks that you should have gotten an adequate immune response from vaccination, then you should be free to follow the same guidance around travel that has now been updated by the CDC related to fully vaccinated travelers,” says Dr. Aronoff.  “But if you are immunocompromised such that there’s doubt as to whether the vaccine was fully able to induce a strong immune response, then you may want to continue to travel under the same guidance as people who are not vaccinated.”

Dr. Aronoff says it boils down to asking your doctor this question: “Do you think it’s likely that the vaccine did its job, and am I okay to behave like any other fully vaccinated person?”

If the answer to that is no or uncertain, then there may need to be further conversations about what that means for you in terms of travel.

In general, the CDC currently recommends against non-essential travel for those who are not fully vaccinated. Of course, the lowest-risk option is to avoid non-essential travel until more data is available, but that’s not always possible.

If you need or want to travel, it’s important to be careful to reduce your risk of contracting COVID-19. Don’t let your guard down just because you’ve gotten the vaccine.

“Although traveling is safer after vaccination, you may still be at increased risk of getting infected and spreading COVID-19, especially depending on your travel destination and type of activity planned during travel,” says Dr. Lee.

How to Stay Safe While Traveling If You’re Fully Vaccinated and Immunocompromised

 The CDC recommends delaying travel until you’re fully vaccinated, and even then, you should take the everyday steps you know so well by now:

  • Wear a mask over your nose and mouth in public
  • Stay six feet away from anyone who’s not traveling with you and avoid crowds
  • Wash your hands often or use hand sanitizer (with at least 60 percent alcohol)

It may be worth it to double mask, which research has shown can reduce exposure to infectious particles by up to 96 percent. Double masking involves wearing a cloth mask over a medical procedure mask, which makes the fit of your mask tighter.

“Immunocompromised folks really should give thought to double masking with a medical mask under a cloth mask,” says Dr. Aronoff. “That’s good advice, independent of vaccine status, for people whose immune systems are not fully functional.”

According to a Global Healthy Living Foundation poll, more than 40 percent of chronic illness patients recently said that they always or usually double mask.

And despite the CDC stating that the risk of contracting COVID-19 from surfaces — called  surface transmission — is low, continue to practice good hygiene, especially hand hygiene.

“As an infectious disease physician, I will never eschew hand hygiene because clean hands are important for limiting illness from lots of different diseases, including foodborne illnesses and viruses and bacteria,” says Dr. Aronoff. “While the risk of transmitting or getting infected from COVID-19 is much lower when it comes to touch than breathing, it’s always good to be limiting that risk to the extent possible, because it’s easy to do.”

As long as you are regularly cleaning your hands and not touching your eyes, nose, or mouth after touching public surfaces, you likely don’t need to sanitize everything in your vicinity. That said, if you think you might forget and, say, rub your nose after touching the tray table in a plane, then it might be worth doing a quick wipe-down for peace of mind.

Understanding Travel Risk Levels

There are three levels of risk when traveling, according to the CDC:

  • Safer: Short road trips with household members or fully vaccinated people with few stops along the way. If you must fly, try to take flights that have the fewest stops or layovers.
  • Less Safe: Longer trips by car or RV with many stops, trips by car or RV with people who are not from your household or who are not vaccinated, and flights with layovers.
  • Avoid: Long-distance train or bus trips and traveling on a cruise ship or river boat.

“Given how active COVID-19 is in the United States, it’s still prudent to limit travel to what you would consider to be essential if you’re unvaccinated or you may not have had a normal response to a vaccine,” says Dr. Aronoff. “Right now, we are seeing hot spots in the United States where disease activity is higher than it has been recently.”

If you’re trying to decide if your trip is essential, Dr. Aronoff recommends asking yourself this question: Is this trip necessary for my well-being in terms of my employment or my relationships? (For example, if a family member is very sick or there’s a pressing work-related issue.)

Watching for COVID-19 Symptoms After You Return from Travel

“You don’t necessarily need to get tested after travel if you are asymptomatic, but you should monitor to see if you develop any COVID-19 symptoms and get tested if you do,” says Lisa Zhu, MD, a rheumatologist at Ronald Reagan UCLA Medical Center.

Even if you are fully vaccinated, you should get tested for COVID-19 if you experience any symptoms, such as fever or chills, cough, shortness of breath or difficulty breathing, and new loss of taste or smell. Here is the latest list of COVID-19 symptoms from the CDC.

The Good News About the Future of Travel

Although any type of travel carries the potential for disease transmission, it may not be high-risk if you’re fully vaccinated and your doctor believes you mounted an adequate response to the virus.

“In the United States, we haven’t seen major point-source outbreaks associated with trains, busses, or airplanes,” says Dr. Aronoff. “I do think a lot of that is because people are being very careful about travel. And getting vaccinated absolutely reduces the risk of infection and the likelihood of severe infection, so that’s adding a whole new layer of safety to travel.”

More and more people are getting vaccinated every day, which will make traveling safer for those who don’t mount a full response to the vaccine.

“If we can get as many people as possible vaccinated this summer, and people can continue to do the things we need to do to limit the risk of transmission, my hope is that we really do reach the full benefit of herd immunity — where the immunity of the majority of people protects even those who cannot develop immunity to the virus,” says Dr. Aronoff.

That’s the purpose of vaccination on a societal level: to create enough immunity among the masses to help shield those who are still vulnerable.

“Things are headed in a great direction in terms of vaccination, and I think that’s really to be celebrated,” adds Dr. Aronoff. “The light at the end of the tunnel is starting to burn brighter for us, and we will get there.”

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Interim Public Health Recommendations for Fully Vaccinated People. COVID-19. U.S. Centers for Disease Control and Prevention. April 2, 2021. https://www.cdc.gov/coronavirus/2019-ncov/vaccines/fully-vaccinated-guidance.html.

Interview with David Aronoff, MD, Director of the Division of Infectious Diseases at Vanderbilt University School of Medicine in Nashville, Tennessee

Interview with Jiha Lee, MD, Clinical Assistant Professor specializing in rheumatology at Michigan Medicine

Interview with Lisa Zhu, MD, a rheumatologist at Ronald Reagan UCLA Medical Center

Science Brief: SARS-CoV-2 and Surface (Fomite) Transmission for Indoor Community Environments. COVID-19. U.S. Centers for Disease Control and Prevention. April 5, 2021. https://www.cdc.gov/coronavirus/2019-ncov/more/science-and-research/surface-transmission.html.

Symptoms of COVID-19. COVID-19. U.S. Centers for Disease Control and Prevention. February 22, 2021. https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html.

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