Travel is a growing challenge in efforts to contain the coronavirus. Take the case of a man with COVID-19 symptoms who boards a flight to Massachusetts after a work trip to North Carolina. He doesnt want to ride out a serious illness in a hotel room. A woman from the Boston area develops a sore throat, her first sign of COVID-19, as she and five companions drive north from Florida, dropping off three passengers in New Jersey.

And then theres the family of four who lands at Logan Airport after visiting relatives in Texas. Theyve taken three flights and stayed overnight in a hotel because they missed a connection. Two days later, three members of the family test positive for the coronavirus. Its hard to fathom all the surfaces they touched and the individuals they may have exposed to the virus.

Its a lot, says Lorna Kiplagat, a contact tracer assigned all three cases, a lot of people.

Kiplagat says the travelers in each case isolated as soon as they got home. Her challenge, and that of Massachusetts'Community Tracing Collaborative, is to try and trace the trail of infection. The woman in the car from Florida couldnt remember details about the rest areas or restaurants shed stopped at along the way. With the airline passengers, Kiplagat can collect travel records: all the flight details, seat assignments and notes about movement on the plane.

Then you send that off, says Kiplagat, who is on loan to the contact tracing program from the Lowell Community Health Center. You cant follow after that, you dont know.

Kiplagat can't be sure what happens after the information gets passed on to other agencies and states. Theres little chance fellow air passengers will be warned about a potential exposure in a timely manner. Here are the steps to making a notification:

Each step is a delay that makes tracing a case and getting to someone who may be spreading the virus more difficult, says Adriane Casalotti, chief of government and public affairs with the National Association of City and County Health Officials.

Casalotti says her members, the key contact tracers in most states, are already frustrated by testing shortages and delayed test results as they try to contain the virus.

When you look at these multi-state, multi-methods of transportation challenges, it really is daunting, she says.

Travelers can help by wearing masks, staying at least six feet from anyone besides their regular close contacts and washing their hands often. Heres another tip from Joe Allen, an associate professor at Harvards Chan School of Public Health: Be extra careful before you even board a flight.

The time on the airplane is probably the lowest risk for the whole travel experience when youre flying, says Allen. Thats because cabin air passes through purifying filters, known as HEPA filters, as recommended by the CDC and is replaced 10-12 times an hour.

But think about everything else that takes place when you travel by air, Allen says. You maybe rode in a subway or a taxi or an Uber. You waited in a security line for sure. You waited to check in your bags, you congregated at the gate, you were maybe crowded into a packed jetway.

Allen is urging airlines and airports to improve ventilation inside those jetways. Infectious disease doctors worry about all the places with stagnant air where travelers congregate, such as airports, bus and train stations.

Airlines have increased cleaning and vigilance about wearing masks. Many ask passengers before boardingif they have symptoms or have been exposed to the coronavirus. An airline industry trade group is asking the TSA to do temperature checks but the TSA says temperature is not a uniformly reliable detection measure. Kiplagat, the contact tracer, says the country needs fast test results now as college students travel to distant campuses.

I wish they had instant testing at the airport, just get tested and get your results right there before you board the flight, she says. I think thats the only way out.

But there arent enough rapid, accurate tests available right now. And theyd likely detect a significant number of people who still test positive even though theyve recovered from COVID-19, says Dr. Gabriela Andujar Vazquez, an infectious disease doctor at Tufts Medical Center. Andujar Vazquez says her main worry is about the return to full airplanes even though she understands the need to recover lost revenue.

The concerns are about crowding, she says. Trains and buses are the same, making sure theres a maximum capacity that allows for physical distancing even with a mask.

Don't travel unless it's an emergency, saysAndujar Vazquez, who also works in the hospitals travel clinic.

I would avoid it as much as possible, she says, especially if you see that the state where youre going has a lot of cases.

Andujar Vazquez urges travelers to check the rules for destination states. Twenty five states have imposed travel restrictions during the pandemic. Many, including Massachusetts, require a 14-day quarantine for anyone entering from a higher risk state. The list of states with restrictions is changing as case counts rise and fall.

Lawsuits in Kentucky, Maine and Hawaii have challenged these restrictions with mixed results. Its not clear if the suits will mean fewer states try to limit travel or if residents see them as an excuse to ignore existing orders.

Some public health and elected leaders say they sympathize with the urge to travel and the challenge of deciding when and where to go.

Its difficult to navigate risk in those situations and keep making public health the easy choice when it feels really hard, says Casalotti. These travel cases really show that no matter what corner of the country you live in, we are all in this together.

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The COVID-19 Risks You May Take, And Create, While Traveling - WBUR