Airport Lessons Learned from the COVID-19 Pandemic (2023)

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10 To compile lessons that U.S. commercial service airports learned on preventing COVID-19 transmission among airport workers, tenants, and the traveling public, the project team con- sidered multiple information sources. The primary sources were semi-structured interviews with airport officials (Section 2.1) and public health officials (Section 2.2), as well as a search of peer-reviewed literature (Section 2.3). The remainder of this chapter describes the project team’s methods for accessing this information, noting associated limitations as appropriate. 2.1 Semi-structured Interviews with Airport Officials This project’s principal data collection mechanism was a series of videoconference inter- views with officials from U.S. commercial service airports. An online survey was considered but for multiple reasons was not adopted. Most notably, some lines of inquiry for this research might have been viewed as sensitive, for example (1) COVID-19 transmission incidents at the workplace and their underlying contributing factors, (2) reactions to government mandates and guidance, and (3) assessments of vendors’ claims regarding the effectiveness of emerging technologies. These topics were believed to be best handled via videoconference with assurances that responses would be kept anonymous. Additionally, the project team suspected that airport respondents would be more engaged and inclined to provide thoughtful responses during a videoconference than on an electronic survey. Finally, the project team was concerned that elec- tronic surveys might be either deleted or forwarded to people with limited firsthand knowledge of airports’ pandemic responses, which would make them less useful. This chapter’s subsections describe how the project team planned for, conducted, and docu- mented the videoconference interviews. 2.1.1 Development of Interview Questions Through brainstorming sessions, the project team developed questions designed to investigate airports’ lessons learned from the COVID-19 pandemic, particularly with respect to measures taken to reduce disease transmission. The interview topics were chosen based on (1) a review of the published literature, (2) an ACRP March 2018 Insight Event (Airport Roles in Reducing Trans- mission of Communicable Diseases), (3) a two-hour webinar convened for ACRP in April 2020 (Helping Airports Plan for and Respond to Communicable Disease Threats), and (4) responses from the public health interviews (see Section 2.2). The following topics were chosen for the interviews: • General airport information • Airport CDRPs C H A P T E R 2 Research Methods

Research Methods 11   • Communication and coordination with public health authorities and other parties • Social distancing at airports • Masks and face coverings at airports • Cleaning and hygiene at airports • COVID-19 screening and testing at airports • Changes to airport design and infrastructure For each topic, project team members prepared initial lists of questions. The team reviewed these lists, compiled them into one final list, conducted two test interviews with a draft script, and prepared the script to use in the first wave of interviews. After the first wave of interviews, the project team reevaluated the script. Several questions were removed due to time concerns, and a few were added based on feedback from the first interviews. Appendix A includes the final interview questions, which were used for the remainder of the project. Some questions were restricted to discrete response options; others prompted narrative responses. 2.1.2 Selection of Commercial Service Airports to Invite to Participate Project resources allowed for interviews of up to 140 commercial service airports. Researchers used the most current FAA enplanement statistics to determine which of the nation’s commercial service airports would be invited to participate. At the time this research project commenced, the most recent FAA dataset (FAA 2020b) included enplanement statistics through 2019. That dataset indicated that 522 commercial service airports operated in the United States during 2019. Table 2-1 breaks these down by airport type, as determined by the FAA based on the number of annual enplanements. For example, the FAA defines a large hub as any commercial service airport with at least 1 percent of the nation’s commercial service enplanements in a calendar year. Based on previous experiences engaging with commercial service airports for interviews, the research team expected a 40 percent response rate to interview invitations, suggesting that as many as 350 commercial service airports would need to be contacted to reach the target of 140 interviews. Based on this assessment and the latest FAA enplanement statistics, the research team planned to focus interview recruiting on the 344 commercial service airports that had at least 20,000 enplanements in 2019. This selection process ensured that the sample would not be biased by airports in any given region or with any given ownership structure. The 344 airports chosen for recruiting represented 66 percent of the commercial service airports in the United States as of 2019, and the airports chosen for recruiting collectively represented more than 99 percent of commercial service enplanements in 2019. Airport Type Count Total Number of 2019 Enplanements Percentage of 2019 National Enplanements Considered for Interviews? Large hub 30 663,402,989 70.9 Yes Medium hub 32 159,125,491 17.0 Yes Small hub 74 81,872,201 8.7 Yes Nonhub 267 30,700,055 3.3 Partially* Nonhub nonprimary 119 592,791 0.1 No All combined 522 935,693,527 100 N/A * Due to limitations in project resources, only nonhub commercial service airports with at least 20,000 enplanements in 2019 were invited to participate in interviews. In 2019, 188 of the 267 nonhub airports met this criterion. Source: FAA 2020b. Table 2-1. Profile of commercial service airports in the United States in 2019.

12 Airport Lessons Learned from the COVID-19 Pandemic Another consideration in recruiting airports for interviews was project resources, which limited the total number of invitations that could be issued. As noted in Section 3.1, project resources allowed for recruiting of 313 commercial service airports. 2.1.3 Recruiting Commercial Service Airports for Interviews Recruiting for interviews occurred in waves between February 2021 and December 2021. Roughly once per month, a new recruiting wave targeted 20 to 30 additional commercial service airports. All recruiting occurred via email as follows: • For each commercial service airport chosen for recruiting, the project team first identified an email address for a point of contact. For larger commercial service airports, email addresses were typically obtained for the director of operations (or a similar position); for smaller air- ports, email addresses were obtained for the executive director (or a similar position). Email addresses were obtained for more than 95 percent of the airports targeted for recruiting. • For every airport included in a recruiting wave, the project’s principal investigator sent indi- vidual email messages to the corresponding point of contact. The messages were personalized to contain the name of the airport and the name of the point of contact, but otherwise had identical content. These emails explained the goal of the project, listed the topics to be covered during the videoconference interviews, indicated that interviews would not last longer than 90 minutes, assured the points of contact that all participating airports would remain anony- mous, and asked the points of contact to either list preferred times for an interview or forward the message to a colleague who could better speak to the interview topics. • If an airport did not respond to the initial email interview request after two weeks, the principal investigator sent a second email to the same point of contact. This second message included the original invitation message and encouragement to respond. The project team maintained a tracking spreadsheet to ensure timely distribution of email messages and to ensure that airports were contacted no more than twice. If an interview was not scheduled after the second email message, no further contacts were made with that airport. No attempt was made to identify the reasons that airports did not participate. 2.1.4 Scheduling and Conducting Interviews The process of scheduling interviews generally began with an airport point of contact send- ing the principal investigator an email indicating willingness to participate. Those messages also stated which airport officials planned to be present; in some cases, more than one airport representative participated. After a mutually convenient time for the interview was found, the following actions took place: • The principal investigator immediately sent the airport point of contact a calendar invitation for the interview as well as a confirmation email. That email confirmed the meeting date and time, noted that the interview would be a videoconference, stated the goal of the project, and indicated that a reminder email would be sent one to three days before the interview. • Between one and three days before the interview, the principal investigator sent the airport point of contact a reminder email about the interview. This message also indicated the topics that would be covered during the videoconference, although it did not share the interview questions in advance. • All interviews were conducted using videoconference software, although some airport points of contact participated by phone and without a video camera. Two researchers—one a des- ignated interviewer and one a notetaker—attended the interviews. The principal investigator

Research Methods 13   conducted most of the interviews; two other team members conducted the remaining inter- views. A notetaker also attended each interview. The videoconferences lasted between 45 and 90 minutes and were not recorded. During each interview, the interviewer first gave introductory remarks. These provided background information on the project, explained that questions about COVID-19 health protocols should not be interpreted as requirements, noted that participants were not obli- gated to answer every question, and assured participants of their anonymity. Participants were told that no statements in this report would be attributed to them or to the airports they represented. Participants were asked to base responses on their airport’s commercial service operations. The interviewer also requested that all responses pertain to airports’ experiences during calendar year 2020. This request was emphasized throughout the interview because inter- views took place over 11 months in 2021, during which time various government agen- cies were revising their COVID-19 health recommendations and requirements. Notably, all interviews focused on experiences prior to the January 2021 Executive Order on Promoting COVID-19 Safety in Domestic and International Travel, which required “masks to be worn in compliance with CDC guidelines in or on airports” and other forms of transportation (White House 2021). The interviewer then attempted to ask all questions shown in Appendix A, but that was not always possible due to time constraints and some unexpectedly long responses. Additionally, some off-script content was considered. For example, the interviewers were encouraged to explore any notable or unusual responses in detail (using follow-up questions not included in Appendix A). Airport participants often chose to offer details, insights, and lessons learned throughout the interview, not only when responding to a specific interview question. • After every interview, the interviewer sent the airport point of contact an email to express thanks for participating and to encourage airport officials to submit more information of interest as appropriate, as well as to request a copy of any CDRP the airport had in place prior to the COVID-19 pandemic. The project team updated its tracking spreadsheet after every interview to document which interviews had been completed. 2.1.5 Summarizing Interviews Following every interview, the notetaker transformed notes to a draft written summary of responses. This draft summary was prepared using a standard template file, organized around the questions in Appendix A. For questions with discrete response options, the notetaker checked appropriate boxes in the written summary file. For questions that prompted narrative responses, the notetaker summarized those responses. For each interview, the designated interviewer then reviewed the notetaker’s draft text sum- mary, confirmed that all entries accurately reflected the responses, and made revisions and edits as necessary. In some cases, the interviewer contacted the airport point of contact after the inter- view to confirm that certain responses were correctly documented. Final versions of interview notes were generally completed within three business days of the corresponding interviews. The interviewer was responsible for confirming when each interview summary file was considered final and ready for data entry. All completed interview summaries were then entered into a database developed for this project. Narrative responses were transcribed in text fields; the database used drop-down menus for questions with discrete response options. An analyst reviewed the data entry for accuracy.

14 Airport Lessons Learned from the COVID-19 Pandemic 2.1.6 Limitations of Interviews with Representatives from Commercial Service Airports Although the interviews compiled a broad range of lessons learned and other insights on airports’ measures to prevent the spread of COVID-19, the project’s methodology had the fol- lowing limitations: • Participation bias may have occurred. It is possible that the airport officials who agreed to interviews have a different profile of COVID-19 experiences and lessons learned than the airport officials who chose not to participate. • About two-thirds of the interviews involved just one person from the participating airport. It is possible (and for large airports, likely) that the single interviewee was not aware of an entire airport’s COVID-19 health protocols and policies. Thus, the interviews may not have captured the full range of COVID-19 lessons learned among the airports that participated. • The airport officials participating in the interviews had widely ranging years of experience with their current employers. Some participants had worked at their current airports for more than 20 years and therefore had extensive institutional knowledge; others had started working at their airports within the previous year—after the COVID-19 pandemic had begun. Some recently hired participants noted that they could not accurately answer certain inter- view questions because of their limited experience with their particular airports. • Despite being organized around the script in Appendix A, some interviews did not cover all questions or did not cover them at the same level of detail. This was true for various reasons, but primarily it occurred when participants offered extremely detailed responses to some interview questions (reducing the time available to ask all of the remaining questions). In these cases, the interviewers used their discretion to decide which questions to skip; they typi- cally ensured that all discrete response option questions and all conclusion questions were asked (see Appendix A). • Interviews were limited to no longer than 90 minutes. This duration constrained the amount of detail that participants could provide on certain topics, as well as the amount of time avail- able for interviewers to ask follow-up questions. • Other limitations were associated with the timing of the interviews, which took place over 11 months in 2021. First, across these 11 months, COVID-19 guidance and mandates con- tinually evolved, COVID-19 vaccines became increasingly available, and surges in COVID-19 cases occurred in different regions. Even though all participants were asked to answer ques- tions based on their experiences from the same time frame (2020), it is possible that the com- pilation of lessons learned would have been different had the project been conducted earlier in the pandemic or if interviews were conducted over a shorter period. Second, the final wave of interviews took place about 20 months after the first COVID-19 cases were documented in the United States. With this time lag, some participants noted that they could not recall details for certain questions asked during the interviews, particularly the questions that addressed pre-pandemic preparedness and actions taken early in the pandemic. 2.2 Interviews with Public Health Officials Fifteen 90-minute interviews with public health officials across all levels of government— that is, key stakeholders in efforts to reduce COVID-19 transmission associated with air travel— provided a secondary information source for this project. Project resources allowed for interviews of up to 20 public health officials. However, only 15 of these interviews could be scheduled and conducted before project resources were depleted due to unsuccessful recruiting efforts. The unexpectedly low response likely reflected the timing of the recruiting, which occurred in early 2021 when public health officials had many pandemic-related

Research Methods 15   priorities to address—including sustaining COVID-19 testing sites, implementing contact tracing, and overseeing vaccine administration. The 15 interviews were conducted with CDC quarantine station officials (n = 10), state health department officials (n = 2), county health department officials (n = 2), and a local health officer (n = 1). Interviews with CDC quarantine station officials addressed (1) jurisdictional authority for responding to communicable diseases at airports, (2) quarantine station engagement with com- mercial service airports on COVID-19, (3) CDRPs, (4) screening and testing programs, (5) non- pharmaceutical interventions (i.e., mask use, social distancing, and hygiene), and (6) details of airport-related COVID-19 transmission incidents or outbreaks. The interviews with the state, county, and local public health officials all followed interviews with commercial service airports in their jurisdictions, and the questions for each of these interviews varied because they were framed around input from the airport officials. The 15 interviews with public health officials were completed in early 2021. All interviews were conducted using videoconference software. Two researchers—one designated as the interviewer and one as the notetaker—attended each interview. The interviewers were senior scientists in environmental and occupational health practice. The notetaker drafted written summaries of responses, which the interviewer reviewed and revised as necessary. Chapter 4 summarizes the input gathered from these interviews. Although this content pro- vides further perspective on commercial service airports’ response to COVID-19, the 15 inter- views with public health officials should not be viewed as a statistically representative sample of the hundreds of local, state, and tribal public health authorities in jurisdictions with commercial service airports. 2.3 Search of the Peer-reviewed Literature In December 2020, the project team searched the peer-reviewed literature for publications relevant to airport strategies for reducing the spread of communicable diseases. The primary goal of this search was to help decide what questions should be asked in the airport and public health interviews that were to begin in 2021. The project team used the PubMed search engine and the ScienceDirect website to identify peer-reviewed publications with the key words “COVID” and “airport.” These initial searches identified more than 1,000 citations, with numerous duplicates across the two searches. Screen- ing of titles and abstracts was conducted to remove articles on topics not directly relevant to the project’s scope (e.g., disease transmission aboard aircraft and economic impacts to the airport and airline industries). The remaining articles were reviewed as the project team developed the interview questions and script. The timing of the literature search (December 2020) affected the number of articles retrieved. With the first COVID-19 cases in the United States diagnosed in early 2020, research publications on airport roles in reducing spread of COVID-19 did not start appearing in the peer-reviewed literature until several months later. Further, some high-profile government agency publica- tions (e.g., DHS/U.S. DOT/DHHS 2020) and research initiative reports (e.g., Harvard School of Public Health 2021) had not been issued at the time the literature search was conducted. This project’s literature search met the objective of informing the interview questions and script, even though it did not capture publications issued in and subsequent to December 2020.