Cross-sectional survey of SARS-CoV-2 testing at US airports and one health department’s proactive management of travelers

Airport testing survey

We received responses from 71 HD or airport employees; one person subsequently declined to participate. The 70 survey respondents represented 77 airports: six provided information on more than one airport (five respondents answered for two airports and one respondent answered for three airports). Most of the surveys were conducted online with airport (N = 46; 66%) or HD contacts (N = 23; 33%); one (1%) survey was conducted over the phone with a HD contact. Of the 77 airports for which information was obtained, 38 (49%) had an onsite (on airport grounds) testing site or planned to offer one (N = 7; 9%). Onsite testing was not offered nor planned at 31 (40%) airports, and one airport was not operational at the time of the survey (Fig. 1).

Fig. 1figure 1

SARS-CoV-2 Testing Availability at Airports, Centers for Disease Control and Prevention Survey, November–December 2020 (N = 100)

Of the 38 airports with onsite COVID-19 testing, 30 (79%) offered testing to travelers, and eight (21%) offered testing to non-travelers (e.g., airport or airline crew) only. Seven airports were designated as community testing sites and were open to the general public, including both travelers and non-travelers.

Information on the airport’s testing site location was available for 32 airports. Of those, 18 (56%) were located outside the secure area, and 12 (38%) were located inside the secure area. Five airports had multiple testing sites on airport property, including two (6%) with testing sites both inside and outside the secure area. The most frequently offered SARS-CoV-2 test types were reverse transcription polymerase chain reaction (RT-PCR) or other NAAT (N = 28), followed by antigen tests (N = 15), and antibody tests (N = 8). Thirteen airports offered both RT-PCR/NAAT and antigen testing (Fig. 2).

Fig. 2figure 2

SARS-CoV-2 Test Type at US Airports, Centers for Disease Control and Prevention Survey, November–December 2020 (N = 30)*. *Information was not available for 8 airports where testing is offered. RT-PCR = Reverse transcription polymerase chain reaction tes. NAAT = Nucleic acid amplification test

Information on when testing first began was provided for 26 (68%) airports. Most sites began testing in the fall of 2020: five in October, seven in November, and nine in December. A few airport sites (N = 5) began testing as early as spring or summer of 2020.

Information on testing providers was obtained for 37 airports. Most testing providers were private companies or universities (N = 31; 84%). Several testing sites were run by health departments (N = 5; 14%) or the U.S. military (N = 1; 3%).

Testing at Denver International Airport

On December 16, 2020, Denver International Airport’s testing site began offering both rapid NAAT and lab-based RT-PCR tests. The testing site is located in the secure area and open to travelers or employees with access to that area. From December 21, 2020 through March 31, 2021, 54 positive results for SARS-CoV-2 were identified out of 5724 tests conducted at the airport for a total positivity of < 1%. Of the 54 persons who tested positive at Denver International Airport, 15 were departing on imminent flights that required immediate public health action to prevent travel.

To prevent travel of persons who test positive for SARS-CoV-2 and their travel companions, the Denver HD imposed a public health order requiring the airport’s testing site to: a) obtain accurate contact, travel, and flight information from the customer prior to testing; b) obtain plans for isolation during the infectious period if a positive result is obtained; c) immediately report positive test results to the HD; and d) notify airlines to cancel upcoming flights of travelers who test positive and their traveling close contacts (Fig. 3). Per the order, the Denver HD requires the testing site to serve the HD’s isolation orders to travelers who test positive and quarantine orders to their traveling close contacts. These travelers are responsible for securing appropriate transportation and lodging for the duration of their infectious period. Individuals who reside in Colorado cancelled or deferred their travel plans and returned to their residence to isolate after testing positive. People who tested positive who reside outside of Colorado either returned to their Colorado accommodations or in some cases rented a vehicle and drove back to their home state while agreeing to adhere to the Denver HD isolation order restricting close contact with other people. Denver HD requires the testing site to upload the isolation order to the testing site’s patient portal on the day of testing. The testing site and persons under isolation or quarantine orders are subject to penalties for failure to comply with the orders.

Fig. 3figure 3

Consequence management process at Denver International Airport for travelers, December 2020–March 2021

All 15 travelers with imminent flights who tested positive at Denver International Airport during December 21, 2020 to March 31, 2021 and their travel companions were managed under Denver’s public health orders. Because the orders specify that the testing site must immediately report cases and notify airlines to cancel upcoming flight itineraries, the Denver HD did not require use of the federal DNB list to restrict travel.

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