The requirement for all travelers 2 years old and older to show a negative test result is scheduled to go into effect Jan. 5.
Officials also announced that a voluntary traveler-based genomic surveillance program will expand from five to seven key airports in the United States. The move will allow public health officials to gain information about the genetic profile of the coronavirus from passengers traveling on 500 flights weekly from 30 countries.
The new concerns about contagion from China come almost three years to the day since the first reports emerged from that nation about a concerning pathogen. While officials acknowledged that the measures would not eliminate risk, requirements can be adjusted quickly as circumstances change.
The U.S. move follows actions by several other countries scrambling to respond to China’s sudden announcement this week that it will begin reopening its borders Jan. 8, allowing residents to travel without quarantining upon return. Governments and tourism businesses around the world are preparing for a possible influx of travelers from what had been among the world’s largest outbound tourist markets.
As the coronavirus runs rampant in China, preparations have become all the more difficult, experts and U.S. officials say, because of the lack of transparency by the Chinese government about the extent of the outbreak.
Japan has announced it will require a negative coronavirus test on arrival for travelers from China and quarantine those who test positive.
South Korea’s Disease Control and Prevention Agency is set to announce new measures for Chinese travelers Friday, Choi Seung-ho, a department spokesman, said. In India last week, the government started testing travelers from four Asian countries, including China.
Japan will limit flights to and from mainland China, Hong Kong and Macao to four of its major airports starting Friday. Airlines were asked not to increase flights at those airports.
The restrictions threaten to dampen the rebound of Chinese tourists to countries that had previously welcomed them. They also raise questions about the role of geography-based coronavirus restrictions at a time when the world increasingly regards the virus as endemic — constantly present but under control — and has all but moved on from such rules.
Ali Mokdad, an epidemiologist and professor at the Institute for Health Metrics and Evaluation at the University of Washington School of Medicine, has been monitoring the situation in China closely.
IHME’s modeling, he said, which relies substantially on Hong Kong’s experience with adjustments made for factors such as mainland China’s rural population, suggests there could be 300,000 deaths by April and 1.2 million by the end of 2023 — or closer to 500,000 and 1.6 million respectively if the Chinese government and people decide to let the virus rip through the population.
“Some of the models may be too cautious,” warned J. Stephen Morrison, director of the Global Health Policy Center at the Center for Strategic and International Studies. “There is potential for chaos.”
Scott Kennedy, trustee chair in Chinese Business and Economics at the Center for Strategic and International Studies, who spent seven weeks in China under its zero-covid policy, said the new measures are an effort to address the challenge from new variants that might emerge. Getting reliable data, on the other hand, is a longer-term challenge.
“I think we’re going to have a very difficult time getting full information about the extent of covid in China,” Kennedy said, even as he hoped for greater communication between Chinese and U.S. health officials. “I don’t even think the Chinese government itself has comprehensive information.”
The sudden restrictions by countries such as Japan were already affecting travelers. Alvin Lo, a 42-year-old from Hong Kong, was scheduled to fly from New Chitose Airport in Hokkaido, Japan, directly to Hong Kong on Jan. 4, but that flight will no longer be allowed. He spent Tuesday frantically searching for options and said Wednesday he was considering flying through Bangkok.
Asked about the Japanese restrictions, Chinese Foreign Ministry spokesman Wang Wenbin said measures by any country “need to be science-based and proportionate without affecting normal people-to-people exchange.”
Neysun Mahboubi, who researches China at the University of Pennsylvania, said other countries were bound to be cautious in welcoming travelers from China given its lack of transparency about the status of the pandemic.
While China has reported implausibly low death tolls from the surge of cases, residents have raised concern about widespread infections and a health-care system bursting at the seams. An investigation by The Washington Post found that communities in China are struggling to deal with the wave of infections.
“But any restrictions on Chinese travelers should be temporary and tied directly to scientific factors, including the transparency of public health information from China,” Mahboubi said in an email. “The world does not need (and can ill afford) a return to the paranoia and geopolitical finger-pointing with which the pandemic was met, initially.”
Despite his institute’s high projections, Mokdad said he doesn’t believe new travel restrictions are warranted, particularly given that omicron subvariants are already circulating widely around the world.
“What is circulating now in China is already in the United States,” Mokdad said. “A Chinese guy coming with omicron is not going to harm me at all.”
Ben Cowling, a British epidemiologist at the University of Hong Kong, said travel restrictions would not keep out potential new strains of the coronavirus.
Testing inbound travelers, with the exception of those at a few tourist destinations, “does not have much impact on the domestic spread of infections because travelers only [make up] a small fraction of a population at any given time,” he said in an email, adding that there was no epidemiological rationale for travel restrictions at this stage of the pandemic.
Since the start of the pandemic, China has required strict quarantine for inbound travelers, creating a massive disincentive for its population of more than 1.4 billion people to leave its borders. That has left many popular destinations devoid of the throngs of Chinese travelers commonplace before the pandemic. Chinese tourists made 155 million outbound trips in 2019, according to state media, up 3.3 percent from the year before.
In the Grand Hirafu village in Hokkaidō, Japan, the streets were still bustling with tourists from the United States, Australia, Singapore and Hong Kong. Mai Tanaka, an employee at a ski and snowboard shop, said business was already booming without Chinese tourists.
The potential for 1 million or more deaths in China does not surprise U.S. public health experts, who anticipated a dangerous scenario when China adopted its zero-covid policies.
“With such an extraordinarily infectious variant, there’s no way you are going to avoid it. All you can do is limit its impact,” said Alfred Sommer, former dean of the Johns Hopkins Bloomberg School of Public Health who has been instrumental in combating viruses as varied as flu and smallpox.
Unlike the SARS outbreak of two decades, when that more deadly but less contagious virus could be contained, battling the current variants involves building up herd immunity through vaccination and natural infection.
With China’s vaccines offering limited immunity for a short period of time and a disease that spreads asymptomatically, the smart approach, Sommer said, would have been to roll out an aggressive vaccine campaign using messenger RNA products to protect as many people as possible from severe disease.
“People are going to get sick. Some people are going to die. That’s true,” Sommer said. “But you’ve gotta live.”
Mokdad emphasized the need to work together to combat public health threats, recalling the efforts made to help India during its outbreak sparked by the delta variant.
“Instead of imposing measures on China, we should be helping China,” Mokdad said.
So far Chinese officials have declined U.S. offers of resources, including vaccines.
Niha Masih in Seoul and Fenit Nirappil in Washington contributed to this report.
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