Covid testing for airplane travel is a mess—but infection screening is here to stay

Covid testing for airplane travel is a mess—but infection screening is here to stay
Image: Reuters/Phil Noble
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If you’re traveling internationally this year, you should expect to show a negative Covid-19 test at some point during your journey. And you can expect the process to be a bit of a mess.

On Jan. 15, the US Centers for Disease Control and Prevention (CDC) issued new guidelines for air travelers: Starting Jan. 26, anyone entering the country through an airport, arriving from anywhere in the world, cannot board their flight without presenting proof of a negative Covid-19 test taken no more than three days before the departure time.

An exception is made for people who have contracted Covid-19 and recovered within the last three months, which must be certified with a doctor’s note. There is no exemption for passengers who have been vaccinated, since scientists remain uncertain if vaccinated people can still transmit the virus. Non-US citizens or residents from the UK, Ireland, most European countries, South Africa, and Brazil, with some exceptions, will be barred from entry to the US altogether indefinitely, the Biden administration said on Jan. 25.

The new testing policy was a victory for airline trade groups, which had lobbied for the US to adopt a universal testing mandate. The pandemic has been brutal for the industry, with half the seats filled on passenger flights globally in 2020 compared to 2019.

A common global approach to testing, industry executives have said, is crucial to boost traveler confidence and to chip away at more draconian travel bans and quarantine periods. A Jan. 25 outlook from Cathay Pacific Airways projected that quarantine measures in Hong Kong alone will cost the airline up to $51 million per month in reduced passenger traffic and wasted time by quarantined employees, on top of the $193.5 million the company is losing each month due to the pandemic.

But internationally, there remains little consistency about the requirements and protocols for Covid-19 testing for air travelers, with no two countries or airlines doing the same thing.

“We understand the passenger confusion out there,” said Jim Groark, vice president of airports in the Americas region for Cathay Pacific, which, like many airlines, has partnered with a private health clinic to provide testing services for its passengers worldwide. “Different laboratories have different information on the [test] reports, and different governments require different information. We’re lobbying for a common approach. We need passengers to travel and we’ll do whatever it takes so that passengers feel safe.”

Travelers can check the US Department of State or a database maintained by the travel website Kayak for guidance on whether testing is required by a destination country, how long before travel the test must be completed, and other rules. Today, at least 160 countries require a negative Covid-19 test for entry, according to data compiled by Shoreland Travax, a medical risk management consultancy.

Although most airlines will accept test results from any accredited lab, testing centers have popped up at many international airports for travelers in need of last-minute services. In December, Los Angeles International Airport opened the US’s first facility to perform on-site processing of polymerase chain reaction (PCR) tests, which pick up genetic signals of SARS-CoV-2. The tests, which cost $125, can return results to travelers in less than five hours, compared to up to 48 hours for tests processed off-site.

The airline industry, Groark said, believes the best way to manage testing is the CommonPass, a smartphone app under development by the World Economic Forum, that travelers anywhere in the world will be able to use to share validated Covid-19 health information, including test results and vaccination status, with airport and other officials. That app is undergoing trials, and meanwhile, United, American, Singapore, and other airlines are developing their own apps. But until more airlines get on the same page, said Carlos Ozores, an aviation industry consultant with the firm ICF, the lack of an international standard for whether testing is required, which tests are acceptable, and how testing data is shared and validated by airlines and governments leaves room for problems.

“There’s lots of scope for fraud or ineffective testing,” Ozores said.

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Law enforcement officials in France, Brazil, the UK, and elsewhere have already busted groups hawking forged negative Covid-19 tests to air travelers. On Jan. 26, the CDC scrapped a rule that allowed airlines from low-income countries to apply for a temporary waiver to the testing requirement, which Ozores said will likely inhibit travel from places that lack sufficient testing facilities. And although Groark said Cathay and other airlines are relaxing their refund and rescheduling policies in the event that travelers can’t get a test or test positive, the CDC guidelines stipulate that passengers must get a new test if air traffic delays cause their original test to be older than 3 days.

Then there’s the type of test. The CDC allows passengers to present either a PCR test or a rapid antigen test. The latter detects proteins on the virus and can yield results in a matter of minutes, but can produce high rates of false negatives. Only a few other countries accept antigen tests; about 90% of countries with a testing requirement allow only PCR tests, said David Freedman, managing senior director at Shoreland, because they are better at detecting recently-acquired cases that could become infectious or symptomatic after the person lands in the new country.

Still, although PCR tests can be more decisive than antigen tests, the time lag can render them moot, said Amesh Adalja, a senior scholar at the Johns Hopkins Center for Health Security. “I would rather have an antigen test at the gate than a PCR test 72 hours in advance,” he said.

Ultimately, no single test can be a foolproof firewall. A November 2020 paper by CDC scientists found that when used to screen out infectious air travelers more than a day in advance, a single PCR test limited total virus transmission by less than 40%. However, subsequent research by ICAO, the United Nations aviation agency, found that requiring passengers to take a single PCR test within two days of departure reduced the risk of in-flight transmission by 75%.

The same ICAO study also pointed to an even better solution: A seven-day quarantine upon arrival, followed by PCR testing, reduced transmission by 94%. A growing number of governments see the quarantine-plus-test combo as the best way to allow travel with a high degree of safety and avoid an onerous two-week quarantine, Freedman said. On his second day in office, president Joe Biden instituted a seven-day quarantine for air travelers entering the US, following similar moves this month by France and the Netherlands, which will be required on top of the existing testing rule.

“What we’re seeing is that the industry is against quarantines,” Freedman said. “But governments are mostly moving toward quarantine on arrival and combining it with testing on arrival to make the quarantine as short as possible.”  

Overall, travel in 2021 is more likely to follow the strict example set by countries like South Korea or Australia than the more relaxed approach taken by the US and UK last year. The current situation is analogous to air travel after Sept. 11, 2001, Ozores said, when countries and airlines took years to get on the same page about security screening. Now, passengers worldwide don’t think twice about removing their shoes and emptying their water bottles.

“I highly expect for additional levels of bio-screening to become a permanent facet of cross-border travel,” he said. “But the world needs to come to an agreement on what the right approach is. We’re still very far from that.”

An original version of this story misstated Cathay Pacific’s spending projections in US dollars. The figures have now been converted from the original figures, in HKD, to USD.