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Commentary on Special Report in The New England Journal of Medicine by Mark Barnes, JD, LLM, and Paul E Sax, MD, Challenges of “Return to Work” in an Ongoing Pandemic

Bunn, William B. MD, JD, MPH; Connor, Bradley A. MD; Hamer, Davidson MD; Kozarsky, Phyllis MD

Author Information
Journal of Occupational and Environmental Medicine: October 2020 - Volume 62 - Issue 10 - p e600
doi: 10.1097/JOM.0000000000002000
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To the Editor:

In response to the June 18, 2020 Special Report by Barnes and Sax, we would like to provide additional considerations regarding workforce travel policies.1

Although the authors discuss potential quarantine on arrival at the destination, they make no mention of the very important need for pre-travel care considerations as well as post-travel care on return. The most pertinent omission is the need for post-travel screening on return from an at-risk area, keeping in mind that importation of COVID-19 by international travelers was one of the driving forces in the early spread of this virus globally.

The risk of contagion of international business travelers to co-workers, family, and the community must be considered. Studies show 22%–64% of international travelers will have unresolved health problems meriting post travel case management.2 COVID-19 creates a special consideration, but other infections must also be considered. The symptoms of seasonal influenza are indistinguishable from COVID-19, especially early on and flu vaccination is important.

In addition, the need for pre-travel preparation and counseling is a key part of the discussion. Pre-travel education including information about COVID-19 as well as other destination-specific health risks should be offered. The counseling and education should focus on the prevention of infection, use of protective equipment, strategies to prevent illness, and routine vaccinations and chemoprophylaxis. A full review of all travel vaccinations with detail from the Advisory Committee on Immunization Practices (ACIP) recommendations is indicated.3

Other special considerations for the international business traveler include reporting of infectious diseases acquired during such travel not only to appropriate public health authorities but also to Occupational Safety and Health Administration (OSHA).


1. Barnes M, Sax PE. Challenges of “Return to Work” in an ongoing pandemic. N Engl J Med 2020; 383:779–786.
2. Angelo KM, Kozarsky PE, Ryan ET, Chen LH, Sotir MJ. What proportion of international travellers acquire a travel-related illness? A review of the literature. J Travel Med 2017; 24:tax046.
3. Available at: Accessed July 19, 2020.
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