With the advent of Omicron travel got a whole hell of a lot more complicated.

The United States now requires a negative COVID-19 test within one day of return to the US. Previously it was 3 days. The new 1-day requirement rules out most PCR testing since in many places the turnaround is 24 hours or more.

The irony of all this - is that it leaves us with antigen-based testing, which is NOT recommended for asymptomatic patients - this means it’s a poor choice for travel screening. But don’t let that get in the way of blunt force public policy decisions! Here we have the FDA/CDC, on the one hand, saying “testing is required to return to the US and we accept antigen tests” AND “antigen tests are not recommended for screening purposes”.

In some ways, this ensures closer detection to travel, but in other ways, it just complicates travel further. So what do you do?

What are all the different types of tests?

There are different types of tests – diagnostic tests and antibody tests.

Diagnostic tests can show if you have an active COVID-19 infection and need to take steps to quarantine or isolate yourself from others. Molecular and antigen tests are types of diagnostic tests than can detect if you have an active COVID-19 infection. Samples for diagnostic tests are typically collected with a nasal or throat swab, or saliva collected by spitting into a tube.

Antibody tests look for antibodies in your immune system produced in response to SARS-CoV-2, the virus that causes COVID-19. Antibody tests should not be used to diagnose an active COVID-19 infection. Antibodies can take several days or weeks to develop after you have an infection and may stay in your blood for several weeks or more after recovery. Samples for antibody tests are typically blood from a finger stick, or blood drawn by your doctor or other medical personnel.

Well, there are a few options. Tests are hard to come by these days. On top of that Binax - the maker of many at-home testing kits that you use has manufactured tests with a short shelf life - so they are likely to expire within 3 months of receiving them.

More complex too is what qualifies for a test that you can use. The keyword is “proctoring”. You need to acquire a test that comes with a Telehealth “proctor”. This is a board-certified doctor or nurse who will observe you (via video) completing a rapid antigen test.

There are two types of BINAX Now Tests (these are Antigen-based Immunoassay) and they sound very similar. In fact, the tests are identical the only difference is that you are paying for one with supervised testing and verified results to submit to the airline.

Abbott BinaxNOW™ COVID-19 Ag Card Home Test with eMed Telehealth Services

This is a test that comes one test per box. It comes with Telehealth services from eMed. You set up a proctored session for each person to complete the test, so if there are four people you need a min or 1 hour to do all the testing - assuming there is no delay to get a proctor on the line.

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Abbott BinaxNOW™ COVID-19 Antigen Self Test

This is useless for travel. It’s only for your home needs to see if your cold is covid.

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There is an app that goes along with these tests, the NAVICA app. This is a good app to use for all the tests as it keeps track of your testing and has easy-to-follow instructions.

The good news is that I’ve ordered many of tests from Optum and they ship 2-day FedEx for free.

CUE Health

Stepping up from all this Binax stuff is a new company called CUE that developed a NAAT-based molecular test (the kind suggested for screening) - this test is on par with PCR testing as it tests for the presence of the virus. Cue recently started selling their Direct to Consumer offering that includes a Bluetooth device that accepts testing cartridges.

The Cue Home and OTC Test detects the RNA of SARS-CoV-2, the virus that causes COVID-19, with the accuracy of a central lab test. It is a highly sensitive and specific nucleic acid amplification test (NAAT) that runs on the rechargeable Cue Cartridge Reader, a reusable device which fits in the palm of your hand. Results are displayed directly onto the user’s mobile smart device via the Cue Health App. Each Cue OTC Test Cartridge Pack includes the single-use, self-contained Cue Test Cartridge and the Cue Sample Wand, which is the swab for minimally invasive sample collection. Together, these components make up the Cue Health Monitoring System to offer clinical-grade performance at home or in a non-clinical setting. In prospective studies to evaluate the use of the Cue OTC Test, the results were 97.4% agreement for positive cases and 99.1% agreement for negative cases compared to the results from a highly sensitive EUA PCR laboratory-based test.

It’s more expensive than the Abbott system, but comes with benefits:

It’s a smaller package to travel with - especially for a family of four
It’s very sophisticated technology
They offer a subscription plan that includes 20 tests, a year of Telehealth, and other benefits that come later. They have same-day shipping in most of the United States.

I opted for the Cue Complete Membership since I have a lot of travel planned this year. I’m excited about what CUE will bring to the market.

Testing for Travel

Many countries require a proof of negative PCR test prior to travel. This is different from the rapid antigen tests with proctoring. In Seattle for example you can get same day or next day PCR testing done at Discovery Health MD and you can see their menu of testing options here. Expect to spend about $200 for a same or next day Rapid PCR test.

What happens if you test positive?

It appears that the Omicron variant may result in more breakthrough infections of vaccinated individuals. As such what happens if you are one day from flying home and test positive?

This is a question I would rather not answer. If you want to come home with a positive test, your options are pretty limited. There is one option that I found called Covac Global. You can read about them here and here.

This is a pretty expensive option, but if you test positive, they will send a medical ambulance jet to pick you up and bring you home. Most medical ambulance insurance plans like AirMed and MedJet require you to be admitted to a hospital before they will come get you. Most vaccinated people who have a breakthrough infection will not require hospitalization but you will then be required to quarantine in a foreign country and figure out where you will stay and how you will eat for 10-14 days before being allowed to board a commercial flight.

Traveling Internationally has never been more complicated.