This week, a new US Covid travel requirement was added for entry into the country. While intended to improve safety, the plan is fundamentally flawed for one key reason.
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The US Adds Entry Requirement
On January 12, 2021, the US confirmed that beginning January 26, 2021, all air passengers would have to comply with new COVID-19 testing requirements upon entry into the United States. The travel restriction states that passengers must provide proof of a negative test result within 72 hours of when their flight departs.
Airline staff are to check the negative Covid-19 test results as they would other travel documents, denying boarding to those who fail to qualify. PCR tests are named and approved as are Antigen. Connecting flights are unaffected so long as the passenger qualified for the first flight into the US and do not connect longer than 24 hours. This restriction applies to any traveler entering the country including US citizens and permanent residents.
The announcement with just 14 days to implementation left airlines scrambling.
The Lone Passenger Exception
On the CDC website, there was a cryptic text that stated those who had “recovered” from the virus. Matthew reached out to the CDC for clarification which resulted in this exception:
“In order to travel under this exception, you must bring proof of a positive test result as well as a signed letter from a licensed healthcare provider (on official letterhead) stating that you have been cleared to travel. The letter must include:
- Name
- Address
- Telephone number
Furthermore, the positive test must have occurred within the last 90 days.”
Why It’s Flawed
There are two schools of thought with regard to antibodies. First is that we don’t know for sure how long they last though studies give some guidance.
What this suggests is that the CDC is confident that antibodies will be present within 90 days from when the traveler has recovered from COVID-19. So much so that they don’t need to confirm the negative test (PCR) nor a positive test for antibodies. It’s essentially settled science.
However, given that none of the studies published have shown any diminishment of antibodies, proof of once having the virus should be sufficient, the 90-day requirement is arbitrary and superfluous.
Studies cited here show that while antibodies were thought to have only been present for four months, that was a misinterpretation as the study only lasted four months. Another study lasted seven months and again, antibodies were still present in all subjects for the duration. Still another (courtesy of commenters on the Boarding Area Facebook group) pair of studies that ran eight months showed the cells to still be effective for the duration. That’s not to say the study found them to be effective “for eight months” but rather that in eight months they were still active and would be longer if measured longer, but how long is unknown.
One possible reason for the 90-day rule could be that variants of the virus may be able to mutate and reinfect travelers who have already had the virus. However, for that to be a logical reason, that would assume that the same antibodies that would keep a traveler virus-free from the known version of COVID-19 are useless against the new strain. However, if the antibodies are useless against the new strain, then having COVID-19 (known) within 90 days wouldn’t apply at all.
Further, for those that never had COVID-19 but possess the antibodies, or were asymptomatic, or simply were never tested but had it and recovered – they are not a risk to public health. In fact, they lower the risk for everyone because they cannot contract the virus with antibodies present and thus cannot pass it on to others. Whereas a passenger that has a negative test result because they have never contracted it before remains a risk to public health because they remain susceptible to infection. Antibody holders do not.
A simple $25 test would prove that. If a passenger had the virus 91 days prior and has the antibodies present, they are not a risk, but do not qualify and must produce documentation of a negative test result.
And if the antibodies do eventually wear off and are no longer present, putting the traveler and the public at risk, an antibody test would communicate that as well.
Conclusion
Requiring a negative PCR test result is costly for travelers, slow, and reduces testing capacity for others. An Antibody test (which can be returned in 15 minutes at a Kroger, for example) is cheaper, doesn’t put a strain on the system keeps travel safer for others.
The arbitrary selection of 90 days since a negative test or recovery from COVID-19 doesn’t make logical sense when an antibody test would do the same thing. If, by chance, a person possesses the antibodies after 24 months following their recovery, why should they have to endure a PCR test to travel when they present no risk? And if antibodies aren’t settled science and recovered travelers could still be at risk, why aren’t they too tested inside of the 90-day window?
Some have noted that the 90-day window could be because recovered patients will continue to test positive for up to 90 days despite being COVID-19 free and fully recovered.
Until antibodies are proven ineffective against the virus, the antibody test alone should be sufficient for those that possess them. If no antibodies are present, then a PCR test makes perfect logical sense.
It’s as if the CDC is answering the wrong question. “How do we ensure the public it’s safe to travel?”
By proving that travelers don’t carry a risk at the time of their flight. “How do we prove that?” Either a PCR test or no test at all – you choose.
What do you think? Does this policy make logical sense to you? Shouldn’t antibody results matter?
You’re missing the entire point of the 90-day requirement. They’re not using that time period because of immunity, they’re using it because someone who contracts COVID will often still test positive for up to 90 days after the infection has cleared, so it would be impossible for such a person to produce a negative test even if they are no longer contagious. That’s the only reason for the exception–they would require a negative test from those passengers too if one was possible.
Good Afternoon,
The requirement does not require a PCR test and that is very misleading. The order clearly allows for antigen testing.
@Kyle Harmon: Exactly. Very well said. Travel is an activity that increases risk of transmission so everyone should think twice about it until the pandemic is over. If you do choose to travel (that includes myself) just do the test. It’s not like it’s $600 for a test. And if you can afford to travel across the globe, I am sure the 2x$150 for the tests won’t break the bank.
Point of fact – not all tests are $150. I recently found that in at least one city in Mexico, the tests climb to $300 depending on the facility. Due to capacity constraints, you might not have an opportunity to choose a cheaper provider and also remain in compliance with testing standards.
But if the doctors in the studies included in the post are right, antibody holders pose no risk and re-infection is at anomaly odds. So why use the testing facilities and add the costs for useless tests? If it’s $25 and done in 15 minutes while you grab some bread and cheese at the grocery store, then sure, who cares? But even at your number of $150, that’s in both directions for most countries now ($300) for each traveler. If my family of three had the virus and hold the antibodies still, then $75 to prove they are working is fair enough, but $900 for the same result is ridiculous.
Exactly. Inactive virus stuff can be picked up by some tests for up to around something like 7-8 weeks after a recovered person’s infection has passed.
The US will accept your choice of a negative antigen test or a PCR test for purposes of travel, but the US also needed an exception to allow travel for those who are recovered and no longer infectious but for whatever reason may still test positive for SARS-COV-2
US citizens
@ Kyle Harmon I tested positive in the first part of November. I had to be tested before coming back from the UK and tested negative after 2 months of a positive test, both PCR tests. I also tested negative on a rapid test 2 weeks ago, but I don’t give that much thought.
Where is the bit about only allowing PCR tests? Last I checked (a few days ago), the require specified that an antigen test was sufficient.
They’re not trying to exempt immune people LOL. They’re trying to exempt people for whom a positive test can be explained by an infection long ago.
Why is LALF making ignorance its brand? This seems to be an ongoing project dating back to at least March.
To follow, this is the verbatim language confirming that an antigen test is acceptable:
When do I need to get a test to travel to the US? And what kind of test do I need?
Get tested no more than 3 days before your flight to the US departs. Make sure to be tested with a viral test (NAAT or antigen test) to determine if you are currently infected with COVID-19. Also make sure that you receive your results before your flight departs and have documentation of your results to show the airline.
“Further, for those that never had COVID-19 but possess the antibodies, or were asymptomatic, or simply were never tested but had it and recovered – they are not a risk to public health. In fact, they lower the risk for everyone because they cannot contract the virus with antibodies present and thus cannot pass it on to others.”
What is the source on this? I’m not sure if this is confirmed… yet. Hence why they are not certain that vaccinated people like myself can infect other people (i.e. I can still contract and be infectious while i’m fighting off COVID-19) and why I still have to maintain all social distance rules, wear a mask, etc. There are cases where people have reported contracting COVID-19 multiple times as well.
Not saying I agree with all aspects of the rule, but I disagree with some of what you are saying.
The rule specifically allows PCR and antigen tests to come back into the country. Wholesale an antigen test is often cheaper than an antibody test (but they are close). Allowing antigen tests makes it much easier to comply with the rule and in tourist destinations where a finite number of PCR tests can be run, allows them to be used fore diagnostic purposes.
I think a letter from your physician is better than a negative PCR since it reduces resources required.
Allowing travel with an antibody only test would include people that are vaccinated (there are two points that antibody tests and if you got the vaccine you will test positive on some, but negative on others). They specifically don’t want to include vaccinated people until there is evidence about asymptotic infections (Pfizer said that should be out in February).
I’ve gotten several tests already for international travel over the past few months and what I’m really interested in is how the airlines, CBP, CDC, etc is going to accurately verify the test results? All of the ‘valid’ tests that I’ve received come in either an email or pdf form which could very easily be modified with a pdf editor. So what’s to prevent people from just forging these test results?
Kyle, I believe the CDC order mentions that viral antigen tests are also acceptable. Therefore, a rapid 15-minute test that checks for current viral infection will be acceptable. The CDC doesn’t mention any minimum requirements for specificity or sensitivity which is surprising given that a PCR test isn’t mandatory and that rapid tests can vary greatly.
As KH mentioned, the point about a recent infection and proof of recovery is more to do with not denying boarding to someone who returns a false positive result because some of the very sensitive tests pick up ‘dead’ virus.
They’re not trying to exempt immune people LOL. They’re trying to exempt people for whom a positive test can be explained by an infection long ago.
Why is LALF making ignorance its brand? This seems to be an ongoing project dating back to at least March.
@Stvr – Why is there no waiver for people who don’t have it and cannot transmit it?
Because there is no evidence yet that having the antibodies (by vaccination or by recovery from the disease) means that you cannot transmit it. In addition, it would set a dangerous precedent to give those who are vaccinated “special rights” like seamless international travel. What are we really arguing about here? Getting a nasal swab? Paying a testing fee? It is an inconvenience to me as well but this testing rule has been around for months in many countries.
But there is. The cited studies (click on them, they are linked in the post) from respected Universities demonstrate that the participants’ antibodies more or less blocked the virus from the start, never re-infecting those studied. If it can’t reinfect, it can’t be passed on. This is what the scientists that conducted the studies stated, I’m just citing them.
The other comments require a response as well. We disagree that it would be a dangerous precedent to give those who [pose no risk, or minute risk] seamless international travel. What’s the inherent danger in people who cannot get sick, cannot pass on the virus returning to life as normal? I don’t see one.
Further, your cavalier questions about what the issue is assumes a competent testing system with affordable, accurate, and unlimited tests. The reality is far from that. Check any of the Hawaii travel groups on the internet that discuss how they complied with the testing protocols and procedures and test results weren’t delivered on time and forcing changes. Those changes could them put them out of compliance when the results come in. It also requires a re-test which doubles the cost in at least one direction. False positives are far more common than false negatives.
It assumes that there’s only one test to take and one system with which to comply, but international flights could require connections in two or three countries, especially given limited flights available right now. When governments change their requirements (as the US has done) travelers could be required to take three tests for the outbound and three for the return depending on a variety of factors. In that extreme example, $200/person turns into $1200 in tests alone for someone who can’t be reinfected – and that assumes they are traveling alone.
Even for doubters who don’t trust the scientists and PHDs that studied antibodies in these included examples, they’d still have to admit that antibody holders are less likely to become infected (if not immune). Even if it’s possible but unlikely to pass the virus on to others, that’s still preferred to someone who tests negative but has never had it. If we are going to trust the scientists, we need to trust them when they talk about both infection and recovery, about contagiousness and immunity. We can’t pick the science that works for our narrative and ignore the science that doesn’t.
I’m sure you’re quite an expert on many things, but unfortunately, transmission of infectious disease does not appear to be one of them. I am currently participating in the Moderna clinical trial. My participation has shifted from Phase 3 on the efficacy of the vaccine to the transmission of the virus among those vaccinated. While many doctors believe from history and precedent that the vaccine will likely greatly reduce (but not eliminate) the transmissibility, none of it has been presented let alone peer reviewed, yet.
Stop pretending to be an expert on things on which you are not. It’s dangerous and inflammatory.
@BC – I am sure you’re an expert on many things but reading for comprehension doesn’t appear to be one of them. I didn’t refer to the vaccine(s) at all. I am talking about people who have had the virus and recovered and maintain the antibodies. As you know, because you’re in the trial, the vaccines are not the same as those in the past – you don’t get a small portion of the virus but rather an MRNA shot that gives your body the winning battle plan to fight it off. So the vaccinated never “recover” because they’ve never had the virus (assuming they never did and already hold the antibodies too.)
There are four studies on antibodies linked in post – not vaccines, antibodies – and at least one is from the leading source of COVID-19 modeling. If you want to disqualify 100% of the antibody studies because of your vaccine experience, you’re free to do so, I’m just not willing to dismiss 100% of the scientists on the topic.
If you’re going to accuse me of dangerous and inflammatory fear-mongering, make sure you read the article first and are commenting about what’s written.
You may be an expert in many things but infectious disease transmission is clearly not one of them. While many epidemiologists believe from previous viruses that immunization and previous infection will slow transmission, there have been no reports yet let alone legitimate peer reviewed studies. Kyle’s broken logic would also give fuel to those who believed that masking and distancing should not be required for those that are vaccinated and/or previously infected. It’s just plain wrong.
I am currently participating in the Moderna trial having recently shifted from Phase 3 on efficacy to determining the transmissibility of those vaccinated. It’s expected to be at least 4-6 weeks before initial findings are reported (by any of the studies).
The good news is that the studies can stop because Kyle says they’re unnecessary.
While the first two vaccines, Moderna and Pfizer are using MRNA, nearly all of the rest of them globally (Johnson + Johnson, Astra Zeneca/Oxford, Sinopharm, Sputnik) are not. Even with that said, there is still no medically reviewed data that says that someone who has recovered cannot carry/transmit. As you presumably know, there have been more than an anecdotal amount of folks who have been reinfected.
Stick to your expertise. I’m sure there’s a free Quality Inn night to be had somewhere.
@BC – You talk about me not being an expert on this topic but first you decide to talk about vaccines, something I didn’t discuss, and then defend them improperly (MRNA is the type of vaccine study you claim to be in.) When I bring up that I am talking about ANTIBODIES and why vaccines have nothing to do with it, you spout more unqualified misinformation that “there is still no medically reviewed data that says that someone who has recovered cannot carry/transmit.” despite it being cited in the original post and reminded in the last comment response.
But I am patient. Let’s try this again.
Here’s the State of New York Health Commissioner, Dr. Zucker speaking on antibodies. Research (updated July 23, 2020) suggested as many as 20% of those never tested have the antibodies, either because they naturally acquired them, were asymptomatic, or because they were sick and recovered but never tested. Speaking about antibody tests, “It is a way to say this person had the disease and they can go back into the workforce,” Dr. Zucker said. “A strong test like we have can tell you that you have antibodies.” But he cautioned that the length of any such immunity remained unknown. “The amount of time, we need to see. We don’t know that yet,” he said, adding, “They will last a while.” -New York Times (https://nyti.ms/2S7Q4q8)
Here are two scientific studies that state reinfection was not observed in any of the recovered participants and all had antibodies. Notice that this particular quote from a senior official with the University of Washington Virology department says that they didn’t have any reinfections nor did anyone lose the antibodies in their study.They don’t know if you can get sick again because they didn’t have any that did.
“According to Lauren Rodda, PhD, a senior postdoctoral fellow in immunology at the University of Washington School of Medicine, we don’t know for certain if people are immune to reinfection simply because not enough studies have been done yet. This would require tracking the re-exposure of a significant number of people and determining if they get sick,” she said.- Healthline (https://bitly.com/39IoYxS)
Here’s a report about a preprint (soon to be published scientific study) that concluded reinfections can occur but antibodies appear to be pretty resilient and there’s no evidence that even waning antibodies are ineffective. And a note on those reinfections, about 1,000 cases are “suspected” but only 25 are scientifically proven which makes your chance of becoming reinfected 1 in 3.8 million right now. Your chance of becoming a billionaire in the US is 1 in 785,000 for reference:
“Although antibodies can wane substantially within months—particularly in patients with less severe disease—they sometimes persist, even in mild cases. Neutralizing antibodies, the most important kind, as well as memory B cells and T cells seem to be relatively stable over at least 6 months, a preprint posted on 16 November shows” Science Magazine – http://bitly.com/3iptRjq
So let’s build that all back together now that I’ve done all the research for you on a matter that you keep regurgitating incorrect information about (while suggesting that’s what I am doing.)
1) Antibodies may not be perfect but they should last for an extended period of time and are effective against the virus.
2) In each of the studies that have been conducted, all participants had the antibodies through the duration of the study, first four, then seven, now eight months. While that does not prove that they will never go away, there hasn’t been a scientific example of antibodies being no longer being present. The only time limits on antibodies are associated with the length of the study, not the expiry of the antibodies.
3) Antibodies are not perfect but reinfection is incredibly rare. If everyone in the United States were infected (330,000,000 people) 86 people would be reinfected. 86.
And to your second-to-last comment, how about you support your statement with some evidence. Do you have numbers on reinfected cases that counter what I have found? Let’s see it. I included a source when I made my statement. Now it’s your turn.
Finally, one more misfire for you. If I am an expert on anything, it’s Hyatt. After doing all of this work to correct you, I’ve probably earned a suite upgrade somewhere.
The testing requirement makes perfect sense for security theater, or if you want a de facto ban, without actually closing the border by nationality.
As others have pointed out, the directive clearly states that antigen tests are also acceptable. It’s disappointing that taking 5 mins to research and read the directive was too much work.
@Indyflyer – I have updated the post, antigen wasn’t named in the original release. As you’ll notice by clicking through the links included in this post, Matthew had to reach out and get clarification because the original release didn’t even include the parameters for “recovery” were which turned out to be rather specific but initially unnamed.
https://www.nytimes.com/2021/01/17/us/covid-deaths-2020.html
This article points out how white Republican males are stupid f%$ks and should not be taken seriously. They are also criminals.
Typical intolerant liberal, who uses generalizations to attempt to make a point.
Every time I read Kyles articles I feel stupider for having done so….never again.
1. Tests are flawed. 2. This requirement is a SIW for Airline bottom line, same for cruse industry and resorts. Many customers are rebooking later or canceling vacations. None are willing to add a couple thousand to the cost to have a family tested. And what about false positives? You are then stuck at your vacation destination? Imagine having to pay for weeks unplanned.
Best to simply stay home or take trips in your car to close destinations that are friendly and want the business.
The testing means nothing as you can be virus free at 12 noon have the test= negative go out that night and get it!!!The 72 hours is along of wiggle room.. to catch the chinese virus and spread it…..