You are now somewhat free to move about the globe. But not without one significant hindrance. While Americans have the green light to travel to certain international destinations, admittance to most countries requires a negative COVID-19 test within 48-72 hours of arrival. This seems straightforward, but good luck getting test results back within the time limit. Most countries require the Real-Time Reverse Transcriptase (RT-PCR) test. According to a recent issue of BMJ Practice Pointer, false negative rates for this test range between 2-29%, representing a 71-98% sensitivity. While readily available, turnaround time for results varies. According to the FDA, results are available the same day in some locations, but it can take up to a week. For example, we called about a dozen Manhattan-based physician offices and walk-in clinics. Turnaround time for results in this informal survey ranged from 72 hours to 2 weeks. None would guarantee results in time. Rapid tests won’t do Some travelers have erroneously turned to so-called rapid COVID-19 tests, which offer results in an hour or less. Unfortunately, most countries will not accept rapid test results. According to the CDC, the rapid tests, which detect antigens rather than viral genetic material, are less accurate than the RT-PCR tests. Rapid test sensitivity ranges from 84.0-97.6%. “Antigen levels in specimens collected beyond 5-7 days of the onset of symptoms may drop below the limit of detection of this test,” the CDC says. In other words, travelers relying on this test may have COVID even though the test says otherwise. The FDA recommends that “negative results may need to be confirmed with a molecular test.” We couldn’t find any country that would accept serological test results for admittance. Expensive testing options So, what’s a physician with a bad case of wanderlust to do? It seems you’ll either have to rely on luck, or money. First, let’s look at luck. Cruise a few Tripadvisor ‘COVID testing’ forums (like this one and this one), and it becomes apparent that there are few guaranteed 72-hour turnarounds. It’s going to take some scouting to find a clinic or testing facility that’s seeing a low volume of patients. You’ll also need to find out what the average turnaround time is for results, and place your bet knowing that your trip may be off if you don’t get results in time. The other option is to shell out some serious cash. Some concierge medicine services offer RT-PCR tests at varying price points, depending on the desired turnaround time. For example, this service offers non-members test results guaranteed in 12-72 hours, ranging from $499-$899. They’ll even come to you (if you’re in New York City). A slightly more affordable option, this service will mail you a RT-PCR test kit for $219, plus shipping. As a physician, you’ll likely do a better job self-administering the test than most, but be forewarned: Sticking a swab deep into your nasal cavity and spinning it around will be a sensation you’ll never forget. The service also offers a saliva test. Collect your sample, slap the prepaid priority overnight FedEX shipping label on it, and you’ll have results via email within 24 hours. Moving about the country Traveling within the United States may be easier, but isn’t without risks. Feasibility will be determined by several factors, including the state of the pandemic nationwide, your home state’s quarantine regulations, and your desired destination’s regulations. For example, here in the tri-state area, the governors of New Jersey, New York, and Connecticut require residents returning from any of more than 30 states or territories to self-quarantine for two weeks. The advisory bars residents from “travel by train, bus, car, plane, and any other method of transportation” during the 14-day quarantine period. Source
