Islamabad, 17 April 2021

Ministry of National Health Services, Regulations & Coordination of Pakistan via dated 18 December 2020 issued guidelines to the Civil Aviation Authorities and crew regarding identification, management and reporting of suspected case of COVID 19 to reduce the risk of COVID 19 transmission from passengers
arriving from abroad.

Rationale
The COVID-19 outbreak is a global public health challenge, causing acute respiratory illness leading to severe pneumonia and death in a segment of the cases. This has prompted the demand for the detection and management of suspected cases at Points of Entry (PoEs) including ports, airports and ground-crossings. It was therefore important that measures to limit the spread of the virus are taken ensuring control in earlier phase of the possible outbreak. In view of the above, a protocol was prepared in early 2020 to contain COVID-19.

However, given the speed of spread and newer scientific evidences about the spread of virus, the situation on grounds is changing which has necessitated
updating the guidelines. These protocols are equally applicable to all crew members and staff getting off the planes.

Keeping pace with the evolving epidemiological situation across the world, these guidelines will be reviewed and updated periodically by Ministry of National Health Services, Regulations and Coordination.

Definitions
Contacts are people who (on the aircraft)
• Any person sitting within 2 meters of the suspected case
• Any travel companions or persons providing care who had close contact with the suspected case 2
• Any cabin crew member designated to look after the ill traveler(s), and crew members serving in the section of the aircraft where the suspected case(s) was seated. Cockpit crew are not concerned if they have not circulated into the cabin and come in close proximity of the ill traveler (s)/suspected case(s).
• If severity of the symptoms is high or extensive movement by the case(s) indicate more extensive exposure, passengers seated in the entire section or, depending on aircraft design and assessment on arrival by airport health authorities, all passengers on the aircraft may be considered contacts.

Symptomatic means developing the symptoms specific to a disease - COVID-19 in this case Asymptomatic means absence of any symptoms specific to a disease - COVID-19 in this case

Summary of Criteria for Inbound International Passengers

• All passengers are required to install and register on the Pass Track App.
• Countries will be categorized into category A, B and C primarily based on epidemiological risk assessment reviewed fortnightly by MoNHSR&C
• Returning travellers from Category A countries
o No COVID 19 RT-PCR test required before or after travel
• Returning travellers from Category B countries
o Show proof of a negative RT-PCR test not older than 96 hours prior to travel
• Returning travellers from Category C countries
o Show proof of a negative RT-PCR test not older than 96 hours prior to travel AND mandatory RT-PCR test will be taken when traveller land in Pakistan.
o Additional restrictions can be imposed with prior notice on returning travellers, including mandatory quarantine at arrival.

Category A
• The people coming from this category of countries, do not require RT-PCR test as a criterion before travelling to Pakistan. Passenger from these countries do not need to quarantine after arrival as well, with the essential premise that they are symptoms free based on screening conducted by authorities at the port of arrival.
• Secondly, all passengers need to download pass track app, and insert data on the pass track app before landing in Pakistan (available at Android Play store
https://play.google.com/store/apps/details?id=com.passtrack.nitb.gov.pk) with details of interface presented as Annex C.
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• If the passengers by any possibility do not have pass track app, they would need to fill out the web version of the Pass Track App (https://passtrack.nitb.gov.pk/login) and a health declaration form (HDF) before landing.
• Passengers arriving from these countries if found to have symptoms, when screened at the port of arrival by Pakistani authorities, will be required to have a COVID 19 RT PCR test conducted and its result essentially submitted to the designated authorities. within 48 hours of their arrival. Contact details of such suspected cases will be acquired by port authorities, and information about test report submission process will be provided to such suspected cases before they leave the airport. Such suspected cases (based on screening at the port/point of Entry) are not required to be retained/quarantined by the authorities at the time of disembarkation and can proceed to their destination. In instances where the test is found to be negative, they do not need to be quarantined at their respective homes/place of visit; however, in case of a positive RT-PCR result, such cases would be required to self-isolate as per the guidelines for positive cases and isolation procedures. Furthermore, the contacts of positive case need to self-quarantine in accordance to the guidelines for self-quarantine.

Category B
• Travelers coming from this category of countries would need to get tested and provide a negative COVID 19 RT-PCR test result before boarding for travel to Pakistan. The COVID 19 RT PCR test is required to have been conducted within a duration of 96 hours prior to the time of departure. The negative RT-PCR test needs to be shown at the time of boarding at the port of origin, as well as during the health screening at arrival in Pakistan. Those not possessing a test result, may provisionally be considered for travel to Pakistan, with essential adherence to the procedures of arrival laid out for screening and testing as applicable for Category A countries.
• Secondly, all passengers need to download Pass Track App, and insert data on the pass track app before landing in Pakistan.
• If the passengers by any possibility do not have pass track app, they would need to fill out the web version of the Pass Track App (https://passtrack.nitb.gov.pk/login) and a health declaration form -HDF before landing.

Category C
• Category C countries are defined due to an extraordinary public health event related to the COVID-19 pandemic and require more vigilance.
• Travelers arriving from this category of countries will follow the same procedures as outlined travelers coming from category B countries.
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• Additionally, travelers will be identified upon arrival at a PoE in Pakistan, a mandatory COVID-19 RTPCR test will be taken. Passengers will be allowed to continue to their final location but will need to quarantine until they receive their test results.
• Further restrictions like mandatory quarantine on arrival and ban on travel will be considered. Any such restriction will be communicated to concerned stakeholders.

Risk Level for COVID-19 Travel Health Notices
It is recommended that Pakistanis avoid all non-essential international travel due to the current level of risk for disease transmission across the world.

Preparations-Administrative and Logistics
• Issuing and fortnightly reviewing updated policies, guidelines and SOPs for inbound international travelers.
• Ensured Compliance of guidelines and SOPs for inbound international travelers.
• Updating fortnightly online information for inbound international travelers and requirements (including a map and list of category A, B and C countries) based on MNHSRC guidelines by updating travel section of COVID19/NCOC/Mo NHSR&C website.
• Staggering of flights and passengers in order to avoid congestion at the POE.
• Overall enforcement of health guidelines at airports (including the mandatory mask) and maintaining logistical arrangements for a smooth flow of passengers to avoid congestion.
• Passengers arriving without Pass Track App: Airlines to be informed about non-compliance with fixation of responsibility/imposition of fines.
• Passengers that do not carry a smart phone or have an apple gadget/phone need to fill out the web version of the Pass Track App (https://passtrack.nitb.gov.pk/login) and HDF: Fortnightly notification to all airlines by CAA, strict monitoring and compliance is required.
• Weekly schedule of all the flights to be available with details such as:
o Origin and route
o Time of departure and arrival
o The number of passengers
• Identification of competent staff
o Personnel at health counters
o Doctors
o Nurses/ Paramedics
o Data operators
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• Detailed trainings with refreshers of all the staff and clear guidelines for their roles and responsibilities.
• Establishing coordination between Central Health Establishments and
o Airlines
o Customs
o FIA/ ASF/ CAA
o ED/Directors of the Hospitals
o MoFA
o LEAs / NDMA
o Ministry/Departments of Health etc.

Operations

Once administrative and logistic requirements are met, operational modalities would need exact specifications, following is what is recommended:

STEP-1: INSIDE THE PLANE - BEFORE DISEMBARKATION
• All passengers are mandated to download Pass Track App to insert their data prior to boarding.
• If passengers do not have a smart phone, they will need to fill out the web version of the Pass
Track App (https://passtrack.nitb.gov.pk/login) and the Health Declaration Forms (HDF) prior to boarding.
• The airline shall ensure and guide the travelers to download the Pass Track App or to fill out the web version of the Pass Track App (https://passtrack.nitb.gov.pk/login) and the HDFs if they do not have a smart phone. This will be mandatory for entry inside Pakistan (Annex ‘A’)
• Passengers travelling from category B and C countries will need to show proof of negative COVID-19 RT-PCR test prior to boarding.
• CAA shall ensure that all international airlines landing at any airport of Pakistan follow the guidelines provided by the Federal Government (M/O National Health Regulations and Coordination). Non-compliance should result in strict punitive action.
• Sanitizers should be placed by CAA at arrivals for travelers.

STEP-2: FIRST CONTACT AFTER DISEMBARKING -THERMOSCREENING
• All travelers should be in queue with a distance of 6 feet and will be undergoing thermo screening by thermo guns and/or thermo scanners.
• The staff of CHE will evaluate the results of scanning:
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o Traveler detected with fever shall be marked, supervisor will be informed immediately and shall be taken to Health Counter
o Travelers with no fever shall go through process as such after providing RT-PCR test results if coming from category B country.
• Airport Security Force and CAA will help mob management:
o Mandatory check of RT-PCR test for passengers arriving from category B and C countries.

Passengers are required to have a negative RT-PCR test not older than 96 hrs prior to departure, this will be checked by airline prior to passenger boarding the flight: Fortnightly notification to all airlines by CAA, strict monitoring and compliance is required.
o Passengers arriving from category B countries without negative RT-PCR test will be taken aside, information will be collected, and passengers will undergo mandatory testing by Surveillance/RRT within 48 hours of arrival into the country. Non-compliance will be reported, and CAA will proceed with punitive action to ensure compliance.
o Passenger arriving from Category C countries will be taken to a waiting area, until a RRT arrives at the airport and a COVID-19 RT-PCR is taken.
• Passengers with filled out Pass Track App and negative health screening allowed fast track access to FIA counters.

STEP-3: HEALTH COUNTERS – SEGREGATION OF TRAVELERS
• Each Health counters will be managed by a quarantine assistant and/or health worker
• Pass Track App or filled out web version of the Pass Track App (https://passtrack.nitb.gov.pk/login) and HDFs shall be collected at the counters and analyzed as per the questions, helping segregation and preliminary decisions

STEP-4: ASSESSMENT AND CLASSIFICATION OF TRAVELERS
As stated above once all travelers have passed through the said process, there will be two classes of travelers:
Symptomatic Travelers:
The health officers and health staff will see and examine the HDF, the RT-PCR test report of the travelers coming from the category B and the travelers for the following signs and symptoms.
• Fever
• Cough
• Difficulty in breathing
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Either of these should initiate the protocols for suspicion of COVID-19. Following actions will be taken by Health officer/Health Team Lead in case of a suspect:
• Passengers when screened at the port of arrival by Pakistani authorities, will be required to have a COVID 19 RT PCR test conducted and its result essentially submitted to the designated authorities. within 48 hours of their arrival. Contact details of such suspected cases will be acquired by port authorities, and information about test report submission process will be provided to such suspected cases before they leave the airport. Such suspected cases (based on
screening at the port/point of Entry) are not required to be retained/quarantined by the authorities at the time of disembarkation and can proceed to their destination. In case of a positive RT-PCR result, such cases would be required to self-isolate as per the guidelines for positive cases and isolation procedures.

Furthermore, the contacts of positive case need to self-quarantine in accordance to the guidelines for self-quarantine.
Asymptomatic Travelers
• All other-than-above travelers will be allowed to go home with written instructions/guideline to STAY HOME and will be followed up as per protocol (Annex ‘B’)
• PP/CNIC No and contact details of all will be collected in the Pass Track App before they leave the airport.

STEP-5: PRECAUTIONS TAKEN FOR STAFF
Overall precautions against the spread of COVID-19 shall be observed by all the staff concerned in these guidelines. It is also important that if any of the staff members during this cycle of SOPs has symptoms of the disease post exposure has to be reported at the earliest and isolated as per protocols.

IEC material to be explained to the staff at the airport during detailed briefs and at the same time measures ensured for the aircraft crew.

STEP-6: DATA COLLECTION
• Primary source of data will be coming from the Pass Track App which will share the data with NADRA and subsequently with NEOC. Travelers Surveillance Management Information System-TSMIS shall be updated by integration between Pass Track App data base or IDIMIS
• Where applicable NIH and respective labs will be required to convey results of travelers in the Pass Track App and to CHE.
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Note: The above recommendations are being regularly reviewed by the Ministry of National Health Services,

Regulations & Coordination and will be updated based on the international & national recommendations and best practices. The Ministry acknowledges the contribution of Dr Irfan Tahir, Ms. Sherbano Akhtar, Dr Urooj Aqeel and HSA/HPSIU/ NIH team to compile these guidelines.

References:
1. World Health Organization. Operational considerations for managing COVID-19 cases or outbreak in aviation, Interim
guidance, March 2020

2. ICAO Global Aviation Safety Plan YOUR COOPERATION WILL HIGHLY BE APPRECIATED For health helpline, please dial 1166