COVID-19 Amongst Travelers at Points of Entry in Nepal: Screening, Testing, Diagnosis and Isolation Practices

Abstract

WHO recommends surveillance for COVID-19 among travelers at Points of Entry (POE) to countries. At 13 selected POE at the Nepal-India border, between March 2021 and July 2021, we describe the screening, testing, diagnosis and isolation practices of COVID-19 amongst travelers. Those who stayed in India or elsewhere for > one day and those who did not have a negative RT-PCR result within the last 72 h of travel were tested for COVID-19 with rapid antigen diagnostic tests. Daily surveillance reports maintained at POE were used for analysis. Of 337,338 travelers screened, 69,886 (21%) were tested and 3907 (6%) were diagnosed with COVID-19. The proportions tested averaged 15% during April-May when screened numbers were high and increased to 35% in July when screened numbers had decreased. The proportions diagnosed positive peaked at 10% in April-May, but decreased to below 1% in June and July. Testing coverage varied from 0-99% in the different POE. Most COVID-19 cases were Nepalese, male, <60 years of age, migrant workers and presented with fever. Of COVID-19 cases, 32% had home-based isolation, 64% underwent community-based isolation and the remainder either went to hospital or returned to India. In conclusion, about one fifth of travelers overall were tested, with coverage varying considerably over time and among different POE. Strengthening surveillance processes at POE is needed.

Effectiveness of Point of Entry Health Screening Measures among Travelers in the Detection and Containment of the International Spread of COVID-19: A Review of the Evidence

“…Two studies reported zero confirmed cases out of the suspected cases [34,37]. At the ground crossings, all three studies [24,25,27] reported the detection of COVID-19 cases through POE screenings, similarly to one study conducted at an Italian sea port, where rapid testing detected 212 confirmed cases out of 272 suspected.…”

“…Twenty observational studies reported on screening strategies used at POEs for the detection of COVID-19, as shown in Table 2. Testing of travelers was reported by 14 of the included studies [17][18][19][20][21][22][23][24][25][26][27][28][29][30], Sign and symptom assessment, especially loss of taste or smell, myalgia, cough, shortness of breath, self-reported fever, chills and vomiting, were reported by 10 out of 20 studies [20,21,27,28,[30][31][32][33][34][35], followed by body temperature checks in seven studies [20,24,31,[33][34][35][36] and exposure assessment by six other studies [20,21,27,30,32,35]. Three studies reported on the daily telephone calls of travelers after arrival for 14 days [20], checking vaccination status [22] and inspection of RT-PCR test certificates [27].…”

“…Fourteen observational studies reported on the effectiveness of POE health screening in the detection of COVID-19, of which 10 studies were conducted at international airports [21,22,26,[28][29][30][31]33,35,36], three at ground crossings [24,25,27] and one at a sea port [18], as shown in Table 4a,b. At the international airports, eight studies [21,22,26,[28][29][30][31]35] reported the detection of suspected and confirmed cases of COVID-19 through POE screenings.…”

“…Ten observational studies reported on arrival testing for COVID-19 among international travelers [17,18,21,23,[25][26][27][28]35,36], as shown in Table 5. A combination of molecular testing in the screening of travelers at POEs has been reported with positive outcomes, with one prospective cohort study reporting that out of 248 cases imported in the country, 167 (67%) were detected during entry screening for travelers entering Toronto, Canada, between September and October 2020 [21].…”

“…The author recommended having a testing strategy which combines with genomic surveillance in order to prevent and monitor COVID-19 [26]. In Nepal, POE screenings were conducted at 13 designated borders (Pulghat, Jhulaghat, Gadachhauki, Tri Nagar, Jamunaha, Krishnanagar, Belahiya, Inarwa, Gaur, Bhittamod, Rani, Kakarvitta and Pashupatinagar) in response to a threat of a delta variant in India [27]. Rapid testing using a lateral flow antigen (LFA) detected 3907 cases of COVID-19 out 69,886 tested (travelers without an RT-PCR certificate or displaying signs and symptoms during primary screening) [27].…”