I’m Overseas and I’ve Tested Positive. What Now?

As coronavirus travel restrictions ease across many parts of the world and countries report cases of less severe illness, international trips are top of mind for U.S. travelers, many of whom have started to book overseas journeys for the spring and summer.

But the requirement for air travelers — vaccinated or not — to present a negative coronavirus test for entry into the United States has many people concerned about the prospect of testing positive and finding themselves stuck in a foreign country, unable to return home.

Deborah Haines, 47, a chiropractor from Seattle, was forced to extend her vacation in the Netherlands by 22 days last month because she kept testing positive even after her coronavirus symptoms had subsided. The stress of determining the appropriate documentation for re-entry, and having to cancel work appointments back home, made her feel sicker than the coronavirus itself, she said.

“When I thought about the possibility of getting stuck with Covid in Amsterdam, I thought it would mean a few extra days and then I could get a negative test and go home,” she said. “Boy, was that a miscalculation. I kept testing positive and it was so hard to get any clear guidance for what I should do.”

For months, the travel industry has been lobbying Washington to drop pandemic measures like mask mandates and testing requirements for travelers. A federal judge in Florida struck down the mask mandate on public transportation in April, allowing airlines and other transit authorities to set their own mask policies. The Biden administration has appealed. But it has not commented recently on the status of pre-departure testing, with the White House coronavirus response coordinator, Jeff Zients, announcing on April 5 that there were “no plans to change international travel requirements at this point.”

The uncertainty over the travel rules is making it difficult for travelers to book international trips with confidence. Here’s how to navigate some of the challenges you might face if you test positive abroad.

Time to head home. Remind me of the test requirements?

To enter the United States, all air passengers age 2 and older must have a negative coronavirus test taken within one day of departure, regardless of their vaccination status.

The accepted PCR and viral tests are available at many hotels, airports, health clinics and local pharmacies overseas. Certain antigen or nucleic acid amplification self-tests like BinaxNOW and Ellume that have been approved for emergency use by the Food and Drug Administration are also accepted. These require you to connect to a telehealth service by video, so that you can be supervised by a medical practitioner while you take the test; make sure you have a good internet connection.

There are no testing requirements for travelers entering the United States through land or ferry ports of entry.

I’m positive! Do I need to self-isolate or quarantine?

If you test positive, the Centers for Disease Control and Prevention recommends you should isolate and delay travel for 10 days, regardless of symptoms or a negative test taken within the isolation period. The country where you are staying may have its own rules for quarantine and isolation. The rules differ from country to country and isolation periods may be longer than the 10 days recommended by the C.D.C. Across Europe, many countries follow guidance from the European Center for Disease Prevention and Control, which recommends that fully vaccinated people should self-isolate after testing positive. If their symptoms improve and they feel better for at least 24 hours and they test negative for the virus twice within a 24-hour period, they can stop isolating. Or, if after six days they test negative once, they can stop isolating. Unvaccinated people are advised to self-isolate for 10 days, but can leave isolation if they meet the same requirements for negative tests.

Some other destinations, particularly in Asia, may require mandatory quarantine or isolation in a government facility or designated hotel for 14 days or more.

Am I required to tell government officials that I’m positive?

This will depend on the regulations in the country you are visiting, so be sure to check what they say on local health ministry websites. In most places, tourists are not required to officially report a positive test result to the government, although if you took your test in person at a local health facility, the results are often sent to the regional or national health authority.

Where can I stay if I have to isolate?

Most countries, including popular European destinations like Greece, Italy and France, allow visitors testing positive to choose their own accommodation for the recommended period of self-isolation.You can find this information on U.S. embassy websites. If you have booked a hotel or Airbnb for your trip, it is worth calling ahead of time and seeing what their policy is for isolation and whether they have availability should you need to extend your stay.

Some lodging facilities will require you to isolate alone in a separate room, even if your family members or travel companions test negative. You should also ask about access to food and medical facilities, particularly if you are staying in a remote area.

It’s useful to have a plan B in place in case your hotel or rental cannot accommodate you, or to have a cheaper option available if you do have to self-isolate for 10 days. Many countries have designated “quarantine hotels” or apartments and some resorts in popular tourist destinations like Spain, Portugal and Mexico allow guests to quarantine at a discounted rate.

Feeling fine, yet still positive. What now?

While most people are likely to test negative within 10 days of a positive coronavirus test, for some it can take weeks or even months, according to the global health partnership Gavi, the Vaccine Alliance. If you find yourself in that position, and feel well enough to travel, you can return to the United States but will need to obtain “documentation of recovery.”

For this documentation, there are six pieces of information you must provide:

• The type of coronavirus test you took.

• Evidence of positive results (“invalid” or “inconclusive” results are not accepted).

• Your name on the test results, which must match your identification.

• Where the test was taken, such as the name of the clinic or laboratory. If you self-tested, you can supply the brand name.

• The date the test was taken, which must be within the last 90 days.

• The test result must be accompanied by a letter signed by a licensed health care provider or a public health official stating that you have recovered and have been cleared to travel. This can be your health care provider in the United States.

More information can be found on the C.D.C.’s airline checklist.

Some American doctors are not authorized to provide the documentation outside of the United States or are unable to issue it to you because they need to see you in person. In those cases, Americans have been using telemedicine services like Quick MD, which involves a video or telephone consultation with a doctor, to obtain the documents, or they have booked in-person consultations with a local medical practitioner. Expect to pay $75 for QuickMD, and between $50 and $250 for a local doctor.

Ms. Haines, the chiropractor who got stuck in the Netherlands, tested positive for the virus a day before she was scheduled to fly home in March. She immediately extended her apartment booking in Amsterdam for 11 days, but in a frenzy to rearrange her work commitments, she forgot to reschedule her flight.

“I had thought about the possibility that I might test positive before I booked my trip, but didn’t think it would actually happen and that’s why I didn’t have a thought-out plan,” she said. “It was very high stress trying to figure everything and eventually I got Covid symptoms, which were pretty rough.”

Ms. Haines kept testing positive for the virus, even after her 10-day isolation period. After 17 days, with help from her husband back home, she managed to get a certificate of recovery through a U.S. telemedicine service that she found online. She waited a few more days to fly home because she had to purchase a new flight and went for the cheapest option.

“That process was pretty straightforward in the end,” she said. “But before that, we hit so many obstacles and dead ends and felt really stuck.”

Will my airline accept my document of recovery?

Most airlines flying to the United States accept paperwork that meets the C.D.C.’s requirements for documentation of recovery. If you are traveling through a third country and plan to leave the airport, however, check the local guidance as some governments may require a longer period of isolation or have other restrictions.

“Understand the rules for the country you’re departing from and understand that those rules may change,” said Erika Richter, the senior communications director of the American Society of Travel Advisors, a trade organization. “Travelers should plan to bring with them printed copies of all their paperwork so they can present it to the gate agency,” she said. “You’re really at the mercy of the gate agent upon check-in, so keep that in mind.”

Some travelers have also found it useful to print out the C.D.C. guidelines for certificates of recovery to present to the gate agent, she added.

Will travel insurance cover additional costs if I test positive?

It depends on the type of insurance. The U.S. Travel Insurance Association recommends that travelers concerned about the potential disruption to their plans after testing positive should investigate policies that include sickness and quarantine coverage, and also determine if there are any limits to those benefits.

Some policies will cover lodging costs beyond your scheduled return date but may not cover the full 10 days you are required to isolate (you can compare policies on review sites like Covertrip). If you are worried that you could get stuck for even longer as you try to obtain a certificate of recovery, then you might want to opt for a higher level of coverage.

Many travel insurance plans cover the costs to see a physician in order to obtain the documentation of recovery under medical expense, trip interruption or travel delay, according to the Travel Insurance Association. Under most policies, trip interruption coverage also covers charges for flight change fees.

But travelers should understand that plans often have a daily maximum trip delay limit, and the policy may not cover all costs associated with an extended stay, according to the association.

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