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Returning to the US After International Travel

Returning to the US After International Travel
Editor Note: This article has been updated to reflect the new testing regulations for entering the US that came into effect on December 6, 2021. Under these new guidelines, US-bound travelers must have proof of a negative COVID test taken 1 day before scheduled flight departure. Due to this change, Rapid Antigen tests for travel are recommended, but Molecular PCR tests are still acceptable. Read on to find out why.  It’s been a (very) long two years of mask-wearing, Zoom calls, and physical distancing. But now you’re fully vaccinated and ready to travel! Whether you’re considering a long-overdue business trip or are ready to soak up the sun in Mexico, you know that traveling safely is critical. And right now, that means getting a COVID test for returning from international travel.  Chances are you’ve already had the occasional nose swab to check for COVID, maybe at work, before a school function, or after coming into contact with someone who was sick. But COVID testing for travel, especially COVID testing for returning to the US after international travel, might be a little bit different than what you’re used to.  Here, we’re going to take a closer look at your responsibilities as an international traveler – what you need to know before you go away and how to ensure you can get back home safely. Without risking missed flights, quarantine, or being stranded in a foreign country. If you’ve been itching to get away, here’s what you need to know about COVID testing for international travel. 

Before you go away

The most important thing to remember when it comes to travel right now probably won’t come as much of a surprise – the COVID situation is rapidly changing. Everywhere.  Countries that once had just a handful of cases are grappling with highly infectious, tough-to-fight variants, borders are closing as others are opening, and restrictions, in one form or another, are in place nearly everywhere. As a hopeful traveler, the most important thing you can do is be aware of the COVID situation in your destination country. Things to look out for include:

COVID Travel Questions to Ask

Is a pre-travel COVID test required?

With a few exceptions, most countries will expect you to take some kind of COVID test before boarding a plane. Even if health checks and additional COVID tests are required after reaching your destination, you’ll probably still need to take a COVID test before boarding. What kind of tests are admissible? Molecular PCR is the “gold standard” for COVID testing, but the results can take longer to deliver. Many destinations also accept Rapid Antigen tests, which are very reliable and produce results in just a few minutes.

To return to the USA, for example, you will need a negative result from a Rapid Antigen or Molecular PCR test. With the new travel guidelines set in place December 6, 2021 that require a negative test within 1 day of boarding a US-bound flight, many passengers are choosing to go with Rapid Antigen tests, which return results much faster than a Molecular PCR test, which typically needs to be sent to a lab for analysis.

When does the test need to be administered?

Some locations will accept a COVID test taken up to a whole week before your flight. Other countries require a more recent test, in some cases 24 hours before your scheduled flight.

Who can administer the pre-travel test?

Not all testing providers are equal. For in-person or Molecular PCR tests, only test results from reputable, certified laboratories are acceptable. In the United States, look for labs that are CLIA Certified. This indicates the lab meets the Clinical Laboratory Improvement Amendments set forth by the Food & Drug Administration (FDA). 

What paperwork is required?

Because every country must set its travel and entry requirements, many countries have a particular form that you or your testing provider must fill out.  For example, unvaccinated Hawaii travelers must upload their results to the Hawaii Safe Travels website. Parents traveling to Hawaii with kids will need to upload test results for their little ones, even if the parents are vaccinated. In contrast, Japanese nationals returning home from the US must bring a printed copy of their form, signed by the clinician who administered the test.  Be sure to keep copies of any travel documents, including your COVID test results, with you at all times while traveling, even if you have already submitted them. 

What happens once you’re there?

Depending on the destination, you may need to undergo a health check (such as a temperature reading and symptom check) or give information about where you plan to stay before leaving the airport. Some countries, such as Canada, require all entrants to download and use an app to give information about their health status and travel plans once they’ve entered the country.  You may need to take another COVID test or may be randomly selected for arrival testing.  Local authorities can demand that you quarantine for a certain period if you do not meet the requirements, which you will likely have to pay for out-of-pocket. It’s a good idea to purchase additional travel insurance if you’re planning to travel and check with your provider to confirm what COVID-related expenses they will cover.

What are the local COVID safety regulations?

Some countries may observe different mask rules, physical distancing distances, capacity restrictions, or other guidelines. As a traveler, it is your responsibility to be familiar with these rules and to follow them.  Each country has the right to set its own rules and regulations regarding COVID testing, vaccination, travel insurance and quarantine. There is currently no international standard for vaccine verification or passports, so you will still be expected to follow local laws and regulations even if you are fully vaccinated. 

What you need to know about self-administered COVID tests

Due to the increased necessity of reliable COVID testing, self-administered COVID tests are becoming increasingly common. These kits can be bought in stores and online and stored at home until you need a COVID test.  Self-administered COVID test kits are a great option to keep in your medicine cabinet. They can be used if you suspect you may have COVID, if you plan to visit someone who is unvaccinated, and to confirm your COVID status after attending an event or traveling.  However, check your self-administered COVID kit carefully, as many self-administered COVID tests are not approved for travel.  To avoid disappointment, quarantine, or missed flights, here’s what to look for in a self-administered COVID test for travel:

Does the COVID test come from a reputable source?

Unfortunately, disreputable people have been attempting to profit off of COVID since the beginning of the pandemic, and COVID testing is no different.  Look for a COVID test kit that is manufactured and sold by a reputable company. Look for a known healthcare company (such as Quidel or INDICAID), laboratory, or medical care clinic to ensure the credibility of the test.   If you’re unsure, look for third-party validation. Partnerships with local public health departments, schools, sports teams, and even airlines can indicate that the company you’re purchasing a test from is trustworthy. 

Is the test supervised?

To be assured that the results are authentic, pre-travel COVID tests must be supervised Tests don’t need to be administered by a doctor, but there must be someone to supervise the test who can confirm the identity of the person taking the test. If you can take your self-administered test without being watched by a specialist, it is not acceptable for travel. The results are still accurate, but without a way to verify that it was you who took the test, the results of an unsupervised test cannot be used for travel. 

Does the test include a Digital Health Certificate?

No, you can’t show the test strip at the airport! Your self-administered pre-travel COVID test must include an official results form, such as a Digital Health Certificate. This official document will contain your name, contact information, and test result. It will also indicate exactly when the sample was collected, which is important for meeting testing timeline rules. It should also contain your passport number, as local authorities may use this information (instead of just your name) to validate your results. 

What type of test is it?

Ensuring you’re taking the correct type of test is critical, both for your destination country and coming back home. Check with your destination country to see which test types are admissible.  For returning to the US, you’ll need to take either a Molecular PCR or Rapid Antigen test, even if you are fully vaccinated. If you don’t take the correct COVID test, you will not be allowed to board your flight home.   

How many tests are in a kit?

Hopefully, you’ll only need one. But travels don’t always go as planned. Lost bags and inconclusive test results do happen, meaning packing just one test on your trip is not enough.  If your flight is delayed, your initial COVID test may no longer be valid if it falls outside of the testing window required.  For example, if you take a COVID test 24 hours before your flight and your flight is delayed by 24 hours. That means your COVID test would be 48 hours old at the time of boarding and would not be admissible. You’d need to take another test and wait for another result before you can board and fly.  Reputable self-administered COVID Kits for travel understand this reality and will include two individual tests per test kit. 

Does the test require an app to work?

There’s an app for everything, including your COVID test. This may not be an issue for tech-savvy travelers with smartphones, VPNs, and unlimited data. For other travelers, it’s an unnecessary hassle, especially when other testing options don’t require the same access to your phone.  Be sure to confirm if the travel test you’re considering requires you to download an app to store test results or communicate with your provider. Otherwise, the test or results delivery will not function properly. 

How is the sample tested?

Kits appropriate for international return travel supply users with a testing reagent (a solution that the sample swab is dipped in) to test the sample. This is also why supervision is essential, so a testing specialist can ensure you follow the proper procedure.  If you have to send the sample back to a lab, the test is likely unsuitable for international return travel. International shipping timelines are uncertain and typically take a few days. After more than 24 hours, the sample quality will begin to degrade, making it harder for the lab to return a conclusive result.  CityHealth’s RapidReturn Kit has been designed by testing experts, specifically for travelers. Each test kit contains 2 NAAT Rapid Antigen Tests for one person, plus a supervised telehealth testing appointment and travel documentation. Take your pre-travel test in just 20 minutes, and have travel-approved results sent to you immediately: no apps to download, no airport lineups.   Learn more about CityHealth’s RapidReturn Test Kit here. 

How to come home after international travel

You’re a fully-vaccinated US citizen, so just hop on a plane to your state, right? Not so fast.  The United States maintains strict regulations concerning COVID and travel. These rules apply to everyone entering the US, regardless of nationality or vaccination status.  The rise in COVID variants, especially instances of Delta variant breakthrough infections in fully vaccinated individuals and concerns about the Omicron variant, means that international travelers must continue to remain vigilant, even after returning home. 

COVID tests to return to the US

Vaccinated air passengers flying into the US will need proof of a negative COVID test taken within 1 day of their flight’s departure. The regulation used to be 3 days. However, with the increase in Variants of Concern (such as Delta and Omicron), the timeline has been shortened to 1 day.  Only Molecular PCR and Rapid Antigen tests are acceptable for entering the US. Travelers must have proof of their test results, such as a Digital Health Certificate. This document must state the traveler’s name, time and date of sample collection, and test result. Due to the strict 1 day rule that took effect on December 6th, most savvy travelers are choosing Rapid Antigen tests to return to the States. These tests can be taken remotely, like the RapidReturn Test, and can provide results within just a few minutes – making them perfect for meeting that 1-day testing deadline. Passengers headed for the US will be asked to present proof of a negative COVID test before boarding. This means that you can’t wait until landing in the US to take a COVID test- you must prove you are COVID negative before you can board the plane to come home.  Ok – so you’ll need a COVID test before you leave, and you will need one before you come home. If that has you wondering, “where can I get a COVID test in a foreign country?” you’re not alone. Here is some advice.  

Where to find a COVID test overseas

Finding a reputable testing provider in a foreign country can be a challenge. Cases of fraud, purchasing results without a test, and unlicensed providers are not uncommon. Regulatory bodies and laws are different everywhere in the world, but it’s your responsibility to make sure you’re getting the proper test from a genuine provider. 

Hotel COVID tests

If you’re staying at a hotel or resort, they may have in-house testing facilities or suggest a nearby testing facility. The cost for the return test can vary from being included in your stay to well over one hundred dollars. Check with your hotel before you need your test, as there may be a waiting list or lengthy wait time at local clinics. 

Airport COVID tests

If your hotel doesn’t offer testing, your airline may be able to give you a list of local testing providers.  Many travelers opt to use in-airport testing services provided either by their airline or the airport itself. Many in-airport services are operated on a “first come, first served” basis, resulting in long testing lineups (in some cases, several hours long). Plus, don’t forget about the regular customs and security checks. If you test positive at the airport, you won’t be able to board your plane. You will have to find a local provider for a second test, and will have to isolate in the meantime. 

Bring your own COVID test

Due to the risks associated with sourcing a reputable local provider or waiting until the day of your flight to get tested, many people are understandably hesitant to travel internationally this year.  Fortunately, there are a few self-administered COVID tests on the market that are approved for travel. 

Self-swab COVID tests for returning from international travel

Despite the increase in international travel, most COVID testing is still done in person. But with the huge surge in telehealth (a phone call or video conference with a clinician, instead of visiting in person) due to COVID, this doesn’t need to be the case.  If you’re choosing a self-swab COVID test for international travel, you have a few options.  Two of the most popular are Abbott’s BinaxNOW Home Test or CityHealth’s RapidReturn Kit, which uses INDICAID’s Rapid Antigen test (one of the most sensitive on the market), with specially trained testing specialists on CityHealth’s robust telemedicine platform.  So what does that mean for you as a traveler? We’ve broken it down in this easy-to-understand chart to help you make an informed decision: 
Abbot BinaxNOW CityHealth RapidReturn
Carry-on safe Yes Yes
Molecular or Antigen Test Antigen Rapid Antigen
Approved for travel? Only the BionaxNOW COVID-19 Ag Card Home Test is eligible for travel. The BionaxNOW Self Test is not. Yes
Supervised test Yes Yes
Available 24/7 Yes Yes
Digital Health Certificate securely emailed to the patient No. The Digital Health Record is only available through the NAVICA App, which must be downloaded separately. Yes. Digital Health Certificate is sent by secure email and text message. No App needed.
Patients can access Digital Health Certificate offline No. The Digital Health Record is only available through the NAVICA App, which must be downloaded separately. Yes. Digital Health Certificate may be printed or saved to the device.
Works with any airline Partnered with United Airlines only. Yes
Cost $150 for 6 tests, regardless of how many tests you need. $75 (includes 2 tests and 1 visit with a Testing Specialist).
Time 20-30 minutes 15-20 minutes
Sensitivity (lower sensitivity increases the chances of a false positive) 84.60% 96.60%
Specificity (lower specificity increases the chances of a false negative) 98.50% 99.30%
  Sources: Binax FDA INDICAID FDA So if the thought of waiting in the airport for another couple of hours doesn’t appeal to you (does it appeal to anyone?), and you’d rather not take your chances on tracking down the correct test in a foreign country, bringing your own tests with you is a convenient, reliable, and affordable option.  California’s urgent care experts have designed CityHealth’s RapidReturn test to meet the needs of US travelers returning from international travel. It provides the fastest, most reliable results available, using CityHealth’s easy-to-use telemedicine platform that lets you video chat with a testing specialist. No apps, no appointments, no hassle. 

What to do after returning from international travel

Planning to have some friends over for a Welcome Home party to regale them with travel pics and tall tales from your overseas adventure? While it sounds fun, it’s pretty 2019.  It’s important to remember that, even if you’re fully vaccinated (which you really, really should be before even considering international travel), you can still catch and transmit COVID-19.  Even if your RapidReturn test was COVID-negative, there are still plenty of ways to become infected. You may have contacted someone carrying COVID after taking your return test or contracted it while at the airport or on the plane. And if you’re returning from an international destination where variants are prevalent, you may be coming home with an even more infectious strain of COVID.  This isn’t to say that you can’t travel, but it is a reminder that you need to exercise some reasonable precautions after you’ve returned home.   

Recommendations for after international travel

The Centers for Disease Control (CDC) have a series of recommendations for Americans who have recently returned from international travel.  First, avoid international travel until you are fully vaccinated.  Some countries are not welcoming unvaccinated travelers or are reducing or eliminating testing and quarantine requirements for fully vaccinated travelers. (Remember, “fully vaccinated” means 2 weeks have passed since receiving the second dose of a 2-dose vaccine, or 2 weeks after a single-dose vaccine).  For countries that do accept unvaccinated travelers, remember that many areas or private businesses can set their own requirements for entering establishments like restaurants, hotels, shops, and attractions, meaning that unvaccinated travelers may be allowed to enter the country, but may not be welcome in many places. Unvaccinated travelers may also be prohibited from using public transport, like riding on trains or taking a local flight. Next, take a COVID test within 3-5 days of returning home, even if you feel fine.  Fully vaccinated people can still contract and spread the virus, including variants, while still asymptomatic (without symptoms). With the increase in breakthrough cases of variant infection (meaning fully vaccinated people getting sick with a COVID-19 variant), this step helps protect your health and those around you.  Testing after you return from international travel is important, especially if you come into contact with unvaccinated or immunocompromised individuals.  While you’re waiting to take your test, it’s good practice to self-monitor for COVID symptoms as well. Immediately self-isolate and get a COVID test if you feel unwell or suspect you may be infected.  And of course, continue to follow all local regulations and guidance, no matter where you are. 

If you choose to travel and are not vaccinated

If you choose to travel without being fully vaccinated, there are some additional steps that you should follow. While you are waiting for post-return test results, you should avoid contact with people who are at increased risk for severe illness until you can confirm you are COVID negative. This includes senior citizens, pregnant people, or anyone with a medical condition that makes them more likely to become severely ill As always, you should continue to monitor yourself for COVID symptoms and follow all local regulations.     

Home sweet home! Returning from international travel

The pandemic has changed the way we do just about everything, including how we travel. As the world continues to adjust and grow into a ‘new normal,’ the long-awaited family vacation or getaway that was unthinkable just a year ago might just be on the horizon.  Just remember to check your destination’s COVID policy, get tested before you go, and bring your own COVID RapidReturn travel tests for the return trip to avoid disappointment.  Bon voyage!
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