The federal government says travelers coming from Italy should self-quarantine, and keep their distance from other people. But in practice, passengers arriving at Logan International Airport and in other cities must still re-enter the country through a busy, crowded airport, with some traveling home by public transit, ride-sharing cars, or shuttle services.
Although Italy is one of the global hot spots for the coronavirus, and two Massachusetts residents are presumed to have the illness after returning from trips there, some passengers who disembarked from a sparsely filled flight from Rome on Thursday said they were asked only cursory questions by US Customs Service workers at Logan International Airport.
“Like, where you went or where you had been,” said one of a group of high school students traveling home from a school trip cut short. A friend of hers said she wasn’t even asked those questions as she came through customs.
The students, who like nearly all of the travelers who spoke with the Globe declined to give their names, said US Border and Customs Protection agents did not advise them of the self-quarantine guidance. The group of four was picked up at the airport by two of their mothers.
Some public health experts say that even intensive screening for the coronavirus at airports is not enough to limit its eventual spread.
“It’s not a perfect system,” said Cyrus Shahpar, the former team lead of global rapid response at the US Centers for Disease Control and Prevention. “That’s why a lot of studies that have looked at it have [found] we can’t say we have a system in place to prevent any leaks in the country.”
Passengers traveling from Italy and South Korea, each designated by the US government with a Level 3 travel advisory, do undergo a preboarding medical screening in those countries that includes having their temperature taken, a policy announced by the Trump administration several days ago. The passengers who arrived in Boston on Thursday confirmed they were tested in Rome.
If passengers show symptoms prior to boarding, they may not be allowed to fly, according to the airline Alitalia, which had a direct flight between Rome and Boston Thursday afternoon. The airline also said it distributes pamphlets from the CDC on flights “containing information to travelers that local authorities recommend, as a precaution, a 14-day voluntary home quarantine."
Upon landing, US Customs officials said, travelers may be diverted for further examination if they show symptoms of illness.
“CBP’s role is to identify individuals who have traveled from or transited through affected countries,” spokesman Michael McCarthy said. “If individuals are observed with symptoms of COVID-19 we will continue to work with the CDC to determine if a traveler is a possible public health risk by referring them for enhanced screening.”
But the state Department of Public Health confirmed it would not receive information about most passengers arriving from Italy or South Korea. “Travelers from South Korea and Italy are expected to self-quarantine without active engagement from local health departments,” said Ann Scales, a department spokeswoman.
And Samantha Decker, a spokeswoman for the Massachusetts Port Authority, which operates Logan, said that “unless CDC is called to assess a symptomatic passenger, the passenger will deplane and travel to their final destination on their own."
The United States has set harsher travel restrictions for China and Iran, also designated as Level 3 advisory countries, banning foreign nationals who have been in either country in the previous two weeks and diverting US citizens to one of 11 airports in the country with enhanced testing and screening procedures; Logan International Airport is not among them. These travelers are also subject to 14 days of health monitoring, according to government guidance.
As of Saturday, Italy had nearly 6,000 of the more than 105,000 cases of the COVID-19 coronavirus documented around the world, and at 233, the second highest death toll, after China, according to a coronavirus database maintained by Johns Hopkins University.
Flyers on the Alitalia trip to Boston Thursday estimated that roughly 30 to 35 people were onboard, giving most passengers their own row to sprawl across. It included many students whose school trips or study-abroad semesters had been upended by the virus; they said their respective schools contacted them about the self-quarantine and emphasized that they should stay home for the full two weeks before returning, and planned to follow the guidance.
“My town is small, and I’m not going to be Patient Zero,” said Skyla Lewis, a University of South Carolina student who had been studying abroad in Florence and planned to spend the next two weeks at home in Newbury. “I’m [feeling] fine though.”
But not everybody planned to follow the quarantine advisory. One man on the flight said he did not plan to self-quarantine.
“No, I feel perfect,” he said after emerging from the customs section of Terminal E into the general concourse.
Shahpar, who today directs the prevent-epidemics team at the nonprofit public health organization Vital Strategies, cautioned that even the most intensive screening would still have holes.
Some passengers may land during the incubation phase, without any symptoms from the disease, allowing them to easily pass customs. Others who are showing symptoms may take medicine to keep their temperatures down and lie on questionnaires to avoid facing further screening and medical attention. And as long as the quarantine order is voluntary, it is possible that somebody who passed the screenings but becomes sick later could spread the disease. In one case in New Hampshire, prior to testing positive for coronavirus, a man had been advised to self-quarantine but instead attended a social function.
Screening at airports is often mostly intended to demonstrate that officials are taking an issue seriously, even if its effect is limited, Shahpar said.
“It’s kind of like we’re doing something about it. We’re doing all we can about it,” Shahpar said. “Ultimately, it’s going to have a limited impact, and will potentially spread. The only way to cut off the flow is to shut off all the flights,” which, he added, is unlikely.