Infectious Disease

US to require COVID-19 testing for travelers from China

December 29, 2022

2 min read

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Disclosures:
Adalja and Kaye report no relevant disclosures.

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Starting Jan. 5, the United States will require inbound air travelers from China to present a negative COVID-19 test or documentation of recovery from COVID-19 when boarding their flight, the CDC announced.

The requirement, which comes as China battles a surge in cases after ending its zero-COVID policy, was put in place “to monitor the case surge effectively and decrease the chance for entry of a novel variant of concern,” the CDC said in a press release.

IDN1222ChinaTravel_Graphic_01_WEB updated

“Variants of the SARS-CoV-2 virus continue to emerge in countries around the world,” the agency said. “However, reduced testing and case reporting in [China] and minimal sharing of viral genomic sequence data could delay the identification of new variants of concern if they arise.”

The CDC said all passengers aged 2 years or older who board flights leaving China, Hong Kong or Macau — including those on connecting flights that are traveling to a third destination — will have to show a negative test result to the airline that is no older 2 than days.

The requirement, the CDC said, will apply to all passengers regardless of nationality or vaccination status. Passengers who tested positive more than 10 days before departure can show documentation of their recovery instead of providing a negative test.

Keith S Kaye, MD, mphchief of the division of allergy, immunology and infectious diseases at the Rutgers Robert Wood Johnson Medical School and an Infectious Disease News Editorial Board Member, told Healio that he recommends travelers use antigen testing because of their ease of use and ability to quickly detect asymptomatic .

“I think concerns regarding China’s lack of transparency regarding COVID rates makes testing travelers returning from China reasonable,” Kaye said. “Antigen tests will provide more practical information — a positive PCR test in the setting of no symptoms doesn’t mean a whole lot from a clinical or public health perspective. So, I would recommend that returning travelers use antigen testing if possible.”

The US first implemented pandemic-related travel restrictions in 2020 based on concerns that air travel would facilitate the spread of SARS-CoV-2. Experts have debated whether such rules are worth the time.

amesh A. Adalia, MD, FIDSA, FACEP, senior scholar at the Johns Hopkins Center for Health Security, told Healio that travel restrictions do not work for most infectious diseases — and especially not for “efficiently spreading respiratory viruses like SARS-CoV-2.”

Amesh A. Adalja, MD, FIDSA, FACEP

“The US itself has a high level of cases at baseline and one need not go to China to contract COVID,” Adalja said. “The US has a population flush with hybrid immunity, as well as plentiful access to Paxlovid, which give it resiliency. When a requirement like this is put into place, it is often done for political reasons in the absence of any strong scientific evidence.”

Adalja pointed to previous travel restrictions, such as those placed on southern African countries early in the omicron era, as well as the use of Title 42 on the southern US border as examples.

A better option, he said, would be to seek information that China has not made publicly available — such as genomic studies of patient samples.

“There’s really no benefit I can see from the US placing any testing requirement on travelers from China. The testing requirement will not even meaningfully add to surveillance,” he said. “A better action would be to test the toilet waste from those flights to understand the evolution of the virus, rather than this meaningless requirement.”

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