Even if you’re not a college kid hitting Daytona Beach or the Colorado slopes, spring break offers a chance to kick back, travel, rewind, and refresh. Unfortunately in the age of COVID-19 –– the atypical coronavirus that may cause pneumonia, significant complications, or even death in those whose immune systems are compromised –– some Tarrant County residents found out that the politics of national borders, voluntary quarantine, traveling back from foreign countries, and obtaining basic supplies could change literally overnight. And their travel experiences show the inconsistencies in basic public health measures that are not always evenly applied.
The local residents I spoke with all began their vacations before March 9, when the federal government was telling the general public that travel out of the country was safe, with a few exceptions. Two families traveled to Spain, one family went to Mexico, and one took a cruise from California to Mexico. Their travels to the airport on March 8 and 9 were uneventful, with nothing more than the usual delays in screening. By March 14, the declaration of an international pandemic turned the trickle of travelers hitting DFW Airport into a flood, then a tsunami of humanity as staff began to grapple with rapidly changing public health screening protocols.
At the request of the individuals, names have been changed to protect their privacy.
The story actually starts last year. On December 31, 2019, the Chinese government began reporting cases of atypical pneumonia to the World Health Organization (WHO), which named the virus causing the health issues COVID-19 on February 11, 2020. By that time, passengers aboard cruise lines were in quarantine in Asian ports because some had symptoms of the illness, which include fever, sore throat, cough, and shortness of breath. Also around that time, a Chinese national became ill and died in France after testing positive for the virus.
On February 24, 2020, President Donald Trump took to Twitter to post, “The Coronavirus is very much under control in the USA. We are in contact with everyone and all relevant countries. CDC & World Health [sic] have been working hard and very smart. Stock Market starting to look very good to me!”
In late February, a patient in California with no history of travel to China or Europe began treatment for the virus, marking the first presumptive American case of community contact and transmission. By the first week in March several states –– including Florida, Utah, Maryland, New York, Kentucky, Utah, Washington State, and Oregon –– had declared states of emergency in response to cases of COVID-19, mostly related to contact with individuals who had other risk factors.
On Monday, March 9, Trump tweeted, “At this moment there are 546 confirmed cases of the Corona Virus [sic] with 22 deaths.” In the same tweet, the president also listed the 2019 death toll for influenza at 37,000 Americans, as if there’s no difference between the two illnesses. There are.
Seasonal influenza is caused by one or more strains of a virus from the Orthomyxoviridae family, and it’s pretty predictably rampant from fall to early spring. Sometimes the virus this year looks like a previous year’s edition, and your body can successfully fight it without you getting sick. There’s a vaccine for the flu that isn’t perfect but is capable of lessening the length of misery of the infection. It takes about a week from exposure to the flu virus until you begin to feel sick, which means you could be asymptomatic and pass the flu to anyone you meet during that time. While the flu does cause mortality in certain populations –– notably the elderly, those with compromised immune systems, and occasionally the very young –– approximately 0.1% of the population who become sick with influenza die. COVID-19 is a novel virus from the coronavirus family caused by a betacoronavirus, which has its origin in bats. Transmission of the new virus jumped species from an animal to a human and is now being spread from person-to-person contact. Unlike with influenza, humans have no immune memory for COVID-19, and it may take two weeks from the time of exposure for you to start to feel sick. Data from other countries show that there’s a possible fatality rate of upward of 11% in those aged 64-84 and 3% in those aged 55-63. For the rest of us, the fatality rate hovers around 1%, which is still significantly higher than the influenza death rate. Unfortunately, the main symptoms –– fever and cough –– are similar for both influenza and COVID-19.
That Monday also marked the start of spring break for most local public school districts. Alex and Mark have two students in college in Texas, but their kids’ break did not coincide with Alex’s school district break, so their week off was all about Mark’s 50th birthday. They planned a memory-making trip to Andalusia, in the southern part of Spain. Alex said she booked the trip through Seville, Granada, and Cordoba last year. Although she was aware that there were cases of COVID-19 around Europe, she felt fairly safe because Spain wasn’t listed on the Traveler’s Health site by the Centers for Disease Control and Prevention (CDC) at the time they were packing to travel.
Also on Monday, Christine and her daughter Rebecca traveled to Malaga, Spain, with a stop in Morocco. Rebecca’s college boyfriend had begun a semester abroad, and the college spring break seemed like a good time to visit him and see Spain. The trip was planned in early January 2020.
Melissa and her family of five left on Monday from DFW Airport for an all-inclusive resort in Cancun. Ironically, Melissa said her decision to go to Mexico was based partly on concern about COVID-19.
“We knew that [Southern] California had a handful of cases,” she said. “We didn’t want to go there and then get stuck in quarantine with theme parks and attractions closed.”
She booked the trip with a friend who had also been to the family-friendly resort, and it was just a matter of switching plane tickets.
On Monday, Ruby and her partner were getting ready to board a cruise ship in Southern California which included stops in Puerto Vallarta and Cabo San Lucas. Ruby planned the trip last summer, but given the events of late January and February, she said she also felt better about going to Mexico than going to Europe or Asia.
“I was thinking I would have skipped the trip if it had been to China or Italy but not Mexico,” she said.
The ship was set to sail Sunday, March 8, but Ruby said the departure was delayed a day for what she later learned was a serious ship cleaning in response to a potentially ill traveler on the cruise immediately preceding hers.
Of the four families who were traveling, the three boarding planes had no health screening at the beginning of their journeys. Only Ruby and her partner were required to comply with a formal health screening before boarding the cruise ship.
“They asked us some questions and took our temperatures,” she said.
The health screening questionnaires for COVID-19 generally ask about foreign travel, cough, and febrile illness. As with most health screenings, this one relies completely on the individual to be honest.
On Tuesday, March 10, Trump stated that the concern about COVID-19 “will go away. Just stay calm. We want to protect our shipping industry and our cruise ships.”
None of the four families traveling were routinely checking their social media at this point. Even if they had, it’s likely that they would have had to go digging for hard news about the spread of COVID-19.
That same day Christine, Rebecca, and Rebecca’s boyfriend took a side trip to Morocco, which involved public transportation, including a bus and a ferry. Travelling into Gibraltar included rigorous passport checks, and all three travelers had to complete a health screening form similar to what Ruby saw while boarding the ship. All three had their temperatures taken with a non-contact thermometer. Christine said the trip was fun and uneventful, and she didn’t think much of the health screening at the time. There were no health questions or temperature checks re-entering Spain.
But back on the ship, Ruby said that there was a lot of gossip regarding a passenger who was medically off-loaded at Cabo. Ultimately, Ruby said the diagnosis provided to the passengers was that their fellow passenger had a broken leg. Later that night, she realized more crew members had been out and about during the whole journey, sanitizing railings and other high-touch surfaces. She also noted that the service at the endless cruise-ship buffets was different –– staff with gloves served buffet items rather than allowing passengers to handle the serving utensils. Salt and pepper shakers (high-touch items that are hard to sanitize) disappeared from the dining tables. And, Ruby said, there was an emphasis on hand hygiene in dining rooms.
“You weren’t allowed in the dining room unless you sanitized your hands with the alcohol gel provided,” she said.
On Wednesday, March 11, the WHO declared COVID-19 a global pandemic, and in a remarkable about-face, President Trump announced a ban on nonessential travel from most European countries to be effective midnight on Friday, March 13. The ban affected Spain and 25 other European Union countries but did not include the United Kingdom (U.K.). The State Department issued a Global Level 3 Health Advisory calling on U.S. citizens to reconsider traveling abroad.
Christine said that she woke up Thursday to “about a thousand” messages, from her company and from concerned friends. Because spring break ended for daughter Rebecca on March 15, Christine and company had planned to leave Spain via Paris to Texas early the morning of Friday, March 13. She took advantage of hotel Wi-Fi to realize that the pandemic had reached Spain.
Alex said her first clue that vacation might end badly came from a panicked phone call from her mother late Wednesday night.
“She said they were closing the borders and we had to come home immediately,” Alex said. While this was ultimately untrue, Alex and Mark hadn’t been paying attention to the U.S. media, “and we couldn’t understand the Spanish media.”
What was true was that the count of COVID-19 cases in Spain jumped from about a dozen to 2,800 in the three days the Americans had been in Spain. Alex and Mark had rented a car, which she said mitigated contact with crowded public transit. And this time of year, she said the tourist traps aren’t as crowded as they would be next month, rolling into the Easter celebrations.
Originally, Alex and Mark were set to fly home at 8 p.m. Friday night to London, which would have pushed them past the midnight deadline. Additionally, they were set to fly into Raleigh-Durham, North Carolina, which is not one of 13 U.S. airports approved by the CDC to intake travelers from high-risk countries. Hartsfield-Jackson in Atlanta, Kennedy in New York, and Los Angeles International are three of them. DFW Airport is another.
With the significant confusion about what the president’s orders might mean and concern that they’d have to fly into a specific U.S. airport, Alex said she spent most of Thursday, March 12, in frustrating attempts to contact her airline. She said she could never actually get past a phone tree and a long hold time.
“There was no button on the phone tree to push for ‘This country’s closing,’ ” she said.
Of course, at that point, most Americans abroad had learned of the president’s declaration and that midnight deadline, and they were desperate to change their plans. That also meant rerouting to one of 13 CDC-rated American airports.
Down in Mexico, Melissa said Thursday felt surreal to her and her family.
“Here we were, sitting on a sunny beach by the water, and we’re getting information trickling in that things have gotten bad,” she said.
From the beach, they learned that the school spring break had been extended at least two more weeks. Because they’d already planned to leave on Friday, March 13, they attempted to enjoy one more day of calm on the beaches before they returned home. Melissa said that social media posts from friends on Thursday indicated that stores were running out of everything from toilet paper to milk.
News of the events in the United States and Tarrant County also reached Ruby at sea. She attempted to filter through multiple messages to decipher whether she had been at risk in Mexico or would be in California. Ruby said she contacted her son, who was home, and asked that he pick up some basic food supplies and toilet paper.
On Friday, March 13, Alex and Mark were able to fly from Seville to London and then take a flight that landed them at DFW. When they touched down, Alex said the flight attendant announced that passengers from any E.U. country except the U.K. needed to stay on the plane.
“Most people get off,” she said.
Then she and Mark completed a health form asking if they had fever, cough, or shortness of breath. Alex stated the form did not include identifying information like her zip code or phone number. But instead of being in quarantine or even in a separate line, Alex said they walked off the plane into the Customs and Border Patrol (CBP) lines with everyone else.
“You touch the same screens, and you’re standing with everyone that just got off the plane with you,” she said. “We were crammed in line like Six Flags.”
The intake took approximately two hours. Alex also said that it did not appear that the customs agents had training. There were boxes of masks, she said, but no employee was wearing them.
“It was kind of the honor system,” she said. “Nobody told me to self-quarantine. I could have gotten off the plane and gone straight to the grocery store.”
So why didn’t the passengers from a now no-fly country go through a dedicated line with social distancing and quarantine precautions? DFW media spokesperson Bill Begley wrote in an email that “federally mandated enhanced procedures are part of the effort to prevent the spread of the coronavirus. The increased screening requirements caused initial delays in processing through Customs. In response, CBP changed the process to improve screening times. As a result, wait times today [March 16] were much closer to those normally seen, with most hourly wait time averaging 10 minutes or less. DFW Airport supports our federal partners at Customs and Border Patrol and the CDC as they work to screen passengers as safely and efficiently as possible.”
When asked specifically about Alex’s experience, and why the passengers off a flight from a no-fly country were not quarantined, Begley replied, “Questions about process or procedures should be directed to [the Department of Homeland Security] or CDC.”
A request to the Tarrant County Public Health Department went unanswered as of this writing. Reports and video from the Dallas Morning News and other sources show lines wrapping the length of buildings over the weekend of March 14-15 –– as Alex said, like lines at an amusement park –– as airport personnel attempted to implement the quarantine screenings.
Early Friday morning, the 13th, Christine and daughter Rebecca took their scheduled flight from Spain to Paris, where they had to go through passport control but were not asked any health questions. From Paris, they had a direct flight into Houston’s Hobby Airport, which is not on the list of 13 airports rated to intake travelers from high-risk countries. However, Christine and Rebecca landed before the midnight travel ban went into effect. Again, they were not asked any health questions, and Christine stated that the CBP agents took no unusual precautions, like wearing masks or gloves.
Michelle and her family were able to return from Mexico on their scheduled flight on Friday.
“The airport was packed,” she said. “It was hard to tell what was end of spring break travel and what was people trying to get home.”
Her family was not required to complete a health questionnaire upon arrival into the states, but Michelle took full advantage of mobile passport control from the plane to minimize the amount of time spent in a CBP line and the amount of kiosk screens that she and her kids would have to touch. In an unusual turn of events at DFW, by Saturday, March 14, travelers coming in from Mexico were reportedly being whisked through CBP lines, as Mexico was not on the CDC’s travel caution list.
Upon leaving the cruise ship on March 13, Ruby and her partner weren’t asked any additional health questions. They flew to DFW from Los Angeles and again were not asked any health questions on arrival at DFW.
All the families arrived in Tarrant County to find shortages of almost everything, from hygiene products to milk to lunch meat. Ruby, who had told her son to run to the grocery store, found that he didn’t actually go, and when she sent him on Saturday morning, she said he found “the bare minimum of food to feed my family for four days.”
Ruby has quarantined herself voluntarily for 14 days, which means she’s not going to the grocery store anytime soon.
Alex and Mark have also quarantined themselves, not because the CDC told them to but because both their workplaces said they needed to. Both are able to work from home. They have a son graduating from college this spring, and they’re now worried about what this will look like and whether he’ll be able to find a job during a pandemic.
Michelle said her family is lying low as well.
“There’s no enforced quarantine, but I’ve read enough to minimize activity,” she said. “It’s a flatten-the-curve situation.”
She’s also not allowing her three school-aged children to play with the neighbors “because who knows where anyone went for spring break?”
Finally, Christine is also quarantining herself and Rebecca. Christine is required to by work, but she’s keeping her daughter close “because it’s the right thing to do.”
Christine’s husband, who didn’t go on the trip with her, is able to shop for them, but she said he’s living in another part of the house right now. After the initial panic of Thursday and the regular chaos of international travel, Christine said things aren’t so bad.
“I don’t regret it, but that’s because everything came out fine,” she said. “This will be a cool, long story someday.”
Ed. note: Long-time Weekly writer Laurie James has been a public health educator for three decades.