After months of staying close to home and maintaining social distance, many in the New York metropolitan area are ready for a change of scenery. However, with COVID-19 still prevalent throughout the United States and border restrictions limiting international travel, is leisure travel safe?

Daniel Caplivski, MD, Director of the Travel Medicine Program at Mount Sinai, and Professor of Medicine (Infectious Diseases) at the Icahn School of Medicine at Mount Sinai, explains what you need to know about getting out of town as the nation continues to battle COVID-19.

Would you recommend leisure travel this summer?

I do think it’s possible to safely travel within the United States, but there are caveats.

It is important to assess the risk of COVID-19 for each traveler. The CDC has a nice set of recommendations to help you figure out who is the highest risk for having a very severe reaction to COVID-19. This list includes those who are diabetic or obese and older people—particularly those above age 60 or 70.

That is the first thing a traveler should consider—what is my risk of a severe outcome. Younger people can get very sick from COVID-19, obviously, but it’s a different set of considerations for older people and those with underlying medical conditions.

And then, what is the risk of acquiring the virus when visiting a particular area?  The CDC also has outlines to help people think through this process. In the early spring, New York City had the most cases and the highest level of transmission. But now, the focus of the epidemic has shifted towards the south with states like Texas and Florida reporting a high number of cases.

So, those considering vacations this summer should look at the guidelines from the CDC to assess their risk and the risk of transmission within their destination.

If you will be travelling, what is the safest mode of transportation?

The CDC does a nice job of assessing each one of those modes of travel for risk and there’s some commonalities to all of them—any scenario where you are going to be in close contact with a lot of other people will increase your risk of contracting COVID-19.  Whether in an airport or a train station, if you are in a location where it’s hard to socially distance, you will increase your risk.

In terms of mitigating that risk, wear a face covering throughout your trip—as appropriate—and have hand sanitizer with you at all times. Airlines are now allowing, travelers to carry larger bottles of hand sanitizer in their carry-on, which is helpful.

How high is the risk of contracting the virus from other passengers?

The risk from fellow passengers is probably highest from those who are within about two feet—so, within one row in either direction. That’s fairly small in terms of the overall number of people on the plane. Also, the air in planes is constantly being circulated with the outside air and filtered using high efficiency particulate air (HEPA) filters. That adds to some risk reduction. But you should still wear face coverings and use hand sanitizers, especially after engaging with high-touch surfaces like restroom handles.

If you are travelling by train, you can be a lot more spaced out. So, if you can find a seat that’s more distant from other people, that would mitigate your risk, along with wearing a face covering and using hand sanitizer. It’s also worth noting that Amtrak trains have an air filtration system as well.

Given that air and train travel—even when using proper precautions—involves encountering unknown people who may have the virus, is travelling via car or RV with family or friends the safest?

Since you are traveling with people that you know, that’s generally a safer scenario. But, usually you have to stop for gas, snacks, or even the restroom. So, hand hygiene remains important especially after using public facilities.

Once you reach your destination, are there activities that you should avoid?

Travelers should apply the same principle when traveling as they do in the New York metropolitan area. People have gotten used to the concept of wearing some sort of face covering, practicing social distancing, and avoiding scenarios where it’s very difficult or impossible to socially distance, especially when indoors. We know that the transmission of the virus in indoor facilities is much more efficient than in outdoor scenarios. So, whenever possible, try to look for outdoor activities as opposed to indoor ones.

Beaches are an example where, generally, it is possible to socially distance from people and reduce your risk of contracting the virus. Swimming pools can also be a safe place to go if you’re able to maintain social distancing as the chlorine in the water is considered to inactivate the virus. With these locations, travelers should be hyper vigilant in bathrooms, locker rooms, and changing areas where it may be more crowded and there are more high-touch surfaces.

Should you self-isolate after your vacation?

This depends on where you’re coming back from right. New York State has some guidelines for travelers returning from states where there’s a lot more COVID-19 cases.

There are going to be recommendations at the state level for self-isolation or self-quarantine for asymptomatic returning travelers. Travelers should keep an eye on state recommendations as well as the CDC map of where there are high levels of COVID-19 activity.

If you are going someplace that doesn’t have a high level of COVID-19 cases but you have contact with someone who is at high risk of a severe case of the virus, should you take extra precautions on your return?

The Mount Sinai Health System has some guidelines for our health care workers because we come in contact with people who are immunosuppressed and have a high risk for severe COVID-19. The common sense approach for travelers is what a lot of health care facilities like Mount Sinai are doing, which is requiring that people conduct a self-symptom check.

If you are returning from a relatively low risk area, do a self-assessment. You can return to being in contact with older loved ones, as long as you do not have a high fever, a cough, shortness of breath, loss of smell, or any of the typical symptoms for COVID-19.

Are there any additional behaviors that the public should be aware of when traveling during this time?

Lodging is a big consideration. My Mount Sinai colleague, Mirna Mohanraj, MD, addresses the safety considerations travelers should make when visiting a hotel or vacation rental in this blog.

Additionally, the CDC recommends bringing sanitizing wipes when you travel for high touch surfaces, like doorknobs and bathroom fixtures. The CDC also recommend basic things that have become second nature to many within the New York metropolitan area like no contact service and avoiding buffets, group gatherings, and gymnasiums.

As the New York metropolitan area continues to keep the COVID-19 curve flat, more establishments have opened. But, before hitting the pool or booking an appointment at the day spa, be aware that the risk of contracting the virus has not dissipated.

“Any place where we have public interaction beyond our immediate family or immediate contacts, we are exposing ourselves to the virus,” says Waleed Javaid, MD, Associate Professor of Medicine (Infectious Diseases) at the Icahn School of Medicine at Mount Sinai. “The more people we meet, the more interactions we have, the expansion of our social circle; this increases our risk.”

Dr. Javaid explains what questions you should ask before visiting your local pool or spa to ensure the safest possible visit.

What precautions should you take before heading to the pool?

I think it will be important to make sure that the pool or hot tub that you are entering is following up on disinfection protocols. The cleaners and disinfectants used in and around the area should be registered by the US Environmental Protection Agency to kill the virus.

Do saunas and steam rooms pose a risk of spreading COVID-19?

If you’re not following social distancing guidelines, there is a risk. But it really depends on the size of the facility and how they may be modifying their business practices due to the virus.

Masking is not going to be effective in a sauna or steam room because—besides being incredibly uncomfortable—the moisture will likely reduce the efficacy of a face covering. So perhaps it is best to do individual saunas.

Not every place is going to do the same thing, so people should be proactive in asking about what kind of protections are in place for safety before entering an establishment.

Since there is no standard protocol for these establishments, what should people ask before visiting?

Before visiting a pool or spa, people should ask two questions: What is the facility doing to prevent the spread of COVID-19 and what is the process they are using to ensure the virus does not spread throughout their establishment.

From there, you can go into some specifics.

• What disinfectant is in use?
• What is the social distancing process and how is it being reinforced?
• How many people are allowed in the facility at any given time?
• How often are shared spaces being disinfected?
• Is shared equipment being cleaned between each customer?

Additionally, I would recommend that people review guidance from the Centers of Disease Control and Prevention on public pools, hot tubs, and water playgrounds.

Despite spas being allowed to open, at this time gyms throughout the New York metropolitan area remain closed. Why are gyms particularly risky? Is the virus spread through sweat?

At this time, we do not believe that the virus is spread through sweat. However, the risk with gyms is related to the amount of people in an enclosed area. I continue to recommend that everyone stay safe by keeping their distance. So, individualized outdoor exercise like walking, jogging, running, or even outdoor yoga is better than exercising indoors.

Gyms have many people exercising indoors—whether on machines or in fitness classes—and sharing equipment. Contrast that with a spa where the activity—like a facial or a massage—though indoors, is individualized. So spas—where the interaction is often between one or two individuals—present a more controlled environment.

At least, that is how I think this decision is being evaluated.

Do you have any other advice about how to stay safe as we continue this reopening effort and begin to expand our social circles?

Everybody needs to take charge to protect their health and the health of those around them. If, for example, you feel unsafe in a grocery store because there’s too many people, don’t be afraid to remove yourself from that situation.

Also, just because more places are open doesn’t mean that you have to enter them, especially if strict social distancing is not being practiced.

Much as you may be bored with staying home, the decision to travel during this time is a difficult one. Experts recommend avoiding all non-essential travel. Any travel, says the U.S. Centers for Disease Control and Prevention (CDC), increases your chances of getting and spreading COVID-19. But if you still need—or want—to get away, Mirna Mohanraj, MD, a pulmonologist with the Mount Sinai Health System, answers some of your questions about staying in hotels and vacation rentals like Airbnbs during the pandemic.

Is it safe to travel? How should I decide where to go?

The CDC states that travel increases your chances of getting and spreading COVID-19. You should stay home if you have any COVID-19 symptoms, have been diagnosed with COVID-19, are waiting for COVID-19 test results, or were recently exposed to someone with COVID-19.

There’s never been a better time for a staycation. But, if you do want to travel, talk with your doctor about your personal risk and try to avoid areas that are experiencing an increase in new COVID-19 cases. Also, the CDC provides detailed guidelines on personal precautions to reduce your chances of getting and spreading the virus.

Should I stay at a hotel or a rent an apartment?

Both options may increase your risk of getting and spreading COVID-19. Hotels have the added challenge of high-traffic areas like lobbies, elevators, gyms, restaurants, and other common spaces. For this reason, it may be better to stay at a non-shared facility like an Airbnb. Airbnb has posted its safety guidelines to help travelers and hosts know what to expect. For hotels, safety precautions vary. Be sure to inquire about your specific lodging place before arrival.

How do I pick a safe place to stay?

To find a place that meets your comfort level, do your research in advance. Check the hotel or vacation rental website to see if it is following the guidelines issued by the CDC and the U.S. Environmental Protection Agency (EPA). Also, check that the facility is adhering to any state or local guidelines for cleaning and disinfection. In general, the location should follow special protocols between guests as well as throughout the day. They should be especially careful about disinfecting high contact surfaces like doorknobs, light switches, and elevator panels.

It is also important that the location screens staff daily for COVID-19 symptoms as well as follows guidelines for social distancing and wearing masks/appropriate protective gear. Opt for facilities that have committed to reduced occupancy and contactless check-in/check-out and inquire if there is a minimum vacancy period or ‘booking buffer’ between guest departures (Airbnb recommends 72 hours. This may be based on studies published in The New England Journal of Medicine and The Lancet have shown that the virus can live on hard surfaces for up to three days. So, even if a facility does not perform enhanced cleaning perfectly, this should leave adequate time for the virus to die.). Ask if you can text message hotel services rather than communicate in person during your stay. And, check if the facility has contactless room service as your hotel room is the safest place to eat.

Once you arrive, you may find that your hotel experience is different than what you are used to. Some hotels are sealing guest rooms prior to arrival to show that they are following cleaning protocols. Your room may also be stocked differently and may not contain items that are difficult to disinfect, such as robes and blankets. If your hotel/vacation rental is following all the appropriate guidelines, it should be safe to use whatever materials are in the room.

How can I protect myself?

As with everything else during this pandemic, it is best to be prepared. Bring plenty of face coverings and hand sanitizer. You can’t be sure that your hotel or vacation rental will provide these. Avoid face-to-face encounters whenever possible and wear a face covering as soon as you leave your room. Take the stairs instead of the elevator. Try to avoid any common areas, such as gyms, restaurants, and lobbies, and only use your private bathroom. If you find yourself in a common area, be sure to keep six feet away from everyone outside your travel party.

There should be adequate ventilation—even with air conditioning—so, it’s always good to open windows and/or doors for better air circulation. If you’re concerned about disinfection protocol, you can bring your own cleaning supplies. You may even want to personally wipe down high contact surfaces in your room like remote controls, faucet handles, light switches, hangers, and doorknobs.

Is it safe to visit the hotel’s restaurant?

You might want to decide this in advance. Before you leave home, I recommend checking the hotel restaurant website to review its COVID-19 practices including personal protective gear for hosts and servers.

‘Grab and Go’ stations are safer than a sit-down meal and dining in a distanced open-air location is better than indoor service. But, if you do decide to eat in, avoid buffets, self-serve, and valet parking. Also, ask about safety protocols in advance. Is the restaurant limiting occupancy or making an effort to distance diners?  Are digital menus available? Can you order and pay via mobile device?

Is the hotel’s pool safe?

Being in a swimming pool or open water is unlikely to increase your risk of contracting COVID-19 as long as you maintain appropriate personal protective habits: frequent and appropriate handwashing after touching high-contact surfaces, face covering outside the water, and social distancing both in and out of the water.

However, before you enter the pool, inquire about the facility’s safety protocols. Is the location using enhanced cleaning and restricting capacity? Also, ask about the cleaning of shared equipment, such as bicycles and beach chairs, between guests.

If you have any other questions, check out the CDC website for full guidelines on travelling during the COVID-19 pandemic.