After months of staying home, many people are anxious to get back out in the world. An important–and now essential–step of the travel planning process is getting tested for COVID-19. According to On Call’s Chief Medical Officer, Dr. William Siegart, “A negative COVID-19 test result is certainly not an excuse to let one’s guard down, but it does help reduce the risk of spreading the virus to others.” Dr. Siegart says he’s seen an influx of inquiries about COVID-19 testing and travel, especially since the CDC recently rolled out their new COVID-19 testing guidelines for travelers, so he’s answering some of the most frequently asked questions and sharing some advice with would-be travelers:
What if a traveler received the COVID-19 vaccine or tested positive for antibodies? Does this person need a negative COVID-19 test or documentation of recovery from COVID-19 to enter the US?
Dr. Siegart: Yes. Effective January 26, 2021, all air passengers traveling to the United States, regardless of COVID-19 vaccination or antibody status, must present documentation of a negative COVID-19 test result or documentation of recovery from COVID-19 to the airline.
What kind of documentation of the test result should a traveler present before boarding their flights?
Dr. Siegart: The test documentation must be verifiable and include identification of the person, the specimen collection date, and the type of test. The test must have been completed within three days before the flight and can be either a NAAT or antigen test.
What if a traveler recently recovered from COVID-19 – do they still need to get tested prior to entering the US?
Dr. Siegart: No. The CDC does not recommend repeating COVID-19 testing again in the three months following a positive COVID-19 test. If the traveler has recovered from COVID-19 and meets the criteria to end isolation, travel will be permitted with documentation of the positive viral test associated with the recent COVID-19 illness, and a letter from the traveler’s health care provider or public health official that states they have been cleared for travel. The combined documentation of a positive COVID-19 test result with a letter of travel clearance are referred to as ‘documentation of recovery.’
If a traveler tests negative before their flight, do they need to get another test when they return to the US?
Dr. Siegart: It is currently recommended but not required that testing be performed within 3–5 days of return, and that travelers self-quarantine for seven days. Even if the follow-up test is negative, self-quarantine remains for the full seven days. If no post travel testing is performed, self-quarantine is recommended for ten days. State and local recommendations may vary, so it is important to be aware of them and comply their recommendations or requirements. State and local recommendations may vary, so it is important to be aware of them and comply their recommendations or requirements. Moreover, it is advisable to discuss one’s situation with their healthcare providers in the context of their overall risk, potential for exposure, and presence of any symptoms in order to determine the best testing strategy for them.
Do travelers need to get tested before leaving the US? Where can travelers find a COVID-19 test abroad?
Dr. Siegart: The CDC recommends, but currently does not require, that travelers be tested within three days before departure from the US; however, it’s important to note that some destinations require COVID-19 testing before travel and/or after arrival. For information on specific foreign country testing entry requirements and their respective testing availability please refer to the following US Department of State link: https://travel.state.gov/content/travel/en/traveladvisories/COVID-19-Country-Specific-Information.html.
For travelers looking for tests in the US, I advise travelers to first check with their primary care providers, who may know the best options for testing in their area. They can also look at their city and state health department websites for local testing information. COVID-19 testing is available free of charge at multiple health centers and select pharmacies with which the U.S. Department of Health & Human Services (HSS) has partnered. Travelers can also visit HHS’ website for more information about local COVID-19 testing availability: https://www.hhs.gov/coronavirus/community-based-testing-sites/index.html#nh.
What kind of COVID-19 tests are available?
Dr. Siegart: COVID-19 tests fall into two general categories: antibody and diagnostic. The antibody test determines whether there are antibodies to the virus that causes COVID-19 circulating in one’s blood. Ordinarily, antibodies are produced by the immune system in days or weeks following an infection. If antibodies are detected in the blood, it may mean someone currently has COVID-19 or that they’ve had the virus recently. However, a positive antibody test can also mean an individual was infected with a different coronavirus. For this reason, the antibody test is not particularly useful to the person who needs to know whether they are currently infected or not. The test may be more useful for public health surveillance and research purposes.
Diagnostic tests determine if an individual is currently infected with COVID-19. There are currently two types of diagnostic tests: molecular tests that detect the virus’s genetic material and antigen tests that detect specific proteins from the virus. Nucleic acid amplification (NAAT) tests fall in the category of molecular tests and include RT-PCR, LAMP, and TMA tests. The RT-PCR, LAMP, and TMA tests are nucleic acid amplification tests (NAAT) that detect SARS–COV–2 genetic material, the virus that causes COVID-19. Depending on the test and manufacturer, a specimen is collected by nasopharyngeal swab, nasal swab, throat swab, or saliva sample. The specimen is then placed in a transport medium and sent to a diagnostic laboratory.
Antigen tests detect viral proteins and can be completed on site in as little as 15 minutes. The specimen is collected by swabbing the inside of the nose. Neither of the tests “hurt” per se, but there might be some very brief discomfort when the throat or nasal passage are swabbed. Sometimes a saliva specimen is utilized which involves no discomfort.
How much in advance of travel should an individual plan to get tested? How long does it take to get the results back?
Dr. Siegart: This is not a one-size-fits-all answer as different tests will come with different wait times for results. Having a flexible travel schedule and/or planning some buffer time between test results and the start of the trip can help to skirt around these gray areas. For example, the PCR test takes 2-5 days to receive results, whereas the most convenient and faster Antigen test provides results in 15 minutes. Regardless of which testing method a traveler chooses, it’s important to remember that even if one is promised a specific timeline for your results, there may be a delay, which could pose an issue for those traveling to destinations that require proof of a negative test. Also, it’s important to remember the new CDC guidelines which require a person to be tested within three days before their flight to the US.
In addition to the US, are there other destinations that require proof of negative test results for entry?
Dr. Siegart: Depending on one’s intended destination, proof of a negative COVID-19 test within three days of travel may be required. Some countries require such proof as do some states in the U.S. On Call’s clients are encouraged to consult with us for the most up-to-date guidance on how to prepare for travel to their intended destinations, check the CDC’s Travel Recommendations by Destinations page, and review the U.S. Consulate’s website for their destination countries as well.
Does a negative test help guarantee traveler safety (and the safety of others) when traveling?
Dr. Siegart: No, it does not. A negative test can be falsely reassuring. The PCR test is more accurate and has fewer false negatives than the Antigen test. However, because it is so sensitive, it may detect small bits of genetic material that have not cleared from the body due to an infection that is no longer active or contagious. All tests have some degree of false negatives and positives and must be interpreted clinically based on the context of exposure and presence or absence of symptoms. If COVID-19 exposure is very recent it may be too early for any test to detect. Testing should always be performed in consideration of the likelihood of exposure, current health condition, and the presence of any symptoms. Someone who has had significant exposure and now has a fever and a cough and tests negative may be falsely reassured. Those individuals should self-quarantine pending follow-up with their healthcare providers and have repeat testing to make sure the first test was not falsely negative if there is any question. I also stress that the standard safety precautions should always be followed regardless of test status. Social distancing, wearing a mask, and hand hygiene cannot be overemphasized.
In addition to COVID-19 testing, what other factors should be considered before traveling?
Dr. Siegart: I always advise travelers to consider the availability of healthcare in their destination countries and how they will get home (or get to the nearest facility capable of properly treating their condition if they fall ill). This is important for all populations, but it can’t be stressed enough for higher-risk populations such as the elderly or those with pre-existing conditions. I also think it’s highly important for travelers and their organizations to do a thorough evaluation of existing policies, procedures and resources related to COVID-19 to ensure alignment of coverage between insurers, assistance services, and crisis management protocols prior to travel.
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