At least two countries in the Caribbean are requiring COVID-19 test certificates from stranded nationals before they can return home, while another, Antigua and Barbuda, plans to have tourists undergo rapid testing for the novel coronavirus before boarding aircraft to visit its sun splashed beaches.
The Bahamas announced the requirement Sunday, joining Haiti, which was among the first in the region to do so. Other Caribbean nations are also considering the so-called “virus-free” certificates as health and tourism ministers weigh the return of stranded nationals and tourists amid the devastating economic blows of the global pandemic.
But the push for a COVID-19 “passport” in order to fly comes as the World Health Organization signals its discomfort with such documentation for travel, doctors and scientists still lack a lot of information about the coronavirus, and getting access to testing remains difficult in the United States.
“Requiring some kind of COVID passport is going to be difficult,” said Carlos Espinal, director of the Global Health Consortium at the Robert Stempel College of Public Health at Florida International University.
Nevertheless, countries are forging ahead.
In a national address Sunday, Bahamas Prime Minister Hubert Minnis announced that any citizen or legal resident wishing to return will need to obtain a real time reverse transcription–polymerase chain reaction diagnostic test from an accredited lab, “unless otherwise approved to have the test administered upon arrival.”
The test, also referred to as RT-PCR, is considered the gold standard of testing due to its accuracy for detecting the coronavirus, which causes the respiratory disease COVID-19.
“All those returning will be required to be quarantined for 14 days in a government quarantine facility or self-quarantined,” Minnis said. The Bahamas has 83 confirmed cases spread out among just three islands: New Providence, where the capital of Nassau is located; Grand Bahama and Bimini.
Minnis acknowledged that Bahamians in Florida have informed him of the difficulty of getting tested and said the government will help them to get the diagnostic test.
Late Monday, Bahamian Health Minister Duane Sands submitted his resignation, saying he took full responsibility for allowing six permanent residents to return to the country via private aircraft despite the border closure. The six were bringing badly needed COVID-19 testing swabs. Minnis had cited the incident, saying it was “a breach in protocol.” He accepted Sands’ resignation.
Haiti made a negative coronavirus test a requirement for all passengers entering the country even before confirming its first cases of COVID-19 on March 19. Haitian Prime Minister Joseph Jouthe reiterated the requirement last month when issuing the rules for nationals seeking to return..
A recent Miami Herald analysis showed that only about 1.8 percent of Florida’s population has been tested for COVID-19, with the percentages much lower in rural areas. While restrictions on who can get tested have relaxed in some areas, a shortage of testing kits means that some people are unable to get a second exam after testing positive.
While it remains questionable whether Haiti and the Bahamas can enforce the requirements given the costs of a lab test and the worldwide shortage of testing kits, test results also offer no guarantee, experts say.
Someone who turns up negative one day for COVID-19 after taking a lab test can unknowingly become infected before they travel, Espinal said.
Also, just because someone has had COVID-19 — and now tests negative for the virus — it doesn’t mean they are necessarily in the clear.
“Nobody can say what is the immunity after the infection,” Espinal said. “If you’ve had the infection, we are assuming you’ve developed a solid immunity against the second infection, but as the WHO says, there is no proof that we will be immune from COVID-19. So it’s very hard to request a negative or positive test in order for people to reenter the country.”
Even administering a rapid test at the airport counter as Antigua is pushing has its challenges. The rapid tests do not diagnose a current COVID-19 infection, they only show if someone has been exposed to the virus and developed antibodies against it.
Infected passengers could still end up contaminating others during the flight or once they land.
Clinicians also have been expressing growing concerns about the reliability of the rapid tests because of false negatives.
Espinal said the WHO “is very much opposed” to the COVID passports, and he and other public health experts have been trying to get its Americas office, the Pan American Health Organization, to put together an expert group to make recommendations to countries in the region.
Ashley Baldwin, a PAHO spokeswoman, said it is expected that most people who become infected with COVID-19 will develop an antibody response that will provide some level of protection.
“What we do not know is the level of protection or how long it will last. PAHO/WHO is working with scientists all over the world to better understand the body’s response to COVID-19 infection, but so far no studies have answered these important questions,” she said. “As a result, because there is not enough evidence about the effectiveness of antibody-mediated immunity, it would not be possible to know the accuracy of an ‘immunity passport.’ ”
But absent such recommendations, countries are coming up with their own rules.
In Chile, government officials have been promoting the idea of an immunity card for those who have had the virus in order for them to get back to work. In Jamaica, tourism industry experts are debating the merits of requiring tourists to test before entry.
And in Antigua, where the disease has decimated the government’s coffers, officials are promoting a COVID-free tourism environment. Under the proposed plan, visitors will be confined to the premises of their hotels, including the beaches, but not allowed to mingle with the locals or participate in mass gatherings.
“The local staff will be the younger, healthier ones who would use masks and use proper hygiene etiquette to control the contracting and the spread,” Prime Minister Gaston Browne told the Miami Herald. “They will live on property with the guests to prevent inadvertent community spread in the unlikely event they contract the virus.”
But before even getting to Antigua, visitors would need to undergo rapid testing by the airlines.
“It’s not foolproof, but the test, wearing masks, social distancing and good hygiene will have to be employed to manage the risks of contracting and spreading the virus, considering it could remain in our midst,” said Browne, who is looking to reopen his country’s airport by June. “In essence we have to learn to lie and work with COVID, while managing the risks of contracting and spreading the virus.”
Jim Hepple is an Assistant Professor at the University of Aruba and is Managing Director of Tourism Analytics.