Altitude Sickness: Travel Advice

Rob Roberts Excerpts

Tuesday 21st March 2023 Westminster Hall

[Mr Laurence Robertson (in the Chair)]

I will call Rob Roberts to move the motion in a moment and then the Minister to respond. As is the convention for 30-minute debates, there will be no opportunity for the Member to make a winding-up speech.

[Rob Roberts (Delyn) (Ind)]

I beg to move,

That this House has considered the matter of travel advice on altitude sickness.

It is a pleasure to serve under your chairmanship once again, Mr Robertson. Altitude sickness is somewhat of a blanket term covering a variety of ailments that range from acute mountain sickness to high-altitude pulmonary oedema and high-altitude cerebral oedema. These conditions can be life-threatening, as many people find out each year and, sadly, as my own family recently discovered. I apologise and beg the indulgence of the Chair as some of the comments I will make may be distressing to hear, but it is important to convey the seriousness of the situation.

Altitude sickness is brought on by ascending to a high altitude too quickly or remaining at extreme altitudes for too long. To start with, the common and normal reaction to being at high altitude resembles that of a hangover—something I am sure we have all experienced at least once. It is not pleasant, with a headache being the most reported and common symptom. A few days on, if the headache is still occurring, someone with altitude sickness has what are referred to as category 1 symptoms, which include being out of breath when active, having difficulty sleeping and having a higher than normal heart rate. It is worth mentioning that if people are travelling to places of high altitude and do not know their normal heart rates, both at rest and during activity, they should definitely seek out advice in advance and find them out so that they can judge whether they rise.

The headache and other category 1 symptoms would be annoying or a minor irritation. They may affect the first couple of days of that person’s well-earned holiday but will normally be overlooked as just an annoyance. Those early warning signs, which would normally just mean “Drink more water” and “Take it easy on a Sunday morning”, should be treated very differently if experienced in unfamiliar conditions, especially at high altitude.

We then have what are deemed category 2 symptoms, which occur predominately when no action is taken to relieve the category 1 symptoms. They indicate that something much more significant may be happening and that individuals should seek immediate medical advice. The symptoms may include loss of appetite or nausea, weakness, dizziness or light-headedness, and ongoing fatigue. Category 3 symptoms are the most severe of all and are deemed immediately life-threatening when the aforementioned aliments start to occur.

High-altitude pulmonary oedema is just a fancy way of saying that someone has fluid on their lungs. It is often identified by symptoms such as persistently coughing or bringing up a white frothy liquid that may be tinged with blood. A person with high-altitude pulmonary oedema is deemed to be drowning from the inside, with their chest congesting, and they make abnormal sounds. They will likely experience extreme confusion, slurred vision and a cold, clammy skin. They should not lie down as that can make the situation worse, as I will discuss later.

High-altitude cerebral oedema is a fancy way of saying that someone has fluid and swelling on the brain. Cerebral oedema can be immediately recognised in someone being extremely confused, having blurred vision, being sensitive to light, having the inability to co-ordinate, walk or talk, and if their skin is turning grey.

Altitude sickness typically occurs only above 2,500 metres, or 8,000 feet, although some people are affected at lower altitudes. Risk factors include a prior episode of altitude sickness, a high degree of activity or a rapid increase in elevation. Acute mountain sickness, cerebral oedema and pulmonary oedema are all diagnosed based on clinical findings, and their severity is determined subjectively by the intensity of the symptoms that the individual reports.

Altitude sickness occurs in around 20% of people after rapidly going to 2,500 metres and in 40% of people going to 3,000 metres. Although AMS and cerebral oedema occur equally frequently in both males and females, pulmonary oedema seems to occur more often in males. Being physically fit does not decrease the risk.

Ascending slowly is the best way to avoid altitude sickness. Avoiding strenuous activity such as skiing or hiking in the first 24 hours at high altitude may reduce symptoms. Alcohol and sleeping pills are respiratory depressants—they slow down the acclimatisation process—so should be avoided. Alcohol also tends to cause dehydration and exacerbate AMS, so the avoidance of alcohol consumption in the first 24 to 48 hours at a higher altitude is optimal.

Travel to high-altitude regions and mountainous areas has become increasingly popular for tourism, recreation, adventure activities and sometimes rescue missions. One study in America in 2018 estimated that 30 million people each year travel to mountainous regions of the western United States. That is just one part of one country.

Let me touch on pulmonary oedema in more detail. As I mentioned, my family and I have come to experience this condition at first hand. My sister-in-law, Lorraine Roberts, recently died from pulmonary oedema while on her dream holiday with her partner, visiting Machu Picchu in Peru. It had been on her bucket list for years. She followed the guidance of gradual ascent. She had rest days and did everything that she thought was right, but she was not feeling great. It was nothing too serious: she just felt generally under the weather and a bit sick, with almost hangover-type symptoms. It was nothing that would normally stop anybody who was on their holiday of a lifetime.

On the evening of 31 August, seven days before just her 52nd birthday, Lorraine went to bed at the end of an amazing day, and never woke up. Her symptoms were a sign of altitude sickness which, left untreated, turned into pulmonary oedema as she slept. It was nobody’s fault. The devasting news that took away Gill and Pete’s daughter, Dawn and Gareth’s sister, and Hannah and Joe’s mum, was a complete accident.

A similar fate befell legendary Wales rugby No. 8, and then journalist and commentator, Eddie Butler. He died in his sleep at altitude in Peru on 15 September last year, as he was taking part in one of his many fundraising efforts for the cancer charity Prostate Cymru. He was 65 years old. The condolences of the House go out to his wife and children for their loss.

Despite years of careful research, the exact causes of high-altitude pulmonary oedema remain relatively poorly understood. As I mentioned, fluid has been shown to fill up in the air pockets in the lungs, preventing oxygen from getting into the blood and causing the vicious circle of events that can kill people. As with many biological processes, many factors play a role in the disease. There is good evidence to support several theories about how the fluid gets there, but that is not the purpose of today’s debate or my remarks.

Let me move on to my call to action. On the gov.uk website, each country has travel advice, which is published and provided by the Foreign, Commonwealth and Development Office. There is a section on health for them all. On the Peru page, a number of things are listed. Regarding altitude sickness, it simply says:

“Altitude sickness is a risk in parts of Peru (including Cusco, Puno, the Colca Canyon and Kuelap).”

Then there is a link to another website for more information. It is the 11th link on the Peru health section.

It is my belief that that one line, with a link to another site, simply does not give sufficient prominence to the dangers of altitude sickness, which can prove fatal if left untreated. Plenty of studies show that the number of people who click on links on websites is nowhere even close to 100%, especially when the link in question is the 11th on a particular page. It is highly likely that the reader will have lost patience, given up clicking links or been taken off in some other direction well before that point.

I do not ask a lot of the Government—perhaps for a little more consideration with levelling-up fund bids, or a new train station in my constituency—but this request has to be one of the simplest of all for the Minister to grant. Will he please look at all the countries for which travel advice exists and make the wording much stronger for all those where there is the potential for altitude sickness, thereby giving people a much greater warning about the dangers of this condition without their having to click on a link? Tell them, in the body of the FCDO travel advice, that altitude sickness can prove fatal if untreated. Put it in capital letters.

I am not asking for a massive awareness campaign or a big marketing budget; it is of zero cost to the Government just to add a couple of lines of strongly worded text to a website. That is the only thing that I am asking for. If one person takes that advice and is saved from suffering the same wholly avoidable fate, Lorraine’s legacy will be secured.

[The Parliamentary Under-Secretary of State for Foreign, Commonwealth and Development Affairs (David Rutley)]

It is a pleasure to serve with you in the Chair, Mr Robertson.

I congratulate my hon. Friend the Member for Delyn (Rob Roberts) on securing this debate on altitude sickness travel advice. His constituency is beautiful: I see the Clwydian hills from Macclesfield on the other side of the Cheshire plain and have spent great times there. It is stunning and helps to remind us of the beauty of mountains, and how they attract us to their presence and make us want to spend time in them. However, he is also right to highlight concerns around altitude sickness. I hope he will recognise the sincere condolences that I extend to him and his family for the sad and tragic death of his sister-in-law Lorraine, which he spoke about so powerfully today. I am sure his family will be proud of what he has said and the request that he has made of the Government.

I also extend my condolences to other families who have been bereaved through altitude sickness, including the family of Eddie Butler, who was well known in Wales and will be sorely missed, not least, of course, by his family. Having spent time in some mountains at high altitude, I know that this is a really serious issue.

Supporting British nationals overseas remains the Foreign, Commonwealth and Development Office’s central public service. Since 1990, that service has included our travel advice on 226 countries and territories globally. Millions of people access the advice every year. We regularly review and improve our travel advice to ensure that it helps British people who are living or travelling abroad to take responsibility for their safety. The content reflects our latest assessment of risks to British people—“risks” being the important word there.

FCDO travel advice aims to help UK nationals to make better-informed decisions about international travel and to avoid trouble. The safety of British nationals is our overriding concern and our travel advice is based on an objective assessment of the risks. Multiple sources of information feed into that travel advice, including information from British embassies and high commissions around the world, from foreign Governments, from our expert staff in London and, where relevant, from the intelligence services as well.

All travel advice includes information on entry requirements such as passports and visas, and we also provide relevant information and advice on risks. The risks include safety and security matters, such as protests and demonstrations, or natural disasters, such as in areas susceptible to tropical cyclones, earthquakes and flooding. In compiling our travel advice, we work closely with our closest international partners in Australia, Canada, New Zealand and the United States.

The FCDO has a long-standing approach to travel advice about health risks that has been tried and tested in recent outbreaks of diseases such as Ebola, Zika and, of course, covid-19. We provide health information that is up to date and that draws on specialist medical expertise, including advice from the FCDO’s chief medical officer, and it includes directing British people towards reliable sources of expert information and advice.

All our travel advice pages provide links to expert health guidance and country-specific information from the National Travel Health Network and Centre, the acronym for which—NaTHNaC—is sometimes difficult to say. The centre is commissioned by the UK Health Security Agency to provide travel health advice to the British public and the health professionals who advise them. That health advice complements our FCDO travel advice for each country.

Individuals can visit NaTHNaC’s TravelHealthPro website for information on vaccine recommendations, current health risks and outbreaks, and factsheets about staying healthy abroad. Rightly, it is for individuals to decide whether to travel. Health risks vary considerably, depending on an individual’s personal circumstances. Some people may be at greater health risk in certain locations if they have a pre-existing health condition.

Members will appreciate that the Government cannot, and should not, make decisions about travel for individuals. We encourage British people to check relevant travel information for their destination at least two months before they travel. That gives them the time to make any preparations needed for their trip. Some travellers might want to consult their doctor or pharmacy on advice for preventing illness or managing a health condition overseas.

[Rob Roberts]

I thank the Minister for his thorough answer. I have no doubt that the TravelHealthPro website from the organisation with the complicated acronym is very good—I have read through it in great detail with regard to this issue—but my fundamental point is that the route to get there is more convoluted than necessary. Even if someone needs to follow that route, we need to highlight it.

Rather than the FCDO website just saying that altitude sickness might be an issue, people need to be told why it might be an issue and how dangerous it might be, in order to force them down that route. Obviously, there is a lot of information and it cannot all fit on the FCDO website, but let us make more of a drive for people to click that link, which is way down the page, to force them towards that information and ensure that they do not miss anything.

[David Rutley]

I understand the point my hon. Friend makes and will come to address specific points on that, if he can bear with me. I want to highlight the broader context, because there will be others listening to this debate, but he can be assured that I will get to his specific points.

As I said, it is important to seek advice from doctors or pharmacies. Alongside that, whatever their health preparations, all travellers should ensure that they have adequate health and travel insurance, to ensure that if they have a health emergency while travelling, that they receive the right treatment and support.

[Rob Roberts]

Will the Minister give way?

[David Rutley]

I will; it is my hon. Friend’s debate after all.

[Rob Roberts]

I am very grateful. Does the Minister agree with me, as someone who used to work in financial advice, on how important it is, when filling out applications for health insurance, to disclose all previous medical conditions? People complain about insurances all the time, but one of the biggest reasons for not being able to claim is not putting down pre-existing conditions and things that might make a claim fall out. That is an aside to the issue at hand, which is the importance of disclosing everything in one’s medical history in an insurance form.

[David Rutley]

I completely agree that disclosure is vital to ensure that the cover is valid. To build on what my hon. Friend said, as someone who enjoys outdoor recreation when I travel, it is important for me to check that the activity is covered by the policy. People should make clear pre-existing conditions and also be clear about activities to ensure that they have the proper cover. That particularly relates to altitude, because not every travel insurance policy covers that. I am sure my hon. Friend will agree with that.

We apply the same logic to Government advice on altitude sickness. We know that travelling to high altitudes can have health impacts. In the worst and most extreme cases, such as that of my hon. Friend’s sister-in-law Lorraine, altitude sickness may tragically result in an individual’s death. For countries where altitude sickness may present a particularly high risk—Nepal, Ecuador or China, for example—we include that information in our travel advice. We may point to specific regions that are higher in altitude, particularly if we know that they are a popular tourist or travel destination. For instance, our travel advice for Nepal mentions the risk of altitude sickness on Annapurna, Langtang and Everest base camp treks. As my hon. Friend pointed out, in our advice on Peru, we flag Cusco, Puno, the Colca canyon and Kuélap. In most cases, we point readers to NaTHNaC’s factsheet on altitude sickness. This resource lays out the key facts and symptoms, and gives advice on how travellers can reduce the risk of altitude sickness, and on what they can do if they develop symptoms.

The House will be aware that ultimately, travel advice is just that: advice. Only travellers can decide whether to travel. It is their responsibility to plan for a safe trip, and to take sensible precautions, including when it comes to their health. The Government’s travel advice is intended to be just one source of information that can help British people to make informed decisions about where and how to travel. My hon. Friend has made a powerful argument for more information about altitude sickness in travel advice. I have listened to his concerns, both outside this Chamber and in his powerful speech today. I understand his desire to ensure that British people are better informed of the risks of high-altitude travel. I also recognise and appreciate, as I am sure he will, the desire for an ever-greater number of risks to be clearly outlined in the FCDO travel advice. I assure colleagues that we will always consider these arguments on their merits. However, we must make judgments and consider all risks in proportion. When other organisations have the necessary expertise, it is right to point British nationals in the direction of their detailed advice; in this case, we point them to NaTHNaC.

I remind the House that there is lots of information already available, through links and other sources, on our travel advice pages. I strongly encourage those travelling to click through, and to take the time to absorb all the relevant information available to them. I assure my hon. Friend that I will come the point that he raised; I ask him to bear with me.

We are always looking to improve our consular services, including our travel advice. We welcome any and all feedback, including the feedback that he has provided today, and we use it to improve our services and the information that we provide. Following a surge in demand for clear travel advice during the pandemic, and in line with our commitment to providing accessible, easy to use digital services, FCDO reviewed its approach to travel advice, design and content. Our aim is to improve the presentation and format of our travel advice pages, so that it is easier for the public to find the information that they need when travelling.

I recognise the strength of feeling from my hon. Friend—and others, no doubt—on the issue. We will consider his proposal very carefully. Officials have already updated the Peru travel advice to better highlight the risk of altitude sickness, which my hon. Friend set out today. Previously, the Peru travel advice stated that Peru had areas of high altitude; now we highlight the risk of altitude sickness. That is a step on. I have also asked officials responsible for travel advice to review the advice on other countries where altitude sickness is a risk, to ensure that we are clear about the risk that it presents. We will review opportunities to state more clearly what we are linking to, as that is best practice, and will redouble efforts to proactively encourage people to seek expert advice from NaTHNaC as an essential part of preparing for any trip.

I would be pleased to discuss the matter more fully with my hon. Friend in due course. We are on a journey. He has highlighted a key issue, and I am keen to ensure that we take further steps in making the risks more readily identifiable to people on the FCDO travel advice pages. However, when we highlight a risk, there is a responsibility on the individual to take the extra step of looking to the bodies that can provide detailed advice and information on how to prepare if they are not used to being at altitude.

[Rob Roberts]

I thank the Minister for giving way again, and I appreciate everything he has said. People do not know what they do not know. The words that I am particularly interested in inserting in the FCDO guidance are: “can prove fatal if left untreated.” It is as simple as that. That would be an extra incentive for people to click the link. It would be saying, “I know there are a lot of links on the page, but you should really click this one, because it is important.” It would highlight the gravity of this issue.

[David Rutley]

I have noted my hon. Friend’s request. He made it at the beginning of his speech and has reiterated it. I understand the points he has made. As I say, we have taken a step forward today. The key thing is to highlight not just the fact that places are at high altitude, but that there is a risk of altitude sickness. Then we can look at the other points. I am more than willing to meet once we have had a chance to review our travel advice across multiple countries, because this matter affects not just Peru, but other areas in the world. He has highlighted an important point, and I hope he recognises that we will review the matter in more detail.

In conclusion, I reiterate our commitment to providing clear, accessible and up-to-date travel advice that highlights key risks. We keep it under constant review and ensure that it reflects the latest assessment of the risks to British nationals. I welcome my hon. Friend’s suggestions for improving our advice on the risks of altitude sickness. I share his interest—both personally and as a Government Minister—in ensuring that our travel advice helps British nationals to make more informed decisions, particularly in high-altitude areas.

Question put and agreed to.