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COVID is surging in China, a new variant is reportedly the most contagious yet, testing is back in some airports. How do I avoid the virus while flying?

It's been nearly three years since the COVID-19 pandemic was declared, but if you head to some airports right now you might think you've returned to the earlydays of the outreak.

A surge of cases in China has prompted the U.S. to require a negative COVID test for travelers flying in from the Peoples' Republic of China, Hong Kong and Macau. That went into effect on Jan. 5. The European Union recommends the same measures for its member states.

(Meanwhile, some countries never dropped their testing requirements. Venezuela and Seychelles, for example, still require proof of a negative COVID test to board a flight to those countries.)

And in the U.S. a growing number of airports are swabbing noses — of international passengers only. It's for a voluntary program from the Centers for Disease Control and Prevention to detect new variants in travelers arriving from outside the U.S. Some 7 airports are doing the testing, including LAX and Seattle-Tacoma.

In addition to the China situation, concerns about COVID are rising because of the growing dominance of the omicron variant XBB.1.5, which the World Health Organization calls "the most transmissible variant it has yet detected" – although vaccinations and boosters appear to be holding up when it comes to protection against severe and possibly fatal disease.

"Whether more countries return to mandatory testing because of XBB.1.5 or other variants that emerge is unknown, but also unnecessary since the world is currently swimming in COVID," says Dr. Amesh Adalja, senior scholar in residence at the Center for Health Security at the Johns Hopkins Bloomberg School of Public Health.

Adalja says testing is a political rather than public health decision to allay the fear of citizens. Other public health experts have noted that testing didn't prevent variants from moving around the globe – although it often delayed their arrival.

Meanwhile, an individual passenger has personal concerns: It'd be great not to catch COVID during a trip. To reduce your odds of infection, you can turn to the familiar precautions from early in the pandemic – you know, the ones that many people no longer follow.

Boost yourself

Many older adults have not gotten the latest booster, which protects both against the original virus and Omicron variants, says Dr. Preeti Malani, a professor in the department of infectious diseases at the University of Michigan School of Medicine. She calls the shot "an absolute must prior to travel."

Ahead of your flight

Since airline rules regarding precautions could change, when you book you can improve the chance of getting updates by checking the box that allows text messaging to your phone. Downloading the airline's mobile phone app will let you easily search for boarding requirements for your specific flight. Having trouble reaching customer service by phone to ask about flight rules? Direct message the airline over Twitter or use the online chat options many airlines offer.

At the airport

"My advice around international travel is to wear masks if you are in a crowded indoor space — not just on the airplanes but boarding, security lines and anywhere else that it's crowded," says Dr. Malani. "You can take a break from masks to eat/drink while waiting to board but try to find a spot that's away from the crowd."

You'll definitely want to bring your own masks. Any masks available for folks at airports or on board are likely to be paper masks; the CDC recommends "high quality masks or respirators" during travel." Respirators are masks labeled as N95s or KN95s, which provide a tighter fit and better filtration. Respirators are sold online and in stores like pharmacies. Freebies are handed out at some community health centers and public libraries.

And remember distancing? It's still a good idea during boarding and deplaning, "especially now with the highly contagious XBB COVID variant," says Leonard Marcus, co-director of the Preparedness Initiative at Harvard University.

Don't forget your hands

Research has found that bathroom door handles and seat trays and other objects are not a significant route of transmission for the virus, but it's not impossible. You can gain a bit of an edge by using hand sanitizer or an alcohol wipe. Since airlines aren't always handing out wipes these days and in-flight bottles could be depleted, the experts we spoke to advise bringing your own. "These are good public health measures so people who have concerns or heightened vulnerabilities might consider these extra steps," says Marcus. And it's not just to ward off COVID. The flu, respiratory syncytial virus and colds can also spread via droplets.

If you do bring hand sanitizer in your carry-on luggage, limit the bottle to 3.to-4 ounces so your supply doesn't have to be screened by the Transportation Security Administration (TSA). If you're thinking of reaching into your cupboard for a vial you you purchased at the start of the pandemic, check the date to be sure it hasn't expired.

Create a protective zone for your airplane seat

A window seat reduces exposure to people who are standing in the aisles "and breathing down" on you, says Marcus. He's one of the authors of a 2021 study from the Harvard T.H. Chan School of Public Health on COVID 19 and air travel, which that found that the triple combination of masking, air cabin conditions and distancing during boarding and deplaning combine to lower your risk of contracting COVID on a flight.

He also suggests turning on the air vents: "The ventilation pushes clean air from above to the floor. The more of that the better." (Bring a sweater, though, since opening those vents can make your space colder.)

Make a plan just in case

"I would suggest having a plan for what to do if you become ill," says Dr. Malani — including where you would go to get medical care. U.S. embassies and consulates in many foreign countries have lists of doctors and hospitals that treat foreigners.

Malani also advises packing supplies-- including COVID tests and over-the-counter medications to treat symptoms like a runny nose and sore throat and fever if you get COVID-19 or other illnesses.

If your doctor has said you would be a candidate for Paxlovid if you contract COVID-19, ask for advice with regard to the drug before taking a trip.

Another recommendation from the experts: Trip insurance and travel medical insurance to help transport you back home (if severely ill in an international setting) is another consideration.

Fran Kritz is a health policy reporter based in Washington, D.C., and a regular contributor to NPR. She also reports for the Washington Post and Verywell Health. Find her on Twitter: @fkritz

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