After our summer of housebound limbo, a handful of international travel options are finally opening back up, with conditions. So how do you meet the Covid-19 safety requirements for your dream destination – or at least one that’s allowing in American tourists? Testing mandates run the gamut from basically none at all – and we don’t recommend you visit these places – to documenting that you’ve tested negative within the past 48 to 72 hours, from time of taking the sample to time of arrival. There may also be additional testing and quarantining required when you get there, depending on the country. If you’re up for the challenge, it’s going to take some serious strategizing, plus a bit of good luck with timing. “Rapid testing” is a popular buzzword lately, but it’s still pretty hard to come by in the United States. Pharmacies, minute clinics and nationwide lab chains are reporting test result times of weeks, not hours or days. Quest Diagnostics, one of the biggest labs in the country, had claimed its turnaround time is five days, yet an August 7 CNN investigation found the average time to be 8.4 days. For the past three weeks, however, the average turnaround time has been 2 days, according to an email from Quest Diagnostics. Reliability of rapid results Although there are expensive and often exclusive quick tests whose results can be available in hours, PCR (polymerase chain reaction) tests, the kind required for most travel certification, are generally not rapid results. “These tests detect disease by looking for traces of the virus’ genetic material on a sample most often collected via a nose or throat swab. The Centers for Disease Control and Prevention (CDC) considers the PCR test the “gold standard’ of Covid-19 testing,” according to a report from Time magazine, although it adds that even this method can yield up to 30% inaccurate results. Timely PCR test results as privilege Imperfect as it may be, PCR is what you’ll need if you want to make it into one of the countries welcoming Americans back. You can take your chances with one of the chain venues claiming to be able to deliver quick results. Or you might try a private outfit such as the Covid Consultants, a new venture whose team includes infectious disease physicians and infection prevention experts from across the United States. The company offers Covid-19 PCR testing with expedited turnaround times in 48 hours – for a price. For $219, you’ll get a testing kit with prepaid FedEx overnight shipping label sent to you, says Covid Consultants founding partner and business director Andrea Stone. You’ll also pay the cost of their shipping the kit to you, which can be FedExed overnight. “Depending on how soon your departure is, we can overnight it anywhere within the continental US by 10:30 the next morning,” Stone says. You get the kit, spit in a cup, box it up and ship it back; the company guarantees test results emailed to you within 24 hours from when the sample arrives at the lab. “This is one of the few FDA EUA approved test kits on the market widely accepted by travel authorities in Europe, Africa, the Middle East and of course, here in the US,” Stone says. “We download results from the medical portal and send a PDF with a copy of the FDA emergency-use authorization to the patient via email.” How do they do it? Stone explains that their laboratory, MicroGen, is a CLIA-approved lab. CLIA refers to the Clinical Laboratory Improvement Amendments of 1988 regulations that “include federal standards applicable to all US facilities or sites that test human specimens for health assessment or to diagnose, prevent, or treat disease.” It is also approved by the College of American Pathologists, or CAP. “The lab has been running this type of molecular diagnostic test for over 12 years,” says Stone. “PCRs are widely used in the infectious disease community. The current average turnaround time on results is about 8 hours from when the sample arrives at the lab.” Testing the test result turnaround We ran a scenario with Stone in which a traveler aims to visit a country such as Croatia, which requires an arriving tourist to show a negative result from a sample taken within 48 hours or less. “With the 48-hour mandate, if your departure is at 2 p.m. on Friday, the patient would spit in the cup at 2:01 p.m. or later on Wednesday and drop it off at a FedEx depot using the return box and shipping label we provide. It would arrive at the lab by 10:30 a.m. on Thursday and they would have results, probably that evening, but officially by 10:30 a.m. Friday morning,” Stone says. Since you’ll get your results via email, you can be on your way to the airport while awaiting the news (and hoping it’s good). So why isn’t the spit test more widely available, given that it’s less intrusive as well as able to be carried out by people who have no medical training, unlike the nasopharyngeal swab? “The lab has a limited capacity, so they can’t do it for everybody,” Stone explains. Demand soaring? Given the increasing demand for short-turnaround PCR test results for travelers, it seems likely other companies will spring up in Covid Consultants’ wake. Eventually, alternate testing methods may become acceptable for travel documentation; in the rapidly changing landscape of coronavirus testing, some are arguing that faster if less accurate testing methods should become the norm. But for the moment, your options are limited. Choose your destination wisely, find a reputable testing source that will get you the results you need in time and get ready to start the countdown clock.