You (an American) tested Covid-19 positive while traveling to India. Now what?
I wrote a general set of guidelines on international travel during the pandemic. This post handles a very specific edge case that some folks are already hitting (January 11, 2022). If you are traveling internationally, and test Covid positive, what should you do?
This is not advise on how to cheat the system. This is not advise on traveling while infected and be a danger to others. There are moral and ethical decisions to be made on your behalf and on behalf of the community. My elder daughter regularly challenges me on my moral and ethical choices in life. I try my best to not embarrass her in my actions and decisions in life. This is what I would do, based on my moral and ethical compass, that allows me to face my daughter without shame.
Update Jan 24
The following airlines accept letter of recovery to travel back to the US
- United
- American Airlines
- Air France / Delta
- Qatar
- Air India
The following airlines accept rapid antigen tests for travel back to the US
- United
- AA
- Delta
- Most European airlines (Air France, Lufthansa, KLM, BA)
- Air India direct — unsure. Need verification. Website says they support it, but I don’t have anecdotal evidence of this.
Understand CDC requirements for travel
Please read and understand the requirements defined by CDC for entering the United States during the Covid-19 pandemic.
Few key points.
- You are allowed to travel if test positive for Covid-19 infection, provided you have a Doctor’s note that states that you are safe to travel. CDC guideline says that after day 10, you stop shedding the virus. There are blood tests that can be done to verify you are not shedding the virus. A Doctor can diagnose you properly and deem you to be fit to travel and issue a note.
- Rapid antigen tests are acceptable for travel. Note that, as of December 1, 2021, CDC reduced the time required to test prior to travel from 72 hours before travel to one day before travel. Why did they do that? Because the incubation time for Omicron is 1–2 days, unlike prior variants. The 72 hour testing requirement as needed by countries like India and the UAE are antiquated and are not useful for stopping Omicron. But as you are aware, RT-PCR testing in the United States is severely backlogged. It is very hard to obtain a RT-PCR result within one day. Rapid antigen tests often take less than 30 minutes to complete and can be done quickly. Most European countries also allow you to travel with a rapid antigen test, not requiring RT-PCR tests. In fact, KLM used to do rapid antigen tests just before boarding to all its passengers. They would board passengers who pass these tests.
Differences between RT-PCR tests and Rapid Antigen tests
This is not a technically accurate description of these tests, but broadly speaking, RT-PCR tests are very exact and are designed to track any traces of the virus, dead or alive, in a person. These tests amplify the RNA of the virus in the test sample and identify even the tiniest virus (dead or alive) in a person. Rapid antigen tests are far more forgiving, but they miss people who are at an early stage of infection and are not shedding the virus actively. It is a compromise. CDC and the European countries have made a calculated compromise that Rapid Antigen tests are good enough for travel, to work and to meet others. United airlines, which follows CDC requirements, in fact recommends using www.emed.com, a proctored rapid antigen test for travel. It takes 20 minutes to test under a proctor, get a certificate. You can upload this certificate to United’s website and they will approve you for travel before you arrive at the airport.
Hence, my recommendation, if you are an American to always travel using an airline that supports Rapid Antigen tests. At the time of writing this, it is United Airlines, some European airlines and Air India out of New Delhi. I highly recommend you only fly these airlines.
Update Jan 12: A bit more detailed talk about RT-PCR
A friend forwarded this presentation that goes in depth about RT-PCR, the various factors involved and a threshold for tests.
What about other airlines?
Unfortunately, other airlines, such as Emirates, that I used to fly to India, do not honor CDC’s recommendations. The reason for that is when you transit through Dubai, you have to follow UAE’s Covid requirements. UAE’s Covid requirements are to get a negative RT-PCR test within 72 hours of traveling. The United States requirement is to get a test within one day. Emirates applies the worst of both cases and requires you to get a negative RT-PCR test within one day of traveling.
Why is this a problem?
Let us assume that you catch the virus either during transit or during your stay in India. Most likely, if you are double vaccinated and boostered, you are good for travel within two weeks. You will have a mild illness, you deal with it and get over it.
RT-PCR tests may test positive, for up to 90 days after an infection.
It is the exacting nature of RT-PCR that it may test positive for up to 90 days. That is why for almost all users, Doctors advise you to stop taking RT-PCR tests for months after your infection. It offers no information to them. Unfortunately, this will prevent you from traveling back on airlines, such as Emirates.
As discussed before, CDC allows you to even travel with a positive RT-PCR that is not older than 90 days if you produce a doctor’s note that you are safe to travel. Emirates does not honor the doctor’s note.
In most cases, a person who was infected with Covid-19 two weeks or more (within 90 days), is typically one of the safest people you can be around, during a pandemic.
I would not hesitate to travel with such a person or visit them. In fact, I just did.
You have caught the virus. Now what?
If you are flying in an airline that allows you to fly with a rapid antigen test (typically direct, non-stop flights from New Delhi, or rarely Bangalore — Air India, but please call them first to confirm), all you have to do is wait ten days.
Chances are, within ten days, you are cured. When your symptoms subside, get a rapid antigen test and if it tests negative, you are good to travel. So, at most, you are delayed by a couple of weeks where you recover and you can fly back.
If you are flying in an airline that requires a negative RT-PCR test, your life is a bit harder. You can test negative anywhere from ten days to ninety days (maybe if you are boostered, it happens much quickly, but I do not have any finite answers to this regard). If you keep testing positive in a RT-PCR, you are probably better off doing a rapid antigen test and if it is negative, to reserve a one way ticket using United airlines and fly back from New Delhi.
You would, most likely test negative in RT-PCR within a few weeks, but it is the uncertainty of how long it takes that bothers most travelers.
How do you get to New Delhi?
But how do you get to New Delhi? That is an unknown area to me. Once you have been in India for two weeks, you are treated as a local. You should be allowed to fly with just proof of vaccination. But if the local authorities determine that you had a positive RT-PCR result, maybe a Doctor’s note or explaining the CDC requirements might help. Or maybe use a mode of transport that avoids having to explain this.
Future travels
When I travel to India the next time during the pandemic, I will definitely fly United airlines. I will continue to take all the precautions I talked about in my previous post, but will limit my tests to Rapid Antigen tests, most likely a proctored test kit from www.emed.com, that United Airlines supports.
