Title: Air Travel and Communicable Diseases like COVID-19 Description: COVID-19 has intensified ongoing concerns about air travel's role in spreading diseases globally. How can agencies like the Federal Aviation Administration and the Centers for Disease Control better protect passengers and airline crews from diseases? And what improvements can be made to alert those who have been exposed? We'll find out more from GAO's Heather Krause. Related GAO Work: GAO-22-105018, Contact Tracing For Air Travel: CDC's Data System Needs Substantial Improvement and GAO-22-104579, Air Travel and Communicable Diseases: Federal Leadership Needed to Advance Research Released: July 2022 [Heather Krause:] While aircraft have been shown to have very good ventilation systems, they aren't always in operation, nor do they completely mitigate infection. [Music] [Holly Hobbs:] Hi and welcome to GAO's Watchdog Report, your source for news and information from the U.S. Government Accountability Office. I'm your host--Holly Hobbs. COVID-19 has intensified ongoing concerns about air travel's role in spreading diseases globally. How can agencies like the Federal Aviation Administration and the Centers for Disease Control better protect passengers and airline crews from diseases, and what improvements can be made to alert those who have been exposed? We'll find out more from GAO's Heather Krause, an expert on aviation safety and a director in our Physical Infrastructure Team. Thanks for joining us. [Heather Krause:] Thanks for having me. [Holly Hobbs:] So, Heather, I think we, the public, have sort of been told different things about how safe air travel is from diseases like COVID-19. Things like--you should defiantly wear a mask. It's okay not to wear a mask. What can you tell us? [Heather Krause:] First, you know, while COVID cases, hospitalizations and deaths have declined since their peak, the pandemic isn't over. According to the CDC, the U.S. is still averaging over 100,000 cases and 300 deaths per day. While aircraft have been shown to have very good ventilation systems, they aren't always in operation nor do they completely mitigate infection. So the CDC continues to recommend that people wear masks in indoor public transportation settings. [Holly Hobbs:] And for our report, we looked at research for our report on the spread of diseases on air craft. What did we find? [Heather Krause:] You know, we found that research efforts, especially undertaken by the federal government, is lacking. There's a lack of research on how transmission occurs in real world settings, which considers how people behave in a transportation setting. Our report found that the federal research efforts have been fragmented and intermittent. And this is due to limited funding, highly segmented agency-specific research efforts, and a lack of coordination within the federal government. Both FAA and CDC agree that more coordinated approach is really needed to better leverage federal resources and fill research gaps. While FAA has previously allowed research on disease transmission and aircraft, the agency views public health as outside their aviation safety mandate. However, FAA does have the authority, the expertize, and access to airlines and data that no other agency possesses. [Holly Hobbs:] So let's say somebody does get exposed to COVID on an airplane. Who is responsible for contacting them to let them know? And how do they do this? [Heather Krause:] State and local public health agencies are principally responsible for contact tracing in the U.S., including when involves air transportation. However, for inbound international and domestic air travel passengers--who traveled on flights into the U.S. or between states--CDC is a key supporting role by obtaining those passengers contact information from airlines and other sources. They then communicate that information to local public health agencies. [Holly Hobbs:] But in our work, we've identified some challenges to this effort? [Heather Krause:] Yes. So in addition to all the other challenges the U.S. faced in trying to conduct contact tracing during the pandemic, including a fast spreading disease and under resourced local public health agencies--when you are involving air travel, things become especially challenging. Contact tracing involving air travelers requires coordination among more parties than most contact tracing investigations. It includes airlines, federal agencies, multiple local public health authorities. Contacting air travelers also requires complete and accurate contact information. Airlines aren't always able to collect complete and accurate data from passengers, requiring CDC to seek other sources for information--further delaying the response. [Holly Hobbs:] And you said these issues were already a concern, but the pandemic made this worse? [Heather Krause:] The pandemic brought about a tremendous increase in contact investigations-- more than a 10,000% increase, according to CDC estimates, without a related increase in CDC resources. This increase in investigations exposed longstanding weaknesses in CDC's data collection system and processes. And the time it takes to supplement and correct that information may render that information worthless for investigation purposes. CDC relies on an antiquated data system. The system relies on manual entry, which lacks controls to correct for errors and inconsistencies. Further, due to its design data can't always be easily aggregated across cases, which makes disease surveillance and response difficult. These are longstanding challenges. GAO first identified issues with contact tracing and air travel in 2004 and recommended improvements. [Holly Hobbs:] So, we've made recommendations on this for almost 20 years. Has the CDC taken any steps to improve this effort? [Heather Krause:] Yes. CDC has made some efforts to improve their data collection and processes, especially when it comes to international travelers. The CDC took regulatory actions to ensure that the airlines were collecting more accurate and complete information from passengers. Then in turn, the Customs and Border Protection, in coordination with CDC, has taken steps to automate the provision of that information to CDC for passengers on inbound international flights. While these steps are positive, the vast majority of air travel is domestic, and CDC has not been able to automate the collection of passenger contact information as it has for international travelers. Further, the data system used for contact tracing is outdated and does not meet the CDC's needs. CDC has recognized this as an issue, but has not dedicated funds for updating or replacing the system. {MUSIC} [Holly Hobbs:] So Heather just told us that while the pandemic has been on-going for years, the Federal Aviation Administration and CDC are still struggling to understand how best to protect passengers and crews from getting communicable diseases, and also struggling to notify travelers quickly when they've been exposed. Heather, what more do we think these agencies should be doing? [Heather Krause:] FAA has been resistant to expanding their leadership role in regards to public health safety on aircraft and in airports. We experienced this general reticence to taking on public health responsibilities when we recommended to FAA in 2015 that they develop a national aviation preparedness plan for communicable disease following the Ebola epidemic. While FAA agreed that a national plan was necessary, they didn't want to be the ones to do it. We believe that the FAA is the best position to coordinate federal research efforts on communicable disease and air travel. And therefore, we made the recommendation that Congress consider directing the FAA to identify and advance necessary research on communicable disease and air travel. This work should be done in coordination with relevant federal agencies as well as external partners. [Holly Hobbs:] And what recommendations did we make for the CDC about contact tracing? [Heather Krause:] We made three recommendations to CDC. We recommended that CDC improve the quality of air passenger information it collects and manages, including opportunities to increase automation and take action as appropriate based on this assessment. And we recommended that CDC redesign its data system or deploy a new one that would allow CDC to more effectively facilitate contact tracing for air passengers and conduct disease surveillance for air travel. [Holly Hobbs:] And last question. What's the bottom line of this report? [Heather Krause:] Just as we warned in 2015 that the U.S. aviation system needed to be better prepared for the pandemic, these two studies demonstrated that the insufficient research on how to better protect passengers from exposure of communicable disease--combined with an antiquated system for contacting passengers that are exposed--increases the risk that a pandemic could have a devastating impact on the U.S. aviation system and U.S. public health. If our recommendations are acted on, the nation will be better prepared for the next communicable disease threat. [Holly Hobbs:] That was Heather Krause talking about GAO's recent reports on aviation and communicable diseases and contact tracing. Thanks for your time, Heather. [Heather Krause:] Thank you. [Holly Hobbs:] And thank you for listening to The Watchdog Report. 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