December tends to be a busy travel month: many of us are flying or driving to see family, fitting trips around work, school events, and holiday gatherings. It’s a fun time of year, but it also coincides with peak respiratory virus season, and a lot of close indoor contact.
Getting sick on day two of a long-planned trip is one of the fastest ways to derail those plans. With a bit of preparation, you can lower your chances of getting seriously ill, and make it easier to handle minor issues that come up while you’re away.
As a direct primary care (DPC) doctor, I spend a fair amount of time helping patients prepare for travel from a medical standpoint: reviewing their health, refilling prescriptions, and discussing vaccines they may want to consider prior to their trip. I also make sure they have a reasonable plan if something comes up while they’re away. This post is a quick guide to how I think about “DPC on the go” for my patients at Sana Sana.
Plan Ahead with your Doctor
One of the advantages of DPC is that you don’t have to wait weeks for a rushed visit to talk about travel. A brief pre-trip check-in can go a long way, especially if you:
- Have chronic conditions like diabetes, heart disease, asthma, COPD, or any others that may require some consideration prior to travel
- Are traveling with young children, or visiting older or medically fragile relatives
- Are heading somewhere with very different medical infrastructure than what you’re used to
In a typical pre-travel visit, we’ll review your current health and any recent issues, and make sure your regular medications and refills will comfortably cover the whole trip. We’ll also talk through your itinerary, focusing on things like the climate, altitude, and adventurous excursions or activities (planned or possible). We also take known region-specific health risks into consideration, like infectious diseases, or little to no access to healthcare infrastructure. From there, we can decide together what makes sense for your personal travel health kit and whether any preventative or “just in case” prescriptions are appropriate for you.
Because DPC gives you direct access by text, phone, and telehealth, you also don’t have to make these decisions in a vacuum once you’ve left home. If a new symptom pops up the night before your flight, if you’re not sure whether to start a medication you packed, or if you’re debating whether something can wait until you return, you can reach out and get guidance from someone who already knows your history, rather than relying on generic advice or urgent care in an unfamiliar place.
Seasonal Vaccines are Travel Vaccines
If you’re traveling in the winter, being up to date on key seasonal vaccines is one of the simplest, highest-yield steps you can take to protect yourself and the people you’re visiting.
A few big ones to think about:
- Flu vaccine: Influenza activity tends to peak in the colder months, and flu spreads easily in indoor gatherings. Getting vaccinated doesn’t guarantee you won’t get sick, but it can reduce your risk of infection and of severe illness or complications.
- RSV vaccine: RSV can be particularly serious in older adults and certain high-risk groups. For many patients in these categories, RSV vaccination is now recommended; we can talk about whether you fall into one of those groups and whether it makes sense for you.
- COVID booster: For older adults, people with chronic conditions, and anyone who wants to reduce the risk of severe COVID, an updated booster remains important heading into a season of crowded airports, planes, and indoor events.
These vaccines are especially important if your trip includes time with elderly relatives, infants, pregnant family members, or anyone who is immunocompromised. Even if you feel well, lowering your own likelihood of infection also lowers the chance of bringing something serious into a higher-risk household.
If you’re traveling internationally, there may also be destination-specific vaccines or preventive medications to think about (for example, certain parts of the world where additional vaccines or malaria prophylaxis are recommended). That’s exactly the kind of thing that benefits from a conversation with a doctor who has time to look at your specific itinerary and health history.
Prepare a Simple Travel Kit
Having a few thoughtful basics in your carry-on can make a big difference when small issues arise at the wrong time. Not everything here is right for everyone. I like to customize this kind of list with patients based on their health and their trip, but the medications below help you better manage health issues that might come up while you’re away.
Over-the-Counter Basics
Pain and Fever
These anti-inflammatories can cover most minor headaches, muscle aches, and low-grade fevers that might pop up during travel.
- Acetaminophen
- Ibuprofen or similar non-steroid anti-inflammatory (unless you need to avoid due to other health conditions)
Stomach and Digestion
- Loperamide (Imodium) for short-term control of diarrhea on travel days
- A heartburn/acid-relief option (particularly if you eat or drink a more acid inducing diet while traveling):
- Simple antacids (chewable tablets), and/or
- An acid reducer, such as famotidine or ranitidine
Allergies and Mild Skin Reactions
- An antihistamine, such as diphenhydramine (Benadryl)
- Over the counter cortisone cream
Your Regular Medications
This one sounds obvious, but it’s easy to underestimate:
- Pack enough of each daily medication for your entire trip, plus a small buffer
- Keep critical medications in your carry-on, not checked baggage
- Bring an up-to-date medication and allergy list (on your phone and on paper)
- For some patients, having an extra inhaler, an EpiPen, or nitroglycerin (if prescribed) is essential rather than optional
Basic First Aid
A tiny first-aid bundle can cover a lot of minor issues. None of these take up much space, and can spare you from hunting for supplies in an unfamiliar place.
- A few adhesive bandages
- Small packets of antibiotic ointment or alcohol wipes
- Blister pads if you’re planning to walk a lot
“Just in Case” Prescriptions
My wife and I had the great fortune of visiting China in 2018, and we ended up having Peking duck as a substitute for turkey on Thanksgiving day abroad. The food was great, but my wife is a bit more of an adventurous eater than I am, and something along the way got her sick.
I suspected a travel illness that would respond to simple antibiotics, and found myself navigating the dark streets of old Beijing, at a time when only tiny convenience marts were open, using a mix of Google Translate and my best charade act to explain that I was looking for medications. A kind shopkeeper understood my plea, and provided me with an appropriate course of antibiotics (that I was familiar with and had prescribed stateside). He insisted I didn’t need to pay, and wished recovery for my wife. Thankfully, the meds helped her bounce back quickly, and ever since then I seldom travel without a “just in case” course of antibiotics when it’s appropriate.
The key word there is appropriate. “Just in case” prescriptions are not something everyone should have by default. But for certain patients and certain trips, they can make sense if you and your doctor have talked clearly about when and how to use them, and when to seek in-person care.
A few of the more common ones include:
- A broad spectrum antibiotic, such as azithromycin
For some travelers, especially going to areas where bacterial traveler’s diarrhea is common, a short course should be considered, if paired with a discussion on when they would be appropriate and how best they might be taken. - Scopolamine patches for motion sickness
For patients with significant motion sickness (for example, cruises or rough ferry rides), there is a prescription strength formulation of the small scopolamine patches that is a bit more effective than the over-the-counter products - Acetazolamide to help manage altitude
For patients traveling to high altitude who are at risk for altitude sickness, a preventive or early-treatment dose of acetazolamide, a diuretic, can sometimes be appropriate. - Ondansetron (Zofran) for vomiting
A few tablets of ondansetron can help reduce significant nausea and vomiting, and this medication can be particularly helpful if a vomiting illness is making it hard to stay hydrated. It really only treats the symptom, and won’t eliminate the nausea and vomiting entirely, but can buy you some valuable time to seek further care and try to recover some fluids lost.
The common thread is that none of these medications should be used in a vacuum. They’re most helpful when they’re chosen and explained in advance by a doctor who knows your conditions, your other medications, and the realities of where you’re traveling.
Reducing Respiratory Illness Risk in Transit
During the early phases of the COVID-19 pandemic, airplanes understandably developed a reputation in many people’s minds as high-risk settings. Over time, however, data and modeling have suggested the airplane itself is not a common site for infectious spread. Modern commercial aircraft use high-efficiency particulate air (HEPA) filtration and high air-exchange rates, with cabin air refreshed roughly every 2–3 minutes. These systems are highly effective at removing airborne particles, including respiratory droplets and aerosols. A review of documented Covid travel cases found very few confirmed instances of in-flight transmissions, compared with the enormous number of passengers who flew throughout the pandemic.
These studies suggest the airplane cabin itself may not be the highest-risk part of your journey, but travel remains a common way to catch a winter bug. Given the volumes of people from all over crossing paths during mass transit, it is worth considering simple risk reducing techniques for places like airports or train stations. This is especially true if you’re visiting vulnerable family members.
- Use hand sanitizer, or better yet wash your hands, after handling security bins, railings, and touch screens, and before eating.
- Consider wearing a mask in crowded indoor areas like airports and boarding lines if you can tolerate it, particularly if you or your loved ones are at higher risk.
Before you Head Out!
Travel is meant to be a time to reconnect, rest, and see something new, not to spend days in a hotel bed googling where the nearest clinic is and how tourists can seek care. A bit of planning can dramatically reduce the stress around holiday trips. If you’ve got winter travel on your calendar and want help getting ready, I’m always happy to walk through your plans, your health history, and your questions.
If you’re already a Sana Sana Clinic patient, you’re always welcomed to reach out and schedule a pre-travel visit or telehealth check-in. If you’re not yet a member and you’re curious about what it’s like to have this kind of ongoing, direct access to your doctor, I invite you to click the link to sign up for a meet and greet!
Wishing you and your family a happy and healthy Holiday season!
