The United States will require all travelers from China to show a negative Covid-19 test before boarding flights to the U.S., federal health officials announced Wednesday, citing concerns about a surge of Covid infections in China and a lack of transparency from Chinese government officials about how widespread that country’s outbreak is.
“We know these measures will not eliminate all risk or completely prevent people who are infected from entering the United States,” a federal health official said Wednesday during a media briefing, but added that the steps will limit the number of infected people entering the country.
The new rules apply to all travelers departing from China, Hong Kong, and Macau who are over two years old, including American citizens, and applies to all travelers regardless of vaccination status. The new requirements will take effect at 12:01 a.m. ET on Jan. 5, to give airlines time to implement them. China plans to begin reopening its borders and allowing residents to travel without quarantine upon return home on Jan. 8; a broad increase in travelers from China is expected globally,
The rules met with quick criticism from many public health experts who said they were popular as “seen to be doing something” measures but would do little to stem transmission while possibly inspiring xenophobia and anti-Asian hate.
But one public health expert who has vehemently opposed travel bans nor been in favor of pre-departure testing said in this case, China’s lack of transparency and woeful efforts to contain the virus through widespread vaccination and other methods forced the hands of other countries to add restrictions. “Every country has struggled with Covid, but China has struggled in an inexplicable way,” said Jennifer Nuzzo, who directs the Center for Pandemic Preparedness at the Brown University School of Public Health.
“They’ve really dialed back testing and sequencing. China is really falling down on their international obligations,” Nuzzo said. “What are other countries supposed to do?”
Japan, India, and Malaysia are countries that already have instituted new travel requirements for those arriving from China, and other countries such as South Korea are expected to follow suit. Italy is requiring all travelers arriving from China to be tested for Covid upon arrival after announcing that one recent flight to Milan found half of the passengers had tested positive for Covid.
If such high rates of infection among travelers departing China are further confirmed, such results merit testing of all passengers coming from China when they land in the U.S., said Carlos del Rio, the president of the Infectious Diseases Society of America and a professor of medicine at Emory University. Del Rio was a co-author of a study that found a small number of travelers in 2020 who had tested negative 72 hours before boarding a plane tested positive upon landing. “I would do both,” he said.
In addition, he said, Covid tests and results given in China might not be trustworthy. “Why should we trust them in testing if we don’t trust them in other areas?” he asked. He also called on the U.S. government to be transparent about the new restrictions and report on how effective they are.
In addition, federal health officials announced they would increase their efforts to track new variants by adding airports in Seattle and Los Angeles to the airports taking part in the CDC’s traveler-based genomic surveillance program, a volunteer program which asks travelers to take Covid tests when arriving and then sequences the viruses of those who test positive. The program will now cover 500 flights weekly, including nearly 300 from China and surrounding areas and could “provide us an early warning about new variants,” the federal official said.
Nuzzo said the increase in surveillance by the U.S. and other countries was critical since China was not providing information about which variants may be circulating there. “They have the resources, they just don’t want to use them,” she said, adding that “having a massive blind spot on the map is really irresponsible.”
The move comes as Covid cases, hospitalizations, and deaths from Covid reportedly have exploded in China following the country’s relaxation of Covid rules after many months of a “zero-Covid” strategy. U.S. health officials are especially concerned about widespread infection because so few Chinese citizens have been infected and are considered “immunologically naive.” Nuzzo likened the situation in China, which has a massively undervaccinated population and little access to antiviral medications like Paxlovid to “basically being in almost 2020 conditions.”
Ali Mokdad, an epidemiologist and professor at the Institute for Health Metrics and Evaluation at the University of Washington told the BBC that his models suggest that due to the low effectiveness of vaccines used in China and the time that has passed since many people there were vaccinated, 1 million people in China could die from Covid in 2023, with 300,000 of those deaths occurring by April 1. Mokdad is among a number of public health officials who do not support new travel restrictions but instead are urging the U.S. to help China vaccinate more of its population with updated mRNA vaccines to better deal with currently circulating variants.
But federal officials remain frustrated that China has rebuffed offers of support, and doses of vaccines, from the United States and other countries. Chinese officials have indicated publicly that “they don’t need the support at this time,” a federal official said at Wednesday’s briefing, adding that the U.S. stands ready to offer support if it is requested.
Others said they were perplexed with new rules imposed on travelers from China when U.S. health officials have done little to ask their own citizens to mask and vaccinate to control viral spread. “Like we’ve peed in the proverbial pool til it’s bright yellow but now we don’t want anyone else to pee in it,” Stella Safo, an HIV primary care physician and health equity advocate posted on Twitter.
To comply with the new rules, passengers can submit results from a PCR test or an approved antigen test taken via a monitored telehealth appointment. Travelers who tested positive for Covid recently and ten days before their flight, can submit documentation of their infection and recovery to be able to fly.
The restrictions apply to travelers departing from China, and also to passengers flying through gateway airports popular among travelers from China, including Vancouver, Toronto and Seoul. China currently requires travelers arriving from the U.S. to submit negative Covid tests taken within 48 hours of departure.
NOTE: This story has been updated to include reaction to the new federal travel requirements from public health experts.
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