With the United States still requiring a negative COVID test within one day of traveling to the U.S., countless travelers are faced with the possibility of getting stuck abroad if they test positive.
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I knew the minute I woke up groggy with a sore throat that my time had come. After successfully dodging COVID-19 for more than two years, I quickly confirmed I was positive using a rapid antigen test from the front desk of my hotel in Oberammergau, the village in southern Germany where I had come in late April to attend a travel conference.
I was lucky—the conference organizers had a COVID response team with clearly defined protocols about what to do next: Isolate in my hotel room until the on-site testing unit could come to proctor a PCR test. About two hours later, a woman in full PPE knocked on my door and swabbed my throat. Two hours after that, I received an email confirming what my body already knew: I had COVID.
The hotel left breakfast and lunch for me outside my door and I waited for my next steps. Meanwhile, I canceled all my appointments and engagements for the week ahead since I was supposed to depart for home in the San Francisco Bay Area the following day. Germany currently recommends a five-day isolation period for individuals who test positive for COVID. I knew I wasn’t going home for a while, and I tried to make my peace with that.
The next morning the conference organizers transferred me and one other COVID-positive (though asymptomatic) attendee by coach to a quarantine hotel at the Munich Airport. We were both masked and sat in the back of the bus, far from the driver. The hotel had been prepped that we were coming and told that we were both positive, which was a relief to me since I don’t speak German.
When we arrived at the hotel I checked in, hightailed it to my room on the second floor, shut the door behind me, and settled in. I stayed in the room for a total of six nights until my five-day isolation period was complete and I tested negative. (See more below on what happens when travelers continue to test positive for a prolonged time.) It was clear the staff here knew exactly what to do, and they couldn’t have been more helpful: Food was left outside my door twice a day, along with bottles of water. Housekeeping called every day to check if I needed anything.
About me: I’m 41 and fully vaccinated. I received my booster shot last November. I’ve been cautious about wearing masks and avoiding large crowds, and I still wear N95 masks on airplanes, buses, trains, and in theaters, museums, and common indoor areas. My symptoms included a sore throat, fever, night sweats, nasal congestion, nausea, headaches, fatigue, brain fog, loss of sense of smell and taste, and a cough.
My story is not uncommon. And as more and more Americans travel overseas this spring and summer, many will test positive for COVID. Some will get sick; others will be completely asymptomatic.
The reason you might get stuck abroad is that the U.S. still has a pretesting requirement in place, so all travelers entering the country must have proof of a negative COVID antigen, PCR, or CDC-approved self-test within one day of travel, regardless of vaccination status. (All foreign nationals entering the United States must also be vaccinated.)
Thankfully, testing has become easier to access throughout the world. Many airports now have testing facilities that offer travelers rapid tests for a fee, and most destinations throughout the world have testing sites. If you want to find out what the testing options are, check the U.S. State Department’s detailed COVID-19 travel information and country-specific advisories, which include an entire section devoted to the availability of COVID-19 tests within the country or countries you are traveling to. Additionally, the U.S. Centers for Disease Control and Prevention (CDC) has approved several at-home test kits for international travel, the caveat being that the use of these kits must be supervised by a health provider in the form of a telehealth video call (so users need to ensure that they have reliable Internet service to be able to conduct this virtual consultation). We have compiled and reviewed the at-home COVID tests that meet the requirements for international travel.
But everyone should have a plan—most travelers won’t be as fortunate as I was to have a team of native-speaking conference organizers to tell them what to do and take care of them if they test positive. So here are some things to think about and what I wish I’d known before I left the States.
Make a contingency plan before you leave home
If you’re traveling with a group, tour, or on a cruise, ask them or your travel advisor before you depart about testing policies and protocols around positive cases. What costs—if any—will they cover? Do you have travel insurance that covers expenses associated with a COVID infection while you’re out of the country? (These can include both any necessary medical treatment as well as an extended hotel stay.) Can you change your airplane ticket? What kinds of fees will be associated with that should you test positive and need to delay your departure? These are the kinds of details that travel advisors deal with every day. If you haven’t considered booking with one before, think about it as an option, especially as we continue to navigate the ever-evolving patchwork of COVID rules and regulations.
If you’re traveling independently, think about where you’ll spend your last night before returning to the U.S. Is it an accommodation you could comfortably spend a week in, should you test positive or fall ill? Does it have high-speed Wi-Fi if you might need to work, video chat with family or friends, or binge watch The Crown (guilty as charged)? If not, do a little research to determine if there’s a nearby hotel or rental better suited for quarantine. Consider cost and comfort. My room was spacious, equipped with a mini-fridge and full bathroom with a tub and steam shower, and most importantly, a large window I could open to circulate fresh air.
The kid scenario
I was traveling solo, which was a blessing and a curse. On the plus side, I didn’t accidentally bring the virus home to my four-year-old, who’s still not eligible for vaccination. And I didn’t have to worry about anyone else in my family of four and when they might or might not test positive. If I’d had my kids with me and we were all stuck for some amount of time, I would have contacted my elder daughter’s teacher and asked about possible distance learning while we remained isolated. If you’re traveling with kids, think about possible childcare needs in your contingency planning.
If you start feeling sick, test and isolate
Be sure to pack plenty of at-home rapid COVID tests so that the minute you start to feel unwell or suspect a possible exposure, you can administer a test. It’s better to know if you have COVID than to be in the dark. If you test positive on a rapid test, schedule a PCR test immediately to confirm the result. A lab-generated PCR test will mean that your COVID case will be officially documented by the country you are in and can help trigger government-generated instructions on next steps. In some countries, your case will go into the contact tracing system. After the PCR test confirmed my infection, the Bavarian State Ministry of Health and Care was notified and sent me a notice that clearly outlined what I needed to do before I could exit my isolation period:
Your isolation lasts a minimum of 5 days after the positive testing.
For your information: Day 0 always equals the day of your initial positive test.
If you are asymptomatic for a minimum of 48 hours you may leave isolation at the earliest after day 5 of isolating (on day 6).
If your symptoms persist beyond day 3, you must isolate until you don’t show symptoms like coughing, fever, and other cold-like symptoms any longer for at least 48 hours.
In any case, isolation will not last more than 10 days.
If you are unsure what to do, you can always reach out to the U.S. embassy of the country you are in for guidance.
What I wish I’d packed
En route to SFO for my flight to Munich, I realized I forgot my personal stash of rapid antigen tests. After I tested positive and before I was transferred to the Munich Airport hotel, conference organizers gave me a bag of at-home tests so I could monitor my progress through the illness. Don’t be like me—pack a bunch of tests so you aren’t left in the lurch (and remember you can receive free at-home COVID tests from the U.S. government).
During my sickest days (days 2–4), I wished I’d brought a Farenheit thermometer to track my temperature, as well as a pulse oximeter to keep an eye on my blood oxygen levels. I had a bottle of Advil with me that proved very useful the first couple of days of fever and headache. I’d also recommend packing some cough drops and cold medicine (Advil Cold & Sinus worked for me) to have on hand. Bring more high-quality masks, such as N95 or KN95 masks, than you think you need. If you do get sick, you will want to protect others in the event you are required to move from one location to another (such as when I transferred to the quarantine hotel) and you won’t want to reuse them.
By the time I arrived at my quarantine hotel, I had a carry-on suitcase of dirty clothes. After all, I was at the end of my trip (or so I thought) and had spent the prior week hiking in the Alps and attending business meetings. I called the front desk and had a stack of my most comfortable clothes laundered, which was a little luxury I didn’t regret.
Know who to call in an emergency
If you do test positive and fall ill with the virus, it’s a good idea to know how to get help if your symptoms worsen rapidly or become severe. Study up on a few phrasebook terms (“I need a doctor,” “It’s a medical emergency”), especially if you’re traveling to a place where English isn’t widely spoken. If you’re in a hotel room or vacation rental with a landline, find out the number to call in an emergency and write it down. Having local contacts or a travel advisor with in-depth knowledge of the destination on your side can really help. Look into travel risk management services such as Global Rescue and International SOS, which provide travel protections that include 24-hour assistance and medical evacuation.
If you continue to test positive after having recovered
According to the CDC, in order to be able to enter the United States from abroad, you either need a negative COVID test or “if you recently recovered from COVID-19, you may instead travel with documentation of recovery from COVID-19—i.e., your positive COVID-19 viral test result on a sample taken no more than 90 days before the flight’s departure from a foreign country and a letter from a licensed healthcare provider or a public health official stating that you were cleared to travel.”
This second option is important because, “We have people who are testing positive 42 days out from when they first tested and yet they’re completely asymptomatic,” says Dr. Robert Quigley, senior vice president and global medical director at International SOS.
One of the services travel risk management companies like International SOS will provide is connecting travelers to a heathcare provider in the destination who can write a certified “fit to fly” or “fit to travel” letter that can be used to board an airplane to the United States. If you just Google “fit to fly certificate,” you will find an overwhelming patchwork of resources and it’s unclear which are legitimate. It’s best to identify a certified healthcare practioner in the destination from whom you can obtain the necessary documentation.
“If a traveler continues to test positive for COVID they will need to obtain a letter of recovery from a healthcare provider to be able to travel. Each country has their own requirements. Most require the individual to have had COVID for a specific amount of time before they can be seen and evaluated for a letter of recovery. The average is 10 days. The letter of recovery is sufficient for travel,” says Jeff Weinstein, medical operations supervisor at Global Rescue, who has extensive experience in emergency and disaster response, critical care paramedicine, and emergency management.
Don’t get discouraged
If you find yourself reading this and falling into a pit of despair with concern about testing positive while abroad: Take a deep breath. For one, it’s very likely you don’t test positive, especially if you take precautions such as masking up in public spaces and if you are traveling to a destination where COVID cases are low.
If you do test positive, as I did, while there will definitely be some challenging moments, there will also be a light at the end of the tunnel. For me, days 2–4 were the most difficult. I could feel my immune system actively fighting the virus, and my spirits were low. Because of the timing of my sickness, I knew I was going to miss my daughter’s first chorus concert, Mother’s Day, and an important in-person meeting with colleagues. I had to process feeling upset and then focus on getting well. In the grand scheme of the horror of the last two years, I ultimately knew I was going to be fine. My advice if you do test positive while abroad: Drink a lot of water, test frequently, phone a friend to counteract loneliness, and try to distract yourself and rest. The good news? I wrote this during my flight home.
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